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  • Title: Usefulness of Wada test in predicting seizure outcome following anterior temporal lobectomy.
    Author: Rathore C, Kesavadas C, Sarma SP, Radhakrishnan K.
    Journal: Epilepsy Res; 2013 Dec; 107(3):279-85. PubMed ID: 24120923.
    Abstract:
    OBJECTIVE: To study the usefulness of the Wada test for predicting seizure outcome following anterior temporal lobectomy (ATL). METHODS: From 1996 to 2002, all patients with left mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS) and selected patients with right MTLE-HS underwent the Wada test before ATL at our center. Patients were selected for ATL on the basis of unilateral HS on MRI and concordant electro-clinical data. Twelve-item recognition paradigm was used for Wada memory testing. Score of +1 was awarded for a correct response and -0.5 for an incorrect response. We defined Wada failure as a contralateral score of <5, ipsilateral score of >8, and difference score of <0. No patient was denied surgery based on the Wada results. Means of the three scores were compared between seizure free and non-seizure free patients. Sensitivity, specificity and receiver operator characteristic curves of various scores for predicting seizure outcome were calculated. RESULTS: 151 patients (129 left MTLE; mean age: 27.80±8.72 years) formed the study group. At mean postoperative follow-up of 6.4±2.0 years, 127 patients were seizure free. Mean contralateral score was lower in the seizure-free group (7.15±3.07 vs. 8.71±4.13; p<0.001) while ipsilateral and difference scores were similar between the two seizure outcome groups. Areas under the curves for contralateral, ipsilateral and difference scores for predicting seizure-free outcome were 0.49, 0.58 and 0.59, respectively, suggesting its modest usefulness in individual patients. Results remained same when the analysis was restricted to left MTLE patients. CONCLUSIONS: Wada test has limited usefulness for predicting seizure outcome following ATL.
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