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Ailion A, Duong P, Maiman M, Tsuboyama M, Smith ML. Clinical recommendations for conducting pediatric functional language and memory mapping during the phase I epilepsy presurgical workup. Clin Neuropsychol 2024; 38:1060-1084. [PMID: 37985747 DOI: 10.1080/13854046.2023.2281708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
Objective: Pediatric epilepsy surgery effectively controls seizures but may risk cognitive, language, or memory decline. Historically, the intra-carotid anesthetic procedure (IAP or Wada Test) was pivotal for language and memory function. However, advancements in noninvasive mapping, notably functional magnetic resonance imaging (fMRI), have transformed clinical practice, reducing IAP's role in presurgical evaluations. Method: We conducted a critical narrative review on mapping technologies, including factors to consider for discordance. Results: Neuropsychological findings suggest that if pre-surgery function remains intact and the surgery targets the eloquent cortex, there is a high chance for decline. Memory and language decline are particularly pronounced post-left anterior temporal lobe resection (ATL), making presurgical cognitive assessment crucial for predicting postoperative outcomes. However, the risk of functional decline is not always clear - particularly with higher rates of atypical organization in pediatric epilepsy patients and discordant findings from cognitive mapping. We found little research to date on the use of IAP and other newer technologies for lateralization/localization in pediatric epilepsy. Based on this review, we introduce an IAP decision tree to systematically navigate discordance in IAP decisions for epilepsy presurgical workup. Conclusions: Future research should be aimed at pediatric populations to improve the precision of functional mapping, determine which methods predict post-surgical deficits and then create evidence-based practice guidelines to standardize mapping procedures. Explicit directives are needed for resolving conflicts between developing mapping procedures and established clinical measures. The proposed decision tree is the first step to standardize when to consider IAP or invasive mapping, in coordination with the multidisciplinary epilepsy surgical team.
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Affiliation(s)
- Alyssa Ailion
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School
- Department of Neurology, Boston Children's Hospital, Harvard Medical School
| | - Priscilla Duong
- Department of Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University School of Medicine
| | - Moshe Maiman
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School
| | - Melissa Tsuboyama
- Department of Neurology, Boston Children's Hospital, Harvard Medical School
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, University of Toronto Mississauga
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2
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Noorizadeh N, Rezaie R, Varner JA, Wheless JW, Fulton SP, Mudigoudar BD, Nevill L, Holder CM, Narayana S. Concordance between Wada, Transcranial Magnetic Stimulation, and Magnetoencephalography for Determining Hemispheric Dominance for Language: A Retrospective Study. Brain Sci 2024; 14:336. [PMID: 38671988 PMCID: PMC11047819 DOI: 10.3390/brainsci14040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Determination of language hemispheric dominance (HD) in patients undergoing evaluation for epilepsy surgery has traditionally relied on the sodium amobarbital (Wada) test. The emergence of non-invasive methods for determining language laterality has increasingly shown to be a viable alternative. In this study, we assessed the efficacy of transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG), compared to the Wada test, in determining language HD in a sample of 12 patients. TMS-induced speech errors were classified as speech arrest, semantic, or performance errors, and the HD was based on the total number of errors in each hemisphere with equal weighting of all errors (classic) and with a higher weighting of speech arrests and semantic errors (weighted). Using MEG, HD for language was based on the spatial extent of long-latency activity sources localized to receptive language regions. Based on the classic and weighted language laterality index (LI) in 12 patients, TMS was concordant with the Wada in 58.33% and 66.67% of patients, respectively. In eight patients, MEG language mapping was deemed conclusive, with a concordance rate of 75% with the Wada test. Our results indicate that TMS and MEG have moderate and strong agreement, respectively, with the Wada test, suggesting they could be used as non-invasive substitutes.
