RESUMEN
The absence of the adhesio interthalamica (AI; also called interthalamic adhesion or massa intermedia) and the presence of a large cavum septum pellucidum (CSP) later in life have been related to neurodevelopmental alterations and have not been systematically investigated in epilepsy to date. This study carried out a MRI evaluation of the AI and CSP in a large sample with mesial temporal lobe epilepsy (MTLE). A total of 179 patients, classified according to the side of the epileptogenic focus, and 156 age- and sex-balanced healthy controls were assessed. Between-group comparisons of the prevalence and length of both AI and CSP were conducted. Neuropsychological assessments were also performed in 160 MTLE patients. The patients exhibited reduction in the AI prevalence (P < 0.05; FDR-uncorrected) and length (P < 0.05; FDR-corrected) when compared to controls. Patients without AI showed lower scores in a proportion of neuropsychological tests than patients with AI. No CSP differences were found between MTLE patients and controls. These results support that AI anomalies have clinical significance in MTLE, as well as indicate that neurodevelopmental alterations may be implicated in this disorder.
Asunto(s)
Epilepsia Refractaria/diagnóstico por imagen , Epilepsia del Lóbulo Temporal/diagnóstico por imagen , Tabique Pelúcido/diagnóstico por imagen , Tálamo/diagnóstico por imagen , Adulto , Epilepsia Refractaria/psicología , Epilepsia del Lóbulo Temporal/psicología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Pruebas Neuropsicológicas , Tamaño de los Órganos , Esclerosis/diagnóstico por imagen , Esclerosis/psicología , Tabique Pelúcido/crecimiento & desarrollo , Tálamo/crecimiento & desarrolloRESUMEN
The cellular prion protein, encoded by Prnp gene, is involved in neuroprotection, neuroplasticity and neurodevelopment. The variant allele Valine at codon 129 of the Prnp was associated with decreased brain volume in healthy volunteers and schizophrenic patients. We investigate the association between the cerebellum volume and the presence of variant allele Valine at codon 129 of the Prnp gene in patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS). The Prnp coding sequence was determined in 41 refractory MTLE-HS patients. The cerebellum volume corrected by the intracranial volume of patients with the normal Prnp genotypes was compared with that of patients presenting the variant alleles at codon 129. Twenty patients showed the Met129Met genotype, 16 showed Met129Val, and 5 had Val129Val. There were no association among clinical, demographic, electrophysiological, antiepileptic drugs used, and the presence of the Prnp variant alleles. The presence of Prnp variant allele at codon 129 was not associated with the analyzed cerebellum volume. Prnp variant alleles at codon 129 are not associated with cerebellum volume in patients with refractory MTLE-HS.
Asunto(s)
Cerebelo/patología , Epilepsia del Lóbulo Temporal/genética , Epilepsia del Lóbulo Temporal/patología , Priones/genética , Adulto , Alelos , Anticonvulsivantes/uso terapéutico , Encéfalo/patología , Electroencefalografía , Epilepsia del Lóbulo Temporal/tratamiento farmacológico , Epilepsia del Lóbulo Temporal/fisiopatología , Femenino , Variación Genética , Humanos , Imagen por Resonancia Magnética , Masculino , Tamaño de los Órganos , Proteínas Priónicas , Convulsiones/tratamiento farmacológico , Convulsiones/genética , Convulsiones/patología , Convulsiones/fisiopatologíaRESUMEN
Patients with left mesial temporal lobe epilepsy (MTLE) have deficits in verbal memory processes, while patients with right MTLE have visuospatial memory impairment. However, atypical cognitive phenotypes among patients with MTLE may occur. In this study, we analyzed preoperative memory deficits in a cohort of 426 right-handed patients with unilateral MTLE. We also evaluated the cognitive outcome after anterior temporal lobectomy (ATL) of patients with atypical profiles in comparison with those with typical memory profile. We found that 25% of our patients had a typical cognitive profile, with verbal memory deficits associated with left side hippocampal sclerosis (HS) and visuospatial memory deficits associated with right side HS. However, 75% of our patients had atypical memory profiles. Despite these atypical profiles, patients submitted to right ATL had no significant cognitive deficit after surgery. In patients submitted to left ATL, the higher the presurgical scores on verbal memory and naming tests, the higher the cognitive decline after surgery.
