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1.
Clin Neuropsychol ; 38(1): 164-181, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37035940

RESUMO

Objective: Historically, naming has been assessed with visual object naming; however, we have found that auditory description naming significantly enhances lateralization and localization of dysfunction. We previously published auditory naming (ANT) and complementary Visual Naming Tests (VNT) for young adults, and recently developed these measures for children (ages 6-15 years) and older adults (ages 56-100 years). Here, we update the original stimuli and more rigorously norm the tests for ages 16-55, addressing prior limitations. Methods: Test stimuli were selected based on item characteristics and preliminary screening, eliminating those with less than 90% name agreement. A sample of 178 healthy individuals ages 16-55 years were administered the updated ANT and VNT, and other standardized measures, either in person (n = 114) or via telehealth (n = 64). Results: With no effect of age, yet a significant influence of education, education-based normative data are provided for accuracy, tips-of-the-tongue (i.e. delayed, accurate responses plus correct responses following phonemic cueing), and an aggregate Summary Score. Internal and test-retest reliability coefficients were reasonable (.67-.90). Conclusions: These measures provide updated and improved naming assessment for ages 16-55 years, contributing to a contiguous set of naming tests for school-aged children through elderly adults. Compared to the original ANT and VNT, these measures were designed to have stimuli longevity, and offer reduced item burden and evidence-based recommendations for performance measures with the greatest clinical sensitivity. The addition of these measures enables continuity in assessment across the age span, facilitating longitudinal assessment related to disease progression or therapeutic intervention.


Assuntos
Sinais (Psicologia) , Idoso , Criança , Adulto Jovem , Humanos , Reprodutibilidade dos Testes , Testes Neuropsicológicos
2.
J Int Neuropsychol Soc ; 28(6): 574-587, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34085630

RESUMO

OBJECTIVES: Naming difficulty is a common symptom of multiple age-related neurodegenerative disorders. As naming difficulty increases with age, valid, up-to-date naming assessment tools are crucial for differentiating between neurotypical changes in healthy aging and pathological naming difficulty. We aimed to develop and provide normative data for complementary auditory description naming and visual naming tests for older adults. Furthermore, these measures would include not only untimed accuracy, typically the sole naming performance measure, but also additional scores that incorporate features characteristic of actual word finding difficulty. METHODS: A normative sample of 407 healthy older adults, aged 56-100 years, were administered the Auditory Naming Test (ANT) and Visual Naming Test (VNT), and other standardized measures. RESULTS: Item analyses resulted in 36 stimuli for both tests. Age-stratified, education-based normative data are provided for accuracy, response time, tip-of-the-tongue (i.e., delayed, yet accurate responses plus correct responses following phonemic cueing), and multiple Summary Scores. Internal and test-retest reliability coefficients were reasonable (.59-.84). Untimed accuracy scores were high across age groups, seemingly reflecting stability of naming into late adulthood; however, time- and cue-based scores revealed reduced efficiency in word retrieval with increasing age. CONCLUSIONS: These complementary auditory and visual naming test for older adults improve upon the current standard by providing more sensitive performance measures and the addition of an auditory-verbal component for assessing naming. Detection of subtle naming changes in healthy aging holds promise for capturing symptomatic naming changes during the early stages of neurocognitive disorders involving expressive language, potentially assisting in earlier diagnoses and more timely treatment.


