Language Before and After Temporal Lobectomy: Specificity of Acute Changes and Relation to Early Risk Factors

Abstract

We evaluated language functions in 154 patients with left hemisphere speech dominance undergoing anterior temporal lobectomy (ATL). Measures of phonemic and semantic fluency, confrontation naming, repetition, comprehension, and reading were administered before and 3 weeks postoperatively. Patients were grouped by focus (left, LT; right, RT) and presence of early risk factors for development of seizures (ER, early risk, < or = 5 years; NER, no early risk): (LT-ER, n = 45; RT-ER, n = 49; LT-NER, n = 27; RT-NER, n = 33). Preoperatively, the LT group showed a selective naming deficit as compared with the RT group. Postoperatively only the LT-NER group showed significant overall decline in language. For this group, the change was attributable to a selective decline in naming as compared with other functions. These data indicate that there is a specific risk to naming after dominant ATL for adult temporal lobe epilepsy (TLE) patients with a left hemisphere focus and the absence of an early risk factor for the development of seizures.

Naming Decline After Left Anterior Temporal Lobectomy Correlates with Pathological Status of Resected Hippocampus

“…These percentages indicate that standard ATL as assessed by other than nominal speech measures, is a safe procedure with regard to language outcome. Our findings replicate those of Saykin et al (10): As shown on a battery of language tests, only nominal speech of the patients was affected. Saykin et al (10) assessed patients acutely, and our current findings suggest that the same trend they reported persists 6-8 months postoperatively.…”

“…Our findings replicate those of Saykin et al (10): As shown on a battery of language tests, only nominal speech of the patients was affected. Saykin et al (10) assessed patients acutely, and our current findings suggest that the same trend they reported persists 6-8 months postoperatively. The degree to which nominal speech declines, when it does, and the degree to which it subsequently returns to preoperative levels, remains to be determined and is an important issue.…”

“…Indeed, the minimal neuropsychological morbidity among patients with left MTLE in the context of the significant verbal memory decline associated with left ATL in patients without MTLE (27)(28)(29)(30)(31)(32) is consistent with such a thesis. The risk of postoperative language decline after left ATL is associated with later age at onset of left TLE, implying that the earlier age at onset associated with MTLE may involve reorganization of cortical language function (10). Further evidence suggestive of reorganization of language function was provided by Devinsky et al, who reported that earlier age at onset of left TLE was associated with an increased probability of nominal speech areas in the anterior left temporal lobe (13).…”

Category-specific naming and recognition deficits in temporal lobe epilepsy surgical patients

“…Ultimately, assessing both pre-and post-operative performance in the same patients is necessary to definitively attribute such deficits to the impact of resective surgery. If such a study were to be performed, it would be helpful to evaluate potential intervening variables that might impact outcome on these category-specific measures (e.g., age of seizure onset, early risk factors for epilepsy, impact of primary pathologies leading to epilepsy), as these factors have proven to impact performance outcome using standard naming measures (Davies, Risse, & Gates, 2005;Saykin et al, 1995;Yucus & Tranel, in press) Although some of the newer antiepileptic drugs (AEDs) appear to negatively impact language functioning (e.g., topiramate, zonisamide: Kockelmann, Elger, & Helmstaedter, 2003;L. M. Ojemann et al, 2001), this finding has primarily involved verbal fluency rather than confrontation naming.…”

Differential neuropsychological test sensitivity to left temporal lobe epilepsy

“…Memory risk is greatest following resection of the language dominant temporal lobe, and when the diseased temporal lobe to be resected still actively contributes to memory formation (i.e., high functional adequacy; Chelune, 1995). The risk of naming decline following left ATL is also well-established (Bell et al, 2000;Langfitt & Rausch, 1996;Saykin et al, 1995;Schwarz et al, 2005), and the role of the hippocampus in naming performance both pre-and postoperatively is increasingly appreciated (Hamberger et al, 2007;Seidenberg et al, 2005).…”