Slide Slam G15
Anomia rehabilitation in drug-resistant left temporal lobe epileptic patients using a single case Experimental Design (SCED)
Véronique sabadell1,2, Agnès Trébuchon1, F.-Xavier Alario2; 1Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France, 2Aix Marseille Univ, CNRS, LPC, Marseille, France
Introduction: Around 40% of patients who undergo a left temporal lobe epilepsy (LTLE) surgery suffer from anomia (i.e., word-finding difficulties), a condition that negatively impacts quality of life (Miller et al., 2019). Word finding difficulties could result from perturbations of the semantic or the phonological systems (Miozzo et Hamberger, 2015 ; Campo et al., 2014). These two cognitive loci have been linked to the functional organization of the temporal lobe (Hamberger et al., 2016; Miozzo et al., 2016). Despite these observations, cognitive rehabilitation programs are still understudied in this population. The available literature reports some rehabilitation programs for verbal memory or attention (Farina et al., 2015; Joplin et al., 2018) whereas language rehabilitation has been poorly and rarely described (Mazur et al., 2015). Method: We used a Single Case Experimental Design (SCED; Krasny-Pacini et Evans, 2018 ; Perdices et al., 2019) to assess the effect of an intensive speech therapy rehabilitation in 4 drug-resistant temporal lobe epilepsy patients. The anomia rehabilitation protocol we developed was based on cognitive descriptions of the word finding deficit in temporal lobe epilepsy, clinical research regarding success factors in anomia rehabilitation in cerebro-vascular aphasia (Jacquemot et al., 2012), and consideration of other psychological features such as stress (Neumann, 2018). We enforced a double rehabilitation strategy, combining both semantic and phonological intensive training with a psycho-education approach to help patients coping with their daily communication issues. We repeatedly assessed word finding abilities for trained and untrained words, before and during the therapy using a multiple baseline design. Three patients entered concurrently in the hospital protocol while the fourth patient benefited from a later self-rehabilitation protocol, inspired by the previous ones and supervised by a private speech therapist. Results: All patients completed the rehabilitation procedure successfully. Visual and statistical analysis converged on a positive effect of the intervention on naming skills. Patients improved specifically for trained words but also for untrained words during the therapy, suggesting some generalization effects. However, the rehabilitation did not have clear positive effects on naming speed. The patient who benefited from self-rehabilitation responded similarly as the first three patients despite a different context and manner of intervention. Discussion: These left temporal lobe epilepsy patients benefited from an intensive targeted anomia rehabilitation protocol. Nevertheless, we found no relation between naming improvement and changes in anomia complaint. A negative impact of seizures was suspected because of a brief decrease of naming performance following the crisis. In patient 4, the procedure was adapted as a self-rehabilitation procedure that showed similar positive effects. These results open promising avenues for helping epileptic patients suffering from anomia. References : Campo et al., 2016, Brain Structure and Function, https://doi.org/10.1007/s00429-014-0919-1; Farina et al., 2015, Epilepsy research, https://doi.org/10.1016/j.eplepsyres.2014.10.017; Joplin et al., 2018, Neuropsychology review, https://doi.org/10.1007/s11065-018-9367-7; Hamberger et al., 2016, Epilepsy&Behavior, https://doi.org/10.1016/j.yebeh.2016.04.021; Mazur et al., 2015, Epilepsia, https://doi.org/10.1111/epi.12963; Miller et al., 2019, Epilepsy&Behavior, https://doi.org/10.1016/j.yebeh.2019.106484; Miozzo et Hamberger, 2015, Neuropsychology, https://doi.org/10.1037/neu0000097; Miozzo et al., 2017, Human brain mapping, https://onlinelibrary.wiley.com/doi/epdf/10.1002/hbm.23409; Neumann, 2018, Clinical Linguistics&phonetics, https://doi.org/10.1080/02699206.2017.1326166; Perdices et al., 2019, Behavior Modification, https://doi.org/10.1177/0145445519863035.