Asunto(s)
Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Epilepsia del Lóbulo Temporal/complicaciones , Lateralidad Funcional/fisiología , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/etiología , Adulto , Análisis de Varianza , Electroencefalografía , Epilepsia del Lóbulo Temporal/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuroimagen , Pruebas Neuropsicológicas , Procedimientos Neuroquirúrgicos , Percepción Espacial/fisiología , Grabación en VideoRESUMEN
BACKGROUND: Where neurocysticercosis (NCC) is endemic, chronic calcified neurocysticercosis (cNCC) can be observed in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). Considering that both disorders cause recurrent seizures or cognitive impairment, we evaluated if temporal lobectomy is cognitively safe and effective for seizure control in MTLE-HS plus cNCC. METHODS: Retrospective cohort study of neuropsychological profile and surgical outcome of 324 MTLE-HS patients submitted to temporal lobectomy, comparing the results according to the presence or absence of cNCC. FINDINGS: cNCC occurred in 126 (38.9%) of our MTLE-HS patients, a frequency higher than expected, more frequently in women than in men (O.R.â=â1.66; 95% C.I.â=â1.05-2.61; pâ=â0.03). Left-side (but not right side) surgery caused impairment in selected neuropsychological tests, but this impairment was not accentuated by the presence of cNCC. Ninety-four (74.6%) patients with MTLE-HS plus cNCC and 153 patients (77.3%) with MTLE-HS alone were Engel class I after surgery (O.R.â=â1.16; 95% C.I.â=â0.69-1.95; pâ=â0.58). However, the chances of Engel class IA were significantly lower in MTLE-HS plus cNCC than in patients with MTLE-HS alone (31.7% versus 48.5%; O.R.â=â2.02; 95% C.I.â=â1.27-3.23; pâ=â0.003). Patients with MTLE-HS plus cNCC showed higher rates of Engel class ID (15.1% versus 6.6%; O.R.â=â2.50; 95% C.I.â=â1.20-5.32; pâ=â0.012). INTERPRETATION: cNCC can be highly prevalent among MTLE-HS patients living in areas where neurocysticercosis is endemic, suggesting a cause-effect relationship between the two diseases. cNCC does not add further risk for cognitive decline after surgery in MTLE-HS patients. The rates of Engel class I outcome were very similar for the two groups; however, MTLE-HS plus cNCC patients achieved Engel IA status less frequently, and Engel ID status more frequently. Temporal lobectomy can be safely performed in most patients with MTLE-HS plus cNCC without affecting cognitive outcome. Long-term surgical seizure control in MTLE-HS plus cNCC is still satisfactory, as long as selected patients remain under medication.
Asunto(s)
Cognición , Epilepsia del Lóbulo Temporal/fisiopatología , Epilepsia del Lóbulo Temporal/cirugía , Hipocampo/patología , Neurocisticercosis/complicaciones , Adulto , Niño , Estudios de Cohortes , Toma de Decisiones , Epilepsia del Lóbulo Temporal/complicaciones , Epilepsia del Lóbulo Temporal/patología , Femenino , Humanos , Masculino , Esclerosis/complicaciones , Resultado del TratamientoRESUMEN
OBJECTIVES: Patients that undergo epilepsy surgery for temporal lobe epilepsy (TLE) in the dominant hemisphere are more susceptible to naming deficits. The aim of the present study was to perform an observational retrospective study comparing two groups of patients for naming performance, those with left and right temporal lobe resections regarding the performance in naming by Boston Naming Test (BNT). METHODS: A total of 120 right-handed patients (52 right temporal lobe and 68 left temporal lobe), aged between 18 and 59, with pharmacoresistant mesial TLE were retrospectively analyzed. All patients underwent pre and postoperative neuropsychological assessment. RESULTS AND CONCLUSIONS : The BNT was a good predictor for possible post-surgical language deficits in patients submitted to left temporal lobectomy.
