---------- Biological Basis of Behavior ------ ----
---------- SPRING, 2005 ----------

                            
                            
                       BIOLOGICAL BASIS OF BEHAVIOR

Psychology 321                     	                   
Spring, 2005					HGH 225
Dr. John M. Morgan                 	MWF, 8am to 9:00                                                   


The Temporal Cortex 
Monica Wood
PJ Hall
Kathryn E. Martinez
Justin Clarke 
Kristen Kelly
Miranda Cook


Introduction
       The temporal cortex, also known as the temporal lobes, is 
the part of the verbal cortex in the left and right hemispheres 
of the brain lying inside the temples. In general the temporal 
lobes handle a wide variety of task that are essential to every 
day functioning. 
Temporal Lobe


Patient him/herself
Monica Wood

	The temporal lobes are readily recognizable brain 
structures with a thumb like appearance when viewed from the 
side.  Their name reflects their location beneath the temporal 
bone on the side of the head.  In some ways, the temporal lobes 
are more a convenient fiction than anatomical entities.  They 
share borders with the occipital and parietal lobes, but the 
precise boundaries are not clearly defined by landmarks.  A 
better definition of the anatomical limits of the temporal lobe 
would come from thalamic and intracortical projections and a 
functional analysis of the various subunits within the lobe.  
Because excision of the anterior temporal lobe is often used to 
help control medically intractable seizure disorders, much of 
our knowledge of the effects of damage to this area comes from 
studies of persons with epilepsy (Encyclopedia of the Human 
Brain).

	The functions of the temporal lobe are: auditory, ventral 
visual stream, processing of auditory input, visual object 
recognition and categorization, long term storage of sensory 
input, Amygdala (adds affective or emotional tone to sensory 
input and memories), and Hippocampus (cells code places in space 
and allow us to navigate space and remember where we are) 
(www.brain place.com/bp/brain system/temporal.asp).
	The temporal lobe is separated into two sides: dominate and 
non-dominate.  The dominate side of the temporal lobe is usually 
the left side and is involved in the perception of words, 
processing language related to sounds, sequential analysis, 
increased blood flow during speech perception, processing 
details, intermediate term memory, long term memory, auditory 
learning, retrieval of words, complex memories, and visual and 
auditory processing.  
	A patient who is experiencing dominant temporal lobe 
problems may be suffering from one or more of the following 
symptoms:  decreased verbal memory (words, lists, stories), 
difficulty placing words or pictures into discreet categories, 
trouble understanding the context of words, aggression; 
internally or externally driven, dark or violent thoughts, 
sensitivity to slights, mild paranoia, word finding problems, 
auditory processing problems, reading difficulties, as well as 
emotional instability (www.brain place.com/bp/brain 
system/temporal.asp).

	The non-dominate side of the temporal lobe is usually the 
right side and is involved in perception of melodies, 
pitch/prosody, social cues, reading facial expressions, 
increased blood flow during tonal memory, decoding vocal 
intonation, rhythm, and visual learning.  A patient who is 
experiencing non-dominate temporal lobe problems may be 
suffering from one or more of the following symptoms: difficulty 
recognizing facial expressions, difficulty decoding vocal 
intonation, implicated in social skill struggles, trouble 
processing music, decreased social cues/context, poor visual 
imagery, decreased selective attention to visual input, and 
decreased recall of nonverbal items-shapes, faces, tunes 
(www.brain place.com/bp/brain system/temporal.asp).
	
       Individuals with a temporal lobe tumor or lesion are often 
said to have a temporal lobe personality.  Aspects of this 
particular personality are that they may be more likely to have 
aggressive outbursts, overemphasis on trivia, pedantic speech, 
egocentric, preoccupation with religion (www.brain 
place.com/bp/brain system/temporal.asp).

	Research has found that emotional stability is heavily 
influenced by the dominant (left side) of the temporal lobe.  
Optimal activity in the temporal lobes enhances mood stability, 
while increased or decreased activity in this part of the brain 
leads to fluctuating, inconsistent or unpredictable moods and 
behaviors.  An individual who has a tumor or lesion on this side 
of the temporal lobe may be moody and often aggressive.  The 
following is an example of a patient who came to see a doctor 
because he was sure he had a temporal lobe problem:
	
       Blain, age 60, had memory problems and was moody and often 
aggressive.  Blain also frequently saw shadows out of the corner 
of his eyes and had an annoying “buzzing” sound in his ear, 
which his previous doctor could not find a cause for.  “The 
temper problems just seem to come out of the blue.  The littlest 
things seem to set me off.  Then I feel terribly guilty,” he 
said.  When Blain was 5 years old he fell off a porch headfirst 
into a pile of bricks.  As a schoolboy he had a terrible time 
learning to read and he frequently got into fights.  His brain 
SPECT study showed significant abnormalities in his left 
temporal lobe.  It was decreased in both the front and back of 
the temporal lobe and there was an area of increased activity 
deep within the left temporal lobe.  Seeing this abnormality, it 
was clear to the doctor that many of Blain’s problems came from 
the instability of his left temporal lobe, likely from his 
childhood accident.  Blain was placed on Depakote, an 
antiseizure medication known to stabilize activity in the 
temporal lobes.  When the doctor spoke with Blain three weeks 
later he was elated.  The buzzing and shadows went away and he 
had not lost his temper since he started the medication.  He 
said, “That was the first time in my life I can remember going 
three weeks and not screaming at someone.”  Four years later his 
temper remains under control  (www.brain place.com/bp/brain 
system/temporal.asp).
	
	In addition to aggression, individuals with a tumor or 
lesion on their left temporal lobe may be more sensitive to 
slights and even appear mildly paranoid. Unlike people with 
schizophrenia who can become frankly paranoid, temporal lobe 
dysfunction often causes a person to think others are talking 
about them or laughing at them when there is no evidence for it.  
This sensitivity can cause serious relations and work problems 
for the individual (www.brain place.com/bp/brain 
system/temporal.asp).
	
       Reading and language processing problems are also common 
when a tumor or lesion occurs on the left temporal lobe.  Being 
able to read in an efficient manner, remember what you read and 
integrate the new information relies heavily on the dominant 
temporal lobe.  This is an essential skill in the modern-day 
world and can cause sever distress for individuals who are 
unable to perform such tasks sufficiently (www.brain 
place.com/bp/brain system/temporal.asp).

	While a tumor or lesion on the left temporal lobe is more 
frequently associated with externally directed discomforts (such 
as anger, irritability and aggressiveness), a tumor or lesion on 
the right temporal lobe is likely to be associated with internal 
discomforts (such as anxiety and fearfulness) (www.brain 
place.com/bp/brain system/temporal.asp).
	
       An individual with a tumor or lesion on the non-dominate 
temporal lobe is likely to experience social skill trouble, 
especially in the areas of reading, recognizing facial 
expressions and recognizing voice intonations. The following 
illustrates the difficulties experienced by a patient who had a 
dysfunction in this part of the brain:
	
       Mike, age 30, came to see the doctor because he wanted a 
date.  He had never had a date in his life and was very 
frustrated by his inability to meet and successfully ask a  
woman on a date.  During the doctors evaluation Mike said he was 
at a loss as to what his problem was.  His mother, who was in 
the room at the time, had her own ideas as to Mike’s problem.  
“Mike“, she said, “misreads situations.  He has always done 
that.  Sometimes he comes on too strong, sometimes he is 
withdrawn when another person is interested.  He doesn’t read 
the sound of my voice right either.  I can be really mad at him 
and he doesn’t take me seriously.  Or he can think I’m mad, when 
I’m nowhere near mad.”  Mike’s SPECT showed marked decreased 
activity in his right temporal lobe; his left temporal lobe was 
fine.  The intervention that was most effective for Mike was 
intensive social skills training.  He worked with a psychologist 
who coached him on facial expressions, voice tones, and proper 
social etiquette.  He had his first date 6 months after coming 
to the clinic (www.brainplace.com/bp/brain system/temporal.asp).

