Changes in singing performance and fMRI activation following right temporal lobe surgery

Abstract

Introduction: This study arose in the context of having to estimate risk to the musical abilities of a trained singer (patient A.M.) recommended for right anterior temporal lobectomy (RATL) to ameliorate medically intractable seizures. To date there has been no systematic investigation of reorganisation of musical functions in the presence of epileptogenic lesions, although it is well established that RATL can impair pitch processing in nonmusicians.

Methods: Using fMRI, we compared the network activated by covert singing with lyrics in A.M. before and after surgery, while taking language activation and singing expertise into consideration. Before surgery, A.M. showed lower pitch accuracy of singing relative to individuals of similar experience (experts), thus we compared her to 12 healthy controls matched for singing pitch accuracy.

Results: We found atypical organisation of A.M.'s singing network before surgery in the presence of a malformation of cortical development, including partial activation of the singing network of pitch-matched controls, and diffuse activation along the midline spreading laterally into association cortex, typical of generalised cortical hyperexcitability in intractable epilepsy. After tailored RATL, A.M. showed striking behavioural and neuroimaging changes, including significant improvement in pitch accuracy of singing relative to controls (p = .026) and the subjective experience of being a more technically proficient singer. This was accompanied by a significant reduction in cortical activation (p < .05, corrected), with a more focal, expert-like pattern of singing activation emerging, including decreased involvement of frontal language regions. These changes were largely specific to singing, with A.M. showing language activation and performance similar to controls.

Conclusions: This case provides evidence for selective disruption of the singing network that reorganised after successful resection of an epileptogenic lesion and likely occurred through decoupling of the singing and language networks.

Keywords: Epilepsy surgery; Language; Outcome; Singing; fMRI.