Temporal lobe epilepsy (TLE) in children is a slightly different entity than TLE in adults not only because of its semiology and pathology but also because of the different approach to surgical treatment. Presurgical investigations for eloquent cortex, especially language, must take these differences into account. Most diagnostic tests were created for adults, and many of the assessment tools need to be adapted for children because they are not just small adults. This paper will highlight the specific challenges and solutions in mapping language in a pediatric population with TLE. 1. Introduction In refractory temporal lobe epilepsy (TLE), it is important to be able to determine which hemisphere is dominant and hosts the majority of the language areas. When a patient is evaluated as a potential candidate for resective surgery, language mapping should be able to indicate which hemisphere is dominant and precisely identify where the language areas are situated within the brain. While the general principle of mapping language for TLE in children might be the same as for adults, many challenges are encountered in the mapping process because children are not small adults but differ from adults in many aspects. To understand some of the differences between children and adults in TLE features, a brief overview of TLE is provided, focusing on surgical candidates and preoperative investigations. Then, a brief summary of language development and lateralization differences between normal children and children with epilepsy is provided. Finally, various techniques for language assessment are described. 2. Temporal Lobe Epilepsy in Children The semiology of temporal lobe originating seizures is not as well characterized in children compared to adults and is dependent on age. For example, infants have a predominance of behavioral arrests, they also tend to have more prominent convulsive activity than adults, and their seizures appear clinically generalized. In younger patients, the automatisms are first discrete and mostly orofacial, but the complexity of hand automatisms increases with age. After the age of 3 years, tonic or myoclonic spasms decrease, as do other motor phenomena, which might have been reminiscent of frontal lobe seizures, and the overall semiology becomes closer to that observed in adults [1, 2]. The etiology of the seizure in children is also different. Mesial temporal sclerosis (MTS) is the most common adult etiology, while in children it is relatively rare. In the pediatric population, when MTS is present, it is often accompanied by a neocortical
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