RESUMO
BACKGROUND: Mesial temporal lobe epilepsy (MTLE) is a symptomatic epilepsy syndrome clinically characterized by high prevalence, pharmacoresistance, good surgical prognosis and hippocampal sclerosis (HS); however, no singular criteria can be considered sufficient for the MTLE-HS diagnosis. MicroRNAs (miRNAs) are small non-coding molecules that act as important gene-expression regulators at post-transcriptional level. Evidences on the involvement of miRNAs in epilepsy pathogenesis as well as their potential to be employed as biomarkers claim for investigations on miRNAs' applicability as epilepsy diagnosis and prognosis biomarkers. Consequently, the present study aimed to evaluate the applicability of three specific miRNAs as biomarkers of diagnosis and surgical outcomes in adult patients with MTLE-HS. METHOD: Hippocampus, amygdala and blood samples from 20 patients with MTLE-HS were analyzed, 10 with favorable surgical prognosis (Engel I) and 10 with unfavorable surgical prognosis (Engel III-IV). For the control groups, hippocampus and amygdala from necropsy and blood samples from healthy individuals were adopted. The miRNAs expression analysis was performed using Real-Time Quantitative Polymerase Chain Reaction for miRNAs highlighted from microarray as being involved in GABAergic neurotransmission. RESULTS: The miRNAs miR-629-3p, miR-1202 and miR-1225-5p were found to be hyper-expressed in MTLE-HS patients' blood. CONCLUSIONS: Our data suggest the existence of three circulating miRNAs (miR-629-3p, miR-1202 and miR-1225-5p) that could possibly act as additional tools in the set of factors that contribute to MTLE-HS diagnose.
Assuntos
Epilepsia do Lobo Temporal , MicroRNAs , Adulto , Humanos , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/genética , Epilepsia do Lobo Temporal/cirurgia , Esclerose/diagnóstico , Esclerose/metabolismo , Esclerose/patologia , Hipocampo/cirurgia , Hipocampo/metabolismo , Hipocampo/patologia , MicroRNAs/genética , MicroRNAs/metabolismo , BiomarcadoresRESUMO
BACKGROUND AND PURPOSE: MTS is characterized by gliosis and atrophy of the hippocampus and related limbic structures. However, the damage is not limited to those structures with atrophy and has been reported in extratemporal regions. Because volumetric studies are nonspecific, the pathophysiology of the brain damage remains to be solved. MTI is an MR imaging technique more sensitive to subtle neuropathologic changes than conventional MR imaging. Here we combined MTI with VBM analysis to evaluate extratemporal damage in patients with TLE. MATERIALS AND METHODS: We studied 23 healthy controls and 21 patients with TLE with mean ages, respectively, of 37.6 ± 10.9 and 38.6 ± 9.02 years. All subjects had a full clinical follow-up and MR imaging. We processed the images with VBM for volumetric analysis of WM and GM, as well as with voxel-based analysis of MTR for macromolecular integrity analysis. RESULTS: In addition to MTR decrease in the temporal lobes, we found a significant decrease in GM and WM volumes. In the WM, the MTR decrease was correlated to volume loss detected by VBM, indicating that brain atrophy may explain part of the MTR decrease. We also found areas in which the MTR decrease was not associated with volume loss, suggesting an additional pathophysiologic process other than neuronal loss and atrophy underlying the MTR changes. CONCLUSIONS: Our results support the hypothesis that there are widespread lesions in the brain, including the corpus callosum and the frontal lobe, affecting both GM and WM.
Assuntos
Corpo Caloso/patologia , Epilepsia do Lobo Temporal/patologia , Lobo Frontal/patologia , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Magnetometria/métodos , Adulto , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Febrile seizures (FS) affect almost 2-5 percent of children and factors related to an increase susceptibility of children to FS may involve an imbalance of inflammatory cytokines and genetic factors. FS had low morbidity, but may be associated with the occurrence of late chronic epilepsy. Here we describe factors related to FS and its possible correlation with SUDEP.
Crises febris (CF) afetam aproximadamente 2-5 por cento das crianças e os fatores envolvidos com essa maior susceptibilidade das crianças às CF podem estar relacionados com uma ação inadequada de citocinas inflamatórias, além de fatores genéticos. As CF têm baixa morbidade, mas podem estar associadas à ocorrência de epilepsia crônica. Nós discutiremos os fatores relacionados com CF, considerando-se sua possível associação com SUDEP.
