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Epilepsia. 2014 May;55(5):633-7. doi: 10.1111/epi.12553. Epub 2014 May 9.

Cortical cartography reveals political and physical maps.

Author information

1
Departments of Neurology and Pediatrics, Emory University, Atlanta, Georgia, U.S.A.

Abstract

Advances in functional imaging have provided noninvasive techniques to probe brain organization of multiple constructs including language and memory. Because of high overall rates of agreements with older techniques, including Wada testing and cortical stimulation mapping (CSM), some have proposed that those approaches should be largely abandoned because of their invasiveness, and replaced with noninvasive functional imaging methods. High overall agreement, however, is based largely on concordant language lateralization in series dominated by cases of typical cerebral dominance. Advocating a universal switch from Wada testing and cortical stimulation mapping to functional magnetic resonance imaging (fMRI) or magnetoencephalography (MEG) ignores the differences in specific expertise across epilepsy centers, many of which often have greater skill with one approach rather than the other, and that Wada, CSM, fMRI, and MEG protocols vary across institutions resulting in different outcomes and reliability. Specific patient characteristics also affect whether Wada or CSM might influence surgical management, making it difficult to accept broad recommendations against currently useful clinical tools. Although the development of noninvasive techniques has diminished the frequency of more invasive approaches, advocating their use to replace Wada testing and CSM across all epilepsy surgery programs without consideration of the different skills, protocols, and expertise at any given center site is ill-advised.

KEYWORDS:

Cortical stimulation mapping; Magnetoencephalography; Wada testing; fMRI

PMID:
24815217
PMCID:
PMC4197796
DOI:
10.1111/epi.12553
[Indexed for MEDLINE]
Free PMC Article
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