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1.
J Neurol Neurosurg Psychiatry ; 74(5): 566-9, 2003 May.
Artículo en Inglés | MEDLINE | ID: mdl-12700292

RESUMEN

From a series of 217 consecutive temporal resections for intractable epilepsy between 1993 and 2000, we identified all patients with large non-neoplastic extratemporal lesions. Only patients with known postsurgical outcomes with follow up for more than two years were included. Fifteen patients were identified. All patients had a history of medically refractory epilepsy with clinical and ictal evidence of mesial temporal seizure onset. Eleven patients had extratemporal lesions ipsilateral to the seizure focus, whereas four patients had the lesions contralateral to the seizure focus. Nine of the 15 patients had evidence of hippocampal atrophy on magnetic resonance imaging (MRI). Following temporal resection, nine of these patients (60%) became seizure free (Engel class 1A), two patients were free of disabling seizures only (Engel class 1B), and two patients had a few early seizures but then became seizure free for at least two years (Engel class 1C). Two patients had significant improvement (Engel class 2). Thus, the finding of large extratemporal lesions on MRI was potentially misleading. When clinical semiology and ictal EEG recordings provide evidence of temporal onset seizures, anterior temporal resection should be considered in patients with extratemporal lesions.


Asunto(s)
Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Epilepsia del Lóbulo Temporal/etiología , Epilepsia del Lóbulo Temporal/cirugía , Adulto , Neoplasias Encefálicas/patología , Electroencefalografía , Epilepsia del Lóbulo Temporal/patología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Cuidados Preoperatorios , Factores de Riesgo , Lóbulo Temporal/patología , Lóbulo Temporal/fisiopatología , Lóbulo Temporal/cirugía , Factores de Tiempo
2.
Clin Electroencephalogr ; 34(1): 28-31, 2003 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-12515450

RESUMEN

A 58-year-old patient who was somnolent, distractible and confused is presented. She was previously treated with lithium, and a plasma level was mildly elevated at 1.7 mmol/l (normal 0.5-1.5 mmol/l). The EEG was suggestive of electrographic status epilepticus. Following treatment with i.v. lorazepam, neither mental status nor EEG abnormalities improved. She had a full recovery of mental function and markedly improved EEG findings following discontinuation of lithium. The EEG is an effective tool for diagnosing lithium neurotoxicity in patients with normal or mildly elevated lithium plasma levels. However, caution is needed before making an assumption of status epilepticus.


Asunto(s)
Electroencefalografía , Litio/envenenamiento , Síndromes de Neurotoxicidad/diagnóstico , Estado Epiléptico/diagnóstico , Femenino , Humanos , Persona de Mediana Edad
3.
Clin Electroencephalogr ; 33(4): 174-7, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12449849

RESUMEN

Carbamazepine has been reported to exacerbate seizures in children with primary generalized epilepsy and epilepsy with mixed seizure types. Seizure exacerbation has been rarely observed in adults, mainly in the mentally retarded or in those with primary generalized epilepsy. We present an adult patient who had frequent absence seizures and simple partial seizures for 20 years. She was treated with carbamazepine for over 16 years. The patient's EEG showed generalized spike and wave complexes. Her seizures remitted and the EEG normalized after the discontinuation of carbamazepine therapy.


Asunto(s)
Carbamazepina/efectos adversos , Epilepsias Parciales/inducido químicamente , Epilepsias Parciales/tratamiento farmacológico , Epilepsia Tipo Ausencia/inducido químicamente , Epilepsia Tipo Ausencia/tratamiento farmacológico , Adulto , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/efectos adversos , Carbamazepina/administración & dosificación , Relación Dosis-Respuesta a Droga , Electroencefalografía , Epilepsias Parciales/diagnóstico , Epilepsia Tipo Ausencia/diagnóstico , Femenino , Humanos
4.
Neurology ; 57(3): 532-4, 2001 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-11502929

RESUMEN

The authors present two patients with medically refractory partial seizures who had invasive recordings with stereotactic depth EEG (SEEG) and subdural electrodes (SDE) as part of their presurgical workup. SDE recordings were falsely lateralizing in both of these patients with pathologically proven mesial temporal sclerosis. In temporal lobe epilepsy, SEEG electrodes should be considered when presurgical studies are discordant.


