Transient shivering during Wada test provides insight into human thermoregulation.
OBJECTIVE
Some patients with pharmacoresistant epilepsy undergoing the Wada test experience transient shivering. The purpose of this study was to investigate various clinical and radiographic characteristics of these individuals to delineate underlying mechanisms of this phenomenon.


METHODS
A systematic review of prospectively collected information on patients undergoing the Wada test was performed. All demographic, clinical, and radiographic information was obtained and reviewed by the appropriate expert in the field; statistical analysis was performed to determine the predictors of transient shivering.


RESULTS
A total of 120 consecutive carotid artery injections in 59 patients were included in the study. Shivering was observed in 46% of the patients, and it was not significantly affected by gender, age, location of epileptogenic zone, brain lesion on magnetic resonance imaging (MRI), side of the first injection, duration of the hemiparesis, or excess slow wave activity on electroencephalography (EEG). However, shivering was more likely to follow sodium amobarbital injection if there was no filling of the posterior circulation on cerebral angiogram.


CONCLUSIONS
Transient shivering during the Wada test is common. A transient but selective functional lesion of the anterior hypothalamus produced by the effects of sodium amobarbital may result in disinhibition of the posterior hypothalamus and other brainstem thermoregulatory centers, thereby inducing transient shivering.
Shah
Aashit K
AK
Department of Neurology, Wayne State University, Detroit Medical Center, Detroit, Michigan 48201, USA. ashah@medwayne.edu
Atkinson
Marie D
MD
Gupta
Preeti
P
Zak
Imad
I
Watson
Craig E
CE
Rothermel
Robert
R
Asano
Eishi
E
Fuerst
Darren
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000654:Amobarbital / Q000008:administration & dosage / Q000494:pharmacology; D001833:Body Temperature Regulation / Q000187:drug effects / Q000502:physiology*; D001921:Brain / Q000187:drug effects / Q000502:physiology*; D002343:Carotid Artery, Internal; D002648:Child; D004292:Dominance, Cerebral / Q000187:drug effects / Q000502:physiology*; D004569:Electroencephalography / Q000187:drug effects; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007269:Injections, Intra-Arterial; D007802:Language; D008297:Male; D008568:Memory / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012768:Shivering / Q000502:physiology*
D000654:Amobarbital