title: Mapping the distribution of amobarbital sodium in the intracarotid Wada test by use of Tc-99m HMPAO with SPECT.
abstract: The intracarotid amobarbital sodium, or Wada, test has been used to localize speech and memory function prior to surgical treatment of temporal lobe seizures. The authors mixed technetium-99m hexamethyl-propyleneamine oxime (HMPAO) with amobarbital sodium and injected the mixture in 25 patients with epilepsy. Single photon emission computed tomography (SPECT) of the brain was then performed to determine intracerebral distribution of the amobarbital sodium. Results of SPECT were compared with those of conventional and digital subtraction angiography (DSA). The distribution of Tc-99m HMPAO and, presumably, amobarbital sodium varied from patient to patient. SPECT revealed a statistically different distribution from that predicted with conventional angiography. The distribution also often differed from that of DSA, although the difference was not significant. SPECT revealed infrequent delivery to mesial temporal lobe structures. This emphasizes the need for caution in the use of the intracarotid amobarbital sodium test to predict the outcome of removal of these areas.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
authors.forename: P J
authors.initials: PJ
authors.lastname: Jeffery
authors.forename: L H
authors.initials: LH
authors.lastname: Monsein
authors.forename: Z
authors.initials: Z
authors.lastname: Szabo
authors.forename: J
authors.initials: J
authors.lastname: Hart
authors.forename: R S
authors.initials: RS
authors.lastname: Fisher
authors.forename: R P
authors.initials: RP
authors.lastname: Lesser
authors.forename: G M
authors.initials: GM
authors.lastname: Debrun
authors.forename: B
authors.initials: B
authors.lastname: Gordon
authors.forename: H N
authors.initials: HN
authors.lastname: Wagner
authors.forename: E E
authors.initials: EE
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000328:Adult; D000654:Amobarbital; D015901:Angiography, Digital Subtraction; D002343:Carotid Artery, Internal; D004292:Dominance, Cerebral / Q000502:physiology*; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime; D000654:Amobarbital