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Affiliation(s)
- Negar Noorizadeh
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Roozbeh Rezaie
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Jackie A. Varner
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - James W. Wheless
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Stephen P. Fulton
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Basanagoud D. Mudigoudar
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Leigh Nevill
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Christen M. Holder
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Shalini Narayana
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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3
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Ji Z, Song RR, Swan AR, Angeles Quinto A, Lee RR, Huang M. Magnetoencephalography Language Mapping Using Auditory Memory Retrieval and Silent Repeating Task. J Clin Neurophysiol 2024; 41:148-154. [PMID: 35512180 PMCID: PMC9633581 DOI: 10.1097/wnp.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The study aims to (1) examine the spatiotemporal map of magnetoencephalography-evoked responses during an Auditory Memory Retrieval and Silent Repeating (AMRSR) task, and determine the hemispheric dominance for language, and (2) evaluate the accuracy of the AMRSR task in Wernicke and Broca area localization. METHODS In 30 patients with brain tumors and/or epilepsies, the AMRSR task was used to evoke magnetoencephalography responses. We applied Fast VEctor-based Spatial-Temporal Analyses with minimum L1-norm source imaging method to the magnetoencephalography responses for localizing the brain areas evoked by the AMRSR task. RESULTS The Fast-VEctor-based Spatial-Temporal Analysis found consistent activation in the posterior superior temporal gyrus around 300 to 500 ms, and another activation in the frontal cortex (pars opercularis and/or pars triangularis) around 600 to 900 ms, which were localized to the Wernicke area (BA 22) and Broca area (BA 44 and BA 45), respectively. The language-dominant hemispheric laterization elicited by the AMRSR task was comparable with the result from an Auditory Dichotic task result given to the same patient, with the exception that AMRSR is more sensitive on bilateral language laterization cases on finding the Wernicke and Broca areas. CONCLUSIONS For all patients who successfully finished the AMRSR task, Fast-VEctor-based Spatial-Temporal Analysis could establish accurate and robust localizations of Broca and Wernicke area and determine hemispheric dominance. For subjects with normal auditory functionality, the AMRSR paradigm evaluation showed significant promise in providing reliable assessments of cerebral language dominance and language network localization.
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Affiliation(s)
- Zhengwei Ji
- Radiology Department, University of California, San Diego, California, U.S.A
| | - Ryan R. Song
- Department of Molecular and Cell Biology, University of California, Berkeley, California, U.S.A.; and
| | - Ashley Robb Swan
- Radiology Department, University of California, San Diego, California, U.S.A
| | | | - Roland R. Lee
- Radiology Department, University of California, San Diego, California, U.S.A
- Radiology Service, San Diego VA Healthcare System, San Diego, California, U.S.A
| | - Mingxiong Huang
- Radiology Department, University of California, San Diego, California, U.S.A
- Radiology Service, San Diego VA Healthcare System, San Diego, California, U.S.A
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Noorizadeh N, Varner JA, Birg L, Williard T, Rezaie R, Wheless J, Narayana S. Comparing the efficacy of awake and sedated MEG to TMS in mapping hand sensorimotor cortex in a clinical cohort. Neuroimage Clin 2024; 41:103562. [PMID: 38215622 PMCID: PMC10821581 DOI: 10.1016/j.nicl.2024.103562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/19/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024]
Abstract
Non-invasive methods such as Transcranial Magnetic Stimulation (TMS) and magnetoencephalography (MEG) aid in the pre-surgical evaluation of patients with epilepsy or brain tumor to identify sensorimotor cortices. MEG requires sedation in children or patients with developmental delay. However, TMS can be applied to awake patients of all ages with any cognitive abilities. In this study, we compared the efficacy of TMS with MEG (in awake and sedated states) in identifying the hand sensorimotor areas in patients with epilepsy or brain tumors. We identified 153 patients who underwent awake- (n = 98) or sedated-MEG (n = 55), along with awake TMS for hand sensorimotor mapping as part of their pre-surgical evaluation. TMS involved stimulating the precentral gyrus and recording electromyography responses, while MEG identified the somatosensory cortex during median nerve stimulation. Awake-MEG had a success rate of 92.35 % and TMS had 99.49 % (p-value = 0.5517). However, in the sedated-MEG cohort, TMS success rate of 95.61 % was significantly higher compared to MEG's 58.77 % (p-value = 0.0001). Factors affecting mapping success were analyzed. Logistic regression across the entire cohort identified patient sedation as the lone significant predictor, contrary to age, lesion, metal, and number of antiseizure medications (ASMs). A subsequent analysis replaced sedation with anesthetic drug dosage, revealing no significant predictors impacting somatosensory mapping success under sedation. This study yields insights into the utility of TMS and MEG in mapping hand sensorimotor cortices and underscores the importance of considering factors that influence eloquent cortex mapping limitations during sedation.
