Spoken Language Outcomes after Hemispherectomy: Factoring in Etiology

Abstract

We analyzed postsurgery linguistic outcomes of 43 hemispherectomy patients operated on at UCLA. We rated spoken language (Spoken Language Rank, SLR) on a scale from 0 (no language) to 6 (mature grammar) and examined the effects of side of resection/damage, age at surgery/seizure onset, seizure control postsurgery, and etiology on language development. Etiology was defined as developmental (cortical dysplasia and prenatal stroke) and acquired pathology (Rasmussen's encephalitis and postnatal stroke). We found that clinical variables were predictive of language outcomes only when they were considered within distinct etiology groups. Specifically, children with developmental etiologies had lower SLRs than those with acquired pathologies (p =.0006); age factors correlated positively with higher SLRs only for children with acquired etiologies (p =.0006); right-sided resections led to higher SLRs only for the acquired group (p =.0008); and postsurgery seizure control correlated positively with SLR only for those with developmental etiologies (p =.0047). We argue that the variables considered are not independent predictors of spoken language outcome posthemispherectomy but should be viewed instead as characteristics of etiology.

Literacy after cerebral hemispherectomy: Can the isolated right hemisphere read?

“…However, the etiologies that led to hemispherectomy for the patients reported on in these previous studies were quite varied and included patients with progressive disorders (Rasmussen encephalitis and Sturge Weber syndrome) and one with a brain tumor. Since the effects of etiology on language outcomes are widely acknowledged [18,21], we, therefore, chose to focus on multiple patients who had undergone cerebral hemispherectomy for the same etiology, namely, perinatal infarct. Even within the same etiology, the clinical variables in our sample were heterogeneous.…”

“…However, only two participants, 3F and 5F, could read ( Table 1). All participants had age-appropriate speech and comprehension of language at testing, based on the data of previously published assessments [21], although detailed examination revealed subtle syntactic deficits in some of them.…”

“…Both near-normal and impaired language outcomes have been reported, and heterogeneity of outcomes has been attributed to the effects of specific etiologies and clinical factors that are associated with them [18,21].…”

Complex syntax in the isolated right hemisphere: Receptive grammatical abilities after cerebral hemispherectomy

“…All participants at school returned to the same grade level without missing a school year, with either no professional intervention or (at most) 1 weekly session with a Speech Language Pathology (SLP) professional. All participants in the group with PI had age-appropriate speech and comprehension of language at testing, based on data using previously published assessments [23]. All families reported no history of lefthandedness in the family, and each child's use of her left hand from early on was, most likely, due to the hemiparesis associated with stroke.…”

GCS: A grammatical coding system for natural language data

“…Thus, although both formal test performance and language samples were used to evaluate language performance, it was for the analysis of the spontaneous speech samples that GCS was developed. Aspects of this research may be reviewed in Caplan, Curtiss, Chugani, and Vinters (1996), Curtiss and de Bode (1998, 1999a, 1999b, 2003, Curtiss, de Bode, and Mathern (2001), Curtiss and Schaeffer (1997a, 1997b), de Bode (1998), and de Bode and Curtiss (1999.…”