Lateralizing language with magnetic source imaging: validation based on the Wada test.
OBJECTIVE
Magnetoencephalography (MEG)/magnetic source imaging (MSI) is a noninvasive functional neuroimaging procedure used to localize language-specific regions in the brain. The Wada test, or intracarotid amobarbital procedure (IAP), is the gold standard in determining speech/language lateralization for presurgical planning, although it is invasive and associated with morbidity. The purpose of this study is to provide further validation on the use of MSI for presurgical language lateralization by comparing results against the IAP.


METHODS
The sample consisted of 35 patients with epilepsy and/or brain tumor undergoing presurgical evaluation at the Minnesota Epilepsy Group. All patients received both an IAP and MSI to determine hemispheric language dominance. For MSI, a 148-channel MEG system was used to record activation of language-specific cortex by an auditory word-recognition task.


RESULTS
The MSI and IAP were concordant in determining language in the hemisphere to be treated in 86% of the cases with sensitivity and specificity values of 80% and 100%, respectively.


CONCLUSIONS
The results from this study are consistent with prior research findings comparing functional neuroimaging procedures to the IAP in determining language lateralization in presurgical patients. The current study provides an important replication and support for Papanicolaou et al.'s findings in 2004 using a consecutive clinical sample from a different institution. An unusually high rate of atypical IAP language cases in this sample and differences between the two procedures are believed to explain the noted discrepancies. MSI is a viable noninvasive alternative to the IAP in the presurgical determination of language lateralization.
Doss
Robert C
RC
Minnesota Epilepsy Group, P.A., St Paul, Minnesota 55102, USA. rdoss@mnepilepsy.net
Zhang
Wenbo
W
Risse
Gail L
GL
Dickens
Deanna L
DL
D000293:Adolescent; D000328:Adult; D000654:Amobarbital / Q000008:administration & dosage / Q000494:pharmacology; D001921:Brain / Q000503:physiopathology* / Q000601:surgery; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D002343:Carotid Artery, Internal; D002540:Cerebral Cortex / Q000503:physiopathology; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007802:Language; D007807:Language Tests; D015225:Magnetoencephalography / Q000706:statistics & numerical data*; D008297:Male; D011300:Preoperative Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014705:Verbal Behavior / Q000187:drug effects
D000654:Amobarbital