Language development before and after temporal surgery in children with intractable epilepsy.
OBJECTIVE
To obtain systematic knowledge of language development before and after epilepsy surgery in regions that, if damaged, are known to entail language impairment in adults.


METHODS
Twenty-four children (mean age 11 years; range 5.8-15.7 years) with pharmacologically intractable epilepsy participated prior to (the majority) anterior temporal lobectomy and 6, 12, and 24 months thereafter. Reception and production of lexicon (vocabulary) and syntax (sentence structure including grammar) were examined using developmental language tests that provide normative data.


RESULTS
Prior to surgery the mean language delay varied from 1.7 years (productive syntax) to 3.5 years (productive lexicon). For lexicon, language delay was larger, the older the children; for syntax it was smaller in children with mothers with higher education. Over the 2 years following surgery, the children developed in all four language components. Development was, however, slower than normal, that is, language delay increased, in three of the four components: in productive lexicon it continued to increase, and in receptive lexicon and productive syntax it appeared to stabilize during the second year. Receptive syntax developed at a normal pace. The development of productive lexicon was remarkably slow when surgery and language mediation were both in the left hemisphere.


CONCLUSIONS
Pharmacologically intractable epilepsy of the temporal lobe, or the underlying condition, is a significant risk factor for delayed language development. Temporal epilepsy surgery does not result in acceleration of language development. If language is still mediated in the operated left hemisphere, development of particular language components may slow down after surgery.
de Koning
Trudi
T
Department of Otorhinolaryngology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
Versnel
Huib
H
Jennekens-Schinkel
Aag
A
van Schooneveld
Monique M J
MM
Dejonckere
Philippe H
PH
van Rijen
Peter C
PC
van Nieuwenhuizen
Onno
O
D000293:Adolescent; D038481:Anterior Temporal Lobectomy; D002648:Child; D004351:Drug Resistance; D004522:Educational Status; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007804:Language Development; D007805:Language Development Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D007807:Language Tests / Q000706:statistics & numerical data; D008037:Linguistics / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000706:statistics & numerical data; D012307:Risk Factors; D013702:Temporal Lobe / Q000503:physiopathology* / Q000601:surgery