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John Hart, Jr, MD; Petra J. Lewis, MBBS; Ronald P. Lesser, MD; Robert S. Fisher, MD, PhD; Lee H. Monsein, MD; Pamela Schwerdt, MPhil; Karen Bandeen-Roche, PhD; Barry Gordon, MD, PhD

Arch Neurol. 1993;50(7):745-750.

Abstract
• 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.

Author Affiliations
From the Division of Cognitive Neurology/Neuropsychology (Drs Hart, Lesser, and Gordon and Ms Schwerdt) and the Epilepsy Center (Drs Hart, Lesser, Fisher, and Gordon), the Departments of Neurology (Drs Hart, Lesser, Fisher, and Gordon) and Neurosurgery (Drs Lesser and Fisher), the Divisions of Nuclear Medicine (Dr Lewis) and Neuroradiology (Dr Monsein), the Department of Radiology, School of Medicine, Division of Biostatistics (Dr Bandeen-Roche), the School of Public Health and Hygiene, Department of Cognitive Science (Dr Gordon), and The Zanvyl Krieger Mind/Brain Institute (Drs Hart, Lesser, and Gordon), The Johns Hopkins University, Baltimore, Md.

Footnotes
Accepted for publication January 7, 1993.

Presented in part at the 43rd Annual Meeting of the American Academy of Neurology, Boston, Mass, April 25, 1991.

Reprint requests to Division of Cognitive Neurology, Department of Neurology, Meyer 100, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205 (Dr Hart).

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