Assuntos
Criança , Humanos , Morte Súbita/etiologia , Epilepsia/complicações , Convulsões Febris/complicaçõesRESUMO
The superposition of medical images, technically known as co-registration, can take a major role in determining the topographic and morphological changes in functional diagnostic and therapeutic purposes. This paper describes a study focused on to find an alternative cost function method for medical images co-registration through the study of performance and robustness of the TSallis Entropy in Statistical Parametric Mapping package (SPM). Images of Magnetic Resonance (MR) and Single Photon Emission Computed Tomography (SPECT) of 3 patients morphologically normal were used for the construction of anatomic phantoms containing predetermined geometric variations. The simulated images were co-registered with the original images using traditional techniques and the proposed method. The comparative analysis of the Root Mean Square (RMS) error showed that the Tsallis Entropy was more efficient in the intramodality alignment, while the Shannon Entropy in the intermodality one; revealing therefore the importance of the implementation of the Tsallis Entropy in SPM for applications in neurology and neuropsychiatric evaluation.
Assuntos
Algoritmos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Encéfalo/patologia , HumanosRESUMO
One of the subjects that most concerns physicians is treatment-resistance. About 30%-60% of schizophrenia patients do not respond adequately to antipsychotic treatment and are known as refractory schizophrenia patients. Clozapine has been the drug of choice in such cases. However, approximately 30% of them do not respond to clozapine either. Here, we describe a patient with an initial diagnosis of refractory schizophrenia who had a history of dramatic aggressiveness. However, in this case, "refractoriness" was a wrong diagnosis. A case of psychosis secondary to epilepsy had been treated as schizophrenia for almost 20 years. Reports like this one are important because they remind us of how a thorough investigation can lead to the correct diagnosis and improve the patient's prognosis.
RESUMO
BACKGROUND: Neurocysticercosis is a major cause of epilepsy in developing countries and is endemic in Brazil. To test the hypothesis that the aetiological profile of patients with intractable epilepsy in Brazil includes neurocysticercosis, we conducted a cross sectional study investigating the aetiology of intractable epilepsy. METHODS: A total of 512 patients evaluated at the outpatient clinic for intractable epilepsy at the Ribeirão Preto School of Medicine were included in the survey. Medical intractability was determined on the basis of seizure incidence and severity, and response to appropriate epilepsy management. Neuroimaging included brain CT with non-contrasted and contrasted phases and high resolution MRI. Patients were divided into neurocysticercosis and non-neurocysticercosis groups according to previous diagnostic criteria. RESULTS: The most common epileptogenic lesions were mesial temporal sclerosis (MTS; 56.0%), malformations of cortical development (12.1%), and brain tumours (9.9%). Neuroimaging was normal in 8.7% of patients. Calcifications were found in 27% of patients and were significantly more common in patients with MTS than in those without MTS (p<0.001). Isolated neurocysticercosis was found in only eight patients (1.56%). CONCLUSIONS: These data suggest that neurocysticercosis is an uncommon cause of intractable epilepsy, even in an endemic region such as Brazil, and that it may only represent a coexistent pathology. However, an analysis of our findings reveals that neurocysticercosis was more common in patients with MTS. This finding could suggest either that there is a cause-effect relationship between MTS and neurocysticercosis, or that MTS and neurocysticercosis co-vary with a missing variable, such as socio-economic status.
Assuntos
Calcinose/complicações , Calcinose/patologia , Epilepsia/etiologia , Neurocisticercose/complicações , Neurocisticercose/patologia , Adolescente , Adulto , Encefalopatias/complicações , Encefalopatias/patologia , Criança , Estudos Transversais , Demografia , Eletroencefalografia , Epilepsia/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurocisticercose/parasitologia , Esclerose/complicações , Esclerose/patologia , Lobo Temporal/patologiaRESUMO
The aim of this investigation was to apply neuroethology to the study of human temporal lobe epilepsy (TLE). For this purpose, 42 seizures in 7 patients recorded during video/EEG monitoring (1997-1998) were analyzed by means of a behavioral glossary containing all behaviors. Video recordings were reobserved, and all patients' behaviors were annotated second-by-second. Data were analyzed using Ethomatic software and displayed as flowcharts including frequency, mean duration, and sequential statistic interaction of behavioral items (chi2 > or = 10.827, P<0.001). Flowcharts of (1) a group of seizures from a single patient, (2) the sum of four seizures per patient of two patients with right and five patients with left TLE, and (3) the comparison of left versus right TLE are shown. Well-established data in the literature were confirmed, such as aura (especially epigastric), contralateral lateralization value of dystonia and version, consciousness and language alterations in ictal and postictal periods, mostly with respect to dominant hemisphere involvement, among others. Less well established data such as awakening seizures in TLE patients, lateralization value of facial wiping (ipsilateral to the focus), statistically significant associations between behavioral pairs (dyads), and new behavioral sequences in TLE were also observed. We suggest that neuroethology also has great potential in the study of human epilepsy semiology. This work had an important role in method standardization for human epilepsy, setting the basis for the development of future clinical studies including correlation with other diagnostic methods (EEG, magnetic resonance, and SPECT). The next step will be the comparative study of seizures of patients with left and right TLE, with a greater number of patients, and the development of a digital video library.
