title: The course of language functions after temporal lobe epilepsy surgery: a prospective study.
abstract: Anterior temporal lobectomy (ATL) within the language-dominant hemisphere can impair naming. This prospective study examined the pre-operative to post-operative course of different language components, clarifying which changes are relevant within the short-term and long-term outcome of language.
  
  
  
  Patients with drug-resistant temporal lobe epilepsy (TLE) were evaluated using the Token, Boston Naming and Word Fluency tests assessing sentence comprehension and word-finding on visual, semantic or phonemic cues.
  
  
  
  A total of 106 patients were evaluated before and 6 months, 1 and 2 years after ATL; 60 patients were also evaluated after 5 years and 38 controls were assessed at baseline. Seizure outcome was comparable between the left and right TLE patients. Before surgery, naming and word fluency were impaired in the left and right TLE patients, whereas sentence comprehension was normal. After left or right ATL, word fluency progressively improved, naming showed early worsening and late improvement after left ATL and progressive improvement after right ATL, and sentence comprehension did not change. At the 5-year follow-up, naming improvement was clinically significant in 31% and 71% of the left and right TLE patients, respectively. Pre-operative naming, ATL laterality, schooling, and post-operative seizure frequency and number of antiepileptic drugs predicted post-operative naming. Pre-operative word fluency and schooling predicted post-operative word fluency.
  
  
  
  Left or right TLE can impair word-finding but not sentence comprehension. After ATL, word-finding may improve for a long time, depending on TLE laterality, seizure control and mental reserve. These findings may clarify prognosis prior to treatment.
authors.affiliation: Unit of Neurology and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
authors.forename: A R
authors.initials: AR
authors.lastname: Giovagnoli
authors.affiliation: Unit of Neurology and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Parente
authors.affiliation: Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Didato
authors.affiliation: Unit of Neurology and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Manfredi
authors.affiliation: Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Deleo
authors.affiliation: Neurosurgery III, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tringali
authors.affiliation: Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Villani
mesh_terms: D000328:Adult; D032882:Comprehension / Q000502:physiology*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007802:Language; D007807:Language Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013702:Temporal Lobe / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: anterior temporal lobectomy; comprehension; naming; temporal lobe epilepsy; word fluency