Can my seizure medicines cause language problems?

For some patients with epilepsy, it is thought that the seizure medicines they take may be causing some of their language problems. In particular, disturbances in naming and comprehension have been associated with use of some of the newer medications, such as Topamax (topiramate). With our current understanding of the actions and effects of these medications, however, it is difficult to understand how they could specifically affect language and not other mental functions. It appears that reported language problems are likely to be a secondary result of more general effects on cognition or attention rather than a disturbance in language alone.

Will I have more language problems if I have epilepsy surgery?

Language problems are a particular concern for patients undergoing surgery for their epilepsy. If the surgery is performed on the hemisphere dominant for language (usually the left), new difficulties with naming sometimes are a result. Other aspects of language are hardly ever disturbed, however. The decision of whether or not a patient should have surgery must involve weighing the benefits of successful treatment against the risks, which do include the chance of causing language difficulties. In making their decisions about whether to perform surgery and the exact procedure to use, the surgeon and others on the surgical team will pay a great deal of attention to the possibility of postoperative language impairment and how it can be prevented.

Testing to determine which hemisphere of the brain is dominant for language is an important part of a patient's routine workup before epilepsy surgery. This is especially important for individuals who have had neurological disorders such as epilepsy since early childhood, because their language centers are more likely to be somewhere other than the typical locations. This testing usually includes the intracarotid amobarbital procedure (IAP or Wada test), which can determine which hemisphere is language-dominant.

If the patient's seizures originate in the language-dominant hemisphere, the specific language zones are often mapped before the operation. Presurgical monitoring may include recordings from surgically implanted grid electrodes to more precisely locate the region of the epileptic abnormality. During this monitoring, testing of expressive speech, naming, comprehension, and other language functions can be performed with electrical stimulation of the electrodes to map out the precise location of key language zones. Some hospitals perform similar types of mapping procedures during the surgery itself. The surgeon uses the mapping information to plan which brain areas can be removed without causing any new language difficulties.