Reading skills after left anterior temporal lobe resection: an fMRI study

Maintaining language functions after left hemisphere lesions has been associated with compensatory right hemisphere activation. It remains unclear whether recruitment of right hemisphere regions necessarily provides an effective mechanism to compensate for language deficits. To investigate the compensatory mechanisms that mediate good reading skills in patients after left anterior temporal lobe resection for mesial temporal lobe epilepsy (mTLE), we tested for the effect of their reading ability on the regional fMRI (functional MRI) signal elicited by sentence reading. Sixteen control subjects and 16 patients participated in the study. In the activation condition, they silently read nine-word sentences, and in the baseline condition they viewed nine-word sentences after all the letters were transformed into false fonts. Reading ability in controls and patients significantly (P < 0.05, corrected) predicted activations in a left hemisphere middle temporal region that was part of the normal sentence reading system. In addition, reading ability in patients, but not controls, significantly predicted activation in the right inferior frontal sulcus, right hippocampus and right inferior temporal sulcus. Right inferior frontal activation was only observed in the patients. In contrast, right hippocampal and inferior temporal activation was observed in all controls and in patients whose reading ability was within the normal range, indicating the importance of these regions for efficient encoding during normal sentence reading. We conclude that proficient reading skills following left anterior temporal lobe resection for mTLE rely on two mechanisms: (i) integrating regions from the normal system (i.e. the left middle temporal, right hippocampus and anterior superior temporal sulcus); and (ii) recruiting right hemisphere regions (i.e. the right inferior frontal sulcus) that are not activated in control subjects.