Bilingualism, Epilepsy, and Connectome Resilience

Epilepsy is among the most prevalent neurologic disorders worldwide, and one-third of patients continue to experience seizures despite medical therapy. Many of these pharmacoresistant patients suffer from temporal lobe epilepsy (TLE). High-resolution MRI has been instrumental to diagnose mesiotemporal sclerosis, the hallmark pathology of TLE, and for mapping distributed substrates of the condition.1 These methods have shaped our understanding of TLE as a network disorder, highlighting how structural changes and brain rewiring beyond the mesiotemporal disease epicenter may affect network signaling. This perspective has granted a powerful framework to study seizure mechanisms and to better understand the unique phenotype of TLE. Indeed, TLE is more than a seizure disorder: Over 50% of patients present with clinically significant neuropsychological impairment,2 with degrees of dysfunction generally mirroring the extent of network compromise.3 Given how cognitive impairment often affects patient functioning, quality of life, and well-being,4 there is a pressing need to identify factors able to mitigate atypical brain network organization in TLE.