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Late Language Transfer in Patients with Rasmussen Encephalitis

Language can transfer to the right hemisphere in patients with early left-sided brain injury (1,2). Rare cases with acquired left hemisphere lesions and language transfer after age 9 years have been reported (1,3,4). The possibility of language transfer in adolescent patients may influence decision making in epilepsy surgery and may alter concepts of language development and plasticity. We report two adolescents with initially lefthemispheric language dominance proven by intracarotid amobarbital testing (IAT) who developed right-sided language between 9 and 15 years and between 12 and 14 years, respectively. Language was impaired in both patients because of Rasmussen chronic encephalitis beginning at 8 and 11 years, with improvement after left hemispherectomy at ages 14 and 15 years. Case one, a right-handed 8-year-old boy, had pharmacologically intractable right clonic seizures associated with left frontocentral EEG seizures. Bilateral IAT at age 9 revealed left hemisphere language dominance. Repeated magnetic resonance imaging (MRI) showed progressive left hemispheric atrophy and increased left temporooccipital signal on T2 sequences. At age 15 years, right-sided epilepsia partialis continua and hemiparesis developed. Handedness shifted from right to left. A repeated IAT at that time showed right-sided language representation. Left functional hemispherectomy was performed. Histopathology was consistent with Rasmussen encephalitis. Postoperatively, no impaired language function was noted. Rare right facial clonic seizures were well controlled. Neuropsychological testing showed language improvement as compared with presurgical assessment (Table 1). Case two, a right-handed 11-year-old girl, had right clonic seizures and left frontocentral EEG seizures. Re-