Discrepant expressive language lateralization in children and adolescents with epilepsy

Neuronavigated transcranial magnetic stimulation (nTMS) has emerged as a presurgical language mapping tool distinct from the widely used functional magnetic resonance imaging (fMRI). We report fMRI and nTMS language‐mapping results in 19 pediatric‐epilepsy patients and compare those to definitive testing by electrical cortical stimulation, Wada test, and/or neuropsychological testing. Most discordant results occurred when fMRI found right‐hemispheric language. In those cases, when nTMS showed left‐hemispheric or bilateral language representation, left‐hemispheric language was confirmed by definitive testing. Therefore, we propose nTMS should be considered for pediatric presurgical language‐mapping when fMRI shows right‐hemispheric language, with nTMS results superseding fMRI results in those scenarios.