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Temporal and extratemporal reorganization of memory functions is described in functional magnetic resonance imaging (fMRI) studies. Functional reorganizations have been shown at the local activation level, but network\u2010level alterations have been underinvestigated. We aim to investigate the functional anatomy of memory networks using memory fMRI and determine how this relates to memory function in TLE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ninety patients with unilateral TLE (43 left) and 29 controls performed a memory\u2010encoding fMRI paradigm of faces and words with subsequent out\u2010of\u2010scanner recognition test. Subsequent memory event\u2010related contrasts of words and faces remembered were generated. Psychophysiological interaction analysis investigated task\u2010associated changes in functional connectivity seeding from the mesial temporal lobes (MTLs). Correlations between changes in functional connectivity and clinical memory scores, epilepsy duration, age at epilepsy onset, and seizure frequency were investigated, and between connectivity supportive of better memory and disease burden. Connectivity differences between controls and TLE, and between TLE with and without hippocampal sclerosis, were explored using these confounds as regressors of no interest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to controls, TLE patients showed widespread decreased connectivity between bilateral MTLs and frontal lobes, and increased local connectivity between the anterior MTLs bilaterally. Increased intrinsic connectivity within the bilateral MTLs correlated with better out\u2010of\u2010scanner memory performance in both left and right TLE. Longer epilepsy duration and higher seizure frequency were associated with decreased connectivity between bilateral MTLs and left\/right orbitofrontal cortex (OFC) and insula, connections supportive of memory functions. TLE due to hippocampal sclerosis was associated with greater connectivity disruption within the MTL and extratemporally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Connectivity analyses showed that TLE is associated with temporal and extratemporal memory network reorganization. Increased bilateral functional connectivity within the MTL and connectivity to OFC and insula are efficient, and are disrupted by greater disease burden.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17370","type":"journal-article","created":{"date-parts":[[2022,7,18]],"date-time":"2022-07-18T07:38:56Z","timestamp":1658129936000},"page":"2597-2622","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Episodic memory network connectivity in temporal lobe epilepsy"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9947-0322","authenticated-orcid":false,"given":"Marine","family":"Fleury","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Epilepsy University College London Queen Square Institute of Neurology  London UK"},{"name":"MRI Unit Epilepsy Society  Buckinghamshire 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