Hegde Shantala, Bharath Rose Dawn, Rao Malla Bhaskara, Shiva Karthik, Arimappamagan Arivazhagan, Sinha Sanjib, Rajeswaran Jamuna, Satishchandra Parthasarathy
a Neuropsychology Unit, Department of Clinical Psychology , NIMHANS , Bangalore , India.
b Department of Neuroimaging and Interventional Radiology , NIMHANS , Bangalore , India.
Neurocase. 2016 Dec;22(6):512-517. doi: 10.1080/13554794.2016.1198815. Epub 2016 Jul 1.
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.
内侧颞叶癫痫（TLE）会影响一系列认知功能和音乐能力。我们报告了一名16岁被诊断为耐药性右侧内侧TLE的男孩。他是一名接受过卡纳蒂克古典音乐训练的职业音乐家。临床、电生理、磁共振成像（MRI）和正电子发射断层扫描评估将癫痫病灶定位在右侧内侧颞叶。患者在手术前接受了详细的神经心理学评估和针对音乐能力的功能磁共振成像（fMRI）检查。他接受了清醒开颅手术，并在皮质刺激和临床监测的指导下对外侧新皮质以及杏仁核海马切除术进行了定制切除。基于任务的fMRI显示激活的颞上回得以保留。在16个月的随访中，没有癫痫复发，他的包括音乐能力在内的认知功能也没有因手术而恶化。在听音乐时进行的基于任务的fMRI显示双侧额颞叶激活。静息态fMRI显示术后左侧额颞叶连接性增加。据推测，尽管患病，但由于从小就接受强化音乐训练，大脑的功能和神经适应性可能有助于他保留认知功能和音乐技能，完整的神经心理学和音乐能力可能就是这样产生的。年轻时的强化音乐训练或许不仅磨练了一系列认知功能，而且尽管进行了手术切除，还导致了功能上更高效的认知网络。
