The intracarotid amobarbital procedure (Wada test) with two protocols combined, Montreal and Seattle

Leite, Paulo J. M.; Pereira, Rosana; Almeida, Diogo F.; Sandmann, Marcos C.; Souza, Paulo César; Sandrinni, Ronei; Kaneguzuko, Jorge; Bittencourt, Paulo Roberto M. de

doi:10.1590/S0004-282X1997000200002

Abstracts

The intracarotid amobarbital procedure was carried out in 8 male and 7 female candidates to temporal lobectomy, and a female candidate to frontal lesionectomy, aged 18-50 (mean 32.5) years. Language and memory were tested after injection in each hemisphere. Both were measured by the Montreal procedure. In 9 patients language and memory were evaluated with the Seattle procedure too. In 12 patients the left hemisphere was dominant for language; three had bilateral dominance. In I patient the Seattle procedure demonstrated the dominant hemisphere by relatively slowness of speech during the drug effect in the left hemisphere. Memory was defined to be in the left hemisphere in 12 patients, in the right in 2, bilateral in 1 and in another lateralization was not possible. In 1 patient memory dominance was determined by the Montreal protocol alone because of lack of cooperation. These early results indicate that the methods may be complementary for determination of language and memory dominance in epilepsy surgery candidates.

amobarbital (Wada) test; epilepsy surgery; language; memory

O testo do amobarbital intracarotídeo foi realizado em 8 homens e 7 mulheres candidatos a lobectomia temporal e em uma mulher candidata a lesionectomia frontal, com idades de 18-50 (média 32,5) anos. Linguagem e memória foram testadas após a injeção do amobarbial em cada hemisfério cerebral. Todos os pacientes foram avaliados pelo método de Montreal e 9 também pelo método de Seattle. Em 12 pacientes o hemisfério cerebral esquerdo foi dominante para linguagem e em 3 pacientes houve dominância bilateral. Em uma paciente a linguagem foi determinada apenas através do método de Seattle, com lentificação relativa da fal a, sob ação da droga no hemisfério cerebral esquerdo. Dominância da memória à esquerda foi observada em 12 pacientes, à direita em 2, bilateral em 1 e em outro não foi lateralizada. Dominância da memória foi definida apenas através do método de Montreal em um paciente, devido à pouca cooperação. Estes resultados preliminares indicam que os métodos podem ser complementares para a determinação da dominância da linguagem e memória em especial nos candidatos à lobectomia temporal.

teste do amobarbital (Wada); cirurgia de epilepsia; linguagem; memória

The intracarotid amobarbital procedure (Wada test) with two protocols combined, Montreal and Seattle

Procedimentos do amobarbital intracarotideo (teste de Wada) com dois protocolos combinados, Montreal e Seattle

Paulo J. M. Leite^I; Rosana Pereira^III; Diogo F. Almeida^IV; Marcos C. Sandmann^I; Paulo César Souza^V; Ronei Sandrinni^V; Jorge Kaneguzuko^V; Paulo Roberto M. de Bittencourt^II

^INeurologist, Program of Epilepsy Surgery, Hospital Nossa Senhora das Graças, Curitiba

^IIHead of Neurology and EEC Services, Program of Epilepsy Surgery, Hospital Nossa Senhora das Graças, Curitiba

^IIISpeech Therapist, Program of Epilepsy Surgery, Hospital Nossa Senhora das Graças, Curitiba

^IVMedical student, Program of Epilepsy Surgery, Hospital Nossa Senhora das Graças, Curitiba

^VRadiologist. Program of Epilepsy Surgery, Hospital Nossa Senhora das Graças, Curitiba

ABSTRACT

The intracarotid amobarbital procedure was carried out in 8 male and 7 female candidates to temporal lobectomy, and a female candidate to frontal lesionectomy, aged 18-50 (mean 32.5) years. Language and memory were tested after injection in each hemisphere. Both were measured by the Montreal procedure. In 9 patients language and memory were evaluated with the Seattle procedure too. In 12 patients the left hemisphere was dominant for language; three had bilateral dominance. In I patient the Seattle procedure demonstrated the dominant hemisphere by relatively slowness of speech during the drug effect in the left hemisphere. Memory was defined to be in the left hemisphere in 12 patients, in the right in 2, bilateral in 1 and in another lateralization was not possible. In 1 patient memory dominance was determined by the Montreal protocol alone because of lack of cooperation. These early results indicate that the methods may be complementary for determination of language and memory dominance in epilepsy surgery candidates.

Key words: amobarbital (Wada) test, epilepsy surgery, language, memory.

