Abstracts

The intracarotid amobarbital test (IAT) is part of the presurgical workup of patients scheduled for epilepsy surgery to determine language and memory lateralization. Most information on results and complications are derived from adults. Little is known about children undergoing IAT. Difficulties arise from anxiety, need for barbiturate dosage adjustment, and impaired baseline memory in children with mental retardation [4]. The goal of this study was 1) to describe language lateralization in children with epilepsy and 2) to outline complications during IAT. 126 consecutive pediatric IAT performed at the Cleveland Clinic Foundation during a seven year period were reviewed. 44 patients were age 5-12 years, 82 were age 13-18. 102 were right-handed. Amobarbital (n=96, average dose: 100 +- 25 mg) or Methohexital (n=30, average dose 5 +- 1 mg) was injected into the left (n=18), right (n=13), or both (n=95) ICA. Language was localized in 95 patients (75.4%): 75 [78.9 %] were left, 6 [6.3 %] were right, 14 [14.7 %] bilateral language dominant.
Neurological complications included prolonged lethargy impairing language and memory evaluation in 4 patients. Four children had a seizure after injection. Additionally, valid data could not be obtained due to fear or agitation in three children age 5-9 years. No lasting neurological deficits were seen.
General complications included shortness of breath after contrast injection in one boy. One girl presented with fever of 38.5 C the night after the procedure complaining of groin pain. No other major complications were seen. This is one of the largest pediatric IAT series studied so far. The data on language lateralization agree with those previously reported [1, 2, 3]. The IAT in children is an invasive test with a potential for complications, as in adults, occuring in 10 out of 126 patients [7.9 %]. Our series highlights the need for refinement and further development of novel methods to establish language lateralization in children during the evaluation for epilepsy surgery.

[1] Loring D et al.: Cerebral language lateralization: Evidence from intracarotid amobarbital testing. [italic]Neuropsychologia[/italic] 28/8 (1990): 831-938.
[2] Mateer CA, Dodrill CB: Neuropsychological and linguistic correlates of atypical language lateralization: Evidence from sodium amytal studies. [italic]Hum Neurobiol[/italic] 2 (1983): 135-142
[3] Strauss E, Wada J: Lateral preferences and cerebral speech dominance. [italic]Cortex[/italic] 19 (1983): 165-177).
[4] Szabo CA, Wyllie E: Intracarotid amobarbital testing for language and memory dominance in children. [italic]Epilepsy Res[/italic] 15(3) (1993): 239-246