[Ectopic relapse of an operated craniopharyngioma. Case report and review of the literature]. / Recidiva a distancia de craneofaringioma intervenido. Caso clínico y revisión de laliteratura.

INTRODUCTION. Craniopharyngioma is an embrionary tumor of the sellar and/suprasellar region derived from fusiform cells of Rathke´s cleft. Although locoregional relapse is the way classically proposed for relapse after treatment, it has been described, in a few cases, the possibility of ectopic relapse out of the sellar-suprasellar region, by direct seeding of cells during surgery on the surgical field, or by cell dissemination in the cerebrospinal fluid (CSF). It is proposed to report the case of a patient with relapse of a craniopharyngioma in the frontal lobe, who was previously operated ten years after, as well as to review the similar cases reported in the literature to the date. RESULTS. A systematic review of the literature has allowed to find 21 cases previously reported. Direct cellular seeding was the most frequent implantation mechanism. In all cases, the preferred treatment was radical surgical removal when this was possible. The time of latency between first surgery and relapse differed from 1 to 21 years. CONCLUSIONS. It is interesting, in the differential diagnosis, to bear in mind the possibility of ectopic relapse of craniopharyngioma in patients who have been operated because of this type of tumor and who present a new mass in nervous central system (CNS). In view of the long time of latency that can pass between the resection of a craniopharyngioma and his relapse, there becomes necessary a long follow-up of these patients by periodic imaging tests.

Recidiva a distancia de craneofaringioma intervenido. Caso clínico y revisión de la literatura / Ectopic relapse of an operated craniopharyngioma. Case report and review of the literature

Introducción. El craneofaringioma es un tumor embrionario de la región selar y/o supraselar derivado de células fusiformes de la bolsa de Rathke. Aunque la forma clásicamente propuesta para la recidiva tras el tratamiento es a nivel locorregional, se ha descrito, en raras ocasiones, la posibilidad de recidiva ectópica fuera de esta localización, bien por siembra directa de células durante la cirugía en el campo quirúrgico, bien por diseminación celular a través de líquido cefalorraquídeo (LCR). Se presenta el caso de una paciente con metástasis en el lóbulo frontal de un craneofaringioma previamente intervenido diez años antes y se revisan los casos similares publicados en la literatura hasta la fecha.Resultados. Una revisión sistemática de la literatura ha permitido encontrar 21 casos publicados previamente. La siembra celular directa fue el mecanismo de implantación más frecuente. En todos, el tratamiento de elección fue la resección quirúrgica completa, cuando esta fue posible. El tiempo de latencia entre la primera cirugía y la recidiva ectópica varió entre 1 y 21 años.Conclusiones. Es interesante tener presente en el diagnóstico diferencial la posibilidad de recidiva ectópica de craneofaringioma en pacientes que hayan sido intervenidos de este tipo de tumor y que presenten una nueva masa en sistema nervioso central (SNC). Dado el largo tiempo de latencia que puede transcurrir entre la resección de un craneofaringioma y su recidiva, se hace necesario un seguimiento largo de estos pacientes mediante pruebas periódicas de imagen (AU)

Introduction. Craniopharyngioma is an embrionary tumor of the sellar and/suprasellar region derived from fusiform cells of Rathke´s cleft. Although locoregional relapse is the way classically proposed for relapse after treatment, it has been described, in a few cases, the possibility of ectopic relapse out of the sellar-suprasellar region, by direct seeding of cells during surgery on the surgical field, or by cell dissemination in the cerebrospinal fluid (CSF). It is proposed to report the case of a patient with relapse of a craniopharyngioma in the frontal lobe, who was previously operated ten years after, as well as to review the similar cases reported in the literature to the date.Results. A systematic review of the literature has allowed to find 21 cases previously reported. Direct cellular seeding was the most frequent implantation mechanism. In all cases, the preferred treatment was radical surgical removal when this was possible. The time of latency between first surgery and relapse differed from 1 to 21 years.Conclusions. It is interesting, in the differential diagnosis, to bear in mind the possibility of ectopic relapse of craniopharyngioma in patients who have been operated because of this type of tumor and who present a new mass in nervous central system (CNS). In view of the long time of latency that can pass between the resection of a craniopharyngioma and his relapse, there becomes necessary a long follow-up of these patients by periodic imaging tests (AU)

