Abstract
Background: Language function may be reorganized in patients with malformations of cortical development (MCD). This prospective cohort study aimed in assessing language dominance in a large group of patients with MCD and epilepsy using functional MRI (fMRI).Methods: Sixty-eight patients (40 women) aged 10–73 years (median, 28.0; interquartile range, 19) with MCD and epilepsy underwent 1.5 T MRI and fMRI (word generation task). Single-subject image analysis was performed with statistical parametric mapping (SPM12). Language lateralization indices (LIs) were defined for statistically significantly activated voxels in Broca's and Wernicke's areas using the formula: LI = (VL – VR)/(VL + VR) × 100, where VL and VR were sets of activated voxels on the left and on the right, respectively. Language laterality was considered typical if LI was between +20 and +100 or atypical if LI was between +19 and −100.Results: fMRI signal was elicited in 55 of 68 (81%) patients. In 18 of 55 (33%) patients, language dominance was typical, and in 37 of 55 (67%) patients, atypical (in 68%, right hemispheric; in 32%, bilateral). Language dominance was not influenced by handedness, electroclinical, and imaging features.Conclusions: In this prospective study on a large group of patients with MCD and epilepsy, about two-thirds had atypical language dominance. These results may contribute to assessing risks of postsurgical language deficits and could assist in planning of “cortical mapping” with intracranial electrodes in patients who undergo presurgical assessment.
Highlights
Malformations of cortical development (MCD) occur when the normal process of cerebral cortical development including neuronal proliferation, migration, and organization is disrupted [1]
Category 2 Category 3 Unilateral Bilateral Temporal Frontal Multifocal/along lateral ventricles Perisylvian Frontoparietal Frontotemporal Insular Epilepsy Age at seizure onset, median years Epilepsy duration, median (IQR) years Medically intractable seizures Temporal lobe epilepsy Extra- temporal lobe epilepsy Febrile seizures Status epilepticus Diffuse slowing on EEG Focal slowing on EEG Epileptiform discharges on EEG Seizure frequency, 1st year of epilepsy
We focused on correlating language lateralization with electroclinical features
Summary
Malformations of cortical development (MCD) occur when the normal process of cerebral cortical development including neuronal proliferation, migration, and organization is disrupted [1]. Functional MRI (fMRI) represents a noninvasive additional tool for lateralizing cortical functions such as language and memory in patients with epilepsy [8]. FMRI and electrophysiological studies suggest that cortical functions may be reorganized in patients with MCD. These studies, have been performed on relatively small samples of patients with MCD [9,10,11,12,13,14,15,16,17]. Language function may be reorganized in patients with malformations of cortical development (MCD). This prospective cohort study aimed in assessing language dominance in a large group of patients with MCD and epilepsy using functional MRI (fMRI)
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