Developmental Aspects of Language Mapping with Stereoelectroencephalography

Summary: This review examines developmental perspectives on the use of stereoelectroencephalography (SEEG) for delineating language areas and networks in pediatric patients with drug-resistant epilepsy, both as a clinical tool for presurgical evaluation and as a modality for gaining neuroscientific insights into speech and language development. Language development is a dynamic process that begins before birth and continues into adulthood, shaped by the maturation of brain networks. SEEG allows high-resolution study of these networks, providing a unique perspective on the organization of language systems. This review traces language acquisition from early infancy through adolescence and adulthood, highlighting the pivotal role of neural oscillations. We then summarize classical and contemporary neural models of language organization, highlighting the distributed and hierarchical networks, and emphasize the high spatial and temporal resolution of SEEG for presurgical planning that enables clinicians to optimize neurosurgical interventions while preserving essential language areas and the tracts connecting them. Our review also addresses the human brain's remarkable plasticity and capacity for reorganization, which are especially pronounced in children and vital for adaptation to and recovery from neurologic injury or surgery. We focus specifically on developmental reorganization in pediatric patients with drug-resistant epilepsy and its implications for language mapping with SEEG. The review concludes with recommendations for designing language-mapping batteries tailored to the unique needs of pediatric patients.