RESUMEN
OBJECTIVE: To compare memory outcomes after surgery for unilateral hippocampal sclerosis (HS)-associated epilepsy in patients with unilateral and bilateral ictal electrographic involvement. METHODS: We prospectively evaluated HS patients, aged 18-55 years and IQ ≥70. Left (L) and right (R) surgical groups underwent noninvasive video-EEG monitoring and Wada test. We classified patients as Ipsilateral if ictal EEG was restricted to the HS side, or Bilateral, if at least one seizure onset occurred contralaterally to the HS, or if ictal discharge evolved to the opposite temporal region. Patients who declined surgery served as controls. Memory was evaluated on two occasions with Rey Auditory-Verbal Learning Test and Rey Visual-Design Learning Test. Baseline neuropsychological test scores were compared between groups. Pre- and postoperative scores were compared within each group. Reliable change index Z-scores (RCI) were obtained using controls as references, and compared between surgical groups. RESULTS: We evaluated 64 patients. Patients were classified as: L-Ipsilateral (9), L-Bilateral (15), L-Control (9), R-Ipsilateral (10), R-Bilateral (9), and R-Control (12). On preoperative evaluation, memory performance did not differ among surgical groups. Right HS patients did not present postoperative memory decline. L-Ipsilateral group presented postoperative decline on immediate (P = 0.036) and delayed verbal recall (P = 0.011), while L-Bilateral did not decline. L-Ipsilateral had lower RCI Z-scores, indicating delayed verbal memory decline compared to L-Bilateral (P = 0.012). SIGNIFICANCE: Dominant HS patients with bilateral ictal involvement presented less pronounced postoperative verbal memory decline compared to patients with exclusive ipsilateral ictal activity. Surgery was indicated in these patients regardless of memory impairment on neuropsychological testing, since resection of the left sclerotic hippocampus could result in cessation of contralateral epileptiform activity, and, therefore, improved memory function.
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Epilepsia del Lóbulo Temporal , Esclerosis del Hipocampo , Humanos , Epilepsia del Lóbulo Temporal/cirugía , Lóbulo Temporal/patología , Lóbulo Temporal/cirugía , Trastornos de la Memoria/etiología , Trastornos de la Memoria/patología , Electroencefalografía , Esclerosis/complicaciones , Esclerosis/patologíaRESUMEN
Neurocognitive research on social concepts underscores their reliance on fronto-temporo-limbic regions mediating broad socio-cognitive skills. Yet, the field has neglected another structure increasingly implicated in social cognition: the cerebellum. The present exploratory study examines this link combining a novel naturalistic text paradigm, a relevant atrophy model and functional magnetic resonance imaging. Fifteen cerebellar ataxia (CA) patients with focal cerebellar atrophy and 29 matched controls listened to a social text (highlighting interpersonal events) as well as a non-social text (focused on a single person's actions), and answered comprehension questionnaires. We compared behavioural outcomes between groups and examined their association with cerebellar connectivity. CA patients showed deficits in social text comprehension and normal scores in the non-social text. Also, social text outcomes in controls selectively correlated with connectivity between the cerebellum and key regions subserving multi-modal semantics and social cognition, including the superior and medial temporal gyri, the temporal pole and the insula. Conversely, brain-behaviour associations involving the cerebellum were abolished in the patients. Thus, cerebellar structures and connections seem involved in processing social concepts evoked by naturalistic discourse. Such findings invite new theoretical and translational developments integrating social neuroscience with embodied semantics. This article is part of the theme issue 'Concepts in interaction: social engagement and inner experiences'.
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Cerebelo , Lóbulo Temporal , Humanos , Cerebelo/diagnóstico por imagen , Cerebelo/patología , Cerebelo/fisiología , Lóbulo Temporal/patología , Imagen por Resonancia Magnética , Atrofia/patología , Vías Nerviosas/fisiologíaRESUMEN
Klüver-Bucy syndrome is a rare neurobehavioral disorder caused by a bilateral temporal lobe lesion affecting the hippocampus and amygdala; clinically characterised by hyperorality, hypermetamorphosis, placidity, altered sexual behaviour, eating, disorders and visual impairment, agnosia and amnesia. However, the complete syndrome is rarely seen, and diagnosis does not require all the symptoms to be manifested simultaneously.We describe a patient who developed a complete Klüver-Bucy syndrome secondary to bilateral temporal involvement due to herpetic encephalitis.
