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Results for “Temporal Lobe”

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PubMed1995

Hippocampal volumetrics differentiate patients with temporal lobe epilepsy and extratemporal lobe epilepsy.

OBJECTIVE: To determine whether the occurrence of hippocampal formation (HF) volumetric asymmetry can reliably discriminate between complex partial seizures (CPSs) of a temporal lobe origin and CPSs of an extra-temporal lobe origin in a prospective study of patients with intractable CPSs (approximately 70% of patients have electrographic foci in the temporal lobe [HF volumetric asymmetry on magnetic resonance imaging scans has been shown to lateralize such foci reliably)]. DESIGN: We examined HF volumetrics on magnetic resonance imaging scans that were acquired with a 1-T magnetic resonance imaging scanner (Siemens Magnetom, Siemens Medical Systems, Iselin, NJ) by using magnetization-prepared rapid gradient echo three-dimensional sequences (producing a gapless series of high-contrast 1.25-mm images). These data were compared with ictal, interictal, invasive, and noninvasive videoelectroencephalographic monitoring data, functional imaging data, and outcome data to define each patient's type of epilepsy. SETTING AND PATIENTS: Forty-one patients were recruited from a tertiary university comprehensive epilepsy program, and 22 control subjects were recruited from the neurologically normal university community. RESULTS: Among the control subjects, the difference in HF volumetrics (right-left HF volumetrics) was + 0.085 +/- 0.253 cm3. Of the 41 patients, 25 had temporal lobe epilepsy. When we set the upper limit of normal at the mean +/- 3 SDs, all patients beyond the upper limit had CPSs of a temporal lobe origin. Of the patients with temporal lobe epilepsy, only three fell within normal limits. No patient with CPSs of an extratemporal lobe origin fell beyond the upper limit. CONCLUSION: The presence of significant HF volumetric asymmetry makes it highly unlikely that a patient's CPSs are of an extratemporal lobe origin.

Adolescent↗

PubMed1996

Phosphorus magnetic resonance spectroscopy in schizophrenia: correlation between membrane phospholipid metabolism in the temporal lobe and positive symptoms.

1. To determine any correlations between phosphorus metabolites in the temporal lobes and clinical symptoms in schizophrenic patients, the authors performed 31phosphorus magnetic resonance spectroscopy in 31 medicated patients and age- and sex- matched normal subjects. 2. Schizophrenic patients demonstrated an increased level of phosphodiesters (PDE) in the temporal lobes bilaterally and a decreased level of beta-adenosine triphosphate (beta-ATP) in the left temporal lobe. 3. A significant positive correlation was observed between the level of PDE in the left temporal lobe and the score of positive symptoms on the Brief Psychiatric Rating Scale. 4. These results suggest that altered membrane phospholipid metabolism in the left temporal lobe is associated with neuroleptic-resistant positive symptoms in schizophrenic patients.

Adenosine Triphosphate↗

PubMed2005

Investigating temporal lobe contribution to confrontation naming using MRI quantitative volumetrics.

Confrontation naming ability entails the operation of distinct cognitive operations and the integrity of a distributed neural network. Previous research has indicated a critical role for the left temporal lobe region in naming ability, but there is less agreement about the relative role of distinct temporal lobe regions. In the current paper, we used quantitative MR volumetrics to investigate the relative contribution of the hippocampus and extrahippocampal temporal lobe (segmented gray and white matter) volumes to confrontation naming performance in 53 patients with temporal lobe epilepsy. Findings showed (1) a stronger relationship for left temporal lobe volume than right temporal lobe volume in predicting naming performance; (2) both left temporal lobe white matter volume and left hippocampus volume contributed a significant amount of unique variance to spontaneous naming performance; and (3) left temporal lobe white matter volume but not left hippocampus volume predicted recognition naming performance.

Adolescent↗

PubMed1995

Comparison of mesial versus neocortical onset temporal lobe seizures: neurodiagnostic findings and surgical outcome.

