Clinical observation on fire needles at bones combined with cupping and Tuina for knee osteoarthritistis / 中国针灸

<p><b>OBJECTIVE</b>To explore a better therapy for knee osteoarthritis.</p><p><b>METHODS</b>One hundred cases were randomly divided into a comprehensive group and an acupuncture group, 50 cases in each one. The comprehensive treatment of fire needles at bones combined with cupping and Tuina on local area of affected knee was applied in the comprehensive group. The Ashi points were mainly selected in the fire needles at bones therapy, once every other day. The cupping and Tuina therapy was adopted once a day. The conventional acupuncture was applied in the acupuncture group, in which Dubi (ST 35), Neixiyan (EX-LE 4), Xuehai (SP 10), Liangqiu (ST 34) and so on were selected, once a day. Ten days of treatment were taken as a treatment course in both two groups, and totally 1 to 2 courses was required. The pain score of joint before and after the treatment was observed and efficacy was assessed in two groups.</p><p><b>RESULTS</b>Compared before the treatment, the pain score of joint after the treatment was obviously improved in two groups (both P<0.05), and the score in the comprehensive group was lower than that in the acupuncture group (P<0.05). The clinical cured rate was 38.0% (19/50), which was superior to 20.0% (10/50) in the acupuncture group.</p><p><b>CONCLUSION</b>The comprehensive treatment of fire needles at bones combined with cupping and Tuina, considered as a better therapy for knee osteoarthritis, could improve joint pain, swelling and action function, which is superior to the conventional acupuncture.</p>

Observation on influence of bone metabolism biochemical indices of senile osteoporosis treated with distant acupuncture and nearby tuina / 中国针灸

<p><b>OBJECTIVE</b>To observe the influence of bone metabolism biochemical indices of senile osteoporosis treated with distant acupuncture and nearby tuina, and to probe the better therapy for senile osteoporosis.</p><p><b>METHODS</b>Sixty-four cases were randomly divided into an observation group and a control group. In control group (30 cases), Calcium Carbonate D, Tablet was orally taken for 12 weeks continuously. In observation group (34 cases), "distant acupuncture and nearby tuina" therapy were applied, that was puncture at Weizhong (BL 40) and Taixi (KI 3), and tuina therapy on lumber region, 30 times treatment was applied totally. The changes of blood calcium (Ca), phosphorus (P), ALP, BGP and urine DPD in bone metabolism biochemical indices were observed and compared before and after treatment in two groups.</p><p><b>RESULTS</b>There were significant differences in P, BGP, DPD in bone metabolism biochemical indices in both groups before and after treatment (P < 0.05, P < 0.01), the contents of blood P decreased, blood BGP increased and urine DPD decreased. But, there were no significant differences in above indices between two groups.</p><p><b>CONCLUSION</b>The calcium with oral administration and "distant acupuncture and nearby tuina" therapy can effectively improve the bone metabolism biochemical indices of senile osteoporosis, and they have positive significance in prevention of osteoporosis, however, it hasn't proved that which method is better for calcium protecting.</p>

Double-center randomized controlled trial on post-stroke shoulder pain treated by electroacupuncture combined with Tuina / 中国针灸