Assuntos
Automatismo , Epilepsia do Lobo Temporal/fisiopatologia , Movimento/fisiologia , Software , Comportamento , Pesquisa Comportamental , Eletroencefalografia/métodos , Epilepsia do Lobo Temporal/psicologia , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Convulsões , Gravação de VideoteipeRESUMO
OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerability of topiramate (TPM) in juvenile myoclonic epilepsy (JME). METHOD: We assessed seizure control and adverse effects of TPM in 22 patients (18 females) aged 13 to 53 years. Target TPM dosage was up to 200 mg/day. The patients were subdivided into 3 groups: those treated with seizure control plus side effects (n=4); treated with non-controlled seizures (n=15) and with JME newly diagnosed (n=3). RESULTS: Sixteen patients completed the first year of the follow-up. Generalized tonic-clonic seizures were completely controlled in 10 (62.5%); more than 50% of reduction in 4 (25.0%) and less than 50% in 2 (12.5%). Myoclonia were controlled in 11 (68.8%) and persisted in 5 (31.2%) patients. Absence seizures were present in 5 (22.7%) of whom 2 (9.0%) showed more than 50% of seizure reduction while 3 (13.6%) presented worsening. Discontinuations were due to inadequate seizure control and adverse events (N=4), low compliance and loss of follow-up (N=2) and subject choice (N=1). CONCLUSION: TPM showed to be an effective and well-tolerated drug in the treatment of JME. Although frequently observed, TPM side effects were tolerable and the drug could be maintained in the majority of patients.
OBJETIVO: Avaliar a eficácia e tolerabilidade do topiramato (TPM) na epilepsia mioclônica juvenil (EMJ). MÉTODO: Avaliamos a resposta terapêutica e efeitos colaterais do TPM em 22 pacientes (18 mulheres) com idades entre 13 e 53 anos. A dose alvo utilizada foi até 200 mg/dia. Os pacientes foram divididos em 3 grupos no início do tratamento: aqueles com controle das crises mas que apresentavam efeitos colaterais (n=4); com crises não controladas (n=15) e com EMJ recém diagnosticada (n=3). RESULTADOS: Dezesseis pacientes completaram o primeiro ano de acompanhamento. Crises tônico-clonicas generalizadas foram completamente controladas em 10 (62,5%), tiveram redução maior de 50% em 4 (25,0%) e menor de 50% em 2 (12,5%). Mioclonias foram controladas em 11 (68,8%) e persistiram em 5 (31.2%) pacientes. As crises de ausências, presentes em 5 (22,7%) pacientes, tiveram redução maior do que 50% em 2 (9,0%) e agravamento em 3 (13,6%). A retirada do estudo foi devida principalmente ao controle inadequado das crises e efeitos colaterais indesejáveis (n=4), pouca adesão e perda do seguimento (n=2) e escolha do paciente (n=1). CONCLUSÃO: TPM foi considerada droga eficaz e bem tolerada no tratamento da EMJ. Apesar de freqüentemente observados, os efeitos colaterais do TPM foram toleráveis e a medicação pode ser mantida na maioria dos pacientes.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anticonvulsivantes/uso terapêutico , Epilepsia Mioclônica Juvenil/tratamento farmacológico , Frutose/análogos & derivados , Anticonvulsivantes/efeitos adversos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Epilepsia Tipo Ausência/tratamento farmacológico , Epilepsia Tônico-Clônica/tratamento farmacológico , Seguimentos , Frutose/efeitos adversos , Frutose/uso terapêutico , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: Although chronic calcified neurocysticercosis (NCC) has been considered a major cause of symptomatic epilepsy in developing countries, it can also be an incidental pathological finding in epileptic patients from endemic regions. The mechanisms of brain plasticity occurring in patients with NCC during and after the inflammatory process related to the parasite infection, death, degeneration, and calcification within the host brain might be an independent factor for cognitive impairment in patients with NCC and epilepsy. In order to assess this possibility cognitive performance of patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) with and without NCC was investigated through structured neuropsychological testing. METHODS: Cognitive performance of long term MTLE-HS patients with (HS-NCC group, n = 32) and without NCC (HS only, n = 48) was compared. Imbalances between the two groups with respect to clinical, demographic, neuroimaging, and electrophysiological variables were adjusted by linear multiple regression analysis and Bonferroni correction for multiple tests. RESULTS AND CONCLUSIONS: There were no cognitive performance differences between HS-NCC and HS only patients, leading to the conclusion that chronic calcified NCC per se does not aggravate the cognitive performance of patients with long term MTLE-HS.
