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      Assessment of language lateralization in epilepsy patients using the super-selective Wada test

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          Abstract

          Background

          The classical Wada test (cWada), performed by injecting a short-acting anesthetic through the intracarotid route, helps determine language dominance. In the cWada, adverse effects are observed in 10–30% of trials, hindering accurate assessments. In this study, we assessed the effectiveness of the super-selective Wada test (ssWada), a more selective approach for anesthetic infusion into the middle cerebral artery (MCA).

          Methods

          We retrospectively examined the data of 17 patients with epilepsy who underwent ssWada via anesthetic injection into one M1 segment of the MCA and at least one contralateral trial.

          Results

          The ssWada identified 12 patients with left language dominance, 3 with right language dominance, and 2 with bilateral language distribution. Nine trials on the language dominant side resulted in global aphasia for patients with left- or right language dominance. Of the 13 trials conducted on the non-dominant language side, 12 revealed intact language function and one resulted in confusion. Among these, the outcomes of global aphasia or no language impairment were confirmed in the contralateral trials. Among the 22 trials of unilateral M1 injections in patients with unilateral language dominance, 21 (95.5%) showed either global aphasia or no language impairment, indicating language dominance.

          Conclusions

          The ssWada yields clear results, with a high rate of over 90% in determining the language dominant hemisphere with few side effects.

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          Most cited references16

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          Intracarotid Injection of Sodium Amytal for the Lateralization of Cerebral Speech Dominance

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            Intracarotid propofol test for speech and memory dominance in man

            To evaluate the usefulness of propofol as an alternative drug to amobarbital for the Wada test.
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              To what extent can aphasic syndromes be localized?

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                Author and article information

                Contributors
                kazuo.kakinuma.c1@tohoku.ac.jp
                Journal
                Acta Neurochir (Wien)
                Acta Neurochir (Wien)
                Acta Neurochirurgica
                Springer Vienna (Vienna )
                0001-6268
                0942-0940
                10 February 2024
                10 February 2024
                2024
                : 166
                : 1
                : 77
                Affiliations
                [1 ]Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, ( https://ror.org/01dq60k83) 2-1 Seiryo, Aoba-ku, Sendai, 980-8575 Japan
                [2 ]Department of Neurosurgery, Tohoku University Graduate School of Medicine, ( https://ror.org/01dq60k83) Aoba-ku, Sendai, Japan
                [3 ]GRID grid.26999.3d, ISNI 0000 0001 2151 536X, Department of Neurology, , The University of Tokyo Graduate School of Medicine Faculty of Medicine, ; Bunkyo-ku, Tokyo, Japan
                [4 ]Department of Rehabilitation, National Hospital Organization Sendai Nishitaga Hospital, ( https://ror.org/00gahk913) Taihaku-ku, Sendai, Japan
                [5 ]Department of Epileptology, Tohoku University Graduate School of Medicine, ( https://ror.org/01dq60k83) Aoba-ku, Sendai, Japan
                [6 ]Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Biomedical Engineering, ( https://ror.org/01dq60k83) Aoba-ku, Sendai, Japan
                [7 ]Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, ( https://ror.org/01dq60k83) Aoba-ku, Sendai, Japan
                Author information
                http://orcid.org/0000-0002-8284-2628
                http://orcid.org/0000-0002-6161-6971
                http://orcid.org/0000-0001-5477-6478
                http://orcid.org/0000-0001-9282-6499
                http://orcid.org/0000-0003-3411-2900
                http://orcid.org/0000-0003-1472-6032
                http://orcid.org/0000-0001-8164-4171
                http://orcid.org/0000-0002-8380-1561
                Article
                5957
                10.1007/s00701-024-05957-8
                10858922
                38340149
                d9d7dcdc-e563-47fe-a734-7dea8c8d3fb2
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 17 October 2023
                : 28 December 2023
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Austria, part of Springer Nature 2024

                Surgery
                epilepsy,epilepsy surgery,functional mapping,lateralization,preoperative planning,wada test
                Surgery
                epilepsy, epilepsy surgery, functional mapping, lateralization, preoperative planning, wada test

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