Elshorst N, Pohlmann-Eden B, Horstmann S, Schulz R, Woermann F, McAndrews M P
Mara Clinic, Epilepsy Center Bethel, Bielefeld, Germany.
Epilepsy Behav. 2009 Oct;16(2):335-40. doi: 10.1016/j.yebeh.2009.08.003. Epub 2009 Sep 13.
The contribution of the Wada test (intracarotid amytal procedure, IAP) to predicting postoperative memory outcome in left temporal lobe epilepsy (LTLE) is becoming increasingly controversial when preoperative neuropsychological evaluation and MRI findings are available. We retrospectively analyzed 59 patients with LTLE who underwent en bloc temporal lobe resection. All patients had valid bilateral IAP test results, complete pre- and postoperative neuropsychological evaluation, and MRI grading on a 5-point scale integrating T 2 signal increase and degree of atrophy. Thirty percent of patients showed postoperative memory decline. Multiple regression analysis revealed that significant predictors of decline [F(2.56)=22.71, P<0.001, r(2)=0.448] included preoperative memory learning score [t=-5.89, P<0.001] and MRI classification [t=3.10, P<0.003], but not IAP scores. The IAP is of no added value in the prediction of postoperative memory outcome in LTLE in the presence of comprehensive neuropsychological and MRI data.
当术前有神经心理学评估和MRI检查结果时，Wada试验（颈动脉内注射异戊巴比妥试验，IAP）对预测左侧颞叶癫痫（LTLE）术后记忆结果的作用越来越具有争议性。我们回顾性分析了59例行整块颞叶切除术的LTLE患者。所有患者均有有效的双侧IAP试验结果、完整的术前和术后神经心理学评估，以及基于T2信号增强和萎缩程度的5分制MRI分级。30%的患者术后出现记忆减退。多元回归分析显示，记忆减退的显著预测因素[F(2.56)=22.71，P<0.001，r(2)=0.448]包括术前记忆学习评分[t=-5.89，P<0.001]和MRI分级[t=3.10，P<0.003]，但不包括IAP评分。在有全面的神经心理学和MRI数据的情况下，IAP在预测LTLE术后记忆结果方面没有额外价值。