	 A tumor or lesion on either or both temporal lobes can 
cause a wide variety of other symptoms for an individual as 
well, including: abnormal perceptions (sensory illusions), 
memory problems, feeling of déjà vu (that you have been 
somewhere before even though you haven‘t), jamais vu (not 
recognizing familiar places), periods of panic or fear for no 
particular reason, periods of confusion, and preoccupation with 
religious or moral issues.  Unexplained headaches and 
stomachaches also seem to be common in temporal lobe 
dysfunction.  Likewise, temporal lobe epilepsy is common in 
individuals who have a tumor or lesion on their temporal lobe  
(www.brain place.com/bp/brain system/temporal.asp).
	
       Temporal lobe epilepsy (TLE) is the most common cause of 
partial seizures and aura.  TLE often begins in childhood.  
Repeated TLE seizures can damage the hippocampus, a part of the 
brain that is important for memory and learning.  Although the 
damage progresses very slowly, it is important to treat TLE as 
early as possible.  Recurrent partial seizures are sometimes 
called psychomotor seizures.  The term “psychomotor” refer to 
the interaction between brain and muscle, and in this case 
refers to the twitches and hallucinations that characterize the 
seizure.  Some people who have partial seizures experience 
unusual sensations that warn them that they are about to have a 
seizure.  This premonitory state is called aura.  Aura takes 
several different forms: sometimes it is perceived as a sinking 
feeling in the pit of the stomach or a sense of “déjà vu”, 
sometimes it takes the form of an auditory hallucination, like 
an advertising jingle.  A person experiencing aura is having a 
simple partial seizure without losing consciousness 
(http://yourmedicalsource.com/library/epilepsy/EPI_kinds.html).

	A tumor or lesion on the temporal lobe is very serious and 
can cause severe health concerns.  It is important for 
individuals who are experiencing any of the before mentioned 
symptoms, for no obvious reason, to go see their physician.  
	
       For individuals who have a temporal lobe tumor or lesion 
and still attend school, the following are some learning hints 
to help alleviate the negative side effects of associated with 
the dysfunction:  In detail oriented classes sit on the left 
side of the classroom to process information with the right ear 
(information will go preferentially to the right ear and 
subsequently left hemisphere).  In creative or music classes sit 
on the right side of the classroom to process information with 
the left ear (information will go preferentially to the left ear 
and subsequently right hemisphere).  

References

Brain Function And Physiology. Retrieved: April 29, 2005. From: 
http://www.brainplace.com/bp/brainsystem/temporal.asp.

Buchtel, Henry A. (2002). Encyclopedia of the Human Brain. 
California: Academic Press.

Feldman, Robert S. (2005). Essentials of Understanding 
Psychology. New York: McGraw-Hill Co.

Kalat, James W. (2004). Biological Psychology. Canada: 
Wadsworth.

Psychological Sequelae: Postconcussion, Frontal Lobe, and 
Temporal Lobe Syndromes.  Retrieved:  May 2, 2005. From: 
http://calder.med.miami.edu/pointsis/tbiprov/NEUROPSYCHOLOGY/psy
ch1.html.

Speyrer, John A. Retrieved: May 2, 2005.  From: http://primal-
page.com/penfield.htm.

What are the Different Kinds of Epilepsy. Retrieved: May 2, 
2005. From: 
http://yourmedicalsource.com/library/epilepsy/EPI_kinds.html


Family Member Perspective
PJ Hall

	The temporal lobe has several functions. Among these 
functions are auditory, memory, and emotional tone to sensory 
input. In these ways temporal lobes allow us to not only hear, 
but to comprehend what we hear and put it in to the proper 
context to effectively remember. (Columbia Encyclopedia, 2005) 
Because of the functions of the temporal lobe, someone who 
suffers from damage to this area due to either a lesion or tumor 
can also suffer from a major change in personality. Drastic 
personality changes are one of the primary reasons it can be 
difficult to live with a family member who is experiencing 
temporal damage. One important role a family member of a person 
who suffers from temporal lobe lesions or tumors plays is 
helping the person recognize that there is a problem.

	 Recognizing that there is a problem can be achieved 
through understanding the various symptoms associate with 
temporal lobe damage. One major area of symptoms deals with the 
drastic personality changes.  The predominate symptom associated 
with personality changes experienced as a result of temporal 
damage is an extreme increase in aggression. Other symptoms of 
personality changes deal primarily with personal behavior, such 
as a change in sexual behavior, and a major shift in general 
personality as well as affective behavior. A second major group 
of symptoms associated with temporal damage is in the area of 
sensation and perception. These symptoms include different 
disorders of visual perception, difficulty perceiving auditory 
stimuli, and difficulty paying attention to visual and auditory 
stimuli. A final group of temporal lobe damage symptoms includes 
difficulty with long term memory, as well as problems with 
language comprehension and organization and categorization of 
verbal material. (“The Temporal Lobe,” 2005) Once symptoms have 
been recognized, a family member can assist in testing for 
damage.


Personality Changes

	As mentioned above, personality changes, particularly 
aggressiveness, are a major side effect of damage to the 
temporal lobes. Aggression can be described as “a form of 
behavior characterized by physical or verbal attack.” (Columbia 
Encyclopedia, 2005) This aggressiveness can be expressed either 
externally or internally. In other words, some patients with 
temporal lobe damage acts out physically towards other people, 
while some patients aggressiveness is directed at themselves, 
through harsh and violent thoughts or physically hurting 
themselves. (Amens, 2005) 

	Family members of those who suffer from temporal lobe 
damage due to lesions or tumors are primarily affected by the 
type of aggressiveness directed outward, toward others. One 
patient, a thirteen-year old girl named Denise, went to a 
neuroscience clinic and was found to have temporal lobe damage 
after she had pulled a knife on her mother, as well as having 
school problems. According to Dr. Amen, founder of the Amen’s 
Clinics, the type of aggression experience by Denise and others 
who direct their aggression outward is generally associated with 
damage to the right side of the temporal lobe. (Amens, 2005) 
Another case study of aggression as a result of temporal lobe 
damage is a five year old boy who suffered for twenty-two months 
before anyone could exactly pinpoint what was causing his 
behavior. Over the twenty-two month period the boy displayed his 
aggression through unprovoked screaming fits, and episodic 
attacks of rage and violence against other children. It wasn’t 
until the boy began complaining frequently about feeling his 
skin was on fire, and episodic nonsensical speech, did he 
receive a diagnoses of chronic sinus disease. Through treatment 
for his sinus diagnosis he received an MRI where doctors found a 
large mass on his right temporal lobe. (Nakaji, et. al, 2003)
	
