Presurgical Evaluation of Patients With Epilepsy: The Wada Test

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Paul Au

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Presurgical Evaluation of Patients With Epilepsy: The Wada Test – ATOTW 474

14 January 2026

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1) Temporal and parietal lobe epilepsy are the most common types of focal epilepsy in adults.

True False

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False. Temporal lobe epilepsy is the most common form of focal epilepsy. Parietal lobe epilepsy is rare

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2) Atypical language representation due to cerebral reorganisation may occur in patients with temporal lobe epilepsy.

True False

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True. Depending on the age of seizure onset, the location of seizure focus and handedness, developmental shift in language dominance can occur in patients with epilepsy, resulting in atypical language representation.

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3) Psychiatric disorder is a common comorbidity in patients suffering from epilepsy.

True False

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True. Psychiatric assessment is an important aspect of presurgical evaluation as epilepsy is associated with high rates of psychiatric comorbidities and there is increasing evidence suggesting a bidirectional relationship.

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4) Structural neuroimaging, neurophysiological assessment and neuropsychological assessment are important aspects of the presurgical evaluation of epilepsy.

True False

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True. Structural imaging aims to identify an epileptogenic lesion responsible for the seizures, which in turn increases the chance of successful resection. Neurophysiological techniques, such as electroencephalography (EEG) and magnetoencephalography (MEG), are used to localise the epileptogenic zones. Neurophysiological testing involves performance-based assessments of various cognitive skills, including learning and memory, language and executive function. All these investigations help provide information on postoperative outcome and potential cognitive deficits.

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5) The Wada test is routinely offered to all patients presenting for temporal lobectomy.

True False

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False. Because of its invasive nature, the Wada test is selectively performed in patients who are at risk of postoperative global amnesia or when their imaging results are inconclusive or incongruent.

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6) Functional magnetic resonance imaging (fMRI) is a commonly used non-invasive technique for evaluating the cerebral dominance for language and memory function.

True False

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True. There is a shift towards the use of non-invasive methods, predominantly fMRI, to determine language and memory lateralisation and predict postoperative outcomes.

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7) Functional magnetic resonance imaging (fMRI) can determine memory lateralisation and assess the risk of postoperative memory decline with high accuracy

True False

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False. To date, there is no fMRI paradigm that can reliably lateralise memory function and predict postoperative outcomes.

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8) Selective Wada tests aim to reduce the confounding effects of inhibiting the entire hemisphere of the brain.

True False

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True. An example of selective Wada testing is posterior cerebral artery injection, which selectively inactivates the mesial temporal lobe and does not cause aphasia.

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9) A persistent trigeminal artery found on the cerebral angiogram is a contraindication to the Wada test.

True False

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True. The finding of a persistent trigeminal artery precludes the Wada test due to concerns of anaesthetising the brainstem.

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10) Premedication with sedative drugs is recommended to prevent patient agitation during the Wada test.

True False

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False. Sedative premedication should generally be avoided as this may interfere with testing.

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11) Usual anti-epileptic medications should be discontinued before the Wada test.

True False

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False. Usual anti-epileptic medications should be continued.

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12) The usual general anaesthesia intravenous induction dose is given in the Wada test.

True False

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False. The intra-arterial dose required is much less than the intravenous dose.

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13) Sodium amobarbital is the most widely used drug for the Wada test nowadays.

True False

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False. Shortages in amobarbital have led to the use of alternatives such as propofol and methohexital.

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14) Repeated boluses or infusion of the anaesthetic drug may be required to complete the Wada test.

True False

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True. For short-acting drugs, additional injections or infusions are required to maintain the anaesthetic effect.

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15) Shivering and seizure-like activity may occur after the injection of the anaesthetic drug.

True False

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True. Side effects associated with anaesthetic injection include shivering and seizure-like activity, such as twitching and myoclonic movements.

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16) Invasive arterial blood pressure monitoring is helpful during the Wada test.

True False

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False. Invasive arterial blood pressure monitoring is generally not necessary and may hinder clinical testing.

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17) Electroencephalography (EEG) is compulsory for the Wada test.

True False

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True. Continuous EEG monitoring is needed to monitor the onset and efficacy hemi-anaesthesia and to observe for any epileptiform discharges.

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18) Wada test is contraindicated in paediatric patients.

True False

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False. Wada test has been performed on paediatric patients before. Careful pre-procedural evaluation is necessary to determine patient suitability on a case-to-case basis.

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19) Activated clotting time (ACT) measurement is necessary during the Wada test.

True False

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True. The use of heparin depends on the discretion of the neuroradiologist. The monitoring of ACT may be useful if heparin is given.

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20) Wada test is a safe, non-invasive examination for patients with epilepsy.

True False

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False. Although generally safe if performed on suitable patients in experienced centres, the Wada test is an invasive examination that is not without risk of neurological and non-neurological complications.

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