WADA for Epilepsy, Cerebral Angioplasty, EEG

by Placerville Newswire / Sep 28, 2018 / comments

My first ever “Bikini Shave” this week and Brain Surgery next week!  The joke about where a man thinks from is inevitable, but this is really what happend.

After an Alphabet soup of tests including PET, EEGs, MRIs, CT, EMU, even an fMRI, I then did a WADA test yestarday.  The two test that really changed my entire outlook was a week in a EMU in June (Epilepsy Monitoring Unit with video and electrodes monitoring my brain’s electrical activity) and the WADA test for epilepsy this week.

The first significant test was a week in a specialized medical unit (EMU) where they recorded many seizures, from a short one while eating where I simply pause a moment and then continued eating as if nothing happened, to a full Tonic/Clonic (Grand Mal).  That convinced me that I was having many seizures, regardless of the fact that I had no recollection of them. I am very “recalcitrant,” or stubborn as a mule, but I could no longer dispute my recorded seizures.

Yesterday I had a WADA test for epilepsy that included an EEG, a Cerebral angioplasty, and the WADA part (also known as the intracarotid sodium amobarbital procedure).  The point of this test was to insure that the left side of my brain would be able to take over the tasks performed by the planned removed part of my right side of my brain.  For me that mostly meant if my left hemisphere would be able to take over critical language and memory for the part they wanted to remove in my right hemisphere.

This was different from previous tests that had focused on finding the exact location of the part of my brain that was starting the seizures, and more tests for elminatinating other potential causes like cancer or physical brain deformities.  After the exact place that was the origin of the seizures was known, and other causes eliminated, it was time to make sure my brain was capable of losing the offending part without serious degrading my mental functions. The WADA test.

The WADA test required that I remain conscience throughout and answer tests as they put one half (hemisphere) of my brain to sleep to see how just one half performed.  Soon after they performed the same tests with the other half put to sleep.

Here is a more clinical description of part of the process: “The Wada test is given by injecting sodium amytal [amobarbital] into the left and right internal carotid arteries, at separate times, causing a "freeze" (that is, putting part of the brain to sleep) to determine individual capabilities. The patient is then shown objects and asked for their names. The freeze wears off after approximately 4 minutes. Choosing which objects were shown during the freeze tests memory. The test is repeated on the opposite side.”

I had done my homework and knew that to do this they would insert a catheter into the artery in my groin and thread it up past my heart into the base of my brain.  Then to inject drugs into each side one at a time. For some reason I was thinking of the arteri in my inner thigh. I soon realized that is not my “groin” as after I was preped and wheeled into the surgical suite. I saw many doctors swarming around and a few of them explained that in order to keep a sterile area for the procedure that I would have to do be able to move my hands for the test and that they would have to give me a “bikini shave” because it was so close to where they would be inserting the catheter in my “groin.”  My first ever “bikini shave” and it was in a large room with nearly a dozen people swarming about. Well, I now understand where a “groin” is located… I could not see what they were doing from my restricted prone position, but after I got home and had a look, my wife laughed out loud and told me that was going to itch for about a week.

I am somewhat of a prude so I tried to occupy my “shaving” time by checking out the surgery area and the many people.  I was stunned by how large the area was and the many machines hanging from the ceiling that were made to be moved about with minimal effort.  I knew there would be a radiologist to make sure the catheter was going the right places so I guessed there was some x-ray equipment. I could also see a big mobile panel of about 6 large screen monitors that the doctors could watch displying critical live information for the procedure.  The room itself looked to be about 1,600 square feet!

I also realized that along with many nurses to do many related tasks there were at least four high-end specialist out of the 5 that compose my “care team.”  I knew beforehand that this would take my neurologist, my neuropsychologist, and my radiologist working together to perform. I saw them and was introduced to a few more as the process was about to start. I looked about the large “operating theater” in this high-end teaching hospital to see the other patients in there, only to realize that all this talent was there just for me.  I am not rich, royal, or even socially notable, so they were there just because they believed they could really help. That was truly humbling.

