Right Hemisphere Language Dominance in a Right-Handed Patient with Late-Onset Seizures

Right hemisphere language dominance is rare in right-handed individuals and usually the result of language transfer associated with early left hemisphere pathology. We studied a 33-year-old right-handed man, with a normal MRI scan, who developed left frontal lobe seizures at age 15 years. Language lateralization testing by intracarotid amobarbital injection and dichotic listening showed the patient to be strongly right hemisphere language dominant. The clinical features of this patient do not fit the profile of pathology-induced language transfer, but instead suggest that he was right hemisphere language dominant before developing seizures. This case underscores the importance of language lateralization testing in patients who are candidates for seizure surgery, even if they are strongly right-handed and have late-onset seizures, features usually associated with left hemisphere language dominance. One implication is that the incidence of right hemisphere language dominance in the right-handed population may be underestimated.