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Encefalitis por Herpes Simple , Síndrome de Kluver-Bucy , Amnesia , Encefalitis por Herpes Simple/complicaciones , Encefalitis por Herpes Simple/diagnóstico , Hipocampo , Humanos , Síndrome de Kluver-Bucy/etiología , Lóbulo Temporal/patologíaRESUMEN
BACKGROUND: The relatively isolated atrophy of the temporal lobes leads to a clinical radiological pattern, referred to as the temporal variant of frontotemporal dementia. While semantic dementia and behavioral variant frontotemporal dementia are classically related to this syndrome, the logopenic variant of primary progressive aphasia has been less commonly reported. This case report aims to give a pictorial description of a case in which a patient with asymmetric temporal lobe atrophy presented with the logopenic variant of primary progressive aphasia and complex rituals of cleanliness. CASE PRESENTATION: We report on the case of a 68-year-old, right-handed White woman with complex rituals and progressive speech impairment. The obsessive-compulsive rituals represented an exacerbation of lifelong preoccupations with cleanliness and orderliness that were praised by her relatives. Neuropsychological assessment revealed a striking impairment of language and memory, with relative sparing of tool-use praxis and visuospatial skills. Magnetic resonance imaging and 18fluorodeoxyglucose-positron emission tomography scans showed bilateral asymmetrical temporal lobe atrophy and hypometabolism. A year later, she was still able to entertain conversation for a short while, but her vocabulary and fluency had further declined. Praxis and visuospatial skills remained intact. She did not experience pathological elation, delusions, or hallucinations. The disease followed a relentless progression into a partial Klüver-Bucy syndrome, abulia, and terminal dementia. She died from acute myocardial infarction 8 years after the onset of aphasia. The symptoms and their temporal course supported a diagnosis of logopenic variant of primary progressive aphasia due to asymmetric temporal variant frontotemporal lobar degeneration. CONCLUSIONS: This report gives a pictorial description of a temporal variant of frontotemporal dementia in a patient who presented with worsening of a lifelong obsessive-compulsive disorder and logopenic variant of primary progressive aphasia.
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Afasia Progresiva Primaria , Demencia Frontotemporal , Anciano , Atrofia/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patologíaRESUMEN
INTRODUCTION: Semantic dementia (SD) is characterized by fluent speech, anomia, and loss of word and object knowledge with varying degrees of right and left anterior-medial temporal lobe hypometabolism on [18F] fluorodeoxyglucose (FDG)-PET. We assessed neurobehavioral features in SD patients across 3 FDG-PET-defined metabolic patterns and investigated progression over time. METHODS: Thirty-four patients with SD who completed FDG-PET were classified into a left- and right-dominant group based on the degree of hypometabolism in each temporal lobe. The left-dominant group was further subdivided depending on whether hypometabolism in the right temporal lobe was more or less than 2 standard deviations from controls (left+ group). Neurobehavioral characteristics determined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) were compared across groups. Progression of NPI-Q scores and FDG-PET hypometabolism was assessed in 14 patients with longitudinal follow-up. RESULTS: The right-dominant group performed worse on the NPI-Q and had a greater frequency of abnormal behaviors and more severe disinhibition compared to the left-dominant group. Performance on the NPI-Q and severity of disinhibition correlated with right medial and lateral, but not left, temporal lobe hypometabolism. Severity of abnormal behaviors worsened over time in most left-dominant and left+ patients but appeared to improve in the 2 right-dominant patients with longitudinal follow-up. All groups showed progressive worsening of metabolism in both temporal lobes over time, with hypometabolism spreading from anteromedial to posterior temporal regions. However, the degree of temporal lobe asymmetry remained relatively constant over time. CONCLUSION: In SD, neurobehavioral features, especially disinhibition, are associated with right medial and lateral temporal lobe hypometabolism and commonly develop over time even in patients that present with left-dominant patterns of hypometabolism.
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Fluorodesoxiglucosa F18 , Demencia Frontotemporal/diagnóstico por imagen , Demencia Frontotemporal/psicología , Tomografía de Emisión de Positrones , Femenino , Demencia Frontotemporal/patología , Demencia Frontotemporal/fisiopatología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Lóbulo Temporal/fisiopatologíaRESUMEN
Epilepsy is among one of the most common neurologic disorders. The role of magnetic resonance imaging (MRI) in the diagnosis and management of patients with epilepsy is well established, and most patients with epilepsy are likely to undergo at least one or more MRI examinations in the course of their disease. Recent advances in high-field MRI have enabled high resolution in vivo visualization of small and intricate anatomic structures that are of great importance in the assessment of seizure disorders. Familiarity with normal anatomic variations is essential in the accurate diagnosis and image interpretation, as these variations may be mistaken for epileptogenic foci, leading to unnecessary follow-up imaging, or worse, unnecessary treatment. After a brief overview of normal imaging anatomy of the mesial temporal lobe, this article will review a few important common and uncommon anatomic variations, mimics, and pitfalls that may be encountered in the imaging evaluation of patients with epilepsy.
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Epilepsia/diagnóstico por imagen , Hipocampo/diagnóstico por imagen , Malformaciones del Desarrollo Cortical de Grupo I/diagnóstico por imagen , Lóbulo Temporal/diagnóstico por imagen , Epilepsia/patología , Hipocampo/patología , Humanos , Imagen por Resonancia Magnética , Malformaciones del Desarrollo Cortical de Grupo I/patología , Lóbulo Temporal/patologíaRESUMEN
INTRODUCTION: Congenital amusia is a specific condition in which the individual is unable to recognise tonal variations in a piece of musical. This cannot be explained by a previous brain injury, hearing loss, cognitive deficit, socio-affective disorder or lack of environmental stimulation. The current estimated prevalence is 1.5% of the world population, with a significant genetic component among those who suffer from it. It has been claimed that certain cognitive abilities in the emotional, spatial and language fields may be affected in people with amusia. AIM: To review the literature describing the effects on non-musical skills that may coexist in individuals with congenital amusia. DEVELOPMENT: Several neuroimaging studies have observed morphological and functional changes in the temporal lobe, as well as in the white matter connections between the superior temporal gyrus and the inferior frontal gyrus. From these affected regions, there may be a deficit in cognitive skills related to adjacent areas. CONCLUSIONS: Congenital amusia has been associated with poor performance in different non-musical cognitive skills, such as visuospatial processing, language processing, reading difficulties, face recognition and emotional aspects.
