Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA, Department of Biomedical Engineering, Georgia Tech, Atlanta, GA, USA.
Epileptic Disord. 2022 Apr 1;24(2):411-416. doi: 10.1684/epd.2021.1390.
We report a case study of a surgical candidate, a 51-year-old woman with left temporal lobe epilepsy, who failed a left injection intracarotid amobarbital procedure (e.g., Wada test), scoring 0 of 8 items. This raised concerns for postoperative memory decline. However, the patient was uninterested in a neuromodulatory approach and wished to be reconsidered for surgery. A stereotactic laser amygdalohippocampotomy (SLAH) was considered, encouraging the need for an alternative test to evaluate risk of memory decline. We developed a novel approach to testing memory during stimulation of a depth electrode implanted in the hippocampus, i.e., an electric Wada. During multiple stimulation trials across a range of amplitudes, the patient scored up to 8 of 8 items, which suggested strong contralateral memory support. The surgical team proceeded with a radiofrequency ablation and a subsequent SLAH. The patient remains seizure-free at 12 months post SLAH with no evidence of verbal or visuospatial memory decline based on a post-surgical neuropsychological battery. We believe that this case study provides a proof of concept for the feasibility and possible utility of an electric version of the Wada procedure. Future studies are needed to develop an optimal paradigm and to validate this approach.
我们报告了一例手术候选者的病例研究，该患者为 51 岁女性，患有左颞叶癫痫，在左侧颈动脉内注射美曲膦酯（例如 Wada 测试）中得到 0 分，有 8 项中的 8 项未通过。这引发了对术后记忆减退的担忧。然而，该患者对神经调节方法不感兴趣，并希望重新考虑手术。因此考虑进行立体定向激光杏仁核海马切除术（SLAH），这就需要寻找替代测试来评估记忆减退的风险。我们开发了一种在刺激植入海马的深部电极时测试记忆的新方法，即电 Wada 测试。在多次刺激试验中，患者在 8 项记忆测试中有高达 8 项通过，这表明对侧记忆支持较强。手术团队进行了射频消融和随后的 SLAH。术后神经心理学测试显示，患者在 SLAH 后 12 个月无癫痫发作，且无言语或视空间记忆减退的迹象。我们认为该病例研究为电 Wada 测试的可行性和可能的实用性提供了概念验证。需要进一步的研究来开发最佳的范式并验证这种方法。