<p><b>OBJECTIVE</b>To evaluate clinical therapeutic effect of post-stroke shoulder pain treated by acupuncture combined with Tuina.</p><p><b>METHODS</b>Three hundred cases of post-stroke shoulder pain were randomly divided into an acupuncture and Tuina group and a rehabilitation group by double-center randomized controlled clinical trial method. In acupuncture and Tuina group, normalized electroacupuncture and Tuina therapy were applied, that was electroacupuncture at main points, such as Chize (LU 5), Quze (PC 3), Shaohai (HT 3), Jianyu (LI 15), Jianliao (TE 14) and Jianjing (GB 21),etc., combined with traditional Tuina manipulations; in rehabilitation group, the rehabilitation methods such as the electrostimulation through nervus cutaneus and the squeezing and stabilizing manipulations of Proprioceptive Neuromuscular Facilitation (PNF), etc. were applied. The treatment courses of both groups were 6 weeks. The main therapeutic effect indices were the Assessment Face Scale (AFS) for pain when shoulder was in passive motion and the Fugl-Meyer Motor Assessment for upper limbs active function; the secondary indices were the moditied Rankin Scale (mRS) and the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia.</p><p><b>RESULTS</b>After 6 weeks treatment and 12 weeks follow-up, AFS score, Fugl-Meyer motor assessment of upper limbs active function and mRS evaluation in acupuncture and Tuina group were more obviously improved than those in rehabilitation group (P < 0.05, P < 0.01). Although the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia in acupuncture and Tuina group was equal to those in rehabilitation group [3.55% (5/141) vs 8.45% (12/142), 1.42% (2/141) vs 5.63% (8/142), both P > 0.05], the data indicated that there was a superiority tendency in acupuncture and Tuina group.</p><p><b>CONCLUSION</b>The combined therapy of electroacupuncture and Tuina is a normative manipulation, and the therapeutic effect is satisfying for post-stroke shoulder pain, superior to that of comprehensive rehabilitation treatment.</p>

Effect of Tuina at breast on postpartum lactation / 中国针灸

<p><b>OBJECTIVE</b>To explore the efficacy of Tuina for postpartum lactation and work out a optimal protocol involved.</p><p><b>METHODS</b>With a randomized, controlled and clinical method, 84 primiparas were divided into a Tuina group and a control group. While patients in the control group received rooming-in conventional managements, those in the Tuina group were additionally treated with Tuina, including local manipulations on breasts combined with acupoint manipulations. The colostrum-time, lactation quantity and prolactin were observed to make the comparisons between two groups.</p><p><b>RESULTS</b>The scores of lactation quantity after 1th, 2nd, 3rd of the treatment were 1.660 +/- 0.785, 2.530 +/- 1.030, 2.880 +/- 1.171 in Tuina group and 1.270 +/- 0.533, 1.460 +/- 0.811, 1.500 +/- 0.583 in control group respectively, where there were significant differences in each time stage between two groups (all P < 0.001). The time of colostrum was (21.6 6 +/- 10.508) h in the Tuina group and (22.5 +/- 9.762) h in the control group, in which the difference was not statistically significant (P > 0.05). The levels of prolactin (314.35 +/- 110.37) ng/mL and (321.56 +/- 109.61) ng/mL in Tuina group, (385.78 +/- 85.19) ng/mL and (340.12 +/- 103.10) ng/mL in control group before and after treatment, there were no significant differences (both P > 0.05).</p><p><b>CONCLUSION</b>Postpartum Tuina on breasts could increase the quantity of lactation and delay the decreasing of the levels of prolactin, which contributes primiparas to lactate more and sooner.</p>

Impacts on biomechanics of senile osteoporosis of kidney deficiency pattern treated with acupuncture and Tuina therapy / 中国针灸

<p><b>OBJECTIVE</b>To explore the mechanism on senile osteoporosis of kidney deficiency pattern in the prevention and treatment with acupuncture and Tuina therapy.</p><p><b>METHODS</b>Sixty-four cases were randomized into an acupuncture and Tuina therapy group (group A, 34 cases) and a calcium carbonate group (group B, 30 cases). In group A, the patients were treated with acupuncture at the distal acupoints and Tuina therapy in the local area. Acupuncture was applied to bilateral Weizhong (BL 40) and Taixi (KI 3). Tuina therapy was given in the lumbar region. Totally 30 treatments were required. In group B, the Calcium Carbonate D3 were prescribed for oral administration, continuously for 12 weeks. The changes in lumbar curvature, lumbar lordosis index, sacral inclination angle, lumbosacral angle, L5 vertebral index and L3 vertebral index of lumbar biomechanical indices were observed and compared before and after treatment in two groups.</p><p><b>RESULTS</b>In group A, the lumbar lordosis index and sacral inclination angle were increased after treatment, indicating the statistical significant differences before and after treatment (P < 0.05, P < 0.01). The improvement of lumbar lordosis index in group A was superior to that in group B [(19.59 +/- 19.16)mm vs (14.47 +/- 13.28)mm, P < 0.05]. After treatment, in group B, L5 vertebral index was improved as compared with that before treatment (P < 0.05). It was required to have a study on the reasons of its lumbar morphological change.</p><p><b>CONCLUSION</b>The acupuncture and Tuina therapy regulate the lumbar biomechanical structure through the positive stress stimulation and reconstruct the mechanical equilibrium of the lumbar vertebra. It plays the active significance in the prevention and treatment of osteoporosis.</p>

