Cortical language mapping in epilepsy: A critical review

One challenge in dominant hemisphere epilepsy surgery is to remove sufficient epileptogenic tissue to achieve seizure freedom without compromising postoperative language function. Electrical stimulation mapping (ESM) of language was developed specifically to identify essential language cortex in pharmacologically intractable epilepsy patients undergoing left hemisphere resection of epileptogenic cortex. Surprisingly, the procedure remains unstandardized, and limited data support its clinical validity. Nevertheless, ESM for language mapping has likely minimized postoperative language decline in numerous patients, and has generated a wealth of data elucidating brain-language relations. This article reviews the literature on topographical patterns of language organization inferred from ESM, and the influence of patient characteristics on these patterns, including baseline ability level, age, gender, pathology, degree of language lateralization and bilingualism. Questions regarding clinical validity and limitations of ESM are discussed. Finally, recommendations for clinical practice are presented, and theoretical questions regarding ESM and the findings it has generated are considered.