측두엽 간질 환자의 Wada 검사에서 병측 반구 진단에 유용한 기억 자극 종류와 점수 측정 방법

Abstract

Background : The Wada test is not yet standardized among epilepsy surgery centers, which makes it difficult to discern the differences between its results. The objectives of this study were to examine the effects of memory stimulus types in the Wada test and the methods of score measurement of results. Methods : We examined the Wada test in 59 patients with temporal lobe epilepsy who had language dominancy in left hemispheres. They underwent surgical treatment and were seizure-free for at least until the 1-year follow up. The Wada test was done on the patients using three different protocols during the presurgical evaluations: 1) protocol A; sixteen cards displaying eight line drawings of common objects and eight words, 13 patients, 2) protocol B; eight line drawings of figures, 14 patients, and 3) protocol C; four line drawings of common objects and four line drawings of figures, 32 patients. Results : Thirty-three patients with RTL (right temporal lobectomy) and 26 patients with LTL (left temporal lobectomy) were not significantly different in demographic and disease characteristics such as age and sex, age at onset, risk factors before 2 years old, epilepsy duration, and Korean Wechsler Adult Intelligence Scale- IQ scores. Patients with RTL recognized significantly more words and line drawings of common objects with a right injection than those with a left injection. Patients with LTL recognized significantly more line drawings of figures and common objects following a left injection versus a right injection. Correct rates obtained through discriminant function analysis (100% (A), 64% (B) and 84% (C) ) were higher than that obtained through cutoff criteria (memory asymmetry scores ³25%: 82% (A), 62% (B) and 56% (C) ). Conclusions : Our study shows that line drawings of common objects as Wada memory stimuli are more useful for the lateralization of the epileptogenic hemisphere than line drawings of figures and words. Discriminant function analysis is also a more effective score measurement than cutoff criteria.