TY - JOUR
T1 - Concordance between the Wada test and neuroimaging lateralization
T2 - Influence of imaging modality (fMRI and MEG) and patient experience
AU - Kemp, Steven
AU - Prendergast, Garreth
AU - Karapanagiotidis, Theodoros
AU - Baker, Gus
AU - Kelly, Thomas P.
AU - Patankar, Tufail
AU - Keller, Simon S.
PY - 2017/12/22
Y1 - 2017/12/22
N2 - The Wada test remains the traditional test for lateralizing language and memory function prior to epilepsy surgery. Functional imaging, particularly functional MRI (fMRI), has made progress in the language domain, but less so in the memory domain. Magnetoencephalography (MEG) has received less research attention, but shows promise, particularly for language lateralization. We recruited a consecutive sample of 19 patients with epilepsy who had completed presurgical work-up, including the Wada test, and compared fMRI (memory) and MEG (language and memory) with Wada test results. The main research question was the concordance between Wada and these two imaging techniques as preepilepsy surgery investigations. We were also interested in the acceptability of the three techniques to patients. Concordance rates (N = 16) were nonsignificant (Cohen's Kappa) between fMRI and Wada test (memory) and between MEG and Wada test (memory and language). The Wada test was a well-established protocol used at several epilepsy surgery centers in the UK. Patients generally found the Wada test an odd, but not aversive procedure. Sixteen (84%) patients who were scanned reported some level of obtundation in MEG. We present these discordant findings in support of the position that functional imaging and the Wada test are distinctive procedures, with little in the way of overlapping mechanisms, and that patient's experience should be taken into account when procedures are selected and offered to them.
AB - The Wada test remains the traditional test for lateralizing language and memory function prior to epilepsy surgery. Functional imaging, particularly functional MRI (fMRI), has made progress in the language domain, but less so in the memory domain. Magnetoencephalography (MEG) has received less research attention, but shows promise, particularly for language lateralization. We recruited a consecutive sample of 19 patients with epilepsy who had completed presurgical work-up, including the Wada test, and compared fMRI (memory) and MEG (language and memory) with Wada test results. The main research question was the concordance between Wada and these two imaging techniques as preepilepsy surgery investigations. We were also interested in the acceptability of the three techniques to patients. Concordance rates (N = 16) were nonsignificant (Cohen's Kappa) between fMRI and Wada test (memory) and between MEG and Wada test (memory and language). The Wada test was a well-established protocol used at several epilepsy surgery centers in the UK. Patients generally found the Wada test an odd, but not aversive procedure. Sixteen (84%) patients who were scanned reported some level of obtundation in MEG. We present these discordant findings in support of the position that functional imaging and the Wada test are distinctive procedures, with little in the way of overlapping mechanisms, and that patient's experience should be taken into account when procedures are selected and offered to them.
KW - Functional MRI (fMRI)
KW - Language
KW - Laterality
KW - Magnetoencephalography (MEG)
KW - Memory
KW - Wada test
UR - http://www.scopus.com/inward/record.url?scp=85037690964&partnerID=8YFLogxK
U2 - 10.1016/j.yebeh.2017.09.027
DO - 10.1016/j.yebeh.2017.09.027
M3 - Article
C2 - 29245083
AN - SCOPUS:85037690964
SN - 1525-5050
VL - 78
SP - 155
EP - 160
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
ER -