Changes in measures of consciousness during anaesthesia of one hemisphere (Wada test)

Neuroimage. 2021 Feb 1;226:117566. doi: 10.1016/j.neuroimage.2020.117566. Epub 2020 Nov 20.

Abstract

Background: In the Wada test, one hemisphere is selectively anaesthetised by unilateral intracarotid injection of a fast-acting anaesthetic agent. This gives a unique opportunity to observe the functions and physiological activity of one hemisphere while anaesthetising the other, allowing direct comparisons between brain states and hemispheres that are not possible in any other setting.

Aim: To test whether potential measures of consciousness would be affected by selective anaesthesia of one hemisphere, and reliably distinguish the states of the anesthetised and non-anesthetised hemispheres.

Methods: We analysed EEG data from 7 patients undergoing Wada-tests in preparation for neurosurgery and computed several measures reported to correlate with the state of consciousness: power spectral density, functional connectivity, and measures of signal diversity. These measures were compared between conditions (normal rest vs. unilateral anaesthesia) and hemispheres (injected vs. non-injected), and used with a support vector machine to classify the state and site of injection objectively from individual patient's recordings.

Results: Although brain function, assessed behaviourally, appeared to be substantially altered only on the injected side, we found large bilateral changes in power spectral density for all frequency bands tested, and functional connectivity changed significantly both between and within both hemispheres. Surprisingly, we found no statistically significant differences in the measures of signal diversity between hemispheres or states, for the group of 7 patients, although 4 of the individual patients showed a significant decrease in signal diversity on the injected side. Nevertheless, including signal diversity measures improved the classification results, indicating that these measures carry at least some non-redundant information about the condition and injection site. We propose that several of these results may be explained by conduction of activity, via the corpus callosum, from the injected to the contralateral hemisphere and vice versa, without substantially affecting the function of the receiving hemisphere, thus reflecting what we call "cross-state unreceptiveness".

Keywords: EEG; Measures of consciousness; Wada test.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anesthesia*
  • Anesthetics, Intravenous*
  • Carotid Artery, Internal*
  • Consciousness / physiology*
  • Drug Resistant Epilepsy / surgery
  • Electroencephalography*
  • Epilepsy, Temporal Lobe / surgery
  • Etomidate*
  • Female
  • Functional Laterality / physiology*
  • Humans
  • Injections, Intra-Arterial
  • Male
  • Middle Aged
  • Neurosurgical Procedures
  • Preoperative Care

Substances

  • Anesthetics, Intravenous
  • Etomidate