TITLE: Amusia congénita y sus efectos en habilidades no musicales.Introducción. La amusia congénita es una condición específica en la que el individuo afectado es incapaz de reconocer variaciones tonales en las piezas musicales. Esto no puede explicarse por una lesión encefálica previa, una pérdida auditiva, un déficit cognitivo, un trastorno socioafectivo o una falta de estimulación ambiental. Actualmente se estima una prevalencia del 1,5% de la población mundial, con un importante componente genético entre los afectados. Se ha descrito que en las personas con amusia puede haber afectación de ciertas habilidades cognitivas en el campo emocional, espacial y del lenguaje. Objetivo. Revisar la bibliografía donde se describen los efectos en las habilidades no musicales que pueden coexistir en individuos con amusia congénita. Desarrollo. Varios estudios de neuroimagen han permitido observar cambios morfológicos y funcionales en el lóbulo temporal, así como en las conexiones de la sustancia blanca entre el giro temporal superior y el giro frontal inferior. Partiendo de estas regiones afectadas, podría existir un déficit en habilidades cognitivas relacionadas con áreas adyacentes. Conclusiones. La amusia congénita se ha relacionado con un pobre desempeño en diferentes habilidades cognitivas no musicales, como el procesamiento visuoespacial, el procesamiento del lenguaje, alteraciones de la lectura, el reconocimiento de rostros y aspectos emocionales.
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Trastornos de la Percepción Auditiva , Síntomas Afectivos/complicaciones , Trastornos de la Percepción Auditiva/complicaciones , Trastornos de la Percepción Auditiva/diagnóstico por imagen , Trastornos de la Percepción Auditiva/patología , Trastornos de la Percepción Auditiva/psicología , Dislexia/complicaciones , Femenino , Humanos , Trastornos del Desarrollo del Lenguaje/complicaciones , Masculino , Vías Nerviosas/diagnóstico por imagen , Prosopagnosia/complicaciones , Desempeño Psicomotor , Navegación Espacial , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Lóbulo Temporal/fisiopatología , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patologíaRESUMEN
A demência é uma das mais importantes causas de morbimortalidade entre os idosos e se caracteriza pelo declínio progressivo em múltiplos domínios cognitivos. Paciente do sexo feminino, 56 anos, iniciou quadro há 3 anos, caracterizado por apatia, anedonia e isolamento social. Procurou atendimento com médico que atribuiu sintomas a depressão. Contudo, não houve melhora. Há dois anos evoluiu com delírios persecutórios, confabulações, alucinação visual. Acompanhante notou que a paciente tinha dificuldades em se expressar e na compreensão. Devido à refratariedade ao tratamento foi solicitada avaliação de neurologista. À consulta inicial, paciente apresentava-se orientada no tempo, espaço. Mini exame do estado mental 26/30 pontos. Fluência verbal semântica. Após 6 meses, evoluiu com empobrecimento do vocabulário. À época estava dependente de familiares para realização de atividades de vida diária. Na ressonância magnética encefálica apresentou atrofia cortical difusa, com predomínio em regiões frontais e temporais à esquerda. Atualmente está em uso de risperidona e memantina. A atrofia cerebral dos lobos frontais e temporais ou demência fronto temporal (DFT) afeta predominantemente o lobo frontal do cérebro, podendo se estender para o temporal. A patologia caracteriza-se por significativa alteração da personalidade e do comportamento, com relativa preservação das funções mnésticas e visuoespaciais. A linguagem é progressivamente afetada. A memória encontra-se preservada no início da doença e as alterações comportamentais e da personalidade são bastante significativas. A variante comportamental é a mais comum. Ela apresenta uma deterioração gradual da função executiva e da personalidade, enquanto a capacidade visuoespacial é afetada apenas em estádios avançados(AU)
Dementia is one of the most important causes of morbimortality among elderly people and is characterized by progressive decline in multiple cognitive domains. A fifty-six-years-old female patient started a medical condition three years ago, characterized by apathy, anhedonia and social isolation. She sought healthcare with a medical who assigned symptoms to depression. However, there was no improvement. Two years ago, she evolved with persecutory delirium, confabulations, visual hallucination. Due to the refractoriness of the treatment, a neurologist evaluation was requested. At the initial consultation, the patient was oriented in time and space. The MiniMental State Examination (MMSE) test was 26/30 points. Regarding to Semantic verbal fluency, after 6 months, she evolved with impoverishment of vocabulary. At the time she was dependent on family members for daily activities. In brain magnetic resonance, she showed having diffuse cortical atrophy, with predominance in frontal and temporal regions on the left. Currently, she's using risperidone and memantine. Cerebral atrophy of the frontal and temporal lobes or Front-Temporal Dementia (FTD) affects, predominantly the frontal lobe of the brain, and may extend to the temporal. The pathology is characterized by significant personality and behavioral changes, with relative preservation of the mnestic and visuospatial functions. The language is progressively affected. Memory is preserved at the onset of the disease and the behavioral and personality changes are quite significant. The behavioral variant is the most common. It presents a gradual deterioration of executive function and personality, while visuospatial capacity is affected only in advanced stages(AU)