	Although the family members of those with temporal damage 
that leads them to inward aggression may not have to deal with 
the outburst as described above, inward aggression is as, if not 
more, serious. Dr. Amen, reports that sixty-two percent of her 
temporal damage patients had suicidal thoughts or actions. 
(Amens, 2005)Along with inward aggressiveness, depression is 
also prevalent, which may help in explaining the high percentage 
of suicidal thoughts or actions as reported by Dr. Amen.  In 
general depression is characterized by those suffering as having 
feelings of despair and sadness, as well as a lack of interest 
in activities of previous enjoyment, for an extended period of 
time. (Weiten,p.437)Whatever the cause, having close contact 
with a person who suffers from depression is never easy. Many 
patients who suffer from depression have family members that 
report that although they have not physically lost their loved 
one, they feel as though they have because the depressed person 
lacks characteristics they had before the depression.(National 
Institute of Mental Health, 2000)



	Treatment is essential in the alleviation of both types of 
aggressiveness patients with temporal damage experience. One 
common treatment is Depakote. This drug is in the 
anticonvulsants drug class, specifically in the category of 
valproates. Depakote is a mood stabilizer that is generally 
given in the time-release capsule form and is known generically 
as divalproex sodium. The most common side effects of this drug 
are weight gain, menstrual changes hair loss, 
drowsiness/weakness, headache, tremors/shaking, and anemia. 
Other more serious side effects include difficulty breathing, 
hives/rashes, unusually bleeding or bruising, double vision or 
back-and-forth movement of the eyes, liver failure, and 
pancreatitis Aside from the major personality changes, such as 
those that lead to the use of Depakote, as mentioned above, 
temporal lesions or tumors can also result in major difficulties 
perceiving stimuli. (Micromedex, 2005)

Perceptual and Learning Changes 
	
	Language is one of the major areas of perceptual difficulty 
a person with a temporal tumor or lesion may experience. 
Depending on what side of the brain the temporal lobe containing 
the lesion/tumor is located, it can impact language differently. 
For instance, a person who suffers impairment on the right side 
of the temporal lobe may result in the loss of the ability to 
talk, while the left temporal lobe if damaged may result in 
difficulty recognizing words. (Amens, 2005) In general, the 
temporal lobe contains an area devoted to auditory processing, 
and when damaged can lead to aphasia. Aphasia is defined as “a 
sever impairment of language.”(Kalat, p.443) 

	The Wernicke’s area of the brain is believed to be strongly 
associated with language. This area is housed with in the left 
temporal lobe, and include part of the supramarginal gyrus, the 
angular gyrus,the superior temporal gyrus, and the middle 
temporal gyrus. (McPherson, 2005) When damage occurs to the 
temporal area containing Wernicke’s area, the patient having 
difficultly in comprehending speech, specifically in 
understanding spoken words. (Weiten, p.75) This condition is 
also sometimes called Wernicke’s aphasia, or fluent aphasia. 
Wernicke’s aphasia although still deals with the impairment of 
language, specifically is associated with the ability to 
continue to speak smoothly.  Wernicke’s aphasia also leads to 
the inability to comprehend language that is either read or 
heard. In addition, those with Wernicke’s aphasia have 
difficulty finding the proper words to use when speaking, and 
often make up names as substitutes for the names they cannot 
remember. (Kalat, p.443)

	Difficulty with language can have a profound impact on the 
family members of those who suffer from temporal lesions or 
tumors because it impairs the patient’s ability to communicate 
fully. Communication in general is an essential part of family 
functioning, and difficulties with communication can make daily 
interactions with the patient a major struggle. As a family 
member of someone with aphasia, it is important to recognize 
that outside support is available. The National Aphasia 
Association is one of the organization geared at helping those 
who suffer from aphasia as a result of brain injury. Essentially 
the National Aphasia Association, is a non-profit organization 
that’s goal is to educate the community about aphasia as well as 
research, rehabilitate and provide services to assist those with 
aphasia including their families.(National Aphasia Association, 
2005) One of the major resources created by the National Aphasia 
Association is a book they have created called The Aphasia 
Handbook, which is a guide for those who suffer from Aphasia. In 
addition to the handbook, the National Aphasia Association has a 
website available with a variety of other resources ranging from 
a pen-pal program so families of those with aphasia can 
communicate, to support groups, and even suggestions for helping 
diagnose aphasia.  

	Memory is another major area difficulty those who suffer 
from temporal lobe lesions/tumors experience. The type of memory 
most commonly affected by temporal lobe lesions or tumors is 
long term memory. Long term member is classified as memories of 
events that are not currently taking place, and that are from a 
previous time. (Kalat, p291) Problems with long term memory can 
be difficult for family members to cope with because like 
communication, it impacts the general functioning of the family. 
Different types of long-term memory impairment impacts the way a 
family copes with such difficulty.  How exactly memory is 
impaired as a result of a brain tumor/lesion to the temporal 
area is influenced by the specific area within the temporal 
cortex that is damaged.

	One of the major areas leading to memory problems when 
damaged is the hippocampus. The hippocampus is named for its 
shape, the sea horse, and is one of the oldest parts of he 
brain. (McPherson, 2005) Generally, the hippocampus is believed 
to contain cells that “code places in space and allow us to 
navigate space and remember where we are.” (Amens, 2005) 
However, how exactly the hippocampus contributes to memories is 
debatable, although multiple theories exist that attempt to 
explain the exact contribution of the hippocampus to the 
declaration and recall of memories. The data existing regarding 
patients, who have memory problems as a result of temporal lobe 
damage most, supports the Hippocampus and Declarative Memory 
hypothesis.  The Declarative Memory hypothesis, as its name 
suggests, holds that the hippocampus is essential for 
declarative memory, which contains memories that the patient 
conveys to others regarding specific instances that have 
previously occurred. This type of memory contains single events, 
and is known as episodic memory. (Kalat, p398) In addition, 
researchers believe that the hippocampus is linked with 
“encoding face-name associations, the encoding of events, and 
the recall of personal memories in response to smells,” and 
possibly even memory consolidation during sleep. (McPherson, 
2005)

	Coping with the challenges temporal lesions or tumors 
present can be difficult for any family. However, seeking help 
for problems that are being presented to the individual is only 
half the battle, and understanding the classic symptoms is 
essential in discovering, and eventually treatment of temporal 
damage. Dr. Amen from the Amen’s clinics understands the 
challenges of the diagnosis process and puts multiple screens in 
place to alleviate some of the difficulty associated with 
diagnosis. One of these screens is the way she gathers 
background information regarding previous experiences resulting 
in brain injury. According to Dr. Amen, many of the patients 
don’t even remember that they previously had suffered from brain 
injury, and therefore do not suspect they would have a brain 
tumor/lesion. (Amens, 2005) 
	

Works Cited 

Amens, Daniel (2005) The Temporal Lobes. Retrieved March 24, 
2005 from 
http://www.brainplace.com/bp/brainsystem/temporal.asp

Columbia Encyclopedia, Sixth Ed. (2005) 

Feldman, Robert S. (2005) Remembering: A Phenomenological Study. 
IN: Indiana University Press.

Gorfein, David S.; Hoffman, Robert R. (1987) Memory and 
Learning: The Ebbinghaus Centennial Conference. Hillsdale: 
Larence Erlbaum Associates, Inc. 


