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False lateralization of language cortex on functional MRI after a cluster of focal seizures

From the Department of Neurology (Dr. Jayakar) and Radiology (Drs. Bernal, Medina, and Altman), Miami Children’s Hospital, Miami, FL.

Address correspondence and reprint requests to Dr. Prasanna Jayakar, Neuroscience Center, Miami Children’s Hospital, 3100 SW 62nd Avenue, Miami, FL 33155; e-mail: prasanna.jayakar{at}mch.com

fMRI can define language cortex but its limitations are not yet fully understood. This article describes a child in whom fMRI falsely lateralized language cortex when performed after a cluster of left temporal lobe seizures. Multiple language tasks revealed no activation over the left temporal lobe despite a normal neurologic exam at the time of the study. A second fMRI performed 2 weeks later activated sites predominantly over the left, which were confirmed by extra-operative functional language mapping. fMRI may be unhelpful after frequent seizures.

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