Prabhakar Anuj, Khandelwal Niranjan, Vyas Sameer, Gupta Vivek, Kharbanda Parampreet S, Mohanty Manju
Department of Neuro Imaging and Interventional Neuroradiology, AIIMS, New Delhi, India.
Department of Radiodiagnosis, Post Graduate Institute of Medical Imaging and Research, Chandigarh, India.
Indian J Radiol Imaging. 2019 Apr-Jun;29(2):168-176. doi: 10.4103/ijri.IJRI_281_18.
To evaluate the role of functional magnetic resonance imaging (fMRI) in epilepsy management and to ascertain whether laterality index (LI) derived from fMRI data, using routinely utilized paradigms, can serve as an adjunct to/or replace preoperative neuropsychological testing for evaluation of language lateralization and impairment.
This was a prospective study which included 20 consecutive patients with a clinical diagnosis of temporal lobe epilepsy over a period of 1 year. Neuropsychological assessment included oral word association test and animal names test. The scores of both tests were compared with normographic data provided in the NIMHANS neuropsychology battery. Three fMRI paradigms were used, namely, picture naming, word generation, and sentence completion. Processing and statistical analysis were performed subsequently.
Right temporal lobe epilepsy (RTLE) was seen in 12 patients and left temporal lobe epilepsy (LTLE) in 8 patients. All patients were right handed. The activation pattern was predominantly left lateralized. Language lateralization varied with the type of paradigm. The overall percentage of patients showing left lateralization ranged from 44.00% for the picture naming task to 75% for the sentence completion. Reduced left lateralization was noted in both LTLE and RTLE patients. A negative correlation was observed in LTLE patients between performance in the verbal fluency and the lateralization index in the temporal and parietal regions of interest (ROI) in the word generation paradigm, suggesting that increased left lateralization was associated with a poorer score on neuropsychological tests. In RTLE patients, however, there was no significant correlation between performance in neuropsychological tests and LI. In conclusion, language lateralization using LI can serve as an adjunct during preoperative evaluation. However, it cannot replace neuropsychological testing.
评估功能磁共振成像（fMRI）在癫痫管理中的作用，并确定使用常规范式从fMRI数据得出的偏侧指数（LI）是否可作为术前神经心理学测试的辅助手段或替代方法，用于评估语言偏侧化和损伤。
这是一项前瞻性研究，在1年的时间里连续纳入了20例临床诊断为颞叶癫痫的患者。神经心理学评估包括口头词语联想测试和动物名称测试。将两项测试的分数与NIMHANS神经心理学量表提供的常模数据进行比较。使用了三种fMRI范式，即图片命名、词语生成和句子完成。随后进行处理和统计分析。
12例患者为右侧颞叶癫痫（RTLE），8例患者为左侧颞叶癫痫（LTLE）。所有患者均为右利手。激活模式主要为左侧化。语言偏侧化因范式类型而异。显示左侧化的患者总体百分比从图片命名任务的44.00%到句子完成任务的75%不等。在LTLE和RTLE患者中均观察到左侧化减少。在LTLE患者中，词语生成范式中感兴趣的颞叶和顶叶区域（ROI）的言语流畅性表现与偏侧指数之间存在负相关，这表明左侧化增加与神经心理学测试得分较差相关。然而，在RTLE患者中，神经心理学测试表现与LI之间没有显著相关性。总之，使用LI进行语言偏侧化评估可作为术前评估的辅助手段。然而，它不能替代神经心理学测试。
