Baxendale Sallie
Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, London, UK.
Curr Opin Neurol. 2009 Apr;22(2):185-9. doi: 10.1097/WCO.0b013e328328f32e.
To examine the current clinical indications for conducting a Wada test in the presurgical evaluation of epilepsy surgery candidates in the light of research on the reliability and validity of proposed, noninvasive alternatives.
There has been a significant shift in the role of the Wada test in epilepsy surgery programmes. The majority of epilepsy centres no longer conduct a Wada test on every surgical candidate. The lateralization of language via invasive methods may not be necessary for temporal lobe epilepsy patients in whom a tailored resection will spare areas associated with language function. Functional MRI is being used in some centres to lateralize and localize language function in epilepsy surgery candidates. Magnetoencephalography also shows promise in this regard. Patients at high risk of a postoperative memory decline can be identified via multivariate models that utilize noninvasive measures of cerebral function and structure, together with demographic and clinical variables.
The clinical indications for a Wada test should be determined on a case-by-case basis, with careful consideration of the available noninvasive alternatives, to ensure that the risk-benefit ratio is appropriate for every patient.
鉴于对拟议的非侵入性替代方法的可靠性和有效性的研究，探讨在癫痫手术候选者的术前评估中进行Wada试验的当前临床指征。
Wada试验在癫痫手术项目中的作用发生了重大转变。大多数癫痫中心不再对每个手术候选者进行Wada试验。对于颞叶癫痫患者，通过侵入性方法进行语言定侧可能没有必要，因为定制切除术可以保留与语言功能相关的区域。一些中心正在使用功能磁共振成像来对癫痫手术候选者的语言功能进行定侧和定位。脑磁图在这方面也显示出前景。可以通过多变量模型识别术后记忆衰退高风险患者，该模型利用脑功能和结构的非侵入性测量方法，以及人口统计学和临床变量。
Wada试验的临床指征应根据具体情况确定，同时仔细考虑可用的非侵入性替代方法，以确保每个患者的风险效益比是合适的。