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: IV. General principles of antiepileptic polytherapy and therapeutic strategies in refractory epilepsy]. / Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: IV. Principios generales de politerapia antiepiléptica y estrategias terapéuticas en epilepsia refractaria.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: III. Antiepileptic therapy in special situations]. / Guia terapeutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: III. Tratamiento antiepileptico en situaciones especiales.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: II. Chronic therapy with antiepileptic drugs in adults and in children]. / Guia terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: II. Terapéutica antiepiléptica crónica en el adulto y en el nino.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: III. Tratamiento antiepiléptico en situaciones especiales / The Andalusia epilepsy society´s guide toe pilepsy therapy 2005: III. Antiepileptic therapy in special situations

Aims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care (AU)

Objetivo. Elaborar una guía de práctica clínica basada en la evidencia científica que aborde las cuestiones básicas acerca del tratamiento de la epilepsia. Desarrollo. Un comité de 11 expertos pertenecientes a la Sociedad Andaluza de Epilepsia, en el que se incluían seis neurólogos, tres neuropediatras, un neurocirujano y una farmacóloga, todos con especial dedicación y competencia en epilepsia, realizó una revisión bibliográfica exhaustiva en busca de las evidencias disponibles relacionadas con el tema propuesto. Se utilizaron las siguientes bases de datos: MEDLINE, Cochrane Library y bases de datos de guías de práctica clínica (National Guideline Clearinghouse, National Institute of Clinical Excellence y Guías Clínicas de la Academia Americana de Neurología). La guía se estructuró en siete secciones y se dividió para su publicación en cuatro partes. Se identificaron 187 documentos relevantes, de los que se extrajeron un total de 63 evidencias científicas y 91 recomendaciones terapéuticas, que se tabularon y clasificaron según los criterios de elaboración de Guías de Práctica Clínica de la Federación Europea de Sociedades Neurológicas. Conclusión. Los resultados de esta revisión proveen unas guías de práctica clínica basadas en la evidencia científica útiles, sencillas y aplicables en los diferentes niveles asistenciales (AU)

Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: IV. Principios generales de politerapia antiepiléptica y estrategias terapéuticas en epilepsia refractaria / The andalusia epilepsy society´s guide to epilesy therapy 2005: IV general principles of antiepileptic polytherapy and therapeutic strategies in refractory epilepsy

Aims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care (AU)

Objetivo. Elaborar una guía de práctica clínica basada en la evidencia científica que aborde las cuestiones básicas acerca del tratamiento de la epilepsia. Desarrollo. Un comité de 11 expertos pertenecientes a la Sociedad Andaluza de Epilepsia, en el que se incluían seis neurólogos, tres neuropediatras, un neurocirujano y una farmacóloga, todos con especial dedicación y competencia en epilepsia, realizó una revisión bibliográfica exhaustiva en busca de las evidencias disponibles relacionadas con el tema propuesto. Se utilizaron las siguientes bases de datos: MEDLINE, Cochrane Library y bases de datos de guías de práctica clínica (National Guideline Clearinghouse, National Institute of Clinical Excellence y Guías Clínicas de la Academia Americana de Neurología). La guía se estructuró en siete secciones y se dividió para su publicación en cuatro partes. Se identificaron 187 documentos relevantes, de los que se extrajeron un total de 63 evidencias científicas y 91 recomendaciones terapéuticas, que se tabularon y clasificaron según los criterios de elaboración de Guías de Práctica Clínica de la Federación Europea de Sociedades Neurológicas. Conclusión. Los resultados de esta revisión proveen unas guías de práctica clínica basadas en la evidencia científica útiles, sencillas y aplicables en los diferentes niveles asistenciales (AU)

