Cortical Localization in Temporal Lobe Epilepsy

颞叶癫痫的皮质定位

• 批准号: 7013045
• 负责人: MARLA J HAMBERGER
• 金额: $ 6.98万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-12-01 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7013045
• 关键词: adolescence (12-20); brain mapping; clinical research; epilepsy; human middle age (35-64); human subject; language disorders; nervous system disorder therapy; neural information processing; neurosurgery; patient oriented research; postoperative complications; psycholinguistics; psychological tests; temporal lobe /cortex; young adult human (21-34)

DESCRIPTION (provided by applicant): It is well established that the temporal lobe plays a critical role in language mediation. Yet, the functional-anatomical organization of language within the temporal lobe region is not well understood. This is a significant concern for temporal lobe epilepsy patients who elect surgical treatment for seizure control, because a substantial portion of temporal cortex is removed with this procedure. To preserve verbal abilities, cortical language mapping is often performed to identify "essential" language cortex and spare these areas from resection. Nonetheless, many patients decline post-operatively despite such mapping, primarily with respect to word finding. Although most surgery programs rely on visual object naming to identify 'essential' language cortex, the addition of auditory naming revealed a distinct region in anterior temporal cortex where stimulation impaired auditory but not visual naming. Preliminary follow-up testing suggests that sparing these auditory naming sites preserves word finding whereas resecting these sites results in decline (without affecting seizure outcome). Interestingly, a number of patients declined on both auditory and visual naming, despite the fact that only "pure auditory" sites were resected, and that all visual naming sites were spared. In the proposed studies, psycholinguistic tasks will be used before and after temporal lobe resection to study the role of anterior temporal cortex in the access of words and their meaning. Similar tasks will be used during mapping to delineate language-related structure-function relations at a level of analysis that is not attainable with other methods. Continued post-operative follow-up will assess the reliability of the preliminary findings, and determine whether deficits persist. Seizure outcome will be monitored as well. Primary goals are: 1) To determine how often, and in which patients, removing auditory naming sites results in word finding decline; 2) To determine the extent to which processes involved in word selection and access to word meaning are anatomically distinct, and where these process are represented neuroanatomically, 3) Determine why resection of cortex that appears to support modality-specific (auditory) naming can result in general word finding decline; 4) Determine whether sparing auditory naming sites from resection affects seizure outcome. Results promise deeper understanding of the neuro-functional organization of language, potentially offering improved treatment and preservation of language skills, not only to epilepsy surgery patients, but also to individuals with other neurologically based language disorders.

描述（由申请人提供）：众所周知，颞叶在语言中介中发挥着关键作用。然而，颞叶区域内语言的功能解剖结构尚不清楚。对于选择手术治疗来控制癫痫发作的颞叶癫痫患者来说，这是一个重要的问题，因为该手术会切除大部分颞叶皮层。为了保留语言能力，通常进行皮层语言映射来识别“必要的”语言皮层并使这些区域免遭切除。尽管如此，尽管有这样的映射，主要是在单词查找方面，许多患者术后还是出现了衰退。尽管大多数手术程序依靠视觉对象命名来识别“基本”语言皮层，但听觉命名的添加揭示了前颞叶皮层的一个独特区域，该区域的刺激会损害听觉命名，但不会损害视觉命名。初步的后续测试表明，保留这些听觉命名部位可以保留单词发现能力，而切除这些部位会导致单词发现能力下降（不影响癫痫发作结果）。有趣的是，许多患者拒绝听觉和视觉命名，尽管事实上只切除了“纯听觉”部位，并且所有视觉命名部位都幸免于难。在拟议的研究中，将在颞叶切除术之前和之后使用心理语言学任务来研究前颞叶皮层在单词获取及其含义中的作用。在映射过程中将使用类似的任务来在其他方法无法达到的分析级别上描绘与语言相关的结构功能关系。持续的术后随访将评估初步结果的可靠性，并确定缺陷是否持续存在。癫痫发作结果也将受到监测。主要目标是： 1) 确定移除听觉命名位点导致单词发现能力下降的频率以及在哪些患者中； 2) 确定单词选择和获取单词含义所涉及的过程在解剖学上的不同程度，以及这些过程在神经解剖学上的表示方式， 3) 确定为什么会导致支持特定模态（听觉）命名的皮层切除总体而言，单词查找能力下降； 4）确定从切除中保留听觉命名部位是否会影响癫痫发作的结果。研究结果有望更深入地了解语言的神经功能组织，有可能为癫痫手术患者以及患有其他神经语言障碍的患者提供更好的治疗和保留语言技能。