ABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Phosphorus/metabolism , Temporal Lobe/pathology , Magnetic Resonance Spectroscopy/methods , Sclerosis/diagnosis , Sclerosis/metabolism , Temporal Lobe/metabolism , Case-Control Studies , Epilepsy, Temporal Lobe/metabolismABSTRACT
Durante a XXX Reunião da Liga Brasileira de Epilepsia, ocorrida durante o XX Congresso Brasileiro de Neurofisiologia Clínica em Gramado, a Comissão de Aspectos Legais optou-se por colocar em pauta a discussão da Portaria nº 391 de 07 de julho de 2005 do Ministério da Saúde (http://dtr2001.saude.gov.br/sas/portarias/ port2005/pt-391). Tendo por objetivo regulamentar a assistência de alta complexidade ao paciente com doença neurológica, a portaria 391 define que a rede de assistência a este paciente será composta por Unidades de Assistência de Alta Complexidade em Neurocirurgia (UAAC em NC) e Centros de Referência de Alta Complexidade em Neurocirurgia (CRAC em NC). A Cirurgia de Epilepsia passa então a ser um dos procedimentos oferecidos por um CRAC em NC. As implicações práticas desta regulamentação serão discutidas.(AU)
In the XXX Brazilian Epilepsy Meeting, taking place during the XX Brazilian Clinical Neurophysiology Meeting in Gramado, the Commission for Legal Aspects decided to discuss the Health Ministry Decision number 391 of July 07 2005 (http://dir2001.saude.gov.br/sas/portarias/port2005/pt-391). This decision defined that the high complexity neurological assistance, in the public health system, will be offered in two hierarchic different centers: Higt Complexity Neurosurgical Units and High Complexity Neurosurgical Reference Centers. Epilepsy Surgery can only take place in a High Complexity Neurosurgical Reference Center. The possible consequences of this decision will be discussed.(AU)
Subject(s)
Credentialing/legislation & jurisprudence , Ordinances , Epilepsy , National Health Systems/legislation & jurisprudence , JurisprudenceABSTRACT
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
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Brain Neoplasms/surgery , Epilepsy, Temporal Lobe/surgery , Temporal Lobe/surgery , Brain Neoplasms/complications , Brain Neoplasms/diagnosis , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/etiology , Follow-Up Studies , Magnetic Resonance Imaging , Neoplasm Staging , Prognosis , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
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