Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy

H. E. Kirsch, J. A. Walker, F. S. Winstanley, R. Hendrickson, S. T C Wong, Nicholas Barbaro, K. D. Laxer, P. A. Garcia

Research output: Contribution to journalArticle

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Abstract

Background: The intracarotid amobarbital (Wada) test can be used to evaluate hemispheric memory capacity before anterior temporal lobectomy (ATL). Most patients demonstrate better memory with injection ipsilateral to planned resection (expected asymmetry [EA]), but a substantial minority show better memory with contralateral injection (unexpected asymmetry [UA]). Both degree and direction of Wada memory asymmetry (WMA) have been associated with worse surgical outcome in small series. Reports also suggest that UA is associated with greater decline in verbal memory after left ATL (L-ATL). Methods: The relationship between WMA and surgical outcome (at 3 months, 1 year, and last follow-up) was examined in a large group of ATL patients (108 L, 119 R) with both EA and UA. Also, memory in a subgroup (96 L, 108 R) was examined, comparing subscores of the Rey Auditory Verbal Learning Test obtained preoperatively, at 3 months, and at 1 year. Results: Thirty-six percent of L-ATL and 8% of R-ATL patients had UA. UA was associated with worse surgical outcome at 1 year for R-ATL patients but was not associated with worse outcome for L-ATL patients. There was no correlation between WMA and persistent postoperative verbal memory change for patients with L- or R-ATL. Conclusions: Unexpected asymmetry is uncommon in patients with right anterior temporal lobectomy (R-ATL) and may be a risk marker of poor surgical outcome. This relationship may be obscured by language confounds in patients with L-ATL. The results suggest that Wada asymmetry (using mixed stimuli) does not predict postoperative verbal memory; it is unclear whether this finding is generalizable to centers using only nonverbal stimuli.

Original languageEnglish (US)
Pages (from-to)676-680
Number of pages5
JournalNeurology
Volume65
Issue number5
DOIs
StatePublished - Sep 13 2005
Externally publishedYes

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Anterior Temporal Lobectomy
Amobarbital
Verbal Learning
Injections
Patient Rights
Language

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Kirsch, H. E., Walker, J. A., Winstanley, F. S., Hendrickson, R., Wong, S. T. C., Barbaro, N., ... Garcia, P. A. (2005). Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy. Neurology, 65(5), 676-680. https://doi.org/10.1212/01.wnl.0000174440.31387.65

Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy. / Kirsch, H. E.; Walker, J. A.; Winstanley, F. S.; Hendrickson, R.; Wong, S. T C; Barbaro, Nicholas; Laxer, K. D.; Garcia, P. A.

In: Neurology, Vol. 65, No. 5, 13.09.2005, p. 676-680.

Research output: Contribution to journalArticle

Kirsch, HE, Walker, JA, Winstanley, FS, Hendrickson, R, Wong, STC, Barbaro, N, Laxer, KD & Garcia, PA 2005, 'Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy', Neurology, vol. 65, no. 5, pp. 676-680. https://doi.org/10.1212/01.wnl.0000174440.31387.65
Kirsch HE, Walker JA, Winstanley FS, Hendrickson R, Wong STC, Barbaro N et al. Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy. Neurology. 2005 Sep 13;65(5):676-680. https://doi.org/10.1212/01.wnl.0000174440.31387.65
Kirsch, H. E. ; Walker, J. A. ; Winstanley, F. S. ; Hendrickson, R. ; Wong, S. T C ; Barbaro, Nicholas ; Laxer, K. D. ; Garcia, P. A. / Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy. In: Neurology. 2005 ; Vol. 65, No. 5. pp. 676-680.
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abstract = "Background: The intracarotid amobarbital (Wada) test can be used to evaluate hemispheric memory capacity before anterior temporal lobectomy (ATL). Most patients demonstrate better memory with injection ipsilateral to planned resection (expected asymmetry [EA]), but a substantial minority show better memory with contralateral injection (unexpected asymmetry [UA]). Both degree and direction of Wada memory asymmetry (WMA) have been associated with worse surgical outcome in small series. Reports also suggest that UA is associated with greater decline in verbal memory after left ATL (L-ATL). Methods: The relationship between WMA and surgical outcome (at 3 months, 1 year, and last follow-up) was examined in a large group of ATL patients (108 L, 119 R) with both EA and UA. Also, memory in a subgroup (96 L, 108 R) was examined, comparing subscores of the Rey Auditory Verbal Learning Test obtained preoperatively, at 3 months, and at 1 year. Results: Thirty-six percent of L-ATL and 8{\%} of R-ATL patients had UA. UA was associated with worse surgical outcome at 1 year for R-ATL patients but was not associated with worse outcome for L-ATL patients. There was no correlation between WMA and persistent postoperative verbal memory change for patients with L- or R-ATL. Conclusions: Unexpected asymmetry is uncommon in patients with right anterior temporal lobectomy (R-ATL) and may be a risk marker of poor surgical outcome. This relationship may be obscured by language confounds in patients with L-ATL. The results suggest that Wada asymmetry (using mixed stimuli) does not predict postoperative verbal memory; it is unclear whether this finding is generalizable to centers using only nonverbal stimuli.",
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AU - Kirsch, H. E.

