Abstract
The use of intracarotid propofol procedure (IPP) when assessing musical lateralization has not been reported in literature up to now. This procedure (similar to Wada Test) has provided the opportunity to investigate not only lateralization of language and memory functions on epileptic patients but also offers a functional mapping approach with superior spatial and temporal resolution to analyze the lateralization of musical abilities. Findings in literature suggest that musical training modifies functional and structural brain organization. We studied hemispheric lateralization in a professional musician, a 33 years old woman with refractory left medial temporal lobe (MTL) epilepsy (TLE). A longitudinal neuropsychological study was performed over a period of 21 months. Before epilepsy surgery, musical abilities, language and memory were tested during IPP by means of a novel and exhaustive neuropsychological battery focusing on the processing of music. We used a selection of stimuli to analyze listening, score reading, and tempo discrimination. Our results suggested that IPP is an excellent method to determine not only language, semantic, and episodic memory, but also musical dominance in a professional musician who may be candidate for epilepsy surgery. Neuropsychological testing revealed that right hemisphere's patient is involved in semantic and episodic musical memory processes, whereas her score reading and tempo processing require contribution from both hemispheres. At one-year follow-up, outcome was excellent with respect to seizures and professional skills, meanwhile cognitive abilities improved. These findings indicate that IPP helps to predict who might be at risk for postoperative musical, language, and memory deficits after epilepsy surgery. Our research suggests that musical expertise and epilepsy critically modifies long-term memory processes and induces brain structural and functional plasticity.
Highlights
Neuroplasticity as a neural consequence of environmental enrichment or epileptic lesions has been previously reported in literature on human and comparative animal studies (Sutula, 2001, 2004; Elger et al, 2004; Rickard et al, 2005)
Using the Yasargil-selective amygdalohippocampectomy (SAH) technique (Yasargil et al, 1985), the results showed a significant improvement over time
Normal rates of execution were found for tests of attention/concentration such as Letter Cancellation Test, Trail Making Test A (TMTA), Trail Making Test B (TMTB) and Digit Symbol
Summary
Neuroplasticity as a neural consequence of environmental enrichment or epileptic lesions has been previously reported in literature on human and comparative animal studies (Sutula, 2001, 2004; Elger et al, 2004; Rickard et al, 2005). Experimental studies in chronic animal models support the viewpoint that recurring alterations in synaptic transmission triggered by seizures evolve into morphological reorganization of neurons and neural circuits, especially in the hippocampus, which leads to functional deficits and enhanced seizure susceptibility (Stafstrom and Sutula, 2005). TBI when she was 1 year old No 9 years old 6 years old 24 years On cluster/4–5 month Yes Trileptal, Keppra, Noiafren and Stilnox Normal Video EEG predominance interictal activity in left temporal lobe Video EEG ictal activity in left temporal lobe Reduction of left hippocampal size, with hypointensity and loss of internal differentiation Left anterior temporal lobe hypoperfusion. Resection of the anterior portion of the left hippocampus with preservation of the dorsal portion and tail Hippocampal sclerosis. Massive pyramidal cells loss in Ammon’s sectors (CA1 to CA4), astrocytosis and neuronal dispersion of dentate gyrus www.frontiersin.org
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