Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
Epilepsy Res. 2011 Aug;95(3):246-54. doi: 10.1016/j.eplepsyres.2011.04.007. Epub 2011 May 18.
In patients with left temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) decreased naming ability is common, suggesting a critical role for the medial left temporal lobe in this task. We investigated the integrity of language networks with functional MRI (fMRI) in controls and TLE patients.
We performed an fMRI verbal fluency paradigm in 22 controls and 66 patients with unilateral mesial TLE (37 left HS, 29 right HS). Verbal fluency and naming ability were investigated as part of the standard presurgical neuropsychological assessment. Naming ability was assessed using a visual confrontation naming test.
Left TLE patients had significantly lower naming scores than controls and those with right TLE. Right TLE patients performed less well than controls, but better than those with left TLE. Left TLE had significantly lower scores for verbal fluency than controls. In controls and right TLE, left hippocampal activation during the verbal fluency task was significantly correlated with naming, characterised by higher scores in subjects with greater hippocampal fMRI activation. In left TLE no correlation with naming scores was seen in the left hippocampus, but there was a significant correlation in the left middle and inferior frontal gyri, not observed in controls and right TLE. In left and right TLE, out of scanner verbal fluency scores significantly correlated with fMRI activation for verbal fluency in the left middle and inferior frontal gyri.
Good confrontation naming ability depends on the integrity of the hippocampus and the connecting fronto-temporal networks. Functional MRI activation in the left hippocampus during verbal fluency is associated with naming function in healthy controls and patients with right TLE. In left TLE, there was evidence of involvement of the left frontal lobe when naming was more proficient, most likely reflecting a compensatory response due to the ongoing epileptic activity and/or underlying pathology.
在因海马硬化（HS）导致左侧颞叶癫痫（TLE）的患者中，命名能力下降很常见，这表明内侧左颞叶在该任务中起着关键作用。我们使用功能磁共振成像（fMRI）研究了对照组和 TLE 患者的语言网络完整性。
我们在 22 名对照组和 66 名单侧内侧 TLE 患者（37 例左侧 HS，29 例右侧 HS）中进行了 fMRI 言语流畅性范式。言语流畅性和命名能力作为标准术前神经心理学评估的一部分进行了研究。命名能力通过视觉命名测试进行评估。
左侧 TLE 患者的命名得分明显低于对照组和右侧 TLE 患者。右侧 TLE 患者的表现不如对照组，但优于左侧 TLE 患者。左侧 TLE 的言语流畅性得分明显低于对照组。在对照组和右侧 TLE 中，言语流畅性任务期间左侧海马的激活与命名显著相关，表现为海马 fMRI 激活程度较高的受试者得分较高。在左侧 TLE 中，左侧海马与命名得分无相关性，但在左侧中、下额回存在显著相关性，在对照组和右侧 TLE 中未观察到。在左侧和右侧 TLE 中，扫描外言语流畅性得分与左中、下额回言语流畅性 fMRI 激活显著相关。
良好的命名能力取决于海马体及其连接的额颞网络的完整性。言语流畅性任务期间左侧海马的 fMRI 激活与健康对照组和右侧 TLE 患者的命名功能相关。在左侧 TLE 中，当命名更熟练时，左侧额叶存在证据表明存在参与，这很可能反映了由于持续的癫痫活动和/或潜在的病理导致的代偿反应。