La demencia es una de las causas más importantes de morbimortalidad entre personas mayores y se caracteriza por una disminución progresiva en múltiples dominios cognitivos. Una paciente de cincuenta y seis años de edad comenzó una condición médica hace tres años, caracterizada por apatía, anedonia y aislamiento social. Ella buscó atención médica y asignaron sus síntomas a depresión. Hace dos años, ella evolucionó con delirio persecutorio, confabulaciones, alucinación visual. Debido a la refractariedad del tratamiento, se solicitó una evaluación neurológica. En la consulta, el paciente estaba orientado con respecto a tiempo y espacio. En el Examen de Estado Mini-Mental (EEMM) obtuvo 26/30 puntos. Con respecto a la fluidez verbal semántica, después de 6 meses, evolucionó poco en su vocabulario. En ese momento ella dependía de los miembros de la familia para las actividades diarias. En la resonancia magnética cerebral, mostró una atrofia cortical difusa, con predominio en las regiones frontal y temporal de la izquierda. Actualmente, ella está usando risperidona y memantina. La atrofia cerebral de los lóbulos frontal y temporal afecta predominantemente el lóbulo frontal del cerebro, y puede extenderse al temporal. La patología se caracteriza por cambios significativos en la personalidad y el comportamiento, con una preservación relativa de las funciones mnisticas y visuoespaciales. El lenguaje se ve progresivamente afectado. La memoria se preserva al inicio de la enfermedad con variaciones constantes en la personalidad. La función ejecutiva se deteriora paulatinamente, mientras que la capacidad visuoespacial se ve afectada en etapas avanzadas(AU)
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Humanos , Femenino , Persona de Mediana Edad , Trastornos Neurocognitivos , Demencia Frontotemporal , Lóbulo Temporal/patología , Memantina , Risperidona , Demencia Frontotemporal/diagnóstico , Demencia Frontotemporal/diagnóstico por imagen , Pruebas de Estado Mental y Demencia , Lóbulo Frontal/patologíaAsunto(s)
Neoplasias Encefálicas/diagnóstico , Melanoma/diagnóstico , Nevo Sebáceo de Jadassohn/diagnóstico , Neoplasias Encefálicas/etiología , Neoplasias Encefálicas/terapia , Quimioradioterapia Adyuvante , Preescolar , Progresión de la Enfermedad , Humanos , Masculino , Melanoma/etiología , Melanoma/terapia , Procedimientos Neuroquirúrgicos , Nevo Sebáceo de Jadassohn/complicaciones , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Auditory encoding abnormalities, gray-matter loss, and cognitive deficits are all candidate schizophrenia (SZ) endophenotypes. This study evaluated associations between and heritability of auditory network attributes (function and structure) and attention in healthy controls (HC), SZ patients, and unaffected relatives (UR). METHODS: Whole-brain maps of M100 auditory activity from magnetoencephalography recordings, cortical thickness (CT), and a measure of attention were obtained from 70 HC, 69 SZ patients, and 35 UR. Heritability estimates (h2r) were obtained for M100, CT at each group-difference region, and the attention measure. RESULTS: SZ patients had weaker bilateral superior temporal gyrus (STG) M100 responses than HC and a weaker right frontal M100 response than UR. Abnormally large M100 responses in left superior frontal gyrus were observed in UR and SZ patients. SZ patients showed smaller CT in bilateral STG and right frontal regions. Interrelatedness between 3 putative SZ endophenotypes was demonstrated, although in the left STG the M100 and CT function-structure associations observed in HC and UR were absent in SZ patients. Heritability analyses also showed that right frontal M100 and bilateral STG CT measures are significantly heritable. CONCLUSIONS: Present findings indicated that the 3 SZ endophenotypes examined are not isolated markers of pathology but instead are connected. The pattern of auditory encoding group differences and the pattern of brain function-structure associations differ as a function of brain region, indicating the need for regional specificity when studying these endophenotypes, and with the presence of left STG function-structure associations in HC and UR but not in SZ perhaps reflecting disease-associated damage to gray matter that disrupts function-structure relationships in SZ.