AU - Walker, J. A.

AU - Winstanley, F. S.

AU - Hendrickson, R.

AU - Wong, S. T C

AU - Barbaro, Nicholas

AU - Laxer, K. D.

AU - Garcia, P. A.

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N2 - Background: The intracarotid amobarbital (Wada) test can be used to evaluate hemispheric memory capacity before anterior temporal lobectomy (ATL). Most patients demonstrate better memory with injection ipsilateral to planned resection (expected asymmetry [EA]), but a substantial minority show better memory with contralateral injection (unexpected asymmetry [UA]). Both degree and direction of Wada memory asymmetry (WMA) have been associated with worse surgical outcome in small series. Reports also suggest that UA is associated with greater decline in verbal memory after left ATL (L-ATL). Methods: The relationship between WMA and surgical outcome (at 3 months, 1 year, and last follow-up) was examined in a large group of ATL patients (108 L, 119 R) with both EA and UA. Also, memory in a subgroup (96 L, 108 R) was examined, comparing subscores of the Rey Auditory Verbal Learning Test obtained preoperatively, at 3 months, and at 1 year. Results: Thirty-six percent of L-ATL and 8% of R-ATL patients had UA. UA was associated with worse surgical outcome at 1 year for R-ATL patients but was not associated with worse outcome for L-ATL patients. There was no correlation between WMA and persistent postoperative verbal memory change for patients with L- or R-ATL. Conclusions: Unexpected asymmetry is uncommon in patients with right anterior temporal lobectomy (R-ATL) and may be a risk marker of poor surgical outcome. This relationship may be obscured by language confounds in patients with L-ATL. The results suggest that Wada asymmetry (using mixed stimuli) does not predict postoperative verbal memory; it is unclear whether this finding is generalizable to centers using only nonverbal stimuli.

AB - Background: The intracarotid amobarbital (Wada) test can be used to evaluate hemispheric memory capacity before anterior temporal lobectomy (ATL). Most patients demonstrate better memory with injection ipsilateral to planned resection (expected asymmetry [EA]), but a substantial minority show better memory with contralateral injection (unexpected asymmetry [UA]). Both degree and direction of Wada memory asymmetry (WMA) have been associated with worse surgical outcome in small series. Reports also suggest that UA is associated with greater decline in verbal memory after left ATL (L-ATL). Methods: The relationship between WMA and surgical outcome (at 3 months, 1 year, and last follow-up) was examined in a large group of ATL patients (108 L, 119 R) with both EA and UA. Also, memory in a subgroup (96 L, 108 R) was examined, comparing subscores of the Rey Auditory Verbal Learning Test obtained preoperatively, at 3 months, and at 1 year. Results: Thirty-six percent of L-ATL and 8% of R-ATL patients had UA. UA was associated with worse surgical outcome at 1 year for R-ATL patients but was not associated with worse outcome for L-ATL patients. There was no correlation between WMA and persistent postoperative verbal memory change for patients with L- or R-ATL. Conclusions: Unexpected asymmetry is uncommon in patients with right anterior temporal lobectomy (R-ATL) and may be a risk marker of poor surgical outcome. This relationship may be obscured by language confounds in patients with L-ATL. The results suggest that Wada asymmetry (using mixed stimuli) does not predict postoperative verbal memory; it is unclear whether this finding is generalizable to centers using only nonverbal stimuli.

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