Atypical Language Network Reorganization Following Anterior Temporal Resection in an Adult Epilepsy Patient
Yuvraj Bhagat1, Rachel Feldstein2, Maysaa Basha1
1Wayne State University, Detroit Medical Center, 2Wayne State University - School of Medicine
Objective:
To characterize an atypical case of bilateral neural network reorganization following temporal lobectomy in an adult patient with mesial temporal sclerosis (MTS).
Background:
Anterior temporal resection (ATR) is a well-established, highly effective intervention for temporal drug-resistant epilepsy (DRE). However, the procedure is associated with unintended cognitive impairments, affecting language and memory, and a subset of patients experience seizure recurrence. The precise mechanisms underlying these outcomes remain incompletely understood. Emerging evidence suggests that reorganization of neural language networks following temporal lobe resection is multifactorial with some evidence that unique patterns of reorganization correlate with neuropsychiatric metrics.
Design/Methods:
A retrospective review was conducted of two longitudinal functional MRI (fMRI) studies related to a DRE case status post ATR. Related assessments including neuropsychiatric testing, epilepsy history and course, and neuroimaging were reviewed.
Results:
Patient was a 34-year-old left-handed man with drug-resistant epilepsy. Pre-surgical evaluation was diagnostic of left temporal lobe epilepsy with fMRI reflecting left-sided language dominance. The patient underwent ATR with pathology revealing MTS and achieved seizure freedom for six years. Follow-up fMRI conducted following recurrence showed increased activation within the right lateral and inferior frontal regions. New activation in the posterosuperior right temporal lobe was also seen. Serial neuropsychological testing revealed stable low to low-average scores in reading, naming and verbal fluency, with some improvement of verbal fluency postoperatively
Conclusions:
This case highlights the complexity of neural network reorganization following ATR. The patient's seizure recurrence six years post-surgery was accompanied by a significant shift from left-sided dominant to bilateral activation of key language areas. New activation of contralateral temporal regions is atypical and not regularly seen in the adult population. These findings suggest that postoperative neural plasticity, particularly in language networks, is poorly understood and its role relating to language function and development is complex. Questions regarding reorganization and contribution to seizure recurrence remain.
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