RESUMO

O testo do amobarbital intracarotídeo foi realizado em 8 homens e 7 mulheres candidatos a lobectomia temporal e em uma mulher candidata a lesionectomia frontal, com idades de 18-50 (média 32,5) anos. Linguagem e memória foram testadas após a injeção do amobarbial em cada hemisfério cerebral. Todos os pacientes foram avaliados pelo método de Montreal e 9 também pelo método de Seattle. Em 12 pacientes o hemisfério cerebral esquerdo foi dominante para linguagem e em 3 pacientes houve dominância bilateral. Em uma paciente a linguagem foi determinada apenas através do método de Seattle, com lentificação relativa da fal a, sob ação da droga no hemisfério cerebral esquerdo. Dominância da memória à esquerda foi observada em 12 pacientes, à direita em 2, bilateral em 1 e em outro não foi lateralizada. Dominância da memória foi definida apenas através do método de Montreal em um paciente, devido à pouca cooperação. Estes resultados preliminares indicam que os métodos podem ser complementares para a determinação da dominância da linguagem e memória em especial nos candidatos à lobectomia temporal.

Palavras-chave: teste do amobarbital (Wada), cirurgia de epilepsia, linguagem, memória.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

ACKNOWLEDGMENT

The authors wish to thank Dr Carl B Dodrill (Seattle, USA) for the advice he has continuously given to the team of the Program for Epilepsy Surgery of Hospital Nossa Senhora das Graçs.

Aceite: 4-fevereiro-1997.

Dr. Paulo R. M. de Bittencourt - Unidade de Neurologia Clínica - Rua Padre Anchieta 155 - 80410-030 Curitiba PR - Brasil.

