Epileptogénesis y corteza piriforme: entendiendo a la epilepsia del lóbulo temporal más allá del hipocampo / Epileptogenesis and the piriform cortex: understanding temporal lobe epilepsy beyond the hippocampus

Introducción: Con la experiencia de los registros electroencefalográficos invasivos y el fracaso quirúrgico después de la cirugía, se ha hecho evidente que la epilepsia del lóbulo temporal es mucho más compleja de lo que se creía, y en la actualidad es considerada una enfermedad de redes anatomofuncionales y no de lesiones estructurales. Contenido: La información neurofisiológica e imagenológica actual permite concluir que en esta epilepsia están involucradas varias redes neuronales temporales y extratemporales que contribuyen a la extensión de la zona epileptógena. Una forma de entender el concepto de red epiléptica en la epilepsia del lóbulo temporal es a partir del conocimiento de la corteza piriforme. Varios estudios clínicos han mostrado que en pacientes con epilepsia del lóbulo temporal asociada a esclerosis hipocampal existe una disfunción interictal del procesamiento olfatorio que es más significativa, en comparación con pacientes con epilepsia focal extrahipocampal y controles sanos. Esta alteración es, probablemente, la consecuencia de una red neuronal disfuncional que se extiende más allá del hipocampo y que afecta a otras estructuras cercanas, incluida la corteza piriforme. Conclusión: En este artículo llevamos a cabo una revisión narrativa de la literatura con el objetivo de establecer un vínculo entre la corteza piriforme y la epileptogénesis del lóbulo temporal, y demostramos que esta enfermedad es la consecuencia de una disfunción de redes neuronales que no depende exclusivamente de una anormalidad estructural en el hipocampo o en estructuras cercanas.

Introduction: With the experience of invasive EEG recordings and surgical failure after surgery, it has become clear that temporal lobe epilepsy is much more complex than previously thought, and currently, is conceptualized as a disease of anatomical networks instead of structural lesions. Content: The current neurophysiological and imaging information allows us to conclude that several temporal and extratemporal anatomical networks are involved in this type of epilepsy. One way of understanding the concept of the epileptic network in temporal lobe epilepsy is from the knowledge of the piriform cortex. Several clinical studies have shown that in patients with temporal lobe epilepsy associated with hippocampal sclerosis exists an interictal dysfunction of olfactory processing that is more significant compared to patients with focal extra-hippocampal epilepsy and healthy controls. This alteration is probably the consequence of a dysfunctional neural network that extends beyond the hippocampus and affects other nearby structures, including the piriform cortex. Conclusion: In this article, we carry out a narrative review of the literature with the aim of establishing a link between the piriform cortex and temporal lobe epileptogenesis, demonstrating that this disease is the consequence of a dysfunctional network that does not depend exclusively of a hippocampal structural abnormality.

Differential Clinical Features in Colombian Patients With Rolandic Epilepsy and Suggestion of Unlikely Association With GRIN2A, RBFOX1, or RBFOX3 Gene Variants.

PURPOSE: Our purpose was to describe the phenotypic features and test for association of genes GRIN2A, RBFOX1 and RBFOX3 with rolandic epilepsy in patients from Colombia. METHODS: Thirty patients were enrolled. A structured interview was applied. In addition, saliva samples were collected from the patients and their parents. One polymorphism in each of GRIN2A, RBFOX1 and RBFOX3 genes was tested. RESULTS: The average age at onset was 5.3 years. Almost half the sample presented prolonged seizures (>5 minutes); although the majority of the patients presented their seizures only while asleep, over a quarter presented them only while awake. The most frequent comorbidity was the presence of symptoms compatible with attention-deficit hyperactivity disorder (ADHD). Personal history of febrile seizures and parasomnias were equally frequent (20%). Family history of any type of epilepsy was reported in 80% of the patients, followed by migraine (73.3%) and poor academic performance (63.3%). About half the sample reported sleepwalking in parents or sibs. Most patients had received pharmacologic treatment. We found no association of rolandic epilepsy with the single nucleotide polymorphisms tested. CONCLUSIONS: Our rolandic epilepsy cohort presents clinical features clearly different from other cohorts. For instance, age at onset is much earlier in our set of patients, and personal and family history of febrile seizures as well as parasomnias are highly prevalent in our sample. No association of rolandic epilepsy with variants at the 3 genes tested was found. This lack of association may reflect the high genetic heterogeneity of the epilepsies.

