RESUMO
OBJECTIVE: To investigate the association between left epileptiform activity and language laterality indices (LI) in patients with right mesial temporal sclerosis (MTS). METHODS: Twenty-two patients with right MTS and 22 healthy subjects underwent fMRI scanning while performing a language task. LI was calculated in multiple regions of interest (ROI). Data on the presence of left epileptiform abnormalities were obtained during prolonged video-EEG monitoring. RESULTS: After correction for multiple comparisons, LI was reduced in the middle temporal gyrus in the left interictal epileptiform discharges (IED+) group, compared with the left IED- group (p < 0.05). SIGNIFICANCE: Using a responsive reading naming fMRI paradigm, right MTS patients who presented left temporal interictal epileptiform abnormalities on video-EEG showed decreased LI in the middle temporal gyrus, indicating decreased left middle temporal gyrus activation, increased right middle temporal gyrus activation or a combination of both, demonstrative of language network reorganization, specially in the MTG, in this patient population. PLAIN LANGUAGE SUMMARY: This research studied 22 patients with right mesial temporal sclerosis (a specific type of epilepsy) comparing them to 22 healthy individuals. Participants were asked to perform a language task while undergoing a special brain imaging technique (fMRI). The findings showed that patients with epilepsy displayed a change in the area of the brain typically responsible for language processing. This suggests that their brains may have adapted due to their condition, altering the way language is processed.
Assuntos
Epilepsia do Lobo Temporal , Epilepsia , Esclerose Hipocampal , Humanos , Encéfalo , IdiomaRESUMO
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.
Assuntos
Epilepsia do Lobo Temporal , Esclerose Hipocampal , Humanos , Epilepsia do Lobo Temporal/cirurgia , Lobo Temporal/patologia , Lobo Temporal/cirurgia , Transtornos da Memória/etiologia , Transtornos da Memória/patologia , Eletroencefalografia , Esclerose/complicações , Esclerose/patologiaRESUMO
OBJECTIVE: We evaluated extratemporal metabolic changes with phosphorus magnetic resonance spectroscopy (31P-MRS) in patients with unilateral mesial temporal sclerosis (MTS). METHOD: 31P-MRS of 33 patients with unilateral MTS was compared with 31 controls. The voxels were selected in the anterior, posterior insula-basal ganglia (AIBG, PIBG) and frontal lobes (FL). Relative values of phosphodiesters- PDE, phosphomonoesters-PME, inorganic phosphate - Pi, phosphocreatine- PCr, total adenosine triphosphate [ATPt = γ- + a- + b-ATP] and the ratios PCr/ATPt, PCr/γ-ATP, PCr/Pi and PME/PDE were obtained. RESULTS: We found energetic abnormalities in the MTS patients compared to the controls with Pi reduction bilaterally in the AIBG and ipsilaterally in the PIBG and the contralateral FL; there was also decreased PCr/γ-ATP in the ipsilateral AIBG and PIBG. Increased ATPT in the contralateral AIBG and increased γ-ATP in the ipsilateral PIBG were detected. CONCLUSION: Widespread energy dysfunction was detected in patients with unilateral MTS.
Assuntos
Espectroscopia de Ressonância Magnética/métodos , Fósforo/metabolismo , Lobo Temporal/patologia , Adulto , Estudos de Casos e Controles , Epilepsia do Lobo Temporal/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose/diagnóstico , Esclerose/metabolismo , Lobo Temporal/metabolismo , Adulto JovemRESUMO
ABSTRACT Objective We evaluated extratemporal metabolic changes with phosphorus magnetic resonance spectroscopy (31P-MRS) in patients with unilateral mesial temporal sclerosis (MTS). Method 31P-MRS of 33 patients with unilateral MTS was compared with 31 controls. The voxels were selected in the anterior, posterior insula-basal ganglia (AIBG, PIBG) and frontal lobes (FL). Relative values of phosphodiesters- PDE, phosphomonoesters-PME, inorganic phosphate - Pi, phosphocreatine- PCr, total adenosine triphosphate [ATPt = γ- + a- + b-ATP] and the ratios PCr/ATPt, PCr/γ-ATP, PCr/Pi and PME/PDE were obtained. Results We found energetic abnormalities in the MTS patients compared to the controls with Pi reduction bilaterally in the AIBG and ipsilaterally in the PIBG and the contralateral FL; there was also decreased PCr/γ-ATP in the ipsilateral AIBG and PIBG. Increased ATPT in the contralateral AIBG and increased γ-ATP in the ipsilateral PIBG were detected. Conclusion Widespread energy dysfunction was detected in patients with unilateral MTS.
