Journal
WORLD NEUROSURGERY
Volume 75, Issue 3-4, Pages 509-516Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.wneu.2010.11.006
Keywords
Arcuate fasciculus; Diffusion tensor imaging; Language; Temporal lobe epilepsy; Uncinate fasciculus
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Funding
- Ministry for Health, Welfare & Family Affairs, Republic of Korea [A084368]
- Korea Health Promotion Institute [A084368] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
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OBJECTIVE: The language pathways consist of ventral and dorsal systems connected via the uncinate fasciculus and arcuate fasciculus, respectively. Seizures in medial temporal lobe epilepsy (mTLE) affect both tracts. Previous studies, however, have focused on the arcuate fasciculus to explain the language disturbance in mTLE. In contrast, we compared changes in both the uncinate and arcuate fasciculi using diffusion tensor imaging. METHODS: Thirteen patients with left mTLE and 12 with right mTLE were studied. The Wada test showed left dominance for language in all these patients. Sixteen healthy right-handed subjects were also studied. The mean fractional anisotropy and mean apparent diffusion coefficient with their lateralization index of two fasciculi were compared between hemispheres and between subjects. RESULTS: The mean apparent diffusion coefficient of the arcuate and uncinate fasciculi in both left-and right-mTLE patients increased bilaterally compared with that in healthy subjects. In left mTLE, the fractional anisotropy of the uncinate fasciculus was lower ipsilaterally (P = 0.002) and was significantly lateralized contralaterally (P < 0.001) compared with control subjects, whereas the fractional anisotropy of the arcuate fasciculus showed no lateralization (P = 0.577). In right mTLE, such a difference was not prominent. CONCLUSION: The seizure network affects both arcuate and uncinate fasciculi bilaterally in both left-and right-mTLE patients. The change is most prominent in the left uncinate fasciculus in left mTLE.
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