Language mapping in non-lesional extratemporal intractable epilepsy with epileptic focus at elquent cortex

Patients with focal intractable epilepsy are candidate for surgical intervention. The goal is to achieve seizure freedom without morbidities or neurological deficit. Ictal onset zone at eloquent cortex, makes surgical intervention less favorable1. Language representation on the cortex is variable among people, especially in structural or functional abnormality of the brain. Early onset epilepsy with left hemisphere lesion or ictal onset zone are more likely to demonstrate atypical language dominance2. From this prospective, intraoperative awake cortical mapping of the language designated to delineate the cortex and minimize the post-operative deficit. We report a case of young lady studying Arabic language with good collage performance, her epileptogenic zone at the language area without language deficit post-operatively. Focal intractable epilepsy patients deserve full presurgical workup aiming to achieve seizure freedom. To delineate surgical margin, concordance of data is needed. In case of uncertainty, invasive subdural and depth electrodes are inserted for the best localization and lateralization. The challenge in dominant hemisphere epilepsy is to remove the whole epileptogenic tissue with minimization of the post-operative deficit3. Cortical language mapping served as a gold standard for over 50 years. Here we have a young lady who diagnosed with frontal lobe epilepsy, referred to our tertiary center for pre-surgical evaluation. Her data localized and lateralized to an eloquent cortex of language area. She is a college student, studying Arabic language and her neuropsychology assessment was normal apart from borderline naming testing. She had been undergone language cortical mapping and her post-operative bedside language assessment was intact.