Language after temporal or frontal lobe surgery in children with epilepsy

The purpose of this study was to compare language function in children undergoing temporal or frontal lobe surgery to control intractable epilepsy. Language measures (expressive vocabulary, receptive vocabulary, comprehension, reading, spelling, phonemic fluency, and category fluency) were administered to 9 children with frontal lobe epilepsy (mean age: 10.8 +/- 2.7 years) and 10 children with temporal lobe epilepsy (11.5 +/- 2.6 years). The results indicate that no differences exist, in language function, before and after surgery between children with frontal and temporal lobe epilepsy (all p > or = .05). Children with left hemisphere lesions had significantly lower scores than those with right on category fluency and comprehension, but laterality effects were not seen on the other measures. In both groups, language function was not significantly affected by surgery.     

The effects of right and left hemiparkinsonism on prosody

Recent studies show right hemisphere dominance in the mediation of emotional prosody and left hemisphere contribution to linguistic prosody in patients with cortical injury. The present study investigated emotional and linguistic functions of prosody as well as facial and musical processing in 21 patients with lateralized subcortical disease. Fourteen right hemiparkinsonians (RPD) and 7 left hemiparkinsonians (LPD) were compared to 17 normal controls (NC). Patients were impaired on receptive and expressive tests of emotional and linguistic prosody. Patients were also selectively impaired on emotional processing of facial stimuli and in the musical processing of pitch and tonal memory, though not timber. These findings suggest that monotone speech reported in PD is of multimodal origins and may involve dysfunction in neural centers involved in emotional and linguistic processing. There were no differences between RPD and LPD groups in the pattern of deficits, suggesting bilateral involvement in emotional processing at the subcortical level.     

Can small lesions induce language reorganization as large lesions do?

Shift of the cortical mechanisms of language from the usually dominant left to the non-dominant right hemisphere has been demonstrated in the presence of large brain lesions. Here, we report a similar phenomenon in a patient with a cavernoma over the anterolateral superior temporal gyrus associated with epilepsy. Language mapping was performed by two complementary procedures, magnetoencephalography, and electrocorticography. The maps, indicated right temporal lobe dominance for receptive language and left frontal lobe dominance for expressive language. These results indicate that a small lesion, associated with epilepsy, may produce selective shifting of receptive language mechanisms as large lesions have been known to produce.     

Lesion localization in acquired deficits of emotional expression and comprehension

This study investigated the relationship between intrahemispheric location of lesion and disturbances of emotional expression and comprehension. Twenty-eight right hemisphere strokes, 18 left hemisphere strokes, and 20 controls were examined on a standardized test of the expression, repetition, and comprehension of emotional prosody as well as the visual recognition of emotional situations and faces. The patients were classified into aprosodic syndromes according to the test scores. The lesions were independently traced, and overlapped for each aprosodic syndrome. The results, for lesions in either hemisphere, indicated involvement of the basal ganglia most frequently in aprosodic syndromes followed by anterior temporal lobe and insula lesions. Basal ganglia damage was also seen most frequently in patients with impaired comprehension of emotional facial expressions and situations. The anterior temporal lobe was also frequently involved in patients with such deficits. The basal ganglia emerged as a structure of particular importance in the mediation of emotional expression and comprehension.     

Verbal and affective laterality effects in P-dyslexic, L-dyslexic and normal children.

Lateralization of verbal and affective processes was investigated in P-dyslexic, L-dyslexic and normal children with the aid of a dichotic listening task. The children were asked to detect either the presence of a specific target word or of words spoken in a specific emotional tone of voice. The number of correct responses and reaction time were recorded. For monitoring words, an overall right ear advantage was obtained. However, further tests showed no significant ear advantage for P-types, and a right ear advantage for L-types and controls. For emotions, an overall left ear advantage was obtained that was less robust than the word-effect. The results of the word task are in support of previous findings concerning differences between P- and L-dyslexics in verbal processing according to the balance model of dyslexia. However, dyslexic children do not differ from controls on processing of emotional prosody although certain task variables may have affected this result.     

