Language and Literacy Together: Supporting Grammatical Development in Dual Language Learners With Risk for Language and Learning Difficulties.

Purpose Early Interventions in Reading (Vaughn et al., 2006), the only literacy intervention with demonstrated effectiveness for U.S. dual language learners, was enhanced to support the development of oral language (vocabulary, grammar, and narrative) and literacy, which we refer to as "Language and Literacy Together." The primary focus of this study is to understand the extent to which grammatical skills of bilinguals with risk for language and/or reading difficulties improve in the Language and Literacy Together intervention. Method Fifteen first-grade dual language learners with risk for language and/or reading difficulties participated in an enhanced version of Early Interventions in Reading in Spanish. Children completed pre- and postintervention evaluations in Spanish and English, including grammatical testing from the Bilingual English Spanish Oral Screener (Peña et al., 2008) and narrative evaluation Test of Narrative Language story prompts (Gillam & Pearson, 2004; Gillam et al., n.d.). Data from six comparison participants with typical language skills who completed pre- and posttesting demonstrate the stability of the measures. Results The intervention group made gains in English and Spanish as evidenced by significant increases in their cloze and sentence repetition accuracy on the Bilingual English Spanish Oral Screener Morphosyntax subtest. They increased productivity on their narratives in Spanish and English as indexed by mean length of utterance in words but did not make gains in their overall grammaticality. Conclusions Structured intervention that includes an emphasis on grammatical elements in the context of a broader intervention can lead to change in the production of morphosyntax evident in both elicited constructions and narrative productivity as measured by mean length of utterance in words. Additional work is needed to determine if and how cross-linguistic transfer might be achieved for these learners.

Iterative Development of a Home Review Program to Promote Preschoolers' Vocabulary Skills: Social Validity and Learning Outcomes.

Purpose This article describes the iterative development of a home review program designed to augment vocabulary instruction for young children (ages 4 and 5 years) occurring at school through the use of a home review component. Method A pilot study followed by two experiments used adapted alternating treatment designs to compare the learning of academic words taught at school to words taught at school and reviewed at home. At school, children in small groups were taught academic words embedded in prerecorded storybooks for 6 weeks. Children were given materials such as stickers with review prompts (e.g., "Tell me what brave means") to take home for half the words. Across iterations of the home intervention, the home review component was enhanced by promoting parent engagement and buy-in through in-person training, video modeling, and daily text message reminders. Visual analyses of single-subject graphs, multilevel modeling, and social validity measures were used to evaluate the additive effects and feasibility of the home review component. Results Social validity results informed each iteration of the home program. The effects of the home program across sites were mixed, with only one site showing consistently strong effects. Superior learning was evident in the school + home review condition for families that reviewed words frequently at home. Although the home review program was effective in improving the vocabulary skills of many children, some families had considerable difficulty practicing vocabulary words. Conclusion These studies highlight the importance of using social validity measures to inform iterative development of home interventions that promote feasible strategies for enhancing the home language environment. Further research is needed to identify strategies that stimulate facilitators and overcome barriers to implementation, especially in high-stress homes, to enrich the home language environments of more families.

Impact of Nonmedical Factors on Neurobehavior and Language Outcomes of Preterm Infants.

Preterm infants are at increased risk for adverse neurodevelopmental outcomes. The impact of maternal, NICU, and social environmental factors on early neurobehavior and language outcomes of preterm infants is recognized. There is a need for health care professionals to have a clear understanding of the importance of facilitating positive mother-infant relationships, and to address not only the infant's sensory and language environment, but also focus on adverse maternal mental health and social adversities to optimize infant outcomes.