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Affiliation(s)
- Negar Noorizadeh
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Jackie Austin Varner
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Liliya Birg
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Theresa Williard
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Roozbeh Rezaie
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States
| | - James Wheless
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Shalini Narayana
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, United States.
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5
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Greiner HM, Maue E, Horn PS, Vannest J, Vedala K, Leach JL, Tenney JR, Williamson B, Fujiwara H, Coghill RC, Mangano FT, Kadis DS. Tolerability of transcranial magnetic stimulation language mapping in children. Epilepsy Res 2023; 194:107183. [PMID: 37352728 PMCID: PMC10527515 DOI: 10.1016/j.eplepsyres.2023.107183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Transcranial Magnetic Stimulation (TMS) has emerged as a viable non-invasive method for mapping language networks. Little is known about the tolerability of transcranial magnetic stimulation language mapping in children. METHODS Children aged 5-18 years underwent bilateral language mapping using repetitive transcranial magnetic stimulation (rTMS) to target 33 sites/hemisphere. Stimulation was delivered at 5 Hz, in 1-2 second bursts, during visual naming and auditory verb generation. Pain unpleasantness and pain intensity were assessed using an unpleasantness visual analog scale (VAS). RESULTS 49 participants tolerated motor mapping and had repetitive transcranial magnetic stimulation. 35/49 (71%) completed visual naming and 26/49 (53%) completed both visual naming and verb generation. Mean electrical field per participant was 115 V/m. Young age and lower language ability were associated with lower completion. Visual analogue scale scores were significantly higher (6.1 vs. 2.8) in participants who withdrew early compared to those who completed at least visual naming. CONCLUSIONS Pain measured by VAS was a major contributor to early withdrawal. However, a complete bilateral map was obtained with one paradigm in 71% of participants. Future studies designed to reduce pain during repetitive transcranial magnetic stimulation over language cortex will boost viability. SIGNIFICANCE This study represents the first attempt to characterize tolerability of bilateral repetitive transcranial magnetic stimulation language mapping in healthy children.
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Affiliation(s)
- Hansel M Greiner
- Division of Neurology, Cincinnati Children's Hospital Medical Center; Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Ellen Maue
- Division of Neurology, Cincinnati Children's Hospital Medical Center; Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center; Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jennifer Vannest
- Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kishore Vedala
- Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James L Leach
- Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey R Tenney
- Division of Neurology, Cincinnati Children's Hospital Medical Center; Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brady Williamson
- Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Physiology, Faculty of Medicine, University of Toronto, Canada
| | - Hisako Fujiwara
- Division of Neurology, Cincinnati Children's Hospital Medical Center; Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert C Coghill
- Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Childrens Hospital Medical Center, USA; Center for Understanding Pediatric Pain, Cincinnati Childrens Hospital Medical Center, USA
| | - Francesco T Mangano
- Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, USA
| | - Darren S Kadis
- Neurosciences and Mental Health, Research Institute, Hospital for Sick Children, Toronto, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Canada
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6
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Braden AA, Weatherspoon SE, Boardman T, Williard T, Adkins A, Gibbs SK, Wheless JW, Narayana S. Image-guided TMS is safe in a predominately pediatric clinical population. Clin Neurophysiol 2022; 137:193-206. [DOI: 10.1016/j.clinph.2022.01.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
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7
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Narayana S, Gibbs SK, Fulton SP, McGregor AL, Mudigoudar B, Weatherspoon SE, Boop FA, Wheless JW. Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary Evidence. Front Neurol 2021; 12:650830. [PMID: 34093397 PMCID: PMC8170483 DOI: 10.3389/fneur.2021.650830] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022] Open
Abstract