Benign rolandic epilepsy of childhood and central auditory processing disorder: A noncasual neurophysiological association.

PURPOSE: The purpose of this study was to demonstrate the association between benign rolandic epilepsy of childhood (BREC) and central auditory processing disorders (CAPDs) and to test the hypothesis that an early onset of BREC could be associated with more cases of CAPD. METHOD: This study has a retrospective cross-sectional design conducted from January 2006 to January 2016 including 93 patients with BREC and without intellectual disability, dyslexia, and attention-deficit hyperactivity disorders. All patients were evaluated for central auditory processing (CAP), and its presence or absence was compared with age of seizure onset. RESULTS: In all patients, audiometric test results were normal, and in 43 cases (46.2%), CAPD was detected. There was no significant statistical difference in the mean age of seizure onset. CONCLUSION: A significant proportion of children with BREC will have a diagnosis of CAPD at school age.

The relevance of attention deficit hyperactivity disorder in self-limited childhood epilepsy with centrotemporal spikes.

In this study, we aimed to evaluate the attentional and executive functions in patients with benign childhood epilepsy with centrotemporal spikes (BCECTS) with and without attention-deficit hyperactivity disorder (ADHD) compared with controls and compared with patients with ADHD without epilepsy. We evaluated 12 patients with BCECTS and ADHD (66.7% boys; mean age of 9.67years); 11 children with non-ADHD BCECTS (63.6% boys; mean age of 11.91years); 20 healthy children (75% boys; mean age of 10.15years); and 20 subjects with ADHD without epilepsy (60% boys; mean age of 10.9years). We used a comprehensive battery of neuropsychological tests to evaluate attentional and executive functions in their broad domains. Patients with BCECTS and ADHD had worse performance in Conners' Continuous Performance Test II (reaction time standard error [p=0.008], variability [p=0.033], perseverations [p=0.044] and in reaction time interstimuli interval [p=0.016]). Patients with ADHD showed worse performance in Trail Making Test B errors [p=0.012]. In conclusion, patients with BCECTS and ADHD had worse executive and attentional performance compared with controls than non-ADHD patients with BCECTS. Regardless of the presence of epilepsy, ADHD also negatively impacted executive and attentional functions but in different executive subdomains compared with patients with epilepsy.

Benign rolandic epilepsy and generalized paroxysms: A study of 13 patients.

PURPOSE: To present a retrospective study of 13 children with benign epilepsy with centrotemporal spikes (BECTS), also known as benign rolandic epilepsy (BRE), associated with generalized spikes and waves as the only EEG manifestation at onset. METHOD: Charts of children with typical clinical criteria of BRE electroclinically followed-up between February 2000 and February 2015 were reviewed. RESULTS: Among 309 patients who met the electroclinical criteria of BRE, we identified 13 children who presented with the typical clinical manifestations but who, on the EEG, only had generalized paroxysms at onset that continued along the course of the syndrome. Generalized spike-and-wave discharges were observed in all patients when awake and during sleep (100%). During the evolution no particular electroclinical pattern was observed. The patients responded well to antiepileptic drugs, such as valproic acid and levetiracetam. Outcome was good in all patients. CONCLUSIONS: We found evidence that patients with BRE may have generalized EEG discharges at onset as the sole manifestation lasting throughout the course of the syndrome. In some, focal paroxysms developed later. The course was benign. In our group of patients, clinical features and evolution were similar to those of typical cases of BRE. Response to valproic acid and levetiracetam was found to be particularly good.

