Abstract
Objective: To evaluate interictal language functions in patients with medically intractable left and right sided mesial temporal lobe epilepsy (TLE).
Methods: Spontaneous speech, language comprehension, confrontation naming, repetition, reading, writing, and word fluency were examined in 12 patients with left sided TLE and 11 patients with right sided TLE.
Results: Four patients out of 23 displayed language deficits in more than one language domain. Three further patients exhibited isolated language deficits. Linguistic deficits were observed in both left TLE and right TLE. In quantitative analyses left and right TLE only differed in spontaneous speech (p = 0.02); no difference was found in other language functions, laterality quotient of Wada test, or overall IQ. Qualitative error analysis of object naming, however, showed typical errors associated only with left TLE. Patients with linguistic deficits were older at testing compared to patients without linguistic deficits (p = 0.003), whereas other factors including side of TLE, handedness, educational level, age at epilepsy onset, and duration of epilepsy did not differ between groups.
Conclusions: Possible explanations for these findings include neuronal cell loss and deafferentiation in cortical areas, and disruption of the basal temporal language area pathways. Our study suggests that some patients with chronic mesial TLE exhibit linguistic deficits when specifically tested, and underlines the need to routinely investigate linguistic functions in TLE.
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Selected References
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- Bartha Lisa, Brenneis Christian, Schocke Michael, Trinka Eugen, Köylü Bülent, Trieb Thomas, Kremser Christian, Jaschke Werner, Bauer Gerhard, Poewe Werner. Medial temporal lobe activation during semantic language processing: fMRI findings in healthy left- and right-handers. Brain Res Cogn Brain Res. 2003 Jul;17(2):339–346. doi: 10.1016/s0926-6410(03)00135-6. [DOI] [PubMed] [Google Scholar]
- Bartha Lisa, Trinka Eugen, Ortler Martin, Donnemiller Eveline, Felber Stephan, Bauer Gerhard, Benke Thomas. Linguistic deficits following left selective amygdalohippocampectomy: a prospective study. Epilepsy Behav. 2004 Jun;5(3):348–357. doi: 10.1016/j.yebeh.2004.02.004. [DOI] [PubMed] [Google Scholar]
- Bell Brian D., Seidenberg Michael, Hermann Bruce P., Douville Kelli. Visual and auditory naming in patients with left or bilateral temporal lobe epilepsy. Epilepsy Res. 2003 Jun-Jul;55(1-2):29–37. doi: 10.1016/s0920-1211(03)00110-4. [DOI] [PubMed] [Google Scholar]
- Bell Brian, Dow Christian, Watson E. Ryann, Woodard Austin, Hermann Bruce, Seidenberg Michael. Narrative and procedural discourse in temporal lobe epilepsy. J Int Neuropsychol Soc. 2003 Jul;9(5):733–739. doi: 10.1017/S1355617703950065. [DOI] [PubMed] [Google Scholar]
- Breier J. I., Fletcher J. M., Wheless J. W., Clark A., Cass J., Constantinou J. E. Profiles of cognitive performance associated with reading disability in temporal lobe epilepsy. J Clin Exp Neuropsychol. 2000 Dec;22(6):804–816. doi: 10.1076/jcen.22.6.804.948. [DOI] [PubMed] [Google Scholar]
- Brázdil Milan, Zákopcan Jozef, Kuba Robert, Fanfrdlová Zuzana, Rektor Ivan. Atypical hemispheric language dominance in left temporal lobe epilepsy as a result of the reorganization of language functions. Epilepsy Behav. 2003 Aug;4(4):414–419. doi: 10.1016/s1525-5050(03)00119-7. [DOI] [PubMed] [Google Scholar]
- Delazer M., Gasperi A., Bartha L., Trinka E., Benke T. Number processing in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):901–903. doi: 10.1136/jnnp.2003.023614. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Field S. J., Saling M. M., Berkovic S. F. Interictal discourse production in temporal lobe epilepsy. Brain Lang. 2000 Sep;74(2):213–222. doi: 10.1006/brln.2000.2335. [DOI] [PubMed] [Google Scholar]
