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Behavioural status during the intracarotid amobarbital procedure (Wada test): relevance for surgical management
  1. MARIE F O’SHEA,
  2. MICHAEL M SALING
  1. Department of Neuropsychology
  2. Department of Neurology, Austin and Repatriation Medical Centre, Melbourne, Australia; and Department of Medicine, University of Melbourne, Grattan Street, Parkville 3052, Australia.
  1. Dr Marie F O’Shea, Department of Neuropsychology, Austin and Repatriation Medical Centre (Austin Campus), Studley Road, Heidelberg, Victoria 3084, Australia. Telephone 613 3 03 9496 5913; Fax 613 3 03 9457 2654.
  1. SAMUEL F BERKOVIC
  1. Department of Neuropsychology
  2. Department of Neurology, Austin and Repatriation Medical Centre, Melbourne, Australia; and Department of Medicine, University of Melbourne, Grattan Street, Parkville 3052, Australia.
  1. Dr Marie F O’Shea, Department of Neuropsychology, Austin and Repatriation Medical Centre (Austin Campus), Studley Road, Heidelberg, Victoria 3084, Australia. Telephone 613 3 03 9496 5913; Fax 613 3 03 9457 2654.

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Presurgical evaluation in many epilepsy programmes often includes the intracarotid amobarbital procedure (IAP). Sodium amytal is injected into the internal carotid artery to produce a temporary “pharmacological paralysis” of hemispheric function. Traditionally, the IAP has been employed in patients with refractory temporal lobe epilepsy being considered for anterior temporal lobectomy. In these cases it is used to determine cerebral dominance for language,1 to assess the risk of severe postsurgical amnesia,2 and to predict postsurgical material specific memory changes.3 More recently, the use of the IAP has been extended to compliment EEG localisation and radiological data by lateralising temporal lobe dysfunction.4

The IAP may have a hitherto unrecognised role in patients with refractory frontal lobe epilepsy being considered for frontal lobectomy. Specifically, observation of behavioural function during the period of the ablation may provide useful information about the integrity of the contralateral frontal lobe. This is particularly relevant in those candidates with a history of cerebral trauma in whom damage to the bifrontal lobe is known or suspected. A review of the IAP studies performed on patients with temporal lobe epilepsy in our comprehensive epilepsy programme (1991–8) suggests that the emergence of frontal lobe behavioural features is common in patients in whom the aetiology leads to the suspicion of bifrontal compromise (for example, a history of traumatic head injury). By contrast, these features rarely emerge in cases of non-traumatic aetiology, in which the integrity of frontal lobe systems is presumed. Although it remains an incidental finding in the context of determining the …

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