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

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Abstract

Introduction

Wada test is well-known to assess lateralization of memory and language functions; however, super-selective Wada (ss-Wada) to evaluate motor leg function is rare. We present a ss-Wada test within the anterior cerebral artery (ACA) to assess the motor function of the leg.

Methods

Retrospective chart review.

Results

Comprehensive phase-I/II surgical evaluation revealed an ictal focus around the left post-central gyrus with immediate involvement around the left para-central regions. To avoid potential right leg motor dysfunction with the surgery, the patient underwent a ss-Wada procedure. Angiography revealed bilateral ACAs were supplied by the left A1 segment. Super-selective microcatheter injection of amobarbital into the left ACA was performed to avoid cross-filling the contralateral ACA. The ss-Wada test confirmed no right leg motor impairment. Afterward, a craniotomy with direct cortical stimulation confirmed that the left-sided ictal/peri-ictal zone had no clear leg motor function. The patient underwent disconnection of that region and remained seizure-free at 10-month post-op follow-up without any motor or sensory deficits in the right limbs.

Conclusion

This case demonstrates the proof of concept for ss-Wada in assessing lower extremity motor function. The ss-Wada procedure accurately predicted no motor deficits in the right leg, consistent with preserved motor function post-surgery.

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Author information

Authors and Affiliations

  1. Division of Pediatric Neurology, Department of Neurology, University of Louisville School of Medicine, 615 S Preston Street, 2nd floor, Louisville, KY, 40202, USA

    Alexander Kuruvilla, Charles J. Sadle, Samir Karia, Jeetendra Sah & Cemal Karakas

  2. Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, 40202, USA

    Ian Mutchnick

  3. Norton Children’s Neuroscience Institute and Children’s Hospital, Louisville, KY, 40202, USA

    Ian Mutchnick, Samir Karia, Jeetendra Sah, Rebecca Stilp, Shervin Dashti & Cemal Karakas

  4. Department of Neurosurgery, Billings Clinic, Billings, MT, 59101, USA

    Shervin Dashti

Authors
  1. Alexander Kuruvilla
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  2. Charles J. Sadle
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  3. Ian Mutchnick
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  4. Samir Karia
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  5. Jeetendra Sah
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  6. Rebecca Stilp
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  7. Shervin Dashti
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  8. Cemal Karakas
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Contributions

AK: writing, reviewing, and editing; CS: writing, reviewing, and editing; IM, JS, SK, RS, and SD: reviewing and editing; CK: concept, design, writing, reviewing, and editing.

Corresponding author

Correspondence to Cemal Karakas.

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This case was approved by the Institutional Review Board.

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The authors declare no competing interests.

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Kuruvilla, A., Sadle, C.J., Mutchnick, I. et al. Super-selective Wada test for pre-surgical leg motor function assessment: A case report. Childs Nerv Syst 40, 1631–1636 (2024). https://doi.org/10.1007/s00381-024-06302-1

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  • DOI: https://doi.org/10.1007/s00381-024-06302-1

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