Barrow Neurological Institute, United States of America.
Florida Hospital Medical Group, United States of America.
Epilepsy Behav. 2020 Nov;112:107451. doi: 10.1016/j.yebeh.2020.107451. Epub 2020 Sep 18.
An important role of neuropsychology in the preoperative evaluation of epilepsy surgery candidates is to assess risk for postoperative memory decline. One factor associated with postoperative verbal memory decline is surgery in the language-dominant temporal lobe (TL). The aim of the study was to determine whether atypical language representation has a protective effect against verbal memory decline following left temporal, frontotemporal, or hippocampal excision.
Data from 61 patients with medically refractory epilepsy, Wada testing, and pre- and postsurgical memory assessment from four comprehensive epilepsy surgery centers were gathered and examined for pre- to postsurgical memory change. Wada testing was used to determine language dominance (left vs. atypical [bilateral + right]). Postoperative memory change was examined at both the individual (using nonparametric analyses) and group (using parametric analyses) levels for the two language dominance groups.
Significant postoperative verbal memory decline was observed in the left hemisphere language-dominant group, while the atypical language group showed verbal memory improvement. Individuals with left hemisphere language dominance were more likely to show postoperative declines in verbal memory, whereas individuals with atypical language dominance were significantly less likely to decline. As expected, there were no significant differences between language groups with regard to postoperative visuospatial memory outcome.
Patients with atypical language dominance had better verbal memory outcomes following left hemisphere resections than those with left hemisphere language dominance suggesting that typical memory substrates likely reorganized along with language. Thus, atypical cerebral organization of language may be considered a protective factor against verbal memory decline following epilepsy surgery involving the left TL.
神经心理学在癫痫手术候选者术前评估中的一个重要作用是评估术后记忆下降的风险。与术后言语记忆下降相关的一个因素是在优势颞叶（TL）进行手术。本研究旨在确定非典型语言表现是否对左颞叶、额颞叶或海马切除术后言语记忆下降具有保护作用。
从四个综合癫痫手术中心收集了 61 名药物难治性癫痫患者、Wada 测试和术前及术后记忆评估的数据，并对术前至术后记忆变化进行了检查。Wada 测试用于确定语言优势（左侧与非典型[双侧+右侧]）。在个体（使用非参数分析）和群体（使用参数分析）水平上，对两个语言优势组进行了术后记忆变化的检查。
在左侧半球语言优势组中观察到显著的术后言语记忆下降，而在非典型语言组中则表现出言语记忆改善。具有左侧半球语言优势的个体更有可能在术后出现言语记忆下降，而具有非典型语言优势的个体则明显不太可能下降。正如预期的那样，语言组之间在术后视觉空间记忆结果方面没有显著差异。
与左侧半球语言优势相比，具有非典型语言优势的患者在左半球切除术后言语记忆结果更好，这表明典型的记忆底物可能与语言一起重新组织。因此，在涉及左 TL 的癫痫手术后，非典型的语言大脑组织可能被认为是防止言语记忆下降的保护因素。
