Language mapping in temporal lobe epilepsy in children: special considerations

Abstract

Temporal lobe epilepsy (TLE) in children is a slightly different entity than TLE in adults not only because of its semiology and pathology but also because of the different approach to surgical treatment. Presurgical investigations for eloquent cortex, especially language, must take these differences into account. Most diagnostic tests were created for adults, and many of the assessment tools need to be adapted for children because they are not just small adults. This paper will highlight the specific challenges and solutions in mapping language in a pediatric population with TLE.

Figure 1

Example of fMRI with the superposition of different language tasks. While most of the tasks produce a left dominant hemispheric language activation, naming has a bilateral activation in the Broca area. Red: Verb generation, Green: sentence completion, Blue: naming.

Figure 2

Another example of fMRI language activation map. This time the language map is solely left hemispheric in this sentence completion task.