A propósito de la denominada epilepsia benigna con puntas centrotemporales (rolándicas) / Apropos the so-called benign epilepsy with centrotemporal spikes (rolandic)

La epilepsia benigna con puntas centrotemporales o rolándicas se caracteriza por crisis parciales motoras en la infancia y un electroencefalograma en que observan descargas de puntas en las regiones centrotemporales medias. Ha sido reconocida como benigna, debido a la ausencia de déficits neurológicos evidentes; sin embargo, en los últimos años en la literatura médica internacional han aparecido varias publicaciones que cuestionan su evolución favorable. El objetivo de este trabajo es actualizar algunos criterios que no concuerdan con el buen pronóstico referido inicialmente. Representa una etapa fundamental en la historia de la epilepsia, debido a que es la primera vez que se describió una epilepsia focal o parcial en la que se presumía que no existía una lesión cortical subyacente. La evolución de esta forma de epilepsia puede mostrar elementos que niegan su benignidad. Se recomienda en un futuro efectuar en nuestro servicio un estudio que confirme los criterios expuestos en la literatura médica internacional(AU)

Benign epilepsy with centrotemporal spikes, aka benign rolandic epilepsy, is characterized by partial motor crisis in childhood and electroencephalography showing point discharges in medial centrotemporal regions. The condition has been recognized as benign due to the absence of evident neurological deficits. However, in recent years several publications have appeared in international medical literature in which its favorable evolution is questioned. The objective of the present study is to update some criteria differing from the good prognosis initially stated. It constitutes a fundamental stage in the history of epilepsy, since for the first time a case of focal or partial epilepsy was being described in which presumably there did not exist an underlying cortical lesion. The evolution of this form of epilepsy may display features denying its benignity. It is recommended that in the future a study be conducted in our service confirming the criteria expounded in international medical literature(AU)

Caracterización de pacientes con Epilepsia Rolándica e identificación de factores de riesgo de evolución atípica / Characterization of Patients with Rolandic Epilepsy and Recognition of Risk Factors for an Atypical Course

La Epilepsia Rolándica (ER) o Epilepsia con espigas centrotemporales, es la epilepsia idiopática más frecuente, focal autolimitada, de buena evolución. Debuta entre los 3 a 13 años, con crisis estereotipadas durante el sueño, al inicio o al despertar, focales motoras y somatosensoriales. El electroencefalograma (EEG) muestra una base normal con actividad epileptiforme interictal centrotemporal, con espigas con escaso desarrollo de onda lenta, uni o bilaterales. Se describe en los últimos años una forma atípica de ER (ERA), asociando otros tipos de crisis, que responden peor a tratamiento, manteniendo crisis, con complicaciones neuropsicológicas asociadas y deterioro del EEG, observándose en algunos casos, actividad, continua o casi continua en sueño. El objetivo de este trabajo es caracterizar a los pacientes con ER que se controlan en Red Salud UC-Christus y describir la presencia de posibles factores de riesgo asociados a la evolución atípica de la ER. 16 pacientes con ER típica y otros 6 con ERA, ambos grupos edad promedio 6 años al debut presentación, de predominio sexo masculino, la mayoría con buen rendimiento escolar y examen neurológico normal. En ER, crisis de predominio focales y base de EEG 62% normal. EEG entre ocasional y muy frecuentes descargas epileptiformes. En ERA, solo un 33% base normal, y predominio crisis generalizadas. Mayoría evoluciona con descargas EEG contínuas o casi continuas en sueño No-REM. Hubo peor respuesta a FAEs en ERA. Concluimos que este estudio es concordante con lo descrito en la literatura actual para pacientes con ER y ERA, por lo que recomendamos considerar la presencia de posibles factores indicadores, iniciales o durante la evolución, de formas atípicas de ER.