1. Bittencourt PRM. Epileptogênese, estrutura e função cerebral na epilepsia do lobo temporal: um estudo prospectivo controlado. Thesis for the degree of Professor of Medicine (Neurology), Universidade Federal do Paraná. Curitiba, 1991.
2. Blume WT. Grabow JD, Darley FL, Aronson AE. Intracarotid amobarbital test of language and memory before temporal lobectomy for seizure control. Neurology 1973;23:812-819.
3. Davis AE, Wada JA. Speech dominance and handedness in the normal human. Brain & Language 1978:5:42-45.
4. Dodrill CB. Preoperative criteria for identifying eloquent brain: intracarotid amytal for language and memory testing. Neurosurg Clin North Am 1993:4:211-215.
5. Hermann BP, Wyler AR, Somes G. Language function following anterior temporal lobectomy. J Neurosurg 1991 ;74:560-566.
6. Ivnic RJ, Sharbrough FW. Laws ER. Anterior temporal lobectomy for the control of partial complex seizures: information for counseling patients. Mayo Clin Proc 1988;63:783-793.
7. Jones-Gotman M. Commentary: psychological evaluation-testing hippocampal function. In J Engel (ed). Surgical treatment of the epilepsies. New York: Raven Press. 1987:203-211.
8. Kneebone AC. Chelune GJ. Dinner DS, Naugle RI, Awad IA. Intracarotid amobarbital procedure as predictor of material-specific memory change after anterior temporal lobectomy. Epilepsia 1995,36:857-865.
9. Lee GP, Loring DW, Smith JR. Flanigin HF. Intraoperative hippocampal cooling and Wada memory in the evaluation of amnesia risk following anterior temporal lobectomy. Arch Neurol 1995;52:857-861.
10. Leite PJM, Pereira R_: Sandmann MC, Souza PC, Sandrinni RA, Kaneguzuko J, Bittencourt PRM. Intracarotid amobarbital procedure with the Montreal and Seattle protocols combined. (Abst). 21 st International Epilepsy Congress. Sydney, Australia, 1995, Vol 36(Suppl 3):123.
11. Lesser RP, Dinner DS, Luders H, Morris HH. Memory for objects presented soon after intracarotid amobarbital sodium injections in patients with medically intractable complex partial seizures. Neurology 1986;36:895-899.
12. Loring DW, Lee GP. Meador KJ. Flanigin HF, Smith JR, Figueroa RE, Martin RC. The intracarotid amobarbital procedure as a predictor of memory failure following unilateral temporal lobectomty. Neurology 1960;40:605-610.
13. Loring DW, Meador KJ, Lee GP. Nichols ME, King DW, Gallgher BB, Muno AM, Smith JR. Wada memory perfomance predicts seizure outcome following anterior temporal lobectomy. Neurology 1994;44:2322-2324.
14. Loring DW, Meador KJ, Lee GP, King DW, Gallagher BB, Murro AM. Smith JR. Stimulus timing effects on Wada memory testing. Arch Neurol 1994;51:806-810.
15. Loring DW, Murro AM, Meador KJ, Lee GP, Gratton CA, Nichols ME. Gallagher BB, King DW, Smith JR. Wada memory testing and hippocampal volume measurements in the evaluation for temporal lobectomy. Neurology 1993:43:1789-1793.
16. Milner B, Brench C, Rasmussen T. Study of short-term memory after intracarotid injection of sodium amytal. Trans Am Neurol Assoc 1962;87:224-226.
17. Ojemann GA, Dodrill CB. Verbal memory deficits after left temporal lobectomy for epilepsy. J Neurosurg 1985;62:101-107.
18. Ojemann GA, Ojemann BAJ, Lettich E, Berger M. Cortical language localization in left dominant hemisphere: an electrical stimulation mapping investigation in 117 patients. J Neurosurg 1989;71:316-326.
19. Perrine K, Gershengom J, Brown ER. Choi IS, Luciano DJ, Devinski O. Material-specific memory in the intracarotid amobarbital procedure. Neurology 1993;43:706-711.
20. Rausch R, Babb TL, Engel J JR, Crandall PH. Memory following intracarotid amobarbital injection contralateral to hippocampal damage. Arch Neurol 1989;39:783-788.
21. Sandmann MC, Leite PJM, Pontes L, Bittencourt PRM. Early results of a new epilepsy surgery program. (Abst). 21st International Epilepsy Congress. Sydney, Australia. 1995. Vol 36 (Suppl 3):259.
22. Sandmann MC, Rogasheski E. Mazer S, Bittencourt PRM. Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal. Arq Neuropsiquiatr 1994;52:309-313.
23. Sass KJ, LenczT. Westerveld M, Novelly RA, Spencer DD, Kim JH. The neural substrate of memory impairment demonstrated by the intracarotid amobarbital procedure. Arch Neurol 1991,48:48-52.
24. Sperling MR, Saykin AJ, Glosser G. Moran M, French JA, Brooks M, O'Connor MJ. Predictors of outcome after anterior temporal lobectomy: the intracarotid amobarbital test. Neurology 1994;44:2325-2330.
25. Stafiniak P, Saykin AJ, Sperling MR, Kester DB, Robinson LJ, O'Connor MJ, Gur RC. Acute naming deficits following dominant temporal lobectomy: prediction by age at 1 st risk for seizures. Neurology 1990,40:1509-1512.
26. Wada J. A new method for the determination of the side of cerebral speech dominance: aprcliminary report on the intracarotid injection of sodium amytal in man. Igaku to Seibutsugaki 1945;14:221-222.
27. Wada J, Rasmussen T. Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance: experimental and clinical observations. J Neurosurg 1960;17:266-282.
28. Wyllie E. Naugle R, Awad I, Chelune G, Luders H, Dinner D, Skibinski C, Ahl J. Intracarotid amobarbital procedure: prediction of decreased modality-specific memory scores after temporal lobectomy. Epilepsia 1991,32:857-864.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
June 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bittencourt PRM. Epileptogênese, estrutura e função cerebral na epilepsia do lobo temporal: um estudo prospectivo controlado. Thesis for the degree of Professor of Medicine (Neurology), Universidade Federal do Paraná. Curitiba, 1991.

[2] 2. Blume WT. Grabow JD, Darley FL, Aronson AE. Intracarotid amobarbital test of language and memory before temporal lobectomy for seizure control. Neurology 1973;23:812-819.

[3] 3. Davis AE, Wada JA. Speech dominance and handedness in the normal human. Brain & Language 1978:5:42-45.

[4] 4. Dodrill CB. Preoperative criteria for identifying eloquent brain: intracarotid amytal for language and memory testing. Neurosurg Clin North Am 1993:4:211-215.

[5] 5. Hermann BP, Wyler AR, Somes G. Language function following anterior temporal lobectomy. J Neurosurg 1991 ;74:560-566.

[6] 6. Ivnic RJ, Sharbrough FW. Laws ER. Anterior temporal lobectomy for the control of partial complex seizures: information for counseling patients. Mayo Clin Proc 1988;63:783-793.

[7] 7. Jones-Gotman M. Commentary: psychological evaluation-testing hippocampal function. In J Engel (ed). Surgical treatment of the epilepsies. New York: Raven Press. 1987:203-211.

[8] 8. Kneebone AC. Chelune GJ. Dinner DS, Naugle RI, Awad IA. Intracarotid amobarbital procedure as predictor of material-specific memory change after anterior temporal lobectomy. Epilepsia 1995,36:857-865.

