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NEUROLOGY 2004;63:1825-1832
© 2004 American Academy of Neurology

Reorganization of language-specific cortex in patients with lesions or mesial temporal epilepsy

E. Pataraia, MD, P. G. Simos, PhD, E. M. Castillo, PhD, R. L. Billingsley-Marshall, PhD, A. L. McGregor, MD, J. I. Breier, PhD, S. Sarkari, PhD and A. C. Papanicolaou, PhD

From the Departments of Neurosurgery (Drs. Pataraia, Castillo, Billingsley-Marshall, Breier, Sarkari, and Papanicolaou) and Neurology (Dr. McGregor), Vivian L. Smith Center for Neurologic Research, University of Texas Health Science Center at Houston; and Department of Psychology (Dr. Simos), University of Crete, Greece.

Address correspondence and reprint requests to Dr. E. Pataraia, Department of Neurosurgery, University of Texas Medical Center at Houston, 1333 Moursund St., H 114, Houston, TX 77030; e-mail: epataraia1{at}uth.tmc.edu

Objective: To examine brain activation profiles for receptive language function, using magnetoencephalography (MEG), in patients with left hemisphere space-occupying lesions and patients with left temporal lobe epilepsy due to mesial temporal sclerosis (MTS) and to evaluate whether cross- and intrahemispheric plasticity for language varied as a function of lesion type or location.

Methods: Twenty-one patients with MTS and 23 lesional patients underwent preoperative language mapping while performing a word recognition task. The anatomic location of late activity sources was determined by co-registering MEG coordinates onto structural MRI scans. A language laterality index was calculated based on the number of activity sources in each hemisphere. The location of language-specific activity was examined in relation to its proximity or overlap with Wernicke’s area.

Results: A higher incidence of atypical language lateralization was noted among patients with MTS than lesional patients (43 vs 13%). The majority of MTS patients with early seizure onset (before age 5) showed atypical language lateralization. In contrast, the precise location of receptive language-specific cortex within the dominant hemisphere was found to be atypical (outside of Wernicke’s area) in 30% of lesional patients and only 14% of MTS patients.

Conclusions: There is an increased probability of a partial or total displacement of key components of the brain mechanism responsible for receptive language function to the nondominant hemisphere in mesial temporal sclerosis patients. Early onset of seizures is strongly associated with atypical language lateralization. Lesions in the dominant hemisphere tend to result in an intrahemispheric reorganization of linguistic function.

Received February 24, 2004. Accepted in final form August 2, 2004.

See also pages 1772 and 1818


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