Propofolを用いたWada testの利点と問題点

Objective : Wada test using Propofol is getting popular in Japan. We compared speech dominancy detected by Propofol Wada test and speech task fMRI. Materials and Methods : Total 7 patients ; three refractory epilepsy cases, three glioma cases, and one cavernous angioma, were included in this study. Wada test was performed after the conventional cerebral angiography by Seldinger method. Sufficient Propofol was administered to induce the contralateral side paresis recognized by arm Barre's test. To evaluated the speech ability, picture naming, reading tasks were tested, followed by memory test after recovering patient's paresis and consciousness. Total six cases performed the speech task functional MRI test successfully, while one unable to perfomed the speech task. Results : All patients were determined their speech dominancy on their left side in Propofol Wada test. Five patients showed concordant speech dominancy between Propofol Wada test and fMRI. While one showed bilateral speech ability with right side dominancy, who presented the bilateral speech ability with left side dominancy at Wada test. Two patients revealed transient side effects of laughing and dystonic posture of contralateral side after injection of Propofol. Conclusion : Propofol Wada test is useful for determining speech dominancy, even with the cognitive disturbed patients. This method is relatively safe with transient minor side effect.journal articl