Cortical Localization in Temporal Lobe Epilepsy

颞叶癫痫的皮质定位

• 批准号: 8686964
• 负责人: MARLA J HAMBERGER
• 金额: $ 34.17万
• 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 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8686964
• 关键词: Address; Adult; Affect; Age; Area; Auditory; Benchmarking; Biological Preservation; Brain; Caring; Child; Childhood; Clinical; Clinical assessments; Cognitive; Comorbidity; Data; Development; Epilepsy; Evaluation; Excision; Exhibits; Frequencies; Functional disorder; Funding; Goals; Grant; Hippocampus (Brain); Image; Impaired cognition; Individual; Knowledge; Language; Language Development; Lateral; Lead; Left; Linguistics; Location; Maps; Measures; Mediating; Memory; Methods; Modality; Names; National Institute of Neurological Disorders and Stroke; Nature; Operative Surgical Procedures; Patients; Performance; Pharmacological Treatment; Postoperative Period; Prevention; Process; Psycholinguistics; Refractory; Research; Risk; Role; Seizures; Semantics; Severities; Site; Source; Structure; Temporal Lobe; Temporal Lobe Epilepsy; Testing; Visual; Visual Perception; Vocabulary; Work; age group; base; clinically relevant; cost; improved; insight; phonology; prevent; skills; sound; tool; visual object processing

DESCRIPTION (provided by applicant): Temporal lobe resection offers the best hope of cure for patients who suffer from refractory temporal lobe epilepsy. Unfortunately, this surgery often comes with a cost to naming ability, which is typically already compromised before surgery. Identification of naming deficits prior to surgery provides valuable information that can lateralize seizure onset. Furthermore, sparing of naming cortex identified via stimulation mapping helps prevent naming decline postoperatively. Historically, visual object naming has been the sole method both for assessing naming and for stimulation mapping to identify essential language cortex. However, visual naming has failed to reliably identify true naming deficits and has failed to consistently protect postoperative naming. The recent addition of auditory description naming has enhanced our ability to lateralize and localize cortical dysfunction associated with epileptogenic cortex. In stimulation mapping, auditory naming has improved mapping efficacy by identifying clinically relevant language cortex that otherwise would have remained undetected. Despite these considerable advances, two problems persist. First, some patients still exhibit postoperative naming decline and second, the work in auditory naming has not been extended to children. These two issues will be addressed in the two subcomponents of the proposed project: Adult Mapping and Child Naming. Regarding Adult Mapping, preliminary studies suggest two new potential sources of naming decline: 1) Hippocampal removal (the hippocampus is generally considered a memory structure without language involvement, but recent postoperative and imaging data implicate it in naming decline) and 2) Surgical disruption of lateral temporal areas that support naming-related linguistic functions (pilot mapping results reveal anatomically distinct sites that mediate semantic and phonological access, both of which are necessary for naming). To address these two possibilities, the linguistic processes that comprise naming will be tested during direct stimulation of hippocampal and lateral temporal sites to establish the role and clinical relevance of these brain areas in naming. Project goals for Adult Mapping are to determine: a) Which aspects of naming are mediated by the hippocampus, b) Whether "non-naming" lateral temporal sites mediate critical naming sub-processes, and c) Whether the nature and severity of naming decline are related to the location, type, or number of naming sites disrupted by surgery. Regarding Child Naming, we will address the absence of age appropriate naming measures for children with epilepsy. Project goals for this component of the project are to: a) Develop and standardize analogous pediatric versions of the adult auditory and visual naming tests via normative study and patient testing, and b) Determine whether auditory naming performance predicts hemispheric lateralization of seizure onset in children with lateralized epilepsy, as it does in adults. Results from the overall project promise new insights into temporal lobe organization of language, better prediction and prevention of postoperative deficits, and improvements in pediatric epilepsy care.

描述（由申请人提供）：颞叶切除为患有难治性颞叶癫痫的患者提供了治愈的最大希望。不幸的是，这种手术通常具有命名能力的成本，命名能力通常已经在手术前已经妥协了。手术前的命名赤字识别提供了有价值的信息，可以横向癫痫发作。此外，通过刺激映射鉴定的命名皮质的保留有助于防止命名术后命名下降。从历史上看，视觉对象命名一直是评估命名和刺激映射以识别基本语言皮质的唯一方法。但是，视觉命名未能可靠地识别真正的命名缺陷，并且未能始终如一地保护术后命名。最近增加听觉描述命名增强了我们对与癫痫病皮质相关的皮质功能障碍和定位皮质功能障碍的能力。在刺激映射中，听觉命名通过识别临床相关的语言皮质来提高映射功效，否则否则将无法被发现。尽管取得了相当大的进步，但两个问题仍然存在。首先，一些患者仍然表现出术后命名下降，其次，听觉命名的工作尚未扩展到儿童。这两个问题将在拟议项目的两个子组件中解决：成人地图和儿童命名。 Regarding Adult Mapping, preliminary studies suggest two new potential sources of naming decline: 1) Hippocampal removal (the hippocampus is generally considered a memory structure without language involvement, but recent postoperative and imaging data implicate it in naming decline) and 2) Surgical disruption of lateral temporal areas that support naming-related linguistic functions (pilot mapping results reveal anatomically distinct sites that mediate semantic and语音访问，两者都是命名所必需的）。为了解决这两种可能性，将在直接刺激海马和横向时间位点进行测试，包括命名的语言过程，以确定这些大脑区域在命名中的作用和临床相关性。成人映射的项目目标是确定：a）命名的哪些方面是由海马介导的，b）“非命名”的侧面时间站点是否介导关键的命名命名子过程以及c）命名下降的性质和严重性是否与手术中断的位置，类型，类型，类型，类型，类型，类型，类型，命名位置相关。关于儿童命名，我们将解决癫痫儿童没有适当年龄的命名措施。该项目的该组成部分的项目目标是：a）通过规范研究和患者测试来开发和标准化成人听觉和视觉命名测试的类似小儿版本，b）确定听觉命名命名性能预测癫痫病儿童的癫痫发作的半球偏向偏向癫痫发作是否像成人一样。整个项目的结果有望对暂时叶的语言组织，更好地预测和预防术后缺陷的预测和改善小儿癫痫护理的新见解。