Rouleau I, Robidoux J, Labrecque R, Denault C
Service de Neurologie, Hôpital Notre-Dame, Montréal, Canada.
Brain Cogn. 1997 Mar;33(2):224-41. doi: 10.1006/brcg.1997.0894.
Despite the use of stimuli that can be processed by both hemispheres, a number of studies have reported lower memory scores after the left intracarotid amobarbital procedure (IAP) than after the right IAP. Because of that, failure after ipsilateral IAP is observed more often in patients with a left temporal seizure focus (LT) than in right temporal patients (RT), possibly needlessly excluding some LT patients from surgery. In order to overcome the deleterious effects of anesthetizing the dominant hemisphere, we designed an IAP protocol that did not promote verbal encoding of the stimuli. For this purpose, a large number of visual and tactile stimuli (colored pictures and real objects) were presented to be recognized later. The effect of seizure focus lateralization was examined in 82 temporal lobe epileptic patients who underwent IAP as part of their presurgical evaluation. As expected, for both RT and LT patients, long-term recognition of pictures presented under the effect of amobarbital was highly sensitive to the presence of a contralateral epileptic focus. However, contrary to what is generally reported, LT patients performed better than RT patients when their left (ipsilateral) hemisphere was anesthetized. In RT patients, although memory scores were lower after the left contralateral injection, the disparity in memory scores between the right and left injection was not as marked as in LT patients. These results are discussed in terms of the influence of type of processing required during the initial encoding on later recognition during IAP.
尽管使用了可被双侧半球处理的刺激，但多项研究报告称，左侧颈内动脉阿米妥试验（IAP）后的记忆分数低于右侧IAP后的记忆分数。因此，左侧颞叶癫痫灶（LT）患者同侧IAP失败的情况比右侧颞叶患者（RT）更常见，这可能会不必要地将一些LT患者排除在手术之外。为了克服麻醉优势半球的有害影响，我们设计了一种不促进刺激言语编码的IAP方案。为此，呈现了大量视觉和触觉刺激（彩色图片和实物）以供之后识别。在82例接受IAP作为术前评估一部分的颞叶癫痫患者中，研究了癫痫灶定位的影响。正如预期的那样，对于RT和LT患者，在阿米妥作用下呈现的图片的长期识别对侧癫痫灶的存在高度敏感。然而，与一般报道相反，当LT患者的左（同侧）半球被麻醉时，他们的表现比RT患者更好。在RT患者中，尽管左侧对侧注射后的记忆分数较低，但左右注射后记忆分数的差异不如LT患者明显。本文根据初始编码过程中所需处理类型对IAP期间后期识别的影响来讨论这些结果。