Human Memory. n.d.  Retrieved April 22, 2005, from 
http://www.cc.gatech.edu/classes/6751_97_winter/Topics/huma
n-cap/memory.html	

Kalat, James W. (2004) Biological Psychology.(8th ed.) Belmont: 
       Wadsworth 

McPherson, Fiona. (2005) About Memory. Retrieved April 3, 2005 
from http://www.memory-key.com/MemoryGuide/glossary-
brain.htm 

Micromedex Corp. (2005) Depakote. Retrieved on May 1, 2005 from 
http://www.drugs.com/depakote.html

Nakaji, Peter; et. al. (2003) Improvement of Aggressive and 
Anitsocial Behavior After Resection of Temporal Lobe Tumors 
[Electronic version]. Pediatrics, 121

National Institute of Mental Health (2000) Depression. Retrieved 
on May 4, 2005 from 
	http://www.nimh.nih.gov.punlicat.depression.cfm#ptdep1

The Temporal Lobe. N.D. Retrieved March 25, 2005 from 
       http://www.wfu.edu/users/perrtk2/temporallobepage.htm

Weiten, Wayne. (2002). Psychology: Themes and Variations. 
       (5th ed.) Belmont: Wadsworth 


Employer/Social Worker
Kathryn E. Martinez

Going Home after a brain tumor or lesion can be exciting, 
joyous, and fearful for the whole family. It can be hard to 
leave the security of your doctors and nurses, even though they 
are only a phone call away. Luckily social services can help 
homecoming along with the many laws protecting people with 
disabilities. 

Employment

The workforce includes many individuals with psychiatric 
disabilities who face employment discrimination because their 
disabilities are stigmatized or misunderstood.  Congress 
intended Title I of the Americans with Disabilities Act (ADA) 
(1990) to combat such employment discrimination as well as the 
myths, fears, and stereotypes upon which it is based. The Equal 
Employment Opportunity Commission ("EEOC" or 
"Commission")(2005)receives a large number of charges under the 
ADA alleging employment discrimination based on psychiatric 
disability. These charges raise a wide array of legal issues 
including, for example, whether an individual has a psychiatric 
disability as defined by the ADA and whether an employer may ask 
about an individual's psychiatric disability.  People with
psychiatric disabilities and employers also have posed numerous 
questions to the EEOC about this topic. The purpose of the ADA 
is to: (1) provide a clear and comprehensive national mandate 
for the elimination of discrimination against individuals with 
disabilities; (2) provide a clear, strong, consistent, 
enforceable standard addressing discrimination against 
individuals with disabilities; (3) ensure that the Federal 
Government plays a central role in enforcing the standards 
established in this chapter on behalf of individuals with 
disabilities; and (4) invoke the sweep of congressional 
authority, including the power to enforce the fourteenth 
amendment and to regulate commerce, in order to address the 
major areas of discrimination faced day to day by people with 
disabilities.

The first employment lawsuit filed under the Americans with 
Disabilities Act of 1990 (ADA) was on behalf of a brain tumor 
survivor. In July 1992, Charles L. Wessel, Executive Director of 
AIC Security Investigations, was fired with one day’s notice 
after telling his company he had inoperable brain metastases 
from lung cancer. The Chicago-based company’s owner told Mr. 
Wessel that his position had been eliminated. On November 5, 
1992, the EEOC filed this first federal ADA “test case” with 
their Chicago district office. The EEOC claimed Mr. Wessel was 
able to perform the essential functions of his role of executive 
director and that his firing violated Title I of the ADA. EEOC 
lawyers described the case as “a classic example of the type of 
discrimination” the ADA was intended to prevent. On March 18, 
1993, the Chicago jury awarded Mr. Wessel $22,000 in back pay, 
$50,000 in compensatory damages, $250,000 in punitive damages 
against AIC, and $250,000 in punitive damages against the 
company owner. The court later reduced the punitive damage 
awards the jury had made because they exceeded the amount 
allowed. 

Insurance

The Brain Tumor Foundation (2005) explains the employment issues 
faced by brain tumor patients in their article The Truth About 
Insurance Companies and HMOs. Insurance is based on a simple 
concept: the many help the few. The many employers pay premiums 
to the company which establishes a cash reserve. The cash 
reserves are used to settle claims from the few. There is an 
administrative cost and everything left over is profit. The goal 
of most health insurance companies is to make a profit. Profits 
are made by collecting more in insurance premiums than they pay 
out in administrative costs, dividends and, oh yes, the 
settlement of claims. Insurers look at money the employer has 
faithfully paid them in monthly premiums as their money, which 
they begrudgingly have to pay out from time to time to settle a 
claim. Patients expect good service from the doctor. Their 
employer has been paying for good service in the form of hefty 
insurance premiums each year while they've been healthy. 
However, delay on the payment of claims means that reserves 
drawing interest or earning money in investments can earn more 
money for just a little bit longer. Sometimes the "red tape" 
involved in getting a claim settled discourages the enrollee 
bringing the claim altogether. That's good news for the 
insurance company; it's one less claim they have to pay out. The 
longer the company can hold off paying a claim as it waits for 
further information, proper documentation, internal review by 
the "medical director", fee negotiations, computer glitch 
repairs, etc., the more interest the undisturbed capital 
reserves earn. The more paperwork an insurance company insists 
on having completed prior to processing a claim, the greater 
number of possibilities for claim payment delay or claim denial. 
Employers get sick and tired of paying what they consider to be 
huge premiums to insurance companies. These costs get passed on 
to employees and result in higher prices for their goods and 
services. Brain tumor and lesion patients expect health 
insurance from their employers. U.S. employers are "stuck". By 
subscribing to a Managed Care Plan, an employer can give the 
illusion of providing health insurance to employees while saving 
significant money. The employees won't know the difference until 
they get some serious disease. They then find out that one gets 
what one pays for.
	
School Issues

The Children’s Brain Tumor Foundation (2005) provides 
information on three main federal laws that may apply to 
children returning to school who have or had a brain tumor or 
lesion. The first is the Individuals With Disabilities Education 
Act (IDEA), which applies to all public schools and to children 
with specified disabilities or special needs. A child with a 
brain tumor might be classified as having “traumatic brain 
injury” or other health impairment, which adversely affect their 
performance. All children are entitled to an evaluation, 
resulting in an “Individualized Education Plan” (IEP), detailing 
the child’s needs and accommodations the school will make. The 
second is Section 504 of the Rehabilitation Act of 1973 (Section 
504). Section 504 applies to schools receiving federal funds, 
public or private. It prohibits discrimination against a child 
or individual with disabilities, and a child with special needs 
is entitled to appropriate education with accommodations. Early 
intervention programs entitle children up to age three, who are 
experiencing life threatening illness and treatments to free 
services such as physical and occupational therapy, speech 
therapy, and special instruction. The family may be entitled to 
services as well. Following assessment, the early intervention 
team will develop an Individualized Family Service Plan (IFSP) 
with the parent or guardian. The third is the American with 
Disabilities Act (ADA, passed in 1990. ADA is the most general 
of the federal laws. While it does not deal directly with 
schools or children’s educational needs, it may help in 
guaranteeing that a child gets the required support.  
	
The effects of a tumor or lesion may compromise cognitive and/or 
sensory functions, resulting in learning difficulties. Special 
education services may be appropriate for children whose 
treatment interferes with education and learning. Many children 
can continue to attend school while they are in treatment.  Some 
medical centers provide an “education team” who can help prepare 
the child’s class for the child’s return. Social workers working 
with the child and classmates can ensure that the child is 
treated as normally as possible.  They can also help educate 
teachers about the consequences or side effects of the child’s 
treatment and disease. The following accommodations in school 
may be needed: wheel chair accessibility for classroom and 
toilet facilities, special bathroom privileges, playground or 
gym exemptions or adaptations, opportunities to rest, classroom 
seating arrangements for hearing, vision or attention problems, 
homework and test modifications because extra time may be 
needed, and arrangements to take medications during the day.  

