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NEUROLOGY 2009;73:518-525
© 2009 American Academy of Neurology

Cortical reorganization following anterior temporal lobectomy in patients with temporal lobe epilepsy

S.W.H. Wong, PhD, L. Jong, MD, D. Bandur, MCISc, F. Bihari, BSc, Y. -F. Yen, PhD, A. M. Takahashi, PhD, D. H. Lee, MD, FRCP(C), D. A. Steven, MD, MPH, FRCS(C), A. G. Parrent, MD, FRCS(C), S. E. Pigott, PhD and S. M. Mirsattari, MD, PhD, FRCP(C)

From the Brain and Creativity Institute (S.W.H.W.), University of Southern California, Los Angeles; Department of Clinical Neurological Sciences (L.J., F.B., D.A.S., A.G.P., S.M.M.), Department of Medical Imaging (Y.-F.Y., A.M.T., D.H.L., S.M.M.), Department of Psychology (S.M.M.), and Department of Medical Biophysics (S.M.M.), University of Western Ontario, London, Ontario, Canada; and Speech-Language Pathology Services (D.B.) and Psychology Services (S.E.P.), London Health Sciences Centre, London, Ontario, Canada.

Address correspondence and reprint requests to Dr. Seyed M. Mirsattari, B10-108, 339 Windermere Rd., London, Ontario N6A 5A5, Canada smirsat2{at}uwo.ca.

Background: Functional MRI was used to study the impact of temporal lobe epilepsy (TLE) and anterior temporal lobectomy (ATL) on the cortical language network in patients with medically refractory TLE.

Methods: Nineteen patients with medically refractory TLE and 11 healthy control subjects were enrolled in this study. Ten patients underwent left ATL (mean age 35.2 ± 3.8 years), and 9 underwent right ATL (mean age 35.9 ± 2.6 years). The subjects silently generated verbs in response to a series of visually presented nouns inside the scanner. Correlation analysis was performed between the subjects' performance on the clinical language tests and their neural response in the a priori cortical regions.

Results: Preoperative data revealed that the patients with TLE showed increased neural activity in the right inferior frontal gyri (IFG) and middle frontal gyri (MFG). The right TLE patients demonstrated strong correlation between their language performance and the level of cortical activation within the typical language areas. However, such a correlation was absent in the left TLE patients. After the ATL surgery, the left TLE patients showed reduced activation in the left MFG and right IFG, whereas no difference was observed in the right TLE patients. In the right TLE patients, the correlation between language performance and neural response shifted from the typical language areas to the anterior cingulate cortex.

Conclusion: This study demonstrates that the cortical language network is affected differently by the left and right temporal lobe epilepsy and is reorganized after anterior temporal lobectomy.

Abbreviations: ACC = anterior cingulate cortex; ATL = anterior temporal lobectomy; BDAE = Boston Diagnostic Aphasia Examination; BNT = Boston Naming Test; BOLD = blood oxygenation level–dependent; fMRI = functional MRI; FOV = field of view; IFG = inferior frontal gyrus; LHSC = London Health Sciences Centre; LQ = Language Quotient; MFG = middle frontal gyrus; MNI = Montreal Neurological Institute; ROI = region of interest; SFG = superior frontal gyrus; TE = echo time; TLE = temporal lobe epilepsy; TR = repetition time; WAB = Western Aphasia Battery.

Supplemental data at www.neurology.org.

Supported by Lawson Health Research Institute, The Physicians' Services Incorporated Foundation, and The Summer Research Training Program from Schulich School of Medicine and Dentistry at The University of Western Ontario, London, Ontario, Canada.

Disclosure: The authors report no disclosures.

Received October 4, 2008. Accepted in final form May 6, 2009.






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