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Landau–Kleffner syndrome and temporal cortical volume reduction

It has been almost half a century since Landau and Kleffner published in this Journal their observations on six children with acquired aphasia and convulsive disorder.1 Although uncommon, the Landau–Kleffner syndrome (LKS) has generated strong interest because of the vexing facts that neither pathogenesis nor proper treatment has been defined.2–5⇓⇓⇓

Classic LKS presentation is the experience of one or more seizures and progressive aphasia in normal children with normal language development, with peak incidence between 5 and 7 years, rarely as early as age 2. The aphasia is predominantly receptive, followed by secondary impairment of expressive language. Patients have few seizures, usually readily controlled; up to one-third have none. Epileptiform EEG abnormalities are most often found in the temporal regions bilaterally. Potentiation of the spikes during sleep is characteristic, often to a degree that meets the criteria of status epilepticus of slow sleep. The epileptiform changes, along with …