We compared historical features, surface EEG findings, results of intracarotid sodium amobarbital memory testing (IAT), and outcome after anterotemporal lobectomy (ATL) in patients with mesiotemporal lobe seizure onset with those with more diffuse temporal lobe seizure onset (intracranial EEG). Forty-eight patients evaluated consecutively between July 1985 and October 1991 with both scalp/sphenoidal and intracranial EEG were shown to have seizures originating in one temporal lobe. No patients had temporal lobe tumor or vascular malformation. Thirty-seven of the 48 patients had seizure onset in the amygdala/hippocampus (amyg/hipp). Eleven of the 48 had either temporal neocortical onset or simultaneous amyg/hipp and neocortical onset. Patients with mesial onset seizures were more likely to have lateralized memory impairment on IAT (p = 0.05). We noted a trend toward a difference in age of first risk for epilepsy between the two groups (p = 0.09) but not for a difference in any specific risk factor. There were no significant differences in surface EEG interictal findings. Unlike in previous studies, comparison of outcome between the two groups showed no difference in seizure-free outcome. Sudden unexpected death (SUD) was more frequent in neocortical seizure patients who were not seizure-free (p < 0.05).

Adolescent↗

PubMed1991

Recognition memory for text and melody of songs after unilateral temporal lobe lesion: evidence for dual encoding.

The role of left and right temporal lobes in memory for songs (words sung to a tune) was investigated. Patients who had undergone focal cerebral excision for the relief of intractable epilepsy along with normal control subjects were tested in 2 recognition memory tasks. The goal of Experiment 1 was to examine recognition of words and of tunes when they were presented together in an unfamiliar song. In Experiment 2, memory for spoken words and tunes sung without words was independently tested in 2 separate recognition tasks. The results clearly showed (a) a deficit after left temporal lobectomy in recognition of text whether sung to a tune or spoken without musical accompaniment, (b) impaired melody recognition when the tune was sung with new words following left or right temporal lobectomy and (c) impaired melody recognition in the absence of lyrics following right but not left temporal lobectomy. The different role of each temporal lobe in memorizing songs provides evidence for the use of dual memory codes. The verbal code is consistently related to left temporal lobe structures, whereas the melodie code my depend on either or both temporal lobe mechanisms, according to the type of encoding involved.

Attention↗

PubMed1989

Alterations of hippocampal acetylcholinesterase in human temporal lobe epilepsy.

Hippocampal sclerosis is the most common pathological finding associated with human temporal lobe epilepsy. Histochemical study with acetylcholinesterase (AChE) staining was used to investigate 7 surgically resected temporal lobes with hippocampal sclerosis from patients with temporal lobe epilepsy. In all 7 specimens, an abnormal but consistent pattern of staining was noted. In the hilum of the dentate gyrus, AChE-rich polymorphic cells were relatively preserved in comparison to the pyramidal neurons. In Ammon's horn, AChE fibers were lost in regions corresponding to the pyramidal cell dropout. AChE fibers were also lost along the inner portion of the molecular layer of the dentate gyrus, yet they were preserved within the outer portions of the molecular layer. These findings provide additional evidence for the relative selectivity of hippocampal pathology in human temporal lobe epilepsy.

Acetylcholinesterase↗

PubMed1976

Psychiatric aspects of temporal lobe epilepsy.

This study is an attempt to investigate cases of temporal lobe epilepsy, the starting point being a large number of psychiatric patients. The data presented in this study suggest that a certain number of schizophrenic-like psychoses are produced by temporal seizural activity. There is some evidence that if there is a centrencephalic seizure at the beginning of such a psychotic state, the patient's behavior will have confusional characteristics (perhaps a postictal centrencephalic state). Some findings suggest that the side localization of the temporal lobe focus affects the feature of the psychotic state. None of the nine patients with periodic psychoses had schizoid or paranoid premorbid personality. As to the interictal behavioral disorders of epileptics, we have noticed that two patients with hysteroepilepsy and two with compensation neurosis had dominant temporal lobe focus. Of 10 cases with behavior disorders, all had grand mal or petit mal epilepsy, and none had a temporal lobe focus. Although this study is not based on sufficient data, it may provide working hypotheses for further research.

