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NEUROLOGY 1988;38:1233
© 1988 American Academy of Neurology

Severe behavioral complications following intracarotid sodium amobarbital injection

Implications for hemispheric asymmetry of emotion

G. P. Lee, PhD, D. W. Loring, PhD, K. J. Meador, MD, H. F. Flanigin, MD and B. S. Brooks, MD

Section of Neurosurgery Medical College of Georgia, Augusta, GA (Drs. Lee and Flanigin)
Department of Neurology Medical College of Georgia, Augusta, GA (Drs. Loring and Meador)
Department of Radiology Medical College of Georgia, Augusta, GA (Dr. Brooks)

The intracarotid sodium amobarbital (ISA) procedure is effective in determining cerebral language dominance. However, severe emotional and behavioral reactions during ISA evaluation may invalidate the results or necessitate aborting the procedure. In an effort to identify patients at risk for behavioral complications, we reviewed 92 patients undergoing ISA evaluation and found five with severe changes in affect and behavior following amobarbital injection, ranging from prolonged coma to an extended confusional state. Severe behavioral disturbances were more likely to occur in patients with left frontal structural lesions upon injecting amobarbital into the right hemisphere. Analysis of patients with structural lesions of the anterior regions of the right hemisphere showed no evidence of similar behavioral complications. These findings suggest a special role for the left frontal region in the inhibition of affective expression and provide further evidence of the importance of right hemisphere mechanisms in emotion.

Address correspondence and reprint requests to Dr. Lee, Section of Neurosurgery, Medical College of Georgia, Augusta, GA 30912–4010.

Supported in part by the Medical College of Georgia Research Institute Small Grants program and NIH/NIA Clinical Investigator Award #1K08 AG00314.

Received August 27, 1987. Accepted for publication in final form January 12, 1988.




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