Use of Lorazepam in Drug-Assisted Interviews: Two Cases of Dissociative Amnesia

Drug-assisted interviews are useful for psychiatric diagnosis and treatment. However, amobarbital, a typical medication used for this purpose, is associated with elevated risk of respiratory depression. Benzodiazepines are good substitutes for amobarbital, with similar therapeutic effects and fewer complications. Although drug-assisted interviews are not widely used, they may be beneficial for selected patients who do not respond to conventional treatments such as supportive psychotherapy or psychopharmacotherapy. We report two cases of dissociative amnesia that were treated using lorazepam-assisted interviews. The use of lorazepam in drug-assisted interviews is effective and safe for resolving dissociative amnesia.

The Related Factors to Atypical Language Dominance in Patients with Epileptic Foci in the Left Hemisphere

BACKGROUND: Several studies have revealed the increased incidence of atypical language dominance in patients with left hemisphere epileptic foci. We retrospectively investigated the incidence and related factors for language dominance shift determined by intracarotid amobarbital procedure (IAP) in patients with left hemispheric epilepsies. METHODS: We included 222 epileptic patients with epileptic foci in left hemisphere whose language dominance was determined by IAP at Asan Medical Center from 1994 to 2004. The items on the language test in IAP included spontaneous speech (6 items), understanding (2 items), and repetition (2 items). Language lateralization index (LI) was computed according to the formula L=(Score IAP right-Score IAP left)/(Score IAP right+Score IAP left). Clinical information was obtained from medical records including age, gender, age at onset of epilepsy, duration of epilepsy, frequency of seizures, risk factors, onset age of risk factors, and lateralization of MRI or EEG. RESULTS: Of the 222 patients (male 110 patients, 49.5%), complete left language dominance was 142 patients (64.0%), and complete right hemispheric language dominance was 29 patients (13.1%). Seizure onset age, onset age of risk factors, handedness and MRI lesions (hippocampal atrophy or left extensive lesion) had statistically significant association with atypical language dominance. On a linear regression analysis, the significant predictors of the atypical language dominancy were handedness and left extensive lesion (R2=.64). CONCLUSIONS: Atypical language dominancy in patients with left epileptic foci was highly correlated with non-right handedness and extensive lesion on the left hemisphere.

Early Onset Hemiparesis with Epilepsy: Pattern of Surgical Outcome according to Ictal Onset Zone / 대한간질학회지