RESUMO Objetivo Nós avaliamos as alterações metabóblicas através da espectroscopia de fósforo por ressonância magnética (31P-MRS) em pacientes com esclerose mesial temporal (EMT) unilateral. Método 31P-MRS de 33 pacientes com EMT unilateral foram comparadas aos de 31 controles. Foram selecionados os voxels nas regiões insulonuclear anterior e posterior (RINA e RINP) e frontal (RF). Os valores relativos de fosfodiésteres – PDE, fosfomonoésteres- PME, fosfato inorgânico- Pi, fosfocreatina –PCr, adenosina trifosfato total [ATPt = γ- + a- + b-ATP] e as razões PCr/ATPt, PCr/γ-ATP, PCr/Pi e PME/PDE foram obtidas. Resultados Nós encontramos anormalidades em pacientes com EMT em comparação aos controles. Redução de Pi nas RINA bilateralmente, RINP ipsilateral e RF contralateral, redução de PCr/γ-ATP nas RINA e RINP ipsilaterais foram detectadas. Aumentos de ATPT na RINA contralateral e aumento de γ-ATP na RINP ipsilateral também foram encontradas. Conclusão Disfunção energética difusa foi encontrada em pacientes com EMT unilateral.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Fósforo/metabolismo , Lobo Temporal/patologia , Espectroscopia de Ressonância Magnética/métodos , Esclerose/diagnóstico , Esclerose/metabolismo , Lobo Temporal/metabolismo , Estudos de Casos e Controles , Epilepsia do Lobo Temporal/metabolismoRESUMO
PURPOSE: Material-specific memory impairment is used as a lateralizing tool in the evaluation of temporal lobe epilepsy. Lateralizing ability of material-specific memory deficits in temporal lobe epilepsy remains controversial. METHODS: We studied memory impairment profiles of verbal and nonverbal memory deficits with eight memory subtests of four neuropsychological instruments (two verbal and two nonverbal) in 87 right-handed patients with epilepsy associated with unilateral mesial temporal sclerosis (MTS; 44 right - R, 43 left - L) and 42 controls, with an IQ >70, at least 8 years of education, and without comorbidities. KEY FINDINGS: Selective verbal memory impairment was noted in 11 of 43 or 25.6% of left MTS cases, with 82.2% specificity, whereas selective nonverbal memory impairment was noted in 11 of 42 or 26.2% of right MTS cases, with 92% specificity. Nonlateralizing profiles of memory performance were seen in the remaining 65 of 87 patients. Approximately half (46/87 or 52.9%) of the patients had intact memory function in both modalities, equally distributed between patients with right MTS (23/44) and left MTS (23/43). Global impairment of both memory types was seen in 12 of 87 or 13.8% of patients, equally distributed between the two groups (7/43 left and 5/44 right). SIGNIFICANCE: Lateralizing profiles of selective verbal and nonverbal memory deficits are highly specific for left and right MTS, although infrequently encountered in our patients. Nonlateralizing profiles predominated in this population. These findings suggest hemispheric asymmetry memory function, with complex functional interaction of the hippocampi, and possible compensatory mechanisms in the setting of a unilateral lesion.
