Abstracts

The Wada[acute]s test (also known as the intracarotid amytal test) had been considered a key test in the preoperative work of patients with refractory epilepsy in many centers; it has been considered a good predictive factor for postoperative memory loss. More recently, after taking into consideration practical and technical aspects, many authors have discussed the actual usefulness of the test. As a result, this test is currently used only in very selected patients in many centers. This paper reports on the clinical results of patients who were submitted to cortico-amygadalo-hippocampectomy for refractory epilepsy associated to mesial temporal sclerosis without Wada[acute]s testing. One hundred patients with refractory temporal lobe epilepsy and MR-defined mesial temporal sclerosis who were submitted to CAH were studied. They had unilateral (66%) or bilateral (34%) interictal EEG discharges. All patients were submitted to CAH at the MR[acute]s lesion side. Eighty-seven percent of the patients have been seizure-free after surgery. Forty-six percent of the patients presented improvement in memory scores postoperatively. Two patients submitted to surgery on the dominant temporal lobe presented transitory worsening of verbal memory. These two patients presented with venous infarction on the posterior border of the CAH[acute]s cortical resection which was very likely the cause of the verbal memory decline. Symptoms remitted afterwards and were not related to hippocampectomy itself. Cognitive outcome, especially regarding memory, has always been a concern in temporal lobe epilepsy surgery. Patients with mesial temporal sclerosis submitted to CAH usually get improvement (and not loss) of memory function. Wada[acute]s testing has no important role in the preoperative assessment of these patients. (Supported by Sao Paulo[apos]s Secretary of Health)