Quantitative fMRI assessment of the differences in lateralization of language-related brain activation in patients with temporal lobe epilepsy.

Defining language lateralization is important to minimize morbidity in patients treated surgically for temporal lobe epilepsy (TLE). Functional magnetic resonance imaging (fMRI) offers a promising, noninvasive, alternative strategy to the Wada test. Here we have used fMRI to study healthy controls and patients with TLE in order to (i) define language-related activation patterns and their reproducibility; (ii) compare lateralization determined by fMRI with those from of the Wada test; and (iii) contrast different methods of assessing fMRI lateralization. Twelve healthy right-handed controls and 19 right-handed preoperative patients with TLE (12 left- and seven right-TLE) were studied at 3T using fMRI and a verbal fluency paradigm. A Wada test also was performed on each of the patients. Greater activation was found in several areas in the right hemisphere for the left-TLE group relative to controls or right-TLE patients. Relative hemispheric activations calculated based on either the extent or the mean signal change gave consistent results showing a more bihemispheric language representation in the left-TLE patients. There was good agreement between the Wada and fMRI results, although the latter were more sensitive to involvement of the nondominant right hemisphere. The reproducibility of the fMRI values was lowest for the more bihemispherically represented left-TLE patients. Overall, our results further demonstrate that noninvasive fMRI measures of language-related lateralization may provide a practical and reliable alternative to invasive testing for presurgical language lateralization in patients with TLE. The high proportion (33%) of left-TLE patients showing bilateral or right hemispheric language-related lateralization suggests that there is considerable plasticity of language representation in the brains of patients with intractable TLE.

The interpretation of sentence ambiguity in patients with unilateral focal brain surgery.

Interpretations of ambiguous sentences were studied in patients with unilateral anterior temporal lobectomy or selective amygdalo-hippocampectomy. The sentences represented lexical and syntactic ambiguities. In both left- and right-sided groups, regardless of type of surgery, total mean score on the test was below normal. Left-sided cases, regardless of type of surgery, provided significantly fewer alternative interpretations than right-sided cases. The results suggest greater left than right hemisphere specialization in both lexical and syntactic processing, but also suggest right hemisphere involvement in resolution of lexical ambiguity.

Changes in focal interictal epileptiform activity during and after the performance of verbal and visuospatial tasks in a patient with intractable partial seizures.

An 18-year-old male with intractable complex partial seizures is described in whom localised epileptiform discharges in the EEG were influenced in a specific manner by different cognitive tasks. The patient had impaired verbal skills but above average visuospatial ability, and seizures probably arising in the left temporal lobe. Comparison of verbal and visuospatial tasks showed that focal epileptiform activity was suppressed or enhanced depending on the nature of the immediate and preceding cognitive tasks. The finding of particular interest was the activity of a posterior temporal spike focus only during rest periods after verbal tasks, by contrast with an independent mid-to-anterior temporal focus that was suppressed during verbal tasks.

Persistent memory impairment following transient global amnesia.

A controlled neuropsychological study of 41 patients tested at 6 months after attacks of transient global amnesia (TGA) revealed no evidence of general intellectual, immediate (short-term) memory or nonverbal memory impairment. The patient group's performance was, however, significantly worse than that of the control's on measures of verbal memory notably immediate, 30-minute and 24-hour delayed paragraph recall. In addition, tests of public and personal remote memory revealed significant impairment of naming and recognition of famous faces, and of dating famous events without evidence of a temporal gradient, and impairment of cued recall of autobiographical memories on the Modified Crovitz Test. These findings suggest that following TGA there is persistent, albeit mild, hippocampal-diencephalic dysfunction which appears to involve left-sided structures preferentially. This impairment probably results from the attack, although a pre-existent deficit cannot be excluded.