Hong S B, Kim K W, Seo D W, Kim S E, Na D G, Byun H S
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Epilepsia. 2000 Feb;41(2):207-12. doi: 10.1111/j.1528-1157.2000.tb00141.x.
To relate the occurrence of contralateral electroencephalogram slowing (CES) to amobarbital distribution, we performed electroencephalogram (EEG) monitoring and intracarotid single photon emission computed tomography (SPECT) during an intracarotid amobarbital procedure (IAP).
IAP was performed on 22 patients with temporal lobe epilepsy. CES was defined as the occurrence of significant EEG slowing on the contralateral hemisphere (>50% of the ipsilateral hemisphere slowing) after amobarbital injection. To map the distribution of the amobarbital, we injected a mixture of amobarbital and (99m)technetium-ethylcysteinate dimer (99mTc-ECD) into the internal carotid artery and performed a brain SPECT 2 h later. In the SPECT images, regions of interest were determined by ipsilateral and contralateral anterior cerebral artery territories (iACA, cACA), ipsilateral and contralateral middle cerebral artery territories (iMCA, cMCA), and ipsilateral and contralateral posterior cerebral artery territories (iPCA, cPCA), as well as ipsilateral and contralateral anterior and posterior mesial temporal regions (iAMT, cAMT, iPMT, cPMT). The perfusion of amobarbital was interpreted visually in each region.
Amobarbital was distributed in the iMCA in all the patients; in the iACA in 20 (90.9%) patients; in the iAMT in 14 (63.5%); and in the iPCA and iPMT in only two (9.1%). CES was observed in 13 (59.1%) patients. Cross-perfusion of amobarbital in limited areas of the cACA were observed in only four of 13 patients. Wada retention memory scores (WRMS) showed no significant difference between the CES- (n = 9) and CES+ (n = 13) groups.
Amobarbital rarely perfused the iPCA territory and the iPMT region and was rarely delivered to the contralateral hemisphere. The occurrence of CES was not related to the cross-perfusion of amobarbital. CES appears to be produced by a transient functional disconnection from the ipsilateral hemisphere.
为了将对侧脑电图减慢（CES）的发生与异戊巴比妥分布相关联，我们在颈动脉内异戊巴比妥试验（IAP）期间进行了脑电图（EEG）监测和颈动脉内单光子发射计算机断层扫描（SPECT）。
对22例颞叶癫痫患者进行IAP。CES定义为异戊巴比妥注射后对侧半球出现明显的脑电图减慢（>同侧半球减慢的50%）。为了描绘异戊巴比妥的分布，我们将异戊巴比妥和锝-乙半胱氨酸二聚体（99mTc-ECD）的混合物注入颈内动脉，并在2小时后进行脑部SPECT检查。在SPECT图像中，感兴趣区域由同侧和对侧大脑前动脉区域（iACA、cACA）、同侧和对侧大脑中动脉区域（iMCA、cMCA）、同侧和对侧大脑后动脉区域（iPCA、cPCA）以及同侧和对侧颞叶内侧前后区域（iAMT、cAMT、iPMT、cPMT）确定。在每个区域对异戊巴比妥的灌注进行视觉解读。
所有患者异戊巴比妥均分布于iMCA；20例（90.9%）患者分布于iACA；14例（63.5%）患者分布于iAMT；仅2例（9.1%）患者分布于iPCA和iPMT。13例（59.1%）患者观察到CES。13例患者中仅4例在cACA的有限区域观察到异戊巴比妥的交叉灌注。韦达保留记忆评分（WRMS）在CES-（n = 9）组和CES+（n = 13）组之间无显著差异。
异戊巴比妥很少灌注iPCA区域和iPMT区域，很少输送到对侧半球。CES的发生与异戊巴比妥的交叉灌注无关。CES似乎是由与同侧半球的短暂功能断开产生的。