Asunto(s)
Electrodos Implantados , Epilepsia del Lóbulo Temporal/fisiopatología , Lateralidad Funcional/fisiología , Electroencefalografía , Humanos , Masculino , Persona de Mediana Edad
5.
Epilepsia ; 42(7): 954-6, 2001 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-11488900

RESUMEN

PURPOSE: We studied the effect of vagus nerve stimulation (VNS) on seizure reduction in patients with intractable epilepsy with bilateral independent temporal lobe foci. METHODS: Ten patients who met the criterion of the presence of two distinctive clinical and ictal EEG seizure patterns were identified and followed up for 1 year. RESULTS: Six patients had >50% reduction in their seizure frequency that persisted up to > or =1 year of follow-up, whereas four patients reported small or no reduction in their partial seizures. CONCLUSIONS: VNS is often effective and well tolerated in this select group of intractable epilepsy patients.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Epilepsia del Lóbulo Temporal/terapia , Lateralidad Funcional/fisiología , Nervio Vago/fisiología , Adolescente , Adulto , Terapia por Estimulación Eléctrica/instrumentación , Electrodos Implantados , Electroencefalografía/estadística & datos numéricos , Epilepsia del Lóbulo Temporal/diagnóstico , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Proyectos Piloto , Estudios Retrospectivos , Resultado del Tratamiento
6.
J Neuroimaging ; 11(3): 243-7, 2001 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-11462289

RESUMEN

BACKGROUND AND PURPOSE: The effect of temporal lobe transection area, volume of postoperative gliosis, and surgical technique on patients' seizure-free outcome is unknown. The authors studied the effects of these variables on patients' seizure-free outcome. METHODS: A retrospective review of magnetic resonance imaging examinations acquired 3 to 18 months after temporal lobe resection was carried out for 18 patients with intractable temporal lobe seizures and known postsurgical outcomes for more than 2 years. The total volume of radiologically probable gliosis evident on axial proton-density-weighted images was calculated for each patient using software on an independent console. The total area of temporal lobe surface transected by the scalpel was calculated as well, using sagittal T1-weighted images. The total volume of gliosis, the total area of transected temporal lobe, and the specific type of surgery (sparing vs no sparing of the superior temporal gyrus) were then correlated with the postsurgical outcome of the patients. An examiner with no prior knowledge of the patients' postsurgical outcomes carried out the above calculations and measurements. The patients' postoperative outcome was defined using Engel classifications, and patients were divided into 2 groups: group A with Engel class 1 (n = 9) and group B with Engel classes 2-4 (n = 9). RESULTS: The mean volumes of postoperative gliosis were not significantly different between group A (3592.3 mm3) and group B (4270 mm3). The mean area of transected temporal lobe was also similar between group A (1865.2 mm2) and group B (1930 mm2). With regard to surgical technique, there were 5 patients who had the superior temporal gyrus resected and 13 who did not. Eighty percent of patients with the superior temporal gyrus resected were Engel class 1 or 2, whereas only 20% were of Engel class 3 or 4. CONCLUSIONS: The authors found no clear association between postoperative outcome and residual temporal lobe gliosis, the surgical technique, or the total area of temporal lobe transected by the scalpel.


Asunto(s)
Epilepsia del Lóbulo Temporal/cirugía , Gliosis/diagnóstico , Imagen por Resonancia Magnética , Adulto , Electroencefalografía , Epilepsia del Lóbulo Temporal/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Cuidados Posoperatorios , Estudios Retrospectivos , Lóbulo Temporal/cirugía , Resultado del Tratamiento
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