title: Preservation of cognitive and musical abilities of a musician following surgery for chronic drug-resistant temporal lobe epilepsy: a case report.
abstract: Mesial temporal lobe epilepsy (TLE) affects a range of cognitive functions and musical abilities. We report a 16-year-old boy diagnosed with drug-resistant right-medial TLE. He is a professional musician, trained in Carnatic classical music. Clinical, electrophysiological, magnetic resonance imaging (MRI) and positron emission tomography evaluation localized the seizure focus to the right medial temporal lobe. Patient underwent detailed neuropsychological evaluation and functional MRI (fMRI) for musical abilities prior to surgery. He underwent an awake craniotomy and tailored resection of lateral neocortex as well as amygdalohippocampectomy under guidance of cortical stimulation and clinical monitoring. The superior temporal gyrus where activation was revealed on task-based fMRI was preserved. At 16-month follow-up, there was no seizure recurrence and his cognitive functions including musical abilities did not deteriorate with surgery. The task-based fMRI while listening to music revealed bilateral frontotemporal activation. There was evidence of increased left frontotemporal connectivity during the postsurgical period in the resting state fMRI. It is hypothesized that the intact neuropsychological and musical abilities might be as a result of intense musical training from an early age despite the illness leading to functional and neural adaptation of the brain might have contributed to his preserved cognitive functions and musical skills. Intense musical training at a young age perhaps not only honed a range of cognitive functions but also resulted in functionally more efficient cognitive networks despite the surgical resection.
authors.affiliation: a Neuropsychology Unit, Department of Clinical Psychology , NIMHANS , Bangalore , India.
authors.forename: Shantala
authors.initials: S
authors.lastname: Hegde
authors.affiliation: b Department of Neuroimaging and Interventional Radiology , NIMHANS , Bangalore , India.
authors.forename: Rose Dawn
authors.initials: RD
authors.lastname: Bharath
authors.affiliation: c Department of Neurosurgery , NIMHANS , Bangalore , India.
authors.forename: Malla Bhaskara
authors.initials: MB
authors.lastname: Rao
authors.affiliation: b Department of Neuroimaging and Interventional Radiology , NIMHANS , Bangalore , India.
authors.forename: Karthik
authors.initials: K
authors.lastname: Shiva
authors.affiliation: c Department of Neurosurgery , NIMHANS , Bangalore , India.
authors.forename: Arivazhagan
authors.initials: A
authors.lastname: Arimappamagan
authors.affiliation: d Department of Neurology , NIMHANS , Bangalore , India.
authors.forename: Sanjib
authors.initials: S
authors.lastname: Sinha
authors.affiliation: a Neuropsychology Unit, Department of Clinical Psychology , NIMHANS , Bangalore , India.
authors.forename: Jamuna
authors.initials: J
authors.lastname: Rajeswaran
authors.affiliation: d Department of Neurology , NIMHANS , Bangalore , India.
authors.forename: Parthasarathy
authors.initials: P
authors.lastname: Satishchandra
mesh_terms: D000293:Adolescent; D001307:Auditory Perception / Q000502:physiology*; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D003399:Craniotomy / Q000009:adverse effects; D004351:Drug Resistance; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008959:Models, Neurological; D009146:Music; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: Cognition; awake craniotomy; cortical stimulation; drug resistant epilepsy; functional MRI; music; resting state fMRI