[9] 9. Lee GP, Loring DW, Smith JR. Flanigin HF. Intraoperative hippocampal cooling and Wada memory in the evaluation of amnesia risk following anterior temporal lobectomy. Arch Neurol 1995;52:857-861.

[10] 10. Leite PJM, Pereira R_: Sandmann MC, Souza PC, Sandrinni RA, Kaneguzuko J, Bittencourt PRM. Intracarotid amobarbital procedure with the Montreal and Seattle protocols combined. (Abst). 21 st International Epilepsy Congress. Sydney, Australia, 1995, Vol 36(Suppl 3):123.

[11] 11. Lesser RP, Dinner DS, Luders H, Morris HH. Memory for objects presented soon after intracarotid amobarbital sodium injections in patients with medically intractable complex partial seizures. Neurology 1986;36:895-899.

[12] 12. Loring DW, Lee GP. Meador KJ. Flanigin HF, Smith JR, Figueroa RE, Martin RC. The intracarotid amobarbital procedure as a predictor of memory failure following unilateral temporal lobectomty. Neurology 1960;40:605-610.

[13] 13. Loring DW, Meador KJ, Lee GP. Nichols ME, King DW, Gallgher BB, Muno AM, Smith JR. Wada memory perfomance predicts seizure outcome following anterior temporal lobectomy. Neurology 1994;44:2322-2324.

[14] 14. Loring DW, Meador KJ, Lee GP, King DW, Gallagher BB, Murro AM. Smith JR. Stimulus timing effects on Wada memory testing. Arch Neurol 1994;51:806-810.

[15] 15. Loring DW, Murro AM, Meador KJ, Lee GP, Gratton CA, Nichols ME. Gallagher BB, King DW, Smith JR. Wada memory testing and hippocampal volume measurements in the evaluation for temporal lobectomy. Neurology 1993:43:1789-1793.

[16] 16. Milner B, Brench C, Rasmussen T. Study of short-term memory after intracarotid injection of sodium amytal. Trans Am Neurol Assoc 1962;87:224-226.

[17] 17. Ojemann GA, Dodrill CB. Verbal memory deficits after left temporal lobectomy for epilepsy. J Neurosurg 1985;62:101-107.

[18] 18. Ojemann GA, Ojemann BAJ, Lettich E, Berger M. Cortical language localization in left dominant hemisphere: an electrical stimulation mapping investigation in 117 patients. J Neurosurg 1989;71:316-326.

[19] 19. Perrine K, Gershengom J, Brown ER. Choi IS, Luciano DJ, Devinski O. Material-specific memory in the intracarotid amobarbital procedure. Neurology 1993;43:706-711.

[20] 20. Rausch R, Babb TL, Engel J JR, Crandall PH. Memory following intracarotid amobarbital injection contralateral to hippocampal damage. Arch Neurol 1989;39:783-788.

[21] 21. Sandmann MC, Leite PJM, Pontes L, Bittencourt PRM. Early results of a new epilepsy surgery program. (Abst). 21st International Epilepsy Congress. Sydney, Australia. 1995. Vol 36 (Suppl 3):259.

[22] 22. Sandmann MC, Rogasheski E. Mazer S, Bittencourt PRM. Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal. Arq Neuropsiquiatr 1994;52:309-313.

[23] 23. Sass KJ, LenczT. Westerveld M, Novelly RA, Spencer DD, Kim JH. The neural substrate of memory impairment demonstrated by the intracarotid amobarbital procedure. Arch Neurol 1991,48:48-52.

[24] 24. Sperling MR, Saykin AJ, Glosser G. Moran M, French JA, Brooks M, O'Connor MJ. Predictors of outcome after anterior temporal lobectomy: the intracarotid amobarbital test. Neurology 1994;44:2325-2330.

[25] 25. Stafiniak P, Saykin AJ, Sperling MR, Kester DB, Robinson LJ, O'Connor MJ, Gur RC. Acute naming deficits following dominant temporal lobectomy: prediction by age at 1 st risk for seizures. Neurology 1990,40:1509-1512.

[26] 26. Wada J. A new method for the determination of the side of cerebral speech dominance: aprcliminary report on the intracarotid injection of sodium amytal in man. Igaku to Seibutsugaki 1945;14:221-222.

[27] 27. Wada J, Rasmussen T. Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance: experimental and clinical observations. J Neurosurg 1960;17:266-282.

[28] 28. Wyllie E. Naugle R, Awad I, Chelune G, Luders H, Dinner D, Skibinski C, Ahl J. Intracarotid amobarbital procedure: prediction of decreased modality-specific memory scores after temporal lobectomy. Epilepsia 1991,32:857-864.