Landau-Kleffner syndrome. Treatment with subpial intracortical transection

• Published in: Brain (London, England : 1878) Vol. 118 ( Pt 6); p. 1529
• Main Authors: Morrell, F, Whisler, W W, Smith, M C, Hoeppner, T J, de Toledo-Morrell, L, Pierre-Louis, S J, Kanner, A M, Buelow, J M, Ristanovic, R, Bergen, D
• Format: Journal Article
• Language: English
• Published: England 01-12-1995
• Subjects: Adolescent; Cerebral Cortex - surgery; Child; Child, Preschool; Electroencephalography; Female; Humans; Landau-Kleffner Syndrome - diagnosis; Landau-Kleffner Syndrome - physiopathology; Landau-Kleffner Syndrome - surgery; Magnetic Resonance Imaging; Magnetoencephalography; Male; Methohexital; Morbidity; Pia Mater; Postoperative Period; Speech; Time Factors; Treatment Failure
• ISSN: 0006-8950
• DOI: 10.1093/brain/118.6.1529

Landau-Kleffner syndrome (LKS) is an acquired epileptic aphasia occurring in childhood and associated with a generally poor prognosis for recovery of speech. It is thought to be the result of an epileptogenic lesion arising in speech cortex during a critical period of development. Utilizing a new surgical technique designed to eliminate the capacity of cortical tissue to generate seizures while preserving the normal cortical physiological function, we have treated 14 children with aphasia, seizures and a severely abnormal EEG by multiple subpial transection of the epileptogenic cortex. Seven of the 14 patients (50%) have recovered age-appropriate speech, are in regular classes in school and no longer require speech therapy. Four of the 14 (29%) have shown marked improvement, are speaking and understanding verbal instruction but are still receiving speech therapy. Thus, 11 of the 14 (79%), none of whom had used language to communicate for at least 2 years, are now speaking--a rate of sustained improvement considered unusual in this disorder. This study documents the value of a treatment modality not previously used in LKS. Success depends on selection of cases having severe epileptogenic abnormality that can be demonstrated to be unilateral in origin despite a bilateral electrographic manifestation.