Olfactory functioning before and after temporal lobe resection for intractable seizures.

An olfactory test battery was administered monorhinically to 21 epilepsy patients prior to and 6 mo after unilateral medial temporal lobe resection for treatment of intractable seizures. 33 matched control Ss were also tested. Presurgically, controls and patients exhibited normal sensitivity for 1-butanol. Patients performed at levels significantly below controls on tests for odor discrimination, odor memory, and odor naming. Left-resected patients did not show significant changes following surgery. Right-resected patients demonstrated significant right nostril decline. Postsurgical changes demonstrated by the right-resected group were not attributable to deficits in primary sensory function or to deficits in cognition brought on by surgery. These findings imply that right medial temporal lobe structures play a greater role in olfactory processing than do corresponding structures in the left hemisphere. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal working memory components can be selectively influenced by transcranial magnetic stimulation in patients with left temporal lobe epilepsy

The aim of this study was to investigate whether transcranial magnetic stimulation (TMS) can be used for a lateralization of verbal and non-verbal memory functions in candidates for epilepsy surgery by inducing focal, material-specific memory deficits. Twenty patients who underwent presurgical epilepsy evaluation with chronically implanted subdural strip electrodes were submitted to focal TMS over the temporal lobes and the vertex while sequences of items of the Digit Span and the Corsi Block test were presented on a computer screen. TMS was applied synchronously or 200 msec following presentation of each item. The effects of TMS on the memory span and the serial position curve were analysed in comparison to baseline levels. The following results were obtained: the quantitative effects on the verbal (Digit Span) and non-verbal (Corsi Block) memory span were not significant, but there were significant qualitative changes of serial position effects. In the group of six patients with left temporal epilepsy, TMS over the left temporal lobe induced a significant recency effect in the Digit Span test, while TMS over the vertex significantly increased the recency errors. The absolute number of errors remained unchanged. No such effects were observed in the group of nine patients with right temporal lobe epilepsy. These results suggest that in the presence of a left temporal lobe focus TMS can induce qualitative, material specific changes in verbal working memory (phonological loop) which become apparent in the serial position curve. The dissociation of TMS effects for temporal and vertex stimulation imply that TMS can selectively influence specific phonological loop components and that the phonological loop has a functionally and neuroanatomically multimodular structure.     

Preoperative predictors of anterior temporal language areas

OBJECT: Although it is known that 5 to 10% of patients have language areas anterior to the rolandic cortex, many surgeons still perform standard anterior temporal lobectomies for epilepsy of mesial onset and report minimal long-term dysphasia. The authors examined the importance of language mapping before anterior temporal lobectomy. METHODS: The authors mapped naming, reading, and speech arrest in a series of 67 patients via stimulation of long-term implanted subdural grids before resective epilepsy surgery and correlated the presence of language areas in the anterior temporal lobe with preoperative demographic and neuropsychometric data. Naming (p < 0.03) and reading (p < 0.05) errors were more common than speech arrest in patients undergoing surgery in the anterior temporal lobe. In the approximate region of a standard anterior temporal lobectomy, including 2.5 cm of the superior temporal gyrus and 4.5 cm of both the middle and inferior temporal gyrus, the authors identified language areas in 14.5% of patients tested. Between 1.5 and 3.5 cm from the temporal tip, patients who had seizure onset before 6 years of age had more naming (p < 0.02) and reading (p < 0.01) areas than those in whom seizure onset occurred after age 6 years. Patients with a verbal intelligence quotient (IQ) lower than 90 had more naming (p < 0.05) and reading (p < 0.02) areas than those with an IQ higher than 90. Finally, patients who were either left handed or right hemisphere memory dominant had more naming (p < 0.05) and reading (p < 0.02) areas than right-handed patients with bilateral or left hemisphere memory lateralization. Postoperative neuropsychometric testing showed a trend toward a greater decline in naming ability in patients who were least likely to have anterior language areas, that is, those with higher verbal IQ and later seizure onset. CONCLUSIONS: Preoperative identification of markers of left hemisphere damage, such as early seizure onset, poor verbal IQ, left handedness, and right hemisphere memory dominance should alert neurosurgeons to the possibility of encountering essential language areas in the anterior temporal lobe (1.5-3.5 cm from the temporal tip). Naming and reading tasks are required to identify these areas. Whether removal of these areas necessarily induces long-term impairment in verbal abilities is unknown; however, in patients with a low verbal IQ and early seizure onset, these areas appear to be less critical for language processing.     