Assuntos
Sinais (Psicologia) , Idioma , Adulto , Idoso , Humanos , Testes Neuropsicológicos , Tempo de Reação/fisiologia , Reprodutibilidade dos Testes
3.
Rev. bras. cir. plást ; 35(2): 161-167, apr.-jun. 2020. ilus
Artigo em Inglês, Português | LILACS-Express | LILACS | ID: biblio-1103827

RESUMO

Introdução: A cirurgia de contorno corporal está entre os procedimentos cirúrgicos mais solicitados em cirurgia estética. Mentz foi o primeiro a realizar lipoaspiração superficial para definição da musculatura abdominal de pacientes masculinos. Todavia, o uso de ultrassom contínuo para produzir fragmentação de gordura em lipoplastia foi popularizado, pela primeira vez, por Scuderi. O ultrassom, quando aplicado internamente ao tecido adiposo por uma sonda ou cânula metálica, realiza a quebra das células por meio de três mecanismos: cavitação, efeito térmico e efeito mecânico direto. Métodos: A partir de novembro de 2018, 50 pacientes com indicação de lipoaspiração corporal realizaram o procedimento com a assistência do equipamento de ultrassom de terceira geração (VASER). Resultados: Durante o período de novembro de 2018 a março de 2019, 50 pacientes com indicação cirúrgica foram submetidos à lipoaspiração de contorno corporal com uso da tecnologia VASER de 3a geração. Desse universo de pacientes, 96% eram mulheres (47), apresentando os pacientes idade média de 35 anos (21-54). Conclusão: A associação do VASER na lipoaspiração é uma técnica segura e reprodutível, com a vantagem de melhorar o resultado das lipoesculturas. Bons resultados estéticos foram atingidos, com um contorno atlético e mais natural.


Introduction: Body contouring surgery is among the most requested surgical procedures in cosmetic surgery. Mentz was the first to perform superficial liposuction to define the abdominal muscles in male patients. However, Scuderi first popularized the use of continuous ultrasound to produce fat fragmentation in lipoplasty. Ultrasound, when applied internally to adipose tissue using a probe or metal cannula, breaks cells through three mechanisms: cavitation, thermal effect, and direct mechanical effect. Methods: Since November 2018, 50 patients with an indication for body liposuction performed the procedure with the help of the third-generation ultrasound equipment (VASERTM). Results: During the period between November 2018 and March 2019, 50 patients with a surgical indication underwent body contour liposuction using third-generation VASERTM technology. Of this universe of patients, 96% were women (47), with patients with an average age of 35 years (21-54). Conclusion: The association of VASERTM with liposuction is a safe and reproducible technique that has the advantage of improving the result of liposculpture. Good aesthetic results were achieved, with an athletic and more natural contour.

4.
Epilepsia ; 60(8): 1619-1626, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31251399

RESUMO

OBJECTIVE: Critical decisions regarding resection boundaries for epilepsy surgery are often based on results of electrical stimulation mapping (ESM). Despite the potentially serious implications for postoperative functioning, age-referenced data that might facilitate the procedure are lacking. Age might be particularly relevant, as pediatric ESM studies have shown a paucity of language sites in young children followed by a rapid increase at approximately 8-10 years. Beyond adolescence, it has generally been assumed that the language system remains stable, and therefore, potential age-related changes across the adult age span have not been examined. However, increasing age during adulthood is associated with both positive and negative language-related changes, such as a broadening vocabulary and increased word finding difficulty. Because most patients who undergo ESM are adults, we aimed to determine the potential impact of age on the incidence of ESM-identified naming sites across the adult age span in patients with refractory epilepsy. METHODS: We analyzed clinical language ESM results from 47 patients, ages 17-64 years, with refractory dominant-hemisphere epilepsy. Patients had comparable location and number of cortical sites tested. The incidence of naming sites was examined as a function of age, and compared between younger and older adults. RESULTS: Significantly more naming sites were found in older than younger adults, and age was found to be a significant predictor of number of naming sites identified. SIGNIFICANCE: Unlike the developmental changes that coincide with increased naming sites in children, increased naming sites in older adults might signify greater vulnerability of the language system to disruption. Because preservation of language sites can limit the extent of the resection, and thereby reduce the likelihood of seizure freedom, further work should aim to determine the clinical relevance of increased naming sites in older adults.


