Simple, cost-effective technique for portable digital eletrocorticography.

We revised 16 patients submitted to epilepsy surgery using a new method of digital, real-time, portable electrocorticography. Patients were operated upon over a period of 28 months. There were no complications. The exam was useful in 13 cases. The low installation and operational costs, the reliability and simplicity of the method, indicate it may be useful for defining the epileptogenic regions in a variety of circumstances, including surgery for tumors, vascular malformations, and other cortical lesions associated with seizure disorders.

Prognostic factors in mesial temporal lobe epilepsy surgery.

Eighty-four patients submitted to anterior temporal lobectomy were evaluated retrospectively in order to correlate the different type of simple partial seizure (SPS) and their prognostic implications in patients with mesial temporal sclerosis. The patients were divided in two groups following the classification of Engel; Group 1 (53 patients) included patients Class I (without seizures or of good outcome) and Group 2 (31 patients) included Classes II, III and IV (with seizures or of bad outcome). The two groups were compared and results showed no statistical difference in relation to the demographic aspects as sex, side of surgery, age at onset of seizures and time of the patients' postoperative follow-up. Statistical analysis revealed no relationship between type of SPS and outcome. SPS did not show a statistical value in localizing the side of pathology. However, when the two groups were compared statistically in terms of patients' ages at the time of surgery, and the time elapsed from the onset of the seizures to the surgical intervention, it was observed that Group 1 (of good outcome) had seizures for smaller interval (p <0.05) and was operated at an earlier age (p<0.02) than Group 2 (of bad outcome). The presence or the type of SPS can not be used as a prognostic measure; surgical therapy must be considered as soon as clinical resistance is demonstrated.

[Neuroleptic malignant syndrome: case report with recurrence associated with the use of olanzapine]. / Síndrome neuroléptica maligna. Relato de caso com recorrência associada ao uso de olanzapina.

The neuroleptic malignant syndrome (NMS) consists in an idiosyncratic reaction to neuroleptic drugs, probably related to a blockage of dopamine receptors in basal ganglia. Research criteria for diagnosing NMS from DSM-IV require severe rigidity and fever accompanied by 2 of 10 minor features including diaphoresis, dysphagia, tremor, incontinence, altered mentation, mutism, tachycardia, elevated or labile blood pressure, leukocytosis and elevation of creatine phosphokinase. From a clinical point of view, the NMS may range a large spectrum of presentations. Haloperidol is the most frequent drug associated with this syndrome. We report the case of a 30 year-old man who developed NMS at two different occasions, the first related to haloperidol and chlorpromazine and the second related to olanzapine, to our knowledge without previous mention in the indexed literature.

The intracarotid amobarbital procedure (Wada test) with two protocols combined, Montreal and Seattle.

The intracarotid amobarbital procedure was carried out in 8 male and 7 female candidates to temporal lobectomy, and a female candidate to frontal lesionectomy, aged 18-50 (mean 32.5) years. Language and memory were tested after injection in each hemisphere. Both were measured by the Montreal procedure. In 9 patients language and memory were evaluated with the Seattle procedure too. In 12 patients the left hemisphere was dominant for language; three had bilateral dominance. In 1 patient the Seattle procedure demonstrated the dominant hemisphere by relatively slowness of speech during the drug effect in the left hemisphere. Memory was defined to be in the left hemisphere in 12 patients, in the right in 2, bilateral in 1 and in another lateralization was not possible. In 1 patient memory dominance was determined by the Montreal protocol alone because of lack of cooperation. These early results indicate that the methods may be complementary for determination of language and memory dominance in epilepsy surgery candidates.

Epilepsy surgery without invasive EEG. Early results of a new program.

A total of 42 patients were submitted to a clinical, behavioural and neuropsychological evaluation with the objective of eventual surgical treatment of epilepsy refractory to the usual clinical therapies. Prolonged video-EEG monitoring, MRI hippocampal volume measurement, lateralization of speech and memory using the amobarbital (Wada) test were used. Of 18 operated cases, 12 were submitted to temporal lobectomy, with a follow-up of 6-30 months; 8 patients had significant improvement in seizures control; 2 patients had partial improvement in seizure frequency and intensity; 2 patients had no improvement in seizure control. One patient underwent right frontal lobectomy with total remission of seizures and 5 had callosotomy with varying degrees of success. There was no mortality. Morbidity included one subdural hematoma, one transient hemiparesis, one episode of mania, one lobar pneumonia and frequent immediately post-operative muscular tension headaches. These early results indicate good results of temporal lobectomy patients investigated through a non-invasive presurgical evaluation.

[Digital EEG with brain mapping in Alzheimer's dementia and Parkinson's disease. A prospective controlled study]. / Eletrencefalograma digital com mapeamento em demência de Alzheimer e doença de Parkinson: estudo prospectivo controlado.