Material-specific memory in temporal lobe epilepsy: Effects of seizure laterality and language dominance.

This study investigated the effects of seizure laterality and language dominance on material-specific memory in temporal lobe epilepsy (TLE). Left TLE (LTLE) patients with left-hemisphere language dominance (LHLD) showed significantly higher nonverbal than verbal memory capacity, whereas right TLE patients with LHLD showed significantly better verbal than nonverbal memory capacity. LTLE patients with non-left-hemisphere language dominance (NLHLD) showed significantly better verbal memory capacity compared with LTLE patients with LHLD. Thus, selective verbal or nonverbal memory deficits that are dependent on side of seizure onset were apparent in patients with LHLD but not in patients with NLHLD. Relative sparing of verbal memory capacity in LTLE patients with NLHLD may reflect interhemispheric reorganization of verbal memory function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spatial memory deficits in patients with lesions to the right hippocampus and to the right parahippocampal cortex

Spatial memory tasks, performance of which is known to be sensitive to hippocampal lesions in the rat, or to medial temporal lesions in the human, were administered in order to investigate the effects of selective damage to medial temporal lobe structures of the human brain. The patients had undergone thermo-coagulation with a single electrode along the amygdalo-hippocampal axis in an attempt to alleviate their epilepsy. With this surgical technique, lesions to single medial temporal lobe structures can be carried out. The locations of the lesions were assessed by means of digital high-resolution magnetic resonance imaging and software allowing a 3-D reconstruction of the brain. A break in the collateral sulcus, dividing it into the anterior collateral sulcus and the posterior collateral sulcus is reported. This division may correspond to the end of the entorhinal/perirhinal cortex and the start of the parahippocampal cortex. The results confirmed the role of the right hippocampus in visuo-spatial memory tasks (object location, Rey-Osterrieth Figure with and without delay) and the left for verbal memory tasks (Rey Auditory Verbal Learning Task with delay). However, patients with lesions either to the right or to the left hippocampus were unimpaired on several memory tasks, including a spatial one, with a 30 min delay, designed to be analogous to the Morris water maze. Patients with lesions to the right parahippocampal cortex were impaired on this task with a 30 min delay, suggesting that the parahippocampal cortex itself may play an important role in spatial memory.     

Cloning and expression of a novel juvenile hormone-metabolizing epoxide hydrolase during larval-pupal metamorphosis of the cabbage looper, Trichoplusia ni

This study explored the pattern of memory functioning in 58 patients with chronic schizophrenia and compared their performance with 53 normal controls. Multiple domains of memory were assessed, including verbal and non-verbal memory span, verbal and non-verbal paired associate learning, verbal and visual long-term memory, spatial and non-spatial conditional associative learning, recognition memory and memory for temporal order. Consistent with previous studies, substantial deficits in long-term memory were observed, with relative preservation of memory span. Memory for temporal order and recognition memory was intact, although significant deficits were observed on the conditional associative learning tasks. There was no evidence of lateralized memory impairment. In these respects, the pattern of memory impairment in schizophrenia is more similar in nature to that found in patients with memory dysfunction following mesiotemporal lobe lesions, rather than that associated with focal frontal lobe damage.     

Intact perceptual and conceptual priming in temporal lobe epilepsy: Neuroanatomical and methodological implications.

Explicit memory appears to be supported by medical temporal lobe structures, whereas separate neocortical regions may mediate perceptual and conceptual implicit memory. Children and adults with temporal lobe epilepsy (TLE) and matched controls were administered experimental verbal memory tests. Performance on implicit tests--word identification and word generation--was contrasted with explicit recognition and recall. Encoding conditions emphasized either conceptual or perceptual aspects of study words and were crossed with presentation modality. The priming performance of participants with TLE did not differ from controls, but participants with TLE did show deficits on recognition and recall measures. Thus, intact left temporal cortex does not appear to be necessary for normal implicit memory performance, even when conceptual processing is emphasized at study or test. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intrauterine or oral administration of levonorgestrel in combination with estradiol to perimenopausal women--effects on lipid metabolism during 12 months of treatment

