Pediatric Intracarotid Sodium Amytal (ISA) Procedure in Determiination of Cerebral Dominance for Language and Memory Function - Preliminary Prport

以兒童勁動脈內sodium amytal注射(瓦達試驗)決定語言及記憶功能優勢大腦半球之初步經驗

楊翠芬(Tsui-Fen Yang) ； 黃棣棟(Tai-Tong Wong) ； 關尚勇(Shang-Yeong Kwan) ； 張開屏(Kai-Ping Chang) ； 呂炳榮(Ping-Wing Lui) ； 徐道昌(Tao-Chang Hsu)

《中華民國復健醫學會雜誌》 23卷1期 (1995/06) Pp. 1-8

摘要

本研究總共收集了5位罹患複雜性局部癲癇發作的患者，其中4位男孩，1位為女孩。他們的發病年齡由3至11歲不等，發病頻率由一個月數次到一天數十次不等。其中4位患者慣用右手，1位慣用左手。他們的智力均落在正常顳葉，1位位於左側顳葉。瓦達試驗結果顯示有4位患者的語言優勢大腦位於左側大腦半球，1位位於右側大腦半球。在記憶功能方面，除1位患者不管語言或非語言記憶的優勢大腦均位於左側大腦半球外，其患者兩側大腦半球對語言及非語言記憶均有不等程度的管轄能力。因經過兩年以上的抗癲癇藥物治療均無法有效控制痲癇的發作，有4位患者（3位為左優勢大腦，1位為右優勢大腦）接受了痲癇病灶該側的局部顳葉切除術，均為非語言優勢大腦半球的顳葉。手術後患者均未發生失語症與失憶症，可說是間接證明了瓦達試的準確性。此4位患者術後癲癇發作的頻率及嚴重程度均有顯著的降低。

並列摘要

The intracarotid sodium amytal (ISA) procedure, introduced by Wada in 1949, is used to identify cerebral dominance for language and memory function in preparation for epilepsy surgery such as unilateral temporal lobectomy . Five cases with complex partial seizure, four boys and one girl, were included in this study, Their ages of onset ranged from 3 to11 years old. Frequency of seizure ranged from 2 to3 fits per month to 50 to 60 fits per day. Four cases were right-handers, one case was left-hander. All of them had normal intelligence. MRI scan of three cases showed positive findings, In continuous EEG/video monitoring, epileptogenic foci were over right temporal region in four cases, and over left temporal region in one case, ISA procedure revealed left speech dominance in four cases and right speech dominance in one case, As to cerebral dominance for memory function, there were no significant lateralization regarding both verbal and nonverbal memory in four cases. Four cases, three with left speech dominance and one with right sreech dominance, finally recrived unilateral temporal lobectomy with partial removal of hippocampus contralateral to the speech dominant hemisphere. There were neither aphasia noted postoperatively, which gave indirect evidence to the accuracy of ISA procedure. Severity of seizure reduced markedly in these four cases after operation.

並列關鍵字

intracarotid sodium amytal ； ISA ； procedure ； epilepsy ； temporal lobectomy ； complex partial seizure ； lateralization ； aphasia ； amnrsia