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: I. Criteria for starting and discontinuing and the pharmacological bases of antiepileptic treatment]. / Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: I. Criterios de inicio y cese y bases farmacológicas del tratamiento antiepiléptico.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: I. Criterios de inicio y cese y bases farmacológicas del tratamiento antiepiléptico / The Andalusia epilepsy society’s guide to epilepsy therapy 2005: I. criteria for starting and discontinuing and the pharmacological bases of antiepileptic treatment

Objetivo. Elaborar una guía de práctica clínica basada en la evidencia científica que aborde las cuestiones básicas acerca del tratamiento de la epilepsia. Desarrollo. Un comité de 11 expertos pertenecientes a la Sociedad Andaluza de Epilepsia, en el que se incluían seis neurólogos, tres neuropediatras, un neurocirujano y una farmacóloga, todos con especial dedicación y competencia en epilepsia, realizó una revisión bibliográfica exhaustiva en busca de las evidencias disponibles relacionadas con el tema propuesto. Se utilizaron las siguientes bases de datos: MEDLINE, Cochrane Library y bases de datos de guías de práctica clínica (National Guideline Clearinghouse, National Institute of Clinical Excellence y Guías Clínicas de la Academia Americana de Neurología). La guía se estructuró en siete secciones y se dividió para su publicación en cuatro partes. Se identificaron 187 documentos relevantes de los que se extrajeron un total de 63 evidencias científicas y 91 recomendaciones terapéuticas, que se tabularon y clasificaron según los criterios de elaboración de Guías de Práctica Clínica de la Federación Europea de Sociedades Neurológicas. Conclusión. Los resultados de esta revisión proveen unas guías de práctica clínica basadas en la evidencia científica útiles, sencillas y aplicables en los diferentes niveles asistenciales

Aims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health careAims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care

Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: II. Terapéutica antiepiléptica crónica en el adulto y en el niño / The Andalusia epilepsy society’s guide to epilepsy therapy 2005: II. chronic therapy with antiepileptic drugs in adults and in children

Objetivo. Elaborar una guía de práctica clínica basada en la evidencia científica que aborde las cuestiones básicas acerca del tratamiento de la epilepsia. Desarrollo. Un comité de 11 expertos pertenecientes a la Sociedad Andaluza de Epilepsia, en el que se incluían seis neurólogos, tres neuropediatras, un neurocirujano y una farmacóloga, todos con especial dedicación y competencia en epilepsia, realizó una revisión bibliográfica exhaustiva en busca de las evidencias disponibles relacionadas con el tema propuesto. Se utilizaron las siguientes bases de datos: MEDLINE, Cochrane-Library y bases de datos de guías de práctica clínica (National Guideline Clearinghouse, National Institute of Clinical Excellence y Guías Clínicas de la Academia Americana de Neurología). La guía se estructuró en siete secciones y se dividió para su publicación en cuatro partes. Se identificaron 187 documentos relevantes, de los que se extrajeron un total de 63 evidencias científicas y 91 recomendaciones terapéuticas, que se tabularon clasificándolas según los criterios de elaboración de Guías de Práctica Clínica de la Federación Europea de Sociedades Neurológicas. Conclusión. Los resultados de esta revisión proveen unas guías de práctica clínica basadas en la evidencia científica útiles, sencillas y aplicables en los diferentes niveles asistenciales

Aims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health careAims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care

[Clinical neuropsychology of the surgery of temporal lobe epilepsy]. / Neuropsicología clínica en la cirugía de la epilepsia del lóbulo temporal.

