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1.
Epilepsia ; 62(6): 1429-1441, 2021 06.
Article in English | MEDLINE | ID: mdl-33884614

ABSTRACT

OBJECTIVE: We aimed to better characterize the magnetic resonance imaging (MRI) findings of mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE), a rare clinicopathological entity associated with pharmacoresistance recently described in patients with frontal lobe epilepsy. METHODS: We studied 12 patients who underwent epilepsy surgery and whose surgical specimens showed histopathological findings of MOGHE, characterized by preserved cortical lamination, blurred gray-white matter interface due to increased number of oligodendrocytes, and heterotopic neurons in the white matter. The age at MRI evaluation ranged from 11 to 58 years, except for one 4.5-year-old patient. RESULTS: Following a detailed MRI analysis using an in-house protocol, we found abnormalities in all cases. The lesion was circumscribed in the frontal lobe in six (50%) and in the temporal lobe in three (25%) patients. In the remaining three patients (25%), the lesion was multilobar (frontotemporal and temporoparieto-occipital). Cortical thickening was mild in all patients, except in the 4.5-year-old patient, who had pronounced cortical thickening and white matter blurring. We also identified cortical/subcortical hyperintense T2/fluid-attenuated inversion recovery signal associated with gray/white matter blurring in all but one patient. When present, cleft cortical dimple, and deep sulci aided in localizing the lesion. Overall, the MRI findings were like those in focal cortical dysplasia (FCD) Type IIa. Surgical outcome was excellent in five patients (Engel Class I in 25% and II in 17%). The remaining seven patients (58%) had worthwhile seizure reduction (Engle Class III). Incomplete lesion resection was significantly associated with worse outcomes. SIGNIFICANCE: MRI findings associated with MOGHE are similar to those described in FCD Type IIa. Although more frequent in the frontal lobe, MOGHE also occurred in the temporal lobe or involved multiple lobes. Multilobar or extensive MOGHE MRI lesions are associated with less favorable surgical outcomes. Because this is a rare condition, multicenter studies are necessary to characterize MOGHE further.


Subject(s)
Epilepsy, Frontal Lobe/diagnostic imaging , Epilepsy, Frontal Lobe/pathology , Malformations of Cortical Development/diagnostic imaging , Oligodendroglia/pathology , Adolescent , Adult , Age of Onset , Child , Child, Preschool , Cohort Studies , Drug Resistant Epilepsy/diagnostic imaging , Drug Resistant Epilepsy/pathology , Drug Resistant Epilepsy/surgery , Electroencephalography , Epilepsy, Frontal Lobe/surgery , Female , Humans , Magnetic Resonance Imaging , Male , Malformations of Cortical Development/surgery , Middle Aged , Neurons/pathology , Neurosurgical Procedures , Positron-Emission Tomography , Treatment Outcome , Young Adult
2.
Rev cuba neurol neurocir ; 10(1)Ene-Abr. 2020. ilus
Article in Spanish | CUMED | ID: cum-76951

ABSTRACT

Objetivo: Describir los resultados de la evaluación prequirúrgica, transquirúrgica y postquirúrgica, en un adolescente con epilepsia farmacorresistente con zona epileptogénica estimada en un área elocuente del lóbulo frontal izquierdo.Caso clínico: Paciente masculino, de 18 años, con epilepsia frontal izquierdafarmacorresistente desde los tres años, con una frecuencia de crisis de desconexión, atónicas y, en ocasiones, tónico clónico bilateral entre 30 y 40 diarias, previo a la cirugía. Laevaluación prequirúrgica identificó la zona de inicio ictal frontal izquierda, no lesional por imagen de resonancia magnética de 3 tesla. Se indicó tomografía computarizada por emisiónde fotón único interictal / ictal corregistrada con resonancia magnética, donde se identificó hiperperfusión frontal izquierda. Se realizó la cirugía con el uso de potenciales evocadossomatosensoriales para identificar el surco central, la estimulación cortical directa para mapear el área motora primaria, y la electrocorticografía transoperatoria para delimitar la zona de resección. Se empleó la técnica combinada desconectiva (callosotomía anterior) y resectiva del giro frontal superior y medio izquierdos, con modificación del patrón eléctrico en la electrocorticografía posterior a la cirugía. El resultado anatomopatológico fue displasia cortical focal tipo IA. En el seguimiento postquirúrgico, el paciente presenta solo entre 2-3 crisis semanales.Conclusiones: La cirugía de epilepsia extratemporal no lesional y con zona epileptogénica que incluye áreas elocuentes del lóbulo frontal es factible de realizar en nuestro país con mínima invasividad y buenos resultados(AU)