Enough of all that, now onto the actual procedure, a procedure that monumentally changed my view of the upcoming surgery.  After the “shave” they cut and inserted the catheter. That was somwhat painful and caused me to grimace, but not shout out. It was done in a minute or so.  That was a short pain in what was a five hour procedure. Even being conscious, the rest of the procedure was relatively pain free. As they were about to inject the drugs through the catheter I was told there would be a hot feeling behind that eye and that I would see light flashes in that eye. I indeed did feel the heat and saw blue dots on my right side field of vision followed by what looked like lighting strikes across the whole visual field.  This lasted just a second or two.

I was asked to count loudly so all could hear from 1 to 10.  When I reached 4 I could hear my neurologist say start and a moment after that I could feel the effect of the heat of the drugs behind my eye.  I continued on to 10. They first put the side with the seizures to sleep and I was a bit amazed that my cognitive, recognition, memory, was so robust that the test seemed easy with just half of my brain awake! It was like any normal day in any classroom setting.  A breeze really. They then waited for the effects to fully wear off on that side before reversing and putting the seizure free side of my brain to sleep to test the side that was causing the seizures.

That is when the magic happened.  I was fully aware of what was going on.  My higher thought processes were so intact that I immediately recognized the radical difference in performance, but without the ability to perform some tests at all and most of the tests very poorly!

To start it began with the same count from 1 to 10 with the drugs administered at 4.  For no reason I can even postulate I simply stopped counting at 7. I don’t have any idea why.  I could tell I had stopped, but not why. I still knew I was supposed to county to 10, but simply stopped at 7.  The testing started with the same questions as asked in the earlier part on the other side. Question most of which I could not even form answers to let alone begin to articulate anything.  At what would have been the about the 10 count I began to shiver violently and several times though the test I was asked if I was cold, but I was not. As the test continued I was asked my name and I was able to answer, but in a very staccato manner with many interjected grunt-like sounds.  The test that I could do, I could do very poorly and with the shaking and staccato replies that did not go away throughout the test. All of my physical movements were very jerky and I had a part where I was to touch my nose with each hand’s index fingertip. This is a test I have been asked to do often in the last few months and I always performed well, but not this time.  With each hand I had to focus very hard and still ended up at my upper lip. Oddly, I could recognize the error and even as I thought to myself, “damn.”

In reading some simple sentences that were the same sentences I had read for the previous side without any difficulty, I could still read somewhat, but I had to look at them very quickly and then close my eyes to say them.  In the physical items memory part I knew that I was failing terribly when it was not so hard in the prior prior side’s test. I could not remember so few that I knew I was doing very bad and even commented that I did not even recall her showing me the items at the beginning of this side’s test.  As the test was finished I was still shaking uncontrollably and it took more time for me to regain control then it did for the other side. I then automatically started to use a few calming exercises I had been taught by my regular psychologist to combat my extreme temper outburst that he described as “Amygdala Hijacking.” They included rhythmic breathing exercises and “mindfulness” exercises where I took a inventory of how each part of my body felt at that moment, starting at my toes and working up.  I started with the rhythmic breathing and each count of the breathing (four counts in, five counts out) I interjected grunt like sounds. As I calmed down some the sounds went away and I continued until I felt in better control and calmer. I then started the “mindfulness” exercise without realizing I was sayin “my toes feel fine, my feet feel ok but my right foot feels a little numb” and then a nurse asked me what I was doing. That is when I realized I was saying it aloud.

The first half of the test with my right hemisphere (bad side) was put to sleep was a cakewalk and the effects were fast to wear off.  

The second part when the (good) side was put to sleep I felt like a severely autistic person knowing what I wanted to do but having very little control of my body’s actions. The results were radically different and the only difference between the test results were which hemisphere of my brain was asleep.  I suddenly realized the effects that seizures in one little part of my right temporal lobe was having tremendous effect on that half of my brain. It was only the strength of the left half combating these effects that was demonstrated to me in real time and with stunning results. This was a profound realization for me.  
Suddenly the fear of brain surgery beame the fear that something might delay brain surgery.

Cris Alarcon, 9-28-2018

Part 1 "Provoked Seizures and what I learned from a week in an EMU"

Part 2 "Brain Surgery - It Just Got Real"

Part 3 "Major Illness is Life's Best Roller Coaster"

Part 4 "My tiny part in a far reaching medical breakthrough"

Part 5 "Rounding Third and Headed Home with my Neurological Team"

Part 6 "Neuropsychological assessment before epilepsy surgery"

Part 7 “WADA for Epilepsy, Cerebral Angioplasty, EEG”