Htet Natalie N, Pizarro Ricardo, Nair Veena A, Chu Daniel Y, Meier Timothy, Tunnell Evelyn, Rutecki Paul, Hermann Bruce, Meyerand Elizabeth M, Prabhakaran Vivek
Department of Radiology, University of Wisconsin School of Medicine and Public Health, USA.
Department of Biomedical Engineering, University of Wisconsin Madison, USA.
Front Neurol Neurosci Res. 2021;2. Epub 2021 Apr 16.
The intracarotid sodium amobarbital procedure (ISAP or Wada test) lateralizes cerebral functions to the cerebral hemispheres preoperatively. Functional magnetic resonance imaging (fMRI) is increasingly used to characterize preoperative language and memory lateralization. In this study, concordance of fMRI with Wada was examined in patients with medically intractable seizures. The relationship of the distance between the epileptogenic focus to functional activation area with patients' post-operative deficits in language was also analyzed. 27 epilepsy patients with preoperative fMRI and Wada data were analyzed using established fMRI paradigms for language and memory. Activation of Broca's and Wernicke's areas were measured in three dimensions. Language and memory lateralization were determined, and standard neuropsychiatry Wada test procedures were used for comparison. The shortest distance between a language area to the border of surgical focus (LAD) was also measured and compared with postoperative language deficits. Our study found that concordance between fMRI and Wada testing was 0.41 (Kappa's 'fair to good' concordance) for language dominance and 0.1 (Kappa's 'poor' concordance) for memory. No significant correlation was found between LAD and post-op language deficit (=0.439). A correlation was found between LAD and post-op memory deficit (=0.049; the further distance from surgical lesion to language area is associated with less post-operative memory loss). Females demonstrated significantly increased postoperative seizure improvement (Fisher's p-value=0.0296; female=8; male=6). A significant association between handedness (right-handed subjects) and postoperative seizure improvement was found (=0.02) as well as a significant trend for interaction of gender and handedness on postoperative seizure improvement (=0.09). Overall, our results demonstrate fMRI as a useful preoperative adjunct to Wada testing for language lateralization in patients with medically intractable seizures.
颈动脉内注射异戊巴比妥钠程序（ISAP或Wada试验）在术前可使大脑功能定位于大脑半球。功能磁共振成像（fMRI）越来越多地用于术前语言和记忆定侧的特征描述。在本研究中，对药物难治性癫痫患者进行了fMRI与Wada试验一致性的检查。还分析了致痫灶与功能激活区之间的距离与患者术后语言功能缺损的关系。使用既定的fMRI语言和记忆范式，对27例有术前fMRI和Wada数据的癫痫患者进行分析。在三个维度上测量了布洛卡区和韦尼克区的激活情况。确定了语言和记忆定侧，并使用标准的神经精神病学Wada试验程序进行比较。还测量了语言区与手术病灶边界之间的最短距离（LAD），并与术后语言功能缺损进行比较。我们的研究发现，fMRI与Wada试验在语言优势方面的一致性为0.41（卡帕值为“一般到良好”的一致性），在记忆方面为0.1（卡帕值为“差”的一致性）。未发现LAD与术后语言功能缺损之间存在显著相关性（=0.439）。发现LAD与术后记忆功能缺损之间存在相关性（=0.049；手术病灶到语言区的距离越远，术后记忆丧失越少）。女性术后癫痫改善情况显著增加（费舍尔p值=0.0296；女性=8例；男性=6例）。发现利手（右利手受试者）与术后癫痫改善之间存在显著相关性（=0.02），以及性别和利手对术后癫痫改善的相互作用存在显著趋势（=0.09）。总体而言，我们的结果表明，fMRI作为术前辅助手段，对于药物难治性癫痫患者的语言定侧，是Wada试验的有用补充。
