PubMed · 1699262
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A Clements. 1990. Never give up.. https://pubmed.ncbi.nlm.nih.gov/1699262/
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BACKGROUND: Although language disorders occur in about 50% of patients with a left hemispheric tumour and are a significant cause of morbidity, the effects of resective neurosurgery and their relation to tumour pathology are unclear. We report the immediate effects of resective surgery on language functions in a heterogeneous group of patients with left-sided intracranial tumours. METHODS: 40 patients were studied. The Western Aphasia Battery (WAB) and Boston Naming Test (BNT) were administered preoperatively and before discharge following resective neurosurgery. Dexamethasone dose at time of testing was recorded, as was time taken to complete the tests, and tumour neuropathology. FINDINGS: 15 patients with normal aphasia quotients and language quotients before resective surgery all had normal quotients postoperatively. 25 who were dysphasic (ie, aphasia quotient <93.8) preoperatively showed significant postoperative improvements in both their mean aphasia quotient (from 81.8 to 89.1, p=0.004) and their mean language quotient (from 73.4 to 85.4, p=0.001), though 13 remained dysphasic. Two of the 25 dysphasic patients had their WAB scores lowered by tumour resection. The findings and postoperative changes in BNT scores were almost identical to the pattern of those in WAB scores. At second assessment, dexamethasone therapy was significantly (p<0.01) lower than preoperative dose (reduction from mean 10.3 mg/day to 0.7 mg/day in the dysphasic group). Patients with glioblastoma were more likely to have lower aphasia quotients, language quotients, and BNT scores than patients with anaplastic glioma, metastasis, or meningioma. Although the glioblastoma group had the greatest improvements in WAB operative scores, 57% remained dysphasic after resective surgery. Two additional patients declined postoperative assessment. INTERPRETATION: Resective surgery for left-sided intracranial tumours significantly improves language function in dysphasic patients, and is unlikely to impair language functions in non-dysphasic patients. Dysphasia and its response to resective surgery are related to the tumour neuropathology.
Restriction endonuclease fingerprinting (REF) has been utilized to screen 19 of the 28 exons in the L1CAM gene using only 5 PCR reactions. The clustered exons were amplified and the PCR products were subjected to endonuclease digestion and subsequent gel electrophoresis to produce a highly informative fingerprint for each PCR product. An alteration in the fingerprint, when compared to a control, determined the specific DNA fragment containing the mutation. Sequencing of the corresponding exon and flanking region was done to determine the precise location of the mutation. Using this method we have identified 6 novel mutations in the L1CAM gene in 5 patients with X-linked hydrocephalus and 2 patients with MASA. One of the mutations was common to both a patient with HSAS and a patient with MASA. The utilization of REF will allow for easier and quicker detection of mutations in the L1CAM gene. This method should be applicable for screening other genes with multiple, clustered exons.
Models of language processing are becoming extremely complex. As a result, it has become very difficult to develop a thorough understanding of even a single patient's deficits, let alone to represent those deficits in a way which renders their significance apparent to others. In this paper, we describe and demonstrate the use of a notational system which has been developed specifically for representing the complexities of neurolinguistic deficits. The notational system is simple to learn and to use and may easily be extended and adapted to different models of language processing. It may also be used to represent the results from other nonlinguistic neuropsychological batteries which are composed of tightly interdependent subtests with many related factors included in each subtest. Despite its simplicity, the notational system has proven itself in the field as a useful tool for rendering complex deficits more easily interpretable.