Lateralization of auditory rhythm length in temporal lobe lesions

In the visual modality, short rhythmic stimuli have been proven to be better processed (sequentially) by the left hemisphere, while longer rhythms appear to be better (holistically) processed by the right hemisphere. This study was set up to see if the same holds in the auditory modality. The rhythm task as originally designed by Seashore was computerized and is part of the Fepsy Neuropsychological battery. This task was performed by 85 patients with intractable temporal lobe epilepsy (left TLE = 32; right TLE = 53) enrolled in the Dutch Collaborative Epilepsy Surgery Program. They performed the task before and 6 months after surgery. The task consists of 30 pairs of rhythmic patterns in 3 series of 10 items. The series contains patterns of 5, 6, or 7 notes. The purpose is to indicate whether the two patterns are the same or different. Reaction times are also measured. If the hypothesis is true, the short-item sequence will be better processed by patients with right temporal lobe epilepsy (nonimpaired left temporal lobe), the longer sequence will be better processed by the left temporal epilepsy group (nonimpaired right temporal lobe). No overall laterality effect on rhythm perception could be found and no difference was found between both test moments. IQ did not correlate with rhythm performance. However, there was an interaction effect of laterality and rhythm length on performance and reaction time. This effect can be explained by the increase after the operation of the score of the left focus group and a decrease in the right focus group on the longer rhythms. This effect was somewhat less strong in the reaction times: a clear tendency for faster reaction times after surgery in the left and longer reaction times in the right focus group. The effect could not be explained for by the difference in extent of resection in either temporal lobe. This study showed that memory for and discrimination of auditory rhythm is dependent on which hemisphere is used in processing. The effect could be demonstrated for the right hemisphere, which uses a holistic processing of stimuli, which outperforms the left in rhythms consisting of a long sequence. In left temporal resections an improvement occurs on the longer rhythms and in right temporal resections the performance on the longest rhythms decreases.     

Disruption of spelling-to-sound correspondence mapping during single-word reading in patients with temporal lobe epilepsy

Processing and/or hemispheric differences in the neural bases of word recognition were examined in patients with long-standing, medically-intractable epilepsy localized to the left (N=18) or right (N=7) temporal lobe. Participants were asked to read words that varied in the frequency of their spelling-to-sound correspondences. For the right temporal lobe group, reaction times (RTs) showed the same pattern across spelling-to-sound correspondence conditions as previously reported for normal participants. For the left temporal lobe group, however, the pattern of RTs suggested a greater relative influence of orthographic frequency than rime frequency, such that performance was worse on words whose orthographic body was less frequent in the language. We discuss these results in terms of differences in processing between the two cerebral hemispheres: the results for the right-temporal lobe patients are taken to support connectionist models of reading as described for the dominant (left) hemisphere, while results for the left-temporal lobe patients support a view of the right hemisphere as relatively less sensitive to phonology and relatively more sensitive to orthography.     

Relationship of temporal lobe volumes to neuropsychological test performance in healthy children

Ecological validity of neuropsychological assessment includes the ability of tests to predict real-world functioning and/or covary with brain structures. Studies have examined the relationship between adaptive skills and test performance, with less focus on the association between regional brain volumes and neurobehavioral function in healthy children. The present study examined the relationship between temporal lobe gray matter volumes and performance on two neuropsychological tests hypothesized to measure temporal lobe functioning (visual perception-VP; peabody picture vocabulary test, third edition-PPVT-III) in 48 healthy children ages 5-18 years. After controlling for age and gender, left and right temporal and left occipital volumes were significant predictors of VP. Left and right frontal and temporal volumes were significant predictors of PPVT-III. Temporal volume emerged as the strongest lobar correlate with both tests. These results provide convergent and discriminant validity supporting VP as a measure of the "what" system; but suggest the PPVT-III as a complex measure of receptive vocabulary, potentially involving executive function demands.     

Right hemispheric dysfunction in nonverbal learning disabilities: social, academic, and adaptive functioning in adults and children

This review addresses recent research on social and nonverbal learning disabilities. Involvement of right hemispheric dysfunction in these disabilities has been hypothesized, as studies with adults have suggested that documented right hemisphere damage may lead to deficits in social skills, prosody, spatial orientation, problem solving, and recognition of nonverbal cues. Studies of children purported to evidence nonverbal learning disabilities are reviewed and compared with the results from studies of adults with right hemisphere damage. Specific subtypes of nonverbal learning disabilities are reviewed, including the nonverbal perceptual-organization-output subtype, Asperger's Syndrome, Developmental Gerstmann Syndrome, left hemisyndrome, right hemisphere syndrome, and right parietal lobe syndrome. Finally, implications and future research needs are addressed. The need for a diagnostic nosology and improved and validated intervention techniques is stressed as is early identification of these types of specific nonverbal learning disabilities.     