Assuntos
Envelhecimento/patologia , Mapeamento Encefálico , Encéfalo/patologia , Epilepsia Resistente a Medicamentos/patologia , Idioma , Adolescente , Adulto , Fatores Etários , Encéfalo/crescimento & desenvolvimento , Epilepsia Resistente a Medicamentos/cirurgia , Estimulação Elétrica , Feminino , Humanos , Testes de Linguagem , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Neurology ; 92(1): e1-e8, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30518557

RESUMO

OBJECTIVE: With this prospective, observational study, we aimed to determine whether noninvasive language tasks, developed specifically for children, could reliably identify the hemisphere of seizure onset in pediatric epilepsy. METHODS: Seventy-eight children with unilateral epilepsy (44 left), aged 6-15 years (mean age = 11.8, SD = 2.6), completed the Children's Auditory Naming and Visual Naming Tests, the Boston Naming Test, and other verbal and nonverbal tasks. Multivariate analysis of variance was used to compare test performance between left and right hemisphere epilepsy groups, and χ2 analyses and odds ratios were used to examine classification of left vs right hemisphere epilepsy for individual patients based on test performance. RESULTS: Group comparisons revealed poorer auditory naming in children with left hemisphere epilepsy (p = 0.02), yet no significant differences on measures of visual naming, general intelligence, or other cognitive functions. Moreover, χ2 analyses using auditory naming cutoff scores to define intact vs impaired performance correctly classified seizure laterality in a significant proportion of children (p = 0.004). The odds of left hemisphere epilepsy were 4.2 times higher (95% confidence interval 1.4-11.7) than the odds of right hemisphere epilepsy with poor auditory naming performance. In the subset of patients with temporal lobe epilepsy (TLE), the odds of left TLE were 11.3 times higher (95% confidence interval 2.00-63.17) than the odds of right TLE with poor auditory naming performance. CONCLUSION: Contrary to previous findings, naming performance can lateralize hemisphere of seizure onset in children with epilepsy, thereby assisting in the preoperative workup for pediatric epilepsy surgery.


Assuntos
Epilepsia/diagnóstico , Lateralidade Funcional , Idioma , Nomes , Testes Neuropsicológicos , Estimulação Acústica , Adolescente , Criança , Feminino , Humanos , Testes de Linguagem , Masculino , Estimulação Luminosa
6.
Child Neuropsychol ; 24(7): 903-922, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29258379

RESUMO

Assessment of naming in children has been hampered by the use of tests that were developed, either to assess naming in adults or to assess related verbal functions in children. We developed comparable visual naming test (VNT) and auditory description naming (ANT) specifically for children. We collected normative data, not only for accuracy, typically the sole performance measure, but also for response time (RT) and reliance on phonemic cuing. The normative sample consisted of 200 typically developing children, ages 6-15, with 40 children per 2-year age group (6-7, 8-9, 10-11, 12-13, and 14-15). Children were tested individually by a trained examiner. Based on item analysis, naming tests were finalized at 36 items for ages 8-15 and 28 items for ages 6-7. Age-stratified normative data are provided for accuracy, mean RT, tip-of-the-tongues (i.e., delayed but accurate responses plus items named following phonemic cueing), and a summary score, which incorporates all performance measures. Internal and test-retest reliability coefficients for both tests were reasonable. Accuracy scores were high across age groups, indicating that item names were within the mental lexicon of most typically developing children. By contrast, time and cue-based scores improved with age, reflecting greater efficiency in word retrieval with development. These complementary auditory naming and visual naming tests for children address a longstanding clinical need, improving upon the current standard with respect to the sensitivity of performance measures and the addition of an auditory verbal component to the assessment of naming in children.


