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To the Editor:
The editorial by Abou-Khalil and Schlaggar1 presented a rather narrow perspective on the future of the Wada test. By focusing almost exclusively on the role fMRI may play in the future, they do not acknowledge the important roles that baseline neuropsychological tests and structural MRI now play in replacing the traditional functions of the Wada test.
We agree that the Wada test remains the standard tool for language lateralization. However, language lateralization is frequently inferred by baseline neuropsychological tests, ictal semiology, and clinical history, without the need for the invasive Wada test.
Clearly, language lateralization is very important for some epilepsy patients with operative sites close to eloquent areas. However, although some fMRI language paradigms have been shown to be highly effective in lateralizing language in group studies, the majority of these studies have reported less than 100% concordance between the fMRI paradigms and the Wada test.2 Jayakar et al.3 have reported false lateralization of the language cortex on functional MRI following clusters of seizures. There are also important variations associated with age, sex, and task competence on fMRI activation …
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