SERIAL RECOVERY OF LANGUAGE DURING THE INTRACAROTID AMOBARBITAL PROCEDURE

There is considerable variability among epilepsy centers in the method s and interpretations of the intracarotid amobarbital procedure. Promi nent among these differences is the determination of language represen tation and assessment of language functions, Some centers rely on spee ch arrest following amobarbital injection as a marker for language rep resentation, whereas other centers examine verbal output for the prese nce of aphasic errors. The present study assessed the pattern of langu age recovery following amobarbital injection in epilepsy patients who were candidates for temporal lobectomy. Language recovery from dominan t hemisphere injection (left or right) followed a stereotypical progre ssion, with 71.8% of patients showing return of vocalization followed by return of naming and comprehension. Repetition deficits with paraph asic errors persisted the longest (mean = 12'30 ''), with a conduction aphasia persisting after the acute global aphasia resolved. Although two patients interpreted as left hemisphere language dominant were mut e following right hemisphere injection, all language functions were in tact immediately upon resumption of vocalization and they showed no ot her signs of aphasia such as paraphasias or anomia. Possible explanati ons for serial language recovery and persistent conduction aphasia are discussed. These findings have significant implications for the deter mination of cerebral language dominance. (C) 1997 Academic Press.