Assuntos
Estimulação Acústica/métodos , Desenvolvimento Infantil/fisiologia , Estimulação Luminosa/métodos , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Adolescente , Criança , Sinais (Psicologia) , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
7.
Acta ortop. bras ; 25(6): 243-247, Nov.-Dec. 2017. tab
Artigo em Inglês | LILACS | ID: biblio-886502

RESUMO

ABSTRACT Objective: Despite advances in medical care, patients who are hospitalized or have spinal cord injuries often develop pressure sores. The objective of this study was to describe the epidemiological characteristics of pressure sores and evaluate factors associated with recurrence and cure. Methods: In this historical cohort study, clinical and laboratory data were collected from medical records between 1997 and 2016. Results: Sixty individuals with pressure ulcers were included; mean patient age was 38.1±16.5 (37.0) years, 83.3% were men, and 86.8% identified as white. Most patients (85.1%) had paraplegia, amputation, or trauma of the lower limbs with motor sequelae; the remainder (14.9%) were quadriplegic. Most (78.3%) underwent surgery, and the mean follow-up time was 1.8±2.5 years. The lesions were cured in 25 patients; they recurred in 25% of the patients, and recurrence was seen to be associated with the location of the lesions. Patients with recurrent lesions had more medical consultations and a longer treatment time. Individuals whose ulcers had healed had fewer lesions, higher body mass index (BMI), and a higher proportion of these patients underwent surgery. Conclusions: BMI and location and number of lesions are prognostic factors. Level of Evidence IV, Case Series.


RESUMO Objetivo: Apesar do progresso dos cuidados médicos, os pacientes hospitalizados ou com lesões medulares frequentemente desenvolvem úlceras de pressão. O objetivo deste estudo foi descrever as características epidemiológicas das úlceras de pressão e avaliar os fatores associados à recorrência e à cura. Métodos: Neste estudo de coorte histórico, foram coletados dados clínicos e laboratoriais de prontuários médicos de 1997 a 2016. Resultados: Sessenta indivíduos com úlceras de pressão foram incluídos. A média de idade dos pacientes foi 38,1 ± 16,5 (37,0) anos, 83,3% eram homens e 86,8% foram identificados como brancos. A maioria dos pacientes (85,1%) tinha paraplegia, amputação ou trauma nos membros inferiores com sequelas motoras; os restantes (14,9%) eram tetraplégicos. A maioria dos pacientes (78,3%) foi submetida à cirurgia e o tempo médio de acompanhamento foi 1,8±2,5 anos. A cicatrização das lesões foi observada em 25 pacientes; houve recorrência em 25% dos pacientes e verificou-se que estavam associadas à localização das lesões. Os pacientes com lesões recorrentes tinham maior número de consultas médicas e maior tempo de tratamento. Os indivíduos cujas úlceras cicatrizaram tinham menos lesões, maior índice de massa corporal (IMC) e maior proporção deles foi submetida à cirurgia. Conclusões: O IMC, a localização e o número de lesões são fatores prognósticos. Nível de Evidência IV, Série de Casos.

8.
Minerva Chir ; 72(3): 188-199, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28198179

RESUMO

BACKGROUND: Early reconstruction after mastectomy for breast cancer with definitive implants has been widely used, especially with the evolution of conservative surgical breast cancer treatments. We aimed to identify different characteristics associated with plastic surgery, based on immediate or delayed reconstruction time and evaluate quality of life in patients undergoing mastectomy for cancer. METHODS: This is a cross-sectional analytical study that evaluated adult patients undergoing mastectomy for breast cancer and breast reconstruction in Plastic Surgery Service at a tertiary hospital. RESULTS: Between March 2011 and November 2015, 58 patients who underwent mastectomy were included, with a mean age of 51.6±10.6 years and 98.3% of them being women. Eighty percent of the patients underwent a radical mastectomy and 20% underwent segmentectomies. Immediate and delayed surgical reconstructions occurred in 22.4% and 77.6% of the cases, respectively, including immediate reconstruction with the local flap trade (15.5%), immediate reconstruction with prosthesis (6.9%), transverse rectus abdominis myocutaneous (TRAM) flap (6.9%), delayed reconstruction with local flap (8.6%), expander and prosthesis (35.7%), and reconstruction with latissimus dorsi flap and prosthesis (22.4%). When comparing subjects undergoing reconstructive surgery based on timing of reconstruction, it was observed that patients undergoing delayed breast reconstruction surgery presented a higher proportion of radical mastectomy (90.7% vs. 41.7%; P=0.001) and the need for two or more surgical interventions (64.1% vs. 20.0%; P=0.029). There was no difference in the quality of life according to reconstruction time. CONCLUSIONS: The characteristics associated with postmastectomy reconstruction timing are related to preoperative factors such as the procedure employed and the number of interventions performed and have no influence on complications or the quality of life.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia , Mastectomia , Qualidade de Vida , Retalhos Cirúrgicos , Adulto , Neoplasias da Mama Masculina/cirurgia , Estudos Transversais , Feminino , Humanos , Masculino , Mamoplastia/métodos , Mastectomia/métodos , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Acta Ortop Bras ; 25(6): 243-247, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29375252

