The interpretation of language fMRI results in the pediatric population represents an extreme challenge for the following reasons: Many children with epilepsy have co-existent developmental delay and cognitive decline and are on long-term antiepileptic medications, which may diminish their capacity to undergo fMRI language tests In healthy toddlers, language representation is still more bilateral.[ 42 ] Various authors have also shown an increasing trend toward lateralization of the networks to the left perisylvian region until 18 years.[ 29 43 44 ] Hence, a left-sided lesion occurring early in life may have diminished propensity to produce speech disturbance In subjects with early brain lesions, cortical reorganization seems to occur, resulting in bilateral or right hemispheric dominance.
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