Cribado de la hipoacusia (parte 1) / Hearing loss screening (part 1)

El proceso por el que aprendemos y desarrollamos el lenguaje de forma natural es a través de la audición. La hipoacusia en la primera infancia limitará los estímulos auditivos y afectará significativamente al desarrollo del lenguaje y el habla, además de restringir el vínculo con el mundo que nos rodea. En los lactantes y niños pequeños, la detección y el tratamiento precoces de la hipoacusia pueden mejorar los resultados lingüísticos y escolares. En ausencia de cribado, la edad media a la que se confirma el diagnóstico de hipoacusia congénita en niños sin factores de riesgo está en torno a los 2-3 años. Los programas de cribado auditivo neonatal universal se han extendido ampliamente a pesar de la falta de pruebas sólidas que avalen su eficacia y coste-efectividad. En el presente trabajo, que se ha dividido en dos partes, el autor expone el tema de forma exhaustiva, con sus controversias y claroscuros, para finalmente pronunciarse sobre recomendaciones que el grupo PrevInfad ha consensuado para la consulta de los pediatras en Atención Primaria

The process of learning and developing our language in a natural way is through hearing. Infancy hearing loss will limit auditory stimuli and will significantly harm language and speech development and will narrow the bonds with the world around. In infants and small children, early hearing loss detection and treatment can improve language and school performance. In the absence of screening, medium age of congenital hearing loss diagnosis in children without risk factors is around 2-3 years. Universal new-born hearing screening has spread widely despite the lack of solid evidence supporting its effectivity and cost- efficiency. In this paper, that has been divided in two parts, the author thoroughly describes the topic, with its controversy and nuances, and finally declares on the recommendations that PrevInfad group have agreed for primary care paediatricians

Improving language mapping in clinical fMRI through assessment of grammar.

INTRODUCTION: Brain surgery in the language dominant hemisphere remains challenging due to unintended post-surgical language deficits, despite using pre-surgical functional magnetic resonance (fMRI) and intraoperative cortical stimulation. Moreover, patients are often recommended not to undergo surgery if the accompanying risk to language appears to be too high. While standard fMRI language mapping protocols may have relatively good predictive value at the group level, they remain sub-optimal on an individual level. The standard tests used typically assess lexico-semantic aspects of language, and they do not accurately reflect the complexity of language either in comprehension or production at the sentence level. Among patients who had left hemisphere language dominance we assessed which tests are best at activating language areas in the brain. METHOD: We compared grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking) with standard tests (object naming, auditory and visual responsive naming), using pre-operative fMRI. Twenty-five surgical candidates (13 females) participated in this study. Sixteen patients presented with a brain tumor, and nine with epilepsy. All participants underwent two pre-operative fMRI protocols: one including CYCLE-N grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking); and a second one with standard fMRI tests (object naming, auditory and visual responsive naming). fMRI activations during performance in both protocols were compared at the group level, as well as in individual candidates. RESULTS: The grammar tests generated more volume of activation in the left hemisphere (left/right angular gyrus, right anterior/posterior superior temporal gyrus) and identified additional language regions not shown by the standard tests (e.g., left anterior/posterior supramarginal gyrus). The standard tests produced more activation in left BA 47. Ten participants had more robust activations in the left hemisphere in the grammar tests and two in the standard tests. The grammar tests also elicited substantial activations in the right hemisphere and thus turned out to be superior at identifying both right and left hemisphere contribution to language processing. CONCLUSION: The grammar tests may be an important addition to the standard pre-operative fMRI testing.

Zonisamide in Brain Tumor-Related Epilepsy: An Observational Pilot Study.

