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Controversies in Neurology
June 2008

Is the Wada Test Still Relevant? Yes

Author Affiliations

Author Affiliation:Division of Child Neurology, Ohio State University College of Medicine, Columbus. Dr Paolicchi is now with the Department of Neurology, Vanderbilt University School of Medicine, Monroe Carell Jr Children’s Hospital, Nashville, Tennessee.



Arch Neurol. 2008;65(6):838-840. doi:10.1001/archneur.65.6.838

For neurosurgical and presurgical epilepsy evaluations, localization of eloquent cortical functions is imperative in predicting the postsurgical outcome. In the case of presurgical epilepsy evaluations, localization of language and memory is an important factor in determining whether further presurgical evaluation is needed, whether intraoperative or extraoperative electrocorticography is indicated, and whether the patient is a suitable surgical candidate at all. The decades-old gold standard has been the intracarotid amobarbital procedure (IAP), or the Wada test. Functional magnetic resonance imaging (fMRI) is a newer, relatively safe neuroradiological technique for localization of cortical function. Although fMRI is a widely used research tool, it has increasingly been used in clinical settings as a technique for presurgical cortical localization. Because it is noninvasive, fMRI has multiple possible advantages compared with the IAP. Is the Wada test, therefore, replaceable? As the following concerns demonstrate, not yet.

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