Objective criteria for reporting language dominance by intracarotid amobarbital procedure

We propose a standardized method for reporting language lateralization by intracarotid amobarbital procedure (IAP). We retrospectively reviewed 165 IAPs, and classified language lateralization as left, right, or bilateral by three different methods, all based on the duration of speech arrest following each injection: absolute duration, side-to-side difference, and a "laterality index" defined as (L-R/L+R). Cutoff values were obtained by studying a pure subgroup of left hemisphere dominant right-handed subjects. In 142 patients (86%), the classification remained unchanged among all three methods: left in 112 (79%), right in 19 (13%), and bilateral in 11 (8%). In the other 23 patients (14%), language classification varied among the three criteria used. The change of category was never between left and right, and always involved bilateral language. Thus, this index may be helpful in standardizing and comparing IAP results from different series.     

A reconsideration of bilateral language representation based on the intracarotid amobarbital procedure

Hemispheric language dominance was established for 368 epilepsy surgery candidates based on results of objective language performance during the intracarotid amobarbital procedure. Eight-three percent of patients were found to be left hemisphere dominant, while six percent were right dominant, and eleven percent demonstrated some degree of bilateral language representation. Bilateral patients were grouped according to modality-specific patterns of language performance in each hemisphere, with a majority demonstrating left hemisphere superiority in overall language processing. Variables affecting atypical language development are reviewed and results are considered in the context of previous research.     

Electrocerebral recovery during the intracarotid amobarbital procedure: influence of interval between injections

PURPOSE AND METHODS: During the intracarotid amobarbital procedure (IAP) at the University of Michigan, continuous scalp EEG monitoring guides the timing for presentation of memory items and postinjection testing. Most of our patients have undergone bilateral injections. The interval between injections varied from 22 to 60 min, depending on the test and recovery time, as well as the time to catheterize the second side. After noting a trend toward prolonged electrographic recovery following the second injection, we tested our clinical impression that recovery of the second hemisphere may be influenced by (a) the time between injections and (b) which hemisphere is injected first (epileptogenic or nonepileptogenic). To study these questions, we analyzed EEG recovery data from 48 consecutive IAPs. Approximately half the patients had the epileptogenic side injected first. RESULTS: We found that (a) electrographic recovery after the second injection is prolonged if the interval between bilateral injections is less than 40 minutes and (b) electrographic recovery is more rapid after injection of the epileptogenic hemisphere. CONCLUSIONS: We now recommend waiting at least 45 min between injections. The pathophysiology of more prolonged amobarbital effect on the nonepileptogenic hemisphere than on the epileptogenic hemisphere remains unclear.     

Asymmetries in the effect of side of seizure onset on recognition memory following intracarotid amobarbital injection

OBJECTIVE: To report gross anatomic examination of the canine myocardial bridge (MB), a muscular band found above the coronary artery (CA), with respect to its occurrence, location, vascularization, and innervation. SAMPLE POPULATION: 629 canine hearts obtained within 1 to 3 hours after euthanasia. PROCEDURE: After an incision was made at the left fifth intercostal space, the pericardial sac was cut open, and if an MB was present, the heart, lungs, and annexed structures were removed together and subsequently subjected to macroscopic examination of MB musculature and innervation after formalin fixation. Vascular casting was performed by use of methyl methacrylate perfusion. RESULTS: Of the 629 canine hearts examined, 189 (30%) had MB, occurrence of which was independent of sex, age, and breed. Among 13 MB-containing specimens examined in detail, there was great variation in thickness (0.11 to 2.24 mm; mean, 0.45 mm) of MB and distance (24 to 236 microns; mean, 103 microns) between the MB and the paraconal interventricular branch of the left CA (PIBL). One pair or 2 pairs of blood vessels from the PIBL supplied the MB muscle. Venous blood returned to the coronary circulation via the branches of the great coronary vein coursing on both sides of the PIBL, in close contact with the PIBL and the groove wall. The 2 veins rejoined at the upper portion of the PIBL and passed obliquely to the coronary groove under the left auricle, and finally drained the blood through the coronary sinus into the right ventricle. Innervation to the MB muscle was derived from nerve branches of the middle cervical ganglion and left vagus nerve. CONCLUSION: Prevalence and localization of MB in dogs and human beings are similar. Vascularization of the MB muscle originates from the PIBL. The cervical ganglion and vagus nerve control the MB muscle.     

