Abstracts

Rationale: To characterize the interaction between language dominance and lateralization of the epileptic focus for pre- and postoperative Boston Naming Test (BNT) performance in patients undergoing anterior temporal lobectomy (ATL). Methods: Analysis of pre- and postoperative BNT scores depending on lateralization of language as measured by the intracarotid amobarbital procedure (IAP) versus lateralization of the temporal lobe epileptic focus. Results: Left temporal lobe epilepsy (TLE) was associated with postsurgical deterioration in BNT performance (n = 50, p < 0.01), whereas right TLE patients’ BNT scores improved (n = 51; p < 0.01). This postoperative decline depended on language lateralization. In left TLE, postoperative decline in BNT scores was significant in patients with atypical language dominance (n = 14; p < 0.05, uncorrected), but did not reach statistical significance in patients with left language dominance. In left TLE, a chi-square test revealed a trend of higher proportions of patients experiencing postsurgical deterioration in naming performance in atypical (57.1%) as compared to left language dominance (30.6%; p = 0.082). Surgical failure was also associated with greater decline on the BNT and was more common in atypical compared to left language dominant patients (chi-square (1, n = 98) = 4.62, p = 0.032). Small numbers limited right TLE patients’ analysis. Conclusions: Atypical language dominance is linked to a decline in visual naming performance after ATL reflecting a higher degree of structural derangement. It may also impact on postsurgical seizure control and cognitive outcome, which should be considered when counseling surgical candidates.