Objective: To describe the results of pre-surgical, trans-surgical and post-surgical assessment of an adolescent with drug-resistant epilepsy and an estimated epileptogenic zone in an eloquent area of the left frontal lobe.Clinical case: Male patient, 18 years old, who had drug-resistant left frontal epilepsy since the age of three. Before surgery, the patient suffered 30 and 40 daily disconnection episodes, atonic and, occasionally, daily bilateral clonic tonic. The pre-surgical evaluation identifiedthe left frontal, non-lesional ictal onset zone using 3-tesla magnetic resonance imaging. An interictal / ictal single photon emission computed tomography corrected with magnetic resonance imaging was indicated, which identified left frontal hyperperfusion. Surgery wasperformed using somatosensory-evoked potentials to identify the central sulcus, direct cortical stimulation to map the primary motor area, and intraoperative electrocorticography to delimit the resection area. Combined disconnective technique (anterior callosotomy) andresective technique of the left superior and middle left gyrus was used, modifying the electrical pattern in the electrocorticography after surgery. The pathological result was type IA focal cortical dysplasia. In the post-surgical follow-up, the patient only has 2-3 weekly crises.Conclusions: Surgery is feasible in a non-lesional extra-temporal epilepsy with an epileptogenic zone that includes eloquent frontal lobe areas in our country with minimal invasiveness and good results(AU)


Subject(s)
Humans , Male , Adolescent , Epilepsy/epidemiology , Epilepsy, Frontal Lobe/diagnostic imaging , Epilepsy, Frontal Lobe/surgery , Drug Resistant Epilepsy/diagnostic imaging , Drug Resistant Epilepsy/surgery
3.
Epilepsy Res ; 148: 37-43, 2018 12.
Article in English | MEDLINE | ID: mdl-30366204

ABSTRACT

Neuroinflammation has been shown to constitute a crucial mechanism in the pathophysiology of epileptic brain and several genes of inflammatory mediators have been detected in surgically resected hippocampus tissue but not in non-related seizure brain regions. Interestingly, it has been reported an olfactory dysfunction in frontal lobe epilepsy (FLE). Our aim was to quantify the gene expression of inflammatory-related and nitric oxide synthase genes in olfactory bulbs (OB) tissue from FLE patients. RNA was isolated from OB resection of FLE patients and autopsy subjects without any neurological disease (n = 7, each). After cDNA synthesis, we performed qPCR for interleukin-1ß (IL-1ß), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), nuclear factor κB p65 (RELA), Toll-like receptor 4 (TLR 4), its agonist high mobility group box 1 (HMGB 1) as well nitric oxide synthase isozymes (NOS 1, 2 and 3). We found a significant increase in gene expression of pro-inflammatory cytokines (IL-1ß, IL-6 and TNFα), TLR4 receptor and in its agonist HMGB1 and the downstream transcription factor NFκB p65. Moreover, we observed an increase of both NOS1 and NOS3 and a slightly increase of NOS2; however, it was not significant. Our study describes the overexpression of inflammatory-related genes and NOS isozymes in OB from FLE patients. Even though, the number of patients was limited, our findings could point out that neuroinflammation and nitrosative stress-related genes in the OB could be produced in general manner in all brain regions and thus contribute in part, to the olfactory dysfunction observed in FLE patients.


