A revised intracarotid etomidate memory (Wada) procedure.
OBJECTIVE
To evaluate unilateral memory function by the means of a modified Montreal etomidate speech and memory procedure (e-SAM) in epilepsy patients who were candidates for standard anterior temporal lobectomy involving resection of mesial temporal lobe structures.


METHODS
After the first three patients experienced significant side effects with the e-SAM procedure, we modified the procedure to a single bolus injection. The neuropsychological data of all 21 patients who underwent unilateral memory testing by means of intracarotid injection of etomidate were analyzed.


RESULTS
There was a significant difference in memory scores when injections were on the side ipsilateral to the epileptogenic focus compared with when the injections were on the contralateral side (P < 0.01), supposedly reflecting unilateral hippocampal memory function and dysfunction. In addition, the procedural modification resulted in eradication of all major side effects in the ensuing 18 patients.


CONCLUSIONS
The technical modification of the Montreal procedure from continuous to bolus injection effectively enabled the demonstration of the relative weakness of the memory function of the epileptogenic hemisphere. The revised etomidate procedure provided the clinical information on unilateral hippocampal memory function necessary for surgical decision.
Functional Neurosurgery Unit, Department of Neurosurgery, Tel Aviv Medical Centre, Israel. fani@hermes.tau.ac.il
F
F
Andelman
S
S
Kipervasser
S
S
Maimon
I
I
Fried
Y
Y
Parmet
M Y
MY
Neufeld
D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods; D002339:Carotid Arteries; D004827:Epilepsy / Q000601:surgery*; D005045:Etomidate / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D007839:Functional Laterality / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007269:Injections, Intra-Arterial; D008297:Male; D008568:Memory / Q000187:drug effects; D009483:Neuropsychological Tests; D055815:Young Adult
D006993:Hypnotics and Sedatives; D005045:Etomidate