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Intrahemispheric reorganization of language in children with medically intractable epilepsy of the left hemisphere

Published online by Cambridge University Press:  20 March 2007

DARREN S. KADIS ,
KOJI IIDA ,
ELIZABETH N. KERR ,
WILLIAM J. LOGAN ,
MARY PAT MCANDREWS ,
AYAKO OCHI ,
HIROSHI OTSUBO ,
JAMES T. RUTKA ,
O. CARTER SNEAD III  and
SHELLY K. WEISS
...Show all authors
DARREN S. KADIS
Affiliation:
Department of Psychology, University of Toronto, Toronto, Ontario, Canada Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
KOJI IIDA
Affiliation:
Division of Neurosurgery, Hiroshima University, Hiroshima, Japan
ELIZABETH N. KERR
Affiliation:
Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
WILLIAM J. LOGAN
Affiliation:
Department of Pediatrics, Division of Neurology, University of Toronto, Toronto, Ontario, Canada Department of Neurology, Hospital for Sick Children; Toronto, Ontario, Canada
MARY PAT MCANDREWS
Affiliation:
Department of Psychology, University of Toronto, Toronto, Ontario, Canada Applied and Interventional Research, Toronto Western Research Institute, Toronto, Ontario, Canada
AYAKO OCHI
Affiliation:
Department of Neurology, Hospital for Sick Children; Toronto, Ontario, Canada
HIROSHI OTSUBO
Affiliation:
Department of Pediatrics, Division of Neurology, University of Toronto, Toronto, Ontario, Canada Department of Neurology, Hospital for Sick Children; Toronto, Ontario, Canada
JAMES T. RUTKA
Affiliation:
Department of Surgery, Division of Neurosurgery, University of Toronto, and Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
O. CARTER SNEAD III
Affiliation:
Department of Pediatrics, Division of Neurology, University of Toronto, Toronto, Ontario, Canada Department of Neurology, Hospital for Sick Children; Toronto, Ontario, Canada
SHELLY K. WEISS
Affiliation:
Department of Pediatrics, Division of Neurology, University of Toronto, Toronto, Ontario, Canada Department of Neurology, Hospital for Sick Children; Toronto, Ontario, Canada
MARY LOU SMITH
Affiliation:
Department of Psychology, University of Toronto, Toronto, Ontario, Canada Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract

We investigated language representation in nine children (six male, three female; 5.6–17.7 years of age) who underwent surgical treatment of medically intractable epilepsy of the left hemisphere. Although interhemispheric reorganization has been previously documented in similar groups, this is the first study to systematically evaluate possible intrahemispheric effects of early insult. All cases had left hemisphere seizure foci and underwent extraoperative stimulation mapping (ESM) for language localization prior to receiving cortical resections. To compare ESM findings across subjects and to assess intrahemispheric reorganization, we developed a novel coregistration technique whereby independent raters plotted two-dimensional (2D) ESM findings in 3D standard space. Expressive language sites identified with ESM were compared with a structural probability map of pars opercularis, or Broca's area. The average difference between independent raters' estimates of 28 language sites was 3.9 mm (SD = 2.0), indicating excellent agreement; the coregistration procedure permitted assessment of 2D ESM findings in 3D standard space. We observed language sites in regions substantially anterior and superior to canonical Broca's area, possibly reflecting intrahemispheric reorganization. Findings suggest that left hemisphere insult in young children may result in anterior displacement of language within the frontal cortex. (JINS, 2007, 13, 505–516.)This study was drawn from a thesis submitted by D.S.K. in partial fulfillment of requirements of the MA degree through the Graduate Program in Psychology and the Collaborative Program in Neuroscience at the University of Toronto (Ontario, Canada).

Keywords

PediatricPlasticityExtraoperative stimulation mappingSubdural electrodesCoregistrationBrain mapping
Type
NEUROBEHAVIORAL GRAND ROUNDS
Information
Journal of the International Neuropsychological Society , Volume 13 , Issue 3 , May 2007 , pp. 505 - 516
Copyright
© 2007 The International Neuropsychological Society

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