Sablik Maria, Fleury Marine N, Binding Lawrence P, Carey David P, d'Avossa Giovanni, Baxendale Sallie, Winston Gavin P, Duncan John S, Sidhu Meneka K
Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
MRI Unit, Chalfont Centre for Epilepsy, Chalfont St. Peter, UK.
Epilepsia. 2025 Jan;66(1):207-225. doi: 10.1111/epi.18147. Epub 2024 Nov 6.
Anterior temporal lobe resection (ATLR) is an effective treatment for drug-resistant temporal lobe epilepsy (TLE), although language deficits may occur after both left and right ATLR. Functional reorganization of the language network has been observed in the ipsilateral and contralateral hemispheres within 12 months after ATLR, but little is known of longer-term plasticity effects. Our aim was to examine the plasticity of language functions up to a decade after ATLR, in relation to cognitive profiles.
We examined 24 TLE patients (12 left [LTLE]) and 10 controls across four time points: pre-surgery, 4 months, 12 months, and ~9 years post-ATLR. Participants underwent standard neuropsychological assessments (naming, phonemic, and categorical fluency tests) and a verbal fluency functional magnetic resonance imaging (fMRI) task. Using a flexible factorial design, we analyzed longitudinal fMRI activations from 12 months to ~9 years post-ATLR, relative to controls, with separate analyses for people with hippocampal sclerosis (HS). Change in cognitive profiles was correlated with the long-term change in fMRI activations to determine the "efficiency" of reorganized networks.
LTLE patients had increased long-term engagement of the left extra-temporal and contralateral temporal regions, with better language performance linked to bilateral activation. Those with HS exhibited more widespread bilateral activations. RTLE patients showed plasticity in the left extra-temporal regions, with better language outcomes associated with these areas. Both groups of patients achieved cognitive stability over 9 years, with more than 50% of LTLE patients improving. Older age, longer epilepsy duration, and lower pre-operative cognitive reserve negatively affected long-term language performance.
Neuroplasticity continues for up to ~9 years post-epilepsy surgery in LTLE and RTLE, with effective language recovery linked to bilateral engagement of temporal and extra-temporal regions. This adaptive reorganization is associated with improved cognitive outcomes, challenging the traditional view of localized surgery effects. These findings emphasize the need for early intervention, tailored pre-operative counseling, and the potential for continued cognitive gains with extended post-ATLR rehabilitation.
颞叶前部切除术（ATLR）是治疗耐药性颞叶癫痫（TLE）的有效方法，不过左、右ATLR术后均可能出现语言功能缺陷。在ATLR术后12个月内，已观察到同侧和对侧半球语言网络的功能重组，但对于长期可塑性效应知之甚少。我们的目的是研究ATLR术后长达十年的语言功能可塑性，并探究其与认知概况的关系。
我们在四个时间点对24例TLE患者（12例左侧TLE [LTLE]）和10名对照者进行了检查：手术前、术后4个月、术后12个月以及术后约9年。参与者接受了标准神经心理学评估（命名、音素和分类流畅性测试）以及言语流畅性功能磁共振成像（fMRI）任务。采用灵活的析因设计，我们分析了ATLR术后12个月至约9年期间相对于对照者的纵向fMRI激活情况，并对伴有海马硬化（HS）的患者进行了单独分析。认知概况的变化与fMRI激活的长期变化相关，以确定重组网络的“效率”。
LTLE患者左颞叶外和对侧颞叶区域的长期参与度增加，语言表现越好与双侧激活相关。伴有HS的患者表现出更广泛的双侧激活。右侧TLE（RTLE）患者在左颞叶外区域表现出可塑性，语言结果越好与这些区域相关。两组患者在9年中均实现了认知稳定，超过50%的LTLE患者病情有所改善。年龄较大、癫痫持续时间较长和术前认知储备较低对长期语言表现产生负面影响。
LTLE和RTLE患者在癫痫手术后长达约9年的时间里神经可塑性仍在持续，有效的语言恢复与颞叶和颞叶外区域的双侧参与有关。这种适应性重组与改善的认知结果相关，挑战了局部手术效果的传统观点。这些发现强调了早期干预、个性化术前咨询的必要性，以及ATLR术后延长康复可能带来持续认知改善的潜力。
