Retained absolute pitch after selective amygdalohippocampectomy

Area of Science:

• Neuroscience
• Neurosurgery
• Cognitive Science

Background:

• Drug-resistant temporal lobe epilepsy (TLE) poses significant challenges, necessitating surgical intervention.
• Preservation of unique cognitive functions, such as absolute pitch (AP), is critical in epilepsy surgery planning.
• Assessing the impact of selective amygdalohippocampectomy on language and music processing is essential.

Observation:

• A 21-year-old Japanese woman with drug-resistant right TLE underwent selective amygdalohippocampectomy.
• The patient achieved seizure freedom and retained her rare absolute pitch (AP) capability.
• Neuropsychological testing revealed preserved general cognitive function with improved attention/concentration.

Findings:

• Functional magnetic resonance imaging (fMRI) demonstrated significant alterations in brain activation patterns post-surgery.
• Preoperative music task activation involved bilateral frontal and temporal lobes; postoperative activation was localized to the left angular gyrus.
• Language task performance remained stable, but underlying functional organization shifted.

Implications:

• Selective amygdalohippocampectomy can be effective in achieving seizure control while preserving specialized cognitive functions like AP.
• Postoperative functional reorganization may underlie the successful preservation of music and language abilities.
• This case highlights the importance of individualized surgical approaches in TLE to protect critical cognitive domains.