Assuntos
Encefalopatias/patologia , Encefalopatias/parasitologia , Calcinose/complicações , Calcinose/patologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Epilepsia do Lobo Temporal/etiologia , Neurocisticercose/complicações , Neurocisticercose/patologia , Demografia , Eletroencefalografia , Epilepsia do Lobo Temporal/diagnóstico , Feminino , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Neurocisticercose/líquido cefalorraquidiano , Testes Neuropsicológicos , Estudos Prospectivos , Índice de Gravidade de Doença , Trombose dos Seios Intracranianos/epidemiologia , Trombose dos Seios Intracranianos/etiologiaRESUMO
We report two male patients with medically intractable epilepsy and obsessive-compulsive disorder (OCD) symptoms. Both patients experienced remission of obsessive-compulsive symptoms after surgical treatment of epilepsy. Although the surgeries targeted different brain regions, the two patients had in common unilateral anterior cingulate cortex ablation. On the basis of these observations, we discuss the pathophysiology of OCD symptoms, emphasizing the role of corticosubcortical pathways in their genesis. Our data suggest that surgeries that affect neural loops associated with obsessive-compulsive symptoms can lead to an improvement of OCD; however, the structures responsible for this effect cannot be conclusively determined.
Assuntos
Transtorno da Personalidade Compulsiva/etiologia , Epilepsia/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Psicocirurgia/métodos , Adulto , Epilepsia/complicações , Epilepsia/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Resultado do TratamentoRESUMO
Studies in animals lacking the cellular prion protein (PrP(c)) gene (Prnp) showed higher neuronal excitability in vitro and increased sensitivity to seizures in vivo. The authors previously reported a rare polymorphism at codon 171 (Asn-->Ser) of human Prnp to be associated with mesial temporal lobe epilepsy related to hippocampal sclerosis. They demonstrated that the same variant allele is also associated with symptomatic epilepsies related to different forms of malformations of cortical development.
Assuntos
Substituição de Aminoácidos , Amiloide/genética , Córtex Cerebral/anormalidades , Epilepsia/genética , Polimorfismo de Nucleotídeo Único , Precursores de Proteínas/genética , Adolescente , Adulto , Alelos , Apoptose , Brasil/epidemiologia , Divisão Celular , Movimento Celular , Córtex Cerebral/patologia , Criança , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/genética , Anormalidades Congênitas/patologia , Análise Mutacional de DNA , Epilepsia/epidemiologia , Epilepsia/patologia , Etnicidade/genética , Europa (Continente)/epidemiologia , Feminino , Frequência do Gene , Genótipo , Humanos , Masculino , Proteínas Priônicas , PríonsRESUMO
BACKGROUND: Mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) is the most common surgically remediable epileptic syndrome. Ablation of the cellular prion protein (PrP(c)) gene (PRNP) enhances neuronal excitability of the hippocampus in vitro and sensitivity to seizure in vivo, indicating that PrP(c) might be related to epilepsy. OBJECTIVE: To evaluate the genetic contribution of PRNP to MTLE-HS. METHODS: The PRNP coding sequence of DNA from peripheral blood cells of 100 consecutive patients with surgically treated MTLE-HS was compared to that from a group of healthy controls adjusted for sex, age, and ethnicity (n = 180). The presence of PRNP variant alleles was correlated with clinical and presurgical parameters as well as surgical outcome. RESULTS: A variant allele at position 171 (Asn-->Ser), absent in controls, was found in heterozygosis (Asn171Ser) in 23% of patients (p < 0.0001). The PRNP genotypes were not correlated with any clinical or presurgical data investigated. However, patients carrying the Asn171Ser variant had a five times higher chance of continuing to have seizures after temporal lobectomy (95% CI 1.65 to 17.33, p = 0.005) than those carrying the normal allele. At 18 months after surgery, 91.8% of patients with the normal allele at codon 171 were seizure free, in comparison to 68.2% of those carrying Asn171Ser (p = 0.005). CONCLUSIONS: The PRNP variant allele Asn171Ser is highly prevalent in patients with medically untreatable MTLE-HS and influences their surgical outcome. The results suggest that the PRNP variant allele at codon 171 (Asn171Ser) is associated with epileptogenesis in MTLE-HS.