OBJECTIVES: Epilepsy heavily affects the quality of life (QoL) of patients with brain tumor because in addition to taking treatments for the oncological illness, patients are required to live with the long-term taking of antiepileptic drugs (AEDs). The AEDs' adverse effects are common in these patients and can negatively influence their perceptions of their QoL.We conducted an observational pilot study in patients with brain tumor-related epilepsy to verify efficacy, tolerability, and impact on QoL and global neurocognitive performances of zonisamide (ZNS) in add-on. MATERIALS AND METHODS: We recruited 13 patients (5 females, 8 males; mean age, 49.6 years) presenting uncontrolled seizures. At first visit and at final follow-up at 6 months, patients underwent neurological examination, evaluation of adverse events, and cognitive and QoL tests. A seizure diary was given. RESULTS: Eight patients underwent chemotherapy, 3 underwent radiotherapy, and 5 had disease progression. Mean dosage of ZNS at final follow-up was 300 mg/d.Of 9 patients who reached the sixth month follow-up, the mean weekly seizure number before ZNS had been 3.2 ± 5.0, and at final follow-up, the mean weekly seizure number was 0.18 ± 0.41 (P = 0.05).Compared with baseline, we observed stability in all cognitive domains, except for verbal fluency that significantly worsened.Results on QoL tests showed that QoL remained unchanged over time, which could indicate that ZNS did not influence the patients' perceived QoL. CONCLUSIONS: Zonisamide as add-on in our patients seems to be well tolerated and efficacious in controlling seizures. Despite having limitations represented by the fact that our study is observational, with a small study population and a short follow-up period, our results confirm that when choosing an AED, in addition to efficacy, the drug's effect on patients' QoL also needs to be considered, especially for patients facing many psychosocial challenges, such as those with brain tumor-related epilepsy.

Preoperative navigated transcranial magnetic stimulation and tractography in transparietal approach to the trigone of the lateral ventricle.

OBJECTIVE: Eloquent neural structures including white matter tracts surround the trigone of the lateral ventricle. Surgical resection of trigonal tumors via the transparietal approach may cause neurological deterioration depending on the trajectory. METHODS: The authors retrospectively reviewed patients with trigonal tumors that underwent combined preoperative navigated transcranial magnetic stimulation (nTMS) and optic radiation tractography to guide a transparietal approach towards the trigone. RESULTS: Five patients underwent preoperative nTMS motor mapping, rTMS language mapping, nTMS-derived corticospinal tract tractography, and optic radiation tractography. The information was used to select the optimal trajectory for a transparietal approach and for intraoperative neuronavigation. Four patients underwent surgical resection. None of them experienced a new permanent deficit. CONCLUSION: Combination of preoperative nTMS and optic radiation tractography facilitates the identification of the optimal parietal trajectory towards the trigone. It allows for sparing of visual and motor pathways as well as cortical language areas.

The routines-based model for supporting speech and language / El modelo basado en las rutinas para apoyar la comunicación, el habla y el lenguaje

The more we understand the importance of children's learning during their everyday routines, the more we realize methods of delivering speech and language services must change. The Routines-Based Model has emerged as a viable structure for the delivery of family-centered, functional early intervention. It is described briefly, followed by specific speech and language needs of young children with disabilities as addressed through this model. The model includes methods for getting to know the child and family, including their needs, planning interventions, and service delivery. Practices involved in the Routines-Based Model include developing ecomaps, conducting Routines-Based Interviews, writing participation-based goals, and providing collaborative consultation to families and teachers. Two primary tenets of the model are that all the intervention occurs between visits and children learn through distributed trials. The primary language needs addressed are language delays and errors in language, and the primary speech needs addressed are articulation and apraxia and sequelae to structural problems. New roles for speech-language pathologists are described in an era of functional, family-centered early intervention. These roles require therapists to serve as consultants and to accept new roles, if they are to serve as comprehensive service providers (AU)