Relation between intracarotid amobarbital memory asymmetry scores and hippocampal sclerosis in patients undergoing anterior temporal lobe resections

The intracarotid amobarbital procedure (IAP) is used to evaluate memory function preoperatively in candidates for anterior temporal lobe resections (ATL). We examined IAP memory asymmetry scores in 30 patients undergoing ATL (17 R, 13 L), as a function of the presence (HS+) or absence (HS-) of hippocampal sclerosis. Ictal onset zones were determined by extraoperative recording with subdural strip electrodes in all but 3 patients in whom magnetic resonance imaging (MRI) scan showed HS. MRI scans were otherwise normal. All patients were left hemisphere dominant for language except 1, in whom language was represented bilaterally. IAP memory testing involved presentation of eight subjects during anesthesia of each hemisphere, followed by recognition testing after patients recovered from amobarbital effects. A score of 1 was given for each correctly recognized object, and 0.5 was deducted for each false-positive identification. There were 16 foils. A total asymmetry score was calculated, which was positive if there was agreement between the direction of the symmetry and side of operation and negative if reversed. The mean asymmetry score for HS- (n = 8) was 0.9; that for HS+ (n = 22) was 4.1 (p < 0.01). IAP memory performance provided lateralizing information (asymmetry score > or = + or -2) in 73% of cases; among these, the lateralization was correct in 91%. Our data indicate that IAP memory asymmetry predicts both laterality of ictal onset and the presence of HS.     

Anatomic correlates of memory from intracarotid amobarbital injections with technetium Tc 99m hexamethylpropyleneamine oxime SPECT

OBJECTIVE: To better identify regions of the brain affected by intracarotid amobarbital injections and to more precisely predict whether resections of specific brain regions will cause postoperative memory deficits. DESIGN: We modified the standard intracarotid amobarbital procedure by adding a radioactive tracer to the amobarbital injection, thereby providing better correlation between behavior and deactivated brain region. SETTING: Tertiary-care hospital center with a dedicated program for medical and surgical treatment of epilepsy. PATIENTS: We studied 39 patients with medically intractable epilepsy drawn from a regional referral base. INTERVENTION: Intracarotid injection of 125 mg of sodium amobarbital with 37 MBq of technetium Tc 99m hexamethylpropyleneamine oxime (HMPAO), followed by language and memory testing. MAIN OUTCOME MEASURES: The distribution of amobarbital as measured by single photon emission computed tomographic imaging of HMPAO and patient performance on memory tasks. RESULTS: Medial temporal regions were irrigated by the amobarbital in only 28% of the injections. Overall, findings suggest that medial temporal and lateral neotemporal cortex play a role in memory. CONCLUSIONS: The regions involved in memory function vary by individual, as does the distribution of amobarbital. Thus, the most accurate method of determining correlation of brain region with memory function during intracarotid amobarbital injection involves the use of a tracer such as HMPAO.     

Neural organization of material-specific memory functions in temporal lobe epilepsy patients as assessed by the intracarotid amobarbital test.

Lateralization of material-specific memory processing was evaluated in 105 epilepsy patients undergoing the intracarotid amobarbital test prior to temporal lobectomy (TL). Left hemisphere (LH) language dominant patients demonstrated LH specialization for long-term verbal recognition memory and right hemisphere specialization for visuospatial recognition memory. The pattern of hemispheric memory specialization was similar for LH language dominant patients with brain injuries before 2 yrs of age and those without history of early brain injury, suggesting that the apparent sparing of memory post-TL in early brain injury patients reflects reorganization of memory functions within the epileptic hemisphere. Non-LH-language dominant patients showed no lateral specialization for either verbal or visuospatial memory processing, suggesting that in these individuals reorganization of memory functions between hemispheres accompanies the lateral shift in language representation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Material-specific memory in temporal lobe epilepsy: Effects of seizure laterality and language dominance.

This study investigated the effects of seizure laterality and language dominance on material-specific memory in temporal lobe epilepsy (TLE). Left TLE (LTLE) patients with left-hemisphere language dominance (LHLD) showed significantly higher nonverbal than verbal memory capacity, whereas right TLE patients with LHLD showed significantly better verbal than nonverbal memory capacity. LTLE patients with non-left-hemisphere language dominance (NLHLD) showed significantly better verbal memory capacity compared with LTLE patients with LHLD. Thus, selective verbal or nonverbal memory deficits that are dependent on side of seizure onset were apparent in patients with LHLD but not in patients with NLHLD. Relative sparing of verbal memory capacity in LTLE patients with NLHLD may reflect interhemispheric reorganization of verbal memory function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Material-specific memory in traumatic brain injury: Differential effects during acquisition, recall, and retention.