Bipolar Disorder↗

PubMed2000

Localizing and lateralizing value of epileptic symptoms in temporal lobe epilepsy.

The symptoms and signs associated with all stages of a temporal lobe seizure may be helpful in determining both the localization and lateralization of seizure onset. Auras, when present, may be very suggestive of temporal lobe onset and may further localize to a mesiobasal or lateral temporal lobe site of onset. During the ictus, automatisms and motor phenomena may be highly indicative of temporal lobe seizure activity and may even help lateralize the discharge. In the post-ictal period, motor paresis and aphasia are helpful in lateralization. Video E.E.G. data has provided extensive information on the utility of ictal symptomatology in seizure localization. Thus, the seizure semiology provides important adjunctive information in evaluating patients for epilepsy surgery and should be concordant with information obtained from ictal EEG, neuroimaging and neuropsychology.

Automatism↗

PubMed1988

Pitch perception of complex tones and human temporal-lobe function.

Sixty-four patients with unilateral temporal-lobe excisions as well as 18 normal control subjects were tested in a missing fundamental pitch perception task. Subjects were required to indicate if the pitch of a pair of tones rose or fell. The excisions encroached upon Heschl's gyri in some cases, whereas, in others, this region was spared. All subjects included for study were able to perform well on a control task in which complex tones including a fundamental were presented. Stimuli for the experimental task, which was procedurally identical with the control task, consisted of several harmonic components spanning the same spectral range, but without a fundamental. Only subjects with right temporal lobectomy in whom Heschl's gyri were excised committed significantly more errors than the normal control group on this task. Patients with left temporal-lobe lesions or with anterior right temporal-lobe excisions were unimpaired. These results suggest that Heschl's gyri and surrounding cortex in the right cerebral hemisphere play a crucial role in extracting the pitch corresponding to the fundamental from a complex tone.

Auditory Perception↗

PubMedDate not supplied

[Neuropsychological findings in patients with middle temporal lobe epilepsy].

INTRODUCTION: Cognitive dysfunction in mesial temporal lobe epilepsy (MTLE) is still a controversial subject. Since refractory MTLE is considered a surgically remediable syndrome, the neuropsychological assessment to establish the presence of cognitive impairment in the surgical candidate became an important issue, given its possible relevance in predicting outcome after surgery. OBJECTIVE: Our aim was to study the cognitive profile of MTLE patients and to correlate the cognitive status with the presence or absence of hippocampal sclerosis. PATIENTS AND METHODS: Fifty patients with MTLE and 20 control subjects were matched by age and educational level. All subjects were studied with EEG, MRI scan, SPECT, and a comprehensive neuropsychological battery that included measures of language (naming and verbal fluency), visuospatial function (Block Design Test), memory (Signoret Battery), attention (Digit Span and Trail Making Test A) and executive abilities (Trail Making Test B and Wisconsin Card Sorting Test). RESULTS: MTLE patients, particularly those with hippocampal sclerosis, were found to have a considerable lower performance in learning (p < 0.01), naming (p < 0.05), attention (p < 0.05) and executive functions (p < 0.001). Among the MTLE patients a considerable number of subjects showed results within the normal range (n = 27) while others evidenced laterality specific cognitive impairments (n = 13). Material specific memory effects were seen in some patients but not all. CONCLUSIONS: Our results showed the neuropsychological heterogeneity of temporal lobe epilepsy, thus ruling out the existence of a single specific cognitive pattern of impairment in all MTLE patients, and suggesting the need of a thorough pre-surgical neuropsychological evaluation to be used with post-surgical prognosis purposes.