Cuanto más entendemos la importancia del aprendizaje de los niños durante sus rutinas diarias, más nos damos cuenta de que los métodos de prestación de servicios logopédicos deben cambiar. El modelo basado en rutinas se ha convertido en una estructura viable para la realización de la intervención temprana del modelo funcional centrado en la familia. Se describe brevemente el modelo, seguido de una descripción de las necesidades específicas para la comunicación, el habla y lenguaje de los niños pequeños con discapacidades. El modelo incluye métodos para conocer al niño y su familia, incorporando sus necesidades, la planificación de las intervenciones y la prestación de servicios. Las prácticas de intervención del modelo basado en rutinas incluyen el desarrollo de ecomapas, la realización de entrevistas basadas en rutinas, la definición de objetivos basados en la participación, la consulta y la disponibilidad de colaboración de las familias y los maestros. Dos principios primarios (dogmas) del modelo son que toda la intervención se produce entre las visitas y que los niños aprenden a través de ensayos distribuidos. Las necesidades principales del lenguaje van dirigidas a los retrasos y los errores en el lenguaje, y las necesidades primarias de habla que se abordan son la articulación y la apraxia, así como las secuelas de problemas estructurales. Se describen nuevas funciones para los logopedas en la era de la intervención temprana funcional, centrada en la familia. Estas funciones requieren que los terapeutas actúen como consultores y acepten nuevos roles, para que puedan servir a los proveedores de servicios de forma integral (AU)

Resection of highly language-eloquent brain lesions based purely on rTMS language mapping without awake surgery.

BACKGROUND: The resection of left-sided perisylvian brain lesions harbours the risk of postoperative language impairment. Therefore the individual patient's language distribution is investigated by intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions. The present study analyses the extent of resection (EOR) and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions based purely on rTMS language mapping. METHODS: Four patients with left-sided perisylvian brain lesions (two gliomas WHO III, one glioblastoma, one cavernous angioma) underwent rTMS language mapping prior to surgery. Data from rTMS language mapping and rTMS-based diffusion tensor imaging fibre tracking (DTI-FT) were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (POD5), and 3 months after surgery (POM3) clinical follow-up examinations were performed. RESULTS: No patient suffered from a new surgery-related aphasia at POM3. Three patients underwent complete resection immediately, while one patient required a second rTMS-based resection some days later to achieve the final, complete resection. CONCLUSIONS: The present study shows for the first time the feasibility of successfully resecting language-eloquent brain lesions based purely on the results of negative language maps provided by rTMS language mapping and rTMS-based DTI-FT. In very select cases, this technique can provide a rescue strategy with an optimal functional outcome and EOR when awake surgery is not feasible.

Habilidades sociales en preadolescentes con trastorno específico del lenguaje / Social skills in preadolescent children with specific language impairment

El objetivo de este trabajo es explorar la relación existente entre el trastorno específico del lenguaje (TEL) y las habilidades sociales en la preadolescencia. Se trata de un área poco estudiada pero que tiene especial interés dado el gran peso que cobran las relaciones sociales y las amistades íntimas en la adolescencia para el desarrollo psicosocial del individuo. Para ello, se han comparado 2 grupos de 18 sujetos cada uno: un grupo integrado por niños con TEL y otro por niños de la misma edad con desarrollo típico. Las medidas utilizadas se obtuvieron mediante el Sistema de evaluación de la conducta de niños y adolescentes (BASC; Reynolds y Kamphaus, 1992; adaptación española de González et al., 2004), recogiendo las valoraciones de los tutores en habilidades sociales, liderazgo, adaptabilidad y habilidades adaptativas. Los resultados mostraron que los niños con TEL tenían un índice menor que sus iguales en todas las variables medidas excepto en adaptabilidad. Estos resultados son indicativos de que los niños con TEL presentan un déficit también en habilidades sociales y liderazgo. Por lo tanto, es necesario tener en cuenta otras áreas, además de la lingüística, en la intervención con los niños con TEL (AU)

The aim of this paper is to explore the relationship between specific language impairment (SLI) and social skills in preadolescence. This aim is few explored, but has a great interest because in preadolescence social relations and close friendship are key factors in psychosocial development. We compared a group of children with SLI (n = 18) with a group of children with typical language development from the same age and classroom. We measured social skills, leadership, adaptability and adaptative skills through the System Behavioral Assessment of Children and Adolescents (BASC; Reynolds y Kamphaus, 1992; Spanish adaptation by González et al., 2004). Results showed that children with SLI had a lower index in all the variables except on adaptability. These results indicate that children with SLI show a deficit in social skills and leadership. Therefore, other areas, different from linguistic, are needed to take into account in order to intervene in children with SLI (AU)

Embedded Instruction Improves Vocabulary Learning During Automated Storybook Reading Among High-Risk Preschoolers.