INTRODUCTION AND OBJECTIVES: The surgery of epilepsy has become a real alternative for the treatment of patients with drug resistant epilepsy. In this study we review the part played by Clinical Neuropsychology in programmes of surgery for epilepsy, particularly in operations designed to treat drug resistant temporal lobe epilepsy. DEVELOPMENT: Firstly we describe the function of the clinical neurologist in relation to these patients. Then we consider the main national and international forms of assessment. Finally we describe the main findings of neuropsychological investigation regarding the approach to temporal lobectomy. Thus we describe the main presurgical characteristics of candidates for surgery regarding cognition and personality. Similarly we describe what is known of the possibilities of finding the site of the epilepetogenic focus and prognosis of the results and neuropsychological consequences of the operation. Finally, we describe the cognitive results, particularly memory, after temporal lobectomy. CONCLUSIONS: Review of the literature shows how important it is for the clinical neuropsychologist to be involved in programmes of the surgery of epilepsy, studying the patients before and after surgery and assessing prognosis. Clinical neuropsychology is also important for predicting the post surgical neuropsychological results.

Neuropsicología clínica en la cirugíade la epilepsia del lóbulo temporal / Clinical neuropsychology of the surgery of temporal lobe epilepsy

Introducción y objetivos. La cirugía de la epilepsia se ha convertido en una importante alternativa terapéutica para los pacientes con epilepsia resistente al tratamiento farmacológico. Este trabajo pretende revisar el papel de la neuropsicología clínica en los programas de cirugía de la epilepsia, concretamente en la s intervenciones dirigidas a aliviar la epilepsia del lóbulo temporal farmacorresistente. Desarrollo. Exponemos en primer lugar las funciones que el neuropsicólogo clínico realiza con los pacientes. Posteriormente, mostramos las principales propuestas internacionales y nacionales de evaluación. Por último, mostramos los principales hallazgos que la investigación neuropsicológica ha arrojado dentro de las funciones desempeñadas en el abordaje de la lobectomía temporal. Así, exponemos las principales características prequirúrgicas de los candidatos a cirugía, abarcando las áreas cognitivas y de personalidad. Del mismo modo, exponemos los hallazgos relativos a la capacidad de localización y lateralización del foco epileptógeno, y de predicción de los resultados y consecuencias neuropsicológicas de la intervención. Por último, abordamos la descripción de las consecuencias cognitivas y, particularmente, mnésicas, de la lobectomía temporal. Conclusiones. De la revisión de la bibliografía se desprende la importancia de la labor de cooperación del neuropsicólogo clínico dentro de los programas de cirugía de la epilepsia, estudiando a los pacientes pre y posquirúrgicamente y asesorando en el pronóstico quirúrgico. Además, destaca el papel de la neuropsicología clínica en la predicción de las consecuencias neuropsicológicas posquirúrgicas (AU)

[Patient aged 45 with refractory epilepsy of the temporal lobe since early childhood]. / Paciente de 45 años con epilepsia refractaria del lóbulo temporal desde la infancia.

INTRODUCTION: Temporal lobe epilepsy is the most frequent of the epilepsies related with localization and one of the most refractory to pharmacological treatment. Temporal lobectomy curbs seizures in many of these patients, which improves their quality of life. CASE REPORT: Patient aged 45 who, during early infancy, started to suffer simple partial seizures that later went on to become generalised. These were well under control by adolescence but at 23 they became complex partial seizures that were resistant to different antiepileptic drugs. The patient was submitted to a complete presurgical evaluation and a left anterior temporal lobectomy was performed at the age of 44. After surgery he evolved favourably. The final diagnosis was that he was suffering from mesial temporal sclerosis, associated with a subcortical neuronal heterotopy of the parahippocampal region. We discuss the semiology and the aetiology with regard to this patient and in a general sense, and we also define the foundations upholding the decision to perform surgery, the areas that make up the epileptogenic zone, and the neurophysiological and neuropsychological tests, and the structural and functional neuroimaging that are used to measure those areas. Likewise, the different techniques that can be used in resection of the temporal lobe are analysed. We also set out an etiopathogenic hypothesis according to the histopathological results and comment on a number of related general aspects. CONCLUSIONS: Progress in physiopathological knowledge, the development of diagnostic and surgical techniques, and its high efficiency and low morbidity have consolidated temporal lobectomy as a radical form of treatment for temporal lobe epilepsy that should be performed as early as possible once resistance to medication has been observed.