The role of the cerebral hemispheres in music.

This review examines the cerebral control of musical behaviors. In clinical populations, impairment of related musical and linguistic functions, such as reading, writing, articulation, time sense, and prosody, implies the likely role of the language hemisphere in music. Similarly, for both clinical and normal populations, an investigation of mental abilities common to music and language points to left hemisphere control for certain aspects of temporal order, duration, simultaneity, rhythm, effector motor control, and categorical perception. While clinical studies have revealed deficits in various kinds of music capabilities with both left and right cerebral lesions, normal subjects similarly demonstrate varying degrees of asymmetry for components of music emphasizing pitch, harmony, timbre, intensity, and rhythm. Since differential laterality effects are apparent as a function of subjects' training or adopted strategies, the way musical information is processed may be an important determinant of hemispheric mediation. One hemisphere should not be regarded as “dominant” for music, but rather each interacts with the other, operating according to its own specialization.     

Olfactory Information Processing and Temporal Lobe Epilepsy

It has been suggested that olfactory information processing is impaired in patients with temporal lobe epilepsy. However, the existing evidence is not wholly in accordance with this notion. Patients with epileptogenic foci in the left temporal lobe, the right temporal lobe, or other brain regions were compared with normal control subjects in the identification and retention of common odors. All three patient groups were substantially and equally impaired in verbally labelling the odors in question. The patients with epilepsy associated with the left temporal lobe or with nontemporal regions showed no sign of any impairment on a test of immediate recognition memory for common odors. However, the patients with epilepsy associated with the right temporal lobe showed a specific disturbance in their retention of nameable odors. It is suggested that the latter patients were selectively impaired in their retrieval of the episodic memories which provide the context for the encoding of distinctive odors.     

Neurology of affective prosody and its functional-anatomic organization in right hemisphere

Unlike the aphasic syndromes, the organization of affective prosody in brain has remained controversial because affective-prosodic deficits may occur after left or right brain damage. However, different patterns of deficits are observed following left and right brain damage that suggest affective prosody is a dominant and lateralized function of the right hemisphere. Using the Aprosodia Battery, which was developed to differentiate left and right hemisphere patterns of affective-prosodic deficits, functional-anatomic evidence is presented in patients with focal ischemic strokes to support the concepts that (1) affective prosody is a dominant and lateralized function of the right hemisphere, (2) the intrahemispheric organization of affective prosody in the right hemisphere, with the partial exception of Repetition, is analogous to the organization of propositional language in the left hemisphere and (3) the aprosodic syndromes are cortically based as part of evolutionary adaptations underlying human language and communication.     

Dichotic listening with forced attention in patients with temporal lobe epilepsy: significance of left hemisphere cognitive dysfunction

Fifty right-handed patients with focal temporal lobe epilepsy were administered a dichotic listening test with consonant-vowel syllables under non-forced, forced right and forced left attention conditions, and a neuropsychological test battery. Dichotic listening performance was compared in subgroups with and without left hemisphere cognitive dysfunction, measured by the test battery, and in subgroups with left and right temporal epileptic focus. Left hemisphere cognitive dysfunction led to more correct responses to left ear stimuli in all three attention conditions, and fewer correct responses to right ear stimuli in the non-forced attention condition. This was probably caused by basic left hemisphere perceptual dysfunction. Dichotic listening was less affected by a left-sided epileptic focus than by left hemisphere cognitive dysfunction. General cognitive functioning influenced dichotic listening performance stronger in forced than in non-forced attention conditions. Larger cerebral networks were probably involved in the forced attention conditions due to the emphasis on conscious effort.     