Abstract: Rolandic Epilepsy (ER) or epilepsy with centrotemporal spikes, is a focal and selflimited epilepsy and it is the most frequent and well-recognized idiopathic epilepsy. It is characterized by an age of presentation between 3 and 13 years, with stereotyped seizures during sleep, at the beginning or on awakening, which can be focal, motor and sensory. The electroencephalogram shows a normal base with interictal epileptiform activity, centrotemporal spikes with poor slow wave development, which can be unilateral o bilateral. In recent years, an atypical presentation of Rolandic Epilepsy (ERA) has been described, with presence of other types of seizures, with poor response to treatment, continued seizures and associated neuropsychological complications and deterioration of the electroencephalogram, in some cases with continuous or almost continuous activity during sleep. Our work aims to characterize the patients that are controlled in the Red Salud UC-Christus and to describe the presence of possible risk factors associated with the atypical evolution of Rolandic Epilepsy. We studied 16 patients with typical ER and other 6 with ERA, both groups with an age average of 6 years at time of debut presentation, more frequent in males, most with good school performance and normal neurological examination. In ER there were focal prevalence seizures and 62% had an EEG with a normal base. The EEG showed occasional to very frequent epileptiform discharges. In ERA, only 33% of the EEG had a normal base, and it most frequently showed generalized seizure. Most of the patients followed up with continuous or nearly continuous discharges in the EEG during REM sleep. There was worse response to FAEs in ERA. We conclude that this study is consistent with that described in the current literature for patients with ER and ERA, we recommend physicians to consider the presence of possible initial of belated indicators of atypical forms of ER.

The executive profile of children with Benign Epilepsy of Childhood with Centrotemporal Spikes and Temporal Lobe Epilepsy.

RATIONALE: Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS) and temporal lobe epilepsy (TLE) represent two distinct models of focal epilepsy of childhood. In both, there is evidence of executive dysfunction. The purpose of the present study was to identify particular deficits in the executive function that would distinguish children with BECTS from children with TLE. METHODS: We prospectively evaluated 19 consecutive children and adolescents with TLE with hippocampal sclerosis (HS) (57.9% male; mean 11.74years [SD 2.05]; mean IQ 95.21 [SD 15.09]), 19 with BECTS (36.8% male; mean 10.95years [SD 2.33]; mean IQ 107.40 [SD 16.01]), and 21 age and gender-matched controls (33.3% male; mean 11.86years [SD 2.25]; mean IQ 108.67 [15.05]). All participants underwent a neuropsychological assessment with a comprehensive battery for executive and attentional functions. We used ANOVA and chi-square to evaluate differences on demographic aspects among groups (BECTS, TLE-HS, and control groups). Group comparisons on continuous variables were complemented by MANOVA and Bonferroni posthoc comparisons. RESULTS: Patients with BECTS had worse performance than controls in: Matching Familiar Figures Test, time (p=0.001); Matching Familiar Figures Test, time×errors index (p<0.001); Verbal Fluency for foods (p=0.038); Trail Making Test, part B time (p=0.030); Trail Making Test, part B number of errors (p=0.030); and WCST, number of categories achieved (p=0.043). Patients with BECTS had worse performance than patients with TLE-HS on Matching Familiar Figures Test, time (p=0.004), and Matching Familiar Figures Test, time×errors index (p<0.001). Patients with TLE-HS had worse performance than controls on the following tests: Verbal Fluency for foods (p=0.004); Wisconsin Card Sorting Test, the number of categories achieved (p<0.001); and Wisconsin Card Sorting Test, the number of perseverative errors (p=0.028). Patients with TLE-HS had worse performance than patients with BECTS on Digit Backward (p=0.002); and the Wisconsin Card Sorting Test, the number of perseverative errors (p<0.001). CONCLUSIONS: Patients with TLE and BECTS present distinct cognitive profiles. Patients with TLE-HS had worse performance in mental flexibility, concept formation, and working memory compared to BECTS. Patients with BECTS had worse inhibitory control compared to children with TLE-HS. Both TLE-HS and BECTS had a higher number of errors on an inhibitory control test. However, patients with BECTS had a slower mental processing even when compared to patients with TLE-HS. Rehabilitation programs for children with epilepsy must include children with benign epilepsies and must take into account the epileptic syndrome and its particular neurocognitive phenotype.

