Knake Susanne, Haag Anja, Hamer Hajo M, Dittmer Christine, Bien Siegfried, Oertel Wolfgang H, Rosenow Felix
Department of Neurology, Interdisciplinary Epilepsy Center, Philipps-University, Marburg, Germany.
Neuroimage. 2003 Jul;19(3):1228-32. doi: 10.1016/s1053-8119(03)00174-5.
This study prospectively investigates whether noninvasive functional transcranial Doppler sonography (fTCD) is a useful tool to determine hemispheric language lateralization in the presurgical evaluation of patients with medically intractable temporal lobe epilepsy (TLE). fTCD results were compared with the Wada test as the gold standard. Wada test and fTCD were performed in 13 patients suffering from TLE. fTCD continuously measured blood flow velocities in both middle cerebral arteries, while the patient was performing a cued word generation task. During the Wada test, spontaneous speech, comprehension, reading, naming, and repetition were investigated. A laterality index (LI) was obtained by both procedures. Due to a lack of an acoustic temporal bone window, fTCD could not be performed in two patients (15%). In 9 of the remaining 11 patients hemispheric language dominance was found on the left side, in 1 patient on the right side, and 1 patient showed bihemispheric language representation. In all patients fTCD and the Wada test were in good agreement regarding hemispheric language lateralization, and the LI of both techniques were highly correlated (r = 0.776, P = 0.005). fTCD gives predictions of hemispheric language dominance consistent with the Wada test results even in children, patients with low IQ, and nonnative speakers. It is an alternative to the Wada test in determining language lateralization in patients with temporal lobe epilepsy.
本研究前瞻性地调查了无创功能性经颅多普勒超声检查（fTCD）在药物难治性颞叶癫痫（TLE）患者术前评估中是否是确定半球语言优势化的有用工具。将fTCD结果与作为金标准的Wada试验进行比较。对13例TLE患者进行了Wada试验和fTCD检查。在患者执行提示性单词生成任务时，fTCD连续测量双侧大脑中动脉的血流速度。在Wada试验期间，对自发言语、理解、阅读、命名和复述进行了研究。两种检查方法均获得了偏侧化指数（LI）。由于缺乏声学颞骨窗，2例患者（15%）无法进行fTCD检查。在其余11例患者中，9例发现左侧为半球语言优势，1例右侧为半球语言优势，1例显示双侧半球语言表征。在所有患者中，fTCD和Wada试验在半球语言优势化方面具有良好的一致性，两种技术的LI高度相关（r = 0.776，P = 0.005）。即使在儿童、低智商患者和非母语者中，fTCD对半球语言优势的预测也与Wada试验结果一致。在确定颞叶癫痫患者的语言优势化方面，它是Wada试验的一种替代方法。
