The Wada-Test in 2000–2005at German, Swiss and Austrian and Dutch Epilepsy-Centres – the experience of the Arbeitsgemeinschaft für prächirurgische Epilepsiediagnostik und operative Epilepsietherapie e.V regarding 1421 procedures

A. Haag; S. Knake; H. M. Hamer; F. Boesebeck; H. Freitag; R. Schulz; P. Baum; C. Helmstaedter; J. Wellmer; H. Urbach; P. Hopp; T. Mayer; A. Hufnagel; H. Jokeit; H. Lerche; I. Uttner; H. J. Meencke; H. Meierkord; E. Pauli; U. Runge; J. Saar; E. Trinka; T. Benke; S. Vulliemoz; G. Wiegand; U. Stephani; H. G. Wieser; D. Rating; K. Werhahn; S. Noachtar; A. Schulze-Bonhage; K. Wagner; W. Alpherts; W. van Emde Boas; F. Rosenow

doi:10.1055/s-2007-987750

The Wada-Test in 2000–2005at German, Swiss and Austrian and Dutch Epilepsy-Centres – the experience of the Arbeitsgemeinschaft für prächirurgische Epilepsiediagnostik und operative Epilepsietherapie e.V regarding 1421 procedures

A Haag ¹, S Knake ¹, HM Hamer ¹, F Boesebeck ¹, H Freitag ¹, R Schulz ¹, P Baum ¹, C Helmstaedter ¹, J Wellmer ¹, H Urbach ¹, P Hopp ¹, T Mayer ¹, A Hufnagel ¹, H Jokeit ¹, H Lerche ¹, I Uttner ¹, HJ Meencke ¹, H Meierkord ¹, E Pauli ¹, U Runge ¹, J Saar ¹, E Trinka ¹, T Benke ¹, S Vulliemoz ¹, G Wiegand ¹, U Stephani ¹, HG Wieser ¹, D Rating ¹, K Werhahn ¹, S Noachtar ¹, A Schulze-Bonhage ¹, K Wagner ¹, W Alpherts ¹, W van Emde Boas ¹, F Rosenow ¹

¹Marburg, Münster, Bethel, Leipzig, Bonn, Radeberg, Essen; Zürich, CH; Ulm, Berlin, Erlangen, Greifswald, Kehl-Kork; Innsbruck, A; Genf, CH; Kiel; Heidelberg, Mainz, München, Freiburg; Heemstede, NL

Abstract

For the Arbeitsgemeinschaft für prächirurgische Epilepsiediagnostik und operative Epilepsietherapie e.V we asked 26 German, Swiss, Austrian and Dutch Epilepsy-Centres to report the use of the Wada-Test (intracarotid amobarbital procedure; IAP) from 2000 to 2005. We used a half-standardized questionnaire to ask about clinical indications for the procedure, number of tests applied, the test-protocol, interpretation of results and complication rates. We also asked representatives to give their opinion regarding the current and future role of the Wada-Test in presurgical diagnosis of epilepsy (e.g. reliability, validity, alternative methods).

16 of 23 centres providing information stated to have applied the Wada-Test during the requested time period. Altogether 1421 Wada-Tests had been carried out, with the classic bilateral IAP having the highest proportion (73%). The overall complication rate was 1.09% (0.36% with permanent deficit). Test protocols reported were similar regarding the procedure itself as well as language and memory testing, even though no universal standard protocol exists. Clinicians rated the Wada-Test to have good reliability and validity for language determination, whereas the reliability and validity for memory lateralization was questioned. As expected, functional MRI was the most frequently used non-invasive imaging technique. More than 50% of the centers use it as a standard procedure for language lateralization and approximately 30% do apply it regularly for memory lateralization. Other non-invasive functional imaging techniques used less frequently were functional transcranial Dopplersonography (fTCD) or the dichotic listening test as well as repetitive transcranial magnetic stimulation (rTMS), near infrared spectroscopy (NIRS), event-related potentials (N400/N300) and PET. Sixty seven percent of representatives believe that the Wada-Test will be replaced by other imaging techniques and nearly all representatives agreed with the statement, that Wada-Test frequency will decrease in the future.