Left parietal structural connectivity mediates typical and atypical language laterality in temporal lobe epilepsy

Abstract Objective Subjects with left temporal lobe epilepsy may either show altered hemispheric language lateralization or retain typical, left lateralization. Examining the integrity of white matter pathways involved in the adaptation or maintenance of language lateralization in these patients could have important clinical implications for preserving or potentiating compensatory language mechanisms. Methods We combined task functional magnetic resonance imaging and structural diffusion metrics to determine the dependency of lobe‐based language laterality on white matter integrity in healthy participants and left temporal lobe epilepsy (TLE) patients. We tested for differences between individuals who expressed typical, left hemisphere laterality compared to those with atypical laterality patterns (bilateral or right hemisphere biased). Results A total of 41 left TLE patients and 51 sex‐ and age‐matched healthy participants (HPs) were enrolled. In left temporal lobe epilepsy, typical patterns of frontal and temporal lateralities were less conditioned by the language‐related white matter connections of the left temporal lobe. In typically organized epilepsy subjects, temporal lobe language laterality was dependent upon the structural connectivities of the left parietal lobe. Among atypically organized individuals, compared to HPs, TLE patients displayed frontal and parietal language lateralities mediated by the structural connectivities of the left parietal lobe. Significance Language‐related left parietal lobe connections were critical both for maintaining typical left hemisphere‐biased language processing in the temporal lobe and for the formation of noncanonical, potentially adaptive language processing asymmetries in the frontal and parietal lobes. Assessments of the laterality and integrity of language skills in left temporal lobe epilepsy will require modeling white matter structural influences.