- Giovagnoli A. R. Verbal semantic memory in temporal lobe epilepsy. Acta Neurol Scand. 1999 Jun;99(6):334–339. doi: 10.1111/j.1600-0404.1999.tb07361.x. [DOI] [PubMed] [Google Scholar]
- Gleissner U., Elger C. E. The hippocampal contribution to verbal fluency in patients with temporal lobe epilepsy. Cortex. 2001 Feb;37(1):55–63. doi: 10.1016/s0010-9452(08)70557-4. [DOI] [PubMed] [Google Scholar]
- Hamberger M. J., Tamny T. R. Auditory naming and temporal lobe epilepsy. Epilepsy Res. 1999 Jul;35(3):229–243. doi: 10.1016/s0920-1211(99)00023-6. [DOI] [PubMed] [Google Scholar]
- Hammers A., Koepp M. J., Labbé C., Brooks D. J., Thom M., Cunningham V. J., Duncan J. S. Neocortical abnormalities of [11C]-flumazenil PET in mesial temporal lobe epilepsy. Neurology. 2001 Apr 10;56(7):897–906. doi: 10.1212/wnl.56.7.897. [DOI] [PubMed] [Google Scholar]
- Helmstaedter C. Effects of chronic epilepsy on declarative memory systems. Prog Brain Res. 2002;135:439–453. doi: 10.1016/S0079-6123(02)35041-6. [DOI] [PubMed] [Google Scholar]
- Hermann B. P., Seidenberg M., Haltiner A., Wyler A. R. Adequacy of language function and verbal memory performance in unilateral temporal lobe epilepsy. Cortex. 1992 Sep;28(3):423–433. doi: 10.1016/s0010-9452(13)80152-9. [DOI] [PubMed] [Google Scholar]
- Hermann B. P., Wyler A. R., Richey E. T. Wisconsin Card Sorting Test performance in patients with complex partial seizures of temporal-lobe origin. J Clin Exp Neuropsychol. 1988 Aug;10(4):467–476. doi: 10.1080/01688638808408253. [DOI] [PubMed] [Google Scholar]
- Howell R. A., Saling M. M., Bradley D. C., Berkovic S. F. Interictal language fluency in temporal lobe epilepsy. Cortex. 1994 Sep;30(3):469–478. doi: 10.1016/s0010-9452(13)80342-5. [DOI] [PubMed] [Google Scholar]
- Joanette Y., Goulet P. Criterion-specific reduction of verbal fluency in right brain-damaged right-handers. Neuropsychologia. 1986;24(6):875–879. doi: 10.1016/0028-3932(86)90087-4. [DOI] [PubMed] [Google Scholar]
- Jokeit Hennric, Ebner Alois. Effects of chronic epilepsy on intellectual functions. Prog Brain Res. 2002;135:455–463. doi: 10.1016/S0079-6123(02)35042-8. [DOI] [PubMed] [Google Scholar]
- Knecht S., Dräger B., Deppe M., Bobe L., Lohmann H., Flöel A., Ringelstein E. B., Henningsen H. Handedness and hemispheric language dominance in healthy humans. Brain. 2000 Dec;123(Pt 12):2512–2518. doi: 10.1093/brain/123.12.2512. [DOI] [PubMed] [Google Scholar]
- Krauss G. L., Fisher R., Plate C., Hart J., Uematsu S., Gordon B., Lesser R. P. Cognitive effects of resecting basal temporal language areas. Epilepsia. 1996 May;37(5):476–483. doi: 10.1111/j.1528-1157.1996.tb00594.x. [DOI] [PubMed] [Google Scholar]
- Lehrl S., Triebig G., Fischer B. Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence. Acta Neurol Scand. 1995 May;91(5):335–345. doi: 10.1111/j.1600-0404.1995.tb07018.x. [DOI] [PubMed] [Google Scholar]
- Liu Rebecca S. N., Lemieux Louis, Bell Gail S., Hammers Alexander, Sisodiya Sanjay M., Bartlett Philippa A., Shorvon Simon D., Sander Josemir W. A. S., Duncan John S. Progressive neocortical damage in epilepsy. Ann Neurol. 2003 Mar;53(3):312–324. doi: 10.1002/ana.10463. [DOI] [PubMed] [Google Scholar]
- Lüders H., Lesser R. P., Hahn J., Dinner D. S., Morris H. H., Wyllie E., Godoy J. Basal temporal language area. Brain. 1991 Apr;114(Pt 2):743–754. doi: 10.1093/brain/114.2.743. [DOI] [PubMed] [Google Scholar]
- Martin R. C., Loring D. W., Meador K. J., Lee G. P. The effects of lateralized temporal lobe dysfunction on formal and semantic word fluency. Neuropsychologia. 1990;28(8):823–829. doi: 10.1016/0028-3932(90)90006-a. [DOI] [PubMed] [Google Scholar]
- Mayeux R., Brandt J., Rosen J., Benson D. F. Interictal memory and language impairment in temporal lobe epilepsy. Neurology. 1980 Feb;30(2):120–125. doi: 10.1212/wnl.30.2.120. [DOI] [PubMed] [Google Scholar]
- Moran N. F., Lemieux L., Kitchen N. D., Fish D. R., Shorvon S. D. Extrahippocampal temporal lobe atrophy in temporal lobe epilepsy and mesial temporal sclerosis. Brain. 2001 Jan;124(Pt 1):167–175. doi: 10.1093/brain/124.1.167. [DOI] [PubMed] [Google Scholar]