[Changes in episodic and semantic memory associated with temporal lobectomy]. / Cambios en memoria episódica y semántica asociados a la lobulectomía temporal.

INTRODUCTION: Temporal lobectomy (TL) is an effective treatment for drug refractory temporal lobe epilepsy. The main neuropsychological consequences of the intervention are changes in episodic and semantic memory. Aim. To study the consequences of right temporal lobectomy (RTL) and left temporal lobectomy (LTL) on episodic and semantic mnemonic functioning. PATIENTS AND METHOD: 27 patients who had undergone TL in the Hospital Universitario Virgen de las Nieves in Granada were submitted to pre and post surgical evaluation by means of a battery of neuropsychological tests that included episodic and semantic memory tests for both verbal and visual material. RESULTS AND CONCLUSIONS: ANOVA analysis was employed to analyse the pre and post surgical changes for the whole group of patients, and Student s t and Wilcoxon s non parametric test were used for each group of RTL and LTL. No deterioration was found in ipsilateral memory after the intervention, that is to say, in the verbal memory of the patients submitted to LTL and in the visual memory of RTL patients. With regard to contralateral memory, that is, the visual memory of patients submitted to LTL and the verbal memory of RTL patients, the ANOVA analyses of the whole group revealed a statistically significant improvement. The analyses performed for the whole group (LTL and RTL), however, did not reveal any statistically significant changes.

Cambios en la memoria episódica y semántica asociados a la lobulectomía temporal / Changes in episodic and semantic memory associated to temporal lobectomy

Introducción. La lobulectomía temporal (LT) representa un tratamiento eficaz para la epilepsia del lóbulo temporal refractaria al tratamiento farmacológico. Las principales consecuencias neuropsicológicas de la intervención son los cambios en memoria episódica y semántica. Objetivo. Estudiar las consecuencias de la lobulectomía temporal derecha (LTD) y lobulectomía temporal izquierda (LTI) sobre el funcionamiento mnésico episódico y semántico. Pacientes y métodos. 27 pacientes sometidos a LT en el Hospital Universitario Virgen de las Nieves de Granada. Se evaluaron pre y posquirúrgicamente mediante una amplia batería de pruebas neuropsicológicas, que incluía tests de memoria episódica y semántica, tanto para material verbal como visual. Resultados y conclusiones. Se analizaron los cambios pre y posquirúrgicos mediante análisis ANOVA para todo el conjunto de pacientes, y t de Student y test no paramétrico de Wilcoxon para cada grupo de LTD y LTI. No se han encontrado empeoramientos en la memoria ipsilateral a la intervención, es decir, en la memoria verbal de los pacientes sometidos a LTI y en la memoria visual de las LTD. Respecto a la memoria contralateral, es decir, la memoria visual de los pacientes sometidos a LTI y la memoria verbal de los pacientes con LTD, los análisis de todo el grupo mediante ANOVA revelaron una mejora estadísticamente significativa. En cambio, los análisis realizados a cada grupo (LTI y LTD) no mostraron cambios estadísticamente significativos (AU)

Paciente de 45 años con epilepsia refractaria del lóbulo temporaldes de la infancia / Patient aged 45 with refractory epilepsy of the temporal lobe since early childhood