PURPOSE: To reveal the pattern of surgical outcome according to the location of ictal onset zone in the patients who had a history of early onset (less than two years old) hemiparesis and delayed epilepsy. Many children with acute infantile hemiplegia (AIH) develop delayed epilepsy. This can lead to HHE (Hemiplegia, hemiconvulsion, and epilepsy) syndrome. Epilepsy patients associated with AIH or HHE syndrome generally have been thought to be medically intractable and difficult to treat surgically. METHODS: Patients with a history of early onset hemiparesis with epilepsy who had undergone surgical treatment from November 1995 to May 2002 at Seoul National University Comprehensive Epilepsy Center were recruited. Diagnostic criteria include convulsions, followed by a flaccid hemiplegia, and later epilepsy with partial seizures. Multidisciplinary presurgical evaluations were performed which include a complete neurological examination, brain MRI, long-term video-EEG monitoring, FDG-PET, intracarotid amobarbital test, and ictal and interictal SPECT if possible. Patients with epileptogenic zone outside the hippocampus underwent implantation of intracranial electrodes. The surgical side was localized by the clinical, neuroimaging, and electrophysiological results includeing results of invasive studies. Anterior temporal lobectomy (ATL), cortical resection, functional hemispherectomy, and callosotomy were performed according to the results of presurgical evaluation. RESULTS: Twenty-five patients were included. Mean age was 29.8 ranging from 19 to 60 years old. Fifteen were male and 10 were female. All had a previous history of febrile convulsions. The onset age of febrile convulsion and hemiplegia was one to 48 months (mean=18.0+/-13.2) and the onset age of epileptic seizures were 0.5 to 40 years (mean=9.9+/-8.2). Seventeen of them were right-handed, eight were left-handed and one was bilateral-handed. Follow-up periods after surgery were one to eleven years (mean=5.6+/-2.2). Twelve patients were diagnosed as medial TLE and underwent ATL. The other thirteen patients were diagnosed as neocortical or multifocal epilepsy. Eleven of medial TLE patients were seizure free after ATL and only one had aura. However, only four patients with neocortical epilepsy were seizure free and nine were not. Surgical outcome was significantly different between ATL only and other surgical procedures (p=0.004). CONCLUSION: In patients of early onset hemiparesis with epilepsy, various ictal onset zones can be possible. The medial TLE patients diagnosed by comprehensive presurgical evaluation, in spite of hemiatrophy on brain MRI, showed a good surgical outcome. Surgical treatment should be considered for the selected patients.

Epilepsy Surgery of the Cerebral Paragonimiasis

OBJECTIVE: The authors investigate appropriate evaluation and surgical methods in treatment of the cerebral paragonimiasis accompanying epilepsy. METHODS: Thirteen patients with the cerebral paragonimiasis accompanying epilepsy were included for this study. Preoperative evaluation methods included history taking, skin and serologic tests for Paragonimus westermani, neurologic examinations, computerized tomography, magnetic resonance imaging, amytal test, PET or SPECT, and video-EEG monitoring with depth and subdural grid electrodes. Seizure outcome was evaluated according to Engel's classification. RESULTS: Surgical methods were temporal lobectomy including lesions in six, lesionectomy in five, and temporal lobectomy plus lesionectomy in two. Postoperative neurological complications were not noticed, and seizure outcomes were class I in 12 patients (92%), class II in one (8%). CONCLUSION: In patients with a cerebral paragonimiasis accompanying epilepsy, further evaluation methods must be done to define the epileptogenic zone, and complete resection of the epileptogenic zone with different surgical methods should be performed for seizure control.

O Methohexital Sódico (Brevital) no Teste de Wada: relato de dois casos / The sodium methohexital (Brevital) in Wada's test: report of two cases

O Teste de Wada continua sendo um exame frequentemente utilizado, para a avaliação qualitativa e quantitativa da lateralidade das funções de linguagem e das funções de memória verbal, e do possível déficit residual, uma vez que simula o efeito da cirurgia na investigação pré-operatória de candidatos a lobectomia temporal. No Brasil, há consideráveis dificuldades impostas pelas autoridades sanitárias para obtenção do Amytal (amobarbital sódico). Descreve o protocolo do Teste de Wada realizado com Brevital (methoexital sódico) em dois candidatos a lobectomia temporal, comentar sua eficácia e suas diferenças em relação ao realizado com o Amytal. Relatou-se o uso do Brevital em dois pacientes submetidos a determinação da lateralidade da linguagem e da memória através de protocolo adaptado pata tal. O Brevital, um anestésico de ação curta, mostrou-se eficiente em ambos os casos como substituto ao Amytal. O Brevital pode ser utilizado no Brasil para a realização do Teste de Wada, com a vantagem de possibilitar um exame mais breve, assim como uma investigação abrangente das funções de memória

