Document Detail


Selective middle cerebral artery Wada tests as a part of presurgical evaluation in patients with drug-resistant epilepsies.
MedLine Citation:
PMID:  12366738     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To analyze the role of selective middle cerebral artery (MCA) Wada tests in the presurgical workup of patients with drug-resistant focal epilepsies. METHODS: Twenty MCA Wada test procedures were performed to identify eloquent cortex (a) in nine patients with hemispheric lesions involving the motor cortex (connatal MCA infarct, n = 5; unilateral cortical dysplasia, n = 3; Rasmussen encephalitis, n = 1), (b) five patients with circumscribed neoplastic or nonneoplastic lesions adjacent to the motor cortex or classic language areas, and (c) for purely electrophysiologic reasons, in two patients with electrical status epilepticus in sleep (ESES). Sodium amobarbital and [99mTc]-HMPAO were simultaneously injected via a microcatheter into the distal M1 segment (n = 7), the inferior MCA trunk (n = 3), or into MCA branches (n = 10). RESULTS: Co-registered single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI;n = 18) showed that sodium amobarbital did not reach the target area in three procedures. Temporary neurologic deficits occurred in 12 procedures. Eleven patients were operated on with the following surgical approaches: functional hemispherectomy, n = 3; partial or extended lesionectomy, n = 4; anterior temporal lobectomy, n = 1; and multiple subpial transsections, n = 3. Seizure freedom (Engel class I) was achieved in five patients. CONCLUSIONS: Selective MCA Wada tests can contribute to risk assessment concerning postsurgical motor deficits before functional hemispherectomy. Other indications are less clear: The identification of language areas is targeted primarily by electrical-stimulation mapping after subdural grid implantations, and selective MCA Wada tests in ESES patients yet have to be validated in larger patient groups.
Authors:
Horst Urbach; Joachim Von Oertzen; Edzard Klemm; Roy Koenig; Detlef B Linke; Martin Kurthen; Johannes Schramm; Christian E Elger
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Epilepsia     Volume:  43     ISSN:  0013-9580     ISO Abbreviation:  Epilepsia     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-07     Completed Date:  2002-11-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1217-23     Citation Subset:  IM    
Affiliation:
Departments of Radiology, Epileptology, Nuclear Medicine, and Neurosurgery, University of Bonn, Bonn, Germany. urbach@uni-bonn.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Amobarbital / administration & dosage,  diagnostic use*,  pharmacology
Brain / drug effects*,  physiopathology,  surgery
Brain Mapping
Child
Child, Preschool
Epilepsies, Partial / diagnosis*,  physiopathology,  surgery
Female
Follow-Up Studies
Functional Laterality / drug effects,  physiology
Humans
Injections, Intra-Arterial
Magnetic Resonance Imaging
Male
Memory / drug effects*,  physiology
Middle Cerebral Artery
Motor Cortex / drug effects,  physiopathology,  surgery
Preoperative Care / methods
Technetium Tc 99m Exametazime / diagnostic use
Tomography, Emission-Computed, Single-Photon
Treatment Outcome
Chemical
Reg. No./Substance:
100504-35-6/Technetium Tc 99m Exametazime; 57-43-2/Amobarbital
Comments/Corrections
Comment In:
Epilepsia. 2003 Apr;44(4):624   [PMID:  12681016 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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