Awareness of deficits during intracarotid anesthetic procedures in epilepsy: Comparisons of motor, naming, and comprehension awareness under amobarbital versus under etomidate.
Awareness of deficits is often impaired following disruption of the right hemisphere. Intracarotid anesthetic procedures (IAPs) represent a unique method by which we can assess functioning of each hemisphere in isolation. We used this technique to explore deficits of awareness of specific functions-motor ability, naming, and comprehension-in patients with temporal lobe epilepsy. Some patients were injected with amobarbital, whereas others were injected with etomidate. We found that injection into the right hemisphere, or epileptogenic focus in the right hemisphere following injection in the left, resulted in the lowest levels of motor awareness. We also found a higher level of awareness for expressive language deficits and less awareness for receptive language deficits. Comparison of etomidate and amobarbital suggested more awareness following injection of etomidate. We discuss how these findings contribute to our understanding of the right hemisphere's special role in awareness, and how research in other disorders and in comparative neurology has shaped our conceptualization of the neuroanatomy of insight.
Montreal Neurological Institute, Montreal, Canada. sarah.banks@mcgill.ca
Sarah
S
Banks
Viviane
V
Sziklas
Jelena
J
Djordjevic
Rose
R
Golinski
Marilyn
M
Jones-Gotman
D000293:Adolescent; D000328:Adult; D000654:Amobarbital / Q000494:pharmacology*; D001364:Awareness / Q000187:drug effects*; D032882:Comprehension / Q000187:drug effects*; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000601:surgery; D005045:Etomidate / Q000494:pharmacology*; D005260:Female; D007839:Functional Laterality / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007269:Injections, Intra-Arterial / Q000379:methods; D007806:Language Disorders / Q000139:chemically induced / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects*; D009483:Neuropsychological Tests; D055815:Young Adult
D006993:Hypnotics and Sedatives; D000654:Amobarbital; D005045:Etomidate