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Atención/fisiología , Percepción Auditiva/fisiología , Endofenotipos , Lóbulo Frontal , Predisposición Genética a la Enfermedad/genética , Sustancia Gris/patología , Red Nerviosa , Esquizofrenia , Lóbulo Temporal , Adulto , Familia , Femenino , Lóbulo Frontal/patología , Lóbulo Frontal/fisiopatología , Humanos , Magnetoencefalografía , Masculino , Persona de Mediana Edad , Red Nerviosa/patología , Red Nerviosa/fisiopatología , Esquizofrenia/genética , Esquizofrenia/patología , Esquizofrenia/fisiopatología , Lóbulo Temporal/patología , Lóbulo Temporal/fisiopatologíaRESUMEN
SUMMARY BACKGROUND AND PURPOSE Cerebral atherosclerosis is the main cause of lesions that contribute to vascular cognitive impairment and vascular dementia, followed by arteriosclerosis of small vessels and cerebral amyloid angiopathy. The purpose of this study was to compare the post-mortem radiological alterations of autopsied adults with the macroscopic alterations in the posterior region of these brains in order to establish a relationship between the two forms of analysis and to discuss the relevance of the prevention of vascular cognitive impairment in patients with encephalic atherosclerosis. MATERIALS AND METHODS Thirteen brains were analysed macroscopically to assess the degree of atherosclerosis of the basilar and the posterior cerebral arteries. The patients were autopsied in the Subject of General Pathology at General Hospital of Triângulo Mineiro Federal University in Uberaba, state of Minas Gerais, Brazil. The qualitative analysis of atherosclerosis was performed with classification into mild, moderate or severe. In the posterior region of the brains, width of sulcus and thickness of gyrus were measured by macroscopic analysis and by tomographic analysis. RESULTS AND CONCLUSIONS There was a decrease in calcarine sulcus width and an increase in medial temporal occipital gyrus thickness in patients with a higher degree of atherosclerosis, macroscopically and in tomography, respectively. Low oxygenation caused by atherosclerosis probably leads to an encephalic parenchyma inflammation that causes microglial cells hypertrophy provoking increase in the gyrus thickness and decrease in the sulcus width, as observed in the present study.
RESUMO INTRODUÇÃO E OBJETIVO A aterosclerose cerebral é a principal causa de lesões que contribuem para o comprometimento cognitivo vascular (CCV) e demência vascular, seguida da arteriosclerose de pequenos vasos e da angiopatia amiloide cerebral. Sendo assim, este estudo comparou as alterações radiológicas post mortem de adultos autopsiados com as alterações macroscópicas na região posterior desses encéfalos a fim de estabelecer uma relação entre as duas formas de análise e discutir sobre a relevância da prevenção do CCV em pacientes com aterosclerose encefálica. MATERIAL E MÉTODOS Treze encéfalos foram analisados macroscopicamente para avaliar o grau de aterosclerose das artérias basilar e cerebral posterior. Os pacientes foram autopsiados na disciplina de Patologia Geral no HC-UFTM em Uberaba, Minas Gerais, Brasil. A análise qualitativa da aterosclerose foi realizada com as classificações discreta, moderada ou acentuada. A espessura dos giros e a largura dos sulcos na região posterior dos encéfalos foram analisadas macroscopicamente e por tomografia computadorizada. RESULTADOS E CONCLUSÃO Houve diminuição na largura do sulco calcarino e aumento na espessura do giro occipital temporal medial de acordo com o aumento do grau de aterosclerose macroscopicamente e por tomografia, respectivamente. A baixa oxigenação causada pela aterosclerose provoca a inflamação do parênquima encefálico, provavelmente levando à hipertrofia das células da micróglia e ao consequente aumento dos giros e estreitamento dos sulcos, como observado no presente estudo.
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Lóbulo Temporal/patología , Demencia Vascular/prevención & control , Arteriosclerosis Intracraneal/patología , Disfunción Cognitiva/prevención & control , Lóbulo Occipital/patología , Valores de Referencia , Lóbulo Temporal/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Demencia Vascular/etiología , Demencia Vascular/patología , Tomografía Computarizada por Rayos X , Arteriosclerosis Intracraneal/complicaciones , Arteriosclerosis Intracraneal/diagnóstico por imagen , Reproducibilidad de los Resultados , Análisis de Varianza , Estadísticas no Paramétricas , Disfunción Cognitiva/etiología , Disfunción Cognitiva/patología , Lóbulo Occipital/diagnóstico por imagenRESUMEN
Despite the many studies focusing on epilepsy, a lot of the basic mechanisms underlying seizure susceptibility are mainly unclear. Here, we studied cellular electrical excitability, as well as excitatory and inhibitory synaptic neurotransmission of CA1 pyramidal neurons from the dorsal hippocampus of a genetic model of epilepsy, the Wistar Audiogenic Rat (WARs) in which limbic seizures appear after repeated audiogenic stimulation. We examined intrinsic properties of neurons, as well as EPSCs evoked by Schaffer-collateral stimulation in slices from WARs and Wistar parental strain. We also analyzed spontaneous IPSCs and quantal miniature inhibitory events. Our data show that even in the absence of previous seizures, GABAergic neurotransmission is reduced in the dorsal hippocampus of WARs. We observed a decrease in the frequency of IPSCs and mIPSCs. Moreover, mIPSCs of WARs had faster rise times, indicating that they probably arise from more proximal synapses. Finally, intrinsic membrane properties, firing and excitatory neurotransmission mediated by both NMDA and non-NMDA receptors are similar to the parental strain. Since GABAergic inhibition towards CA1 pyramidal neurons is reduced in WARs, the inhibitory network could be ineffective to prevent the seizure-dependent spread of hyperexcitation. These functional changes could make these animals more susceptible to the limbic seizures observed during the audiogenic kindling.
