Word-finding deficits persist after left anterotemporal lobectomy

J. T. Langfitt and R. Rausch
Department of Neurology, University of Rochester, NY, USA.

OBJECTIVE: To determine the incidence and extent of exacerbation of word-finding difficulty following anterotemporal lobectomy and to identify predictors of change. DESIGN: Case-series study of qualitative and quantitative changes in confrontation naming ability before surgery and 1 year after surgery. Stepwise multiple regression analysis of predictors of postoperative naming change. SETTING: A university epilepsy surgery program. PARTICIPANTS: Fifty-nine consecutive patients. INTERVENTION: Standard, en bloc anterotemporal lobectomy. MAIN OUTCOME MEASURE: Raw scores and types of errors on the 85-item Boston Naming Test. RESULTS: A significant exacerbation of word-finding difficulty was noted that persisted at least 1 year after surgery in 25% of patients with left, speech-dominant anterotemporal lobectomy (Laterality x Time interaction [F = 24.5; P < .0005]). "Tip-of-the-tongue"-type errors were most frequent (F = 54.66; P < .001), as opposed to paraphasic-type errors seen more frequently among patients with aphasia or dementia. Word-finding decline was worse among patients who underwent a left anterotemporal lobectomy and who were left-hemisphere speech dominant, older, or evaluated earlier in the postoperative course. CONCLUSIONS: Significant, persisting worsening of word-finding difficulties is not a rare consequence of a left anterotemporal lobectomy, as suggested by previous studies. Differences between these results and those of previous studies may reflect differences in extent of surgical resection and/or differential sensitivity of psychometric measures of naming to word-finding problems. Information regarding extent, frequency, and predictors of word-finding declines may be used in counseling surgical candidates about the potential cognitive side effects of anterotemporal lobectomy.