Verbal and Affective Laterality Effects in P-Dyslexic,L-Dyslexic and Normal Children

Lateralization of verbal and affective processes was investigated in P-dyslexic, L-dyslexic and normal children with the aid of a dichotic listening task. The children were asked to detect either the presence of a specific target word or of words spoken in a specific emotional tone of voice. The number of correct responses and reaction time were recorded. For monitoring words, an overall right ear advantage was obtained. However, further tests showed no significant ear advantage for P-types, and a right ear advantage for L-types and controls. For emotions, an overall left ear advantage was obtained that was less robust than the word-effect. The results of the word task are in support of previous findings concerning differences between P- and L-dyslexics in verbal processing according to the balance model of dyslexia. However, dyslexic children do not differ from controls on processing of emotional prosody although certain task variables may have affected this result.     

The sad, the angry, and the asymmetrical brain: dichotic listening studies of negative affect and depression

Dichotic Listening (DL) is a valuable tool to study emotional brain lateralization. Regarding the perception of sadness and anger through affective prosody, the main finding has been a left ear advantage (LEA) for the sad but contradictory data for the anger prosody. Regarding an induced mood in the laboratory, its consequences upon DL were a diminished right ear advantage (REA) for the induction of sadness and an increased REA for the induction of anger. The global results fit with the approach-withdrawal motivational model of emotional processing, pointing to sadness as a right hemisphere emotion but anger processed bilaterally or even in the left hemisphere, depending on the subject's preferred mode of expression. On the other hand, the study of DL in clinically depressed patients found an abnormally larger REA in verbal DL tasks which was predictive of therapeutic pharmacological response. However, the mobilization of the available left hemisphere resources in these responders (reflected in a higher REA) would indicate a remission of the episode but would not assure the absence of new relapses.     

The role of the right hemisphere in the control of speech prosody in propositional and affective contexts

Sixteen right-handed adult males with localized insult to either the right or left hemisphere and five control subjects without brain damage read aloud target sentences embedded in paragraphs, while intoning their voices in either a declarative, interrogative, happy, or sad mode. Acoustical analysis of the speech wave was performed. Right-anterior (pre-Rolandic) and right-central (pre- and post-Rolandic) brain-damaged patients spoke with less pitch variation and restricted intonational range across emotional and nonemotional domains, while patients with right posterior (post-Rolandic) damage had exaggerated pitch variation and intonational range across both domains. No such deficits were found in patients with left posterior damage, whose prosody was similar to that of normal control subjects. It is suggested that damage to the right hemisphere alone may result in a primary disturbance of speech prosody that may be independent of the disturbances in affect often noted in right-brain-damaged populations.     

Hemispheric processing of affective and linguistic intonation contours in normal subjects

In a previous study of the comprehension of linguistic prosody in brain-damaged subjects, S. R. Grant and W. O. Dingwall (1984. The role of the right hemisphere in processing linguistic prosody, presentation at the Academy of Aphasia, 1984) demonstrated that the right hemisphere (RH) of nonaphasic patients plays a prominent role in the processing of stress and intonation. The present study examines laterality for affective and linguistic prosody using the dichotic listening paradigm. Both types of prosody elicited a significant left ear advantage. This advantage was more pronounced for affective than for linguistic prosody. These findings strongly support previously documented evidence of RH involvement in the processing of affective prosody (R. G. Ley & M. P. Bryden, 1982. A dissociation of right and left hemispheric effects for recognizing emotional tone and verbal content, Brain and Cognition, 1, 3-9). They also provide support for the previously mentioned demonstration of RH involvement in the processing of linguistic intonation (S. Blumstein & W. E. Cooper, 1974. Hemispheric processing of intonation contours, Cortex, 10, 146-158; Grant & Dingwall, 1984).     

Neural systems for recognition of emotional prosody: a 3-D lesion study

Which brain regions are associated with recognition of emotional prosody? Are these distinct from those for recognition of facial expression? These issues were investigated by mapping the overlaps of co-registered lesions from 66 brain-damaged participants as a function of their performance in rating basic emotions. It was found that recognizing emotions from prosody draws on the right frontoparietal operculum, the bilateral frontal pole, and the left frontal operculum. Recognizing emotions from prosody and facial expressions draws on the right frontoparietal cortex, which may be important in reconstructing aspects of the emotion signaled by the stimulus. Furthermore, there were regions in the left and right temporal lobes that contributed disproportionately to recognition of emotion from faces or prosody, respectively.