RESUMO

OBJECTIVE: Despite advances in medical care, patients who are hospitalized or have spinal cord injuries often develop pressure sores. The objective of this study was to describe the epidemiological characteristics of pressure sores and evaluate factors associated with recurrence and cure. METHODS: In this historical cohort study, clinical and laboratory data were collected from medical records between 1997 and 2016. RESULTS: Sixty individuals with pressure ulcers were included; mean patient age was 38.1±16.5 (37.0) years, 83.3% were men, and 86.8% identified as white. Most patients (85.1%) had paraplegia, amputation, or trauma of the lower limbs with motor sequelae; the remainder (14.9%) were quadriplegic. Most (78.3%) underwent surgery, and the mean follow-up time was 1.8±2.5 years. The lesions were cured in 25 patients; they recurred in 25% of the patients, and recurrence was seen to be associated with the location of the lesions. Patients with recurrent lesions had more medical consultations and a longer treatment time. Individuals whose ulcers had healed had fewer lesions, higher body mass index (BMI), and a higher proportion of these patients underwent surgery. CONCLUSIONS: BMI and location and number of lesions are prognostic factors. Level of Evidence IV, Case Series.


OBJETIVO: Apesar do progresso dos cuidados médicos, os pacientes hospitalizados ou com lesões medulares frequentemente desenvolvem úlceras de pressão. O objetivo deste estudo foi descrever as características epidemiológicas das úlceras de pressão e avaliar os fatores associados à recorrência e à cura. MÉTODOS: Neste estudo de coorte histórico, foram coletados dados clínicos e laboratoriais de prontuários médicos de 1997 a 2016. RESULTADOS: Sessenta indivíduos com úlceras de pressão foram incluídos. A média de idade dos pacientes foi 38,1 ± 16,5 (37,0) anos, 83,3% eram homens e 86,8% foram identificados como brancos. A maioria dos pacientes (85,1%) tinha paraplegia, amputação ou trauma nos membros inferiores com sequelas motoras; os restantes (14,9%) eram tetraplégicos. A maioria dos pacientes (78,3%) foi submetida à cirurgia e o tempo médio de acompanhamento foi 1,8±2,5 anos. A cicatrização das lesões foi observada em 25 pacientes; houve recorrência em 25% dos pacientes e verificou-se que estavam associadas à localização das lesões. Os pacientes com lesões recorrentes tinham maior número de consultas médicas e maior tempo de tratamento. Os indivíduos cujas úlceras cicatrizaram tinham menos lesões, maior índice de massa corporal (IMC) e maior proporção deles foi submetida à cirurgia. CONCLUSÕES: O IMC, a localização e o número de lesões são fatores prognósticos. Nível de Evidência IV, Série de Casos.

