Journal article
Lesion and lesion network localization of dysnomia after epilepsy surgery
Brain (London, England : 1878), Vol.148(3), pp.776-787
03/06/2025
DOI: 10.1093/brain/awae322
PMCID: PMC11884675
PMID: 39423309
Appears in UI Libraries Support Open Access
Abstract
Temporal lobe (TL) epilepsy surgery is an effective treatment option for patients with drug-resistant epilepsy. However, neurosurgery poses a risk for cognitive deficits - up to one third of patients have a decline in naming ability following TL surgery. In this study, we aimed to better understand the neural correlates associated with reduced naming performance after TL surgery, with the goal of informing surgical planning strategies to mitigate the risk of dysnomia. We retrospectively identified 85 patients who underwent temporal lobe (TL) resective surgery (49 left TL, 36 right TL) for whom naming ability was assessed before and >3 months post-surgery using the Boston Naming Test (BNT). We used multivariate lesion-symptom mapping to identify resection sites associated with naming decline, and we used lesion-network mapping to evaluate the broader functional and structural connectivity profiles of resection sites associated with naming decline. We validated our findings in an independent cohort of 59 individuals with left temporal lobectomy, along with repeating all analyses after combining the cohorts. Lesion laterality and location were important predictors of post-surgical naming performance. Naming performance significantly improved after right temporal lobectomy (P = 0.015) while a decrement in performance was observed following left temporal lobectomy (P = 0.002). Declines in naming performance were associated with surgical resection of the left anterior middle temporal gyrus (Brodmann area 21, r =0.41, P = <.001), along with a previously implicated basal temporal language area. Resection sites linked to naming decline showed a functional connectivity profile featuring a left-lateralized network closely resembling the extended semantic \ default mode network, and a structural connectivity profile featuring major temporo-frontal association white matter tracts coursing through the temporal stem. This extends prior work by implicating the left anterior middle temporal gyrus in naming decline and provides additional support for the role of the previously identified basal temporal language area in naming decline. Importantly, the structural and functional connectivity profiles of these regions suggest they are key nodes of a broader extended semantic network. Together these regional and network findings may help in surgical planning and discussions of prognosis.Temporal lobe (TL) epilepsy surgery is an effective treatment option for patients with drug-resistant epilepsy. However, neurosurgery poses a risk for cognitive deficits - up to one third of patients have a decline in naming ability following TL surgery. In this study, we aimed to better understand the neural correlates associated with reduced naming performance after TL surgery, with the goal of informing surgical planning strategies to mitigate the risk of dysnomia. We retrospectively identified 85 patients who underwent temporal lobe (TL) resective surgery (49 left TL, 36 right TL) for whom naming ability was assessed before and >3 months post-surgery using the Boston Naming Test (BNT). We used multivariate lesion-symptom mapping to identify resection sites associated with naming decline, and we used lesion-network mapping to evaluate the broader functional and structural connectivity profiles of resection sites associated with naming decline. We validated our findings in an independent cohort of 59 individuals with left temporal lobectomy, along with repeating all analyses after combining the cohorts. Lesion laterality and location were important predictors of post-surgical naming performance. Naming performance significantly improved after right temporal lobectomy (P = 0.015) while a decrement in performance was observed following left temporal lobectomy (P = 0.002). Declines in naming performance were associated with surgical resection of the left anterior middle temporal gyrus (Brodmann area 21, r =0.41, P = <.001), along with a previously implicated basal temporal language area. Resection sites linked to naming decline showed a functional connectivity profile featuring a left-lateralized network closely resembling the extended semantic \ default mode network, and a structural connectivity profile featuring major temporo-frontal association white matter tracts coursing through the temporal stem. This extends prior work by implicating the left anterior middle temporal gyrus in naming decline and provides additional support for the role of the previously identified basal temporal language area in naming decline. Importantly, the structural and functional connectivity profiles of these regions suggest they are key nodes of a broader extended semantic network. Together these regional and network findings may help in surgical planning and discussions of prognosis.
Details
- Title: Subtitle
- Lesion and lesion network localization of dysnomia after epilepsy surgery
- Creators
- Asmaa Mhanna - University of IowaJoel Bruss - University of IowaJoseph C Griffis - University of IowaAlyssa W Sullivan - University of IowaHiroto Kawasaki - University of IowaJeffrey Binder - Medical College of WisconsinSara B Pillay - Medical College of WisconsinMatthew A Howard III - University of IowaDaniel Tranel - University of IowaAaron D Boes - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Brain (London, England : 1878), Vol.148(3), pp.776-787
- DOI
- 10.1093/brain/awae322
- PMID
- 39423309
- PMCID
- PMC11884675
- NLM abbreviation
- Brain
- ISSN
- 1460-2156
- eISSN
- 1460-2156
- Publisher
- Oxford University Press
- Grant note
- National Institute of Neurological Disease and Stroke: 1 R01 NS114405-02, 5R01DC004290-22
This study was supported by the National Institute of Neurological Disease and Stroke (1 R01 NS114405-02; 5R01DC004290-22). This work was conducted on an MRI instrument funded by 1S10OD025025-01.
- Language
- English
- Electronic publication date
- 10/18/2024
- Date published
- 03/06/2025
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Psychiatry; Stead Family Department of Pediatrics; Psychological and Brain Sciences; Iowa Neuroscience Institute; Neurology (Pediatrics); Neurosurgery; Otolaryngology
- Record Identifier
- 9984736748202771
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