J Neurol Neurosurg Psychiatry 84:379-385 doi:10.1136/jnnp-2012-303141
  • Cognitive neurology
  • Review

Patterns and predictors of atypical language representation in epilepsy

Patient's Choice
  1. Cyrille Henri Ferrier2
  1. 1University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
  2. 2Rudolf Magnus Institute of Neuroscience, Department of Neurology & Neurosurgery, University Medical Center Utrecht, University of Utrecht, The Netherlands
  1. Correspondence to Dr Cyrille Henri Ferrier, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Neurology & Neurosurgery F02.2.30, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; cferrier{at}
  1. Contributors Both authors made substantial contributions to conception and design, acquisition, analysis and interpretation of data. The manuscript was drafted by KKD and critically revised for important intellectual content by CHF.

  • Received 6 May 2012
  • Revised 14 July 2012
  • Accepted 1 August 2012
  • Published Online First 1 September 2012


In the majority of the normal population, the left hemisphere is dominant for language. In epilepsy, a higher proportion of ‘atypical’ language representation is encountered. This can follow one of three patterns: (1) altered interhemispheric representation, where the spectrum of lateralisation is shifted to the right; (2) interhemispheric dissociation of linguistic subfunctions; or (3) intrahemispheric changes in representation. Knowledge of these patterns is essential for avoiding postoperative language deficits in epilepsy patients undergoing surgery. Several predictors of atypical language representation exist. It is more prevalent in left-handed individuals. Lesions in rough proximity to classical language areas are more associated with atypical language, although in some cases, remote lesions, such as in the hippocampus, can also lead to altered language representation. The more disruptive the lesion, the more likely atypical language is to be found. Widespread and frequent interictal epileptiform discharges are also associated with atypical language. Atypical language representation is more likely to be present when injury or epilepsy onset occurred at a young age. Thus, a subgroup of patients can be defined in whom atypical language representation is more likely to be found.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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