Resident Physician University Hospitals Cleveland Medical Center Cleveland Hts, OH, US
Introduction: The Wada procedure is utilized as a definitive diagnostic test for language lateralization. While the test has a high yield for definitive results, it requires an invasive procedure. Newer methods for lateralizing language have been developed including functional magnetic resonance imaging (fMRI). We aim to identify concordance between invasive and noninvasive modalities in the workup of surgical epilepsy patients.
Methods: A retrospective review was conducted at a single academic institution. A total of 50 patients undergoing Wada testing were identified between 2018 and 2024 from procedural logs. All patients underwent cerebral angiography with selective catheter infusions of Methohexital into sequential internal carotid arteries in concordance with clinical testing to evaluate language and memory function. Neuropsychological testing was completed via multi-visit assessments with a neuropsychologist. Data was extracted from medical records including procedural complications, surgical epilepsy treatment, and results of Wada testing, fMRI, and neuropsychological testing.
Results: All 50 patients undergoing Wada testing completed the procedure and no procedural complications were identified. Eighteen of the 50 patients (36%) had fMRI prior to Wada testing which was inconclusive for language lateralization in all but one case. A total of 39 patients underwent surgical treatment for epilepsy with 17 undergoing temporal lobectomy, 7 undergoing radiofrequency ablation, 7 undergoing lesional resection of epileptogenic focus excluding the temporal lobe, 5 undergoing laser interstitial thermal therapy (LITT), and 3 undergoing responsive neurostimulation implantation. In patients with complete data sets available for analysis (n=25), there was discordance between neuropsychological testing language lateralization and Wada testing language lateralization in 21 cases (84%).
Conclusion : While Wada testing requires invasive testing, the utility of a definitive modality of language lateralization plays an important role in the preoperative evaluation of epilepsy patients. Our results identified a patient population where Wada testing was critical in the diagnostic approach to epilepsy surgery when fMRI and neuropsychological testing was inconclusive.
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