Investigations

On neuropsychological investigation, the child proved to have good attention. The Wechsler Intelligence Scale for Children (version III) disclosed clear dissociation between verbal abilities (a score of 56) and non-verbal abilities (a score of 90). There were phonological defects and articulation troubles. The Chevrie—Muller test revealed major difficulties in repetition of simple words as well as dyssyntaxia. Naming remained difficult, with phonemic paraphasias. In addition, memory for both verbal and non-verbal items was affected. While these neuropsychological findings are consistent with the Landau—Kleffner syndrome, the patient's persistent speech abnormalities meant that it was not possible to determine whether she was affected by additional cognitive dysfunction consistent with mesial temporal sclerosis.

Ictal EEG recording showed that most discharges affected the left temporal area, although a single seizure affected the right temporal area (Figure 37.3). An MRI scan showed left mesial temporal atrophy (Figure 37.4).

Long-lasting video—EEG with bilateral foramen ovale electrodes was obtained at the age of 12 years; 11 electro-clinical seizures were registered with onset in left mesio-temporal or fronto-temporal lobe. Discharges from right mesial temporal structures were always a reflection of the left-sided discharges and were asymptomatic. We

Mesio Temporal Lobes
FIGURE 37.4 FLAIR MRI sequence at the age of 12 years, showing bilateral mesial temporal atrophy, predominating on the left, with hyperintensity signal on this side.

performed intracranial exploration with grids and depth electrodes placed in the left fronto-temporal region, which confirmed the left mesio-temporal onset of seizures.

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