The Association of Oncology Social Work (AOSW)

Oncology social work is the primary professional discipline that 
provides psychosocial services to patients, families and 
significant others facing the impact of brain tumors or lesions. 
The Association of Oncology Social Work (AOSW) (2005) is a non-
profit, international organization dedicated to the enhancement 
of psychosocial services to people with brain tumors or lesions. 
Created in 1984 by social workers interested in oncology and by 
existing national cancer organizations, AOSW is an expanding 
force of psychosocial oncology professionals. The scope of 
oncology social work includes clinical practice, education, 
administration and research. The Masters in Social Work degree 
provides oncology social workers with theoretical knowledge, 
clinical expertise and practical experience with patients. In 
addition, oncology social workers often receive specialized 
training in cancer care through continuing education, in service 
training and on the job experience. The AOSW’s mission is to 
advance excellence in the psychosocial care of persons with 
tumors or lesions, their families, and caregivers through: 
networking, education, advocacy, research, and research 
development. 
Psychosocial services provided by oncology social workers 
include individual, family and group counseling, education, 
advocacy, discharge planning, case management and program 
development. These services are designed to maximize the 
patient's utilization of the health care system, foster coping, 
and mobilize community resources in order to support optimal 
functioning. Oncology social work services are available to 
patients and families throughout all phases of the continuum, 
including prevention, diagnosis, survivorship, terminal care, 
and bereavement. Services are delivered in a wide variety of 
settings including specialty cancer centers, general hospitals 
and health systems, ambulatory centers, home health and hospice 
programs, community based agencies, and private practice 
settings. Oncology social workers are an integral part of the 
health care team and contribute to the development and 
coordination of the overall treatment plan. In addition to 
services to patients and families, oncology social workers 
address organizational and community needs through professional 
practice. Services are provided to institutions, voluntary 
health organizations, and community agencies with the overall 
aim of promoting health and improving the delivery of care to 
individuals at risk for or affected by cancer.

Coping

There are many organizations for brain tumor patients and their 
families that provide up to date educational information about 
this multi faceted disease. One of the most beneficial programs 
of The Brain Tumor Society (2005) has been the one t one support 
provided to thousands of patients and their families. Through a 
toll free telephone line support is given to callers to help 
them make informed decisions about treatment and help them 
regain a sense of control, which is so often lost under the 
circumstances. Bereavement support, including information about 
the late stages of the illness, is available to families facing 
the loss of a loved one. Because long term survivors represent 
an ever growing number of The Brain Tumor Society’s callers, 
they have developed resources where none existed before, 
including long term survivorship stories in their newsletter, 
survivorship panels at their conferences, and articles 
addressing some of the ongoing and unresolved concerns of this 
group. 
	
The Brain Tumor Society (2005), American Brain Tumor Association 
(2005), Acoustic Neuroma Association (2005), and the Brain Tumor 
Foundation for Children Inc.(2005) to name a few all provide 
support groups. These groups address all the associated features 
of this life threatening disease and problems it may cause with 
memory, perception, behavior, personality, and overall health. 
Often, affected persons have played a pivotal family role. 
Sometimes the illness necessitates an immediate shift in family 
roles without allowing time for negotiation. Experience has 
shown that providing information and education, as well as 
psychological support and advocacy, helps patients and families 
cope with the ongoing situation. A group setting led by a social 
worker offers a ready made support network and furthers the 
chances that others will have shared one’s particular 
experience. For those who are currently homebound, alternatives 
to group meetings include patient/family telephone networks and 
computer-based support groups such as BRAINTMR or a chat room on 
the Internet.



References: 

(2005). Support Groups. Retrieved April 25, 2005, from 
	Acoustic Neuroma Association. http://www.anausa.org. 

(2005). Care And Support. Retrieved April 25, 2005, from 
	American Brain Tumor Association. http://www.abta.org.

(2005). Mission & Positions. Retrieved May 1, 2005, from 
Association Of Oncology Social Work. http://www.aosw.org. 

(2005). Support Programs. Retrieved April 25,2005, from 
Brain Tumor Foundation for Children, Inc. 
http://www.brfcgainc.org. 

(2005). School Issues. Retrieved April 25, 2005, from 
Children’s Brain Tumor Foundation. http://www.cbtf.org.

(2005). The Truth About Insurance Companies and HMOs. 
Retrieved May 3, 2005, from The Brain Tumor Foundation. 
http://www.braintumorfoundation.org. 

(2005). Employment and Financial Issues. Retrieved April 
25, 2005, from The Brain Tumor Society. 
http://www.tbts.org.

(2001). EEOC Enforcement Guidance on the Americans with 
Disabilities Act and Psychiatric Disabilities. Retrieved 
May 2, 2005, from U.S. Equal Employment Opportunity 
Comission. http://www.eeoc.gov. 



Justin Clarke
Perspective from a Neuropsychologist
Emphasis on the Temporal Lobe and its Effects on Language

   My paper has to due with the duties of a Neuropsychologists 
when examining damage or abnomalities to the Temporal lobe of 
the human brain and the various impairments that can happen to 
language.  The temporal lobe is a vital area of the brain for 
many of the humans abilities such as memory and auditory 
processing, an also language.  The neuropsychologist 
responsibility is for evaluating problems in this area when 
dealing with a client and implementing therapy solutions.  Also 
the duties of a neuropsychologist are in the aspects of research 
and developing tools to assist people with temporal lobe 
malfunctions and other areas of the body too.  This paper will 
delve into these functions of a neuropsychologist and how the 
practitioner uses these tools to assist people with the various 
afflictions that arise from problems in the human temporal lobe. 
   	
   A pivotal area of the temporal lobe and language comprehension 
is the Wernike’s area. When theirs damage to this section of the 
brain a condition related to language problems is known as 
Wernike’s Aphasia.  Aphasia is known as a severe language 
impairment but with this version the person is still able to 
speak fluently but are unable to comprehend written and spoken 
language. (Kalat, 2005)  The principal signs of aphasia are 
impairments in the ability to express oneself when speaking, 
trouble understanding speech, and difficulty with reading and 
writing. Aphasia is most often the result of stroke or head 
injury, but can also occur in other neurological disorders, such 
as brain tumor or Alzheimer's disease. The effects of aphasia 
differ from person to person, and can sometimes benefit from 
speech therapy. (Aphasia.org, 2005)  
   
	Neuropsychologists have extensive training in the anatomy, 
physiology, and pathology of the nervous system so when 
examining a patient with symptoms dealing with aphasia a battery 
of tests are performed.  Clinical neuropsychologists evaluate 
patients using one of three general methods. The first method is 
to use an assessment technique in which a fixed battery of tests 
is given and in which we only want to know what functions are 
impaired and what functions are not impaired.  The most commonly 
used representative of this type of test is the Halstead - 
Reitan Neuropsychological Battery. The second method is to use 
an assessment technique in which a fixed battery of tests is 
given but in this method there is a hierarchical arrangement of 
items within each subtest so that if a function is impaired, the 
level at which it is impaired can be determined. The most common 
representative of this type of test is the Luria - Nebraska. 
Common to both of these tests is a long history of research 
studies examining the ability of the two batteries to measure 
dysfunction of the brain and to accurately identify why that 
dysfunction is occurring. The third method used by 
neuropsychologists is the flexible battery approach. By 
definition, the flexible approach is not a battery because when 
one uses this approach one gives a group of tests allegedly 
picked for just the particular patient. (Appel, 2005) A 
neuropsychological evaluation is a comprehensive assessment of 
cognitive and behavioral functions using a set of standardized 
tests and procedures. Various mental functions are 
systematically tested, including, but not limited to: 
·	Intelligence 
·	Problem solving and conceptualization 
·	Planning and organization 
·	Attention, memory, and learning 
·	Language 
·	Academic skills 
·	Perceptual and motor abilities 
·	Emotions, behavior, and personality (Aphasia.org, 2005)