Assuntos
Epilepsia do Lobo Temporal/complicações , Hipocampo/patologia , Transtornos da Memória/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Epilepsia do Lobo Temporal/patologia , Feminino , Humanos , Masculino , Transtornos da Memória/epidemiologia , Transtornos da Memória/patologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Esclerose , Adulto JovemRESUMO
PURPOSE: The aim of this study was to evaluate phospholipid metabolism in patients with malformations of cortical development (MCDs). METHODS: Thirty-seven patients with MCDs and 31 control subjects were studied using three-dimensional phosphorus magnetic resonance spectroscopy ((31)P-MRS) at 3.0 T. The voxels in the lesions and in the frontoparietal cortex of the control subjects were compared (the effective volumes were 12.5 cm(3)). Robust quantification methods were applied to fit the time-domain data to the following resonances: phosphoethanolamine (PE); phosphocholine (PC); inorganic phosphate (Pi); glycerophosphoethanolamine (GPE); glycerophosphocholine (GPC); phosphocreatine (PCr); and α-, ß-, and γ-adenosine triphosphate (ATP). We also estimated the total ATP (ATP(t) = α-+ß-+γ-ATP), phosphodiesters (PDE = GPC+GPE), phosphomonoesters (PME = PE+PC), and the PME/PDE, PCr/ATP(t) and PCr/Pi ratios. The magnesium (Mg(2+)) levels and pH values were calculated based on PCr, Pi, and ß-ATP chemical shifts. KEY FINDINGS: Compared to controls and assuming that a p-value < 0.05 indicates statistical significance, the patients with MCDs exhibited significantly lower pH values and higher Mg(2+) levels. In addition, the patients with MCDs had lower GPC and PDE and an increased PME/PDE ratio. SIGNIFICANCE: Mg(2+) and pH are important in the regulation of bioenergetics and are involved in many electrical activity pathways in the brain. Our data support the idea that neurometabolic impairments occur during seizure onset and propagation. The GPC, PDE, and PME/PDE abnormalities also demonstrate that there are membrane turnover disturbances in patients with MCDs.
Assuntos
Encéfalo/metabolismo , Espectroscopia de Ressonância Magnética , Malformações do Desenvolvimento Cortical/diagnóstico , Malformações do Desenvolvimento Cortical/metabolismo , Fósforo/metabolismo , Trifosfato de Adenosina , Adolescente , Adulto , Encéfalo/patologia , Criança , Feminino , Seguimentos , Glicerilfosforilcolina , Humanos , Processamento de Imagem Assistida por Computador/métodos , Magnésio/metabolismo , Masculino , Pessoa de Meia-Idade , Diester Fosfórico Hidrolases , Monoéster Fosfórico Hidrolases , Isótopos de Fósforo , Adulto JovemRESUMO
PURPOSE: Video electroencephalography (vEEG) monitoring of patients with unilateral mesial temporal sclerosis (uMTS) may show concordant or discordant seizure onset in relation to magnetic resonance imaging (MRI) evidence of MTS. Contralateral seizure usually leads to an indication of invasive monitoring. Contralateral seizure onset on invasive monitoring may contraindicate surgery. We evaluated long-term outcome after anteromesial temporal lobectomy (AMTL) in a consecutive series of uMTS patients with concordant and discordant vEEG findings, uniformly submitted to AMTL on the MRI evidence of MTS side without invasive monitoring. METHODS: We compared surgical outcome of all uMTS patients undergoing vEEG monitoring between January 1999 and April 2005 in our service. Discordant cases were defined by at least one seizure onset contralateral to the MRI evidence of MTS. Good surgical outcome was considered as Engel's class I. We also evaluated ictal SPECT concordance to ictal EEG and surgical outcome. RESULTS: Fifty-four patients had concordant (C) and 22 had discordant (D) scalp EEG and MRI. Surgical outcome was similar in both groups (C = 74% versus D = 86%). Duration of follow-up was comparable in both groups: C = 56.1 +/- 20.7 months versus D = 59.8 +/- 21.2 months (p = 0.83, nonsignificant). Discordant single-photon emission computed tomography (SPECT) results did not influence surgical outcome. DISCUSSION: Surgical outcome was not influenced by contralateral vEEG seizure onset or contralateral increased flow on ictal SPECT. Although vEEG monitoring should still be performed in these patients, to rule out psychogenic seizures and extratemporal seizure onset, a potentially risky procedure such as invasive monitoring may not only not be indicated in this patient population, but may also lead to patients erroneously being denied surgery.
