Lee Gregory P, Park Yong D, Hempel Ann, Westerveld Michael, Loring David W
Departments of Occupational Therapy and Neurology, Medical College of Georgia, Augusta, Georgia 30912-0700, USA.
Epilepsia. 2002 Sep;43(9):1049-55. doi: 10.1046/j.1528-1157.2002.48301.x.
Because the capacity of intracarotid amobarbital (Wada) memory assessment to predict seizure-onset laterality in children has not been thoroughly investigated, three comprehensive epilepsy surgery centers pooled their data and examined Wada memory asymmetries to predict side of seizure onset in children being considered for epilepsy surgery.
One hundred fifty-two children with intractable epilepsy underwent Wada testing. Although the type and number of memory stimuli and methods varied at each institution, all children were presented with six to 10 items soon after amobarbital injection. After return to neurologic baseline, recognition memory for the stimuli was assessed. Seizure onset was determined by simultaneous video-EEG recordings of multiple seizures.
In children with unilateral temporal lobe seizures (n = 87), Wada memory asymmetries accurately predicted seizure laterality to a statistically significant degree. Wada memory asymmetries also correctly predicted side of seizure onset in children with extra-temporal lobe seizures (n = 65). Although individual patient prediction accuracy was statistically significant in temporal lobe cases, onset laterality was incorrectly predicted in < or =52% of children with left temporal lobe seizure onset, depending on the methods and asymmetry criterion used. There also were significant differences between Wada prediction accuracy across the three epilepsy centers.
Results suggest that Wada memory assessment is useful in predicting side of seizure onset in many children. However, Wada memory asymmetries should be interpreted more cautiously in children than in adults.
由于颈内动脉注射异戊巴比妥（Wada）记忆评估预测儿童癫痫发作起始侧别的能力尚未得到充分研究，三个综合性癫痫手术中心汇总了他们的数据，并检查了Wada记忆不对称性，以预测考虑进行癫痫手术的儿童的癫痫发作起始侧。
152例难治性癫痫患儿接受了Wada测试。尽管每个机构的记忆刺激类型、数量和方法各不相同，但所有患儿在注射异戊巴比妥后不久都被呈现6至10个项目。在恢复到神经学基线后，对刺激的识别记忆进行评估。癫痫发作起始通过多次发作的同步视频脑电图记录来确定。
在单侧颞叶癫痫患儿（n = 87）中，Wada记忆不对称性在统计学上准确预测癫痫发作侧别，具有显著意义。Wada记忆不对称性也正确预测了颞叶外癫痫患儿（n = 65）的癫痫发作起始侧。尽管在颞叶病例中个体患者的预测准确性具有统计学意义，但根据所使用的方法和不对称标准，左颞叶癫痫发作起始的患儿中，高达52%的患儿发作起始侧别被错误预测。三个癫痫中心之间的Wada预测准确性也存在显著差异。
结果表明，Wada记忆评估在预测许多儿童癫痫发作起始侧别方面是有用的。然而，与成人相比，儿童的Wada记忆不对称性应更谨慎地解释。