	In the Wierneke’s area problems with language related to 
Aphasia has been found to be most detrimental when the damage is 
focused on the left temporal lobe.  This side of the brain is 
highly correlated with language and comprehension, more so than 
its counterpart on the right side.  Right handed people process 
most basic language tasks in the left brain area, making recover 
of language effecting the left hemisphere more difficult for 
right-handed people.  One limitation to this idea is the exact 
definition of the Wierneke’s area, which is not as widely agreed 
upon as the Broca’s area.  The most common definition is the 
posterior third of the superior temporal gyrus is the location 
of the Wierneke’s area and the when damaged is the cause of 
Wierneke’s Aphasia.  However there is evidence that a lesion 
restricted to this area does not elicit permanent symptoms of 
Wierneke’s Aphasia, and that a wider lesion is needed. (Martin, 
2003)  Patients have been reported having symptoms of Wierneke’s 
Aphasia but the lesions are outside of the Wierneke’s area. 
(Martin, 2003)  

	There is little treatment by neuropsychologists in regards 
to aphasia.  The disorder can be treated using speech therapy, 
but it depends on the severity of the condition.  The 
neuropsychologist is really only responsible for diagnosing the 
problems or for coming up with methods for diagnosing and 
evaluating the various complexities of a disorder like aphasia.
 
	Neuropsychologists are responsible for evaluating aphasia, 
which is derived very commonly from people who have a stroke.  
Each year 3/4 of a million people suffer a temporary loss of 
blood flow to the brain, known as an ischemic stroke. 
(NewsRX.com, 2005)  This results in damage to the left temporal 
lobe and effects the person’s ability of speech and language.  
Many people recover the majority of their language abilities 
within six to twelve months of their recovery.  Not all aphasia 
diagnosis are a result of stroke, so in some cases recovery is 
not an option, and this can even be true with strokes too.

	Another predominate disorder treated by neuropsychologists 
is temporal lobe epilepsy.  A lesion known as the mesial 
temporal sclerosis is the most commonly found lesion with this 
disabilitating condition.  This lesion is associated with the 
severe and complicated febrile convulsions that are experienced 
with young children. (BMA, 2003)  I personally work with a young 
man who suffers from this disabilitating illness, and I see 
first hand the complications this condition has with his ability 
to process and articulate language.  Neuropsychologists monitor 
his frequency, severity, and the overall toll these seizures 
have on his health.  His speech has slowly deteriated over the 
years causing him to barely be able to utter complete sentences 
and to only be able to comprehend very simple commands and 
statements.  This illness has slowly stolen the ability for him 
to function on any substantial level of language and oratory 
skills.  The neuropsychologists in his case have been really 
unsuccessful in alleviating any of the symptoms of the 
continually compounding illness.
	
	There have been devices devised by neuropsychologists and 
other professionals. The tool that they used on my cohort was a 
implant in his chest that signaled and stimulated an implant in 
his temporal lobe to help circumvent the buildup of tension or 
electrical causes that elicit a seizure.  The neuropsychologists 
are responsible for monitoring its effects and maintaining the 
rate of activation (which stimulates him at a certain rate).  
However with my client’s condition and the condition of many 
others, there is only so much that a professional can due with 
illnesses that affect people’s temporal lobe and other areas of 
the brain.  Unfortunately my client’s condition has not improved 
from the help of these professionals, and treatments for him are 
almost to a stand still or non-existent.
	


Works Cited

Aphasia.org  (2005).  Introduction to Aphasia.  Retrieved May 
2,2005. From Aphasia.org.

Appel, A.  (1997) What is a Neuropsychologist.  Retrieved April 
23, 2005.  From tbidoc.com.
	 
British Medical Association.  (2003). Mesial temporal sclerosis 
lobe epilepsy. Retrieved April 24, 2005. From
WWW.info-trac.com.

Kalat, J. (2004). Biological Psychology. 8Th edition, Chapter 
15.3.	
 	
Martin, R.C.  (2003).  Language processing: functional 
organization and neuroanatomical.  Annual Review of Psychology. 
Annual 2003 p55(35). 

NewsRX.  (2001).  Area of Language Recovery in Brain Imaged.  
Pain & Central Nervous System Week.  Jan 13, 2001 p14.


Kristen Kelley
The Neurologist

       Language is a vital part of both verbal and non-verbal 
communication. Each of us uses language everyday in a variety of 
ways. When our language skills are in jeopardy, it can affect 
our entire lives. The consequences of a loss of language can be 
more restricting then that of loss of sight or hearing. 
Communication is a matter of survival and independence, without 
it ones life will change drastically. 

       There is almost complete agreement that there are four main 
language areas in the left cerebral hemisphere of most people. 
Two of these areas are considered receptive while the other two 
carry out the actual task. These two receptive areas take on 
very different tasks, one involving the perception of written 
language and the other of spoken language. The area that helps 
to regulate written language is located in the angular gyrus, 
while the other occupies the Heschl’s gyri. 

       Although language and speech are usually considered 
synonymous functions, this is not the case in all aspects of 
their roles. Unlike an impairment of speech, language impairment 
always occurs due to an abnormality of the cerebral hemisphere. 
Speech on the other hand may be effected by the same sort of 
abnormality but it also can be effected by damage to other parts 
of the brain.

       Loss of communication and language can be a result of 
damage to the temporal lobe of the brain. The type of language 
loss is dependent of what specific area of the temporal lobe has 
been damaged. Possible types of damage to the brain can be a 
lesion or a tumor. It is the job of the neurologist to locate 
the area of damage and to assess the level of impairment. 
Neurologist use a variety of test to asses the possible damage 
to the brain or spinal cord including CAT scans, Magnetic 
Resonance Imaging (MRI) and a wide variety of functional, skill 
assessments. One of the most popular verbal memory assessments 
used in the field is the Wechsler Memory Scale, the most 
recently revised version has been a useful tool for neurologist 
to determine severity and location of the temporal damage.

       One of the first signs of a lesion to the temporal lobe is 
a change in behavior. Behavior changes can vary dependant on the 
injured area. When the change in behavior is analyzed in 
conjunction with skill assessments the Neurologist can make 
rather accurate predictions about the area of the temporal lobe 
that is effected by a lesion.

       When the Anterior Temporal Lobe has been injured, very 
specific behaviors are prevalent in the patient. Such behaviors 
are auditory memory disturbance, auditory and/or visual 
hallucinations and difficulty with short-term auditory memory. A 
neurologist is also able to pin point possible points of injury 
in the anterior temporal lobe by specific behavior changes. For 
instance, if the left side of the anterior is damaged the 
patient may display difficulty with the learning and retention 
of verbal material presented to them. This same patient though 
will be able to retain information about places, faces and 
melodies. Impairment of these skills are an indication of a 
lesion on the right anterior temporal lobe. Neurologist will 
also seek out information regarding the patients recent social 
judgement, and conduct memory assessments verbally, visually and 
auditory to make a proper assessment.