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Región CA1 Hipocampal/metabolismo , Epilepsia Refleja/genética , Epilepsia/genética , Células Piramidales/metabolismo , Animales , Región CA1 Hipocampal/patología , Modelos Animales de Enfermedad , Epilepsia/metabolismo , Epilepsia/patología , Epilepsia Refleja/patología , Humanos , Células Piramidales/patología , Ratas , Convulsiones/genética , Convulsiones/metabolismo , Convulsiones/patología , Sinapsis/genética , Sinapsis/patología , Transmisión Sináptica/genética , Lóbulo Temporal/metabolismo , Lóbulo Temporal/patologíaRESUMEN
BACKGROUND AND PURPOSE: Anterior temporal lobectomy for mesial temporal sclerosis (MTS) is a very effective measure for the control of seizures, and the probability of becoming seizure-free is approximately 70-90%. However, 30% of patients still experience seizures after surgery. An aura is a subjective ictal phenomenon that may precede an observable seizure. However, there are few studies on the prognostic factor aura although, being the initial symptoms of epileptic seizures, many types of auras have significant localizing or lateralizing value. This study hypothesized that the type of pre-operative aura may predict the post-surgical outcome in patients with medically refractory temporal lobe epilepsy due to MTS. METHODS: Of 1214 patients evaluated for surgery in the Epilepsy Center of Faculdade de Medicina de São Jose do Rio Preto (FAMERP), a tertiary Brazilian epilepsy center, 400 underwent anterior temporal lobectomy (ATL) for MTS. The number and type of auras were analyzed and compared with the Engel classification for outcome. RESULTS: Analyzing the patients by the type of aura, those who had extratemporal auras had the worst post-surgical result according to the Engel classification. Although mesial auras are apparently a good prognostic factor, patients without aura also had a worse prognosis. There were no differences between simple and multiple auras. To identify the most appropriate candidates for ATL, it is very important to consider the favorable prognostic factors for counseling patients in daily practice. CONCLUSIONS: Patients with symptoms and clinical signs that suggest extratemporal involvement may have unfavorable outcomes.
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Lobectomía Temporal Anterior , Epilepsia del Lóbulo Temporal/cirugía , Epilepsia/complicaciones , Lóbulo Temporal/cirugía , Adolescente , Adulto , Anciano , Brasil , Niño , Preescolar , Epilepsia/patología , Epilepsia/cirugía , Epilepsia del Lóbulo Temporal/complicaciones , Epilepsia del Lóbulo Temporal/patología , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pronóstico , Esclerosis/patología , Lóbulo Temporal/patología , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: The objectives of this study were to verify in a series of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) if those with low intellectual quotient (IQ) levels have more extended areas of atrophy compared with those with higher IQ levels and to analyze whether IQ could be a variable implicated on a surgical outcome. MATERIAL AND METHODS: Patients (n=106) with refractory MTLE-HS submitted to corticoamygdalohippocampectomy (CAH) (57 left mesial temporal lobe epilepsy (MTLE); 45 males) were enrolled. To determine if the IQ was a predictor of seizure outcome, totally seizure-free (SF) versus nonseizure-free (NSF) patients were evaluated. FreeSurfer was used for cortical thickness and volume estimation, comparing groups with lower (<80) and higher IQ (90-109) levels. RESULTS: In the whole series, 42.45% of patients were SF (Engel Class 1a; n=45), and 57.54% were NSF (n=61). Total cortical volume was significantly reduced in the group with lower IQ (p=0.01). Significant reductions in the left hemisphere included the following: rostral middle frontal (p=0.001), insula (p=0.002), superior temporal gyrus (p=0.003), thalamus (p=0.004), and precentral gyrus (p=0.02); and those in the right hemisphere included the following: rostral middle frontal (p=0.003), pars orbitalis (p=0.01), and insula (p=0.02). Cortical thickness analysis also showed reductions in the right superior parietal gyrus in patients with lower IQ. No significant relationship between IQ and seizure outcome was found. CONCLUSIONS: This is the first study of a series of patients with pure MTLE-HS, including those with low IQ and their morphometric magnetic resonance imaging (MRI) features using FreeSurfer. Although patients with lower intellectual scores presented more areas of brain atrophy, IQ was not a predictor of surgical outcome. Therefore, when evaluating seizure follow-up, low IQ in patients with MTLE-HS might not contraindicate resective surgery.