Adult↗

PubMed1997

Effect of partial volume correction on muscarinic cholinergic receptor imaging with single-photon emission tomography in patients with temporal lobe epilepsy.

Animal experiments and preliminary results in humans have indicated alterations of hippocampal muscarinic acetylcholine receptors (mAChR) in temporal lobe epilepsy. Patients with temporal lobe epilepsy often present with a reduction in hippocampal volume. The aim of this study was to investigate the influence of hippocampal atrophy on the quantification of mAChR with single photon emission tomography (SPET) in patients with temporal lobe epilepsy. Cerebral uptake of the muscarinic cholinergic antagonist [123I]4-iododexetimide (IDex) was investigated by SPET in patients suffering from temporal lobe epilepsy of unilateral (n=6) or predominantly unilateral (n=1) onset. Regions of interest were drawn on co-registered magnetic resonance images. Hippocampal volume was determined in these regions and was used to correct the SPET results for partial volume effects. A ratio of hippocampal IDex binding on the affected side to that on the unaffected side was used to detect changes in muscarinic cholinergic receptor density. Before partial volume correction a decrease in hippocampal IDex binding on the focus side was found in each patient. After partial volume no convincing differences remained. Our results indicate that the reduction in hippocampal IDex binding in patients with epilepsy is due to a decrease in hippocampal volume rather than to a decrease in receptor concentration.

Adult↗

PubMedDate not supplied

Analysis of electrical discharges made with the foramen ovale electrode recording technique in mesial temporal lobe epilepsy patients.

Foramen ovale electrode (FOE) implantation is usually indicated in patients with mesial temporal lobe (MTL) epilepsy. The authors conducted this study to characterize the electrical discharge patterns obtained using FOE recording and evaluated their clinical significance. Interictal and ictal discharge patterns and their temporal relationships to EEGs were examined in 16 patients who had FOEs implanted bilaterally and had good recovery from surgery. After long-term telemetry recording with FOEs, all patients displayed clear seizure onsets originating in one or both sides of the MTL and underwent an anterior temporal lobectomy. Interictal epileptiform discharges (IEDs) were lateralized to the operated side in 12 patients based on scalp EEGs and in 8 patients based on FOE recordings. Among the various possible IED patterns observed with the FOE recordings, a periodic pattern was dominant in the operated side (P = 0.001), whereas a polyspike pattern was dominant in the nonoperated side (P = 0.002). The number of patients with ictal onsets in the operated side was five based on the scalp EEG and 10 based on FOE recordings. Paroxysmal fast frequency activity, rhythmic spikes (>2 Hz), or sharp waves were dominant over other FOE seizure onset patterns in the operated side. By contrast, delta and theta slowing and positive spikes were prevalent in the nonoperated side. The start-stop-start pattern, previously described using subdural electrodes, was also found in FOE recordings and was concordant with the operated side in all cases. The interhemispheric propagation time recorded with bilateral FOEs was 22.6 +/- 20.0 seconds for ictal discharges initiated in the operated side and 7.0 +/- 8.4 seconds for those in the nonoperated side. Among various IED spreading patterns, the most prevalent progression was FOE --> contralateral FOE --> ipsilateral temporal lobe, or --> contralateral temporal lobe. In this series, FOE implantation caused no serious complications. FOE recording appears to be useful for confirming lateralization in patients with MTL epilepsy previously determined using clinical and neuroimaging methods. A thorough analysis of FOE recordings can provide information that may facilitate the differentiation of primary from secondary (nonepileptogenic) temporal lobes.

Adolescent↗

PubMed1998

Regional distribution of interictal 31P metabolic changes in patients with temporal lobe epilepsy.