       Since the temporal lobes are involved in the primary 
organization of sensory input (Read, 1981) individuals with 
temporal lobes lesions may have a difficult time placing words 
or pictures into their correct categories.
       Frequently temporal lobe lesions also effect ones verbal 
language. Left temporal lesions impair recognition of words 
while right temporal damage can cause a loss of verbal skills 
and verbal cognition. While visual impairments are also noticed 
the diminished verbal skills are more common. 

       Middle temporal lobe lesions will show different changes in 
ones behavior and language memory as well as use. When a patient 
suffers a middle temporal lesion, they are still able to 
comprehend individual words, but have a very difficult time 
retaining two or more at a time. In addition, patients suffering 
from a lesion in this area of the temporal lobe cannot retain 
series of syllables or words. The above disorder is called 
Acoustico-mnestic disorder.  In mild cases of mid-temporal 
lesions, the patient suffering may be able to retain elements of 
word series but not remember what order they belong. For all 
patients stressful situations cause a further difficulty with 
reproduction of word and word series. Phonemic learning is an 
area of language not effected by mid-temporal damage.

       One of the most important discoveries in the understanding 
of the behavior changes associated with temporal lobe lesions 
was Carl Wernickes aphasia. The aphasia syndrome discovered by 
Wernicke in the early nineteen hundreds was a huge breakthrough 
for neuroscience. As Wernicke explained, the aphasia syndrome, 
which is caused by a lesion to the now called Wernicke area, 
will cause dramatic behavior changes pertaining to language in 
patients. The Wernicke area is located right at the tempro-
parietal junction, which is where the temporal lobe and the 
parietal lobe join. 

       The aphasia syndrome consists of much impairment of both 
verbal and now verbal language. Not only is the verbal aspect 
impaired but the comprehension of language has also been 
effected. A neurologist will notice impairments of comprehension 
of spoken language meaning that the patient will have a 
difficult time understanding what is being said in his or her 
surrounding, or even directly to them. Other compromised skill 
would be that of reading silently and writing. 

       A lesion in this area of the temporal lobe also impairs 
articulate speech. The affected persons may speak fluently with 
a natural language rhythm, but the result has neither 
understandable meaning nor syntax. A way to assess this skill 
would be simply to ask the patient to describe a picture they 
are given. The patient will quickly be able to start verbalizing 
but the context of their words will not be applicable to the 
situation. Despite the loss of comprehension, the word memory is 
preserved and words are frequently chosen correctly. 

       Another result of a lesion to Wernickes area that has been 
noticed in some patients is euphoria and/or paranoia. This 
specific aspect of the disorder can be attributed to a cortical 
lesion in the posterior portion of the left first temporal 
convolution.

       Any damage to the temporal lobe will carry with it a high 
probability of diminished language and memory skills. Each 
patient will display behavior changes that will lead to a change 
in lifestyle and both verbal language as well as comprehension. 
Lesions to different area of the brain will effect each patient 
differently. Some again may show very few verbal skills after a 
lesion has occurred while others are able to speak freely but 
with little of it being coherent. The temporal lobe is a very 
vital part to our communication and any damage to it is life 
altering.


Works Cited 

Read, D. (1981) Solving deductive-reasoning problems after 
unilateral temporal lobectomy. Brain and Language.


Milner, B. (1968) Visual recognition and recall after right 
temporal lobe excision in man. Neuropsychologia


Queensland Health
www.health.qld.gov.au


Long, CJ  Neuropsychology and Behavioral Neuroscience
www.neuro.psyc.memphis.edu/neuropsyc


Kalat,J.W.(1998) Biological Psychology 
Sixth Edition, Brooks Cole Publishing


Miranda Cook
The Neurosurgeon

       The temporal lobe comprises all the tissue that lies below 
the Sylvian fissure and anterior to the occipital and parietal 
cortex.  The temporal regions can be divided on the lateral 
surface into those that are auditory (Brodmann’s area) and those 
that form the ventral visual stream on the lateral temporal 
lobe.  The visual regions are referred to as either 
inferotemporal cortex or by von Bonin and Bailey’s designation, 
TE. The sulci of the temporal lobe contains most of the cortex.   
The superior temporal sulcus (STS) which separates the superior 
and middle temporal gyri can be divided into many sub regions.  
It receives input from auditory, visual, and somatic regions as 
well as the frontal and parietal regions and the paralimbic 
cortex.  The medial temporal region includes the hippocampus 
(and surrounding cortex) and the fusiform gyrus.  The posterior 
end of the temporal lobe is referred to as the parahippocampal 
cortex and includes areas known as TH and TF.  The fusiform 
gyrus and interior temporal gyrus are part of the lateral 
temporal cortex.  The uncus refers to the anterior extension of 
the hippocampus.  The hippocampus, as well as the amygdala, are 
buried deep within the temporal lobe.
       
       The temporal lobes have many internal connections which 
project to the sensory systems, to the parietal and frontal 
regions, to the limbic system, and to the basal ganglia.  The 
neocortex of the left and right lobes is connected to the 
archicortex.  Studies have demonstrated four projection pathways 
of information in the temporal lobe which each form separate 
functions.  First, auditory and visual information processes 
from the primary regions ending in the temporal pole form the 
ventral stream of visual processing.  Its function is thought to 
be stimulus recognition. Second, auditory, visual, and somatic 
project into the superior temporal sulcus whose function is 
stimulus categorization.  Third, auditory and visual information 
is projected to the medial temporal regions including the 
hippocampus (called the preforant pathway) and the amygdale.  
This pathway is crucial to long term memory.  Fourth auditory 
and visual information goes to the area of the frontal lobe 
which is necessary for various aspects of movement, control, 
short term memory, and affect.
       
       Three basic functions of the temporal cortex are known: the 
processing of auditory input, visual object recognition, and 
long-term memory storage of sensory input.  This implies that 
damage to the temporal cortex leads to deficits in identifying 
and categorizing stimuli.  The amydgala functions to exhibit 
affective response such as associating positive, negative, or 
neutral stimuli.  The hippocampus functions to allow us to 
navigate space and remember where we are.  Considering these 
functions of the temporal lobe, the loss of these functions 
would have devastating consequences for behavior.  
       
       Temporal damage causes eight different symptoms associated 
with different parts of the temporal lobe:  (1) damage to 
Brodmann’s Areas causes disturbance of auditory sensation and 
perception, (2) damage to Areas TE and STS cause disturbance of 
selective attention of auditory and visual input, (3) damage to 
Areas TE, STS, and amygdale cause disorders of visual 
perception, (4) damage to TE and STS cause impaired organization 
and categorization of verbal material, (5) damage to Brodmann’s 
area 22 cause disturbance of language comprehension, (6) damage 
to areas TE, TF, TH, and Brodmann’s area 28 cause impaired long-
term memory and amnesia, (7) damage to TE and amygdale cause 
altered personality and behavior, and (8) damage to amygdala 
(plus other unknown areas) cause altered sexual behavior.
       
       Studies done by Milner and her colleagues show specific 
effects of the left and right temporal lobes which revealed that 
specific memory defects vary according to the side the lesion is 
on.  Damage to the left temporal lobe is associated with 
deficits in verbal memory such as processing speech sounds and 
damage to the right temporal lobe is associated with deficits in 
nonverbal such as processing music.  In addition the left and 
right temporal lobes are associated with behavior.  Observations 
show that left and right temporal lobe lesions appear to have 
different effects on personality and that only right temporal 
lesions lead to impairments in interpretations of facial 
expressions. 

