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• W1514960960 abstract "Language can transfer to the right hemisphere in patients with early left-sided brain injury (1,2). Rare cases with acquired left hemisphere lesions and language transfer after age 9 years have been reported (1,3,4). The possibility of language transfer in adolescent patients may influence decision making in epilepsy surgery and may alter concepts of language development and plasticity. We report two adolescents with initially left-hemispheric language dominance proven by intracarotid amobarbital testing (IAT) who developed right-sided language between 9 and 15 years and between 12 and 14 years, respectively. Language was impaired in both patients because of Rasmussen chronic encephalitis beginning at 8 and 11 years, with improvement after left hemispherectomy at ages 14 and 15 years. Case one, a right-handed 8-year-old boy, had pharmacologically intractable right clonic seizures associated with left frontocentral EEG seizures. Bilateral IAT at age 9 revealed left hemisphere language dominance. Repeated magnetic resonance imaging (MRI) showed progressive left hemispheric atrophy and increased left temporooccipital signal on T2 sequences. At age 15 years, right-sided epilepsia partialis continua and hemiparesis developed. Handedness shifted from right to left. A repeated IAT at that time showed right-sided language representation. Left functional hemispherectomy was performed. Histopathology was consistent with Rasmussen encephalitis. Postoperatively, no impaired language function was noted. Rare right facial clonic seizures were well controlled. Neuropsychological testing showed language improvement as compared with presurgical assessment (Table 1). Case two, a right-handed 11-year-old girl, had right clonic seizures and left frontocentral EEG seizures. Repeated MRIs demonstrated progressive left-hemispheric volume loss and hyperintensity on T2-weighted images. IAT at 12 years and 8 months showed left hemisphere language. Handedness shifted from right to left. The family initially declined left hemispherectomy because of concerns regarding language function. Steroids and plasmapheresis were tried instead, without effect. She was readmitted at age 13 years and 10 months with right-sided epilepsia partialis continua, dysphasia, right hemiparesis, dehydration, and inability to swallow. Immediate left functional hemispherectomy led to seizure freedom. Histopathology was typical of Rasmussen encephalitis. Postoperatively, language was slow, but she could communicate. Neuropsychological assessment demonstrated improved verbal performance as compared with preoperative assessment (Table 1). Only seven patients with Rasmussen encephalitis have been reported with apparent interhemispheric transfer of language after age 9 years. Transfer was assessed by neuropsychological means, showing initial language deterioration after hemispherectomy and progressive improvement over time in five patients (1), by late IAT showing right hemisphere language dominance at the time of surgery (4), and by functional MRI (fMRI) in one patient (3). We add the first patients with late language transfer, who had initial left hemisphere language dominance proven by IAT early in the illness. Dominant hemispherectomy after age 9 years in patients with Rasmussen chronic encephalitis does not necessarily produce lasting aphasia, even if IAT initially demonstrated left language dominance. Early hemispherectomy also may prevent impending bilateral hemispheric involvement of the disease after prolonged duration (5) and early death due to uncontrolled seizures with epilepsia partialis continua and generalized status epilepticus (6). Acknowledgment: T.L. was supported by Innovative Medizinische Forschung, WWU Münster (FoeKz. LO 610101) and NRW-Nachwuchsgruppe Kn2000, Federal Ministry of Education and Research (Foe.1KS9604/0), Interdisciplinary Center of Clinical Research Münster (IZKF Project NWG2)." @default.
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• W1514960960 date "2003-06-01" @default.
• W1514960960 modified "2023-10-15" @default.
• W1514960960 title "Late Language Transfer in Patients with Rasmussen Encephalitis" @default.
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• W1514960960 doi "https://doi.org/10.1046/j.1528-1157.2003.66402.x" @default.
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