Working memory and phonological awareness in children with Rolandic Epilepsy / Memoria de trabajo y consciencia fonológica en niños con Epilepsia Rolándica

This study investigated how the difficulties in language in children with Rolandic Epilepsy (RE) could be related to alterations in their development of phonological awareness and/or working memory. We evaluated fourty-two children aged 6 to 13 years old. From these, twenty-one children were diagnosed with RE and formed the experimental group; and twenty-one children without RE, paired with the experimental group by sex, age, education and socioeconomic status, formed the control group. The results showed significant differences in the performances of children with RE and healthy children in the tests that evaluated working memory and phonological awareness. Also, positive and high significant correlations were found between working memory and phonological awareness in the RE clinical subgroup. Generally, the results suggest that compromises in both cognitive functions might be associated to loss of language capabilities in children with RE, and also point that the development of working memory and phonological awareness are interconnected.

En este estudio se investigó cómo las dificultades en el lenguaje en niños con epilepsia Rolandica (ER) podrían estar relacionadas con alteraciones en su desarrollo de la conciencia fonológica y/o memoria de trabajo. Se evaluaron 42 niños de 6 a 13 años de edad. De éstos, 21 niños fueron diagnosticados con ER y formaron el grupo experimental; y 21 niños sin RE, emparejados con el grupo experimental por sexo, edad, nivel educativo y socioeconómico, que formaron el grupo de control. Los resultados mostraron diferencias significativas en los resultados de los niños con ER y niños sanos en las pruebas que evaluaron la memoria de trabajo y la conciencia fonológica. Además, se encontraron correlaciones positivas y altas entre la memoria de trabajo y la conciencia fonológica en el subgrupo clínico RE. En general, los resultados sugieren que los compromisos en ambas funciones cognitivas pueden estar asociados a la pérdida de capacidades del lenguaje en los niños con RE, y también señalan que el desarrollo de la memoria de trabajo y la conciencia fonológica están interconectados.

Estudo prospectivo das funções cognitivas em epilepsia idiopática da infância através da ressonância magnética funcional / Study of cognitive function in idiopathic epilepsy of childhood by functional magnetic resonance imaging

Introdução: Uma importante aplicação da técnica de Ressonância Magnética funcional é em pesquisa clínica, acerca das funções cognitivas de pacientes, como por exemplo atenção, memória, linguagem, dentre outras. Pacientes com Epilepsia Idiopática da Infância podem apresentar déficits cognitivos e não possuem alterações estruturais detectáveis o que facilita a aplicação de técnicas computacionais de registro e normalização em estudos de neuroimagem o que possibilita a geração de imagens de um grupo de indivíduos e suas diversas possibilidades de inferências estatísticas. Este estudo teve como objetivo descrever as funções cognitivas em pacientes com Epilespia Rolândica (ER) e Epilepsia de Ausência (EA) através da RMf. Métodos: 57 indíviduos, 23 pacientes com ER ((média= 10,7 anos), 20 pacientes com EA (média= 9,9 anos) e 14 controles saudáveis (média=10 anos) foram submetidos ao vídeo-EEg, testes neuropsicológicos para avaliação das funções cognitivas (QI, funções executivas, dentre outras) e um paradigma de atenção Stoptask Gonogo e um paradigma Resting State (RS). Os dados foram analisados e foram gerados mapas limirializados de ativação da função BOLD. Resultados: As principais áreas ativas em pacientes e controles no paradigma Stoptask foram: hemisférios cerebelares bilateral, córtex orbito frontal bilateral, giros fusiformes, ínsula bilateral, córtex dorso latero pré-frontal, giro do Cíngulo anterior direito e esquerdo, bordas dos sulcos intraparietais, giros frontais superiores, eye-field.(p < 0,01). No paradigma RS as áreas encontradas foram: Córtex medial prefrontal, giro angular, giro supramarginal, giro do cíngulo posterior, giro frontal superior, sulco intraparietal, área motora suplementar, córtex prefrontal lateral (p < 0,05). OS mapas comparativos de grupos mostraram diferenças em ativaçao entre pacientes e controles. Discussão: Nossos mapas de ativação da resposta BOLD são semelhantes aos encontrados por outros autores na...

