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Factors influencing atypical speech lateralization have theoretical importance in understanding the organization and reorganization of higher cognitive functions, as well as having practical implications, especially in brain surgery and neurorehabilitation. Atypical (right-sided or bilateral) language representation is more frequent in focal epilepsy than in healthy people. This difference is thought to be related to early childhood brain injuries localized in the neighbourhood of speech centres. The effect of epileptic activity on speech lateralization has not been investigated, although much data suggest that epileptic activity may interfere with higher brain functions. It can only be evaluated in a homogeneous human population with epilepsy having the same lesion type in the same localization. For these reasons, we investigated 184 patients with medial temporal lobe epilepsy (MTLE) due to unilateral hippocampal sclerosis (HS), but without other epileptogenic lesions. All patients underwent comprehensive presurgical evaluation. In MTLE, the influence of age at the time of brain damage, i.e. the initial precipitating injury (IPI), could be evaluated separately from the other timing factors. Of 100 patients in whom a Wada test was performed, left-sided speech occurred in 76% of the left-sided and in 100% of the right-sided MTLE patients (P < 0.05). For further evaluation, we included only the 83 left-sided MTLE patients. The mean age at seizure onset was 10.1 +/- 7.8 years (range 1-37 years); the mean age at evaluation was 35.7 +/- 9.8 years. Based on the Wada test, left-sided speech was present in 63 patients, while in 20 (24%) patients the Wada test revealed atypical speech dominance. We found that atypical speech representation in left MTLE was associated with higher spiking frequency (P < 0.05) and with sensory auras representing an ictal involvement of the lateral temporal structures (P < 0.01). Psychic auras suggesting limbic seizure spread showed a significant association with left-sided speech dominance in left MTLE (P < 0.05). Neither age at epilepsy onset, nor age at IPI was associated with atypical speech in left MTLE. Conclusively, we found that in patients with focal epilepsy, not only the known factors, i.e. the age at which the brain injury occurred and its localization, but also the epileptic activity itself, i.e. interictal discharges and seizure spread, may influence speech reorganization. Our findings also suggest that not only structural elements but also functional factors have an effect on the language organization of the brain.

Summary:Purpose: By using speech-activated functional MRI (f MRI), we investigated whether the frequency of left-sided interictal epileptic activity (IED: spikes or sharp waves on the EEG) is associated with atypical speech lateralization.Methods: We investigated 28 patients (13 men, aged 17-59 years) with left-sided mesial temporal lobe epilepsy (MTLE) and 11 patients with right-sided MTLE as a control population. Only patients with unilateral hippocampal sclerosis with unilateral IED were included. For f MRI of individual patients, we contrasted images sampled during covert word generation with a low-level rest condition. With SPM99, an individual comparison for the contrast "word generation versus resting inactivity" was conducted. To characterize speech lateralization in individual patients, we calculated asymmetry indexes (AIs): the difference between activated left-sided and right-sided voxels was divided by all activated voxels. Analyzing long-term EEG, the first 2 min of each hour were evaluated for the frequency of IED. Univariate associations with AIs were assessed by Pearson's correlation and by t test. When testing the independent associations, multivariate linear regression was performed.Results: The AIs in patients with left-sided MTLE were 0.40 ± 0.53 on average (range, −0.83 to +1.0), whereas in right-sided MTLE, they were 0.78 ± 0.15 (p = 0.029). For the further investigations, we included left-sided MTLE patients only. The median frequency of IED was six per hour (range, 0-240). Higher IED frequency was correlated with left-right shift of lateralization of speech f MRI activity (p = 0.002).Conclusions: Higher left-sided spike frequency in MTLE was associated with a left-right shift of speech representation, suggesting that chronic frequent interictal activity may induce a reorganization of speech lateralization.

Background: Minimal clinically important difference (MCID) is the smallest change in an outcome, which a patient identifies as meaningful. Although the 2 most frequently applied Parkinson's disease (PD) “quality of life” questionnaires (the PDQ-39 and PDQ-8) provide encouragingly similar results, their MCID thresholds appear to be vastly different. Our aim was to calculate the MCID estimates for both PDQ-39 and PDQ-8 Summary Indices (PDQ-39-SI and PDQ-8-SI) by the utilization of both anchor- and distribution-based techniques. Methods: Nine hundred eighty-five paired investigations of 365 patients were included. Three different techniques were used simultaneously to calculate the MCID values. Results: First, we replicated the previously published results demonstrating how both PDQ-39-SI and PDQ-8-SI provide similar values and respond in a similar way to changes. Subsequently, we calculated the MCID thresholds. The most optimal estimates for MCID thresholds for PDQ-39-SI were -4.72 and +4.22 for detecting minimal clinically important improvement and worsening. For PDQ-8-SI, these estimates were -5.94 and +4.91 points for detecting minimal clinically important improvement and worsening respectively. Conclusions: Our study is the first one that directly compared the MCID estimates for both PDQ-39-SI and PDQ-8-SI on a large pool of patients including all disease severity stages. These MICD estimates varied across PD severity.

