Language-related hemispheric asymmetry in healthy subjects and patients with temporal lobe epilepsy as studied by event-related brain potentials and intracarotid amobarbital test

There are current attempts to replace the WADA test for pre-surgical evaluation of hemispheric language capabilities by one of the methods of functional brain imaging. Recent PET and fMRI studies using verbal cognitive tasks like verb generation, semantic monitoring or semantic ('deep') encoding of words showed asymmetries of activation in the fronto-lateral cortex. In a previous ERP study subjects were required to indicate whether pronounceable non-words and abstract geometric figures were presented for the first time ('new item') or whether they had been shown before ('old item'). Group analyses of this study showed significant material-specific hemispheric asymmetries with ERPs being more negative-going in recordings of the posterior part of the left hemisphere with verbal material (CP5/6) but more negative-going in recordings of the right hemisphere with the spatial material (P7/8). The aim of the present study was to test statistically ERP lateralization effects in individual healthy subjects as well as WADA-tested patients suffering from seizures of the mesio-temporal lobe (MTL). In all subjects ERP lateralization with verbal material was tested in the electrode pair CP5/6, and ERP lateralization with figures in the electrode pair P7/8. Statistical analyses of single trials showed that in 20 out of 24 subjects ERPs with verbal material started to be more negative-going in CP5 as compared to CP6 in the period between 100 and 200 ms after stimulus onset or the subsequent time epoch (200-300 ms). In one subject not CP5/6 but the closely adjacent electrode pair P7/P8 showed this verbal material-related hemispheric effect. In patients language dominance as indicated by ERPs was not always consistent with the data of the WADA test. In one patient with left MTL seizures ERPs with verbal material and figures were found to be significantly lateralized to the right hemisphere although the WADA test assigned this patient to have a language-dominant left hemisphere.     

Neural organization of material-specific memory functions in temporal lobe epilepsy patients as assessed by the intracarotid amobarbital test.

Lateralization of material-specific memory processing was evaluated in 105 epilepsy patients undergoing the intracarotid amobarbital test prior to temporal lobectomy (TL). Left hemisphere (LH) language dominant patients demonstrated LH specialization for long-term verbal recognition memory and right hemisphere specialization for visuospatial recognition memory. The pattern of hemispheric memory specialization was similar for LH language dominant patients with brain injuries before 2 yrs of age and those without history of early brain injury, suggesting that the apparent sparing of memory post-TL in early brain injury patients reflects reorganization of memory functions within the epileptic hemisphere. Non-LH-language dominant patients showed no lateral specialization for either verbal or visuospatial memory processing, suggesting that in these individuals reorganization of memory functions between hemispheres accompanies the lateral shift in language representation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategic processing and memory for temporal order in patients with frontal lobe lesions.

This study evaluated whether deficits in memory for temporal order in patients with frontal lobe lesions result from impaired automatic encoding of temporal information or are secondary to deficits in effortful processes, such as the use of organizational strategies and control of interference. Patients with lesions in the dorsolateral prefrontal cortex and control participants were tested on temporal order reconstruction of semantically related and unrelated word lists learned under intentional or incidental conditions. Memory for temporal order in patients with frontal lobe lesions was sensitive to semantic relatedness but not to intention to learn. Tests of item free recall and recognition using similar encoding manipulations indicated that order performance in these patients was dissociable from item memory. Results indicate that automatic processing of temporal information is intact in patients with frontal lobe lesions but that strategic processing of this information is impaired. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Imitative response tendencies in patients with frontal brain lesions.

It is widely accepted that patients with frontal lesions have problems inhibiting automatic response tendencies. Whereas inhibition deficits of overlearned responses have been extensively investigated using interference tasks like the Stroop task (J. R. Stroop, 1935), it is controversial whether patients with frontal brain lesions also have problems inhibiting imitative responses. Using an interference paradigm, the present study investigated imitative response tendencies in patients with frontal lesions. In addition, it tested whether patients deficient in the inhibition of imitative responses correspondingly have problems inhibiting overlearned responses. It was found that the group with frontal lesions displayed significantly stronger imitative response tendencies than the group with nonfrontal lesions. Furthermore, it was shown that the inhibition of imitative responses is functionally unrelated to Stroop interference. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reflective and reflexive action control in patients with frontal brain lesions.