Introduction: An important application of functional MRI is in clinical research about the cognitive functions of patients, such as attention, memory, language, among others. Patients with Idiopathic Epilepsy of Childhood may show cognitive deficits and have no detectable structural changes which facilitates the application of computational techniques and standardization of registration in neuroimaging studies, which enables to obtain a group map of individuals and their various possibilities for statistical inferences. This study aimed to describe the cognitive functions in patients with Rolandic Epilepsy (RE) and absence epilepsy (AE) by fMRI. Methods: 57 individuals, 23 patients with RE (mean = 10.7 years), 20 patients with AE (mean = 9.9 years) and 14 healthy controls (mean = 10 years) underwent video-EEG, neuropsychological tests for assessment of cognitive function (IQ, executive functions, amongothers) theu also perform an attention paradigm Stoptask Gonogo and the Resting State (RS). Data were analyzed and maps were generated for BOLD activation function. Results: The main areas active in patients and controls in the paradigm Stoptask were bilateral cerebellar hemispheres, bilateral frontal orbital cortex, fusiform gyrus, bilateral insula, dorsal lateral prefrontal cortex, anterior cingulate gyrus right and left edges of the intraparietal sulcus, superior frontal gyrus, eye -field. (p < 0.01). In the RS paradigm areas observed were: medial prefrontal cortex, angular gyrus, supramarginal gyrus, posterior cingulate gyrus, superior frontal gyrus, intraparietal sulcus, supplementary motor area, lateral prefrontal cortex (p < 0.05). there were no statistically significant differences between group means (p < 0,01)Discussion: Our activation maps of BOLD response are similar to those found by other authors in the literature both in Stoptask paradigm as in the RS. The diferences between groups may be due cognitive deficts in patients group. Conclusions:...

Clinical and neuropsychological correlation in patients with rolandic epilepsy / Correlação entre achados clínicos e neuropsicológicos em pacientes com epilepsia rolândica

OBJECTIVES: To evaluate the presence of neurological soft signs (NSS) and to correlate them with the Wechsler Intelligence Scale for Children (WISC III) in patients with rolandic epilepsy (RE). METHODS: Forty children and adolescents aged between 9 and 15 years were studied. They were divided into two groups: G1 - patients with RE (n=20) - and G2 - healthy controls without epilepsy (n=20). They were assessed with the Quick Neurological Screening Test (QNST II) - clinical trial to search for NSS -, and the WISC III - neuropsychological test. RESULTS: No statistical difference between groups was found in WISC III and QNST II. However, children with poorer motor skills had worse performance in the QNST II and also in the execution intelligence quotient - IQ (p=0.001) and in total IQ (p=0.004), thus showing a positive correlation between them. CONCLUSIONS: The QNST II is a good screening tool for the neurologist to detect abnormalities in fine motor skills.

OBJETIVOS: Avaliar a presença de sinais neurológicos menores (SNM) e correlacioná-los com o Escala de Inteligência de Wechsler para Crianças (WISC III) em pacientes com epilepsia rolândica (ER). MÉTODOS: Foram estudados 40 crianças ou adolescentes entre 9 e 15 anos, divididos em dois grupos: G1 - pacientes com ER (n=20); G2 - controles saudáveis sem epilepsia (n=20). Foram avaliados por meio do QNST II - teste clínico que pesquisa SNM - e do WISC III - teste neuropsicológico. RESULTADOS: Não foi encontrada nenhuma diferença estatística entre os grupos no WISC III e QNST II. Entretanto, crianças com habilidades motoras pobres tiveram pior desempenho no QNST II, assim como no quociente de inteligência (QI) de execução (p=0,001) e no QI total (p=0,004), mostrando, portanto, correlação positiva entre os dois instrumentos. CONCLUSÕES: O QNST II é uma boa ferramenta de rastreamento para o neurologista detectar anormalidades nas habilidades motoras finas.

