Abstracts

Previous studies have suggested that mapping of cortical language areas is often successful in children as young as seven years, but is most often successful in children ages 10 and older. However, little is known regarding the success of cortical language mapping in children age six and younger., Patients were six children, ages 3.6 to 6.9 years with a subdural electrode array (SEA) implanted in the dominant frontal (n=1), nondominant frontal (n=1), or dominant frontotemporal area (n=3). A SEA was positioned over the frontotemporal region of the presumed minor language hemisphere in a patient who evidenced possible bilateral language on intracarotid amobarbital procedure (IAP). Etiologies included idiopathic epilepsy (n=1), cortical dysplasia (n=1), tumor (n=3) and Rasmussen syndrome (n=1). IQ ranged from 76 to 114 (mean=96). Language testing included confrontation naming and repetition speech., Frontal and/or temporal language areas were identified in the four patients whose SEAs resided in the language dominant hemisphere (based on the IAP). A frontal language area (FLA) was identified in both patients in whom this region was mapped; however, errors in naming or repetition were seen at only one or two pairs of electrodes, and were seen on an inconsistent basis. A temporal language area (TLA) was identified in all three patients in whom this region was mapped. With the exception of a patient who underwent hemispherectomy for Rasmussen syndrome (and in whom the expected postoperative aphasia was observed), language during the immediate postoperative period was intact. Cortical language areas were not identified in the two patients whose SEAs resided in either the nondominant or presumed minor language hemisphere. No decline in language was observed on bedside exam during the immediate postoperative period in these two patients., It is possible to successfully map cortical language areas in children age 6 and younger when the IAP indicates the presence of language in the hemisphere to be operated. However, errors in naming and repetition speech are more reliable when stimulating the TLA than in the FLA. Repetition or naming errors produced by stimulation of the frontal language area may be circumscribed and inconsistent.,