Results from the intracarotid amytal procedure in patients with uni or bitemporal lobe epilepsy and mesial sclerosis

Caner-Cukiert, Ana Regina; Cukiert, Arthur; Gronich, Gary; Marino Jr, Raul

doi:10.1590/S0004-282X1995000400011

Abstracts

This study discusses the results from the IAP and its lateralizing and prognostic value in patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS). Eighteen patients were submitted to the IAP. Fifteen had bitemporal and 3 unitemporal lobe epilepsies. All patients had MTS on MRI and in one there was an unrelated lesion in the contralateral hippocampus. Nine bitemporal patients passed after the injection ipsilateral to the MTS and 4 failed bilaterally. One bitemporal passed bilaterally. Seven of these bitemporal patients passed an injection ipsilateral to MTS and failed on contralateral injection. Two of the unitemporal lobe patients passed the ipsilateral injection and failed the contralateral one. One of the unitemporal lobe patients failed bilaterally the IAP. Overall, 56% of the group disclosed the pass ipsi/fail contralateral pattern in the IAP. Eight patients were operated, are seizure free and had no additional memory deficit. Many patients with TLE were found to have the pass ipsi-/fail contralateral pattern in the IAP. This might prove to be of lateralizing and prognostic value in such cases.

amytal; epilepsy; temporal lobe; surgery

Este estudo discute os resultados obtidos no teste de amital sódico (TAS) intracarotídeo e seu valor prognóstico e de lateralização em pacientes com epilepsia do lobo temporal (ELT) e esclerose mesial temporal (EMT). Dezoito pacientes foram submetidos ao TAS. Quinze possuíam epilepsias bitemporais e 3 unitemporais. Todos os pacientes possuíam EMT na RMN e em 1 existia uma calcificação hipocampal contralateral. Nove pacientes bitemporais passaram a injeção ipsilateral à EMT e 4 falharam bilateralmente. Um paciente bitemporal passou bilateralmente. Sete pacientes bitemporais passaram a injeção ipsilateral à EMT e falharam do outro lado. Dois pacientes unitemporais tiveram este mesmo comportamento. Um paciente unitemporal falhou bilateralmente no TAS. Globalmente, 56% dos pacientes apresentaram o padrão passa ipsi- / falha contralateral no TAS. Oito pacientes foram operados, estão sem crises e não tiveram déficits adicionais de memória. Muitos pacientes com ELT possuem o padrão passa ipsi- / falha contralateral no TAS. Isto deve representar fator de lateralização e prognóstico relevante.

amital; epilepsia; lobo temporal; cirurgia

Results from the intracarotid amytal procedure in patients with uni or bitemporal lobe epilepsy and mesial sclerosis

Resultados do teste intracarotídeo de amital em pacientes com epilepsia uni ou bilateral do lobo temporal e esclerose mesial

Ana Regina Caner-Cukiert; Arthur Cukiert; Gary Gronich; Raul Marino Jr

Divison of Neurosurgery, Department of Neurology, Faculty of Medicine, University of São Paulo

SUMMARY

This study discusses the results from the IAP and its lateralizing and prognostic value in patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS). Eighteen patients were submitted to the IAP. Fifteen had bitemporal and 3 unitemporal lobe epilepsies. All patients had MTS on MRI and in one there was an unrelated lesion in the contralateral hippocampus. Nine bitemporal patients passed after the injection ipsilateral to the MTS and 4 failed bilaterally. One bitemporal passed bilaterally. Seven of these bitemporal patients passed an injection ipsilateral to MTS and failed on contralateral injection. Two of the unitemporal lobe patients passed the ipsilateral injection and failed the contralateral one. One of the unitemporal lobe patients failed bilaterally the IAP. Overall, 56% of the group disclosed the pass ipsi/fail contralateral pattern in the IAP. Eight patients were operated, are seizure free and had no additional memory deficit. Many patients with TLE were found to have the pass ipsi-/fail contralateral pattern in the IAP. This might prove to be of lateralizing and prognostic value in such cases.

Key words:amytal, epilepsy, temporal lobe, surgery.

RESUMO

Este estudo discute os resultados obtidos no teste de amital sódico (TAS) intracarotídeo e seu valor prognóstico e de lateralização em pacientes com epilepsia do lobo temporal (ELT) e esclerose mesial temporal (EMT). Dezoito pacientes foram submetidos ao TAS. Quinze possuíam epilepsias bitemporais e 3 unitemporais. Todos os pacientes possuíam EMT na RMN e em 1 existia uma calcificação hipocampal contralateral. Nove pacientes bitemporais passaram a injeção ipsilateral à EMT e 4 falharam bilateralmente. Um paciente bitemporal passou bilateralmente. Sete pacientes bitemporais passaram a injeção ipsilateral à EMT e falharam do outro lado. Dois pacientes unitemporais tiveram este mesmo comportamento. Um paciente unitemporal falhou bilateralmente no TAS. Globalmente, 56% dos pacientes apresentaram o padrão passa ipsi- / falha contralateral no TAS. Oito pacientes foram operados, estão sem crises e não tiveram déficits adicionais de memória. Muitos pacientes com ELT possuem o padrão passa ipsi- / falha contralateral no TAS. Isto deve representar fator de lateralização e prognóstico relevante.

