Visual naming performance after ATL resection: impact of atypical language dominance.
OBJECTIVE
To characterize the interaction between language dominance and lateralization of the epileptic focus for pre- and postoperative Boston Naming Test (BNT) performance in patients undergoing anterior temporal lobectomy (ATL).


METHODS
Analysis of pre- and postoperative BNT scores depending on lateralization of language as measured by the intracarotid amobarbital procedure (IAP) versus lateralization of the temporal lobe epileptic focus.


RESULTS
Changes between pre- and postoperative BNT performance depended on epilepsy lateralization (effect size=0.189) with significant decrease in patients undergoing left ATL. Subgroup analysis in these showed that postoperative decline in BNT scores was significant in patients with atypical (n=14; p<0.05), but did not reach statistical significance in patients with left language dominance (n=36; p=0.09). Chi-square test revealed a trend of higher proportions of patients experiencing significant postsurgical deterioration in naming performance in atypical (57.1%) as compared to left language dominance (30.6%; p=0.082). Surgical failure was also associated with greater decline of BNT scores and was more common in atypical than in left language dominant patients (chi(2) (1, n=98)=4.62, p=0.032). Age of onset, duration of epilepsy, and seizure frequency had no impact on changes in BNT performance.


CONCLUSIONS
Atypical language dominance is a predictor of change in visual naming performance after left ATL and may also impact postsurgical seizure control. This should be considered when counseling surgical candidates.
Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA; Department of Neurology, University of Muenster, Muenster, Germany. skovac@ion.ucl.ac.uk
S
S
Kovac
G
G
Möddel
J
J
Reinholz
A V
AV
Alexopoulos
T
T
Syed
M Z
MZ
Koubeissi
S U
SU
Schuele
T
T
Lineweaver
R M
RM
Busch
T
T
Loddenkemper
D000328:Adult; D000654:Amobarbital / Q000627:therapeutic use; D000704:Analysis of Variance; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects*; D004827:Epilepsy / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007806:Language Disorders / Q000209:etiology*; D008297:Male; D009275:Names; D009483:Neuropsychological Tests; D010468:Perceptual Disorders / Q000209:etiology*; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D014796:Visual Perception / Q000502:physiology*; D055815:Young Adult
D006993:Hypnotics and Sedatives; D000654:Amobarbital