Abstracts

Rationale: Auditory naming and complementary visual naming tests have proven clinically useful in the presurgical work-up of adults with epilepsy. In contrast, naming in children with epilepsy has been limited due to use of visual naming measures that are confounded by vocabulary and an absence of standardized measures to assess auditory naming. To address this gap in clinical care, we developed pediatric versions of the auditory and visual naming tests and administered these measures to children with left and right hemisphere-based epilepsy. Unlike traditional measures that assess only naming accuracy, these measures assess response time (RT), response to phonemic cueing, and tip-of-the-tongue states. We hypothesized that, similar to adults, 1) left hemisphere patients would exhibit poorer naming than right hemisphere patients, 2) auditory naming would provide a more sensitive assessment than visual naming, and 3) time-based scores would be most sensitive to left hemisphere word finding dysfunction.Methods: Subjects were 60 children with unilateral (34 left) epilepsy (31 girls), ages 6-15 years (mean age = 11.8, SD=2.7; mean FSIQ =94.0, SD=12.0), evaluated at Columbia University Medical Center (n=18), Hospital for Sick Children (n =29) or New York University Medical Center (n = 13). The Visual Naming Test consists of 36 color photographs of familiar items, each on a white background (i.e., no contextual cues); the Auditory Naming test consists of 36 descriptions of familiar items. Performance measures include Number Correct (within 20 sec), mean RT, Number of items named in >2 seconds, Tip-of-the-tongue responses (TOT), and items requiring a phonemic cue (e.g., “ha” for hammer). T-tests assessed laterality effects, separately for younger (6-9 years, n=18) and older (10-15 years, n=42) children.Results: Mean FSIQ and vocabulary scores were comparable between left and right patients in both younger (FSIQ left: 97.0, SD=8.6; right 96.0, SD=14.9; Vocabulary left: 26.2 SD=11.3, right: 25.3, SD=6.3) and older groups (FSIQ left: 92.0, SD=11.7; right 93.3, SD=13.4; Vocabulary left: 40.0 SD=8.7, right: 37.5, SD=9.1), whereas naming scores tended to be poorer in left hemisphere patients. Within the younger group, all time based naming scores showed a pattern of poorer performance in the left compared to right hemisphere group, reaching significance for VN RT (left: 148.7, SD=46.7; right: 106.6, SD=17.7; P= .02) and VN >2 (left: 6.1, SD= 5.4; right: 2.5, SD=1.3; P= .03). In the older group, all but two scores showed this same pattern, with AN > 2 reaching significance (left: 5.3, SD=2.8; right: 3.5, SD=2.5; P= .04).Conclusions: Consistent with our hypothesis, left hemisphere patients exhibited weaker naming performance than right hemisphere patients; however, only select measures showed reliable, laterality based differences. As anticipated, these differences were most evident in time-based naming scores, and the greater sensitivity of auditory naming was seen in older but not younger children. Nevertheless, these naming tasks appear to provide age appropriate assessment of naming in children with epilepsy. NIH R01 NS35140(MH)