PubMed · 14258561
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D MULLAN, M PLATTS, B RIDGWAY. 1965-03-27. BARBITURATE INTOXICATION.. https://doi.org/10.1016/s0140-6736(65)91858-1
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OBJECTIVE: To examine brain activation associated with receptive language in patients with left temporal lobe epilepsy (TLE) before and after an anterior temporal lobectomy using magnetoencephalography (MEG), and to evaluate which patients were most likely to show a change in the lateralization and localization of the mechanisms supporting receptive language and if such changes were associated with neuropsychological function. METHODS: Twelve patients with left TLE underwent preoperative Wada testing, and pre- and postoperative neuropsychological testing and MEG language mapping. The anatomic location of receptive language-related activity sources observed with MEG was determined by coregistering MEG data with structural MRI scans. Language laterality indices were calculated based on the number of reproducible activity sources in each hemisphere. The proximity of language-specific activity sources to Wernicke's area was also examined. RESULTS: Although the small sample size precluded formal statistical analyses, patients with atypical (bilateral) hemispheric dominance preoperatively were more likely than patients with typical (left-hemisphere) dominance to show evidence of increased right hemisphere participation in language functions after surgery. Patients with left hemispheric dominance preoperatively were more likely to show intrahemispheric changes involving a slight inferior shift of the putative location of Wernicke's area. Patients with bilateral representation tended to perform worse on neuropsychological test measures obtained both pre- and postoperatively. CONCLUSION: Interhemispheric functional reorganization of language-specific areas may occur in patients undergoing left anterior temporal lobectomy. Intrahemispheric reorganization may take place even when the resection does not directly impinge upon Wernicke's area.
PURPOSE OF REVIEW: The Wada or intracarotid amobarbital procedure is already in its fifties and, despite its invasive character, still routine for determining the lateralization of language and memory prior to epileptic surgery. Among the new techniques available, functional magnetic resonance imaging is one of the most promising alternatives. This non-invasive method has several advantages including the possibility of mapping relevant areas within the hemispheres and being able to prolong examination time in case of discordant results. RECENT FINDINGS: Many functional magnetic resonance imaging studies have focused on correlations with the intracarotid amobarbital procedure as the gold standard and found an agreement of about 90%. More importantly, recent studies demonstrated a significant correlation between presurgical functional magnetic resonance imaging testing and postsurgical outcome for functional magnetic resonance imaging activations in frontal language areas. In some studies, prediction for outcome is already higher for functional magnetic resonance imaging than for the intracarotid amobarbital procedure. SUMMARY: Current data support functional magnetic resonance imaging as a valid alternative to the intracarotid amobarbital procedure. Small sample sizes in outcome studies and restrictions to certain sites of operation, however, still call for caution. A standardized series of tasks to activate the whole language and memory system paired with good comparability between medical centres is needed.
PURPOSE: Failure to show adequate anesthetization during the intracarotid amobarbital procedure (IAP or "Wada test") is a rare complication. After an unusually high rate of recent anesthetization failures, we sought to determine the frequency of reduced anesthetization and any common factors underlying these failures. METHODS: We reviewed the records of all patients who underwent IAP tests through the UCLA Seizure Disorder Center between September 1999 and May 2002. Age, date, epileptogenic focus, radiologist, and current medications were all considered. RESULTS: Of a total of 56 patients who underwent our intracarotid amobarbital examination, 11 (19.6%) showed either very rapid recovery ( /=8 weeks after discontinuation of such medications.