Wada test language and memory dominance as predictors of post-surgical outcome using a transsylvian approach selective ATL: Revisiting value of the Wada test for epilepsy surgery decisions.
Abstract number :
2.273
Submission category :
11. Behavior/Neuropsychology/Language / 10A. Adult
Year :
2016
Submission ID :
195577
Source :
www.aesnet.org
Presentation date :
12/4/2016 12:00:00 AM
Published date :
Nov 21, 2016, 18:00 PM
Authors :
Ryan Sever, University of South Florida, Wesley Chapel, Florida; Mike Schoenberg, University of South Florida; William Clifton, Mayo Clinic; Valerie Kelley, University of South Florida; Selim R. Benbadis, University of South Florida; and Fernando Vale, Un
Rationale: Epilepsy surgery for treatment of pharmacoresistent temporal lobe epilepsy is the most effective treatment. The role of the Wada test in the presurgical evaluation remains a source of controversy, but remains procedure to determine hemispheric dominance for both language and memory function. Methods: A total of 50 participants with medication refractory localization related epilepsy who had a transsylvian approach selective anterior temporal resection at the U. of South Florida/Tampa General Hospital Comprehensive Epilepsy Center. All participants had localization related epilepsy confirmed by long-term surface video-EEG and completed pre- and post-surgical evaluations that included video-EEG, MRI, intracarotid methohexital (Wada) test and neuropsychological assessment. Results: Of 50 patients, 23 received resection of the memory dominant hemisphere as determined by the intracarotid methohexital test. No differences between the dominant ATL group (Dom-ATL, n=23) and nondominant ATL group (NonD-ATL, n=27) in participant demographic characteristics. In the Dom-ATL group, FAS scores were observed to improve after successful selective ATL. Verbal memory short- and long-delayed memory scores declined after surgery (RAVLT Trial 6 pre-op=7.7; postop=5.7; RAVLT preop=6.3; postop= 3.6). Verbal memory declines also observed for the Wechsler Memory Scale- 4th Ed. (WMS-IV) Logical Memory I (d = -2.5), Logical Memory II (d = -2.1) scores. Visual delayed memory also declined following dominant resections WMS-IV Visual Reproduction II (d = -1.6) and Rey-Osterrieth Complex Figure Test (ROCFT) 30-minute delay (d = -.5). In the Non-D group, verbal lexical memory slightly improved at post-op as measured by WMS-IV LM I (d = +.6) and LM II (d = +.9) while visual delayed memory scores slightly declined (ROCFT 30' delay raw scores, d = -1.8). Conclusions: Wada memory dominance was predictive of decline in verbal memory while resection of non-dominant mesial temporal lobe structures was associated with improvement in verbal lexical memory. These data suggest Wada memory dominance was a predictor of neuropsychological outcome. Funding: N/A
Behavior/Neuropsychology