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As speech-related symptoms of Landau–Kleffner syndrome (LKS) are often refractory to
pharmacotherapy, and resective surgery is rarely available due to the involvement of the vital cortex,
multiple subpial transection (MST) was suggested to improve patient outcome and preserve cortical
functions. Here, we analyze the reports about MST use in LKS, regarding its impact on seizures,
language, behavior, EEG, cognition, and reported adverse effects. In conditions like LKS, surgery is
not a popular treatment option and presumably should be considered sooner. Candidates for MST
should be selected carefully, optimally with the unilateral onset of epileptic activity. Laterality can be
assessed using a methohexital suppression test (MHXT), electrical intracarotid amobarbital test, or
magnetoencephalography. After MST, a significant percentage of LKS patients present seizure-free
status, normalization of EEG patterns, and rapid behavior improvement. Data comprising language
outcomes are mixed, with improvement reported in 23.8–100% of cases, and no superiority was
found in the only study comparing MST with a non-surgical group. Cognitive outcomes are not
well described. The risk linked to MST is described as low, with cerebral edema and transient
neurological deficits being the most common complications. MST successfully improves seizure, EEG,
and behavioral outcomes in LKS patients. However, its beneficial impact on language and cognition
is not well proven. It is generally a safe neurological operation.
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