Palavras-chave:amital, epilepsia, lobo temporal, cirurgia.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 24-abril-1995.

Dr. Arthur Cukiert - Rua Nova York 744 apto 131 - 04560-001 São Paulo SP - Brasil.

1. Branch C, Milner B, Rasmussen T. Intracarotid sodium amytal for the lateralization of cerebral speech dominance: observations in 123 patients. J Neurosurg 1964, 21:399-405.
2. Jones-Gotman M. Commentary: psychological evaluation - testing hippocampal function. In J Engel Jr (ed). Surgical treatment of the epilepsies. New York: Raven Press 1987, p 203-211.
3. Jones-Gotman M. Neuropsychological techniques in the identification of epileptic foci. Epilepsy Res 1992, 5(Suppl):87-94.
4. Jones-Gotman M. Presurgical psychological assessment in children: special tests. J Epilepsy 1991, 3(Suppl 1):44-47.
5. Milner B, Branch C, Rasmussen T. Evidence of bilateral speech representation in some non-right-handers. Trans Am Neurol Assoc 1966, 91:306-308.
6. Milner B, Branch C, Rasmussen T. Study of short term memory after intracarotid sodium amytal procedure. Trans Am Neurol Assoc 1962, 87:224-226.
7. Penfield W, Mathieson G. An autopsy and a discussion of the role of the hippocampus in experiential recall. Arch Neurol 1974, 41:145-154.
8. Penfield W, Milner B. Memory deficit produced by bilateral lesions in the hippocampal zone. Arch Neurol Psichiat 1958, 79:475-497.
9. Rasmussen T, Milner B. The role of early left-brain injury in determining lateralization of special speech functions. Ann NY Acad Sci 1977, 299:355-369.
10. Salanova V, Morris HH, Rehm P, Wyllie E, Dinner DS, Luders H, Gilmore-Pollak W. Comparison of the intracarotid amobarbital procedure and interictal cerebral 18-fluorodeoxyglucose positron emission tomography scans in refractory temporal lobe epilepsy. Epilepsia 1992, 33:635-638.
11. Scoville W, Milner B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry 1957, 20:11-21.
12. Wada J, Rasmussen T. Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance: experimental and clinical observations. J Neurosurg 1960, 17:226-282.
13. Zatorre RJ. Perceptual asymmetry on the dichotic fused words test and cerebral speech lateralization determined by the carotid sodium amytal test. Neuropsychologia 1989, 27:1207-1219.

Publication Dates

Publication in this collection
20 Dec 2010
Date of issue
Sept 1995

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

[1] 1. Branch C, Milner B, Rasmussen T. Intracarotid sodium amytal for the lateralization of cerebral speech dominance: observations in 123 patients. J Neurosurg 1964, 21:399-405.

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

[3] 3. Jones-Gotman M. Neuropsychological techniques in the identification of epileptic foci. Epilepsy Res 1992, 5(Suppl):87-94.

[4] 4. Jones-Gotman M. Presurgical psychological assessment in children: special tests. J Epilepsy 1991, 3(Suppl 1):44-47.

[5] 5. Milner B, Branch C, Rasmussen T. Evidence of bilateral speech representation in some non-right-handers. Trans Am Neurol Assoc 1966, 91:306-308.

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

[7] 7. Penfield W, Mathieson G. An autopsy and a discussion of the role of the hippocampus in experiential recall. Arch Neurol 1974, 41:145-154.

[8] 8. Penfield W, Milner B. Memory deficit produced by bilateral lesions in the hippocampal zone. Arch Neurol Psichiat 1958, 79:475-497.

[9] 9. Rasmussen T, Milner B. The role of early left-brain injury in determining lateralization of special speech functions. Ann NY Acad Sci 1977, 299:355-369.

[10] 10. Salanova V, Morris HH, Rehm P, Wyllie E, Dinner DS, Luders H, Gilmore-Pollak W. Comparison of the intracarotid amobarbital procedure and interictal cerebral 18-fluorodeoxyglucose positron emission tomography scans in refractory temporal lobe epilepsy. Epilepsia 1992, 33:635-638.

[11] 11. Scoville W, Milner B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry 1957, 20:11-21.

[12] 12. Wada J, Rasmussen T. Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance: experimental and clinical observations. J Neurosurg 1960, 17:226-282.

[13] 13. Zatorre RJ. Perceptual asymmetry on the dichotic fused words test and cerebral speech lateralization determined by the carotid sodium amytal test. Neuropsychologia 1989, 27:1207-1219.