Análisis espectral del electroencefalograma en pacientes con epilepsia rolándica / Spectral analysis of the electroencephalogram in patients with rolandic epilepsy

Objetivo: Describir la presencia de alteraciones de la actividad de base a través del análisis cuantitativo del EEG (QEEG) en pacientes portadores de Epilepsia Rolándica. Material y Método: Se realizó el análisis visual del EEG (29 pacientes) y el QEEG (26 pacientes). Los valores de poder absoluto y poder relativo obtenidos para cada paciente fueron comparados con una base de datos normativos mediante el estadígrafo transformada Z. Resultados: Se encontraron variaciones estadísticamente significativas de energía en 73,08 % de los casos: 73,68 % en las bandas lentas y 26,31 % para las rápidas. La topografía de la actividad lenta fue en regiones centro-temporales y/o centro-parietales 64,28 %, en las regiones anteriores y extratemporales 21,43 % y 14,28 % presentaron actividad lenta aislada extratemporal. Conclusiones: Las alteraciones significativas en la actividad de base electroencefalográfica antes descritas en los pacientes portadores de Epilepsia Rolándica, sugieren una posible relación con un disturbio maduracional o a la presencia de las descargas epileptiformes interictales.

Objective: To describe abnormalities of the background activity by quantitative analysis in patients with Rolandic Epilepsy. Methods: Visual (29 patients) and quantitative EEG (QEEG) (26 patients) analyses were done. Absolute and Relative Power values obtained in the patients were compared with those from a normative database (Z-Maps). Results: Q-EEG results showed a significative changes in a 73,08 % of the patients: 73,68 % in slow frequency and 26,31 % in rapid frequency. A focal significative increase in slow frequency in centro-temporal and/or centro-parietal regions was observed in 64,28 %, in the same regions and extratemporal regions in 21,43 % and only slow activity extratemporal in 14,28 % of the patients. Conclusions: Significative variations in background activity in patients with Rolandic Epilepsy, suggests a possible relation with the presence of interictal epileptiform discharges or a certain age-related functional immaturity.

Características neurológicas e neuropsicológicas na epilepsia rolândica / Neurological and neuropsychological characteristics in rolandic epilepsy

A epilepsia rolândica (ER) corresponde de 15 a 25% de todas as epilepsias na infância antes do 15 anos de idade, caracterizada por crises parciais ou generalizadas, que ocorrem normalmente durante o sono ou durante o despertar. Sugere-se que a atividade epileptiforme eletrográfica possa causar deterioração cognitiva pela perturbação da formação das sinapses, assim como as drogas antiepilépticas, que podem ser uma das variáveis que corroboram um pior desempenho neuropsicológico. Apesar de normalmente não haver alterações no quociente intelectual global, essas crianças podem evoluir para dificuldades escolares, distúrbios de linguagem, funções executivas e coordenação motora. Esse artigo de revisão tem como propósito discutir diferentes achados na literatura acerca da evolução desse quadro clínico(AU)

Rolandic epilepsy (ER) corresponds to 15 - 25 percent of all childhood epilepsy prior to fifteen years of age, characterized by partial or generalized seizures, which typically occur during sleep or waking hours. It is suggested that the electrographic epileptiform activity may cause cognitive impairment by disturbing synopsis formation, as well as antiepileptic drugs, which may be one of the variables to corroborate a decrease in neuropsychological performance. In spite of the fact that typically, no changes are observed in the IQ; learning difficulties, language disorders, executive functions and a diminution in motor coordination are observed. This review purposes a discussion on the evolution of the clinical scenario(AU)

Benign childhood epilepsy with centro-temporal spikes: evolutive clinical, cognitive and EEG aspects / Epilepsia benigna da infância com pontas centrotemporais: aspectos evolutivos clínicos, cognitivos e do EEG

