Strategy for epilepsy surgery: mapping the dual language pathways for preservation of language function

DOI
  • Matsumoto Riki
    Department of Neurology, Kyoto University Graduate School of Medicine
  • Shimotake Akihiro
    Department of Epilepsy, Movement disorders and Physiology, Kyoto University Graduate School of Medicine
  • Yamao Yukihiro
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • Kikuchi Takayuki
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • Kunieda Takeharu
    Department of Neurosurgery, Ehime University Graduate School of Medicine

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  • てんかんの治療戦略:てんかん外科における言語機能温存へ向けた試み

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Abstract

<p>Epilepsy surgery is a treatment option for patients with epilepsy who failed multiple antiepileptic drugs. After detailed investigations for probing the epileptic focus and surrounding functional brain regions, tailor-made resection of the epileptic focus is performed seeking for seizure freedom. Language function is one of the most important higher functions to be preserved in epilepsy and tumor surgery. We have combined the state-of-art systems neuroscience methods to explore and preserve the dual language pathways, such as a less invasive electrical cortical stimulation method, signal analyses and decoding of electrocorticogram (ECoG), cortico-cortical evoked potential, anatomical fiber tractography and longitudinal neuropsychology evaluation. We here report the comprehensive language mapping of the dual language pathway, its clinical application to awake brain surgery, and the novel findings for neural basis of the language dual stream. According to recent function and connectivity studies, the basal temporal language area at and around the anterior fusiform gyrus is one of the crucial regions for semantic memory and is involved in the ventral language pathway. For QOL improvement after epilepsy surgery, a comprehensive multidisciplinary longitudinal study is warranted to delineate the brain plasticity for language functions.</p>

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