PURPOSE: We compared the 31P metabolites in different brain regions of patients with temporal lobe epilepsy (TLE) with those from controls. METHODS: Ten control subjects and 11 patients with TLE were investigated with magnetic resonance imaging (MRI) and [31P]MR spectroscopic imaging (MRSI). [31P]MR spectra were selected from a variety of brain regions inside and outside the temporal lobe. RESULTS: There were no asymmetries of inorganic phosphate (Pi), pH, or phosphomonoesters (PME) between regions in the left and right hemispheres of controls. In patients with TLE, Pi and pH were higher and PME was lower throughout the entire ipsilateral temporal lobe as compared with the contralateral side and there were no significant asymmetries outside the temporal lobe. The degree of ipsilateral/contralateral asymmetry for all three metabolites was substantially greater for the temporal lobe than for the frontal, occipital, and parietal lobes, and these asymmetries provided additional data for seizure localization. As compared with levels in controls, Pi and pH were increased and PME were decreased on the ipsilateral side in patients with TLE. There were changes in Pi, pH, and PME on the contralateral side in persons with epilepsy as compared with controls, contrary to changes on the ipsilateral side. CONCLUSIONS: Our findings provide some insight into the metabolic changes that occur in TLE and may prove useful adjuncts for seizure focus lateralization or localization.

Adult↗

PubMed1997

Volume loss of the hippocampus and temporal lobe in healthy elderly persons destined to develop dementia.

OBJECTIVE: To determine initial locus and rate of degeneration of temporal lobe structures (total lobe, hippocampus and parahippocampus) in preclinical dementia. BACKGROUND: Postmortem studies suggest that the earliest changes in Alzheimer's disease are neurofibrillary tangle formation in hippocampus and adjacent cortex. MRI volume analysis of temporal lobe structures over time in subjects prior to developing dementia may allow the identification of when these processes begin, the rate they develop, and which areas are key to symptom development. METHODS: 30 nondemented (NoD), healthy, elderly individuals enrolled in a prospective study of healthy aging evaluated annually over a mean of 42 months. Twelve subjects with subsequent cognitive decline were assigned to the preclinical dementia group (PreD). All 120 annual MRI studies analyzed by volumetric techniques assessed group differences in temporal lobe volumes and rates of brain loss. RESULTS: NoD as well as PreD subjects had significant, time-dependent decreases in hippocampal and parahippocampal volume. Rates of volume loss between the groups did not significantly differ. PreD cases had significantly smaller hippocampi when asymptomatic. Parahippocampal volume did not differ between PreD and NoD cases. Significant time-dependent temporal lobe atrophy was present only in PreD. CONCLUSIONS: Hippocampal and parahippocampal atrophy occurs at a similar rate regardless of diagnostic group. Those who develop dementia may have smaller hippocampi to begin with, but become symptomatic because of accelerated loss of temporal lobe volume. Temporal lobe volume loss may mark the beginning of the disease process within six years prior to dementia onset.

Aged↗

PubMedDate not supplied

Panic attack symptoms in a patient with left temporal lobe epilepsy.

We describe a 56-year-old woman with left temporal lobe epilepsy who developed symptoms of a panic attack. Owing to normal electroencephalography and brain magnetic resonance imaging results, she was initially diagnosed as suffering from panic attacks and treated for anxiety neurosis. The symptoms persisted and she was re-examined in our department. An interictal electroencephalogram showed paroxysmal spike waves in the left mesial temporal lobe region and this was the basis for a diagnosis of left temporal lobe epilepsy. This report suggests that left temporal lobe epilepsy should be considered as the differential diagnosis when patients frequently complain of fear or anxiety.

Electroencephalography↗

PubMed2004

Levels of processing with free and cued recall and unilateral temporal lobe epilepsy.

