LANGUAGE CORTEX REPRESENTATION - EFFECT OF DEVELOPMENTAL VERSUS ACQUIRED PATHOLOGY

Relatively little is known about language cortex representation in pat ients with developmental pathology and epilepsy. We report the results of mapping language by electrical stimulation of chronically implante d subdural electrodes in 34 patients (mean age, 12.2 years) evaluated for epilepsy surgery, 28 of whom had magnetic resonance imaging or his tological evidence of developmental tumors or cortical dysplasia. Lang uage cortex was identified in the temporal or frontal lobe of 19 patie nts (left hemisphere in 17, right hemisphere in 2), and overlapped or bordered the epileptogenic region in 12. Language cortex was not found in the frontal or temporal lobe of 15 patients (left hemisphere in 4, right hemisphere in 11) and was presumed to be contralateral to grid placement. Three patients with left-hemisphere perinatal or postnatal cerebral insults before the age of 5 years had no language in the left hemisphere, while 3 patients with insults between the ages of 6 and 1 6 years had preserved left-hemisphere language. Developmental lesions and early-onset seizures do not displace language cortex from prenatal ly determined sites, whereas lesions acquired before the age of 5 year s may cause language to relocate to the opposite hemisphere, but only when language cortex is destroyed.