Metabolic Abnormalities Detected in a Survey of Mentally Backward Individuals in Northern Ireland
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OBJECTIVE: To determine concordance rate between functional MRI (fMRI) and Wada test for language lateralization in our cohort of patients with medically intractable epilepsy. BACKGROUND: Preoperative fMRI is a non-invasive test that has been used increasingly in the epilepsy surgery centers to lateralize language. However, concordance rate between fMRI and Wada test has been variable in different studies. We report our local experience. DESIGN/METHODS: Patients with intractable focal epilepsy were studied for language lateralization using fMRI and Wada testing between 2007 and 2014. Three language paradigm tasks were used for fMRI studies: verb generation, sentence completion and naming. fMRI laterality indices were defined as a ratio (L-R)/(L+R) between the number of activated voxels in the left and right ROIs for Brodmann areas 44+45+46+8+9 (Anterior Language Area, ALA) and 22+39+40 (Posterior Language Area, PLA). fMRI and Wada results were divided into the right, left or bilateral hemispheric language dominance. RESULTS: 28 patients (15 men) were studied. Mean age at seizure onset was 19.3±14.57 years, and the mean age at fMRI was 34.8±12.48 years. 17 patients had left temporal epilepsy (TLE), 6 right TLE, 3 bilateral TLE, 1 left frontal and 1 multifocal epilepsy. The concordance rate between Wada and fMRI tests for the ALA and PLA was 68.2[percnt] and 52.2[percnt] for sentence completion; 56[percnt] and 52[percnt] for verb generation and 25[percnt] and 35[percnt] for naming paradigm, respectively. The concordance rate did not improve by combining the activation results of the 3 fMRI paradigms. Bilateral representation in Wada test or fMRI accounted for 68[percnt] of the discordant cases. CONCLUSIONS:Sentence completion and verb generation fMRI paradigms showed greater concordance with Wada test than naming paradigm. The higher discordance between the Wada test and fMRI was related to bilateral results suggestive of less stringent thresholds used for either test. Disclosure: Dr. Massot-Tarrus has nothing to disclose. Dr. Mousavi has nothing to disclose. Dr. Bihari has nothing to disclose. Dr. Hayman-Abello has nothing to disclose. Dr. Hayman-Abello has nothing to disclose. Dr. Mirsattari has nothing to disclose.Keywords:
Wada test
Concordance
Boston Naming Test
Sentence completion tests
Wada test
Temporal lobectomy
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The determination of speech laterality, especially where it is anomalous, is both a theoretical issue and a practical problem for brain surgery. Handedness is commonly thought to be related to speech representation, but exactly how is not clearly understood. This investigation analyzed handedness by preference rating and performance on a reliable task of motor laterality in 34 patients undergoing a Wada test, to see if they could provide an indicator of speech laterality.Hand usage preference ratings divided patients into left, right, and mixed in preference. Between-hand differences in movement time on a pegboard task determined motor laterality. Results were correlated (χ2) with speech representation as determined by a standard Wada test.It was found that patients whose between-hand difference in speed on the motor task was small or inconsistent were the ones whose Wada test speech representation was likely to be ambiguous or anomalous, whereas all those with a consistently large between-hand difference showed clear unilateral speech representation in the hemisphere controlling the better hand (χ2 = 10.45, df = 1, p < .01, η2 = 0.55) This relationship prevailed across hand preference and level of skill in the hands itself.We propose that motor and speech laterality are related where they both involve a central control of motor output sequencing and that a measure of that aspect of the former will indicate the likely representation of the latter. A between-hand measure of motor laterality based on such a measure may indicate the possibility of anomalous speech representation.
