title: Productive and perceptive language reorganization in temporal lobe epilepsy.
abstract: The aim of this work was to determine whether productive and perceptive language functions are differentially affected in homogeneous groups of epilepsy patients with right and left temporal lobe epilepsy (TLE). Eighteen patients with left TLE, 18 with right TLE, and 17 healthy volunteers were studied using fMRI during performance of three tasks assessing the productive and perceptive aspects of language (covert semantic verbal fluency, covert sentence repetition, and story listening). Hemispheric dominance for language was calculated in the frontal and temporal regions using laterality indices (LI). Atypical lateralization was defined as a right-sided LI (LI<-0.20) in the frontal lobes during the verbal fluency task or in the temporal lobes during the story listening task. Control subjects and right TLE patients demonstrated a strong left lateralization for language in the frontal lobes during the fluency task, whereas activation was less lateralized to the left hemisphere in left TLE patients, although the difference did not reach significance. In the story listening and the repetition tasks, activation was significantly more right sided in the temporal lobes of patients with left TLE. Atypical language representation was found in 19% of TLE patients (five left and two right TLE). The shift toward the right hemisphere was significantly larger in the temporal than the frontal lobes in patients with atypical language lateralization compared to TLE patients with a typical language lateralization. Neuropsychological performances of patients with atypical language patterns were better than those of patients with typical patterns, suggesting that this reorganization may represent a compensatory mechanism.
authors.affiliation: Department of Neurology, Hôpital de la Salpêtrière, 75013 Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Thivard
authors.forename: Jérémie
authors.initials: J
authors.lastname: Hombrouck
authors.forename: Sophie Tézenas
authors.initials: ST
authors.lastname: du Montcel
authors.forename: Christine
authors.initials: C
authors.lastname: Delmaire
authors.forename: Laurent
authors.initials: L
authors.lastname: Cohen
authors.forename: Séverine
authors.initials: S
authors.lastname: Samson
authors.forename: Sophie
authors.initials: S
authors.lastname: Dupont
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
authors.forename: Michel
authors.initials: M
authors.lastname: Baulac
authors.forename: Stéphane
authors.initials: S
authors.lastname: Lehéricy
mesh_terms: D000293:Adolescent; D000328:Adult; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011578:Psycholinguistics; D013067:Speech Perception / Q000502:physiology; D013702:Temporal Lobe / Q000503:physiopathology*; D014705:Verbal Behavior / Q000502:physiology