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Brain Advance Access originally published online on April 6, 2004
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Brain, Vol. 127, No. 6, 1229-1236, 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh159

Language reorganization in children with early-onset lesions of the left hemisphere: an fMRI study

F. Liégeois1, A. Connelly2, J. Helen Cross3, S. G. Boyd4, D. G. Gadian2, F. Vargha-Khadem1 and T. Baldeweg1

1 Developmental Cognitive Neuroscience Unit and 2 Radiology and Physics Unit, Institute of Child Health, University College London, 3 Neurosciences Unit and 4 Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK

Correspondence to: Dr F. Liégeois, Developmental Cognitive Neuroscience Unit, Institute of Child Health, UCL, 4th floor, 30 Guilford Street, London WC1N 1EH, UK E-mail: F.Liegeois{at}ich.ucl.ac.uk

It is widely assumed that following extensive damage to the left hemisphere sustained in early childhood, language functions are likely to reorganize and develop in the right hemisphere, especially if the lesion affects the classical Broca’s or Wernicke’s language areas. In the present study, functional MRI (fMRI) was used to examine language lateralization in 10 children and adolescents with intractable epilepsy who sustained an early lesion in the left hemisphere. Lesions were adjacent to or within anterior language cortex in five patients, while they were remote from both Broca’s and Wernicke’s areas in the remainder. A lateralization index was calculated on the basis of the number of voxels activated in the left and right inferior frontal gyri when performing a covert verb generation task. Only two patients were right-handed, suggesting a high incidence of functional reorganization for motor control in the remaining patients. Five out of 10 showed bilateral or right language lateralization, but lateralization could not be inferred from the proximity of lesions to classical language areas on an individual basis. Lesions in or near Broca’s area were not associated with inter-hemispheric language reorganization in four out of five cases, but with perilesional activation within the damaged left hemisphere. Paradoxically, lesions remote from the classical language areas were associated with non-left language lateralization in four out of five cases. Finally, handedness, age at onset of chronic seizures, and site of EEG abnormality also showed no obvious association with language lateralization. In conclusion, it is difficult to infer intra- versus inter-hemispheric language reorganization on the basis of clinical observations in the presence of early pathology to the left hemisphere.

Key Words: cerebral dominance; language; early pathology

Abbreviations: fMRI= functional MRI; ICA = intracarotid amobarbital; LI = lateralization index

Received October 6, 2003. Revised January 20, 2004. Accepted February 9, 2004.


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