Changes in Language Pathways in Patients with Temporal Lobe Epilepsy: Diffusion Tensor Imaging Analysis of the Uncinate and Arcuate Fasciculi

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.