Assuntos
Eletroencefalografia , Epilepsia do Lobo Temporal , Esclerose , Lobo Temporal/patologia , Lobo Temporal/cirurgia , Cirurgia Vídeoassistida/métodos , Adolescente , Adulto , Idoso , Lobectomia Temporal Anterior/métodos , Criança , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/etiologia , Epilepsia do Lobo Temporal/cirurgia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose/complicações , Esclerose/diagnóstico , Esclerose/cirurgia , Lobo Temporal/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do TratamentoRESUMO
PURPOSE: Hypothalamic hamartoma (HH) related epilepsy presents with gelastic seizures (GS), other seizure types and cognitive deterioration. Although seizure origin in GS has been well established, non-GS are poorly characterized. Their relationship with the HH and cognitive deterioration remains poorly understood. We analyzed seizure type, spread pattern in non-GS and their relationship with the epileptic syndrome in HH. METHODS: We documented all current seizure types in six adult patients with HH-epilepsy with video-EEG monitoring, characterized clinical-electrographic features of gelastic and non-gelastic seizures and correlated these findings with cognitive profile, as well as MRI and ictal SPECT data. RESULTS: Only four seizure types were seen: GS, complex partial (CPS), tonic seizures (TS) and secondarily generalized tonic-clonic seizures (sGTC). An individual patient presented either CPS or TS, but not both. GS progressed to CPS or TS, but not both. Ictal patterns in GS/TS and in GS/CPS overlapped, suggesting ictal spread from the HH to other cortical regions. Ictal SPECT patterns also showed GS/TS overlap. Patients with GS-CPS presented a more benign profile with preserved cognition and clinical-EEG features of temporal lobe epilepsy. Patients with GS-TS had clinical-EEG features of symptomatic generalized epilepsy, including mental deterioration. CONCLUSIONS: Video-EEG and ictal SPECT findings suggest that all seizures in HH-related epilepsy originate in the HH, with two clinical epilepsy syndromes: one resembling temporal lobe epilepsy and a more catastrophic syndrome, with features of a symptomatic generalized epilepsy. The epilepsy syndrome may be determined by HH size or by seizure spread pattern.
Assuntos
Transtornos Cognitivos/etiologia , Epilepsias Parciais/etiologia , Epilepsia Tônico-Clônica/etiologia , Hamartoma/complicações , Doenças Hipotalâmicas/complicações , Adolescente , Adulto , Transtornos Cognitivos/patologia , Transtornos Cognitivos/fisiopatologia , Eletroencefalografia , Epilepsias Parciais/patologia , Epilepsias Parciais/fisiopatologia , Epilepsia Tônico-Clônica/patologia , Epilepsia Tônico-Clônica/fisiopatologia , Feminino , Humanos , Masculino , Tomografia Computadorizada de Emissão de Fóton Único , Gravação em VídeoRESUMO
Este relato pretende divulgar a pesquisa em epilepsia na infância realizada por diferentes centros no nosso país. Estas informações foram apresentadas durante o Fórum Nacional de Epilepsia (XX Congresso Brasileiro de Neurofisiologia Clínica), e ilustram os esforços de cada grupo para promover pesquisa e conhecimentos sobre epilepsia em populações pediátricas. Os principais temas pesquisados incluem epidemiologia, eletrencefalografia, genética e aspectos cognitivos em crianças com epilepsia, estudos controlados de drogas antiepilépticas em diferentes síndromes epilépticas da infância, dieta cetogênica, crises únicas e crises febris, epilepsia do lobo frontal e do lobo temporal, síndrome de West e espasmos infantis, estado de mal epiléptico, malformações do desenvolvimento cortical, sono e epilepsia, cirurgia de epilepsia, co-morbidade psiquiátrica e aspectos de neuroimagem associados à epilepsia na infância. Alguns centros relataram a realização de estudos colaborativos envolvendo diferentes instituições, uma importante ferramenta para o desenvolvimento da pesquisa em epilepsia na infância em nosso país.(AU)
