title: Effects of anomalous language representation on neuropsychological performance in temporal lobe epilepsy.
abstract: OBJECTIVE
  To examine the effects of anomalous language representation (i.e., mixed- and right-cerebral dominant) on neuropsychological performance.
  
  
  BACKGROUND
  Right cerebral language dominance resulting from early cerebral injury is associated with relatively preserved language function with decreased visuospatial ability. However, previous reports of this phenomenon have examined patients with relatively large cerebral injuries (e.g., infantile hemiplegia) or limited sample sizes.
  
  
  METHODS
  A total of 561 patients with complex partial seizures of left temporal lobe origin were studied. Patients were classified into left (n = 455), bilateral (n = 58), and right (n = 48) language dominant groups based on Wada testing.
  
  
  RESULTS
  Right language dominant patients performed more poorly on multiple tests of visuospatial function, including Performance IQ (PIQ), than did left language patients. No significant group differences were detected for measures of language or general verbal function. The effects of bilateral language on PIQ differed according to handedness. Lowered PIQ was present in the bilateral nondextral group but not for bilateral dextral patients, and this pattern was observed with other visuospatial measures.
  
  
  CONCLUSIONS
  In patients with relatively small lesions restricted to the left mesial temporal lobe, a shift in language dominance to the right hemisphere is associated with decreased visuospatial functions but preserved verbal abilities. Nondextral patients with bilateral language representation also displayed decreased visuospatial performance, although dextral patients with bilateral language did not.
authors.affiliation: Department of Neurology, Medical College of Georgia, Augusta 30912-3275, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Loring
authors.forename: E
authors.initials: E
authors.lastname: Strauss
authors.forename: B P
authors.initials: BP
authors.lastname: Hermann
authors.forename: K
authors.initials: K
authors.lastname: Perrine
authors.forename: M R
authors.initials: MR
authors.lastname: Trenerry
authors.forename: W B
authors.initials: WB
authors.lastname: Barr
authors.forename: M
authors.initials: M
authors.lastname: Westerveld
authors.forename: G J
authors.initials: GJ
authors.lastname: Chelune
authors.forename: G P
authors.initials: GP
authors.lastname: Lee
authors.forename: K J
authors.initials: KJ
authors.lastname: Meador
mesh_terms: D000328:Adult; D017668:Age of Onset; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007802:Language; D008297:Male; D009483:Neuropsychological Tests