Læknablaðið - 15.01.1997, Page 16

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LÆKNABLAÐIÐ 1997; 83
Rannsókn á mál- og minnisgetu
flogaveikisjúklinga fyrir
gagnaugablaðsaðgerð, Wada próf
Sigurjón B. Stefánsson1’, Elías Ólafsson2’, Ólafur Kjartansson3’
Stefánsson SB, Ólafsson E, Kjartansson Ó
Wada test. An investigation of language and memory
functions in epileptic patients evaluated for temporal
lobectomy.
Læknablaðið 1997; 83; 16-9
Introduction: Intracarotid sodium amytal injection
was introduced as a clinical investigation of epileptic
patients by Juhn Wada around 1950. The Wada test
causes a brief inhibition of cerebral functions of the
anaesthetized hemisphere, thus allowing tests to be
performed on the contralateral hemisphere. The
test is widely used to lateralize language functions
and to assess the risk of postoperative amnesia in
epileptic patients evaluated for temporal lobectomy
Subjects and methods: Five epileptic patients were
investigated. Three patients had hippocampal scle-
rosis and two had a benign tumour in the amygdala
region. The sodium amytal was first injected to the
hemisphere with seizure onset. After the develop-
ment of paralysis of the contralateral side of the
body, language and memory functions of the non-
anaestetized hemisphere were assessed. The test
was then repeated for the other hemisphere.
Results: The left hemisphere was dominant for lan-
guage in three patients. In one patient the right
hemisphere was dominant for language and in an-
other patient language was bilateraliy represented.
In the three patients with hippocampal sclerosis,
verbal and nonverbal memory was worse on the side
of the lesion. This difference was not as marked for
the two patients with lesion in the amygdala region.
Total memory score was worse on the side of the
lesion in all five patients.
Frá '’Tryggingastofnun ríkisins, 2)taugalækningadeild
Landspitalans, 3,röntgendeild Landspítalans. Fyrirspurnir,
bréfaskipti: Sigurjón B. Stefánsson, Haðarstíg 8, 101
Reykjavík.
Discussion: In both right and left handed individuals
language is usually located in the left hemisphere.
When epileptic seizures, with onset in the left hemi-
sphere, start early in life, the language function can
be transferred to the right hemisphere. This is a
likely explanation for the right hemisphere language
dominance in one patient. In all patients total mem-
ory score was lower for the hemisphere with seizure
onset. This is in agreement with the suggestion of a
lateralizing value of the Wada test.
Ágrip
Inngangur: Um 1950 hóf Juhn Wada að
rannsaka flogaveikisjúklinga með hálsæðar-
inndælingu á natríum amýtali. Rannsóknin
byggðist á því að skerða tímabundið starfsemi
annars heilahvels með lyfinu til að geta metið
betur starfsemi hins hvelsins. Wada prófið er
nú notað til að ákvarða, hvorum megin mál-
stöðvar séu og hver minnisgeta hvors heila-
hvels sé hjá sjúklingum sem gangast eiga undir
skurðaðgerð á gagnaugablaði vegna floga-
veiki.
Sjúklingar og aðferðir: Fimm sjúklingar
voru rannsakaðir. Þrír sjúklingar voru með
drekasigg (hippocampal sclerosis) og tveir
voru með góðkynja æxli á möndlukjarnasvæði.
Fyrst var þvf heilahveli gefið lyfið, þar sem
upptök floganna voru talin vera. Eftir að sjúk-
lingurinn hafði helftarlamast gagnstæðu meg-
in, var mál- og minnisgeta ósvæfða hvelsins
metin. Prófið var síðan endurtekið fyrir hitt
heilahvelið.
Niðurstöður: Þrír sjúklingar höfðu mál-
stöðvar í vinstra heilahveli, hjá einum voru
stöðvarnar hægra megin og hjá öðrum beggja
megin. Hjá sjúklingunum þremur með dreka-