The Wada Test: contributions to standardization of the stimulus for language and memory assessment

O Teste de Wada (TW) é parte integrante da avaliação pré-cirúrgica para epilepsias de difícil controle. O TW não é padronizado e os protocolos diferem em vários aspectos, incluindo tipos de estímulos para avaliação de memória, tempo de apresentação e metodologia de avaliação. O objetivo deste estudo foi contribuir no estabelecimento de parâmetros para utilização TW para a população brasileira, investigando o desempenho de 100 controles normais, sem medicação. Dois modelos (Modelos A e B) foram utilizados, baseados no Procedimento de Montreal e adaptadas do protocolo de Gail Risse (MEG-MN,EUA). Foram observadas as proporções de acerto dos sujeitos normais para os modelos de TW, em seguida, os dois modelos foram comparados entre si. Os resultados demonstraram que os dois modelos são similares mas, observaram-se significativas diferenças entre os tipos de estímulos. Os resultados sugerem que tipos de estímulos podem influenciar os resultados do TW e esses dados devem ser considerados na construção de modelos e comparações entre diferentes protocolos.

Bizarre behavior during intracarotid sodium amytal testing (Wada test): are they predictable?

O teste do amital sódico intracarotídeo (TASI ou teste de Wada) é procedimento comum na avaliação de pacientes portadores de epilepsia clinicamente refratária candidatos a cirurgia de epilepsia. Tem por objetivo promover interrupção seletiva e temporária da função hemisferial, definindo lateralização de linguagem e risco de comprometimento de memória no pós-operatório. São esperadas mudanças comportamentais durante o teste, as quais podem durar vários minutos, porém, em geral, são sutis e facilmente manejáveis. Relatamos uma série de casos em que ocorreram comportamentos pouco usuais, bizarros, incluindo agitação e agressividade. Estes comportamentos comprometem o teste (paciente deve ser contido), podendo levar a atrasos ou mesmo abortamento do mesmo, além de produzir dados menos confiáveis. Os casos foram revisados, visando a definição de preditores de sua ocorrência. Estas reações são raras (5% dos casos). Efeito barbitúrico, perfil psiquiátrico, dominância cerebral e seletividade da injeção não puderam ser validados como preditores. Explicações detalhadas, repetição e simulações podem ser utéis na prevenção deste tipo de ocorrência.

O teste de Wada como indicativo do prognóstico de disfunção de memória após lobectomia temporal anterior em pacientes portadores de epilepsia de lobo temporal unilateral / The Wada test as an indicative pf the prognosis of memory disfunction after anterior temporal lobectomy in unilateral temporal lobe epileptic patients

A lobectomia temporal anterior (LTA) é reconhecidamente um tratamento eficaz para epilepsias de lobo temporal de difícil controle. O teste de Wada (TW) é parte da investigação pré-cirúrgica para epilepsia, mas sua capacidade de previsão ainda é discutida. Os resultados no TW para reserva, capacidade e assimetria foram comparados com os resultados nos testes de aprendizagem de lista de palavras de Rey e figura complexa de Rey de 34 pacientes com epilepsia de lobo temporal unilateral submetidos a lobectomia temporal anterior (10 a direita 24 esquerda). A análise demonstrou que reserva e capacidade no TW não são suficientemente sensíveis para prever déficit de memória pós operatório./The anterior temporal lobectomy (ATL) is recognized as an effective treatment for the refractory temporal lobe epilepsy. The Wada test (WT) is part of the pre-surgical assessment but its predictive value is still debated. The WT results for reserve, capacity and asymmetry were compared with pre and post surgery scores on Rey auditory verbal learning test and Rey complex figure test of 34 unilateral temporal lobe epilepsy patients submitted anterior temporal lobectomy (10 right and 24 left). Analysis showed that the WT reserve and capacity scores were not sensitive enough to predict post surgery memory deficits.

