Muhammad Khalid1, Bhrugun Anisetti1, Mohamed Ali1, Rahul Shah1, Amey Savardekar1, Roohi Katyal1, Christina Ledbetter1, Mostafa Hotait1
1LSU Shreveport
Objective:
To describe our institutional experience using etomidate for the Wada test in adults with medically refractory epilepsy undergoing presurgical evaluation.
Background:
The Wada test remains a key diagnostic tool for assessing memory and language lateralization in epilepsy surgery. While sodium amobarbital has been the traditional agent of choice, global shortages and regulatory issues have prompted evaluation of alternatives such as methohexital, pentobarbital, propofol, and etomidate.
Design/Methods:
We conducted a single-center retrospective review of consecutive patients aged >18 years who underwent Wada testing at our institution between January 2024 and July 2025. Clinical records were reviewed, and demographic as well as procedural covariates were extracted. During each Wada test, 16 items (8 visual and 8 verbal) were presented for memory assessment. Descriptive statistical analyses were performed to summarize patient characteristics and test outcomes.
Results:
Nine patients with English as their primary language were included. Of these, 6 were female, and 7 were White. Seizure focus was localized to the left temporal lobe in 7 patients and to the right in 2, as identified by video- EEG. None had a history of prior epilepsy surgery. Mean baseline memory score was 13 ± 1.94.
A total of 18 etomidate injections were administered, one per hemisphere, at doses of 1 mg (7/9) and 2 mg (2/9). Loss of motor power occurred within 13 ± 5.7 seconds after the injection, and recovery was achieved in 277.5 ± 93.5 seconds. The interval between the final item presentation and recovery averaged 262.9 ± 140.5 seconds (Mean ± SD). None required repeat dosing, and no seizures, stroke, or bleeding complications were observed.
Conclusions:
Our findings support etomidate as a reasonable alternative during the Wada test, given its rapid onset, quick recovery time, effective single-dose administration, and lack of complications.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.