Comparison of the Intracarotid Amobarbital Procedure and Interictal Cerebral 18‐Fluorodeoxyglucose Positron Emission Tomography Scans in Refractory Temporal Lobe Epilepsy

Salanova, Vicenta; Morris, Harold H.; Rehm, Patrice K.; Lüders, Hans; Gilmore-Pollak, W.

doi:10.1111/j.1528-1157.1992.tb02339.x

Cited by 31 publications

(14 citation statements)

References 11 publications

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“…In our sample asymmetry ratios of these measures were of high lateralizing value. Moreover, we confirmed the high intercorrelation of these asymmetry ratios [14,31,47]. With respect to the absolute values of the used measures we replicated findings that the hippocampal volume and glucose metabolism are not linearly related in TLE patients [1,41].…”

Section: Discussionsupporting

confidence: 88%

Bilateral reductions of hippocampal volume, glucose metabolism, and Wada hemispheric memory performance are related to the duration of mesial temporal lobe epilepsy

Jokeit¹,

Ebner²,

Arnold³

et al. 1999

Journal of Neurology

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In refractory temporal lobe epilepsy (TLE) temporal lobe structures and functions are continuously or intermittently affected by abnormal brain electrical events, noxious neurochemical agents, and metabolic disturbances. There is conflicting evidence regarding the relationship between the duration of refractory mesial TLE and quantitative measures of temporal lobe functions and volumes of the hippocampi. Twenty patients (aged 28 +/- 7 years, 14 males) with an initial precipitating injury before the age of 5 years were subjected to high-resolution magnetic resonance imaging, fluoro-2-deoxy-d-glucose positron-emission tomography (PET), and the Wada test. We investigated whether the duration of unilateral refractory TLE (12 left, 8 right) affects hippocampal volume, glucose metabolism, or Wada hemispheric memory performance. Ipsilateral to the epileptogenic zone the hippocampal volume, metabolism, and Wada hemispheric memory performance were reduced compared to the corresponding contralateral measures. The duration of epilepsy controlled for age at investigation, side of seizure origin, underlying cause, and sex were negatively correlated with ipsi- and contralateral hippocampal volume, hippocampal metabolism, and Wada hemispheric memory performance. Moreover, ipsilateral Wada hemispheric memory performance and contralateral hippocampal glucose metabolism were correlated with the frequency of habitual seizures. Refractory TLE seems to be associated with a slow but ongoing bilateral temporal lobe damage. These cross-sectional results require verification by longitudinal studies carried out over a period of more than two decades.

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Section: Discussionsupporting

confidence: 88%

Bilateral reductions of hippocampal volume, glucose metabolism, and Wada hemispheric memory performance are related to the duration of mesial temporal lobe epilepsy

Jokeit¹,

Ebner²,

Arnold³

et al. 1999

Journal of Neurology

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“…FDG-PET showed temporal lobe hypometabolism ipsilateral to the epileptogenic focus in 86%, whereas IAP showed impaired memory of the hemisphere of seizure onset in 65%. Sixty-five percent of patients with unitemporal PET hypometabolism had ipsilateral memory impairment (14). Ninety-six percent of patients with TLE had focal functional deficits on the epileptogenic side hemisphere on either PET or IAP (15).…”

Section: Discussionmentioning

confidence: 99%

“…Loring et al (13) reported that a significant correlation was present between Wada memory asymmetries and hippocampal volume asymmetries (r ‫ס‬ 0.78). Salanova et al (14,15) compared PET temporal lobe hypometabolism and IAP failure of TLE patients. 65 and 76% of TLE patients with ipsilateral temporal PET hypometabolism showed impaired memory of the hemisphere of seizure onset in two studies.…”

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confidence: 99%

Correlation of Temporal Lobe Glucose Metabolism With the Wada Memory Test

Hong

Roh²,

Kim³

et al. 2000

Epilepsia

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Summary: Purpose:The goal of the present study was to examine the relationship of 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) and the Wada memory test in lateralizing memory dominance and epileptic focus.Methods: FDG-PET and the Wada test were performed in 18 patients with temporal lobe epilepsy (TLE). The asymmetry indices of FDG-PET (PET-AI) were calculated in mesial, polar, anterolateral, midlateral, and posterolateral regions of the temporal lobe, and those of Wada memory test (Wada-AI) were obtained as well.Results: The Wada-AI was significantly correlated with PET-AI in mesial (r ‫ס‬ 0.67, p ‫ס‬ 0.003), polar (r ‫ס‬ 0.55, p ‫ס‬ 0.019), anterolateral (r ‫ס‬ 0.55, p ‫ס‬ 0.019), and midlateral (r ‫ס‬ 0.51, p ‫ס‬ 0.031) regions of the temporal lobe. However, after a linear regression analysis, PET-AI of only the mesial temporal region was significantly correlated with Wada-AI (p ‫ס‬ 0.008). Wada-AI could correctly lateralize the seizure focus in 90% of the left TLE and 75% of the right TLE patients. The PET-AI of the mesial temporal region showed the highest sensitivity of seizure lateralization (80% of left TLE and 87.5% of right TLE). PET-AI of other temporal regions had lower sensitivities (50-80% of left TLE, 20-75% of right TLE). One or two patients showed false seizure lateralization by PET-AI on each temporal region.Conclusions: Although FDG-PET hypometabolism is observed at both mesial and lateral regions of the temporal lobe in mesial TLE, mesial temporal region appeared to be a dominant and leading area for lateralizing Wada memory dominance and epileptic focus.

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“…Interictal hypometabolism can be seen in 70-80% of the patients with refractory temporal lobe epilepsy after PET scanning 10 . There is usually a good correlation between this hypometabolism and a failure after the contralateral IAP.…”

Section: Commentsmentioning

confidence: 99%

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

Caner-Cukiert

Cukiert

Gronich

et al. 1995

Arq. Neuro-Psiquiatr.

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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.Resultados do teste intracarotídeo de amital em pacientes com epilepsia uni ou bilateral do lobo temporal e esclerose mesial 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.The intracarotid amytal procedure (IAP) was first introduced by John Wada and its technique was published in 1949 in Japanese. It allowed, for the first time, the comparison of the functions of each cerebral hemisphere within the same patient and their contributions to speech. The drug was injected in the internal carotid artery and led to transient anesthesia of the perfused regions. It usually flowed through the anterior and middle cerebral systems, but the posterior cerebral artery is also

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Comparison of the Intracarotid Amobarbital Procedure and Interictal Cerebral 18‐Fluorodeoxyglucose Positron Emission Tomography Scans in Refractory Temporal Lobe Epilepsy

Cited by 31 publications

References 11 publications

Bilateral reductions of hippocampal volume, glucose metabolism, and Wada hemispheric memory performance are related to the duration of mesial temporal lobe epilepsy

Bilateral reductions of hippocampal volume, glucose metabolism, and Wada hemispheric memory performance are related to the duration of mesial temporal lobe epilepsy

Correlation of Temporal Lobe Glucose Metabolism With the Wada Memory Test

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

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