Electrical stimulation of the basal temporal region of the dominant hemisphere before partial temporal lobectomy for epilepsy sometimes produces temporary interruption of language function, but the significance of removal of this area is unknown. We evaluated the correlation between resection of the basal temporal language areas (BTLA) and certain types of postoperative language deficits. In a population of 25 patients, we mapped the inferolateral temporal lobe with cortical electrical stimulation, verifying the positions of the stimulating electrodes with three-dimensional computed tomography (CT). Eighty percent of the patients developed transient language deficits with stimulation, particularly with tests of confrontation naming and comprehension. BTLA was primarily located in the fusiform gyrus, from 1 to 9 cm from the temporal tip. At testing 6-12 months after operation, patients with BTLA resection performed worse (mean 9% decrease) than those with no BTLA resection (mean 4% improvement) on tests of confrontation naming (p = 0.03). Resection size accounted for less of the variance in decrease in confrontation naming than did resection of the BTLA. Tests of performance I.Q. (PIQ), verbal I.Q. (VIQ), or recognition memory for word and verbal learning showed no significant difference between these groups. Most patients do not have language decrease with removal of basal temporal lobe 5-6 cm from the tip, even with removal of BTLA. Some patients, however, have persistent decrease in naming.     

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)     

Endothelial dysfunction and nitrogen monoxide (NO; nitric oxide)

Emotion processing deficits may have an important effect on the quality of life of Alzheimer's disease (AD) patients and their families, yet there are few studies in this area and little is known about the cause of such deficits in AD. This study sought to determine if some AD patients have a disruption in a specific right hemisphere emotion processing system, and to determine if the processing of emotional facial expression is more vulnerable to the pathology of AD than is the perception of emotional prosody. It was specifically hypothesized that patients with greater right hemisphere dysfunction (low spatial AD patients) would be impaired on emotion processing tasks relative to those with predominantly left hemisphere dysfunction (low verbal AD patients). Both groups showed impairment on emotion processing tasks but for different reasons. The low verbal patients performed poorly on the affect processing measures because they had difficulty comprehending and/or remembering the task instructions. In contrast, low spatial AD patients have emotion processing deficits that are independent of language and/or memory and may be due to a more general visuoperceptual deficit that affects the perception of static but not dynamic affective stimuli.     

Left hemispheric neuronal heterotopia: a PET, MRI, EEG, and neuropsychological investigation of a university student

A 21-year-old left-handed medical student had a prominent unilateral cerebral cortical malformation due to an ontogenetic migration disorder. We performed neuropsychological studies, EEG, T1- and T2-weighted and proton-density MRI, and positron emission tomography (PET) (under both the resting condition and neuropsychological activation). Neuropsychological testing revealed normal intelligence and generally normal memory functioning but selective deficits in tests of verbal fluency and spatial-figural relationships. Proton-density and T2-weighted MRI revealed extensive left cortical heterotopia that included parts of the Wernicke area. PET under the resting condition revealed a small interhemispheric difference with slightly reduced glucose metabolism in the left temporoparietal cortical zone. An activation PET (with the patient performing a verbal fluency test) resulted in a normal overall increase in metabolism but marked deviations in cortical areas. The highest activity changes were in the Broca and Wernicke areas of the right hemisphere, and there was very little activation in those regions of the left hemisphere that were expected to respond well to the activation--the temporal, parietal, and temporo-occipital cortical zones. We conclude that there can be large compensations for unilateral heterotopia.     

Observations on the relationship between verbal explicit and implicit memory and density of neurons in the hippocampus

The relationship between neuronal density and verbal memory in left and right hippocampal subfields was investigated in patients who underwent surgery for alleviation of temporal lobe epilepsy. The surgery consisted of unilateral partial removal of the hippocampus along with the anterior temporal lobe and amygdala. Study 1 looked at post-surgical explicit vs implicit verbal memory for lists of words while Study 2 looked at pre- and post-surgical explicit memory for word pairs. Left subfield CA1 appeared to be the most consistently involved in explicit and implicit memory. The results of the two studies confirm presence of hemispheric asymmetry in verbal memory. The notion that hippocampal control of memory is most apparent in post-surgical performance is discussed.     

Working and long-term memory deficits in schizophrenia: Is there a common prefrontal mechanism?

This study tested the hypothesis that dorsolateral prefrontal cortex deficits contribute to both working memory and long-term memory disturbances in schizophrenia. It also examined whether such deficits were more severe for verbal than nonverbal stimuli. Functional magnetic resonance imaging was used to assess cortical activation during performance of verbal and nonverbal versions of a working memory task and both encoding and recognition tasks in 38 individuals with schizophrenia and 48 healthy controls. Performance of both working memory and long-term memory tasks revealed disturbed dorolateral prefrontal cortex activation in schizophrenia, although medial temporal deficits were also present. Some evidence was found for more severe cognitive and functional deficits with verbal than nonverbal stimuli, although these results were mixed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impaired generation and use of strategy in schizophrenia: evidence from visuospatial and verbal tasks

