[Functional reorganization of language in a case of cortical development disorder with continuous spike and wave during sleep].
BACKGROUND
Left cerebral hemisphere dominance for language is a well known fact. However, this typical lateralization may be affected when left hemisphere is damaged at an early age. In this case, neuronal plasticity allows language to be totally or partially transferred to another area within the ipsilateral or contralateral hemisphere.


METHODS
21 year old woman. Congenital right hemiparesis. Focal epilepsy and continuous spike and wave during NREM sleep at 4 years old. Magnetic resonance imaging: extensive malformation of cortical development in the left hemisphere. From 7 years old, seizures were controlled and the continuous spike and wave discharges disappeared.


METHODS
Valproic acid, 500 mg/day. Neuropsychological assessment showed that basic language functions were well preserved, while there were signs of non-dominant hemisphere dysfunction. These paradoxical results, together with the fact that the patient was left-handed, established the possibility of functional reorganization of language to the right hemisphere. A functional magnetic resonance imaging (fMRI) study for language lateralization demonstrated preferential right hemisphere activation on Broca's and Wernicke's areas.


CONCLUSIONS
This case shows the brain's potential for functional reorganization, especially if, according to Kennard's principle, the injury is produced at an early age.
Alvarez Carriles
J C
JC
Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo. juancarriles@hotmail.com
Salas Puig
J
J
Fernández Martínez
J M
JM
Lahoz
C H
CH
D000328:Adult; D004292:Dominance, Cerebral; D004569:Electroencephalography; D004827:Epilepsy / Q000503:physiopathology; D005260:Female; D006801:Humans; D007802:Language; D007807:Language Tests; D008279:Magnetic Resonance Imaging; D009473:Neuronal Plasticity / Q000502:physiology*; D009483:Neuropsychological Tests; D012890:Sleep