Abstracts

Our clinical experience indicates that dysnomia and other language deficits are common in the immediate post-surgical period. These changes can be quite distressing to patients and families. No actuarial data are available to guide physicians in how to advise patients about potential language deficits and rates of recovery. This retrospective study sought to quantify the rates of acute change and recovery in select language functions following epilepsy surgery., Twenty-six patients with focal epilepsy (based on v/EEG monitoring and imaging) and language dominance ascertained via Wada testing were included. 11 patients underwent resection in the language dominant hemisphere (LD), 10 had resections on the nondominant side (ND), and 5 had bilateral (BL) language representation and unilateral resection. The entire sample had a mean age of 34 years and an average of 14 years of education. Their general level of cognitive ability was in the average range ([underline]M[/underline] VCI [amp] POI = 101). The language screening included the Token Test (TT) and Sentence Repetition Test (SRT) from the MAE, and Auditory (ANT) and Visual Naming Tests (VNT) (Hamberger, et al., 2003). Patients were administered an alternate form of the tasks 2-4 days post-operatively ([underline]M[/underline] = 3.1 [1.2]). If performance declined on any of the measures, the patient was tested again several weeks later ([underline]M[/underline] 60 [32] days). Change on the ANT and VNT was determined using RCIs. For the SRT and TT, RCIs are not available, therefore, one standard deviation from the baseline group mean was used as a conservative criterion for change., Fifteen (8 LD, 4 ND, [amp] 3 BL) patients declined on at least one of the language measures in the first days after surgery; 6 declined on more than one measure (4 LD [amp] 2 BL). A second post-op assessment was available for 13/15 patients ([underline]M[/underline] 60 [31] days); 9 (5 LD, 3 ND, [amp] 1 BL) had returned to baseline by that time. Among the 4 who had not, one (BL) had a history of severe TBI, one (ND) was developmentally delayed, and two (LD) were among those who had declined on more than one language measure., Acute post-operative declines in word-finding, sentence repetition, and/or aural language comprehension were common following unilateral surgical resection, regardless of the pre-operative language lateralization relative to the side of surgery. However, the available follow-up data suggested that most patients rapidly recover to baseline language ability. The four that continued to have language deficits two months after surgery had either severe language compromise pre-surgically or were among those with the most significant language deficits immediately following dominant hemisphere resection. While larger samples are needed to verify the results, these data can guide physicians in their pre-operative counseling of patients regarding relative risk for post-operative language deficits, as well as in making speech therapy referrals for those patients at risk for slow/incomplete post-operative language recovery.,