When epilepsy interferes with word comprehension: findings in Landau-Kleffner syndrome.
Landau-Kleffner syndrome is characterized by a regression in receptive language. The factors that affect the clinical expression of this syndrome remain unclear. This study presents neuroimaging findings in 2 patients showing different clinical evolutions. Linguistic regression persisted in 1 patient and evolved positively in the other. In patient A (with severe linguistic regression) there was an overlap between areas engaged during word recognition and those involved in generating the epileptiform activity; in patient B (with better linguistic evolution), receptive language was predominantly represented in the right hemisphere (unaffected). Patient A underwent multiple subpial transections. The 2-year follow-up indicated linguistic improvement, absence of epileptiform activity, and activation of the left temporal cortex during word comprehension. These results suggest that the resolution of the linguistic deficit in Landau-Kleffner syndrome may be modulated by the language-specific cortex freed from interfering epileptiform activity or by reorganization of the receptive language cortex triggered by the epileptic activity.
Castillo
Eduardo M
EM
Department of Pediatrics, University of Texas-Houston Medical School, Houston, TX 77030, USA. eduardo.m.castillo@uth.tmc.edu
Butler
Ian J
IJ
Baumgartner
James E
JE
Passaro
Antony
A
Papanicolaou
Andrew C
AC
D000222:Adaptation, Physiological / Q000502:physiology; D000293:Adolescent; D001041:Aphasia, Wernicke / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000503:physiopathology; D002648:Child; D004292:Dominance, Cerebral / Q000502:physiology; D004827:Epilepsy / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D018887:Landau-Kleffner Syndrome / Q000150:complications* / Q000503:physiopathology; D007805:Language Development Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D015225:Magnetoencephalography; D009473:Neuronal Plasticity / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012043:Regression, Psychology; D013067:Speech Perception / Q000502:physiology; D013702:Temporal Lobe / Q000033:anatomy & histology / Q000502:physiology; D014705:Verbal Behavior / Q000502:physiology