PURPOSE: We investigated a small-group intervention designed to teach vocabulary and comprehension skills to preschoolers who were at risk for language and reading disabilities. These language skills are important and reliable predictors of later academic achievement. METHOD: Preschoolers heard prerecorded stories 3 times per week over the course of a school year. A cluster randomized design was used to evaluate the effects of hearing storybooks with and without embedded vocabulary and comprehension lessons. A total of 32 classrooms were randomly assigned to experimental and comparison conditions. Approximately 6 children per classroom demonstrating low vocabulary knowledge, totaling 195 children, were enrolled. RESULTS: Preschoolers in the comparison condition did not learn novel, challenging vocabulary words to which they were exposed in story contexts, whereas preschoolers receiving embedded lessons demonstrated significant learning gains, although vocabulary learning diminished over the course of the school year. Modest gains in comprehension skills did not differ between the two groups. CONCLUSION: The Story Friends curriculum appears to be highly feasible for delivery in early childhood educational settings and effective at teaching challenging vocabulary to high-risk preschoolers.

El lenguaje y la maduración emocional, ¿Cómo lo trabajamos en grupo? / Language and emotional evolution: How to work on this area in groups?

En este artículo se expone el tratamiento de problemas de lenguaje y maduración emocional a través de grupos. En el CDIAP del Maresme, a menudo la demanda viene focalizada en el retraso de lenguaje, pero observamos que un grupo importante está relacionado con alteraciones en la vinculación. Estos casos se tratan en grupos de niños y padres. Se presentan dos experiencias: grupo de niños y padres con las mismas terapeutas y grupo paralelo de padres. Los beneficios terapéuticos se concretan en la mejor integración de las emociones y su reflejo en el avance en las relaciones con los iguales y en los aprendizajes Maltrato en la infancia y la adolescencia: Características y psicopatología asociada en un Centro de Salud Mental Infanto-Juvenil

In this article we deal with the treatment of language and emotional maturation problems through groups. In CDIAP Maresme, demand it is often focused on problems of language delay, but we have noted that a significant number of cases are related to alterations in entailment. These cases can be treated in groups of children and parents. Two experiences are presented: a group of children and parents with the same therapists, and a parallel group of parents. The therapeutic benefits take the form of improved integration of emotions and their reflection in the progress in relations with peers and learning

Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study.

OBJECT Intraoperative language mapping is traditionally performed with low-frequency bipolar stimulation (LFBS). High-frequency train-of-five stimulation delivered by a monopolar probe (HFMS) is an alternative technique for motor mapping, with a lower reported seizure incidence. The application of HFMS in language mapping is still limited. Authors of this study assessed the efficacy and safety of HFMS for language mapping during awake surgery, exploring its clinical impact compared with that of LFBS. METHODS Fifty-nine patients underwent awake surgery with neuropsychological testing, and LFBS and HFMS were compared. Frequency, type, and site of evoked interference were recorded. Language was scored preoperatively and 1 week and 3 months after surgery. Extent of resection was calculated as well. RESULTS High-frequency monopolar stimulation induced a language disturbance when the repetition rate was set at 3 Hz. Interference with counting (p = 0.17) and naming (p = 0.228) did not vary between HFMS and LFBS. These results held true when preoperative tumor volume, lesion site, histology, and recurrent surgery were considered. Intraoperative responses (1603) in all patients were compared. The error rate for both modalities differed from baseline values (p < 0.001) but not with one another (p = 0.06). Low-frequency bipolar stimulation sensitivity (0.458) and precision (0.665) were slightly higher than the HFMS counterparts (0.367 and 0.582, respectively). The error rate across the 3 types of language errors (articulatory, anomia, paraphasia) did not differ between the 2 stimulation methods (p = 0.279). CONCLUSIONS With proper setting adjustments, HFMS is a safe and effective technique for language mapping.