Introducción. La epilepsia del lóbulo temporal es la más frecuente de las epilepsias relacionadas con la localización y una de las más refractarias al tratamiento farmacológico. La lobulectomía temporal suprime las crisis en muchos de estos pacientes, lo que hace mejorar su calidad de vida. Caso clínico. Paciente de 45 años, que empezó con crisis parciales simples y secundariamente generalizadas en la primera infancia; bien controlado durante la adolescencia, con 23 años comenzó con crisis parciales complejas, resistentes a diversos fármacos antiepilépticos. Se le realizó una evaluación prequirúrgica completa y una lobulectomía temporal anterior izquierda con 44 años; evolucionó favorablemente tras la cirugía. El diagnóstico final fue de esclerosis temporal mesial, asociada a una heterotopía neuronal subcortical de la región parahipocampal. Aplicado al paciente y en sentido amplio, se realiza una discusión semiológica y etiológica, se definen las bases que sustentan la cirugía, las áreas que componen la zona epileptógena y las pruebas neurofisiológicas, de neuroimagen estructural y funcional y neuropsicológicas que las miden. Asimismo, se analizan las distintas técnicas de resección del lóbulo temporal, se establece una hipótesis etiopatogénica en función de los resultados histopatológicos y se comentan algunos aspectos generales relacionados. Conclusiones. El avance en el conocimiento fisiopatológico, el desarrollo de los medios diagnósticos y quirúrgicos y la demostración de su gran eficacia y escasa morbilidad han consolidado la lobulectomía temporal como una forma de tratamiento radical en la epilepsia del lóbulo temporal, que debe practicarse precozmente, en cuanto se demuestre la farmacorresistencia (AU)

[Defects in the visual field in resective surgery for temporal lobe epilepsy]. / Defectos del campo visual en la cirug a resectiva de la epilepsia del l bulo temporal.

INTRODUCTION: Temporal lobe resection is the most used procedure in epilepsy surgery. Visual field defects after resection are frequent. AIM. We try to detect the frequency and severity of visual field defect after anterior temporal lobectomy (ATL) and to study the functional consequences. PATIENTS AND METHODS: We studied 30 patients with refractory temporal lobe epilepsy (15 men, 12 51 years, m= 32.9), in which ATL was performed (11 right, 19 left). The neocortical and hippocampal resection was variable. Visual field was studied with computerized campimetry type Humphrey. Our survey was filled to study the campimetric consequence, seizures incidence, quality of life and surgery satisfaction. RESULTS: Some campimetric disturb was found in 27 patients (90 %), superior or minor homonimus quadantapnosia in 18 (60 %), major one 8 and homonimus hemianopsia in one. Incongruent defects appeared in 19. The bigger neocortical and hippocampal resection was, the bigger defect, with exceptions. Only patient with a hemianopsia was conscious the deficit. 20 patients (66.6 %) were seizures free in the last year. 28 had better quality of life and 29 (96.6 %) would have chosen surgery again. CONCLUSION: Visual field defects after ATL, although frequent, have little functional consequences and in quality of life. The quality of life is better when seizures stopped. After ATL patients are very glad with their decision.

Defectos del campo visual en la cirugía resectiva de la epilepsia del lóbulo temporal / Defects in the visual field in resective surgery for temporal-lobe epilepsy

Introducción. La cirugía resectiva del lóbulo temporal es la más practicada en cirugía de la epilepsia. Las alteraciones del campo visual tras resección temporal son frecuentes. Objetivo. Determinar la frecuencia y gravedad de los defectos campimétricos tras lobectomía temporal anterior (LTA) y valorar su repercusión funcional y en la calidad de vida de los pacientes. Pacientes y métodos. Se estudió a 30 pacientes con epilepsia refractaria del lóbulo temporal (15 hombres; 12-51 años; media, 32,9 años), sometidos a LTA (11 derechas, 19 izquierdas). La resección neocortical e hipocampal fue variable. Se practicó campimetría computadorizada tipo Humphrey (amplitud de 60º). Cumplimentaron un cuestionario anónimo para valorar la repercusión campimétrica, incidencia de crisis, calidad de vida y satisfacción quirúrgica. Resultados. 27 pacientes (90 por ciento) presentaron alguna alteración campimétrica: en 18 (60 por ciento), una cuadrantanopsia homónima superior o menor; en ocho, mayor, y en uno, una hemianopsia homónima, contralaterales. En 19 pacientes, el defecto fue incongruente. Tuvieron mayor defecto a mayor resección neocortical e hipocampal, con excepciones. Sólo el paciente con hemianopsia era consciente del déficit y le afectaban algunas actividades. 20 pacientes (66,6 por ciento) no tuvieron crisis en el último año. 28 mejoraron su calidad de vida y 29 (96,6 por ciento) se ratificaron en su decisión de haberse intervenido. Conclusiones. Las alteraciones del campo visual tras LTA, aunque frecuentes, no tienen apenas repercusión funcional ni afectan la calidad de vida, pues la mejoran con la desaparición de las crisis. Los pacientes sometidos a LTA tienen un alto grado de satisfacción quirúrgica (AU)