Material-specific memory refers to the ability to learn and recall new episodic information on the basis of the nature of the stimulus material (e.g., verbal vs. nonverbal-visuospatial). Structural equation modeling was used to analyze data from a sample of patients with traumatic brain injury to compare 3 models of memory functioning: material-specific, material-specific plus general, and general (non-material-specific). The models were examined separately for acquisition, delayed free recall, and retention aspects of memory. Results suggest that, at least in a population with traumatic brain injury, the acquisition of new information takes place in a material-specific memory fashion, delayed free recall involves both material-specific and general (non-material-specific) memory components, but retention relies primarily on general (non-material-specific) memory processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Language-related hemispheric asymmetry in healthy subjects and patients with temporal lobe epilepsy as studied by event-related brain potentials and intracarotid amobarbital test

There are current attempts to replace the WADA test for pre-surgical evaluation of hemispheric language capabilities by one of the methods of functional brain imaging. Recent PET and fMRI studies using verbal cognitive tasks like verb generation, semantic monitoring or semantic ('deep') encoding of words showed asymmetries of activation in the fronto-lateral cortex. In a previous ERP study subjects were required to indicate whether pronounceable non-words and abstract geometric figures were presented for the first time ('new item') or whether they had been shown before ('old item'). Group analyses of this study showed significant material-specific hemispheric asymmetries with ERPs being more negative-going in recordings of the posterior part of the left hemisphere with verbal material (CP5/6) but more negative-going in recordings of the right hemisphere with the spatial material (P7/8). The aim of the present study was to test statistically ERP lateralization effects in individual healthy subjects as well as WADA-tested patients suffering from seizures of the mesio-temporal lobe (MTL). In all subjects ERP lateralization with verbal material was tested in the electrode pair CP5/6, and ERP lateralization with figures in the electrode pair P7/8. Statistical analyses of single trials showed that in 20 out of 24 subjects ERPs with verbal material started to be more negative-going in CP5 as compared to CP6 in the period between 100 and 200 ms after stimulus onset or the subsequent time epoch (200-300 ms). In one subject not CP5/6 but the closely adjacent electrode pair P7/P8 showed this verbal material-related hemispheric effect. In patients language dominance as indicated by ERPs was not always consistent with the data of the WADA test. In one patient with left MTL seizures ERPs with verbal material and figures were found to be significantly lateralized to the right hemisphere although the WADA test assigned this patient to have a language-dominant left hemisphere.     

Invariance in automatic influences of memory: Toward a user's guide for the process-dissociation procedure.

Three experiments investigated assumptions of the process-dissociation procedure for separating consciously controlled and automatic influences of memory. Conditions that encouraged direct retrieval revealed process dissociations. Manipulating attention during study or manipulating study time affected recollection but left automatic influences of memory relatively invariant. However, paradoxical dissociations were found when conditions encouraged use of a generate-recognize strategy, violating assumptions underlying the estimation procedure. Use of subjective reports to gain estimates produced parallel results. Easily observed correlations are shown to be not useful for testing assumptions underlying the process-dissociation procedure. A multinomial model produced results that agree with those from the process-dissociation approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stochastic relations between conscious and automatic memory processes: an expansion of the process-dissociation procedure

This paper presents an extension of the process dissociation procedure with wordstem completion, allowing the measurement of the stochastic relation between conscious and automatic processes. The conditional probabilities of conscious remembering with and without automatic processes can be determined. The determination of these conditional probabilities succeeds due to the extension of the process dissociation procedure by an indirect wordstem completion test, without referring to the usual assumptions of the dissociation paradigm. For the evaluation of this extended process dissociation procedure a multinomial model is presented which allows the distinction between voluntary and involuntary conscious memory. The model is applied to a study by ourselves and to an experiment published by Toth, Reingold, and Jacoby (1994). The results show that the assumptions of stochastic independence or redundancy as well as exclusivity of conscious and automatic processes are often violated. Two conscious processes with different probabilities of occurrence are found; voluntary and involuntary conscious memory processes.     

