Faculty Collaboration Database

Language lateralization by fMRI and Wada testing in 229 patients with epilepsy: rates and predictors of discordance. Epilepsia 2013 Feb;54(2):314-22

Date

01/09/2013

Pubmed ID

23294162

Pubmed Central ID

PMC3649863

DOI

10.1111/epi.12068

Scopus ID

2-s2.0-84873409900 (requires institutional sign-in at Scopus site)   170 Citations

Abstract

PURPOSE: To more definitively characterize Wada/functional magnetic resonance imaging (fMRI) language dominance discordance rates with the largest sample of patients with epilepsy to date, and to examine demographic, clinical, and methodologic predictors of discordance.

METHODS: Two hundred twenty-nine patients with epilepsy underwent both a standardized Wada test and a semantic decision fMRI language protocol in a prospective research study. Language laterality indices were computed for each test using automated and double-blind methods, and Wada/fMRI discordance rates were calculated using objective criteria for discordance. Regression analyses were used to explore a range of variables that might predict discordance, including subject variables, Wada quality indices, and fMRI quality indices.

KEY FINDINGS: Discordant results were observed in 14% of patients. Discordance was highest among those categorized by either test as having bilateral language. In a multivariate model, the only factor that predicted discordance was the degree of atypical language dominance on fMRI.

SIGNIFICANCE: fMRI language lateralization is generally concordant with Wada testing. The degree of rightward shift of language dominance on fMRI testing is strongly correlated with Wada/fMRI discordance, suggesting that fMRI may be more sensitive than Wada to right hemisphere language processing, although the clinical significance of this increased sensitivity is unknown. The relative accuracy of fMRI versus Wada testing for predicting postsurgical language outcome in discordant cases remains a topic for future research.

Author List

Janecek JK, Swanson SJ, Sabsevitz DS, Hammeke TA, Raghavan M, E Rozman M, Binder JR

Authors

Jeffrey R. Binder MD Professor in the Neurology department at Medical College of Wisconsin
Thomas Hammeke PhD, MS Emeritus Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Julie K. Janecek PhD Associate Professor in the Neurology department at Medical College of Wisconsin
Manoj Raghavan PhD, MD Professor in the Neurology department at Medical College of Wisconsin
Sara J. Swanson PhD Chief, Professor in the Neurology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age of Onset
Amobarbital
Electroencephalography
Epilepsy
Female
Functional Laterality
Humans
Hypnotics and Sedatives
Image Processing, Computer-Assisted
Language
Magnetic Resonance Imaging
Male
Predictive Value of Tests
Prospective Studies