Lipoma de convexidad cerebral y epilepsia focal refractaria / Lipoma of the cerebral convexity and refractory focal epilepsy

Introducción. Los lipomas intracraneales representan alrededor del 0,1 por ciento de los tumores cerebrales. Se los considera malformaciones congénitas causadas por una mala diferenciación y por una persistencia anormal de la meninge primitiva, con posterior transformación en tejido adiposo durante el desarrollo del espacio subaracnoideo. La localización más habitual es la línea media, frecuentemente en la cisterna pericallosa; es infrecuente encontrarlos en la cisura silviana y en la convexidad hemisférica. Las crisis epilépticas, en ocasiones refractarias, son el síntoma más común de los lipomas intracraneales, aunque la mayoría son asintomáticos. Caso clínico. Varón de 20 años de edad que desde los tres presentaba frecuentes crisis focales, sensitivomotoras, de la mitad inferior del hemicuerpo derecho, resistentes a los fármacos antiepilépticos. Un estudio de resonancia magnética mostró una lesión extraaxial en la convexidad parietal posterior y parasagital izquierda, hiperintensa en secuencias T1, que se suprimía en secuencias STIR, compatible con tejido graso. Se practicó resección subtotal de la lesión; el diagnóstico patológico fue de lipoma. El paciente permanece sin crisis al año de realizarse la cirugía. Conclusiones. Los lipomas hemisféricos son lesiones raras cuya sintomatología habitual son crisis epilépticas focales como consecuencia de la irritación cortical inducida por las adherencias íntimas del lipoma a la corteza cerebral, o por anomalías displásicas corticales o vasculares asociadas.Tiene características fácilmente reconocibles en la tomografía computarizada y en la resonancia magnética. El tratamiento debe ser conservador, salvo que curse con epilepsia refractaria, en cuyo caso puede plantearse una resección cuidadosa del lipoma, que pocas veces podrá ser completa (AU)

[The surgery of epilepsy]. / Cirugía de la epilepsia.

INTRODUCTION: At the present time the surgery of epilepsy is a safe, effective therapeutic option which should be offered to the patient with drug resistant epilepsy at the right moment to prevent the irreversible negative consequences of uncontrolled seizures. DEVELOPMENT: All patients with drug resistant epilepsy should be surgically assessed. In recent years the concept of surgically remediable syndrome has been introduced to refer to conditions in which surgical treatment gives excellent results: mesial temporal sclerosis, circumscribed neocortical lesions, Sturge Weber syndrome and infantile hemiplegic epilepsy are good examples in which prolonged, unnecessary delay of surgery should not occur. This type of surgery should be undertaken in centres with suitable trained multi disciplinary teams with adequate resources and preestablished guidelines. The clinical history, surface electroencephalogram monitoring, directed magnetic resonance, functional neuroimaging with SPECT and PET and neuropsychological studies are the basis for pre surgical diagnosis. These and other investigations should be done following the guidelines of each centre and the complexity of the disorder in each case. CONCLUSION: Anteromesial resection of the temporal lobe, selective amigdalo hippocampectomy, neocortical resection, hemispherectomy or a variation of it, section of the corpus callosum and multiple sub pial transection are the most usual surgical techniques since good results are obtained with them in suitable cases.