Subject(s)
Cytokines/metabolism , Epilepsy, Frontal Lobe/enzymology , Epilepsy, Frontal Lobe/immunology , Nitric Oxide Synthase/metabolism , Olfactory Bulb/enzymology , Olfactory Bulb/immunology , Adult , Aged , Child , Drug Resistant Epilepsy/diagnostic imaging , Drug Resistant Epilepsy/enzymology , Drug Resistant Epilepsy/immunology , Drug Resistant Epilepsy/surgery , Epilepsy, Frontal Lobe/diagnostic imaging , Epilepsy, Frontal Lobe/surgery , Female , Gene Expression , Humans , Male , Middle Aged , Young Adult
4.
Epilepsy Res ; 99(1-2): 55-63, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22055353

ABSTRACT

PURPOSE: Refractory frontal lobe epilepsy (FLE) remains one of the most challenging surgically remediable epilepsy syndromes. Nevertheless, definition of independent predictors and predictive models of postsurgical seizure outcome remains poorly explored in FLE. METHODS: We retrospectively analyzed data from 70 consecutive patients with refractory FLE submitted to surgical treatment at our center from July 1994 to December 2006. Univariate results were submitted to logistic regression models and Cox proportional hazards regression to identify isolated risk factors for poor surgical results and to construct predictive models for surgical outcome in FLE. RESULTS: From 70 patients submitted to surgery, 45 patients (64%) had favorable outcome and 37 (47%) became seizure free. Isolated risk factors for poor surgical outcome are expressed in hazard ratio (H.R.) and were time of epilepsy (H.R.=4.2; 95% C.I.=1.5-11.7; p=0.006), ictal EEG recruiting rhythm (H.R.=2.9; 95% C.I.=1.1-7.7; p=0.033); normal MRI (H.R.=4.8; 95% C.I.=1.4-16.6; p=0.012), and MRI with lesion involving eloquent cortex (H.R.=3.8; 95% C.I.=1.2-12.0; p=0.021). Based on these variables and using a logistic regression model we constructed a model that correctly predicted long-term surgical outcome in up to 80% of patients. CONCLUSION: Among independent risk factors for postsurgical seizure outcome, epilepsy duration is a potentially modifiable factor that could impact surgical outcome in FLE. Early diagnosis, presence of an MRI lesion not involving eloquent cortex, and ictal EEG without recruited rhythm independently predicted favorable outcome in this series.


Subject(s)
Epilepsy, Frontal Lobe/diagnosis , Epilepsy, Frontal Lobe/surgery , Adolescent , Adult , Child , Child, Preschool , Electroencephalography/methods , Epilepsy, Frontal Lobe/physiopathology , Female , Humans , Infant , Male , Middle Aged , Predictive Value of Tests , Prognosis , Retrospective Studies , Treatment Outcome , Video Recording/methods , Young Adult
5.
Arch. Inst. Neurol ; 4(3): 122-6, nov. 2001. ilus
Article in Spanish | BVSNACUY | ID: bnu-11410

ABSTRACT

La epilepsia refractaria al tratamiento farmacológico es un tema en revisión debido al surgimiento de nuevos fármacos antiepilépticos, de técnicas de neuroimagen y a la posibilidad de cirugía de la epilepsia Con el objetivo de enfatizar la importancia de la búsqueda etiológica para adecuar el tratamiento y modificar el pronóstico de estos niños, se presenta un caso clínico en una niña de 8 años, portadora de epilepsia refractaria desde los primeros años de vida. El uso de RM permitió establecer que la misma era originada en una zona de displasia cortical. Se realizó cirugía de la epilepsia estableciéndose un pronóstico favorable a mediano plazo(AU)


Subject(s)
INFORME DE CASO , Humans , Female , Child , Epilepsy, Frontal Lobe/surgery , Epilepsy, Frontal Lobe/etiology , Cerebral Cortex/abnormalities , Epilepsy, Frontal Lobe/drug therapy
6.
Arq. neuropsiquiatr ; Arq. neuropsiquiatr;57(3A): 636-42, set. 1999. ilus, graf
Article in English | LILACS | ID: lil-242269