This report describes current pediatric epilepsy research carried out in Brazilian academic centers, presented at the National Epilepsy Forum, during the XX Brazilian Clinical Neurophysiology Congress. It illustrates the different groups efforts to promote research and increase awareness of epilepsy in the pediatric population. Main current research lines include epidemiology, electroencephalography, genetic and cognitive issues in pediatric epilepsy, controlled clinical trials with antiepileptic drugs in different childhood epileptic syndromes, ketogenic diet, single and febrile seizures, temporal and frontal lobe epilepsy, West syndrome-infantile spasms, status epilepticus, malformations of cortical development, sleep and epilepsy, epilepsy surgery in childhood, psychiatric co-morbities and neuroimaging in childhood epilepsy. Collaborative studies, an important tool in fostering research in pediatric epilepsy in our country, are being carried out by some academic centers.(AU)
Assuntos
Humanos , Epilepsia do Lobo Temporal , Pesquisa Científica e Desenvolvimento Tecnológico , Síndromes EpilépticasRESUMO
Neuronal ceroid lipofuscinosis (NCL) were traditionally classified according to age of onset and clinical features in four main groups. Recently, a combination of clinical, ultra structural and genetics data led to the recognition of eight forms of NCL, providing a more precise framework to classify atypical cases. By the other hand, it was shown that mutations in the same gene could be responsible for a large variety of clinical phenotypes. The objective of this study is to describe two brothers with clinical and electroencephalographic abnormalities characteristic of juvenile NCL, but with ultra structural abnormalities suggestive of late infantile NCL. Electroencephalogram is useful for clinical diagnosis of NCL but it is not helpful in its classification.
Assuntos
Lipofuscinoses Ceroides Neuronais/diagnóstico , Adolescente , Criança , Eletroencefalografia , Genótipo , Humanos , Masculino , Mutação , Lipofuscinoses Ceroides Neuronais/classificação , Lipofuscinoses Ceroides Neuronais/genética , FenótipoRESUMO
Tradicionalmente, as lipofuscinoses ceróides neuronais (LCN) eram classificadas de acordo com a idade de início e características clínicas em quatro grandes grupos. Recentemente, os estudos genéticos possibilitaram uma classificação mais pormenorizada dessa entidade em oito formas, permitindo o diagnóstico mais preciso de casos previamente considerados atípicos. Por outro lado, foi demonstrado que mutações de um mesmo gene poderiam ser responsáveis por grande variedade de fenótipos clínicos. O objetivo deste estudo é apresentar dois irmãos com achados clínicos e eletrencefalográficos compatíveis com a forma juvenil de LCN mas com alterações ultra-estruturais características da forma infantil tardia dessa doença. Os achados eletrencefalográficos auxiliam no diagnóstico da LCN, mas pouco contribuem na sua classificação.
