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Atypical language cortex in the left temporal lobe: relationship to bilateral language
R A Jabbour1, P E Penovich, G L Risse
1Minnesota Epilepsy Group, 310 Smith Ave. N., Suite 300, St. Paul, MN 55102-2383, USA. drrjabbour@hotmail.com
Neurology
|November 24, 2004
Summary
The intracarotid amobarbital procedure (IAP) reveals that bilateral language representation is often linked to multiple, distinct language areas in the left temporal lobe. This finding is crucial for epilepsy surgery planning.
Area of Science:
- Neuroscience
- Neurosurgery
- Epileptology
Background:
- The intracarotid amobarbital procedure (IAP) is a standard method for assessing language dominance and memory before epilepsy surgery.
- Cortical brain stimulation is the typical approach for language mapping.
Purpose of the Study:
- To compare left temporal lobe language cortex representation in patients with bilateral language (BL) versus left language dominance (LD) using the IAP.
- To investigate the spatial distribution of language areas in the left temporal lobe.
Main Methods:
- Retrospective review of language maps from 10 patients with BL (Group I) and 10 matched controls with LD (Group II).
- Language function assessed via confrontation naming, automatic speech, reading, repetition, and comprehension during IAP.
- Definition of primary temporal lobe language areas based on clusters of errors in naming, repetition, and comprehension.
Main Results:
- Two distinct language areas were identified in 60% of BL patients compared to 10% of LD patients (p=0.019).
- In BL patients, these areas could be in the same gyrus, different gyri, or intermixed.
- In LD patients, language areas were typically intermixed within the superior and middle temporal gyri.
Conclusions:
- Bilateral language representation is frequently associated with multiple, noncontiguous language areas in the left temporal lobe.
- Identifying multiple language areas is critical, especially in patients with BL, before surgical resection.
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