title: Lateralization of hippocampal activation differs between left and right temporal lobe epilepsy patients and correlates with postsurgical verbal learning decrement.
abstract: We addressed the question whether lateralization of memory-related medial temporal lobe (MTL) activity in medial temporal lobe epilepsy (MTLE) patients is determined by pathology or sex, differentiating between two MTL subregions implicated in visuospatial memory as regions-of-interest (ROI) - the hippocampus (Hc) and the parahippocampal place area (PPA). We further assessed the relation between lateralization of hippocampal activation and postsurgical memory decline regarding performance in standardized neuropsychological tests of verbal and visuospatial learning. Functional magnetic resonance imaging (fMRI) data were acquired from unilateral MTLE patients performing an object location memory task in a virtual environment. Individual lateralization indices (LI) based on memory-related brain activation patterns were calculated for each subject and ROI. Correlational analyses were computed between pre- to postsurgical changes in learning and asymmetry in hippocampal activation. Results revealed that lateralization of hippocampal, memory-related activity in patients with MTLE was determined by the side of seizure focus, not sex. Laterality of activation in the PPA was neither influenced by side of pathology nor sex. Lateralization of hippocampal activation was significantly correlated with decline in verbal learning after surgery. We were able to demonstrate that asymmetry of hippocampal fMRI-activation in unilateral MTLE patients is determined by the side of seizure focus, thus indicating the relative functional integrity of the hippocampi. This is corroborated by the finding that greater activation of the to-be-resected hippocampus leads to stronger verbal memory decline after surgery.
authors.affiliation: Epilepsy Center, University of Freiburg, Germany. lars.frings@uniklinik-freiburg.de
authors.forename: Lars
authors.initials: L
authors.lastname: Frings
authors.forename: Kathrin
authors.initials: K
authors.lastname: Wagner
authors.forename: Ulrike
authors.initials: U
authors.lastname: Halsband
authors.forename: Ralf
authors.initials: R
authors.lastname: Schwarzwald
authors.forename: Josef
authors.initials: J
authors.lastname: Zentner
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
mesh_terms: D000293:Adolescent; D000328:Adult; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006624:Hippocampus / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008569:Memory Disorders / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology* / Q000523:psychology*; D012044:Regression Analysis; D012727:Sex Characteristics; D013028:Space Perception / Q000502:physiology; D016896:Treatment Outcome; D014706:Verbal Learning / Q000502:physiology*