Short-term memory: The effects of inter-item time distribution and recall procedure.

Presents an extension of the M. C. Corballis (see pa, vol. 40:4982) study by exploring the effects of the increasing vs. Decreasing interitem interval variable in a task where retrieval will be from long- and short-term memory. 40 undergraduates served as ss. In the earlier memory-span experiment results revealed that increasing interitem intervals resulted in better performance than decreasing intervals. Corballis used a serial recall procedure in which digits were being recalled from long-term memory. The addition in the present study of the free-ordered recall condition produced an opposite result, I.e., recall was better in the decreasing interval condition. This finding supports the argument that in memory studies effects on the different memory stores must be carefully determined. (french summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The anterior and posterior selective temporal lobe amobarbital tests: angiographic, clinical, electroencephalographic, PET, SPECT findings, and memory performance

The techniques, results, and problems of three types of selective temporal lobe (TL) amobarbital procedures (balloon technique with temporary occlusion of the internal carotid artery distal to the origin of the anterior choroidal artery (acha) [n = 19]; selective anterior catheterization of the acha [n = 20]; and selective catheterization of the peduncular P2-segment of the posterior cerebral artery [n = 5]) are described in a group of 40 patients with medically refractory complex partial seizures of mesial TL origin. Selective amobarbital tests were carried out before surgery to predict the memory deficit after an intended selective amygdalohippocampectomy. The effects of selective anaesthetization of TL were correlated with clinical data, pattern and duration of amobarbital induced EEG changes, and performance on verbal and nonverbal memory tasks measured during the test. In 4 patients the effect of selective amobarbital injection on regional and global metabolism was studied with 18F-FDG-PET, with the PET tracer being injected intravenously immediately after amobarbital. More recently in 2 patients the vascular territory perfused by amobarbital in the acha test was studied with SPECT using 99m Tc ECD injected immediately prior to the amobarbital into the acha. Whereas the PET studies showed a rather widespread and bilateral amobarbital-induced decrease of metabolism, the SPECT studies confirmed the selective distribution of the tracer in the vascular territory of the acha, i.e., in amygdala and hippocampus. The comparison of selective TL amobarbital test performance with postoperative neuropsychological performance showed that the predictive value of this test is rather good for the postoperative verbal memory but underestimates postoperative nonverbal ("figural") memory performance.     

Narrative comprehension in Alzheimer's disease: Assessing inferences and memory operations with a think-aloud procedure.

Objective: To further understanding of text comprehension abilities in Alzheimer's disease (AD), a think-aloud protocol was used to examine the role of inferencing and the memory operations used to produce inferences. Method: Twenty participants with AD and 20 cognitively healthy older adults (OA) read narratives, pausing to talk aloud after each sentence. A verbal protocol analysis developed by Trabasso and Magliano (1996a) was used to code participants' utterances into inferential and noninferential clause types; inferential statements were then coded to identify the memory operation used in their generation. Results: Compared with OA controls, the AD participants showed poorer story comprehension, d = 2.0, produced fewer inferences, d = .67, and were less skilled at providing explanations of story events, d = 1.27, and in using prior text information to explain outcomes, d = .90. The AD group also appeared to rely more on the activation of world knowledge, d = .58, which contributed to less effective inferences and produced more incoherent noninferential statements, d = 1.05. Poorer text comprehension for the AD group was associated with poorer verbal memory abilities, r's > .55, and poorer use of prior text events when producing explanatory inferences, r = .42. Conclusions: The findings suggest that the memory difficulties of the AD group appear to be an important cognitive factor interfering with their ability to integrate story events through the use of inferences and to create a global coherence to support text comprehension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The process-dissociation procedure and similarity: Defining and estimating recollection and familiarity in recognition memory.