Factors Affecting Early Services for Children Who Are Hard of Hearing.

PURPOSE: To describe factors affecting early intervention (EI) for children who are hard of hearing, we analyzed (a) service setting(s) and the relationship of setting to families' frequency of participation, and (b) provider preparation, caseload composition, and experience in relation to comfort with skills that support spoken language for children who are deaf and hard of hearing (CDHH). METHOD: Participants included 122 EI professionals who completed an online questionnaire annually and 131 parents who participated in annual telephone interviews. RESULTS: Most families received EI in the home. Family participation in this setting was significantly higher than in services provided elsewhere. EI professionals were primarily teachers of CDHH or speech-language pathologists. Caseload composition was correlated moderately to strongly with most provider comfort levels. Level of preparation to support spoken language weakly to moderately correlated with provider comfort with 18 specific skills. CONCLUSIONS: Results suggest family involvement is highest when EI is home-based, which supports the need for EI in the home whenever possible. Access to hands-on experience with this population, reflected in a high percentage of CDHH on providers' current caseloads, contributed to professional comfort. Specialized preparation made a modest contribution to comfort level.

Perfil populacional de Grupo de Avaliação e Prevenção de Alterações de Linguagem (GAPAL) / Population profile of the Evaluation and Prevention Group of Language Disorders (EPGLD)

RESUMOObjetivo Caracterizar e analisar o perfil dos usuários atendidos em um Grupo de Avaliação e Prevenção de Alterações de Linguagem (GAPAL) de uma clínica-escola.Métodos Pesquisa retrospectiva de banco de dados do GAPAL, do primeiro semestre/2002 ao primeiro semestre/2013. Foram analisados 261 usuários, quanto à idade, gênero, procedência, encaminhamentos e queixas apresentadas.Resultados Houve maior incidência de queixas relacionadas à linguagem no gênero masculino e na faixa etária de 25 a 30 meses de idade. A cidade com maior procedência de usuários foi Campinas. Quanto aos encaminhamentos, a maior parte foi realizada por profissionais de saúde, em sua maioria pediatras, sendo o relato mais ocorrente o de queixa de atraso de linguagem.Conclusão O estudo possibilitou a caracterização da população assistida, reiterando a importância de ações de promoção e prevenção das alterações de linguagem, principalmente junto às famílias. Também evidenciou limitações e dificuldades quanto ao registro dos dados, indicando a necessidade de readequação dos registros para nortear ações de (re)organização e gestão dos serviços na clínica de linguagem, tendo em vista o aprimoramento das ações de fonoaudiologia para esse grupo populacional.

ABSTRACTPurpose To characterize and analyze the population profile of an evaluation and prevention group of language disorders (GAPAL) in a clinic school.Methods It was a retrospective study from related database of GAPAL from the period of the 1st half/ 2002 through 1st half/ 2013. 261 users were analyzed by age, gender, hometown, referrals and complaints.Results It was found a higher occurrence of complaints related to language in males and aged 25-30 months. The city of origin of most users was Campinas. In terms of referrals, the major part of them was made from health professionals, mostly pediatricians, who reported language delay.Conclusion The study enable to characterize the population who are assisted by this service and reaffirm the importance of language promotion and prevention actions, especially with families. However, this analysis also showed limitations and difficulties in the recording of data, ponting the need to readequate database, so they can be taken as a guide for (re) organization actions and management of services in clinical speech and language with a view to the improvement of Speech and Language Pathology for this population group.