Wada test
Hand preference
Representation
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OBJECTIVE: To determine concordance rate between functional MRI (fMRI) and Wada test for language lateralization in our cohort of patients with medically intractable epilepsy. BACKGROUND: Preoperative fMRI is a non-invasive test that has been used increasingly in the epilepsy surgery centers to lateralize language. However, concordance rate between fMRI and Wada test has been variable in different studies. We report our local experience. DESIGN/METHODS: Patients with intractable focal epilepsy were studied for language lateralization using fMRI and Wada testing between 2007 and 2014. Three language paradigm tasks were used for fMRI studies: verb generation, sentence completion and naming. fMRI laterality indices were defined as a ratio (L-R)/(L+R) between the number of activated voxels in the left and right ROIs for Brodmann areas 44+45+46+8+9 (Anterior Language Area, ALA) and 22+39+40 (Posterior Language Area, PLA). fMRI and Wada results were divided into the right, left or bilateral hemispheric language dominance. RESULTS: 28 patients (15 men) were studied. Mean age at seizure onset was 19.3±14.57 years, and the mean age at fMRI was 34.8±12.48 years. 17 patients had left temporal epilepsy (TLE), 6 right TLE, 3 bilateral TLE, 1 left frontal and 1 multifocal epilepsy. The concordance rate between Wada and fMRI tests for the ALA and PLA was 68.2[percnt] and 52.2[percnt] for sentence completion; 56[percnt] and 52[percnt] for verb generation and 25[percnt] and 35[percnt] for naming paradigm, respectively. The concordance rate did not improve by combining the activation results of the 3 fMRI paradigms. Bilateral representation in Wada test or fMRI accounted for 68[percnt] of the discordant cases. CONCLUSIONS:Sentence completion and verb generation fMRI paradigms showed greater concordance with Wada test than naming paradigm. The higher discordance between the Wada test and fMRI was related to bilateral results suggestive of less stringent thresholds used for either test. Disclosure: Dr. Massot-Tarrus has nothing to disclose. Dr. Mousavi has nothing to disclose. Dr. Bihari has nothing to disclose. Dr. Hayman-Abello has nothing to disclose. Dr. Hayman-Abello has nothing to disclose. Dr. Mirsattari has nothing to disclose.
Wada test
Concordance
Boston Naming Test
Sentence completion tests
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Objective
To investigate the value of navigated transcranial magnetic stimulation (nTMS) in preoperative evaluation of epilepsy in functional zones.
Methods
Retrospective analysis was performed in 12 refractory epilepsy patients had functional cortical lesions and accepted surgery in our hospital from January 2016 to March 2017. The target surgery areas were considered in or near the functional areas by video electroencephalogram and stereotactic electroencephalography or Wada test, nTMS was used to identify the motor or language functional areas before surgery, and direct cortical stimulation (DCS) was performed during the surgery to identify the accuracy of nTMS. Treatment efficacies were evaluated 6-18 months after surgery.
Results
Hand motor areas were detected in all patients by nTMS, of which 72.7% patients (8/11, one severe hemispheric atrophy patient was excluded due to functional zone drift to the opposite) were coincided with intraoperative DCS ( 1.5 cm). And 8 patients had Engel grading I outcome (seizure-free), 2 had grading II outcome (almost seizure-free), and one had grading III outcome (worthwhile improvement). No persistent function deficits were noted.
Conclusion
The nTMS is an accurate, noninvasive and safe functional localization method, which can provide important information for epilepsy patients especially who are not suitable for invasive language evaluation in epilepsy surgery.
Key words:
Transcranial magnetic stimulation; Eloquent area; Language area; Motor area; Electrical cortical stimulation
Wada test
Grading (engineering)
Motor area
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Electrocorticography
Wada test
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Lacy, Maureen Ph.D.; Pyykkonen, Benjamin; Mottlow, Dawn M.S.N., R.N.; Do, Tien M.A.; Hunter, Scott Ph.D.; Frim, David M. M.D.
Wada test
Neurostimulation
Pediatric epilepsy
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Wada test
Amobarbital
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Purpose of review To examine the current clinical indications for conducting a Wada test in the presurgical evaluation of epilepsy surgery candidates in the light of research on the reliability and validity of proposed, noninvasive alternatives. Recent findings There has been a significant shift in the role of the Wada test in epilepsy surgery programmes. The majority of epilepsy centres no longer conduct a Wada test on every surgical candidate. The lateralization of language via invasive methods may not be necessary for temporal lobe epilepsy patients in whom a tailored resection will spare areas associated with language function. Functional MRI is being used in some centres to lateralize and localize language function in epilepsy surgery candidates. Magnetoencephalography also shows promise in this regard. Patients at high risk of a postoperative memory decline can be identified via multivariate models that utilize noninvasive measures of cerebral function and structure, together with demographic and clinical variables. Summary The clinical indications for a Wada test should be determined on a case-by-case basis, with careful consideration of the available noninvasive alternatives, to ensure that the risk–benefit ratio is appropriate for every patient.
Wada test
Magnetoencephalography
Language function
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Amobarbital
Wada test
Anterior temporal lobectomy
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A total of 37 candidates for temporal lobe resection for epilepsy completed the Lateral Dominance Examination, a self-report instrument that measures hand and foot preference. Questionnaire results were compared with speech dominance, which had been determined by Intracarotid Sodium Amytal Procedure. Footedness was as good as handedness as a predictor of language laterality.
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Dominance (genetics)
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