Assuntos
Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/cirurgia , Variação Genética/genética , Príons/genética , Esclerose/genética , Adulto , Substituição de Aminoácidos , Química Encefálica , DNA/análise , Intervalo Livre de Doença , Epilepsia do Lobo Temporal/complicações , Etnicidade/estatística & dados numéricos , Feminino , Frequência do Gene , Hipocampo/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Razão de Chances , Esclerose/complicações , Esclerose/patologia , Distribuição por Sexo , Resultado do TratamentoRESUMO
OBJECTIVE: In mesial temporal lobe epilepsy (MTLE), the rate of correct seizure lateralization of ictal semiology and ictal EEG is better for patients with unilateral interictal spikes (UIS) than for patients with bilateral interictal spikes (BIS), possibly due to rapid seizure propagation patterns associated with bilateral epileptogenesis. In this study, the authors investigated if ictal SPECT is a reliable diagnostic test for both UIS and BIS patients. METHODS: Video-EEG recording was used as the gold standard to examine the accuracy of ictal SPECT and its relationship with interictal and ictal EEG. Ninety-three consecutive patients with MTLE associated with hippocampal sclerosis were included in the analysis. Ictal SPECT was considered accurate if two blinded observers independently lateralized the scan correctly. RESULTS: Ictal SPECT correctly lateralized 75 (80.6%) of 93 scans. The rate of correct seizure lateralization was 87.6% for the UIS group and only 55.0% for the BIS group (p = 0.0027). In the EEG epochs, 66.7% of BIS patients vs 43.4% of UIS patients had nonlateralized ictal EEG (p < 0.001). CONCLUSION: The authors conclude that the accuracy of ictal SPECT is worse for MTLE patients with BIS than for those with UIS. The role of ictal SPECT in presurgical evaluation of patients with BIS must be reviewed.
Assuntos
Epilepsia do Lobo Temporal/diagnóstico por imagem , Epilepsia do Lobo Temporal/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único , Doença Aguda , Adulto , Epilepsia do Lobo Temporal/etiologia , Feminino , Hipocampo/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
OBJECTIVE: To analyze the relationship between periodic lateralized epileptiform discharges (PLED) and status epilepticus (SE), to evaluate the relationship between mortality and periodic patterns, and to determine whether a stereotypic sequence of EEG patterns exists during human SE. METHODS: The authors performed a prospective clinical and electrographic study comprising 62 episodes of SE, 55 patients, and 254 ictal/postictal EEG recordings. Serial daily EEG were obtained in all cases. RESULTS: Partial SE was the predominant clinical type. Four distinct ictal EEG patterns were identified: intermittent EEG seizures (IES), merging EEG seizures (MES), continuous ictal discharges (CID), and periodic epileptiform discharges (PED) which could be lateralized (PLED) or bilateral (PBED). IES was the most common ictal pattern. In the same record, only one combination of ictal patterns was observed corresponding to an association of PLED or PBED and MES pattern. Serial EEG demonstrated that approximately one-third of SE resolved before the second EEG, another one-third persisted and maintained the same ictal pattern throughout the entire evolution, and the final one-third showed variable ictal EEG patterns. PLED were also unequivocally associated with epileptic seizures, and in some patients were the initial ictal pattern. CONCLUSION: PLED can be an ictal pattern; and, in contrast to previous observations, no stereotyped sequence of ictal EEG patterns was found. PLED/PBED were not a terminal ictal pattern in every case, and outcome was more related to age and etiology than to specific ictal EEG patterns.