BACKGROUND: The aim of this study was to investigate mnemonic strategic deficits in schizophrenic patients. METHODS: Analogous tasks were used that required the self-generation of an efficient strategy and its implementation in two domains: visuospatial and verbal. The tasks were given to 20 IQ preserved schizophrenics and 20 matched normal controls. A number of different scores was derived from each task including strategy, short-term memory capacity and perseveration. RESULTS: Overall, the schizophrenic patients were significantly impaired in their ability to generate effective mnemonic strategies on both tasks. In addition, on the visuospatial task there was no difference between the groups on the memory scores, but the schizophrenic patients made significantly more perseverative errors than controls. They were disproportionately worse on the verbal strategy task, showing impairment on memory as well as on strategy scores and were also impaired at semantically classifying the words. Performance was similar to the deficit seen in patients with frontal lobe excisions and Parkinson's disease, in terms of the inability to generate an effective strategy. The deficit on the verbal task was similar to patients with temporal lobe excisions who show impaired verbal memory. However, the pattern differed in the sense that the temporal lobe patients were able to generate effective strategies, unlike the patients with schizophrenia. CONCLUSIONS: High functioning schizophrenic patients are impaired in utilizing visuospatial and verbal mnemonic strategies. By comparing the results with those of neurosurgical excision patients, further evidence is provided for both frontal and temporal lobe involvement in schizophrenia.     

Investigation of WAIS effectiveness in discriminating between temporal and generalized seizure patients.

W. Millberg et al (see record 1980-04482-001) reported that a pattern of WAIS subtests could be used to accurately differentiate between groups of temporal lobe and generalized seizure patients. The discriminative power of the index (Vocabulary plus Information/2 minus Similarities) was thought to reflect specific deficits of the 2 seizure groups in abstract categorization and verbal memory. The present study is a replication and extension of their research. A control group (21 Ss; mean age 31 yrs) was included, and each S was given tests of abstract reasoning and verbal memory to determine the presence of hypothesized deficits for the seizure groups (61 Ss; mean age 31.2 yrs). Discriminant function analysis with the index resulted in a hit rate considerably below the near 80% reported by Millberg et al. One-way ANOVA on the abstract reasoning and verbal memory scores revealed a significant difference between the 3 groups only for abstract reasoning, with the temporal and generalized patients significantly poorer than the controls but not significantly different from each other. Explanations for the differences between the studies and clinical implications are discussed. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinctive forms of partial retrograde amnesia after asymmetric temporal lobe lesions: possible role of the occipitotemporal gyri in memory

We tested the hypothesis that partial forms of retrograde amnesia were associated with highly asymmetric lesions to the inferior and anterior-medial temporal lobe. Postencephalitic subjects EK and DR were both impaired on standardized retrograde memory tests, but showed strikingly different profiles in cognitive tasks of name stem completion, name:face matching, temporal ordering, forced choice recognition, and occupational judgments of famous names and faces from the past 3 decades. EK sustained left inferior and anterior-medial temporal lobe lesion with a small right temporal polar lesion, and showed near-complete loss of retrieval, knowledge, and familiarity associated with famous names but minimal deficiencies with famous faces. DR sustained right inferior and anterior-medial temporal lobe lesion and showed a milder retrograde loss limited to utilizing famous face prompts in name stem completion, name:face matching, occupational judgments, and forced choice recognition. These impairments were also different from the memory retrieval deficit, but intact recognition shown by a case of ruptured anterior communicating artery aneurysm with presumed basal forebrain damage. We hypothesize that EK's extensive loss of famous name knowledge was related to left inferior temporal lobe damage, particularly in the lateral and medial occipitotemporal gyri. This region in the left temporal lobe may serve as a critical processing area for retrograde memory that permits activation of established semantic, temporal, and visual (i.e., facial) associations biographically dependent on the category of proper names. On the basis of connectional anatomy patterns in the nonhuman primate, this region receives extensive hippocampal output and is interconnected with the temporal polar region and cortical association areas, which have been implicated in retrieval and storage aspects of retrograde memory. In the right hemisphere, the occipitotemporal gyri may serve an important role in famous face processing as part of a bilateral neural network.     