Two types of action control derived from the model of action phases (H. Heckhausen & P. M. Gollwitzer, 1987) were analyzed in patients with frontal lesions, patients with nonfrontal lesions, and university students. In Study 1, reflective action control in terms of goal selection was assessed, and impaired deliberation was found in patients with frontal lesions. Study 2 assessed reflexive action control in terms of automatic action initiation as a result of forming implementation intentions (P. M. Gollwitzer, 1999). All participants sped up their responses to critical stimuli by forming implementation intentions. Moreover, lesion patients with weak performances on the Tower of Hanoi (TOH) task did worse than patients with strong TOH performances in Study 1 but better than control participants in Study 2. Findings are interpreted as a functional dissociation between conscious reflective action control and automatic reflexive action control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidence of lesions described by magnetic resonance imaging in the clarification of focal epilepsy of frontal and temporal origin

AIM: Today, MRI is an integral part of the presurgical evaluation of patients suffering from partial epilepsy. These patients frequently show focal morphological abnormalities with potential epileptogenic character and surgical resection of these lesions is associated with superior postsurgical outcome as to seizure frequency. Apart from easily detectable defects, such as post-traumatic lesions or cerebral infarction, as wide variety of mainly small abnormalities can be detected using MRI. METHODS: In this study, 484 patients suffering from partial epilepsy of temporal or frontal onset were evaluated for the incidence of different lesions in this population. RESULTS: All lesions found were included without evaluating their potential epileptogenicity, which remains to be proven using other procedures (EEG, SPECT, PET, etc.). Involvement of the hippocampal formation was a major finding in temporal lobe epilepsy, which could be detected as sclerosis (T2w-images), atrophy (T2w-TSE or T1w-IR-images) or both (15%). In addition and in declining frequency various tumors (14%), post-traumatic lesion (-5%), and focal cortical dysplasia or other disturbances of cortical integrity (-4%) were found. These lesions are detectable with best contrast on different sequences. As a consequence it is suggested to acquire sequences in 3 dimensions including a T1w-SE, two (coronal and axial) double-echo-SE sequences and similarly two T1w-IR-sequences. The application of contrast media can be restricted to special questions, derived either from the first imaging results or from the patients history. CONCLUSION: Using qualitative data for interpretation, the sensitivity as to the detection of any focal pathology of a recent-generation MRI in this population was 75%, with 79% for temporal lobe epilepsies and 67% for frontal lobe epilepsies. Quantitative measurements of hippocampal volume or signal seem to be able to increase the sensitivity of the method.     

Temporal and spatial context memory in patients with focal frontal, temporal lobe, and diencephalic lesions

Patients with focal frontal, temporal lobe, or diencephalic lesions were investigated on measures of temporal (recency) and spatial (position) context memory, after manipulating exposure times to match recognition memory for targets (pictorial stimuli) as closely as possible. Patients with diencephalic lesions from an alcoholic Korsakoff syndrome showed significant impairment on the temporal context (recency) task, as did patients with frontal lesions penetrating the dorsolateral frontal cortex, according to MRI (and PET) evidence. Patients with temporal lobe lesions showed only a moderate (non-significant) impairment on this task, and patients with medial frontal lesions, or large frontal lesions not penetrating the dorsolateral cortical margins, performed as well as healthy controls at this task. On the spatial context memory task, patients with lesions in the temporal lobes showed significant impairment, and patients with right temporal lesions performed significantly worse than patients with left temporal lesions. Patients with diencephalic lesions showed only a modest (non-significant) impairment on this task, and the frontal lobe group performed normally. When a group of patients with temporal lobe lesions resulting from herpes encephalitis were examined separately, an identical pattern of results was obtained, the herpes group being significantly impaired on spatial memory and showing a trend towards impairment for temporal context memory. There were strong correlations between anterograde memory quotients and context memory performance (despite the use of an exposure time titration procedure) and a weak association in the frontal group with one frontal/executive task [corrected] (card-sorting perservations). It is predicted that correlations between temporal context memory and frontal/executive tasks will be greater in samples of patients all of whom have frontal lesions invading the dorsolateral cortical margin.     

Relationship between anatomic lesions of the temporal lobe and temporal lobe epilepsy

A structural lesion of the brain is a frequent finding in intractable partial epileptic patients. We analyse anatomo-electro-clinical characteristics of 58 patients in which MR showed a lesion inside the temporal lobe. They are 29 males and 29 females with a mean age at surgery of 23.5 +/- 10.7 years (2.6-45.9). The mean epilepsy duration is of 13.4 +/- 8 years (1.3-35.5), with a mean seizure frequency of 28.7 +/- 43.6 per month, with a great inter-individual variability (from 3 per month to 15 a day). The minimum follow-up is 3.5 years. A video-EEG monitoring was performed in 21 cases, while a stereo-EEG investigation was judged mandatory in 26. On the basis of anatomo-electro-clinical correlations and of the results of presurgical investigations, the epileptogenic area was proved to be temporal in 49 cases, temporal but controlateral to the lesion in 1, and at least bilobar in 8 patients.     

