Wartość badania mózgu w spoczynku (fMRI) w określeniu lokalizacji obszarów mowy przed operacją u pacjentów z epilepsją ogniska lewostronnego

OBJECTIVE: Focusing on patients with epilepsy and left-sided epileptogenic foci, this study aimed to clarify language lateralization differences from healthy individuals, explore Broca's/Wernicke's area lateralization and dominant hemisphere shift, and construct a laterality index-activation map combined scheme. It provides a theoretical basis for optimizing epilepsy surgery and reducing postoperative language impairment risk. METHODS: We retrospectively studied 36 patients with left-sided epileptogenic foci and 45 healthy controls (2018-2023, Hebei Medical University Second Hospital). After preprocessing rs-fMRI data, 12 bilateral language-related seed points were selected to calculate functional connectivity and generate activation maps. We further computed two types of laterality indexes: the global laterality index (LI) reflecting overall whole-brain language lateralization, and the regional LI assessing independent lateralization of Broca's area (6 frontal seed points) and Wernicke's area (6 temporal seed points). The Kappa coefficient was used to analyze the consistency between different methods, and SEEG cortical stimulation (only performed in surgical candidates) combined with postoperative follow-up was applied to verify clinical reliability. RESULTS: Non-classical language dominance was higher in epilepsy (69.4% vs. 45.5%,  = 0.024), especially in Wernicke's area (81.8% vs. Broca's 50.0%). Laterality index-activation map consistency was 83.3% (Kappa = 0.586); regional laterality index-activation map consistency was 75.0% (Kappa = 0.40). SEEG stimulation and surgical verification confirmed that the left Broca's area retained core language function, whereas the left Wernicke's area showed significant functional impairment (only 10.0% positive stimulation rate, and no language deficits occurred after partial resection in 6 patients). CONCLUSION: Left-sided epilepsy patients show language lateralization remodeling, with Wernicke's area more prone to shift. Bilateral language dominance does not equate to equal functional contribution; the left Broca's area retains core motor language function and requires priority protection in all epilepsy surgeries involving the left frontotemporal lobe, especially left frontal lobe epileptogenic focus resection. The combined laterality index-activation map scheme reliably supports preoperative language lateralization, optimizes surgery, and reduces language impairment risk, with clinical value.