title: Reorganization and stability for motor and language areas using cortical stimulation: case example and review of the literature.
abstract: The cerebral organization of language in epilepsy patients has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping and more recently with noninvasive neuroimaging techniques, such as functional MRI. In the setting of a chronic seizure disorder, clinical variables have been shown to contribute to cerebral language reorganization underscoring the need for language lateralization and localization procedures. We present a 14-year-old pediatric patient with a refractory epilepsy disorder who underwent two neurosurgical resections of a left frontal epileptic focus separated by a year. He was mapped extraoperatively through a subdural grid using cortical stimulation to preserve motor and language functions. The clinical history and extensive workup prior to surgery is discussed as well as the opportunity to compare the cortical maps for language, motor, and sensory function before each resection. Reorganization in cortical tongue sensory areas was seen concomitant with a new zone of ictal and interictal activity in the previous tongue sensory area. Detailed neuropsychological data is presented before and after any surgical intervention to hypothesize about the extent of reorganization between epochs. We conclude that intrahemispheric cortical plasticity does occur following frontal lobe resective surgery in a teenager with medically refractory seizures.
authors: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA. sandra.serafini@dm.duke.edu.
authors: Sandra
authors: S
authors: Serafini
authors: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA. jordan.komisarow@dm.duke.edu.
authors: Jordan M
authors: JM
authors: Komisarow
authors: Division of Pediatric Neurology, Department of Neurology, Duke University Medical Center, Box 3936, Durham, NC 27710, USA. william.gallentine@dm.duke.edu.
authors: William
authors: W
authors: Gallentine
authors: Division of Pediatric Neurology, Department of Neurology, Duke University Medical Center, Box 3936, Durham, NC 27710, USA. mohamad.mikati@dm.duke.edu.
authors: Mohamad A
authors: MA
authors: Mikati
authors: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3527, Durham, NC 27705, USA. melanie.bonner@dm.duke.edu.
authors: Melanie J
authors: MJ
authors: Bonner
authors: Division of Neuroradiology, Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA. peter.kranz@duke.edu.
authors: Peter G
authors: PG
authors: Kranz
authors: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA. michael.haglund@dm.duke.edu.
authors: Michael M
authors: MM
authors: Haglund
authors: Department of Neurosurgery, Stanford University, Lucile Packard Children's Hospital, R211 MC 5327, 300 Pasteur Drive, Stanford, CA 94305, USA. ggrant2@stanford.edu.
authors: Gerald
authors: G
authors: Grant