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Language Organization and Reorganization in Epilepsy

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Abstract

The vast majority of healthy individuals are left hemisphere dominant for language; however, individuals with left hemisphere epilepsy have a higher likelihood of atypical language organization. The cerebral organization of language in epilepsy has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping (ESM), and more recently, with noninvasive neuroimaging techniques such as functional magnetic resonance imaging (fMRI). Investigators have used these techniques to explore the influence of unique clinical features inherent in epilepsy that might contribute to the reorganization of language, such as location of seizure onset, age of seizure onset, and extent of interictal epileptiform activity. In this paper, we review the contribution of these and other clinical variables to the lateralization and localization of language in epilepsy, and how these patient-related variables affect the results from these three different, yet complementary methodologies. Unlike the abrupt language changes that occur following acute brain injury with disruption of established language circuits, converging evidence suggests that the chronic nature of epileptic activity can result in a developmental shift of language from the left to the right hemisphere or re-routing of language pathways from traditional to non-traditional areas within the dominant left hemisphere. Clinical variables have been shown to contribute to cerebral language reorganization in the setting of chronic seizure disorders, yet such factors have not been reliable predictors of altered language networks in individual patients, underscoring the need for language lateralization and localization procedures when definitive identification of language cortex is necessary for clinical care.

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Abbreviations

EEG:

Electroencephalogram

ESM:

Electrical Stimulation Mapping

fMRI:

functional Magnetic Resonance Imaging

HS:

Hippocampal Sclerosis

MRI:

Magnetic Resonance Imaging

MTLE:

Medial temporal lobe epilepsy

TLE:

Temporal lobe epilepsy

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Acknowledgements

This work was supported by the National Institutes of Health: The National Institute of Neurological Disorders and Stroke [grant NIH R01 NS35140 to M.H.]

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  1. The Neurological Institute, Columbia University Medical Center, 710 West 168th Street, 7th floor, New York, NY, 10032, USA

    Marla J. Hamberger

  2. JFK Medical Center/Center for Head Injuries, Edison, NJ, USA

    Jeffrey Cole

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Correspondence to Marla J. Hamberger.

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Hamberger, M.J., Cole, J. Language Organization and Reorganization in Epilepsy. Neuropsychol Rev 21, 240–251 (2011). https://doi.org/10.1007/s11065-011-9180-z

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