Asunto(s)
Epilepsia del Lóbulo Temporal/cirugía , Hipocampo/patología , Discapacidad Intelectual/patología , Esclerosis/patología , Adolescente , Adulto , Atrofia/patología , Corteza Cerebral/patología , Epilepsia del Lóbulo Temporal/patología , Femenino , Lóbulo Frontal/patología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Análisis de Regresión , Convulsiones/patología , Lóbulo Temporal/patología , Tálamo/patología , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Cerebral atherosclerosis is the main cause of lesions that contribute to vascular cognitive impairment and vascular dementia, followed by arteriosclerosis of small vessels and cerebral amyloid angiopathy. The purpose of this study was to compare the post-mortem radiological alterations of autopsied adults with the macroscopic alterations in the posterior region of these brains in order to establish a relationship between the two forms of analysis and to discuss the relevance of the prevention of vascular cognitive impairment in patients with encephalic atherosclerosis. MATERIALS AND METHODS: Thirteen brains were analysed macroscopically to assess the degree of atherosclerosis of the basilar and the posterior cerebral arteries. The patients were autopsied in the Subject of General Pathology at General Hospital of Triângulo Mineiro Federal University in Uberaba, state of Minas Gerais, Brazil. The qualitative analysis of atherosclerosis was performed with classification into mild, moderate or severe. In the posterior region of the brains, width of sulcus and thickness of gyrus were measured by macroscopic analysis and by tomographic analysis. RESULTS AND CONCLUSIONS: There was a decrease in calcarine sulcus width and an increase in medial temporal occipital gyrus thickness in patients with a higher degree of atherosclerosis, macroscopically and in tomography, respectively. Low oxygenation caused by atherosclerosis probably leads to an encephalic parenchyma inflammation that causes microglial cells hypertrophy provoking increase in the gyrus thickness and decrease in the sulcus width, as observed in the present study.
Asunto(s)
Disfunción Cognitiva/prevención & control , Demencia Vascular/prevención & control , Arteriosclerosis Intracraneal/patología , Lóbulo Occipital/patología , Lóbulo Temporal/patología , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Disfunción Cognitiva/etiología , Disfunción Cognitiva/patología , Demencia Vascular/etiología , Demencia Vascular/patología , Femenino , Humanos , Arteriosclerosis Intracraneal/complicaciones , Arteriosclerosis Intracraneal/diagnóstico por imagen , Masculino , Lóbulo Occipital/diagnóstico por imagen , Valores de Referencia , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Lóbulo Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: This study aimed to compare cortex thickness and neuronal cell density in postmortem brain tissue from people with overweight or obesity and normal weight. METHODS: The cortex thickness and neuron density of eight donors with overweight or obesity (mean = 31.6 kg/m2 ; SD = 4.35; n = 8; 6 male) and eight donors with normal weight (mean = 21.8 kg/m2 ; SD = 1.5; n = 8; 5 male) were compared. All participants were Mexican and lived in Mexico City. Randomly selected thickness measures of different cortex areas from the frontal and temporal lobes were analyzed based on high-resolution real-size photographs. A histological analysis of systematic-random fields was used to quantify the number of neurons in postmortem left and right of the first, second, and third gyri of frontal and temporal lobe brain samples. RESULTS: No statistical difference was found in cortical thickness between donors with overweight or obesity and individuals with normal weight. A smaller number of neurons was found among the donors with overweight or obesity than the donors with normal weight at different frontal and temporal areas. CONCLUSIONS: A lower density of neurons is associated with overweight or obesity. The morphological basis for structural brain changes in obesity requires further investigation.
Asunto(s)
Encéfalo/patología , Recuento de Células/instrumentación , Lóbulo Frontal/anomalías , Obesidad/diagnóstico , Lóbulo Temporal/anomalías , Adulto , Autopsia , Recuento de Células/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/patología , Lóbulo Temporal/patologíaRESUMEN
BACKGROUND: The mesial temporal region (MTR) is located deep in the temporal lobe and it is surrounded by important vascular and nervous structures that should be preserved during surgery. OBJECTIVE: To describe microsurgical anatomy and approaches to the MTR in relation to cavernomas and arteriovenous malformations (AVMs). METHODS: Five formalin-fixed and red silicone-embedded heads of adult cadavers were used for this study. Between January 2003 and June 2014, 7 patients with cavernomas and 6 patients with AVMs in the MTR underwent surgery. RESULTS: The MTR of the cadavers was divided into 3 areas: anterior, middle, and posterior. Of the 7 patients with MTR cavernomas, 4 were located anteriorly, 2 were located medially, and 1 was located posteriorly. Of the 6 patients with MTR AVMs, 3 were located in the anterior sector, 2 in the middle sector, and 1 in the posterior sector. For the anterior portion of the MTR, a transsylvian-transinsular approach was used; for the middle portion of the MTR, a transtemporal approach was used (anterior temporal lobectomy); and for the posterior portion of the MTR, a supracerebellar-transtentorial approach was used. CONCLUSION: Dividing the MTR into 3 regions allows us to adapt the approach to lesion location. Thus, the anterior sector can be approached via the sylvian fissure, the middle sector can be approached transtemporally, and the posterior sector can be approached via the supracerebellar approach.
