依托咪酯语言及记忆评估的Wada试验在癫痫外科运动、语言和记忆评估中的初步应用

目的 依托咪酯语言及记忆评估的Wada试验(etomidate speech and memory-Wada testing, eSAM-Wada)在我国还未见相关报道,而血管超选下eSAM-Wada试验国内外还未见报道。探讨eSAM-Wada试验的安全性及其对运动、语言和记忆功能评估的效果。 方法 本文通过回顾性分析我中心5例行eSAM-Wada试验的难治性癫痫患者,观察操作过程中患者运动、语言及记忆功能的改变和术中的不良反应。结果：5例患者均可完成整个评估流程,智商偏低的患者仍可配合完成。2例患者完成血管超选下的eSAM-Wada试验。3例左利手患者中,2例(66.7%)语言优势侧仍位于左侧半球,2例(100%)右利手患者语言优势侧均位于左侧半球。4例左侧半球病变的患者,2例(50%)记忆的优势侧仍位于左侧颞叶,1例(25%)记忆为双侧优势,1例(25%)记忆优势侧转移至右侧颞叶。2例患者进行了后续切除性手术,1例患者进行了立体定向脑电图电极引导下热凝毁损术,1例患者出现左下肢一过性无力,运动、语言及记忆功能改变均与eSAM-Wada试验预测结果相符。2例患者(40%)出现癫痫发作可能与操作流程中依托咪酯静脉推注给药速度过快有关,后给药速度改为>30秒后,患者再无癫痫发作。不良反应需要进一步观察。结论：eSAM-Wada试验是全面评估运动、语言及记忆评估较为可靠且相对安全的方法。与血管超选技术结合,可以更加有效的指导涉及功能区的颅脑外科手术治疗。由于病例数量有限,结论尚需进一步观察。

Etomidate speech and memory-Wada test in motor, speech and memory assessment in epilepsy surgery: preliminary application

Objective: Etomidate speech and memory Wada testing (eSAM-Wada) has not been reported in China, and eSAM-Wada testing with vascluar super-selection have not been reported. To explore the safety and validity of eSAM-Wada testing on the evaluation of motor, language and memory function. Methods: Retrospective analysis of 5 patients with intractable epilepsy who had done eSAM-Wada testing in our center, movement, language and memory function and side-effect during operation were observed. Results: All the 5 patients could complete the whole procedure successfully, including the patients with low IQ. Two patients completed eSAM-Wada testing under vascluar super-selection. In 3 left-handed patients, the language dominant hemisphere was still located in the left hemisphere for two patients(66.7%). All of the three right-handed patients(100%) had their language dominance over the left hemisphere. In 4 patients with left hemisphere lesions, the dominant side of memory was still located in the left temporal lobe in 2 cases (50%), bilateral dominance in 1 case (25%), and completely transfering to the right temporal lobe in 1 case (25%). Two patients underwent subsequent resection and one patient underwent stereotactic electroencephalogram (SEEG)-guided thermocoagulation. One patients had transient postsurgical paralysis over the left extremities. The changes of movement, language and memory function for these 3 patients were consistent with the results of eSAM-Wada testing. There were 2 patients had seizures during the bolus injection of etomidate,which may be related to the rapid injection. No epileptic seizures was recorded in the other 2 patients after lowering speed of the injection (>30s) . Conclusion: eSAM-Wada test is a reliable and relatively safe method for comprehensive evaluation of motor, language and memory. Combined with vascular superselective technology, it can be more effective to guide the neurosurgical plan. Due to the limited number, the conclusion needs further observation.