Language Lateralization in Temporal Lobe Epilepsy: A Behavioral Screening Tool for Surgical Planning

Objective: Temporal lobe epilepsy can disturb eloquent areas, affecting language. We applied a visually-mediated task to measure lateralization of language recognition in drug-resistant temporal lobe epilepsy. Method: Patients with left (n = 26), right (n = 28) temporal lobe epilepsy and controls (n = 30) were administered the translingual lexical decision task. We performed repeated measures analyses of variance, with the visual half-field as an intrasubject factor and the group as an intersubject factor. Results: A main effect of visual half-field was found, showing the right visual field (left hemisphere) advantage for both accuracy and response time. A main effect of the group was found in accuracy, showing that both epilepsy groups performed less accurately than controls, and left temporal lobe epilepsy performed less accurately than right temporal lobe epilepsy. Also, the group-by-visual half-field interaction was significant. Post hoc t tests indicated the controls and right temporal lobe epilepsy performed better in the right visual field than in the left visual field, whereas no visual half-field effect was found in left temporal lobe epilepsy. For response times, the interaction was also significant. Post hoc t tests showed a significant right visual-field advantage for controls (two-tailed) and for the right temporal lobe epilepsy (one-tailed). Right visual-field advantage was absent in left temporal lobe epilepsy. Conclusions: The translingual lexical decision task can efficiently distinguish between left and right temporal lobe epilepsy. Compared to right temporal lobe epilepsy and controls, language lateralization is diminished in left temporal lobe epilepsy. The potential use of the translingual lexical decision task as an effective noninvasive presurgical language lateralization screening tool is highlighted. Key Points Question: How effective is a visual field task for assessing language lateralization in patients with temporal epilepsy? Findings: Results obtained through the Translingual Lexical Decision Task corroborate the known leftward asymmetry for language processing in controls and right temporal lobe epilepsy patients, and also showed decreased language lateralization left temporal lobe epilepsy patients. Importance: The applied task has a potential use as a screening tool for brain surgery planning. Next steps: Future research efforts should directly compare results from the lexical decision task with gold standards presurgical a