Accurate presurgical mapping of motor, speech, and language cortices, while crucial for neurosurgical planning and minimizing post-operative functional deficits, is challenging in young children with neurological disease. In such children, both invasive (cortical stimulation mapping) and non-invasive functional mapping imaging methods (MEG, fMRI) have limited success, often leading to delayed surgery or adverse post-surgical outcomes. We therefore examined the clinical utility of transcranial magnetic stimulation (TMS) in young children who require functional mapping. In a retrospective chart review of TMS studies performed on children with refractory epilepsy or a brain tumor, at our institution, we identified 47 mapping sessions in 36 children 3 years of age or younger, in whom upper and lower extremity motor mapping was attempted; and 13 children 5–6 years old in whom language mapping, using a naming paradigm, was attempted. The primary hand motor cortex was identified in at least one hemisphere in 33 of 36 patients, and in both hemispheres in 27 children. In 17 children, primary leg motor cortex was also successfully identified. The language cortices in temporal regions were successfully mapped in 11 of 13 patients, and in six of them language cortices in frontal regions were also mapped, with most children (n = 5) showing right hemisphere dominance for expressive language. Ten children had a seizure that was consistent with their clinical semiology during or immediately following TMS, none of which required intervention or impeded completion of mapping. Using TMS, both normal motor, speech, and language developmental patterns and apparent disease induced reorganization were demonstrated in this young cohort. The successful localization of motor, speech, and language cortices in young children improved the understanding of the risk-benefit ratio prior to surgery and facilitated surgical planning aimed at preserving motor, speech, and language functions. Post-operatively, motor function was preserved or improved in nine out of 11 children who underwent surgery, as was language function in all seven children who had surgery for lesions near eloquent cortices. We provide feasibility data that TMS is a safe, reliable, and effective tool to map eloquent cortices in young children.
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Affiliation(s)
- Shalini Narayana
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Savannah K Gibbs
- Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States
| | - Stephen P Fulton
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States
| | - Amy Lee McGregor
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States
| | - Basanagoud Mudigoudar
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States
| | - Sarah E Weatherspoon
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States
| | - Frederick A Boop
- Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States.,Semmes Murphey Neurologic and Spine Institute, Memphis, TN, United States.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - James W Wheless
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States
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8
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Beyond the Wada: An updated approach to pre-surgical language and memory testing: An updated review of available evaluation techniques and recommended workflow to limit Wada test use to essential clinical cases. Epilepsy Res 2021; 174:106673. [PMID: 34082393 DOI: 10.1016/j.eplepsyres.2021.106673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 11/21/2022]
Abstract
The Intracarotid amobarbital test (IAT), also called Wada test, is considered the "gold standard" for lateralizing language dominance in the pre-surgical evaluation of patients with epilepsy. In addition, it has been further modified to assess the postoperative risk of amnesia in patients undergoing temporal lobectomy. Since then it has been utilized to lateralize language and assess pre-surgical memory function. Over the years, its popularity has declined due to several limitations and availability of alternative procedures like fMRI and MEG. A survey of its use in the pre-surgical evaluation for epilepsy surgery has not been performed since the 2008 international survey by Baxendale et al. and it was heavily skewed due to data from European and North American countries. Only approximately 12% of the epilepsy centers indicated that they used the Wada test in every patient to assess preoperative memory function and language lateralization before temporal lobectomy. Nowadays, we have many functional mapping tools at our disposal. It has become somewhat unsuitable to have epilepsy patients undergo an invasive test such as the Wada test for the risks associated with it outweigh the benefits. Our objective is to review the Wada Test and alternative methods of assessing language and memory dominance, as it is past its prime and should only be used in specific circumstances.