Prognostic Factors in Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy: Multivariate Analysis

BACKGROUND: In order to identify the prognostic factors of anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (TLE), we performed multivariate analyses in patients with mesial TLE. METHODS: One hundred eighty six patients with mesial TLE (112 men and 74 women; mean age 28.9+/-8.7 years) were included. The primary outcome variable was a the patient's status in the third postoperative year: seizure free (except aura), or not. Clinical, electroencephalographic, radiological, intracarotid amobarbital test, and pathologic data were considered. Clinical data included age at surgery, age at nonfebrile seizure onset, duration of epilepsy, sex, seizure frequency, secondary generalization, history of febrile seizure, and existence of aura. RESULTS: One hundred fifty eight patients (84.9%) had remission of seizure. Univariate analysis found age at surgery (p=0.006) and MRI abnormality including hippocampal sclerosis ipsilateral to surgery (p=0.01) to be significant. Multivariate analyses using logistic regressions, the younger age at surgery (p=0.002) and MRI lateralization (p=0.02) were found to be the significant predictors for good surgical outcome. CONCLUSIONS: Age at surgery and hippocampal findings on MRI are independent prognostic factors for ATL in mesial TLE. These findings suggest that mesial TLE is a progressive disorder and surgical outcome is better when early ATL is performed, at least in medically intractable cases.

The Predictive Value of FDG-PET for Lateralizing Wada Memory Dominance and Epileptic Focus in Patients with Temporal Lobe Epilepsy

Backgroud : To examine the predictability of regional cerebral glucose metabolism in determining Wada memory dominance and lateralizing epileptic focus. METHODS: 1 8 F-fluorodeoxyglucose positron emission tomography (FDG-PET) and Wada test were performed in 18 patients with temporal lobe epilepsy (TLE). Regions of interest were determined in mesial, polar, anterior-lateral, mid-lateral, and posterior-lateral regions of the temporal lobe. The asymmetry indices of FDG-PET (PET-AI) were calculated in each ROI of temporal lobe, and those of Wada memory test (Wada-AI) were obtained as well. RESULTS: Pearson correlation coefficient showed Wada-AI was significantly correlated with PET-AI in mesial (r=0.67, p=0.001), polar (r=0.55, p=0.010), anterior-lateral (0.55, p=0.009) and mid-lateral (r=0.51, p=0.016) temporal regions. However, after simple linear regression analysis, PET-AI of mesial temporal region alone was significantly correlated with Wada-AI (p=0.008). In localizing epileptic focus, Wada-AI could correctly lateralize the seizure focus in 90% of the left TLE and 75% of the right TLE patients. No false lateralization by Wada-AI was observed except two patients showing prolonged confusion after amobarbital injection who were not included in this study. The PET-AI of the mesial temporal region showed the highest sensitivity of seizure lateralization (100% of left TLE and 87.5% of right RLE). CONCLUSIONS: Although FDG-PET hypometabolism is observed both at mesial and lateral regions of the temporal lobe in mesial TLE, mesial temporal region appeared to be a dominant and leading area for lateralizing Wada memory dominance and epileptic focus.

Factors Affecting Impaired Reaction in Wada Test

BACKGROUND: The Wada test is an essential part of the preoperative evaluations in candidates for epilepsy surgery. Impaired reactions (IR) to intracarotid sodium amytal infusions include: confusion, disorientation, and decreased respon-siveness, thereby confounding test results. We retrospectively analyzed the factors affecting the impaired reactions (IR) regarding both individual and methodologic factors. METHODS: Subjects included 202 patients (age;28.5+/-9.48, range:8 to 64 years, M:F=113:89) with intractable epilepsy. Patients with IR (IR group) and those without IR (Non-IR group) were compared with respect to individual factors such as: age, sex, epilepsy syndromes, injected hemispheres, dominan-cy as well as methodologic factors including amobarbital doses. With regards to the dose of amobarbital, the total accu-mulated dose as well as the initial injected dose, were used. RESULTS: IR was observed in 50 patients (24.7%). Compared to the non-IR group, the IR group had more prolonged, contralateral weakness and total test times, but the same duration of EEG changes. IR occurred more frequently with injections into the left hemisphere (p<0.001), the dominant hemi-sphere (p<0.0001), and contralateral hemisphere of epileptic focus (p<0.07). The IR group received significantly higher amounts of amobarbital than the non-IR group (p<0.05). Considering the oversedation as well as the undersedation of amobarbital together, 100mg of amobarbital was the most appropriate dose in the Wada test. CONCLUSIONS: These results suggest that dominant hemisphere injections and usage of higher doses of amobarbital can frequently produce IR in the Wada test. The ideal dose of amobarbital in the Wada test for Korean patients should be 100mg.

