Rathore Chaturbhuj, George Annamma, Kesavadas Chandrasekharan, Sarma P Sankara, Radhakrishnan Kurupath
R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Epilepsia. 2009 Oct;50(10):2249-55. doi: 10.1111/j.1528-1167.2009.02300.x. Epub 2009 Sep 10.
To assess the prevalence and attributes of atypical language lateralization (ALL) in patients with left mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS).
We recruited consecutive patients with left MTLE-HS, who had undergone resective surgery and had pathologically proven HS. Based on the Wada test, language lateralization was classified into typical (left hemispheric) or atypical (right hemispheric or codominant). We assessed the attributes of patients with ALL using univariate and multivariate analyses.
Of 124 patients with left MTLE-HS, 23 (18.5%) had ALL. ALL occurred more frequently in patients with severe initial precipitating injury (IPI), early onset of epilepsy, and a short latent period between IPI and onset of habitual seizures. ALL was more common in patients with bitemporal and extratemporal interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) and extratemporal changes on magnetic resonance imaging (MRI). On multivariate analyses, the age at onset of habitual seizures <6 years, atypical IPI, nonunilateral temporal IEDs, and extratemporal MRI abnormalities independently predicted ALL. The likelihood of ALL was very low ( approximately 1%) when all of these four risk factors were absent, whereas it was very high (>95%), if any three or all four of them were present.
ALL occurs in one-fifth of patients with left MTLE-HS. ALL is more frequent in those with structural or functional extrahippocampal involvement and early onset of epilepsy interrupting the development of normal language networks. Because ALL is uncommon in those with damage/dysfunction restricted to the hippocampus, the hippocampus itself may have only a limited role in determining language lateralization.
评估左侧内侧颞叶癫痫伴海马硬化（MTLE-HS）患者中非典型语言优势半球（ALL）的患病率及特征。
我们招募了连续的左侧MTLE-HS患者，这些患者均接受了切除性手术且病理证实有海马硬化。基于Wada试验，语言优势半球被分为典型（左侧半球）或非典型（右侧半球或双侧优势）。我们使用单因素和多因素分析评估ALL患者的特征。
在124例左侧MTLE-HS患者中，23例（18.5%）有ALL。ALL在有严重初始促发损伤（IPI）、癫痫早发以及IPI与习惯性发作起始之间潜伏期短的患者中更常见。ALL在脑电图（EEG）显示双侧颞叶和颞外间歇期癫痫样放电（IEDs）以及磁共振成像（MRI）有颞外改变的患者中更常见。多因素分析显示，习惯性发作起始年龄<6岁、非典型IPI、非单侧颞叶IEDs以及颞外MRI异常独立预测ALL。当这四个危险因素均不存在时，ALL的可能性非常低（约1%），而如果存在其中三个或全部四个危险因素，则可能性非常高（>95%）。
ALL发生在五分之一的左侧MTLE-HS患者中。在有海马体外结构或功能受累以及癫痫早发从而干扰正常语言网络发育的患者中，ALL更常见。由于ALL在海马损伤/功能障碍局限的患者中不常见，海马本身在确定语言优势半球方面可能仅起有限作用。