Assuntos
Eletroencefalografia , Estado Epiléptico/diagnóstico , Estado Epiléptico/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Lateralidade Funcional , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Periodicidade , Estudos Prospectivos , Estado Epiléptico/mortalidadeRESUMO
PURPOSE: To characterize perfusion patterns of periictal single-photon emission tomography (SPECT) in patients with unilateral temporal lobe epilepsy (TLE) and to determine their relationship to the epileptogenic zone (EZ). METHODS: We studied periictal SPECT scans of 53 patients after anterior mesial temporal lobectomy who had good seizure outcome after surgery. Ictal SPECT scans were performed during video-EEG monitoring. Typical SPECT patterns consisted of ipsilateral ictal hyperperfusion or ipsilateral postictal hypoperfusion. Atypical ictal patterns included normal scans, bilateral temporal hyperperfusion, or contralateral patterns. These perfusion patterns were retrospectively analyzed searching for concordance rate with the EZ. RESULTS: We obtained 51 ictal and two early postictal scans. In the typical group, 40 (75.4%) patients had ipsilateral ictal temporal lobe hyperperfusion, and one (1.9%) patient had ipsilateral postictal temporal lobe hypoperfusion. Twelve (22.7%) patients exhibited atypical perfusion patterns: seven (13.2%) patients had bitemporal ictal hyperperfusion (four cases showed asymmetric temporal lobe changes), four (7.6%) patients had contralateral hyperperfusion, and one (1.9%) patient had a normal SPECT scan. All four patients with bitemporal asymmetric hyperperfusions showed greater perfusion lateralized to the side of the EZ. Three of the four patients who had contralateral hyperperfusion also had a complex postictal-like pattern in the ipsilateral temporal lobe consisting of anteromesial hyperperfusion with adjacent lateral hypoperfusion. CONCLUSIONS: This study analyzed typical and atypical perfusion patterns in unilateral TLE, and suggested that not only typical, but also some atypical perfusion patterns may contribute to the lateralization of EZ.
Assuntos
Epilepsia do Lobo Temporal/diagnóstico por imagem , Lateralidade Funcional/fisiologia , Lobo Temporal/irrigação sanguínea , Lobo Temporal/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Adolescente , Adulto , Eletroencefalografia/estatística & dados numéricos , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/estatística & dados numéricos , Estudos Retrospectivos , Lobo Temporal/fisiopatologia , Gravação de VideoteipeRESUMO
BACKGROUND: Several studies suggest that neurocysticercosis is the main cause of symptomatic epilepsy in developing countries. In such areas, calcified cysticercotic lesions (CCL) are frequently found in patients with complex partial seizures associated with hippocampal sclerosis (HS). The authors studied whether there are clinical and pathologic differences between HS patients with and without CCL. METHODS: The authors determined the clinical and pathologic findings of 30 patients with HS and compared them with 32 patients with HS + CCL. Hippocampi from both groups were measured for fascia dentata Timm staining and cell density in hippocampal subfields. RESULTS: In the HS + CCL group, single or multiple CCL were found in all lobes with no lobar predominance. An initial precipitating event occurred in 83.3% of HS and in 62.5% of HS + CCL. First complex partial seizure occurred at 10.1 years in HS and at 11.9 years in HS + CCL. No significant differences were found for fascia dentata Timm staining and hippocampal cell densities. Good postsurgery outcome (Engel I classification) did not differ between groups, with this result occurring in 76.6% of patients with HS and 81.2% of patients with HS + CCL. CONCLUSIONS: The presence of CCL does not influence the clinical and pathologic profile of patients with hippocampal atrophy. Clinical histories and postsurgical outcomes were similar to those of patients with classic HS, suggesting that the CCL is probably, in this set of patients, a coincidental pathology and does not have a role in epileptogenesis.
Assuntos
Encéfalo/patologia , Calcinose/patologia , Epilepsia do Lobo Temporal/patologia , Neurocisticercose/patologia , Adolescente , Adulto , Análise de Variância , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
The antiphospholipid antibodies (aPLs) are a heterogeneous group of immunoglobulins that have been related with alterations in blood coagulability in recent years. Patients with elevated titers of these antibodies have a high probability to develop thrombotic events, including cerebral infarct (CI). The tests currently used to detect these antibodies are the lupus anticoagulant and ELISA for anticardiolipin antibodies which have a larger proportion of positivity among young patients with CI. In our study we tested 66 patients with cerebral infarcts whose ages ranged from 15 to 40 years for the presence of lupus anticoagulant and anticardiolipin antibodies. The results showed that eleven (16.65%) patients were positive for aPLs and three (4.55%) of them fulfilled the diagnostic criteria for primary antiphospholipid syndrome. These data point out to the importance of investigating aPLs in young patients with CI and its high prevalence in this group compared with healthy population.
