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Super-selective Wada test for pre-surgical leg motor function assessment: A case report. Childs Nerv Syst 2024 May;40(5):1631-1636

Date

01/29/2024

Pubmed ID

38285223

DOI

10.1007/s00381-024-06302-1

Scopus ID

2-s2.0-85183375273 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

INTRODUCTION: Wada test is well-known to assess lateralization of memory and language functions; however, super-selective Wada (ss-Wada) to evaluate motor leg function is rare. We present a ss-Wada test within the anterior cerebral artery (ACA) to assess the motor function of the leg.

METHODS: Retrospective chart review.

RESULTS: Comprehensive phase-I/II surgical evaluation revealed an ictal focus around the left post-central gyrus with immediate involvement around the left para-central regions. To avoid potential right leg motor dysfunction with the surgery, the patient underwent a ss-Wada procedure. Angiography revealed bilateral ACAs were supplied by the left A1 segment. Super-selective microcatheter injection of amobarbital into the left ACA was performed to avoid cross-filling the contralateral ACA. The ss-Wada test confirmed no right leg motor impairment. Afterward, a craniotomy with direct cortical stimulation confirmed that the left-sided ictal/peri-ictal zone had no clear leg motor function. The patient underwent disconnection of that region and remained seizure-free at 10-month post-op follow-up without any motor or sensory deficits in the right limbs.

CONCLUSION: This case demonstrates the proof of concept for ss-Wada in assessing lower extremity motor function. The ss-Wada procedure accurately predicted no motor deficits in the right leg, consistent with preserved motor function post-surgery.

Author List

Kuruvilla A, Sadle CJ, Mutchnick I, Karia S, Sah J, Stilp R, Dashti S, Karakas C

Author

Rebecca L. Stilp PhD Assistant Professor in the Neurology department at Medical College of Wisconsin




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

Amobarbital
Functional Laterality
Humans
Leg
Lower Extremity
Retrospective Studies