The Role of the Intracarotid Amobarbital Procedure in Evaluation of Patients for Epilepsy Surgery

Spencer, David C.; Morrell, Martha J.; Risinger, Michael W.

doi:10.1111/j.1528-1157.2000.tb00162.x

Cited by 37 publications

(21 citation statements)

References 24 publications

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“…The overall capacity of Wada memory assessment to classify seizure onset laterality accurately in children in this study was 69%. This is roughly equivalent to similar investigations that have demonstrated impaired Wada memory scores in 50 to 65% of children (22–24), but lower than correct classification rates reported in studies of adult epilepsy surgery candidates, which have ranged between 70 and 88%(14,16–20). Wada memory asymmetries in the current study also predicted the side of seizure onset better in children with right hemisphere seizure foci than in children with left hemisphere seizure onset.…”

Section: Discussionsupporting

confidence: 87%

Prediction of Seizure‐onset Laterality by Using Wada Memory Asymmetries in Pediatric Epilepsy Surgery Candidates

et al. 2002

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Summary:Purpose: Because the capacity of intracarotid amobarbital (Wada) memory assessment to predict seizureonset laterality in children has not been thoroughly investigated, three comprehensive epilepsy surgery centers pooled their data and examined Wada memory asymmetries to predict side of seizure onset in children being considered for epilepsy surgery.Methods: One hundred fifty-two children with intractable epilepsy underwent Wada testing. Although the type and number of memory stimuli and methods varied at each institution, all children were presented with six to 10 items soon after amobarbital injection. After return to neurologic baseline, recognition memory for the stimuli was assessed. Seizure onset was determined by simultaneous video-EEG recordings of multiple seizures.Results: In children with unilateral temporal lobe seizures (n ‫ס‬ 87), Wada memory asymmetries accurately predicted seizure laterality to a statistically significant degree. Wada memory asymmetries also correctly predicted side of seizure onset in children with extra-temporal lobe seizures (n ‫ס‬ 65). Although individual patient prediction accuracy was statistically significant in temporal lobe cases, onset laterality was incorrectly predicted in Յ52% of children with left temporal lobe seizure onset, depending on the methods and asymmetry criterion used. There also were significant differences between Wada prediction accuracy across the three epilepsy centers. Conclusions: Results suggest that Wada memory assessment is useful in predicting side of seizure onset in many children. However, Wada memory asymmetries should be interpreted more cautiously in children than in adults.

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Section: Discussionsupporting

confidence: 87%

Prediction of Seizure‐onset Laterality by Using Wada Memory Asymmetries in Pediatric Epilepsy Surgery Candidates

et al. 2002

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“…The role of neuropsychological evaluation in epilepsy surgery has evolved with increasing surgical experience. Currently, localization data from both Wada and neuropsychological testing are considered by many to contrib-ute to overall localization of the epileptogenic zone (30)(31)(32)(33). In our study, agreement for Wada lateralization was excellent.…”

Section: Discussionmentioning

confidence: 99%

Interrater Reliability among Epilepsy Centers: Multicenter Study of Epilepsy Surgery

Haut¹,

Berg²,

Shinnar³

et al. 2002

Epilepsia

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Summary:Purpose: To measure the interrater reliability of presurgical testing and surgical decisions among epilepsy centers.Methods: Seven centers participating in an ongoing, prospective multicenter study of resective epilepsy surgery agreed to conform to a detailed protocol regarding presurgical evaluation and surgery. To assess quality assurance, each center independently reviewed 21 randomly selected surgical cases for preoperative study lateralization and localization, and surgical decisions. Interrater reliability was assessed by using intraclass correlation coefficients (ICCs), validated for use with multiple raters, and calculated in a two-way random model based on absolute agreement.Results: Agreement for ICC values: Ն0.75, excellent; 0.60-0.74, good; 0.40-0.59, fair; Յ0.39, poor. One center was excluded for missing data. Agreement was excellent for extracranial EEG lateralization (0.8039), magnetic resonance imaging (MRI) lateralization (0.9521) and localization (0.9130), Wada lateralization (0.9453), and intracranial EEG localization (0.7905). Agreement was good for extracranial EEG localization (0.7384) and neuropsychological testing lateralization (0.7178) and localization (0.6891). Consensus about the decision to perform intracranial monitoring was fair (0.5397), in part reflecting one center's tendency toward intracranial monitoring. Overall agreements on whether to perform surgery (0.8311) and specific surgery recommended (0.8164) were excellent.Conclusions: High interrater reliability among six epilepsy centers was present for interpretation of most components of presurgical testing. Although consensus for the decision to perform intracranial monitoring was only fair, agreements for the ultimate decision about resective surgery and specific choice of resection were excellent. We believe that this study demonstrates the feasibility of implementing multicenter protocols for neurologic management, especially those involving localization, as well as protocols combining study results with clinical decision making.

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“…53 Other centers have reported similar rates of correlation between Wada testing and noninvasive studies (80%-90%) and hippocampal volume. 13,[43][44][45]60 Greater disparity on Wada testing and hippocampal volumetric analyses were inversely correlated with memory decline after surgery 13 (greater dysfunction in the involved hemisphere) and predicted seizure control. [43][44][45] Volumetric analyses were not performed in our series.…”

Section: Utility Of Wada Testing In Tlementioning

confidence: 98%

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

Elliott¹,

Bollo

Berliner³

et al. 2013

JNS

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Object In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH). Methods The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom. Results The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video-EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures. Conclusions Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.

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The Role of the Intracarotid Amobarbital Procedure in Evaluation of Patients for Epilepsy Surgery

Cited by 37 publications

References 24 publications

Prediction of Seizure‐onset Laterality by Using Wada Memory Asymmetries in Pediatric Epilepsy Surgery Candidates

Prediction of Seizure‐onset Laterality by Using Wada Memory Asymmetries in Pediatric Epilepsy Surgery Candidates

Interrater Reliability among Epilepsy Centers: Multicenter Study of Epilepsy Surgery

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

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