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The intracarotid amobarbital procedure as a predictor of memory failure following unilateral temporal lobectomy

Departments of Neurology (Drs. Loring and Meador, and R.C. Martin), Surgery (Neurosurgery) (Drs. Lee, Flanigin, and Smith), and Radiology (Dr. Figueroa), Medical College of Georgia, Augusta, GA.

We investigated the efficacy of the intracarotid amobarbital procedure to accurately predict post-temporal lobectomy anterograde amnesia. We presented items at 2 separate times during amobarbital assessment; both early and late item recall were decreased during the injection contralateral to seizure onset indicating sensitivity to bilateral temporal lobe dysfunction. Ten patients for whom follow-up neuropsychological assessment was available failed either the early or late item recognition portions of their amobarbital evaluation ipsilateral to seizure onset, but had hippocampus included in the temporal lobectomy by virtue of satisfactory performance on other tests of hippocampal function. None of these 10 patients displayed postoperative anterograde amnesia, although there was a reduction in material-specific memory in some patients. These results indicate that relying solely on amobarbital memory testing to assess the functional ability of the contralateral temporal lobe to sustain global memory prior to temporal lobectomy may needlessly exclude patients from a viable therapeutic option.

Address correspondence and reprint requests to Dr. David W. Loring, Section of Behavioral Neurology, Department of Neurology, Medical College of Georgia, Augusta, GA 30912-3275.

Supported in part by K08 AG0003145 awarded to Dr. Meador.

Presented at the Annual Meeting of the American Neurological Association, New Orleans, LA, September 1989.

Received May 24, 1989. Accepted for publication in final form September 8, 1989.

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