The Wada test with propofol in a patient with epilepsy

Abstract

-The usual drug used in the Wada test is amobarbital, but it is not available in Brazil. Propofol was already used by Bazin et al. in 1998, and in their report the test resulted good in the absence of any adverse effect. We report the use of propofol as the anesthetic for the Wada test. The test was carried out in a 26 years old woman with temporal medial lobe epilepsy refractory to medical treatment. Language functions and memory were tested after injection in both hemispheres by three procedures (Seattle, Montreal and Interview procedures). Propofol showed to be good to carry on the Wada test.KEY WORDS: Wada test, epilepsy, propofol, temporal lobe epilepsy. Teste de Wada com propofol em uma paciente com epilepsiaRESUMO -O amobarbital é a droga usada no teste de Wada, mas não é disponível em nosso pais. O propofol, usado por Bazin et al. em 1998, foi útil e sem efeitos adversos. Relatamos o uso do propofol como anestésico no teste de Wada. Este foi realizado como parte da avaliação pre-cirúrgica, em uma mulher de 26 anos com epilepsia do lobo temporal mesial, em uso de carbamazepina e ácido valpróico sem controle de suas crises. As funções da linguagem e memória foram testadas após injeção em ambos hemisférios separadamente por três procedimentos (Seattle, Montreal e Entrevista). O propofol mostrou-se eficaz para a realização do teste de Wada. PALAVRAS-CHAVE: teste de Wada, epilepsia, propofol, epilepsia do lobo temporal.

Propofol, An Alternative to Amobarbital in Wadas Test in Electro corticography Based Epilepsy Surgery for Determining Dominance of Brain

“…Its safetymargin, low incidence of side effect and effectiveness in inducing controlled transitory losses of neurological function in the perfused areas have been reported. 9,11,12 Propofol acts in CNS and is delivered as an emulsifi ed solution of soyabean oil and glycerol microdroplets. Its effect may be mediated by inhibition of the N-methyl D-aspartate receptor modulating calcium infl ux presynaptically and direct activation and potentiation of the gamma-amino-butyric acid-A and glycine CNS receptors postsynaptically through chloride channels.…”

Provocative Test with Propofol: Experience in Patients with Cerebral Arteriovenous Malformations Who Underwent Neuroendovascular Procedures

“…18 Propofol has been cited more frequently, and more experience has been documented with its use in Wada testing. 10,11,13 Propofol is an anesthetic that acts in the CNS and is delivered as an emulsified solution of soybean oil and glycerol microdroplets. Its effect may be mediated by inhibition of the N-methy D-aspar- tate receptor modulating calcium influx presynaptically and by direct activation and potentiation of the gamma-aminobutyric acid-A and glycine CNS receptors postsynaptically through chloride channels.…”

“…Other adverse events have been reported in the literature and are related to intracarotid propofol administration. 10,11,13 Among symptoms that may be peripherally mediated, reports have listed eye pain, warm sensation in the head and face, face contortion, and lacrimation. Laughing and apathy have also been reported, possibly related to frontal lobe disinhibition.…”

“…Amobarbital has been the traditional drug of choice for pre-embolization testing, yet its availability has been affected by several shortages, including the present one. This has led many centers to consider the use of other drugs, such as methohexital, 7 pentobarbital, 8 etomidate, 9 and propofol, 10,11 reported primarily in Wada testing. Similar reports on the use of these or similar anesthetics in cerebral AVM pre-embolization provocative testing are absent or scarce.…”

“…Its safety margin, low incidence of side effects, and effectiveness in inducing controlled transitory losses of neurologic function in the perfused areas has been reported. 10,11,13 In the present study, we report our experience using propofol during provocative testing in a series of patients who underwent embolization for cerebral AVMs. The purpose of this study was to establish the use of propofol as a safe and effective alternative to barbiturate provocative testing in AVM embolization procedures.…”