Seizures during intracarotid methohexital and amobarbital testing.
BACKGROUND
Methohexital and amobarbital have been used as agents for Wada testing in the presurgical evaluation of patients with epilepsy. Previous experience with methohexital as an anesthetic indicates that methohexital may decrease seizure threshold and may trigger seizures.


METHODS
A retrospective chart review of 760 intracarotid amobarbital and methohexital tests was performed to determine the frequency of seizures associated with preoperative intracarotid barbiturate testing for language and memory lateralization.


RESULTS
Sixteen patients (2.1%) who had seizures were found. In 3 patients, seizures occurred prior to barbiturate injection, and in 13, following barbiturate injection. After injection of amobarbital, 4 of 538 patients (0.7%) had a seizure. Nine of 222 patients had a seizure after methohexital injection (4.1%) (P=0.001).


CONCLUSIONS
Patients with a previous history of epilepsy may be at higher risk for seizures after methohexital injection as compared with amobarbital injection.
Loddenkemper
Tobias
T
Department of Neurology, Cleveland Clinic, Cleveland, OH, USA. loddent@ccf.org
Möddel
Gabriel
G
Schuele
Stephan U
SU
Wyllie
Elaine
E
Morris
Harold H
HH
D000293:Adolescent; D000328:Adult; D000654:Amobarbital / Q000008:administration & dosage* / Q000009:adverse effects; D001463:Barbiturates; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007269:Injections, Intra-Arterial; D007802:Language; D008297:Male; D008568:Memory / Q000187:drug effects; D008723:Methohexital / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012640:Seizures / Q000139:chemically induced* / Q000503:physiopathology
D001463:Barbiturates; D006993:Hypnotics and Sedatives; D008723:Methohexital; D000654:Amobarbital; C032232:barbituric acid