Purpose: To review our experience with the Etomidate speech test (EST) for lateralizing language in children undergoing epilepsy surgery evaluation METHODS: This retrospective study included children (<18 years) with drug refractory focal epilepsy undergoing EST for bilateral or poorly reliable language representation on functional MRI. Data for consecutive children who underwent EST between January 2013 to June 2017 were reviewed.
Results: Twenty-one children (mean age at EST, 13.1 ± 4.4 years) were studied, with 19-right hemispheric and 20 left hemispheric injections. Six patients had neurological co-morbidities. Duration of ipsilateral EEG slowing was sufficient for speech testing in all children with a single bolus of Etomidate per carotid artery. Language was lateralized to one hemisphere in 17 (80.9%) and bilateral in two cases. EST was unsuccessful in two patients because of diffuse EEG slowing. Contralateral transient frontal EEG slowing was seen in 14 (73.7%) cases. EST was well tolerated in all the patients.
Conclusions: The EST was found to be successful and safe in lateralizing language in most of our drug refractory pediatric epilepsy cohort.
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Reliability and safety of Etomidate speech test in children with drug resistant focal epilepsy.
Epilepsy Res
October 2019
Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada. Electronic address:
Purpose: To review our experience with the Etomidate speech test (EST) for lateralizing language in children undergoing epilepsy surgery evaluation METHODS: This retrospective study included children (<18 years) with drug refractory focal epilepsy undergoing EST for bilateral or poorly reliable language representation on functional MRI. Data for consecutive children who underwent EST between January 2013 to June 2017 were reviewed.
Results: Twenty-one children (mean age at EST, 13.
Intracarotid etomidate is a safe alternative to sodium amobarbital for the Wada test.
J Neurosurg Anesthesiol
October 2013
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Background: The Wada procedure (the intracarotid amobarbital procedure) has been used widely to evaluate the hemispheric dominance of language and memory before temporal lobe surgery in patients with medically refractory seizures. Because of repeated shortage of sodium amobarbital, attempts have been made to find a suitable alternative to sodium amobarbital. The aim of our study was to review our experience with the use of etomidate as an alternative to sodium amobarbital for Wada testing in patients with medically refractory seizures.
View Article and Find Full Text PDFA revised intracarotid etomidate memory (Wada) procedure.
Acta Neurol Scand
February 2013
Functional Neurosurgery Unit, Department of Neurosurgery, Tel Aviv Medical Centre, Israel.
Objectives: To evaluate unilateral memory function by the means of a modified Montreal etomidate speech and memory procedure (e-SAM) in epilepsy patients who were candidates for standard anterior temporal lobectomy involving resection of mesial temporal lobe structures.
Materials And Methods: After the first three patients experienced significant side effects with the e-SAM procedure, we modified the procedure to a single bolus injection. The neuropsychological data of all 21 patients who underwent unilateral memory testing by means of intracarotid injection of etomidate were analyzed.
Alternatives to sodium amobarbital in the Wada test.
Ann Pharmacother
March 2011
Thomas Jefferson University Hospital, Department of Pharmacy, Neurosurgery/Critical Care, Philadelphia, PA, USA.
Objective: To review the literature and identify alternatives to sodium amobarbital for use in the Wada test.
Data Sources: A search of PubMed (1960-October 2010) was performed using the following key words alone or in combination: Wada test, intracarotid amobarbital procedure, intracarotid, intraarterial, sodium amobarbital, methohexital, Brevital, pentobarbital, etomidate, propofol, and alternative anesthetics. References of the identified articles were reviewed for relevant information.
Intracarotid amobarbital procedure and etomidate speech and memory test.
Can J Neurol Sci
August 2009
Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
The intracarotid amobarbital procedure (IAP) has for over 50 years been an important component of the presurgical investigation of patients with epilepsy who are candidates for surgical intervention as treatment for their seizures. Owing to increasing frequency and duration of amobarbital shortages, alternatives for this drug have been sought and implemented, but until now only the drug was changed, while the basic procedure remained essentially the same as that used with amobarbital. This paper describes the Montreal Neurological Institute experience using etomidate in place of amobarbital and introducing a significant change in the procedure: after an initial bolus injection, an infusion is used to maintain the level of hemianesthesia during critical test times.
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