Super-selective Wada test for pre-surgical leg motor function assessment: A case report

Area of Science:

• Neurosurgery
• Epileptology
• Neurophysiology

Background:

• The Wada test is standard for assessing language and memory lateralization.
• Super-selective Wada (ss-Wada) testing for lower extremity motor function is rarely documented.
• Evaluating motor function of the leg using ss-Wada within the anterior cerebral artery (ACA) is presented.

Observation:

• A patient with an ictal focus near the left post-central and para-central gyri required evaluation for right leg motor function preservation.
• Super-selective amobarbital injection into the left ACA was performed to prevent contralateral A1 segment cross-filling.
• The ss-Wada test confirmed no anticipated right leg motor impairment.

Findings:

• Post-surgical evaluation revealed the ictal zone lacked clear leg motor function.
• The patient underwent successful disconnection of the seizure focus.
• The patient remained seizure-free with no motor or sensory deficits in the right limbs at 10-month follow-up.

Implications:

• This case establishes proof of concept for ss-Wada in assessing lower extremity motor function.
• Accurate prediction of preserved motor function by ss-Wada minimizes surgical risks.
• This method enhances surgical planning for epilepsy involving motor pathways.