| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the UCSF Epilepsy Center, Department of Neurology (Dr. Kirsch, and Garcia, F.S. Winstanley and R. Hendrickson) and Neurosurgery (Dr. Barbaro), University of California, San Francisco, School of Medicine; Center for Bioinformatics (Dr. Wong), Harvard Center for Neurodegeneration and Repair, Harvard Medical School, and Department of Radiology, Brigham and Women's Hospital, Boston, MA; and Department of Neurology (Dr. Laxer), California Pacific Medical Center, San Francisco.
Address correspondence and reprint requests to Dr Kirsch, UCSF Epilepsy Center, 400 Parnassus Ave., San Francisco, CA 94143-0138; e-mail: heidi{at}itsa.ucsf.edu.
Background: The intracarotid amobarbital (Wada) test can be used to evaluate hemispheric memory capacity before anterior temporal lobectomy (ATL). Most patients demonstrate better memory with injection ipsilateral to planned resection (expected asymmetry [EA]), but a substantial minority show better memory with contralateral injection (unexpected asymmetry [UA]). Both degree and direction of Wada memory asymmetry (WMA) have been associated with worse surgical outcome in small series. Reports also suggest that UA is associated with greater decline in verbal memory after left ATL (L-ATL).
Methods: The relationship between WMA and surgical outcome (at 3 months, 1 year, and last follow-up) was examined in a large group of ATL patients (108 L, 119 R) with both EA and UA. Also, memory in a subgroup (96 L, 108 R) was examined, comparing subscores of the Rey Auditory Verbal Learning Test obtained preoperatively, at 3 months, and at 1 year.
Results: Thirty-six percent of L-ATL and 8% of R-ATL patients had UA. UA was associated with worse surgical outcome at 1 year for R-ATL patients but was not associated with worse outcome for L-ATL patients. There was no correlation between WMA and persistent postoperative verbal memory change for patients with L- or R-ATL.
Conclusions: Unexpected asymmetry is uncommon in patients with right anterior temporal lobectomy (R-ATL) and may be a risk marker of poor surgical outcome. This relationship may be obscured by language confounds in patients with L-ATL. The results suggest that Wada asymmetry (using mixed stimuli) does not predict postoperative verbal memory; it is unclear whether this finding is generalizable to centers using only nonverbal stimuli.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 13 issue to find the title link for this article.
Commentary, see page 659
Deceased.
Supported in part by NIH grant R01-NS31966 (K.D.L.). Epilepsy database development was supported in part by National Institute of Neurological Disorders and Stroke RO1-NS36007 and by NLM R29-LM 06300 (S.T.C.W.).
Disclosure: The authors report no conflicts of interest.
Received February 17, 2004. Accepted in final form May 26, 2005.
Related Article
Neurology 2005 65: 659.
This article has been cited by other articles:
|
|
 |
|
  S. A. Baxendale, P. J. Thompson, and J. S. Duncan Evidence-Based Practice: A Reevaluation of the Intracarotid Amobarbital Procedure (Wada Test) Arch Neurol, June 1, 2008; 65(6): 841 - 845. [Full Text] [PDF]
|
|
|
|
 |
|
 L Bonilha, C Rorden, J J Halford, M Eckert, S Appenzeller, F Cendes, and L M Li Asymmetrical extra-hippocampal grey matter loss related to hippocampal atrophy in patients with medial temporal lobe epilepsy J. Neurol. Neurosurg. Psychiatry, March 1, 2007; 78(3): 286 - 294. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