In L. L. Jacoby's (see record 1992-07943-001) 2-study-list process-dissociation (PD) procedure, recollection (R) is estimated by the difference in responding between including and excluding items from previously studied lists. Familiarity (F) is estimated with the estimate of R and equations representing the assumption that F and R are independent. The authors hypothesized that ability to exclude items from 1 list (and hence R and F) depends on similarity between lists. As predicted, R was greater and F was smaller when the 2 study lists were encoded with different tasks rather than the same task. Thus, R in the 2-study-list PD procedure does not necessarily involve retrieval of all attributes of the study episode, and F is not necessarily a completely undifferentiated feeling of oldness. Dividing attention at test (Experiment 2) or study (Experiment 3) dissociated F and R. Results are interpreted using a functionalist approach to recognition memory that combines aspects of dual-process and global memory models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The feasibility of intracarotid adenosine for the manipulation of human cerebrovascular resistance

OBJECTIVES: We sought to determine predictors of restenosis after coronary stenting (CS) in a consecutive series of patients. BACKGROUND: Although stenting in highly selected patient groups reduces restenosis, the results of stenting in a heterogeneous patient group and the effects of clinical and procedural factors on stent restenosis are currently unclear. METHODS: We analyzed the 6-month angiographic outcome of 500 lesions in 463 consecutive patients undergoing successful CS. Clinical, qualitative and quantitative angiographic variables were correlated with restenosis assessed as both a binary and a continuous variable. RESULTS: Restenosis, defined as the presence of >50% diameter stenosis in the dilated segment, was present in 105 (26%) of the 405 lesions with angiographic follow-up. The mean late lumen loss during the follow-up period was 0.79+/-0.64 mm. Implantation of multiple stents (p < 0.0001) and a high acute gain (p < 0.0002) were independently associated with a higher late lumen loss. In contrast, the use of high inflation pressure (p < 0.02) and Palmaz-Schatz stents (p < 0.005) was independently associated with a lower late lumen loss. When restenosis was defined as a qualitative variable, implantation of multiple stents (p < 0.001), stenosis length (p < 0.01), small reference diameter (p < 0.02) and stent type other than Palmaz-Schatz (p < 0.01) were independent predictors of restenosis. None of the clinical variables tested was associated with restenosis. CONCLUSIONS: Coronary stenting in an unselected patient group is associated with an acceptable restenosis rate. Although some risk factors were identified, the risk of restenosis was not related to most of the variables tested. This suggests that the superiority of CS over balloon angioplasty, in terms of restenosis, might also apply to subgroups of patients that were not included in the recent randomized studies.     

Method matters: Systematic effects of testing procedure on visual working memory sensitivity.

Visual working memory (WM) is traditionally considered a robust form of visual representation that survives changes in object motion, observer's position, and other visual transients. This article presents data that are inconsistent with the traditional view. We show that memory sensitivity is dramatically influenced by small variations in the testing procedure, supporting the idea that representations in visual WM are susceptible to interference from testing. In the study, participants were shown an array of colors to remember. After a short retention interval, memory for one of the items was tested with either a same–different task or a 2-alternative-forced-choice (2AFC) task. Memory sensitivity was much lower in the 2AFC task than in the same–different task. This difference was found regardless of encoding similarity or of whether visual WM required a fine or coarse memory resolution. The 2AFC disadvantage was reduced when participants were informed shortly before testing which item would be probed. The 2AFC disadvantage diminished in perceptual tasks and was not found in tasks probing visual long-term memory. These results support memory models that acknowledge the labile nature of visual WM and have implications for the format of visual WM and its assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sequential injections of amobarbital sodium and lidocaine for provocative neurologic testing in the external carotid circulation

PURPOSE: To present the results of a protocol for embolization in the external carotid territory that includes provocative testing with amobarbital sodium and lidocaine. METHODS: Provocative testing with sequential intraarterial injections of amobarbital sodium and lidocaine was done before embolization of 66 vascular pedicles in 26 patients with the following pathologic disorders: 8 meningiomas, 7 paragangliomas, 5 dural arteriovenous fistulas, 3 angiofibromas, 1 endolymphatic sac carcinoma, 1 metastatic renal carcinoma, and 1 Rendu-Osler-Weber syndrome. Findings during provocative testing and any postembolization deficits were recorded. RESULTS: Of the 66 vascular pedicles tested, only 1 showed positive findings on an amobarbital test, in which the patient had transient numbness in the contralateral leg. Results of lidocaine tests were positive, in 7 cases, in which cranial nerve deficits were suspected on the basis of anatomic findings. All deficits resolved within 15 minutes. If results of amobarbital or lidocaine tests were positive, large particles or coils were used for embolization. Otherwise, small particles or liquid agents were used. There were no complications after embolization. CONCLUSIONS: Provocative testing with amobarbital can reveal dangerous anastomoses. Testing with lidocaine can show vascular supply to the cranial nerves. With the use of appropriate protocols, embolization in the external carotid territory can be done with minimal risk.