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Anticorpos Antifosfolipídeos/isolamento & purificação , Síndrome Antifosfolipídica/diagnóstico , Infarto Cerebral/imunologia , Adolescente , Adulto , Síndrome Antifosfolipídica/complicações , Infarto Cerebral/etiologia , Feminino , Humanos , Masculino , PrevalênciaRESUMO
The possible etiologies of cerebral infarcts (CI) in young patients differ from those in the older stroke population. Recently, deficiencies of fibrinolytic factors emerged as an important etiology of stroke in the young population. The literature has emphasized the diagnosis of such conditions especially in stroke cases of undetermined etiology and with history of recurrent thrombosis. We carried out a research on the serum level of protein C, protein S, and antithrombin III in young patients, between 15 and 40 years, with CI of undetermined cause after application of a standard protocol. Three patients had low levels of these proteins; two had protein C deficiency, and one protein S deficiency. None of them had antithrombin III deficiency. We conclude that systematic investigation of such causes of cerebral infarct will reduce the group of undetermined strokes, and will open the possibility of prophylactic treatment in a non-negligible group of patients.
Assuntos
Coagulação Sanguínea , Infarto Cerebral/etiologia , Deficiência de Proteína C , Deficiência de Proteína S/complicações , Adolescente , Adulto , Antitrombina III/análise , Infarto Cerebral/sangue , Infarto Cerebral/diagnóstico por imagem , Feminino , Humanos , Incidência , Masculino , Proteína C/análise , Proteína S/análise , Tomografia Computadorizada por Raios XRESUMO
The antiphospholipid antibodies are associated with a large number of neurologic syndromes, cerebral infarct (CI) being the most common of them. In these cases the pathogenesis of the CI is poorly understood and remains controversial; however, the existence of a vasculopathy is indubitable. We report the cases of two young patients with CI and diagnosis of primary antiphospholipid syndrome who were submitted to cerebral angiograms, and one of them to necropsy. In one case the angiographic findings were similar to those of vasculitis in intracranial vessels. In the other case we observed obstruction in internal carotid artery at the angiography that looked like thrombosis in situ; at necropsy we found non-atherosclerotic obstruction in coronary arteries. In summary, is the primary lesion vasculitis, thrombosis, or both? These cases illustrate the discussion and demonstrate that vasculitic mechanisms may be involved in the vasculopathy of primary antiphospholipid syndrome even though thrombosis occur more frequently.
Assuntos
Síndrome Antifosfolipídica/complicações , Transtornos Cerebrovasculares/etiologia , Adulto , Síndrome Antifosfolipídica/diagnóstico , Artéria Carótida Interna/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Transtornos Cerebrovasculares/diagnóstico por imagem , Feminino , Humanos , RadiografiaRESUMO
BACKGROUND AND PURPOSE: Cerebral infarction among young adults has been little studied in Brazil. Most studies adopt a variable upper age limit and often use the term "young" to designate different age ranges. The objective of the present study was to determine possible differences in etiology of cerebral infarction in specific age subpopulations. METHODS: We studied 106 patients aged 15 to 40 years and divided them into two subpopulations by age at time of ictus (ie, 15 to 29 years and 30 to 40 years). On the basis of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, we classified the patients into the following five groups: (1) large-artery atherosclerosis, (2) small-vessel occlusion or lacunae, (3) cardioembolism, (4) other determined causes, and (5) undetermined causes. The proportions for each group were compared between the two age ranges to determine whether there was a significant difference in group distribution. RESULTS: The proportions were different between the two age ranges, with a predominance of women and TOAST-criterion group 4 in the 15- to 29-year age range. In the 30- to 40-year age range, there was a predominance of men and of TOAST-criterion group 3. CONCLUSIONS: The proportions of the groups in the two age ranges were significantly different for lacunar infarctions and infarctions of other etiologies. This observation suggests that different age ranges present characteristically different distributions and therefore should be considered separately when investigated. The older age range already presents features that suggest a transition to the spectrum observed among the aged.