Abstract
This study evaluated language organization in children with intractable epilepsy caused by temporal lobe focal cortical dysplasia (FCD) alone or dual pathology (temporal lobe FCD and hippocampal sclerosis, HS). We analyzed clinical, neurological, fMRI, neuropsychological, and histopathologic data in 46 pediatric patients with temporal lobe lesions who underwent excisional epilepsy surgery. The frequency of atypical language representation was similar in both groups, but children with dual pathology were more likely to be left-handed. Atypical receptive language cortex correlated with lower intellectual capacity, verbal abstract conceptualization, receptive language abilities, verbal working memory, and a history of status epilepticus but did not correlate with higher seizure frequency or early seizure onset. Histopathologic substrate had only a minor influence on neuropsychological status. Greater verbal comprehension deficits were noted in children with atypical receptive language representation, a risk factor for cognitive morbidity.
Main findings of the study: There was a significantly higher frequency of left handedness and worse immediate face recognition in the subgroup with dual pathology (FCD+HS). The patients with atypical fMRI language representation had lower global intellectual capacity, lower language skills, and more frequent status epilepticus in history. [Display omitted]
•Atypical language representation is a significant risk factor for cognitive morbidity in pediatric patients with temporal lobe epilepsy.•Lesion type has only a small influence on the neuropsychological profile of these children.
