FMRI reveals functional cortex in a case of inconclusive Wada testing

Lanzenberger, Rupert, Wiest, Gerald, Geissler, Alexander, Barth, Markus, Ringl, Helmut, Wober, Christian, Gartus, Andreas, Baumgartner, Christoph and Beisteiner, Roland (2005) FMRI reveals functional cortex in a case of inconclusive Wada testing. Clinical Neurology and Neurosurgery, 107 2: 147-151. doi:10.1016/j.clineuro.2004.06.006

Author Lanzenberger, Rupert
Wiest, Gerald
Geissler, Alexander
Barth, Markus
Ringl, Helmut
Wober, Christian
Gartus, Andreas
Baumgartner, Christoph
Beisteiner, Roland
Title FMRI reveals functional cortex in a case of inconclusive Wada testing
Journal name Clinical Neurology and Neurosurgery   Check publisher's open access policy
ISSN 0303-8467
Publication date 2005-02
Year available 2004
Sub-type Article (original research)
DOI 10.1016/j.clineuro.2004.06.006
Open Access Status Not yet assessed
Volume 107
Issue 2
Start page 147
End page 151
Total pages 5
Place of publication Amsterdam, Netherlands
Publisher Elsevier BV
Language eng
Formatted abstract
Objectives: The intracarotid amobarbital test (Wada test) currently represents the gold standard for preoperative lateralization of hemispheric dominance. Here, we report an epileptic patient with a longstanding extended lesion of the left hemisphere showing absence of motor and speech dysfunction with left carotid amobarbital injection, but tetraplegia and speech arrest with right carotid injection interpreted as a neuroplastic shift of motor and language functions to the right hemisphere. In contrast to the Wada results, motor functional magnetic resonance imaging (fMRI) showed a strong left hemispheric activation with right hand movements.

Methods: Right and left hand motor fMRI was performed. FMRI results and neurophysiological information obtained by motor and sensory evoked potential measurements were compared with the Wada test results.

Results: Initial interpretation of neuroplastic shifts of intrinsic left hemisphere functions to the right brain was revised after fMRI results which were confirmed by motor and sensory evoked potentials.

Conclusion: As motor inactivation usually is thought to be the most robust feature of the Wada test, this case demonstrates that fMRI may reveal residual functional cortex in cases of inconclusive Wada results.
Keyword Epilepsy
Preoperative diagnostic
Wada test
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Centre for Advanced Imaging Publications
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