In order to evaluate the EEG activity during wakefulness in senile dementia of the Alzheimer type (AD) and Parkinson's disease (PD), a prospective controlled study was performed. We compared 6 AD and 11 PD patients with a control group of 12 patients with mild to moderate major chronic depression (DSM-III-R, 1987). The median of the frequencies and the power of the posterior dominant activity was obtained in the three groups using spectral analysis. The posterior activity had a frequency of 8.79 +/- 0.52 (mean +/- sd) in the control group, 6.65 +/- 0.80 (mean +/- sd) in the AD group and 7.69 +/- 1.39 (mean +/- sd) in the PD group. The experimental hypothesis that patients with AD and PD differ from controls in relation to the background activity (defined as abnormal < 8) was confirmed by the chi square test (p = 0.01) and the t test showed that the mean of the frequency of the posterior power was significantly lower in AD (p = 0.01) and PD (p = 0.05) patients, compared with the controls. The results indicate that this abnormality could be correlated with the degree of cortical damage and natural history of these disorders.

[Lateralization of the epileptogenic area by magnetic resonance imaging in temporal lobe epilepsy]. / Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal.

We studied 5 patients with medically refractory temporal lobe epilepsy using special methods of MRI, in order to localize the epileptogenic area. Coronal sequences were obtained with 5 mm sections from the posterior margin of the brainstem to the base of the frontal lobe using: "Inversion recovery T1" (TR = 2500 msec, TE = 26 msec, T1 = 600 msec) to analyse loss of internal structure and atrophy of the hippocampus, and morphology of the temporal lobe; and Spin-echo T2w (TR = 250 msec, TE = 120 msec) looking for abnormal high intensity signal. In two cases with left focal EEG the MRI showed atrophy, loss of internal structure and abnormal high intensity signal in the hippocampus, and atrophy of the anterior temporal lobe, ipsilaterally. One case with independent bilateral foci at the EEG showed atrophy, loss of internal structure and abnormal high intensity signal in the right hippocampus. Other case with right focal EEG showed bilateral atrophy of the anterior temporal lobes. Another case was normal. We conclude that this methodology can facilitate the surgical indication in temporal lobe epilepsy.

Lateralizaçäo da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal / Lateralization of the epileptogenic area by magnetic resonance imaging in temporal lobe epilepsy

Métodos especiais de MRI foram utilizados em 5 pacientes com epilepsia do lobo temporal refratários ao tratamento clínico, com a finalidade de localizar a área epileptogênica. Imagens coronais com espessura de 5mm foram obtidas da borda posterior do tronco cerebral até a base do lobo frontal, utilizando-se as sequências "Inversión Recovery T1" (TR=2500 msec, TE=26 msec, T1=600 msec) para avaliar perda de estrutura interna e atrofia do hipocampo e morfologia do lobo temporal; Spin-echo T2w (TR=2500 msec, TE=120 msec) visando a avaliar sinais de alta intensidade anormais. Em 2 casos com focos esquerdos no EEG, a MRI mostrou atrofia, perda de estrutura interna e aumento de sinal no hipocampo, e atrofia do lobo temporal anterior, ipsilateralmente. Um caso com focos bilaterais independentes no EEG teve atrofia, perda da estrutura interna e aumento de sinal no hipocampo direito. Um caso com EEG focal direito mostrou atrofia em ambos os lobos temporais anteriores. Outro caso näo mostrou anormalidades. Concluimos que esta metodologia pode facilitar a indicaçäo cirúrgica em epilepsia do lobo temporal

[Internal carotid stump syndrome: report of a case]. / Síndrome do "coto" da carótida interna (carotid stump syndrome). Relato de caso.

The authors describe the case of a patient with transient ischemic attacks (TIAs) from the ipsilateral occluded internal carotid artery (carotid stump syndrome). The patient was submitted to surgical resection of the stump with relief of the symptoms. Thromboembolism from the stump via the anastomotic supply is responsible for the TIAs and is worsened by the blood flow turbulence at this level.

Síndrome do "coto" da carótida interna: relato de caso / Internal carotid stump syndrome: report of a case

Os autores relatam o caso de um paciente com ataques isquêmicos transitórios (AITs) cuja fonte de êmbolos originou-se ipsilateralmente ao fundo de saco de uma carótida interna ocluída (carotid stump syndrome). O paciente foi submetido a ressecçäo cirúrgica do "coto" (stump), com alívio total dos sintomas. O tromboembolismo decorrente do fundo de saco ou coto, documentado por arteriografia, se faz através das artérias anastomóticas, sendo agravado pela turbulência do fluxo sangüíneo a esse nível

[Thymectomy and immunosuppression in myasthenia gravis: a prospective study]. / Timectomia e imunossupressão em miastenia gravis: estudo prospectivo.

Between 1982 and 1988 24 women and 6 men with myasthenia gravis were included in a prospective and standardized diagnostic and therapeutic protocol. Age varied between 10 and 74 years (34 +/- 16, mean +/- standard deviation). Three patients with the ocular form were treated with pyridostigmine. Four patients with the generalized form and advanced age received steroids and/or azathioprine. Twenty-three patients with the generalized form underwent thymectomy followed by prednisone and/or azathioprine. One patient died after complex thymectomy for invasive thymoma. Another died soon after admission in myasthenic/cholinergic crisis. Two other patients had minor complications of thymectomy. Of 19 patients followed for 1-60 (mean 24) months, 11 (58%) are in remission, one of them without any medication.