Effects of divided attention on temporal processing in patients with lesions of the cerebellum or frontal lobe.

Prefrontal cortex and cerebellum have both been implicated in temporal processing tasks although the exact contribution of each system remains unclear. To investigate this issue, control participants and patients with either prefrontal or cerebellar lesions were tested on temporal and nontemporal perceptual tasks under 2 levels of attentional load. Each trial involved a comparison between a standard tone and a subsequent comparison tone that varied in frequency, duration, or both. When participants had to make concurrent judgments on both dimensions, patients with frontal lobe lesions were significantly impaired on both tasks whereas the variability of cerebellar patients increased in the duration task only. This dissociation suggests that deficits on temporal processing tasks observed in frontal patients can be related to the attention demands of such tasks; cerebellar patients have a more specific problem related to timing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verb generation in patients with focal frontal lesions: a neuropsychological test of neuroimaging findings

What are the neural bases of semantic memory? Traditional beliefs that the temporal lobes subserve the retrieval of semantic knowledge, arising from lesion studies, have been recently called into question by functional neuroimaging studies finding correlations between semantic retrieval and activity in left prefrontal cortex. Has neuroimaging taught us something new about the neural bases of cognition that older methods could not reveal or has it merely identified brain activity that is correlated with but not causally related to the process of semantic retrieval? We examined the ability of patients with focal frontal lesions to perform a task commonly used in neuroimaging experiments, the generation of semantically appropriate action words for concrete nouns, and found evidence of the necessity of the left inferior frontal gyrus for certain components of the verb generation task. Notably, these components did not include semantic retrieval per se.     

Virtual planning in patients with frontal lobe lesions

The VIrtual Planning Test (VIP) was developed to investigate the planning and organisational abilities of 25 patients with frontal lobe neurosurgical lesions, comparing their performance with 25 matched control subjects. The task, presented in the form of a board game, simulates planning and execution of a set of target activities that have to take place over a four day period, involving those that are either preparatory for a fictional "trip" abroad, or those that relate to the subject's current environment (context). The frontal lobe patients were impaired overall, tending to select inappropriate activities associated with their current context and showing greater impairment on subtasks requiring only one, rather than two, preparatory acts. The findings are discussed in terms of the validity of the VIP test in identifying executive functioning impairment and the degree to which the pattern of deficits are consistent with neuropsychological models of executive function.     

Frequency judgements of abstract designs by patients with diencephalic, temporal lobe or frontal lobe lesions

Patients with diencephalic, temporal lobe or frontal lobe lesions were compared with healthy controls on a frequency judgement task. The three patient groups were disproportionately impaired at estimating how often a series of abstract designs had been presented relative to controls. Diencephalic and temporal lobe patients did not differ from each other. It is argued that the results may reflect a 'core' memory deficit in the temporal lobe patients. The impairment in the frontal patients may reflect their difficulty in making an organised search in memory for multiple traces of an item, while the deficit shown by the diencephalic patients (particularly those with Korsakoff syndrome) may be due to the combined effects of a generally poor memory and superimposed frontal pathology.     

Effect of posterior parietal and frontal neocortical lesions in the squirrel monkey.

2 groups of squirrel monkeys with frontal or parietal cortical lesions and an unoperated control group (N = 12) received the following in the order mentioned: brightness discrimination; 3 forms of a spatial pattern discrimination in which the essential cue and site of reinforcement were separated (SSP); delayed response; form discrimination; and 3 forms of a spatial pattern discrimination in which the essential cue and site of reinforcement were identical. Ss with frontal lesions were impaired on delayed response, and those with parietal lesions were impaired on form and SSP discriminations. Neither group was impaired on brightness discrimination. Results confirm and extend previous findings that the posterior parietal cortex of nonhuman primates is critically involved in visually guided spatial discriminations when the primary cue and the site of reinforcement are separated. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence for intact semantic representations in patients with frontal lobe lesions.