This study investigates the role of the temporal lobes in levels-of-processing tasks (phonetic and semantic encoding) according to the nature of recall tasks (free and cued recall). These tasks were administered to 48 patients with unilateral temporal epilepsy (right "RTLE"=24; left "LTLE"=24) and a normal group (n=24). The results indicated that LTLE patients were impaired for semantic processing (free and cued recall) and for phonetic processing (free and cued recall), while for RTLE patients deficits appeared in free recall with semantic processing. It is suggested that the left temporal lobe is involved in all aspects of verbal memory, and that the right temporal lobe is specialized in semantic processing. Moreover, our data seem to indicate that RTLE patients present a retrieval processing impairment (semantic condition), whereas the LTLE group is characterized by encoding difficulties in the phonetic and semantic condition.

Adult↗

PubMed2003

Surgery of intractable temporal lobe epilepsy presented with structural lesions.

BACKGROUND: Structural lesions are found in about 30% of surgical specimens resected for intractable temporal lobe epilepsy (TLE). Detailed presurgical evaluations can identify the epileptogenic foci, the structural lesions and their correlation. Different surgical approaches have variable seizure control outcomes. METHODS: The preoperative investigations for the intractable TLE consisted of serial electroencephalogram (EEG) recordings, long-term EEG/video monitoring with sphenoidal electrodes, magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), positron emission tomography with fluorodeoxyglucose (FDG-PET) and neuropsychological assessment. Among the 217 patients who underwent anterior temporal lobectomy (ATL) for TLE at Taipei Veterans General Hospital between 1987 and 1998, 47 (21.7%) had structural lesions in the resected specimen. The patients were divided into neoplastic (n = 35) and vascular (n = 12) groups, based on the pathological findings. RESULTS: In the neoplastic group, the interictal scalp-sphenoidal EEG recordings were abnormal in all 35 cases and lateralizing in 30 (85.7%). MRI revealed tumor growth within the temporal lobe in 26 patients (74.3%). FDG-PET was performed on 17 patients. Fifteen (88.2%) of them revealed unilateral mesial temporal lobe hypometabolism. In the vascular group, the interictal EEG tracings revealed unilateral mesial temporal lobe spikes in 11 patients (91.6%). MRI revealed abnormal enhanced lesions within the temporal lobes in all 12 patients. FDG-PET was available for 7 patients, 6 (86%) of whom had unilateral mesial temporal lobe hypometabolism. At the last follow-up (range 2-10 years, with a mean period of 4.2 years), 25 patients (73%) in the neoplastic group became and remained seizure-free postoperatively, 3 (9%) had fewer than 3 attacks per year. Among the vascular group, all 12 patients became and remained seizure-free after surgery. CONCLUSIONS: For intractable TLE with structural lesions, detailed presurgical evaluations are mandatory to identify the concordance of the lesions and the epileptogenic foci. Standard ATL with removal of the lesion may offer good seizure control postoperatively.

Brain Neoplasms↗

PubMed1997

Contribution of medial versus lateral temporal-lobe structures to human odour identification.

To investigate possible distinct contributions of different temporal-lobe structures to odour identification, the University of Pennsylvania Smell Identification Test was administered monorhinally to seizure-free patients who had undergone one of three types of temporal-lobe resection practised in three different institutions for surgical treatment of epilepsy. The resections were neocorticectomy (Dublin), selective amygdalohippocampectomy (Zurich), or anterior temporal-lobe resection with encroachment on amygdala and hippocampus (Montreal). Resections, analysed from MRI scans, showed unexpected encroachment on medial structures in most patients of the neocorticectomy groups, and largest amygdala and hippocampal resections in the amygdalohippocampectomy groups. Impaired odour identification was observed in all patient groups, irrespective of surgical approach, with greatest impairment in the nostril ipsilateral to the resection. The finding of deficits in all three surgical groups suggests that damage in the anterior temporal area, perhaps in piriform cortex, is sufficient to disrupt performance on this task; it may be that function is disrupted in the medial temporal-lobe region by disconnection when the periamygdaloid area is damaged, even when amygdala and hippocampus are left intact. An alternative explanation for our results is that damage in any one of these areas disrupts a complex network involving several distinct temporal-lobe structures.

Adolescent↗