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Atypical language in lesional and nonlesional complex partial epilepsy

From the Departments of Neurosciences (W.D.G., M.M.B., E.N.M., L.R.R., S.L.W., J.A.C., P.L.P., L.G.V., C.J.V., G.G.) and Radiology (L.G.V.), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC; Clinical Epilepsy Section NINDS (W.D.G., E.N.M., E.K.R., L.R.R., S.S., E.W., W.H.T.) and Hearing and Speech Section (C.F.), Clinical Center, NIH, Bethesda, MD; Department of Neurology and Neuroscience (W.D.G., C.J.V.), Georgetown University School of Medicine; Department of Neurology (E.K.R.), Johns Hopkins Hospital, Baltimore, MD; Minnesota Epilepsy Group (F.F.R., G.R.), Minneapolis; and Department of Hearing and Speech Science (N.B.R.), University of Maryland, College Park.

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: We investigated the relationship between partial epilepsy, MRI findings, and atypical language representation.

Methods: A total of 102 patients (4 to 55 years) with left hemisphere epileptogenic zones were evaluated using three fMRI language tasks obtained at 1.5 or 3T with EPI BOLD techniques: verbal fluency, reading comprehension, and auditory comprehension. fMRI maps were visually interpreted at a standard threshold and rated as left or atypical language.

Results: Atypical language dominance occurred in 30 patients (29%) and varied with MRI type (p < 0.01). Atypical language representation occurred in 36% (13/36) with normal MRI, 21% (6/29) with mesial temporal sclerosis, 14% (4/28) with focal cortical lesions (dysplasia, tumor, vascular malformation), and all (6/6) with a history of stroke. Multivariate logistic regression analysis found handedness, seizure onset, and MRI type accounted for much of the variance in language activation patterns (² = 24.09, p < 0.01). Atypical language was more prevalent in patients with early seizure onset (43.2%, p < 0.05) and atypical handedness (60%, p < 0.01). None of the three clinical factors were correlated with each other (p > 0.40). Patients with atypical language had lower verbal abilities (F = 6.96, p = 0.01) and a trend toward lower nonverbal abilities (F = 3.58, p = 0.06). There were no differences in rates of atypical language across time, age groups, or MRI scanner.

Conclusion: Early seizure onset and atypical handedness, as well as the location and nature of pathologic substrate, are important factors in language reorganization.

GLOSSARY: FOV = field of view; MTS = mesial temporal sclerosis; RRN = read response naming; TE = echo time; TR = repetition time; WAIS = Wechsler Adult Intelligence Scale; WISC = Wechsler Intelligence Scale for Children.

Deceased.

Supported by NINDS R01 NS44280 and the NINDS Division of Intramural Research.

Disclosure: The authors report no conflicts of interest.

Received October 27, 2006. Accepted in final form May 16, 2007.

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