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. 2013 Feb;54(2):314-22.
doi: 10.1111/epi.12068. Epub 2013 Jan 7.

Language lateralization by fMRI and Wada testing in 229 patients with epilepsy: rates and predictors of discordance

Julie K Janecek  1 , Sara J Swanson, David S Sabsevitz, Thomas A Hammeke, Manoj Raghavan, Megan E Rozman, Jeffrey R Binder
Affiliations

Language lateralization by fMRI and Wada testing in 229 patients with epilepsy: rates and predictors of discordance

Julie K Janecek et al. Epilepsia. 2013 Feb.

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.

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Conflict of interest statement

Disclosure of Conflicts of Interest: none of the authors has any conflict of interest to disclose.

Figures

Figure 1
Figure 1
Frequency distributions of Wada and fMRI language laterality indices, with scores ranging from 100 (complete left hemisphere dominance) to −100 (complete right hemisphere dominance). Compared to the fMRI distribution, the Wada distribution is more strongly skewed to the left.
Figure 2
Figure 2
Reported rates of discordance in language dominance classification by Wada and fMRI testing. The studies are arranged from top to bottom in order of increasing sample size.
See this image and copyright information in PMC

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