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Comparing the Wada Test and Functional MRI for the Presurgical Evaluation of Memory in Temporal Lobe Epilepsy

  • Epilepsy (C. W. Bazil, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The usefulness of the Wada test (WT) predicting memory impairment from temporal lobe epilepsy (TLE) surgery has been debated, and it has progressively been replaced by functional MRI (fMRI). We review the current role of WT and fMRI in the presurgical assessment of TLE, and how novel surgical techniques might improve cognitive outcomes.

Recent Findings

fMRI’s ability to predict global amnesia has not been assessed. Although WT can produce false-positive results, it is still indicated in patients at risk for developing global amnesia: those with significant bilateral or contralateral memory deficits. In the current review, WT exhibited no added value, beyond preclinical data, for predicting material-specific memory impairment, whereas fMRI was reliable for either verbal or non-verbal memory decline. Abnormal functional connectivity on resting state fMRI (rs-fMRI) between the posterior cingulate and the hippocampus may be a predictor of postsurgical memory outcomes. Restricted resections to the pathogenic tissue, stereotactic laser, radiosurgery, and SEEG-guided thermos-coagulation were associated with better cognitive outcome.

Summary

fMRI should be used routinely in the presurgical workup of TLE to predict verbal and/or non-verbal memory decline, whereas WT may be indicated when there is a high risk of postsurgical global amnesia. Rs-fMRI is a promising tool for the presurgical workup of TLE, and more restricted resections are recommended to enhance cognitive outcomes.

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Abbreviations

ATL:

Anteromedial temporal lobectomy

FC:

Functional connectivity

fMRI:

Functional magnetic resonance

Hc:

Hippocampus

mTL:

Mesial temporal lobe

MTS:

Mesial temporal sclerosis

PCC:

Posterior cingulate cortex

PHc:

Parahippocampal cortex

Post.:

Posterior

rs-fMRI:

Resting state fMRI

TL:

Temporal lobe

TLE:

Temporal lobe epilepsy

WT:

Wada test

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Authors and Affiliations

  1. Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Andreu Massot-Tarrús

  2. Science Right Research Consulting, London, Ontario, Canada

    Kevin White

  3. Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada

    Seyed M. Mirsattari

  4. Department of Physiology and Pharmacology, Western University, London, Ontario, Canada

    Seyed M. Mirsattari

  5. Medical Biophysics, Western University, London, Ontario, Canada

    Seyed M. Mirsattari

  6. Medical Imaging, Western University, London, Ontario, Canada

    Seyed M. Mirsattari

  7. Psychology, Western University, London, Ontario, Canada

    Seyed M. Mirsattari

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  1. Andreu Massot-Tarrús
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Correspondence to Andreu Massot-Tarrús.

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Conflict of Interest

A. Massot-Tarrús has received honoraria for speaking engagements and advisory boards from Bial, Eisai, and UCB Pharma, and research support from Eisai and UCB. S.M. Mirsattari is on the advisory boards and speaker bureaus for UCB Canada Inc., Eisai Limited, and Sunovion Pharmaceuticals Canada, Inc. Kevin White is an independent research consultant who was paid by Dr. Mirsattari to assist with the editing of this manuscript.

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Our original study presented as part of this review paper was approved by Western University’s Research Ethics Board, in London, Ontario, Canada.

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Massot-Tarrús, A., White, K. & Mirsattari, S.M. Comparing the Wada Test and Functional MRI for the Presurgical Evaluation of Memory in Temporal Lobe Epilepsy. Curr Neurol Neurosci Rep 19, 31 (2019). https://doi.org/10.1007/s11910-019-0945-8

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