Los sistemas aumentativos y alternativos de comunicación (SAAC) constituyen una de las herramientas más importantes de la intervención en el ámbito logopédico, permitiendo trabajar la comunicación cuando nos encontramos ante pacientes con trastornos en los que el lenguaje oral tiene dificultades para desarrollarse de forma natural...[editorial] / No disponible

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Impact of epilepsy surgery on development of preschool children: identification of a cohort likely to benefit from early intervention.

OBJECT: Outcomes of focal resection in young children with early-onset epilepsy are varied in the literature due to study differences. In this paper, the authors sought to define the effect of focal resection in a small homogeneous sample of children who were otherwise cognitively intact, but who required early surgical treatment. Preservation of and age-appropriate development of intelligence following focal resection was hypothesized. METHODS: Cognitive outcome after focal resection was retrospectively reviewed for 15 cognitively intact children who were operated on at the ages of 2-6 years for lesion-related, early-onset epilepsy. Intelligence was tested prior to and after surgery. Effect sizes and confidence intervals for means and standard deviations were used to infer changes and differences in intelligence between 1) groups (pre vs post), 2) left versus right hemisphere resections, and 3) short versus long duration of seizures prior to resection. RESULTS: No group changes from baseline occurred in Full Scale, verbal, or nonverbal IQ. No change from baseline intelligence occurred in children who underwent left or right hemisphere surgery, including no group effect on verbal scores following surgery in the dominant hemisphere. Patients with seizure durations of less than 6 months prior to resection showed improvement from their presurgical baseline in contrast to those with seizure duration of greater than 6 months prior to surgery, particularly in Wechsler Full Scale IQ and nonverbal intelligence. CONCLUSIONS: This study suggests that surgical treatment of focal seizures in cognitively intact preschool children is likely to result in seizure remediation, antiepileptic drug discontinuation, and no significant decrement in intelligence. The latter finding is particularly significant in light of the longstanding concern associated with performing resections in the language-dominant hemisphere. Importantly, shorter seizure duration prior to resection can result in improved cognitive outcome, suggesting that surgery for this population should occur sooner to help improve intelligence outcomes.

Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy.

OBJECTIVES: Patients with temporal lobe epilepsy (TLE) experience significant deficits in category-related object recognition and naming following standard surgical approaches. These deficits may result from a decoupling of core processing modules (e.g., language, visual processing, and semantic memory), due to "collateral damage" to temporal regions outside the hippocampus following open surgical approaches. We predicted that stereotactic laser amygdalohippocampotomy (SLAH) would minimize such deficits because it preserves white matter pathways and neocortical regions that are critical for these cognitive processes. METHODS: Tests of naming and recognition of common nouns (Boston Naming Test) and famous persons were compared with nonparametric analyses using exact tests between a group of 19 patients with medically intractable mesial TLE undergoing SLAH (10 dominant, 9 nondominant), and a comparable series of TLE patients undergoing standard surgical approaches (n=39) using a prospective, nonrandomized, nonblinded, parallel-group design. RESULTS: Performance declines were significantly greater for the patients with dominant TLE who were undergoing open resection versus SLAH for naming famous faces and common nouns (F=24.3, p<0.0001, η2=0.57, and F=11.2, p<0.001, η2=0.39, respectively), and for the patients with nondominant TLE undergoing open resection versus SLAH for recognizing famous faces (F=3.9, p<0.02, η2=0.19). When examined on an individual subject basis, no SLAH patients experienced any performance declines on these measures. In contrast, 32 of the 39 patients undergoing standard surgical approaches declined on one or more measures for both object types (p<0.001, Fisher's exact test). Twenty-one of 22 left (dominant) TLE patients declined on one or both naming tasks after open resection, while 11 of 17 right (nondominant) TLE patients declined on face recognition. SIGNIFICANCE: Preliminary results suggest (1) naming and recognition functions can be spared in TLE patients undergoing SLAH, and (2) the hippocampus does not appear to be an essential component of neural networks underlying name retrieval or recognition of common objects or famous faces.