RESUMO
INTRODUCTION: The complicated forms of rolandic epilepsy progress with a continuous spike-wave pattern in slow-wave sleep. Experiments conducted in cats suggest that this pattern can only appear if there is bilateral thalamic insult. AIM. To determine whether thalamic hypoperfusion is associated with the complicated variants of rolandic epilepsy. PATIENTS AND METHODS: A group of 24 children were studied over a period of six years following their first epileptic seizure. During the follow-up an interictal magnetic resonance scan and single-photon emission computerised tomography (SPECT) were performed. Results were examined to ascertain whether there were asymmetries in the distribution of cerebral blood flow through structures, using parametric statistical maps. The brain SPECT was performed when progression to atypical benign partial epilepsy in infancy was diagnosed and in typical forms of rolandic epilepsy when there was some mild neuropsychological deficit that led the specialist to suspect the existence of a focal cortical lesion. RESULTS: Bilateral thalamic hypoperfusion was found in all patients diagnosed with atypical benign partial epilepsy in infancy, which was correlated with the presence of continuous spike-waves during the slow-wave phase of non-REM sleep. CONCLUSIONS: Bilateral thalamic hypoperfusion seems to be a necessary condition for the atypical progression of rolandic epilepsy.
Assuntos
Epilepsia Rolândica , Imageamento por Ressonância Magnética/métodos , Tálamo , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Animais , Gatos , Circulação Cerebrovascular , Criança , Pré-Escolar , Progressão da Doença , Eletroencefalografia , Epilepsia Rolândica/patologia , Epilepsia Rolândica/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/fisiopatologia , Fluxo Sanguíneo Regional , Tálamo/patologia , Tálamo/fisiopatologiaRESUMO
INTRODUCTION: Benign focal epilepsy in infancy with centro-temporal paroxysms is a frequent form of epilepsy within this group of epilepsies. Despite its relative benignity, however, it may be accompanied by neuropsychological deficits and therefore constitutes a suitable in vivo model for studying how the brain functions when processing information. CASE REPORT: We report the case of a 7-year-old child who began with this type of epilepsy by manifesting focal seizures during the early stages of sleep and who, with the absence of any continuous spike-wave activity in non-REM sleep, presented transient unilateral neglect syndrome on the right-hand side related with electroencephalographic intercritical activity. CONCLUSIONS: The neuropsychological manifestations in this type of epilepsy can be due to intercritical paroxysmal activity. The clinical features depend on where the paroxysms are located and in which direction they spread. A dysfunction of the physiological neuronal synchrony among the neuronal networks that are necessary for thinking processes could be the cause of this disorder.