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The base rate of Wada test failure
Steven Kemp1, Katherine Wilkinson, Helen Caswell
1St. James's University Hospital, Leeds, UK. steven.kemp@leedsth.nhs.uk
Epilepsy & Behavior : E&B
|August 22, 2008
Summary
The Wada test, used for epilepsy surgery planning, has a high failure rate in patients with left temporal lesions. Right-handed patients with right temporal lesions and strong verbal memory are unlikely to fail, suggesting selective Wada test use.
Area of Science:
- Neuroscience
- Neurology
- Neurosurgery
Background:
- Functional brain imaging for language lateralization and memory assessment is not yet clinically available.
- The Wada test is the current standard for assessing pre-epilepsy surgery memory decline risk but is invasive and has limitations.
- Evaluating the failure rates of the Wada test is crucial for optimizing its clinical application.
Purpose of the Study:
- To audit Wada test results to determine base rates of failure.
- To identify clinical characteristics associated with Wada test failure.
- To provide data supporting the selective use of the Wada test in epilepsy surgery planning.
Main Methods:
- Audit of 141 consecutive Wada test results.
- Analysis of failure rates and associated clinical characteristics.
- Review of patient demographics, lesion location, and baseline neuropsychological data.
Main Results:
- Patients with left temporal lesions showed a higher likelihood of Wada test failure, irrespective of handedness or baseline neuropsychological scores.
- Right-handed patients with right temporal lesions and strong verbal memory demonstrated a low probability of Wada test failure.
- Failure rates and specific patient profiles were identified to guide selective Wada test utilization.
Conclusions:
- The Wada test may not be necessary for right-handed patients with right temporal lesions and robust verbal memory.
- Left temporal lesions are associated with increased Wada test failure risk, warranting careful consideration.
- Case-by-case evaluation for the Wada test is recommended pending the development of advanced functional imaging protocols.
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