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NEUROLOGY 2009;72:1830-1836
© 2009 American Academy of Neurology

Interhemispheric and intrahemispheric language reorganization in complex partial epilepsy

L. R. Rosenberger, BA, J. Zeck, BA, M. M. Berl, PhD, E. N. Moore, MA, E. K. Ritzl, MD, S. Shamim, MD, S. L. Weinstein, MD, J. A. Conry, MD, P. L. Pearl, MD, S. Sato, MD, L. G. Vezina, MD, W. H. Theodore, MD and W. D. Gaillard, MD

From the Departments of Neurosciences (L.R.R., J.Z., M.M.B., E.N.M., S.L.W., J.A.C., P.L.P., L.G.V., W.D.G.) and Radiology (L.G.V.), Children's National Medical Center, George Washington University School of Medicine, Washington, DC; Clinical Epilepsy Section NINDS (L.R.R., J.Z., E.N.M., E.K.R., S. Shamim, S. Sato, W.H.T., W.D.G.), Clinical Center, NIH, Bethesda, MD; Department of Neurology (W.D.G.), Georgetown University School of Medicine, Washington, DC; and Department of Neurology (E.K.R.), Johns Hopkins Hospital, Baltimore, MD.

Address correspondence and reprint requests to Dr. William Davis Gaillard, Department of Neuroscience, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010 wgaillar{at}cnmc.org

Objective: To investigate interhemispheric and intrahemispheric reorganization in patients with localization-related epilepsy.

Method: We studied 50 patients with a left hemispheric focus and 20 normal right-handed controls with a 3T echoplanar imaging blood oxygen level dependent functional MRI auditory-based word definition decision task. Data were analyzed using SPM 2. Using region of interest for Broca and Wernicke areas and an asymmetry index (AI), patients were categorized as left language (LL; AI ≥0.20) or atypical language (AL; AI <0.20) for region. The point maxima activation for normal controls (p <0.05 corrected FDR) was identified in Broca and midtemporal regions and then used as a point of reference for individual point maxima identified at p < 0.001, uncorrected.

Results: Patient groups showed increased frequency of having activation in right homologues. Activation in AL groups occurred in homologous right regions; distances for point maxima activation in homologous regions were the same as point maxima distances in normal control activation in left regions. Distances for LL patient in left regions showed a trend for differences for midtemporal gyrus (6 mm posterior, 3 mm superior) but variability around mean difference distance was significant. There was no effect of age at epilepsy onset, duration, or pathology on activation maxima.

Conclusions: Right hemisphere language regions in patients with left hemispheric focus are homologues of left hemisphere Broca and broadly defined Wernicke areas. We found little evidence for intrahemispheric reorganization in patients with left hemisphere epilepsy who remain left language dominant by these methods.

Abbreviations: AI = asymmetry index; AL = atypical language; BA = Brodmann area; ECS = electrocortical stimulation; fMRI = functional MRI; IFG = inferior frontal gyrus; LHF = left hemispheric focus; LL = left language; MANOVA = multivariate analysis of variance; MTG = midtemporal gyrus; STG = superior temporal gyrus; STS = superior temporal sulcus.

Supplemental data at www.neurology.org

*These authors contributed equally.

Supported by NINDS R01 NS44280, the American Academy of Neurology Summer fellowship award (J.Z.), and the NINDS Division of Intramural Research.

Disclosure: The authors report no disclosures.

Received June 17, 2008. Accepted in final form February 19, 2009.






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