Abstracts

Intracarotid amobarbital procedure (WADA test) has been widely used to determine the hemisphere for speech dominance and memory function. Recently, there has been a worldwide shortage of the amobarbital despite a need for the test in some epilepsy surgery candidates. There were reports of effective use of propofol for speech and memory testing with safety. We report our experiences in intracarotid propofol test during epilepsy preoperative evaluation. Between October 2004-March 2005, 4 patients, 1 male and 3 females, underwent intracarotid propofol test for epilepsy preoperative evaluation. The patients[apos] ages were 13-23 years. Two patients had left hemispheric epilepsy with congenital right hemiparesis who were considered candidates for functional hemispherectomy. One patient who was ambidexterous had failed left temporal lobectomy and was planning for reoperation. The fourth patient had daily atonic seizures and bisynchronous EEG discharges from a right frontal lobe tumor.
The intracarotid propofol test was performed to determine speech dominant hemisphere in the first three patients and to suppress epileptiform discharges in the fourth. The propofol preparation was 10 mg in 10 ml of normal saline solution. The dose of propofol was between 15-18 mg for each injection. We were able to identify speech dominant hemisphere in all 3 patients. Two patients who underwent left functional hemispherectomy had no postoperative language deficit. Another patient showed left sided speech dominance after left sided injection. He then underwent subdural electrode recording. After cortical stimulation mapping, the speech areas were found on the same hemisphere shown by propofol test. In the patient with right frontal lobe tumor, bisynchronous spike-and-waves were completely suppressed after right sided injection, but unchanged after injection to the left. After tumor resection, she had fewer seizures then became seizure free on the fifth month. There were no complications during and after the tests in all subjects. Intracarotid propofol test can be used for epilepsy preoperative evaluation. The results of the test were confirmed by surgical outcome in our cases.