- Murtha S., Chertkow H., Beauregard M., Evans A. The neural substrate of picture naming. J Cogn Neurosci. 1999 Jul;11(4):399–423. doi: 10.1162/089892999563508. [DOI] [PubMed] [Google Scholar]
- O'Shea M. F., Saling M. M., Bladin P. F., Berkovic S. F. Does naming contribute to memory self-report in temporal lobe epilepsy? J Clin Exp Neuropsychol. 1996 Feb;18(1):98–109. doi: 10.1080/01688639608408266. [DOI] [PubMed] [Google Scholar]
- Oldfield R. C. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971 Mar;9(1):97–113. doi: 10.1016/0028-3932(71)90067-4. [DOI] [PubMed] [Google Scholar]
- Pihlajamäki M., Tanila H., Hänninen T., Könönen M., Laakso M., Partanen K., Soininen H., Aronen H. J. Verbal fluency activates the left medial temporal lobe: a functional magnetic resonance imaging study. Ann Neurol. 2000 Apr;47(4):470–476. [PubMed] [Google Scholar]
- Rubin E., Dhawan V., Moeller J. R., Takikawa S., Labar D. R., Schaul N., Barr W. B., Eidelberg D. Cerebral metabolic topography in unilateral temporal lobe epilepsy. Neurology. 1995 Dec;45(12):2212–2223. doi: 10.1212/wnl.45.12.2212. [DOI] [PubMed] [Google Scholar]
- Sackellares J. C., Siegel G. J., Abou-Khalil B. W., Hood T. W., Gilman S., McKeever P. E., Hichwa R. D., Hutchins G. D. Differences between lateral and mesial temporal metabolism interictally in epilepsy of mesial temporal origin. Neurology. 1990 Sep;40(9):1420–1426. doi: 10.1212/wnl.40.9.1420. [DOI] [PubMed] [Google Scholar]
- Sawrie S. M., Martin R. C., Gilliam F. G., Faught R. E., Maton B., Hugg J. W., Bush N., Sinclair K., Kuzniecky R. I. Visual confrontation naming and hippocampal function: A neural network study using quantitative (1)H magnetic resonance spectroscopy. Brain. 2000 Apr;123(Pt 4):770–780. doi: 10.1093/brain/123.4.770. [DOI] [PubMed] [Google Scholar]
- Saykin A. J., Stafiniak P., Robinson L. J., Flannery K. A., Gur R. C., O'Connor M. J., Sperling M. R. Language before and after temporal lobectomy: specificity of acute changes and relation to early risk factors. Epilepsia. 1995 Nov;36(11):1071–1077. doi: 10.1111/j.1528-1157.1995.tb00464.x. [DOI] [PubMed] [Google Scholar]
- Schäffler L., Lüders H. O., Beck G. J. Quantitative comparison of language deficits produced by extraoperative electrical stimulation of Broca's, Wernicke's, and basal temporal language areas. Epilepsia. 1996 May;37(5):463–475. doi: 10.1111/j.1528-1157.1996.tb00593.x. [DOI] [PubMed] [Google Scholar]
- Semah Franck. Temporoporal metabolic abnormalities in temporal lobe epilepsies. Epileptic Disord. 2002 Sep;4 (Suppl 1):S41–S49. [PubMed] [Google Scholar]
- Spencer S. S., Williamson P. D., Spencer D. D., Mattson R. H. Human hippocampal seizure spread studied by depth and subdural recording: the hippocampal commissure. Epilepsia. 1987 Sep-Oct;28(5):479–489. doi: 10.1111/j.1528-1157.1987.tb03676.x. [DOI] [PubMed] [Google Scholar]
- Springer J. A., Binder J. R., Hammeke T. A., Swanson S. J., Frost J. A., Bellgowan P. S., Brewer C. C., Perry H. M., Morris G. L., Mueller W. M. Language dominance in neurologically normal and epilepsy subjects: a functional MRI study. Brain. 1999 Nov;122(Pt 11):2033–2046. doi: 10.1093/brain/122.11.2033. [DOI] [PubMed] [Google Scholar]
- Strauss E., Hunter M., Wada J. Wisconsin Card Sorting Performance: effects of age of onset of damage and laterality of dysfunction. J Clin Exp Neuropsychol. 1993 Nov;15(6):896–902. doi: 10.1080/01688639308402606. [DOI] [PubMed] [Google Scholar]
- Tröster A. I., Warmflash V., Osorio I., Paolo A. M., Alexander L. J., Barr W. B. The roles of semantic networks and search efficiency in verbal fluency performance in intractable temporal lobe epilepsy. Epilepsy Res. 1995 May;21(1):19–26. doi: 10.1016/0920-1211(95)00002-r. [DOI] [PubMed] [Google Scholar]
- Vilkki J., Holst P. Speed and flexibility on word fluency tasks after focal brain lesions. Neuropsychologia. 1994 Oct;32(10):1257–1262. doi: 10.1016/0028-3932(94)90107-4. [DOI] [PubMed] [Google Scholar]