11.
Ann Neurol ; 67(3): 345-52, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20373346

RESUMO

OBJECTIVE: Preresection electrical stimulation mapping is frequently used to identify cortical sites critical for visual object naming. These sites are typically spared from surgical resection with the goal of preserving postoperative language. Recent studies, however, suggest a potential role of the hippocampus in naming, although this is inconsistent with neurocognitive models of language and memory. We sought to determine whether preservation of visual naming sites identified via cortical stimulation mapping protects against naming decline when resection includes the hippocampal region. METHODS: We assessed postoperative changes in visual naming in 33 patients, 14 who underwent left temporal resection including hippocampal removal and 19 who had left temporal resection without hippocampal removal. All patients had preresection cortical language mapping. Visual object naming sites identified via electrical stimulation were always preserved. RESULTS: Patients without hippocampal resection showed no significant naming decline, suggesting a clinical benefit from cortical mapping. In contrast, patients who had hippocampal resection exhibited significant postoperative naming decline, despite preresection mapping and preservation of all visual naming sites (p < or = 0.02). These group effects were also evident in individual patients (p = 0.02). More detailed, post hoc examination of patients who had hippocampal resection revealed that overall, patients who declined were those with a preoperative, structurally intact hippocampus, whereas patients with preoperative hippocampal sclerosis did not exhibit significant decline. INTERPRETATION: Despite cortical language mapping with preservation of visual naming sites from resection, removal of an intact dominant hippocampus will likely result in visual naming decline postoperatively.


Assuntos
Agnosia/fisiopatologia , Mapeamento Encefálico/métodos , Hipocampo/fisiologia , Transtornos da Memória/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios/métodos , Adulto , Agnosia/etiologia , Agnosia/patologia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Avaliação da Deficiência , Estimulação Elétrica/métodos , Feminino , Hipocampo/anatomia & histologia , Hipocampo/cirurgia , Humanos , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/patologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Procedimentos Neurocirúrgicos/métodos , Reconhecimento Visual de Modelos/fisiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Reconhecimento Psicológico/fisiologia , Lobo Temporal/patologia , Lobo Temporal/cirurgia
12.
Neurology ; 74(19): 1488-93, 2010 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-20335560

RESUMO

OBJECTIVE: Dominant, left anteromedial temporal lobe resection (AMTLR) for seizure control carries risks to verbal episodic memory and visual object naming. Consistent with traditional thinking, verbal memory decline is considered a consequence of hippocampal removal and naming decline has been attributed to lateral temporal resection. Interestingly, recent findings suggest a potential relation between visual naming and hippocampal integrity, which is consistent with studies that link the hippocampus with higher level visual processing. Historically, naming has been evaluated using visual object naming tasks; however, naming can also be assessed using auditory verbal descriptions. Recent cortical stimulation studies have shown a neuroanatomic distinction between visual naming and auditory description naming. We speculated that unlike visual naming, the hippocampus is not involved in auditory naming, and hypothesized that left AMTLR would not result in auditory naming decline, despite visual naming and verbal memory decline. METHODS: In this cohort study, we tested auditory naming, visual naming, and verbal memory in 25 left medial temporal lobe epilepsy (MTLE) and 20 right MTLE patients pre-AMTLR and 1 year post-AMTLR. RESULTS: Left AMTLR patients declined in visual naming and verbal memory, with no decline in auditory naming. Right AMTLR patients exhibited no decline. CONCLUSIONS: Results suggest that left anteromedial temporal lobe resection presents a greater risk to visual naming than auditory naming in patients with left medial temporal lobe epilepsy.


Assuntos
Transtornos da Linguagem/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Lobo Temporal/anatomia & histologia , Lobo Temporal/fisiologia , Adulto , Vias Auditivas/anatomia & histologia , Vias Auditivas/fisiologia , Percepção Auditiva/fisiologia , Mapeamento Encefálico/métodos , Mapeamento Encefálico/normas , Estudos de Coortes , Dominância Cerebral/fisiologia , Epilepsia do Lobo Temporal/cirurgia , Feminino , Humanos , Idioma , Transtornos da Linguagem/etiologia , Transtornos da Linguagem/patologia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/patologia , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Reconhecimento Psicológico/fisiologia , Medição de Risco , Lobo Temporal/cirurgia , Comportamento Verbal/fisiologia , Vias Visuais/anatomia & histologia , Vias Visuais/fisiologia , Percepção Visual/fisiologia
13.
J Int Neuropsychol Soc ; 15(4): 529-35, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19573271

