[Intracarotid amytal testing in the evaluation for epilepsy surgery].
BACKGROUND
The Wada test for language and memory still plays an important role in evaluating the surgery performed on epileptic patients. The measures of the functional deficits carried out with the Wada test, associated with known brain lesions, aid in determining the lateralization of the onset of seizures and provide some estimate of the risk to memory after a temporal lobotomy.


METHODS
A more refined procedure, based on the correlations with the titration from MRI, fMR and MR spectroscopy, will be needed. Moreover, using the Wada test it is possible to make long term forecasts about the cognitive outcome and about the control of seizures. When used together with other neurological, functional and psychometric evaluations, it becomes easier to select the patients with most chances of benefiting from surgical epilepsy treatment. Finally, the non invasive measures of brain functioning include fMR, which provides far more information than that obtained using the Wada test. However, it remains to be determined whether the procedure based on activation provides data of the same quality as those obtained by the Wada test, which can provide a more adequate reversible model of the effects of surgery on cognition.


CONCLUSIONS
. Ideally, as MRI and other imaging techniques progress, they will be able to offer complementary images, which will improve our capacity to forecast and prevent important post operative cognitive deficiencies.
Dpt. of Neurosurgery; Yale University School of Medicine, New Haven, CT 06510, EE.UU. westerm@msn.com
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D000328:Adult; D000654:Amobarbital / Q000494:pharmacology* / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D002339:Carotid Arteries; D002648:Child; D004827:Epilepsy / Q000188:drug therapy / Q000601:surgery*; D007839:Functional Laterality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology* / Q000627:therapeutic use; D007807:Language Tests; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests
D006993:Hypnotics and Sedatives; D000654:Amobarbital