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A revised intracarotid etomidate memory (Wada) procedure.

F Andelman¹, S Kipervasser, S Maimon

¹Functional Neurosurgery Unit, Department of Neurosurgery, Tel Aviv Medical Centre, Israel. fani@hermes.tau.ac.il

Acta Neurologica Scandinavica

|June 2, 2012

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A modified etomidate speech and memory (e-SAM) procedure effectively evaluates unilateral memory function in epilepsy patients. This revised bolus injection method reduces side effects and aids surgical decisions for temporal lobectomy.

Area of Science:

Neuroscience
Neurosurgery
Epileptology

Background:

Assessing unilateral memory function is crucial for epilepsy surgery planning.
Standard anterior temporal lobectomy requires understanding hemispheric memory contributions.
The original etomidate speech and memory (e-SAM) procedure had significant side effects.

Purpose of the Study:

To evaluate unilateral memory function using a modified e-SAM procedure.
To assess memory lateralization in epilepsy patients undergoing temporal lobectomy evaluation.
To refine the e-SAM procedure for improved patient safety and clinical utility.

Main Methods:

A modified etomidate speech and memory (e-SAM) procedure involving single bolus injection was developed.
Unilateral memory testing was performed via intracarotid injection of etomidate in 21 epilepsy patients.

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Neuropsychological data were analyzed to compare memory performance between ipsilateral and contralateral injections.

Main Results:

Significant differences in memory scores were observed between ipsilateral and contralateral injections relative to the epileptogenic focus (P < 0.01).
The modified bolus injection technique eliminated major side effects in 18 subsequent patients.
Results suggest the procedure effectively reflects unilateral hippocampal memory function and dysfunction.

Conclusions:

The modified etomidate procedure successfully demonstrates the memory function of the epileptogenic hemisphere.
The technical revision from continuous to bolus injection is effective and safe.
This revised procedure provides essential clinical data for surgical decision-making in epilepsy patients.