       In reviewing studies, bilateral temporal lobe removal 
produces more dramatic effects than unilateral temporal lobotomy 
which shows that although the temporal lobes have different 
functions, they often overlap.
       
       Sometimes neurosurgeons perform a temporal lobotomy to 
intentionally remove parts of the temporal cortex for patients 
with medically intractable epilepsy. Epilepsy is defined as a 
condition of recurrent seizures.  Patients with temporal lobe 
epilepsy require surgical resection of a lesion in the temporal 
lobe. The goal of temporal epilepsy surgery is to identify an 
abnormal area and remove it without causing any significant 
functional impairment.  
       
       A variety of strategies are used to optimize surgical 
resection while minimizing risk of injury to functional cortex.  
Magnetic resonance imaging (MRI) can detect abnormalities of the 
brain with exceptional anatomical detail by creating a model of 
an individual's brain. The use of an electroencephalograph (EEG) 
can provide evidence of focal electrical dysfunction.  For 
example, intracerebral depth electrodes can be placed through 
small holes in the skull and secured with some form of cranial 
fixation.  Electrodes are targeted towards the amygdala or 
hippocampus and can locate a focal area of seizure. 
Neuropsychological testing and psychosocial assessment along 
with the MRI and EEG provide the most favorable results for 
patients
       
       The typical temporal lobectomy always includes the anterior 
temporal cortex, and, in some neurosurgeries, the amygdala and 
varying amounts of the hippocampus and parahippocampal gyrus are 
also removed.  The extent of excision from the hippocampal 
region is often individually based either because of the 
presence of documented abnormalities or because of the risk of 
memory damage.  The severity of memory deficits is dependent 
upon how much of the hippocampus region in removed.  Such 
decisions are based on the surgeon’s drawings and report at the 
time of the operation. 
       
       Precise identification of anatomy allows the surgeon to 
navigate to the amygdala, hippocampus, or gyrus.  The amygdala 
projects into the anterior aspect of the temporal and is 
connected to the hippocampus. Careful dissection of the amygdala 
will avoid postoperative memory deficits. The amygdala is not 
well defined because it blends with the white matter.  The 
amygdala has a grayish hue and care must be taken in resecting 
lesions in the superior portion. The hippocampus can be easily 
distinguished from the other structures by its shiny white 
color.  
       
       The use of neurosurgical navigational systems is becoming 
more popular as the technology advances.  These systems are 
especially helpful in the resection of deep-seated lesions.  
Anatomical landmarks are used to guide dissection to the 
location of interest.  The advantage is that resection of 
temporal neocortex is not necessary. The pathway to the temporal 
structures through this approach is relatively straight and 
short, with minimal dissection. 
       
       The majority of temporal lobectomies are safely performed 
under general anesthesia.   The patient is positioned on the 
operating table with the head fixed by a three-point Mayfield 
holder.  A skin incision is made behind the hair line.  Temporal 
lobe removals usually extend back 4.5 - 5 cm. but can extend 
beyond 7 or 8 cm.  
       
       Much research has been done on the temporal lobes in 
relation to memory and seizures including the famous 
observations in the 1950’s of the patient known as H.M. who had 
undergone bilateral medial temporal lobe removal to treat severe 
epileptic seizures.  The resection extended 8 cm along the 
medial surface of both temporal lobes, destroying the amygdala, 
the uncus, and the anterior two-thirds of the hippocampus and 
the parahippocampal gyrus, but spared the lateral neocortex.  
H.M.’s surgery was successful in treating his seizures but 
manifested severe anterograde and retrograde amnesia.
       
       More recent clinical data shows that lesional surgery for 
the treatment of temporal lobe epilepsy is less detrimental.  
With modern imaging techniques, surgery in the temporal lobe 
offers well to excellent results in 75 - 85% of the cases and 
seizure free rates are now approaching 90%.  A few examples are 
worth noting:
       
       A patient suffering from seizures showed a small lesion of 
the left parahippocampal gyrus. The seizures caused the 
inability to speak. A left temporal craniotomy was performed for 
resection of the lesions. Postoperative imaging documented 
complete removal of the lesions. Eighteen months after the 
operation, the patient remained seizure free with the help of 
medication. 
       
       A patient had seizure disorder as well as paresis.  Imaging 
of the head revealed two lesions, one in the left gyrus and one 
in the right frontal gyrus. The patient underwent a temporal 
craniotomy for resection of the lesions. Postoperative MR 
imaging demonstrated removal of both lesions. The paresis 
improved with physical therapy and after radiation therapy the 
follow-up MR imaging showed no evidence of disease in the brain. 
At his 6-month follow-up examination, the patient was seizure 
free. 
       
       A patient had relieved chemotherapy for cancer and soon 
after developed memory loss. Imaging of the brain showed two 
large lesions in the right temporal lobe.  A right temporal 
craniotomy was performed for resection of the two lesions. 
Postoperative MR imaging showed removal of both lesions however 
she died of a hemorrhage 3 months after the surgery. 
       
       The two reasons for surgical treatment of epilepsy are to 
abolish the seizures and to entirely remove the lesion for a 
maximal therapeutic benefit. There is major controversy in 
lesional epilepsy surgery whether just removing the lesion 
(lesionectomy) is adequate to achieve these goals or if surgical 
removal of the lesion as well as the identification and 
resection of surrounding cortex (lesionectomy plus corticectomy) 
provides better seizure control. 
       
       The long-standing debate over lesionectomy versus 
lesionectomy plus corticectomy began with the observation that 
many patients do become seizure free or have a dramatic 
reduction in seizures after simple excision of a structural 
cortical lesion. The patient may be cured of seizures even 
though scalp EEG abnormalities remain. These observations 
suggest that a structural lesion does not necessarily result in 
permanent changes in the surrounding cortex and that 
lesionectomy alone may be able to reverse the epileptic 
condition in certain cases. On the other hand, there are cases 
where resection of the lesion alone without removal of the 
functionally independent epileptogenic cortex would result in a 
surgical failure. 
       
       One alternative surgical approach is to suggest that 
patients with lesional epilepsy should undergo resection of the 
structural lesion after appropriate non-invasive presurgical 
evaluation. In many instances, 70 to 80% of patients will remain 
seizure free after surgery. If the seizures persist after 
lesionectomy, then a more detailed and comprehensive evaluation 
could be undertaken with intracerebral electrodes. This approach 
would minimize the expense and risk of invasive intracranial 
monitoring in all patients and seems a cost-efficient and 
effective compromise.


Bibliography

Handbook of Clinical Neurology
Elsevier Science Publishers 1985

Neuropsychological Assessment
Muriel Deutsch Lezak
Oxford University Press 1995

Research Publications of the Association for Research in Nervous 
and Mental Disease
B. Milner, 1958

Location and Neuroimaging in Neuropsychology
Andrew Kertez (Editor)
Dept. of Clinical Neurological Sciences, Canada
Academic Press 1985

Neuropsychology
Stuart J. Dimond, BSC, MA, PhD
University College, Cardiff, Wales, UK
Butterworth & Co. 1980

Surgical Treatment of Epilespy
G. Rees Cosgrove, M.D., F.R.C.S.(C) and Andrew J. Cole M.D., 
FRCP(C) 
Departments of Neurology and Neurosurgery, Massachusetts General 
Hospital Epilepsy Center, Harvard Medical School, Boston, 
Massachusetts 

American Assoication of Neurological Surgeons
www.NeurosurgeryToday.org

Congress of the Neurobiological Surgeons
www.neurosurgeon.org


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