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Neurology. 2007 Oct 30;69(18):1761-71.

Atypical language in lesional and nonlesional complex partial epilepsy.

Author information

  • 1Department of Neuroscience, Children's National Medical Center, George Washington University School of Medicine, 111 Michigan Ave NW, Washington, DC 20010, USA. wgaillar@cnmc.org

Abstract

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 (chi(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.

[PubMed - indexed for MEDLINE]
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