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9
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Han Y, Tong X, Wang X, Teng F, Deng Q, Zhou J, Guan Y, Yan Z, Chen L, Luan G, Wang M. A concordance study determining language dominance between navigated transcranial magnetic stimulation and the Wada test in patients with drug-resistant epilepsy. Epilepsy Behav 2021; 117:107711. [PMID: 33636527 DOI: 10.1016/j.yebeh.2020.107711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/18/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It remains unclear whether transcranial magnetic stimulation (TMS) can replace the Wada test to determine language hemisphere dominance (HD). Using the Wada test as the gold standard, this study aimed to investigate the accuracy of navigated TMS (nTMS) in determining language HD. METHODS This study enrolled nine right-handed patients with drug-resistant epilepsy. We hypothesized that application of nTMS to language-related areas of the language-dominant hemisphere would induce positive manifestation of language dysfunction (LD). To test our hypothesis, the patients were instructed to perform a visual object-naming task while nTMS was applied to the anterior (e.g., Broca's area) and posterior (e.g., Wernicke's area) regions, which are closely related to language processing. The Wada test result was used as the gold standard, and the diagnostic value of nTMS was assessed using the Kappa consistency test. RESULTS The nTMS-induced LD positive rate for the bilateral anterior language areas (85.7%) was higher than that for the posterior language areas (57.1%). There was high consistency between nTMS stimulation of the left anterior and posterior language areas and the Wada test results for determining language HD. In contrast, the consistency of stimulation of the right anterior and posterior transfer sites was moderate (Kappa value = 0.545, P = 0.171) and low, respectively. For the latter, no statistical calculation was performed because stimulation of the right posterior speech area was negative in all patients compared with the Wada test results. CONCLUSIONS Our findings revealed that using nTMS to stimulate language-related left anterior and posterior areas could predict language HD with high accuracy. When the stimulation performance of these areas is positive, nTMS and the Wada test are equally accurate. Observing only negative performance may indicate that language HD has been transferred to the right side.
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Affiliation(s)
- Yixian Han
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Xuezhi Tong
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Xiongfei Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Fei Teng
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Qinqin Deng
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Jian Zhou
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Zhaofen Yan
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Lingling Chen
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Guoming Luan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China.
| | - Mengyang Wang
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China.
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10
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Charbonnier L, Raemaekers MAH, Cornelisse PA, Verwoert M, Braun KPJ, Ramsey NF, Vansteensel MJ. A Functional Magnetic Resonance Imaging Approach for Language Laterality Assessment in Young Children. Front Pediatr 2020; 8:587593. [PMID: 33313027 PMCID: PMC7707083 DOI: 10.3389/fped.2020.587593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is a usable technique to determine hemispheric dominance of language function, but high-quality fMRI images are difficult to acquire in young children. Here we aimed to develop and validate an fMRI approach to reliably determine hemispheric language dominance in young children. We designed two new tasks (story, SR; Letter picture matching, LPM) that aimed to match the interests and the levels of cognitive development of young children. We studied 32 healthy children (6-10 years old, median age 8.7 years) and seven children with epilepsy (7-11 years old, median age 8.6 years) and compared the lateralization index of the new tasks with those of a well-validated task (verb generation, VG) and with clinical measures of hemispheric language dominance. A conclusive assessment of hemispheric dominance (lateralization index ≤-0.2 or ≥0.2) was obtained for 94% of the healthy participants who performed both new tasks. At least one new task provided conclusive language laterality assessment in six out of seven participants with epilepsy. The new tasks may contribute to assessing language laterality in young and preliterate children and may benefit children who are scheduled for surgical treatment of disorders such as epilepsy.
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Affiliation(s)
- Lisette Charbonnier
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mathijs A H Raemaekers
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Philippe A Cornelisse
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maxime Verwoert
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kees P J Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nick F Ramsey
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mariska J Vansteensel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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