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Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report
Language lateralization in patients with focal epilepsy frequently diverges from the left-lateralized pattern that prevails in healthy right-handed people, but the mechanistic explanations are still a matter of debate. Here, we debate the complex interaction between focal epilepsy, language laterali...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600519/ https://www.ncbi.nlm.nih.gov/pubmed/37900727 http://dx.doi.org/10.3389/fnhum.2023.1254779 |
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author | Abarrategui, Belén Mariani, Valeria Rizzi, Michele Berta, Luca Scarpa, Pina Zauli, Flavia Maria Squarza, Silvia Banfi, Paola d’Orio, Piergiorgio Cardinale, Francesco Del Vecchio, Maria Caruana, Fausto Avanzini, Pietro Sartori, Ivana |
author_facet | Abarrategui, Belén Mariani, Valeria Rizzi, Michele Berta, Luca Scarpa, Pina Zauli, Flavia Maria Squarza, Silvia Banfi, Paola d’Orio, Piergiorgio Cardinale, Francesco Del Vecchio, Maria Caruana, Fausto Avanzini, Pietro Sartori, Ivana |
author_sort | Abarrategui, Belén |
collection | PubMed |
description | Language lateralization in patients with focal epilepsy frequently diverges from the left-lateralized pattern that prevails in healthy right-handed people, but the mechanistic explanations are still a matter of debate. Here, we debate the complex interaction between focal epilepsy, language lateralization, and functional neuroimaging techniques by introducing the case of a right-handed patient with unaware focal seizures preceded by aphasia, in whom video-EEG and PET examination suggested the presence of focal cortical dysplasia in the right superior temporal gyrus, despite a normal structural MRI. The functional MRI for language was inconclusive, and the neuropsychological evaluation showed mild deficits in language functions. A bilateral stereo-EEG was proposed confirming the right superior temporal gyrus origin of seizures, revealing how ictal aphasia emerged only once seizures propagated to the left superior temporal gyrus and confirming, by cortical mapping, the left lateralization of the posterior language region. Stereo-EEG-guided radiofrequency thermocoagulations of the (right) focal cortical dysplasia not only reduced seizure frequency but led to the normalization of the neuropsychological assessment and the “restoring” of a classical left-lateralized functional MRI pattern of language. This representative case demonstrates that epileptiform activity in the superior temporal gyrus can interfere with the functioning of the contralateral homologous cortex and its associated network. In the case of presurgical evaluation in patients with epilepsy, this interference effect must be carefully taken into consideration. The multimodal language lateralization assessment reported for this patient further suggests the sensitivity of different explorations to this interference effect. Finally, the neuropsychological and functional MRI changes after thermocoagulations provide unique cues on the network pathophysiology of focal cortical dysplasia and the role of diverse techniques in indexing language lateralization in complex scenarios. |
format | Online Article Text |
id | pubmed-10600519 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-106005192023-10-27 Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report Abarrategui, Belén Mariani, Valeria Rizzi, Michele Berta, Luca Scarpa, Pina Zauli, Flavia Maria Squarza, Silvia Banfi, Paola d’Orio, Piergiorgio Cardinale, Francesco Del Vecchio, Maria Caruana, Fausto Avanzini, Pietro Sartori, Ivana Front Hum Neurosci Human Neuroscience Language lateralization in patients with focal epilepsy frequently diverges from the left-lateralized pattern that prevails in healthy right-handed people, but the mechanistic explanations are still a matter of debate. Here, we debate the complex interaction between focal epilepsy, language lateralization, and functional neuroimaging techniques by introducing the case of a right-handed patient with unaware focal seizures preceded by aphasia, in whom video-EEG and PET examination suggested the presence of focal cortical dysplasia in the right superior temporal gyrus, despite a normal structural MRI. The functional MRI for language was inconclusive, and the neuropsychological evaluation showed mild deficits in language functions. A bilateral stereo-EEG was proposed confirming the right superior temporal gyrus origin of seizures, revealing how ictal aphasia emerged only once seizures propagated to the left superior temporal gyrus and confirming, by cortical mapping, the left lateralization of the posterior language region. Stereo-EEG-guided radiofrequency thermocoagulations of the (right) focal cortical dysplasia not only reduced seizure frequency but led to the normalization of the neuropsychological assessment and the “restoring” of a classical left-lateralized functional MRI pattern of language. This representative case demonstrates that epileptiform activity in the superior temporal gyrus can interfere with the functioning of the contralateral homologous cortex and its associated network. In the case of presurgical evaluation in patients with epilepsy, this interference effect must be carefully taken into consideration. The multimodal language lateralization assessment reported for this patient further suggests the sensitivity of different explorations to this interference effect. Finally, the neuropsychological and functional MRI changes after thermocoagulations provide unique cues on the network pathophysiology of focal cortical dysplasia and the role of diverse techniques in indexing language lateralization in complex scenarios. Frontiers Media S.A. 2023-10-12 /pmc/articles/PMC10600519/ /pubmed/37900727 http://dx.doi.org/10.3389/fnhum.2023.1254779 Text en Copyright © 2023 Abarrategui, Mariani, Rizzi, Berta, Scarpa, Zauli, Squarza, Banfi, d’Orio, Cardinale, Del Vecchio, Caruana, Avanzini and Sartori. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Human Neuroscience Abarrategui, Belén Mariani, Valeria Rizzi, Michele Berta, Luca Scarpa, Pina Zauli, Flavia Maria Squarza, Silvia Banfi, Paola d’Orio, Piergiorgio Cardinale, Francesco Del Vecchio, Maria Caruana, Fausto Avanzini, Pietro Sartori, Ivana Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report |
title | Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report |
title_full | Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report |
title_fullStr | Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report |
title_full_unstemmed | Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report |
title_short | Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report |
title_sort | language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report |
topic | Human Neuroscience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600519/ https://www.ncbi.nlm.nih.gov/pubmed/37900727 http://dx.doi.org/10.3389/fnhum.2023.1254779 |
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