ABSTRACT

Frontal lobe epilepsies may present difficulties in focus localization in the pre-operative work-up for epilepsy surgery. This is specially treu in patients with normal MRIs. We report on a 16 years-old girl that started with seizures by the age of 8 years. They were brief nocturnal episodes with automatisms such as bicycling and boxing. Seizure frequency ranged from 4-10 per night. Scalp EEG showed few right frontal convexity spiking and intense secondary bilateral syncrhony (SBS). High resolution MRI directed to the frontal lobes was normal. Ictal SPECT suggested a right fronto-lateral focus. Ictal video-EEG showed no focal onset. She was submitted to invasive recordings after subdural plates implantation. Electrodes covered all the frontal convexity and mesial surface bilaterally. Ictal recordings disclosed stereotyped seizures starting from the right mesial frontal. Using a high-resolution tool to measure intra and interhemispheric latencies, the timing and direction of seizure spread from the right fronto-mesial region were studied. Motor strip mapping was performed by means of electrial simulation. She was submitted to a right frontal lobe resection, 1,5 cm ahead of the motor strip and has been seizure free since surgery (8 months). Pathological examination found a 4 mm area of cortical dysplasia. Invasive studies are needed to allow adequate localization in patients with non-localizatory non-invasive work-up and may lead to excellent results in relation to seizures after surgery.


Subject(s)
Adolescent , Humans , Female , Epilepsy, Frontal Lobe/pathology , Epilepsy, Frontal Lobe/surgery , Frontal Lobe/pathology , Frontal Lobe/surgery , Seizures/pathology , Brain Mapping , Electrodes, Implanted , Electroencephalography , Magnetic Resonance Imaging , Subdural Space , Tomography, Emission-Computed, Single-Photon
7.
Arq Neuropsiquiatr ; 57(3A): 636-42, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10667289

ABSTRACT

Frontal lobe epilepsies may present difficulties in focus localization in the pre-operative work-up for epilepsy surgery. This is specially true in patients with normal MRIs. We report on a 16 years-old girl that started with seizures by the age of 8 years. They were brief nocturnal episodes with automatisms such as bicycling and boxing. Seizure frequency ranged from 4-10 per night. Scalp EEG showed few right frontal convexity spiking and intense secondary bilateral synchrony (SBS). High resolution MRI directed to the frontal lobes was normal. Ictal SPECT suggested a right fronto-lateral focus. Ictal video-EEG showed no focal onset. She was submitted to invasive recordings after subdural plates implantation. Electrodes covered all the frontal convexity and mesial surface bilaterally. Ictal recordings disclosed stereotyped seizures starting from the right mesial frontal. Using a high-resolution tool to measure intra and interhemispheric latencies, the timing and direction of seizure spread from the right fronto-mesial region were studied. Motor strip mapping was performed by means of electrical stimulation. She was submitted to a right frontal lobe resection, 1.5 cm ahead of the motor strip and has been seizure free since surgery (8 months). Pathological examination found a 4 mm area of cortical dysplasia. Invasive studies are needed to allow adequate localization in patients with non-localizatory non-invasive work-up and may lead to excellent results in relation to seizures after surgery.


Subject(s)
Epilepsy, Frontal Lobe/pathology , Epilepsy, Frontal Lobe/surgery , Frontal Lobe/pathology , Frontal Lobe/surgery , Seizures/pathology , Adolescent , Brain Mapping , Electrodes, Implanted , Electroencephalography , Epilepsy, Frontal Lobe/physiopathology , Female , Frontal Lobe/physiopathology , Humans , Magnetic Resonance Imaging , Seizures/physiopathology , Subdural Space , Tomography, Emission-Computed, Single-Photon
8.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;35(2): 223-8, abr. 1997. tab
Article in Spanish | LILACS | ID: lil-207202

ABSTRACT

Se presenta y analiza un protocolo en cirugía resectiva córtico-focal en epilepsias focales lesionales fármaco resistentes con lesión visible única a la neuroimagen, iniciado en el Instituto de Neurocirugía e Investigaciones Cerebrales Asenjo en 1990. Hasta la fecha se han operado 40 pacientes, 32 (80 porciento) niños, 8 (20 porciento) adultos. El área más frecuentemente intervenida fue el lóbulo temporal en 24 casos (60 porciento); la cirugía extratemporal se practicó en 16 pacientes, frontal en 11 y parietal en 5. No hubo mortalidad y 2 pacientes quedaron con secuela de defecto del campo visual


Subject(s)
Humans , Male , Female , Adolescent , Epilepsy, Frontal Lobe/surgery , Epilepsies, Partial/surgery , Temporal Lobe/surgery , Anticonvulsants/pharmacology
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