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.
Kovac
S
S
Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA; Department of Neurology, University of Muenster, Muenster, Germany. skovac@ion.ucl.ac.uk
Möddel
G
G
Reinholz
J
J
Alexopoulos
A V
AV
Syed
T
T
Koubeissi
M Z
MZ
Schuele
S U
SU
Lineweaver
T
T
Busch
R M
RM
Loddenkemper
T
T
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