RESUMO

Naming is generally considered a left-hemisphere function without precise localization. However, recent cortical stimulation studies demonstrate a modality-related anatomical dissociation, in that anterior temporal stimulation disrupts auditory description naming ("auditory naming") but not visual object naming ("visual naming"), whereas posterior temporal stimulation disrupts naming on both tasks. We hypothesized that patients with anterior temporal abnormalities would exhibit impaired auditory naming, yet normal range visual naming, whereas patients with posterior temporal abnormalities would exhibit impaired performance on both tasks. Thirty-four patients with documented anterior temporal abnormalities and 14 patients with documented posterior temporal abnormalities received both naming tests. As hypothesized, patients with anterior temporal abnormalities demonstrated impaired auditory naming, yet normal range visual naming performance. Patients with posterior temporal abnormalities were impaired in visual naming; however, auditory naming scores were intact. Although these group patterns were statistically significant, on an individual basis, auditory-visual naming asymmetries better predicted whether individual patients had anterior or posterior temporal abnormalities. These behavioral findings are generally consistent with stimulation results, suggesting that modality specificity is inherent in the organization of language, with predictable neuroanatomical correlates. Results also carry clinical implications regarding localizing dysfunction, identifying and characterizing naming deficits, and potentially, in treating neurologically based language disorders.


Assuntos
Encefalopatias/patologia , Mapeamento Encefálico , Córtex Cerebral/patologia , Córtex Cerebral/fisiopatologia , Nomes , Estimulação Acústica/métodos , Humanos , Testes Neuropsicológicos , Reconhecimento Fisiológico de Modelo/fisiologia , Reconhecimento Visual de Modelos/fisiologia , Estimulação Luminosa/métodos
14.
Brain ; 130(Pt 11): 2942-50, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17704527

RESUMO

Naming is mediated by perisylvian cortex in the left (language-dominant) hemisphere, and thus, left anterior temporal lobe resection for pharmacologically intractable temporal lobe epilepsy (TLE) carries risk for post-operative naming decline. Interestingly, this risk is lower in patients with hippocampal sclerosis (HS) relative to those without HS (non-HS). Although the hippocampus has traditionally been considered a critical structure for memory, without contribution to naming, this pattern might implicate direct hippocampal naming involvement. On the other hand, critical naming sites have been found in anterior, lateral temporal (i.e. extra-hippocampal) neocortex, the region typically removed with 'standard' TLE resection. We, therefore, speculated that the relative preservation of naming in post-operative HS patients might reflect cortical reorganization of language to areas outside this region. Using pre-resection electrical stimulation mapping, we compared the topography of auditory and visual naming sites in 12 patients with HS and 12 patients without structural brain pathology. Consistent with previous work, non-HS patients exhibited post-operative naming decline, whereas HS patients did not. As hypothesized, HS patients had proportionally fewer overall naming sites in anterior temporal cortex, the region typically removed with standard anterior temporal resection, whereas non-HS patients exhibited a more even distribution of naming sites in anterior and posterior temporal regions (P = 0.03). Although both groups exhibited the previously reported pattern of auditory naming sites anterior to visual naming sites, auditory naming sites had a significantly more posterior distribution in HS patients (P = 0.02). Additionally, non-HS patients exhibited a greater proportion of visual naming sites above the superior temporal sulcus, whereas visual naming sites in HS patients were scattered across superior and inferior temporal cortex. Results suggest that preserved naming ability in HS patients following anterior temporal resection might be attributable, at least in part, to intrahemispheric reorganization of language in response to the likely, early development of sclerosis in the medial temporal region. Furthermore, their more posterior distribution of naming sites is consistent with the more anterior propagation of EEG discharges in TLE. These results hold theoretical implications regarding the role of the dominant hippocampus in determining the cortical representation of semantic and lexical information, and raise questions regarding the specific roles of medial and lateral temporal cortex in targeted word retrieval. The different patterns of naming areas identified in patients with and without HS may also carry clinical implications, potentially improving efficiency during the time-constrained process of stimulation mapping.


