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Cortical Language Mapping in Epilepsy: A Critical Review

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Abstract

One challenge in dominant hemisphere epilepsy surgery is to remove sufficient epileptogenic tissue to achieve seizure freedom without compromising postoperative language function. Electrical stimulation mapping (ESM) of language was developed specifically to identify essential language cortex in pharmacologically intractable epilepsy patients undergoing left hemisphere resection of epileptogenic cortex. Surprisingly, the procedure remains unstandardized, and limited data support its clinical validity. Nevertheless, ESM for language mapping has likely minimized postoperative language decline in numerous patients, and has generated a wealth of data elucidating brain–language relations. This article reviews the literature on topographical patterns of language organization inferred from ESM, and the influence of patient characteristics on these patterns, including baseline ability level, age, gender, pathology, degree of language lateralization and bilingualism. Questions regarding clinical validity and limitations of ESM are discussed. Finally, recommendations for clinical practice are presented, and theoretical questions regarding ESM and the findings it has generated are considered.

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Acknowledgments

This work was supported in part by a grant from The National Institute of Neurological Disorders and Stroke, Grant Number: NIH R01 NS35140. My thanks to Dr. William T. Seidel for editorial advice and suggestions, Alicia Williams, M.A. for assistance with graphic design, and Kimberly Kozma, B.A. for assistance with database management.

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  1. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Marla J. Hamberger

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Hamberger, M.J. Cortical Language Mapping in Epilepsy: A Critical Review. Neuropsychol Rev 17, 477–489 (2007). https://doi.org/10.1007/s11065-007-9046-6

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