Reorganization of posterior language area in temporal lobe epilepsy: A cortico-cortical evoked potential study

Objective: To investigate the connectivity associated with the reorganized language network in patients with temporal lobe epilepsy (TLE) using cortico-cortical evoked potential (CCEP), which reveals the brain networks. Methods: Six patients with intractable TLE who underwent chronic intracranial electrode placement and revealed an atypical distribution of posterior language areas (Wernicke's areas) were studied. Alternating 1. Hz electrical stimuli were delivered to the anterior language areas (Broca's areas). CCEPs were recorded by averaging electrocorticograms time-locked to stimuli from the subdural electrodes. Thereafter, the posterior language areas identified by the electrical cortical mapping and CCEP distributions were compared by calculating the root mean square of CCEP responses. Results: CCEP responses were observed in various areas within the temporal, temporo-parietal or temporo-occipital area. The correlation between CCEP distributions and posterior language areas revealed two patterns. In two patients, the posterior language areas were located within CCEP distribution, but out of the maximum responses in the temporal lobe. On the other hand, parts of the language areas were outside CCEP-positive areas in four patients. Conclusion: Our results suggest that language reorganization might be associated with a functional shift from the termination of anterior-posterior language connection to the surrounding cortices. It should be noted that language areas can be identified outside the anterior-posterior language connection.