Assuntos
Hipocampo/patologia , Transtornos da Linguagem/patologia , Adulto , Análise de Variância , Lobectomia Temporal Anterior , Percepção Auditiva , Mapeamento Encefálico , Estudos de Casos e Controles , Dominância Cerebral , Eletroencefalografia , Epilepsia do Lobo Temporal/patologia , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/cirurgia , Feminino , Hipocampo/fisiopatologia , Humanos , Transtornos da Linguagem/fisiopatologia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Esclerose , Lobo Temporal/fisiopatologia , Comportamento Verbal , Percepção Visual
15.
Brain ; 128(Pt 11): 2742-9, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16109751

RESUMO

One challenge in dominant temporal lobe epilepsy surgery is to remove sufficient epileptogenic tissue without compromising post-operative language functioning. Pre-resection electrical stimulation mapping enables identification of language areas that can be spared from resection, and also provides a unique opportunity to investigate brain-language relationships. Visual object naming is the gold standard for identifying 'essential' language cortex; however, sparing visual naming (VN) sites has not reliably prevented post-operative language decline. In addition to visual object naming, we included a more 'ecologically valid' auditory description naming task in our pre-resection cortical mapping protocol. Of the seven patients who had auditory naming (AN) sites removed, six declined post-operatively, whereas of the 12 patients who did not have AN sites removed, only 3 declined post-operatively (P = 0.02), suggesting an association between AN site removal and post-operative naming decline. Interestingly, although VN sites were preserved in all patients, AN site removal resulted in decline in both auditory and VN tasks. These findings not only have potentially critical clinical significance, but also argue for modality specificity, with considerable integration within the semantic system.


Assuntos
Córtex Auditivo/fisiopatologia , Epilepsia do Lobo Temporal/psicologia , Epilepsia do Lobo Temporal/cirurgia , Transtornos da Linguagem/prevenção & controle , Adolescente , Adulto , Idoso , Mapeamento Encefálico/métodos , Estimulação Elétrica/métodos , Epilepsia do Lobo Temporal/fisiopatologia , Humanos , Transtornos da Linguagem/etiologia , Transtornos da Linguagem/fisiopatologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Cuidados Pré-Operatórios/métodos , Semântica , Comportamento Verbal
16.
J Int Neuropsychol Soc ; 9(3): 479-89, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12666772

RESUMO

Naming is typically assessed with visual naming tasks, yet, some patients with genuine word-finding difficulty (evident in auditorily based discourse) show minimal difficulty on such measures. Evidence from cortical mapping, brain imaging and neuropsychological studies suggests that auditory naming measures might provide more relevant or at least, complementary information. We developed comparable auditory and visual naming tests and present normative data for accuracy, response time, and tip-of-the-tongue responses based on 100 controls. Test validity was supported by findings that left temporal lobe epilepsy (TLE) patients (i.e., a population with expected naming difficulty) performed more poorly on auditory but not visual naming compared to right TLE patients (i.e., a population without expected naming difficulty). Internal and test-retest reliability coefficients were reasonable. Finally, test utility was assessed on an individual basis, and auditory but not visual naming performance predicted impairment.


Assuntos
Percepção Auditiva , Epilepsia do Lobo Temporal/fisiopatologia , Testes Neuropsicológicos , Tempo de Reação/fisiologia , Percepção Visual , Adulto , Epilepsia do Lobo Temporal/psicologia , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Psicomotor/fisiologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatística como Assunto , Língua/fisiologia , Comportamento Verbal , Vocabulário
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