Abstracts

Limited English language skills complicate neuropsychometric assessment and Wada testing in patients with refractory TLE undergoing pre-surgical evaluation. The patient population at our institution is culturally and ethnically diverse. For many patients English is a second or third language, and is understood and spoken with varying expertise. Although administering the neuropsychological component of the Wada test in a patient[apos]s native language is desirable, direct translation of English-language Wada protocols into other languages does not account for cultural or language-specific content. Our Wada test is a modification of one used at several epilepsy centers. It includes repetition and recall of spoken words and phrases, with additional foil words and phrases used when testing memory performance. Several of the phrases have cultural (e.g. [ldquo]My country [apos]tis of Thee[rdquo]) and / or language-specific (e.g. [ldquo]Mary had a little lamb[rdquo]) significance that would be lost with direct translation to other languages.
We used a combination of culturally congruent substitutions and direct translations to adapt our Wada protocol for use with both Mexican-born Spanish and Iranian-born Farsi speaking patients. In addition, we attempted to preserve phrase length and general semantic content as much as possible. For instance, instead of [ldquo]Mary had a little lamb[rdquo], the Farsi version uses a strikingly similar line from a well-known Persian nursery rhyme, [quot]gaveh Hassan chejooreh?[quot] (How is Hassan[apos]s cow?), and the Spanish version uses a line from a familiar lullaby, [quot]Los pollitos dicen pio pio[quot] (The chicks say pio pio). Instead of [quot]My country [apos]tis of Thee[quot] we substituted [quot]Mexico lindo[quot] in the Spanish version and [quot]zardee-ye man az tow[quot] (My yellowness is from you) in the Farsi version. The latter phrase is part of a traditional exclamation made during a ritual associated with the Persian new year celebration.
Medically-trained native speakers administered the protocol to one Farsi speaking and two Spanish speaking patients, under the direct supervision of a neuropsychologist . The procedure was administered without difficulty to all three patients, and was scored using criteria developed for the original English version. In all three patients, Wada memory and language results were consistent with other clinical data, and were incorporated into the surgical decision-making process. Although the number of patients is small, these data suggest that culturally-sensitive adaptations of English-language Wada protocols provide reliable results, and can be used without independent validation in a large number of patients. (Supported in part by NIH K23 NS46347 to ACG.)