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Determination of language dominance

Wada test confirms functional transcranial Doppler sonography

From the Departments of Neurology (Drs. Rihs, Sturzenegger, Gutbrod, and Mattle) and Neuroradiology (Dr. Schroth), University of Berne, Inselspital, Switzerland.

Address correspondence and reprint requests to Dr Frank Rihs, Department of Neurology, University of Berne, Inselspital, CH-3010 Berne, Switzerland; Frank.Rihs{at}insel.ch

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. Method:— 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.

CONCLUSION: 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.

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