Memory Functions of Temporal Lobe Epileptic Patients in the Intracarotid Amobarbital Procedure:I. Lateralizing Value

BACKGROUNDS: To examine the effects of seizure laterality and stimulus type on Wada memory performance in patients with temporal lobe epilepsy(TLE). METHODS: The subjects were 43 patients with medically intractable TLE (left TLE 26, Right TLE 17) who had no or rare seizures after surgery. The memory stimuli were concrete figures for some subjects and abstract figures for the other subjects. RESULTS: A clinical criterion of at least 2-points difference between left and right injections correctly classified 31(72%) patients into left and right TLE groups, with 4(9%) patients falsely classified. A discriminant function analysis(DFA) based on left and right injection scores allowed for a correct classification of 37(86%) patients into left and right TLE groups. When the memory stimuli were concrete figures, the correct classification rate was greater for right than left TLE patients. In contrast, with abstract figures, the correct classification rate was greater for left than right TLE patients. CONCLUSIONS: The Wada memory test is a valuable diagnostic aid in lateralizing temporal epileptogenic foci. Stimulus type as well as seizure lateralization is a major determinant of Wada memory asymmetries.

Influencing factors on interhemispheric language 'shift' and memory asymmetry in temporal lobe epilepsy

BACKGROUND AND OBJECTIVES: Interhemispheric memory asymmetry & language 'shift' (right hemisphere restitution of originally left hemisphere functions or vice versa) and its lateralizing value in temporal lobe epilepsy (TLE) have been repeatedly reported. We analyzed the factors influencing the memory asymmetry & language 'shift', which, to our knowledge, has rarely been reported. METHODS: The IAP (Intracarotid Amobarbital Procedure) was performed in 94 patients, who were candidates for temporal lobectomy. We determined language dominance (LD) hemisphere and calculated 'memory asymmetry indexes' (difference of percentage of memory recall between left and right hemisphere). We reviewed sex, history of 'risk factors' (episodes of febrile convulsion, head trauma, or meningoencephalitis during period of infant and early childhood), age of epilepsy-onset, duration of epilepsy, and then correlated each of them with the presence of language shift and the degree of memory asymmetry. RESULTS: Atypical LD (bilateral or right hemisphere LD) was significantly more frequent in left TLE group than in right (left TLE: 19%, right: 0%, p=0.009). The 'shift' of LD hemisphere was more frequent in patients with 'risk factors' (p=0.04). The 'shift' of LD hemisphere was seen only in patients with duration of epilepsy of > 10 years, but statistically not significant(p=0.07). Interhemispheric memory asymmetry occurred in most patients. The presence of 'risk factors' (p=0.05), duration of epilepsy of 10-20 years (p=0.04), and female sex (p=0.01) were significantly associated with the memory asymmetry in left TLE group. But in right TLE group, the memory asymmetry was not associated with above factors. CONCLUSION: Only in left TLE group, the presence of 'risk factors' and duration of epilepsy influenced both interhemispheric memory asymmetry & language 'shift', whereas sex influenced memory asymmetry only. In right TLE, we failed to find correlation. These results could be explained that in right TLE, memory might be easily or rapidly shifted to the contralateral hemisphere, even in absence of above factors.