Selective spatial memory impairment after right unilateral temporal lobectomy

Deficits in performance of both spatial and visual tasks are common following tissue loss in the right temporal lobe. Since spatial and visual attributes are frequently confounded in experimental tasks, we have studied patients following unilateral temporal lobectomy, in an attempt to determine which aspect mediates the observed deficits. Spatial and visual memory performance was compared in normal controls (n = 16), left temporal (LTL; n = 19) and right temporal (RTL; n = 19) lobectomy patients, by presentation of eight abstract designs in a spatial array for subsequent recall and recognition of the designs (visual memory) and recall of their spatial position (spatial memory). By varying the retention intervals for each group, all three groups were matched on both recall and recognition of the designs at sub-ceiling levels. In contrast, recall of the position of the designs (spatial memory), tested at equivalent delays to those of the visual memory tests, revealed a deficit in the RTL patients compared to both controls and LTL patients (p < 0.05). Magnetic resonance imaging (MRI) was used to quantify the extent of resection of the hippocampus and parahippocampal regions in the two patient groups and showed a significant correlation between hippocampal and parahippocampal removal and spatial memory in the RTL group only. These data support the notion of a disproportionately large involvement of the right hippocampus and adjacent regions in spatial memory.     

A test of spatial memory and its clinical utility in the pre-surgical investigation of temporal lobe epilepsy patients

Deficits in memory for figurative detail, spatial composition and the spatial location of objects in a scene have been reported postoperatively in right temporal lobectomy patients. The aim of this study was to examine whether these deficits can be used as a sign of lateralised dysfunction in pre-surgical temporal lobe epilepsy (TLE) patients. Sixty-nine patients with lateralised TLE (27 right, 42 left) were assessed on a battery of neuropsychological tests, including tests of general intellectual functioning and psychomotor speed and standardised memory tests involving the learning and recall of verbal and non-verbal material. A new task, the "Aspects of Spatial Memory Test" (AoSMT), based on the experimental tasks developed by Pigott and Milner [39] was also administered. The RTLE and LTLE groups did not differ in their overall level of intellectual function or on measures of cognitive and motor speed. On the AoSMT the LTLE group recognised significantly more figurative detail changes than the RTLE group. In addition, the RTLE group took significantly longer than the LTLE group to identify changes in orientation, figurative detail and filled/unfilled spaces. Poor scores on the AoSMT were significantly correlated with quantitative MRI measures of right hippocampal pathology. The clinical and theoretical implications of these findings are discussed.     

Cortical and hippocampal volume deficits in temporal lobe epilepsy

PURPOSE: To use quantitative magnetic resonance imaging (MRI) methods to examine the extent of volume abnormalities in the hippocampus and in extrahippocampal brain regions in localization-related epilepsy of temporal lobe origin (TLE). METHODS: Hippocampal, temporal lobe, and extratemporal lobe volumes were examined with 3-mm spin-echo coronal MRI scans in patients with unilateral TLE who were candidates for temporal lobe resection. Measures were adjusted for normal variation due to intracranial volume and age based on 72 healthy male controls. Group differences between 14 male TLE [7 left TLE (LTLE), 7 right TLE (RTLE)] patients and a subset of 49 age range-matched controls were examined with analysis of variance (ANOVA). RESULTS: As compared with controls, patients with TLE had smaller temporal lobe and frontoparietal region gray matter volumes, bilaterally, smaller temporal lobe white matter volumes bilaterally, and larger ventricular volumes. In contrast to these bilateral tissue volume deficits, hippocampal volume deficits in TLE were ipsilateral to the epileptogenic temporal lobe. CONCLUSIONS: Extrahippocampal volume abnormalities were bilateral and occurred in both temporal and extra-temporal cortical regions in TLE, whereas hippocampal deficits were related to the side of the epileptogenic focus. These data suggest that brain abnormalities in TLE are not limited to the epileptogenic region.     

Does naming contribute to memory self-report in temporal lobe epilepsy?

The present study evaluated the hypothesis (Mayeux et al., 1980) that visual confrontation naming deficits may underlie the memory complaint in patients with temporal lobe epilepsy (TLE). Thirty-nine patients with medically refractory left (n = 23) and right (n = 16) TLE were compared with an epilepsy control group with idiopathic primary generalized epilepsy (n = 38). All subjects completed selected subtests of the Multilingual Aphasia Examination and Wechsler Memory Scale (Form 1) together with a measure specifically designed for quantification of the memory complaint in TLE. Objective verbal memory test performance, confrontation naming, repetition, and comprehension were unrelated to memory self-report. Controlled Oral Word Association was the only measure to exert an influence on memory self-ratings, and this relationship was specific to the TLE group. The hypothesis of Mayeux et al. (1980) was not specifically supported, but the present findings do suggest that cognitive processes reflected in orthographically based and internally generated word retrieval play a role in memory self-report.