Our minimal clinically important difference thresholds can be utilized in clinical practice in judging clinical relevance. © 2016 International Parkinson and Movement Disorder Society.

Summary: Purpose: Anterior temporal lobe resection (ATR) is a treatment option in drug-resistant epilepsy. An important risk of ATR is loss of memory because mesiotemporal structures contribute substantially to memory function. We investigated whether memory-activated functional MRI (f MRI) can predict postoperative memory loss after anterior temporal lobectomy in right-sided medial temporal lobe epilepsy (MTLE).Methods: We included 16 patients (10 women) aged 16-54 years. The mean age at epilepsy onset was 12.5 years (range, 1-26 years). The patients' mean Wechsler IQ score was 95.2 (range, 62-125). The activation condition of f MRI consisted of retrieval from long-term memory induced by self-paced performance of an imaginative walk. All but one patient had left-sided speech dominance according to speech-activated f MRI. Outside the scanner, we evaluated the pre-and postoperative visual memory retention by using Rey Visual Design Learning Test. Results:We found a correlation between the preoperative asymmetry index of memory-f MRI and the change between preand postsurgical measures of memory retention. Reduced activation of the mesiotemporal region ipsilateral to the epileptogenic region correlated with a favorable memory outcome after rightsided ATR.Conclusions: In light of the postoperative results, the theoretical implication of our study is that f MRI based on a simple introspective retrieval task measures memory functions. The main clinical implication of our study is that memory-f MRI might replace the invasive Wada test in MTLE by using a simple f MRI paradigm. Predictive power, however, will be studied in larger patient samples. Other studies are required for left-sided MTLE and neocortical epilepsies to assess the clinical usefulness of memory-f MRI.

Summary:Purpose: Complex partial seizure is the characteristic seizure type observed in epilepsy arising from temporal lobe structures. The seizure evolution in adult patients is quite stereotyped and well characterized, manifesting initially with an aura, behavioral arrest, and oroalimentary and gestural automatism. A greater variability of semiology including motor features with tonic or myoclonic components, as well as a paucity of automatism, has been reported in young children with temporal lobe epilepsy. The aim of our study was to examine in more detail the effects of age on individual ictal features to be able to determine the critical age when lesional temporal lobe seizure semiology undergoes transition from the pediatric to the more adult-type clinical pattern.Methods: We performed a video analysis of 83 seizures from 15 children (aged 11-70 months) selected by post-temporal lobectomy seizure-free outcome, looking specifically at the motor and behavioral (nonmotor) manifestations in relation to age of the children.Results: All of the children younger than 42 months had seizures with early and marked motor features, which included tonic and myoclonic components and epileptic spasms. Parallel with age, the frequency of these motor components decreased, and in five of 11 children older than 3 years, motor features were totally absent. Analyzed quantitatively, we saw a linear and inverse correlation of the ratio of motor components with age at monitoring.Conclusions: These findings support the hypothesis that events in brain maturation significantly affect clinical seizure semiology and may override the more typical localizing features seen in adult-type temporal lobe epilepsy. These findings are important to consider in the early diagnosis of childhood temporal lobe epilepsy. Key Words: Temporal lobe epilepsy-Children-Seizure semiology-Age-Brain maturation-Lateralization.Temporal lobe (TL) structures are frequently involved in the genesis of partial epilepsy. In adults, TL epilepsy is characterized by a somewhat stereotypic and welldescribed semiology consisting of epigastric auras, arrest of activity, staring, altered consciousness, and oroalimentary and hand automatisms, reflecting activation of limbic structures (1-4).In contrast, the semiology of TL seizures in young children is not that homogeneous, and various agedependent motor phenomena, including tonic, clonic, hypermotor components, and epileptic spasms (ESs) have been reported (5-16).The aim of this cross-sectional study was to investigate and describe seizures of young children with "pure" temporal lobe origin, and also to determine the likely age when the transition of lesional TL seizure semiology from the pediatric to the adult-type clinical pattern occurs. PATIENTS AND METHODS PatientsFifteen consecutive patients younger than 6 years (nine girls and six boys) with refractory lesional TL epilepsy who underwent long-term video-EEG monitoring and became seizure free after temporal lobectomy were selected [postoperative follow-up was between ...

Characteristics considered to be typical of IA (focal, left temporal seizures appearing on grounds of a long-lasting, intractable epilepsy) seem only partially legitimate. We suggest that in new-onset IA, female gender and a preexisting heart condition could serve as predispositions in an otherwise benign epilepsy. We speculate that in late-onset IA, male-predominant changes in neuronal networks in chronic, intractable epilepsy and an accompanying autonomic dysregulation serve as facilitating factors.