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Malformaciones Arteriovenosas/cirugía , Neoplasias Encefálicas/cirugía , Hemangioma Cavernoso/cirugía , Microcirugia/métodos , Lóbulo Temporal/patología , Lóbulo Temporal/cirugía , Adulto , Anciano , Malformaciones Arteriovenosas/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Angiografía Cerebral , Femenino , Hemangioma Cavernoso/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Epilepsy is characterized by spontaneous recurrent seizures and temporal lobe epilepsy (TLE) is the most common serious neurological example of acquired and frequent epilepsy. Oxidative stress is recognized as playing a contributing role in several neurological disorders, and most recently have been implicated in acquired epilepsies. The MTs occur in several brain regions and may serve as neuroprotective proteins against reactive oxygen species causing oxidative damage and stress. The main aim of this work was to describe the immunohistochemical localization of MT in the specimens derived from the patients affected by TLE. Histopathological examination showed NeuN, GFAP and MT immunopositive cells that were analyzed for determinate in hippocampal and parietal cortex samples. An increase in the reactive gliosis associated with increased MT expression was observed in patients with TLE.
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Epilepsia del Lóbulo Temporal/metabolismo , Epilepsia del Lóbulo Temporal/patología , Metalotioneína/análisis , Metalotioneína/biosíntesis , Adulto , Femenino , Hipocampo/química , Hipocampo/metabolismo , Hipocampo/patología , Humanos , Masculino , Estrés Oxidativo/fisiología , Lóbulo Parietal/química , Lóbulo Parietal/metabolismo , Lóbulo Parietal/patología , Lóbulo Temporal/química , Lóbulo Temporal/metabolismo , Lóbulo Temporal/patologíaRESUMEN
Schizophrenia is a complex disorder hypothesized to develop from a combination of genetic, neurodevelopmental, and environmental factors. Molecules that are directly involved in the pathogenesis of schizophrenia and may serve as biomarker candidates can be identified with "omics" approaches such as proteomics and peptidomics. In this context, we performed a peptidomic study in schizophrenia postmortem brains, to our knowledge the first such study in schizophrenia patients. We investigated the anterior temporal lobe (ATL) and corpus callosum (CC) by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) and a label-free ion quantification technique based on data-dependent acquisition (DDA). Results indicated alterations in a specific intracellular neurogranin peptide in both the ATL and CC and a decrease of PepH, a fragment of histone H2B type 1-H intracellular peptide, in the ATL. PepH was tested in serum-deprived Neuro2A cells and showed a protective effect against cell death. Cells were also challenged with lipopolysaccharide (LPS), and PepH was able to prevent the endotoxic effects of LPS. Our data suggest that specific intracellular peptides are altered in schizophrenia patients. The potential biological activity of PepH supports intracellular peptides as novel targets in the study not only of schizophrenia but also of other neuropsychiatric diseases. BIOLOGICAL SIGNIFICANCE: Psychiatric disorders are considerably more difficult to diagnose in their early stages. Usually, by the time the diagnosis is clear and clinical treatment can be started, the disorder is already established and thus of greater severity. Consequently, the scientific community has been searching for biomarker candidates that can aid the early detection of such disorders and for novel therapeutics to improve treatment or at least delay disease progression. Moreover, key molecules involved in the establishment of psychiatric diseases may help the understanding of their pathogenesis and thus drive the development of more effective treatments. The present work screened peptides that might be possible novel targets to control cell machinery in schizophrenia and identified an intracellular peptide with potential cytoprotective activity. To our knowledge, this is the first peptidomic study in schizophrenia patients.
Asunto(s)
Cuerpo Calloso/química , Péptidos/análisis , Esquizofrenia/patología , Lóbulo Temporal/química , Biomarcadores/análisis , Muerte Celular/efectos de los fármacos , Línea Celular , Cromatografía Liquida , Cuerpo Calloso/patología , Histonas/análisis , Humanos , Neurogranina/análisis , Proteómica/métodos , Espectrometría de Masas en Tándem , Lóbulo Temporal/patologíaRESUMEN
This study investigated for the first time the genomewide DNA methylation changes of noncoding RNA genes in the temporal cortex samples from individuals with Alzheimer's disease (AD). The methylome of 10 AD individuals and 10 age-matched controls were obtained using Illumina 450 K methylation array. A total of 2,095 among the 15,258 interrogated noncoding RNA CpG sites presented differential methylation, 161 of which were associated with miRNA genes. In particular, 10 miRNA CpG sites that were found to be hypermethylated in AD compared to control brains represent transcripts that have been previously associated with the disease. This miRNA set is predicted to target 33 coding genes from the neuregulin receptor complex (ErbB) signaling pathway, which is required for the neurons myelination process. For 6 of these miRNA genes (MIR9-1, MIR9-3, MIR181C, MIR124-1, MIR146B, and MIR451), the hypermethylation pattern is in agreement with previous results from literature that shows downregulation of miR-9, miR-181c, miR-124, miR-146b, and miR-451 in the AD brain. Our data implicate dysregulation of miRNA methylation as contributor to the pathogenesis of AD.