Biomedical subjects

Marla J Hamberger

Publications and source records attributed to Marla J Hamberger.

3 recordsLinked to original sources

PubMed2006

Cognitive functioning following epilepsy surgery.

Temporal lobe resection is the most common surgery for intractable epilepsy because of its proven efficacy in seizure control. However, patients who may benefit from the procedure might be deterred from surgical evaluation due to concerns of postoperative cognitive decline. Recent reports on long-term follow-up indicate that, similar to findings within the year after surgery, cognition remains relatively stable in the years following right temporal resection. The verbal memory decline often observed 1 year after left temporal resection persists over time, yet is mitigated to some extent by good seizure outcome. Although memory decline observed on testing is not typically accompanied by functional decline, a small proportion of patients do experience reductions in occupational or academic status. Recent advances in functional imaging and refinements in preoperative mapping promise better prediction and protection of cognitive functioning. Additionally, results from studies comparing cognitive outcome among different surgical techniques suggest that more restricted resections benefit some patients, whereas more extended resections might be appropriate in a select group of well-defined patients. Preliminary reports on alternate treatments such as vagal nerve stimulation suggest no direct influence on cognition, although improvement in quality of life has been reported. The decision to pursue surgical treatment must balance the potential benefit of seizure control with the potential impact and probability of cognitive decline.

Anterior Temporal Lobectomy↗

PubMed2005

Brain stimulation reveals critical auditory naming cortex.

One challenge in dominant temporal lobe epilepsy surgery is to remove sufficient epileptogenic tissue without compromising post-operative language functioning. Pre-resection electrical stimulation mapping enables identification of language areas that can be spared from resection, and also provides a unique opportunity to investigate brain-language relationships. Visual object naming is the gold standard for identifying 'essential' language cortex; however, sparing visual naming (VN) sites has not reliably prevented post-operative language decline. In addition to visual object naming, we included a more 'ecologically valid' auditory description naming task in our pre-resection cortical mapping protocol. Of the seven patients who had auditory naming (AN) sites removed, six declined post-operatively, whereas of the 12 patients who did not have AN sites removed, only 3 declined post-operatively (P = 0.02), suggesting an association between AN site removal and post-operative naming decline. Interestingly, although VN sites were preserved in all patients, AN site removal resulted in decline in both auditory and VN tasks. These findings not only have potentially critical clinical significance, but also argue for modality specificity, with considerable integration within the semantic system.

Adolescent↗

PubMed2003

Auditory and visual naming tests: normative and patient data for accuracy, response time, and tip-of-the-tongue.

Naming is typically assessed with visual naming tasks, yet, some patients with genuine word-finding difficulty (evident in auditorily based discourse) show minimal difficulty on such measures. Evidence from cortical mapping, brain imaging and neuropsychological studies suggests that auditory naming measures might provide more relevant or at least, complementary information. We developed comparable auditory and visual naming tests and present normative data for accuracy, response time, and tip-of-the-tongue responses based on 100 controls. Test validity was supported by findings that left temporal lobe epilepsy (TLE) patients (i.e., a population with expected naming difficulty) performed more poorly on auditory but not visual naming compared to right TLE patients (i.e., a population without expected naming difficulty). Internal and test-retest reliability coefficients were reasonable. Finally, test utility was assessed on an individual basis, and auditory but not visual naming performance predicted impairment.

Adult↗