Temporal lobe regions essential for preserved picture naming after left temporal epilepsy surgery

• Type of Material: Article
• Authors: Jeffrey R. Binder, Medical College of Wisconsin; Jia-Qing Tong, Medical College of Wisconsin; Sara B. Pillay, Medical College of Wisconsin; Lisa L. Conant, Medical College of Wisconsin; Colin J. Humphries, Medical College of Wisconsin; Manoj Raghavan, Medical College of Wisconsin; Wade M. Mueller, Medical College of Wisconsin; Robyn M. Busch, Cleveland Clinic Foundation; Linda Allen, Medical College of Wisconsin; William L. Gross, Medical College of Wisconsin; Christopher T. Anderson, Medical College of Wisconsin; Chad E. Carlson, Medical College of Wisconsin; Mark J. Lowe, Cleveland Clinic Foundation; John T. Langfitt, University of Rochester; Madalina E. Tivarus, University of Rochester; Daniel Drane, Emory University; David Loring, Emory University; Monica Jacobs, Vanderbilt University; Victoria L. Morgan, Vanderbilt University; Jane B. Allendorfer, University of Alabama Birmingham; Jerzy P. Szaflarski, University of Alabama Birmingham; Leonardo Bonilha, Medical University of South Carolina; Susan Bookheimer, University of California Los Angeles; Thomas Grabowski, University of Washington; Jennifer Vannest, University of Cincinnati; Sara J. Swanson, Medical College of Wisconsin
• Language: English
• Date: 2020-08-11
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: 2020
• Final Published Version (URL): http://dx.doi.org/10.1111/epi.16643
• Title of Journal or Parent Work: EPILEPSIA
• Volume: 61
• Issue: 9
• Start Page: 1939
• End Page: 1948
• Grant/Funding Information: The study was supported by grant R01 NS35929 (J. Binder, PI) from the National Institute of Neurological Disorders and Stroke.
• Keywords: WORD; LOCALIZATION; fusiform gyrus; Neurosciences & Neurology; ELECTRICAL-STIMULATION; temporal lobe; anomia; lesion localization; Clinical Neurology; LOBECTOMY; LANGUAGE DEFICITS; RESECTION; Science & Technology; PREDICTORS; epilepsy; DECLINE; OUTCOMES; VARIANTS; Life Sciences & Biomedicine
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Objective: To define left temporal lobe regions where surgical resection produces a persistent postoperative decline in naming visual objects. Methods: Pre- and postoperative brain magnetic resonance imaging data and picture naming (Boston Naming Test) scores were obtained prospectively from 59 people with drug-resistant left temporal lobe epilepsy. All patients had left hemisphere language dominance at baseline and underwent surgical resection or ablation in the left temporal lobe. Postoperative naming assessment occurred approximately 7 months after surgery. Surgical lesions were mapped to a standard template, and the relationship between presence or absence of a lesion and the degree of naming decline was tested at each template voxel while controlling for effects of overall lesion size. Results: Patients declined by an average of 15% in their naming score, with wide variation across individuals. Decline was significantly related to damage in a cluster of voxels in the ventral temporal lobe, located mainly in the fusiform gyrus approximately 4-6 cm posterior to the temporal tip. Extent of damage to this region explained roughly 50% of the variance in outcome. Picture naming decline was not related to hippocampal or temporal pole damage. Significance: The results provide the first statistical map relating lesion location in left temporal lobe epilepsy surgery to picture naming decline, and they support previous observations of transient naming deficits from electrical stimulation in the basal temporal cortex. The critical lesion is relatively posterior and could be avoided in many patients undergoing left temporal lobe surgery for intractable epilepsy.