Comparison of Language and Memory Lateralization by Functional MRI and Wada Test in Epilepsy.
Comparison of Language and Memory Lateralization by Functional MRI and Wada Test in Epilepsy.
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发表时间：
2021
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通讯作者：
Prabhakaran V
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作者：
Htet NN;Pizarro R;Nair VA;Chu DY;Meier T;Tunnell E;Rutecki P;Hermann B;Meyerand EM;Prabhakaran V
颈动脉内异戊巴比妥钠手术（ISAP 或 Wada 试验）在术前将大脑功能偏向大脑半球。功能磁共振成像（fMRI）越来越多地用于表征术前语言和记忆偏侧化。在这项研究中，在患有医学上难治性癫痫发作的患者中检查了功能磁共振成像与世界反兴奋剂机构的一致性。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缺陷的关系。使用已建立的语言和记忆 fMRI 范式对 27 名癫痫患者的术前 fMRI 和 Wada 数据进行了分析。布罗卡区和韦尼克区的激活在三个维度上进行测量。确定语言和记忆偏侧化，并使用标准神经精神病学和田测试程序进行比较。还测量了语言区到手术病灶边界（LAD）之间的最短距离，并与术后语言缺陷进行比较。我们的研究发现，fMRI 和 Wada 测试之间的语言优势的一致性为 0.41（Kappa 的“一般到良好”一致性），而记忆力的一致性为 0.1（Kappa 的“较差”一致性）。 LAD 与术后语言缺陷之间没有发现显着相关性（p=0.439）。 LAD 与术后记忆丧失之间存在相关性（p=0.049；手术病灶到语言区的距离越远，术后记忆丧失越少）。女性术后癫痫发作改善显着增加（Fisher p 值 = 0.0296；女性 = 8；男性 = 6）。发现利手习惯（右手受试者）与术后癫痫发作改善之间存在显着相关性（p = 0.02），并且性别和利手习惯相互作用对术后癫痫发作改善存在显着趋势（p = 0.09）。总体而言，我们的结果表明，fMRI 作为 WADA 测试的有用术前辅助手段，用于治疗难治性癫痫患者的语言偏侧化。
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 (p=0.439). A correlation was found between LAD and post-op memory deficit (p=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 (p=0.02) as well as a significant trend for interaction of gender and handedness on postoperative seizure improvement (p=0.09). Overall, our results demonstrate fMRI as a useful preoperative adjunct to Wada testing for language lateralization in patients with medically intractable seizures.