Assuntos
Adolescente , Criança , Humanos , Masculino , Lipofuscinoses Ceroides Neuronais/diagnóstico , Eletroencefalografia , Genótipo , Mutação , Lipofuscinoses Ceroides Neuronais/classificação , Lipofuscinoses Ceroides Neuronais/genética , FenótipoRESUMO
As encefalopatias epilépticas, como a Síndrome de Landau-Kleffner, são síndromes clínico-eletrencefalográficas progressivas cuja deterioração é tida como consequência das crises epilépticas frequêntes e da atividade epileptiforme abundante. Em crianças com transtorno invasivo do desenvolvimento, a prevalência de epilepsia é maior do que na população em geral e a regressão do comportamento social e linguagem ocorre em 30 por cento. Esta revisão analisou as evidências de que os paroxismos epileptiformes inerictais estão associados com a disfunção cognitiva transitória e discutiu as implicações destas observações nas anormalidades comportamentais autísticas. O DSM-IV-TR 9Diagnostic and Statistic Manual of Mental Disorders, Fourth Edition) e o CID 10 (Classificação Internacional das Doenças, 10 th edição) foram usados para caracterizar os transtornos invasivos do desenvolvimento. O banco de dados PubMed foi usado para revisar os artigos e resumos mais pertinentes. Em crianças com transtorno invasivo do desenvolvimento, as crises epilépticas ocorrem em aproximadamente 10-20 por cento e 8-10 por cento tem paroxismos epileptiformes sem crises clínicas. Trinta por cento das crianças com transtorno invasivo do desenvolvimento tem regressão do comportamento social e linguagem por volta dos 2-3 anos de idade, como observado em algumas encefalopatias epilépticas. Devido a estas analogias, alguns autores especulam que a regressão é causada pela atividade epileptiforme mesmo na ausência de crises clínicas e sugerem que a eliminação da atividade epileptiforme, clínica ou cirurgicamente, deveria levar a melhora do comportamento. Até o momento, não há evidência de que os paroxismos intericatis per se causem (ou contribuam para) o fenótipo comportamental complexo que é observado nos transtornos invasivos do desenvolvimento. Não há justificativa para o uso de drogas entiepilépticas ou cirurgia em crianças com transtornos invasivos do desenvolvimento sem crises, ou seja, não há evidência de que o tratamento dos paroxismos epileptiformes terão um efeito terapêutico nas anormalidades comportamentais dos transtornos invasivos do desenvolvimento
Assuntos
Transtorno Autístico , Comportamento , Eletroencefalografia , Epilepsia , Idioma , Regressão PsicológicaAssuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Epilepsia/diagnóstico , Epilepsia/classificaçãoRESUMO
This is a retrospective study of 21 surgically treated patients with temporal lobe tumors and epilepsy. Evaluation included clinical data, EEG findings, structural scans, pathological diagnosis and post-surgical follow-up. There were 9 cases of ganglioglioma, 5 pilocytic astrocytoma, 3 ganglioneuroma, 2 dysembryoplastic neuroepithelial tumor, 1 pleomorphic xantoastrocytoma, and 1 meningioangiomatosis. Mean follow-up time was 22 months and outcome was evaluated according to Engel's classification; 76.2 percent were classified in class I and 23.8 percent in II and III. All patients classes II and III had been submitted to mesial and neocortical resections. There were no differences related to clinical characteristics, pathological diagnosis or duration of follow-up in patients seizure-free or not. All patients had abnormal MRI and ten of these had normal CT; the MRI characteristics were compared to pathological diagnosis and specific histological characteristics of the tumors were not discernible by MRI. We concluded that MRI was essential for the diagnosis and precise location of TL tumors. Ganglioglioma was the most frequent tumor and lesionectomy associated to mesial resection doesn't guarantee a better prognosis
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Neoplasias Encefálicas/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Lobo Temporal/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/etiologia , Seguimentos , Imageamento por Ressonância Magnética , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Descrevemos um caso de arritmia cardíaca como manifestaçao epiléptica. A monitorizaçao video-eletrencefalográfica de uma paciente com 34 anos de idade que apresentava episódios de perda de consciência permitiu a detecçao de períodos de assistolia como principal manifestaçao clínica, exigindo a implantaçao de marca-passo. O registro eletrencefalográfico concomitante mostrou atividade rítmica a 6-7 Hz de projeçao na regiao temporal esquerda. A ressonância magnética mostrou lesao expansiva no giro para-hipocampal esquerdo. Alteraçoes do ritmo cardíaco como taquicardia sinusal sao frequentes em crises epilépticas. A descriçao de bradicardia e/ou assistolia é rara. As conexoes das estruturas mesiais temporais com estruturas profundas como o hipotálamo devem ser responsáveis pelas manifestaçoes vegetativas durante crises epilépticas temporais
