title: Determination of language dominance: Wada test confirms functional transcranial Doppler sonography.
abstract: OBJECTIVE
  To determine the efficacy of the invasive Wada test in determining language dominance, and to validate the functional transcranial Doppler sonography (fTCD) examination in patients.
  
  
  BACKGROUND
  Previous work shows that simultaneous bilateral fTDC may identify cognitive hemispheric dominance in healthy individuals.
  
  
  METHODS
  fTDC and the Wada test were performed prospectively in 14 patients with various diseases (tumors, cerebrovascular events, head injury, intractable epilepsy). fTDC hemispheric dominance was determined based on the hemispheric blood flow velocity shift for language and visuospatial tasks.
  
  
  RESULTS
  fTDC was performed easily in patients. One patient could not be examined by fTDC because of absent temporal bone window for ultrasonic transmission. Two Wada tests were inconclusive due to patient somnolence. One of these patients suffered from right frontal tumor and had aphasia remitted under steroids when examined. fTDC indicated a bilateral language dominance. In the remaining 11 patients the correlation between fTDC and Wada language lateralization indices was 0.75 (p = 0.008). If a post hoc cutoff score was taken for the fTDC language lateralization index, in eight patients, both fTDC and Wada testing determined the left hemisphere to be dominant for language; in the other three patients, language function was bilateral in both examinations.
  
  
  CONCLUSIONS
  Although the current results are preliminary and require replication in a larger sample, fTDC seems to be able to assess hemispheric language dominance not only in healthy individuals, but also in patients. It might become an alternative noninvasive or complementary tool to the Wada test, particularly in patients in whom the Wada test is impractical or gives inconclusive results.
authors.affiliation: Department of Neurology, University of Berne, Inselspital, Switzerland. Frank.Rihs@insel.ch
authors.forename: F
authors.initials: F
authors.lastname: Rihs
authors.forename: M
authors.initials: M
authors.lastname: Sturzenegger
authors.forename: K
authors.initials: K
authors.lastname: Gutbrod
authors.forename: G
authors.initials: G
authors.lastname: Schroth
authors.forename: H P
authors.initials: HP
authors.lastname: Mattle
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology*; D001927:Brain Diseases / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017585:Ultrasonography, Doppler, Transcranial