OBJETIVO: Pacientes submetidos a cirurgia de epilepsia portadores de epilepsia do lobo temporal (ELT) em hemisfério dominante são mais suscetíveis a apresentarem déficits de nomeação. O objetivo do presente estudo foi realizar um estudo retrospectivo observacional comparando dois grupos de pacientes sendo um grupo submetido a lobectomia temporal dominante e outro a lobectomia temporal não dominante em relação ao desempenho na tarefa de nomeação através do Boston Naming Test (BNT). METÓDOS: Um total de 120 pacientes destros foram retrospectivamente analisados (52 temporal direito e 68 temporal esquerdo) com idade entre 18 e 59 anos, com epilepsia do lobo temporal mesial fármaco resistente. Todos os pacientes foram submetidos a avaliação neuropsicológica pré e pós-operatória utilizando o BNT para medida de nomeação. RESULTADOS E CONCLUSÕES: O BNT foi mostrou-se um bom instrumento para predizer possíveis déficits de linguagem em pacientes submetidos a lobectomia temporal esquerda.
Asunto(s)
Humanos , Lóbulo Temporal , Epilepsia del Lóbulo Temporal , Pruebas del LenguajeRESUMEN
Clinical and demographic presurgical variables may be associated with unfavorable postsurgical neurological outcome in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). However, few reports include preoperative psychiatric disorders as a factor predictive of long-term postsurgical MTLE-HS neurological outcome. We used Engel's criteria to follow 186 postsurgical patients with MTLE-HS for an average of 6 years. DSM-IV criteria and psychiatric comorbidity criteria specific to epilepsy (interictal dysphoric disorder, postictal and interictal psychosis) were used to assess presurgical psychiatric disorders. Kaplan-Meier event-free survival and adjusted hazard ratios were estimated with unconditional logistic regression. Seventy-seven (41.4%) patients had a preoperative Axis I psychiatric diagnosis. Thirty-six patients had depression, 11 interictal dysphoric disorder, 14 interictal psychosis, 6 postictal psychosis, and 10 anxiety disorders. Twenty-three (12.4%) patients had Axis II personality disorders. Regarding seizure outcome, preoperative anxiety disorders (P=0.009) and personality disorders (P=0.003) were positively correlated with Engel class 1B (remaining auras) or higher. These findings emphasize the importance of presurgical psychiatric evaluation, counseling, and postsurgical follow-up of patients with epilepsy and psychiatric disorders.
Asunto(s)
Epilepsia del Lóbulo Temporal/psicología , Epilepsia del Lóbulo Temporal/cirugía , Trastornos Mentales/complicaciones , Trastornos Mentales/psicología , Procedimientos Neuroquirúrgicos , Convulsiones/epidemiología , Adolescente , Adulto , Anciano , Encéfalo/patología , Electroencefalografía , Femenino , Estudios de Seguimiento , Predicción , Humanos , Entrevista Psicológica , Modelos Logísticos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Escalas de Valoración Psiquiátrica , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Cognitive impairment has long been recognized in people with medically refractory epilepsies. Mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS), the most common surgically remediable epileptic syndrome, has been associated with a cellular prion protein (PrPc) gene (Prnp) variant allele at codon 171. The polymorphism consisting of a methionine-for-valine substitution at codon 129 has been associated with early cognitive deterioration in elderly people and patients with Down syndrome. The same variant allele in homozygosis (V129V) has been associated to a lower long-term memory in healthy humans. PrPc mediates several processes related to neuroplasticity, and its role in cognitive processes remains unknown. In this study, we evaluated the genetic contribution of Prnp alleles to cognitive performance in patients with MTLE-HS. Cognitive performance, measured with 19 neuropsychological tests, of patients with refractory MTLE-HS with the normal Prnp genotypes was compared with that of patients with the variant alleles at codons 129 and 171. With the effects of clinical, demographic, electrophysiological, and neuroimaging variable interactions controlled by multiple linear regression analysis and adjustment for multiple test comparisons, the presence of Prnp variant alleles was found not to be significantly associated to cognitive performance of patients with MTLE-HS. The presence of variant alleles at codons 129 and 171 is not associated to cognitive performance of patients with refractory MTLE-HS.