Assuntos
Humanos , Feminino , Adulto , Bradicardia/etiologia , Epilepsia do Lobo Temporal/complicações , Bradicardia/fisiopatologia , Eletrocardiografia , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/fisiopatologia , Imageamento por Ressonância Magnética , Lobo TemporalRESUMO
The analysis of the temporal lobe seizures through video-EEG systems shows that they often consist of a sequence of clinical and EEG features which may suggest the localization and the lateralization of the epileptogenic lobe. We analyzed clinical and EEG features of 50 temporal lobe seizures which were separated in group 1 with 25 patients (related to mesial temporal sclerosis) and group 2 with 25 patients (other neocortical temporal lesions). Among the auras, the epigastric type was the most frequent and predominated in group 1. There were differences between the two groups, considering dystonic and tonic posturing and versive head and eye movements. Dystonic posturing was always contralateral to the ictal onset and was considered the most useful lateralizing clinical feature. Ictal speech, spitting and blinking automatisms, prolonged disorientation for place and a greatest percentage of postictal language preservation occurred in right temporal seizures. Postictal aphasia and global disorientation predominated in left temporal seizures. EEG was important for lateralizing the epileptogenic lobe, specially considering rhythmic ictal activity and postictal findings.
Assuntos
Humanos , Eletroencefalografia , Epilepsia do Lobo Temporal/diagnóstico , Lateralidade Funcional/fisiologia , Distonia/fisiopatologia , Epilepsia do Lobo Temporal/fisiopatologia , Seguimentos , Imageamento por Ressonância Magnética , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/fisiopatologia , Lobo Temporal/fisiopatologiaRESUMO
Vinte e oito estudos intercríticos e 9 críticos/pós críticos de tomografia por emissäo de fóton único (SPECT) foram realizados em 27 pacientes com epilepsia do lobo temporal e esclerose mesial temporal. Estudos intercríticos localizaram corretamente a área epileptogênica em 19 (67 por cento) dos pacientes pela análise visual e 16 (61,5 por cento) pela semi quantitativa, com 10,7 e 15,3 por cento, de falsa lateralizaçä respectivamente. Todos os 9 estudos críticos/ pós críticos detectaram o hemosfério epileptogênico e permitiram localizaçäo correta da área epileptogênica em 5 de 9 pacientes cujos exames intercríticos haviam sido inonclusivos. Três estudos realizados durante crises secundariamente generalizadas e simétricas mostraram hiperfluxo restrito ao lobo temporal
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Compostos de Organotecnécio , Epilepsia do Lobo Temporal , Oxiquinolina , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Eletroencefalografia , Epilepsia do Lobo Temporal/cirurgia , Seguimentos , Imageamento por Ressonância Magnética , Período Pós-Operatório , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Analisamos as manifestaçöes clínicas de 27 crises parciais complexas do lobo temporal registradas em vídeo-EEG com ênfase nas manifestaçöes motoras, principalmente postura distônica, paresia crítica e versäo forçada dos olhos e cabeça. A origem das crises no lobo temporal foi baseada na concordância dos exames pré cirúrgicos, que incluiam vários EEGs intercríticos, alteraçöes na TC e RM do crânio, SPECT intercríticos e, em alguns pacientes, também críticos. 8 pacientes tiveram ressecçöes temporais; em 7 foi feita lobectomia temporal sendo demonstrada esclerose mesial temporal em 5; 1 paciente foi submetido a amígdalo-hipocampectomia seletiva e o achado anátomo-patológico consistiu de hemossiderose e glicose hipocampal, possivelmente decorrente de sangramento de um aneurisma gigante da artéria cerebral posterior. Todos os pacientes estäo sem crises após a cirurgia. Enquanto postura distônica e paresia crítica, presentes em 18(66,6 por cento) das crises, foram sempre contralaterais à área epileptôgênica e assim, de valor indiscutível para lateralizaçäo, versäo de olhos e cabeça ocorreu tanto ipso como contralateralmente