Patients with frontal lobe lesions and control participants were assessed on 2 tests of semantic knowledge. In the triadic comparison task, participants were shown all possible triplets of 12 animal names and judged which 2 of each triplet were most alike. In the ordered similarity task, participants rank ordered animals in terms of their similarity to a target animal. For both tasks, semantic structure-- derived from multidimensional scaling techniques-- revealed similar representations in patients with frontal lobe lesions and control participants. Additional pathfinder analyses also produced networks that did not differ between groups. These patients exhibited intact semantic knowledge despite deficits on tests of free recall and verbal fluency that involved the same semantic category and exemplars. Thus, intact representation of semantic knowledge in frontal patients stands in contrast to their marked deficits in strategic retrieval of semantic knowledge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in patients with mesial temporal lobe epilepsy

Possible sex differences in the pattern of interictal hypometabolism were investigated, and also seizure spread in patients with mesial temporal lobe epilepsy (n=48) and hippocampal sclerosis (MTLE). Male patients (n=21) more often had a frontal lobe hypometabolism ipsilateral to the seizure onset (p<0.0001) and a spread of epileptiform activity to this region (p=0.001). By contrast, female patients more often exhibited hypometabolism (p=0.0052) and an ictal spread to the contralateral temporal lobe (p=0.0097). These findings suggest sex differences in spatial distribution of brain dysfunction in MTLE, perhaps reflecting sexual dimorphism in regional cerebral connectivity.     

Letter and category fluency in patients with frontal lobe lesions.

This study examines the hypothesis that patients with frontal lobe lesions are impaired on tests of letter but not category fluency. This hypothesis was proposed by Moscovitch (1994), based on a series of cognitive studies with young, normal participants. A group of patients with lateral prefrontal lesions and age-matched controls were tested on 2 tests of verbal fluency, the FAS task and a category fluency task that used semantic categories as cues (e.g., animals). Patients with frontal lobe lesions generated fewer items than controls on both letter and category fluency. This effect did not interact with the type of fluency test, suggesting that the frontal lobes are more generally involved in verbal fluency. Moreover, this pattern of findings, along with previous results of impaired free recall and remote retrieval in this patient group, suggests that patients with frontal lobe lesions do not efficiently organize and develop retrieval strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal factors influence recovery of function after embryonic brain tissue transplants in adult rats with frontal cortex lesions.

Adult rats with lesions of the medial frontal cortex received implants of frontal cortex taken from embryos on the 19th day of gestation and placed directly into the zone of injury at 7, 14, 30, or 60 days after initial surgery. Another group was given bilateral frontal lesions, followed 20 days later by a second small lesion to enhance the release of putative neurotrophic factors. They then received transplants 7 days after this second operation. All rats began postoperative training on a spatial alternation learning task within 4 days after the implants of fetal tissue. The brain-damaged rats with transplants at 7 or 14 days after surgery significantly improved postoperative acquisition of spatial alternation. Transplants made 30 or 60 days postoperatively had no effect; these groups were as impaired as those with lesions alone. The animals given a second, "priming" lesion after a 20-day delay, followed by implants of fetal brain tissue, performed as poorly as the group with frontal cortex lesions alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning in monkeys after combined lesions in frontal and anterior temporal lobes.

Assigned 19 rhesus monkeys to 2 unoperated control groups, a group sustaining prefrontal lobectomy, and a group with prefrontal lobectomy plus removal of the anterior temporal neocortex. Ss were compared on delayed response ability, as well as on the ability to make object discriminations and to form learning sets. The combined frontal-temporal lesion did not increase the delayed response deficit produced by frontal damage alone, but it significantly increased difficulty in making 2-object discriminations and apparently also depressed oddity discrimination performance. Ability to form learning sets was not impaired in either lesioned group. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposed modification of the Wada test for presurgical assessment in temporal lobe epilepsy

The distribution of prolactin receptors (PRL-R) in the rat brain was investigated for the first time with the immunohistochemical technique using monoclonal antibodies raised against PRL-R purified from rat liver. Granular immunostaining was observed in neurons and along their dendritic processes and fibers. PRL-R like immunoreactive neurons were found in a number of brain areas. There was a very dense labelling in the cerebral cortex (pyramidal cell layer), septal nuclei, amygdaloid complex as well as in the hypothalamus (suprachiasmatic, supraoptic, paraventricular and dorsomedial nuclei). A dense staining was seen in the substantia nigra, habenula and in the paraventricular thalamic nucleus. Immunostaining was also found in the choroid plexus and in the subcommissural organ. Comparison between the present distribution and that of PRL-like immunoreactivity indicates that the density of PRL-R generally corresponds to that of the fibers. However, in some regions densely stained by PRL-R antibody, there are very few PRL-immunoreactive fibers. These results are suggestive of different modes of action of PRL in the brain.