Wada memory performance predicts seizure outcome after epilepsy surgery in children.
OBJECTIVE
Wada memory asymmetries were examined in children from four comprehensive epilepsy surgery centers who subsequently underwent epilepsy surgery to determine whether Wada memory performance could predict degree of seizure relief in children.


METHODS
One hundred fifty-six children (between ages 5 and 16 years) with intractable epilepsy underwent Wada testing before resective epilepsy surgery (93 within the left hemisphere, and 63 within the right hemisphere). Memory stimuli were presented soon after intracarotid amobarbital injection, and recognition memory for the items was assessed after return to neurologic baseline. Eighty-eight children underwent unilateral temporal lobe resection, and 68 had extratemporal lobe resections. One hundred four (67%) children were seizure free (Engel class I), and 52 (33%) were not seizure free (Engel classes II-IV) at follow-up (mean follow-up interval, 2.3 years).


RESULTS
Seizure-free children recalled 19.3% more Wada memory items after ipsilateral injection than did non-seizure-free children (p = 0.008). If analysis was restricted to youngsters with temporal lobectomies (TLs), seizure-free children recalled 27.7% more items after ipsilateral injection than did non-seizure-free TL children (p = 0.004). With regard to individual patient prediction, 75% of children who had memory score asymmetries consistent with the seizure focus were seizure free. In contrast, only 56% of children whose memory score asymmetries were inconsistent with the seizure focus were seizure free (p = 0.01).


CONCLUSIONS
Results suggest that Wada memory performance asymmetries are related to the degree of seizure relief after epilepsy surgery in children and adolescents.
Lee
Gregory P
GP
Medical College of Georgia, Augusta, Georgia 30912, U.S.A. glee@mail.mcg.edu
Park
Yong D
YD
Westerveld
Michael
M
Hempel
Ann
A
Blackburn
Lynn B
LB
Loring
David W
DW
D000293:Adolescent; D000654:Amobarbital; D038481:Anterior Temporal Lobectomy; D002540:Cerebral Cortex / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004292:Dominance, Cerebral / Q000502:physiology*; D004828:Epilepsies, Partial / Q000503:physiopathology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall / Q000502:physiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D016896:Treatment Outcome; D014888:Wechsler Scales
D000654:Amobarbital