Thirty-two children with benign childhood epilepsy with centrotemporal spikes (BECTS) were studied for a mean period of 27.6 months. The characteristics of the seizures, electroencephalogram (EEG), WISC-III and School Performance Test were compared at the start and end of the study. Nine (28.1 percent) children continued having seizures. Epileptiform activity (EA) on the EEG reduced in number and was no longer recorded in 6 (18.7 percent) children. There was a significant improvement in the performance and perceptual organization IQ values. The improvement in reading performance failed to reach statistical significance. The performance in arithmetic worsened in 43.7 percent of the children, and this was associated with the persistence of epileptic seizures. There were no significant correlations between changes in cognitive aspects and characteristics of EA. There is a need to continue this study, and also search for other factors influencing the evolution of cognitive abilities in children with BECTS.

Foram estudados aspectos evolutivos clínicos, cognitivos e eletrencefalográficos (EEG) de 32 crianças com epilepsia benigna da infância com pontas centrotemporais (EBICT) acompanhadas por 27,6 meses. Foram comparadas as características das crises, do EEG, do WISC-III e do Teste de Desempenho Escolar ao início e ao final do estudo. Nove (28,1 por cento) crianças continuaram apresentando crises. A atividade epileptiforme (AE) ao EEG reduziu-se em número e não mais foi registrada em 6 (18,7 por cento) crianças. Houve melhora significativa nos QI de execução e de organização perceptual. A melhora do desempenho em leitura não alcançou significância estatística, enquanto em 43,7 por cento das crianças houve piora em aritmética. Esta foi associada à persistência de crises epilépticas. Não houve correlações significativas entre aspectos cognitivos e características da AE. Há necessidade de estudar até a remissão total das crises e da AE, assim como procurar outros fatores que influenciem a evolução das habilidades cognitivas das crianças com EBICT.

Benign childhood epilepsy with centrotemporal spikes: word and pseudoword discrimination / Epilepsia benigna da infância com pontas centro-temporais: discriminação entre palavras e pseudopalavras

In the active phase of benign childhood epilepsy with centro-temporal spikes (BCECTS) there may be a fall in scholastic performance. OBJECTIVE: To study lexical decision in children with BCECTS. METHOD: 42 children with BCECTS were compared with a control group with respect to their hits and response time in a visual discrimination of words and pseudowords task (DWPT). RESULTS: The children with BCECTS had a lower percentage of hits for words and pseudowords and showed longer response times for pseudowords. They also frequently showed inferior reading and writing performance in the school performance test. The percentage of hits for pseudowords was lower when there was bilateral, asynchronous epileptiform activity. CONCLUSIONS: The DWPT provided contributions for reading assessments in children with BCECTS. The results indicated the need for attention in detecting reading difficulties in children with BCECTS.

Na fase ativa da epilepsia benigna da infância com pontas centrotemporais (EBICT) pode ocorrer queda de desempenho escolar. OBJETIVO: Estudar a decisão lexical em crianças com EBICT. MÉTODO: 42 crianças com EBICT foram comparadas a grupo controle quanto a acertos e tempo de resposta em tarefa de discriminação visual entre palavras e pseudopalavras (DVPPS). RESULTADOS: As crianças com EBICT tiveram percentual menor de acertos para palavras e pseudopalavras e maior tempo de resposta para pseudopalavras e tiveram, mais frequentemente, desempenho inferior em escrita e leitura em teste de desempenho escolar. Houve relação significativa entre os resultados do DVPPS e o teste de desempenho escolar. A percentagem de acerto de pseudopalavras foi menor quando havia atividade epileptiforme bilateral e assíncronia no eletrencefalograma. CONCLUSÃO: O DVPPS mostrou contribuições na avaliação da leitura em crianças com EBICT. Os resultados apontam para a necessidade de atenção na detecção de dificuldades de leitura em crianças com EBICT.