Corpora amylacea in the neocortex in patients with temporal lobe epilepsy and focal cortical dysplasia.

INTRODUCTION: Corpora amylacea (CoA) are present in about 60% of atrophic hippocampi resected from patients with drug resistant temporal lobe epilepsy (DRTLE). They have also been described in the lateral temporal neocortex, although less frequently. OBJECTIVE: The objective is to measure the presence, distribution and density of CoA in the lateral temporal lobes of patients with DRTLE and focal cortical dysplasia (FCD), also examining how CoA density may be linked to demographic and clinical traits. METHODS: Resected tissue from 35 patients was analysed. CoA density was assessed with a semi-quantitative scale according to the criteria established by Cherian et al. RESULTS: Presence of CoA in the neocortex of 9 patients was associated with hippocampal sclerosis (FCD type iiia, 7 cases), disembryoplastic neuroepithelial tumour (FCD type iiib, 1 case), and cavernous angioma (FCD type iiic, 1 case). The meningeal surface (MS) was involved in all cases, and 8 cases displayed CoA in the cerebral parenchyma (white matter) and around blood vessels. CoA density on the MS showed a negative correlation with age at seizure onset (r = -0.828, P<.05) and a positive correlation with disease duration (r = 0.678, P<.05) but not with postoperative clinical outcome. CONCLUSIONS: Patients with DRTLE and a primary lesion (hippocampal sclerosis, tumour, vascular malformation) associated with mild FCD were shown to have CoA deposits in the neocortex. No association was found between presence of CoA and clinical outcome one year after surgery.

[Pathological neocortical findings in patients with medication-resistant medial temporal lobe epilepsy submitted to surgery]. / Hallazgos patológicos neocorticales en pacientes con epilepsia del lóbulo temporal medial farmacorresistente sometidos a cirugía.

INTRODUCTION: The dual pathology consisting of hippocampal sclerosis plus focal cortical dysplasia (FCD) is often reported in patients with medication-resistant medial temporal lobe epilepsy (MTLE). AIMS: To determine the histopathological changes that take place in the neocortex of patients with medication-resistant MTLE submitted to surgery and to evaluate the relation between the histopathological changes, pathological background and the clinical course of patients who had received surgical treatment. MATERIALS AND METHODS: Tissue obtained by en bloc resection from the neocortex of 18 patients with MTLE refractory to medical treatment was processed histologically and a tailored temporal lobectomy was performed with electrocorticography. RESULTS: Dual pathology was diagnosed in 13 patients (72.2%). Imaging studies confirmed the existence of mesial sclerosis of the temporal in 100% of cases and there was no evidence of neocortical lesions. Histologically, 46.15% and 38.46% of the patients were diagnosed as belonging to FCD type 1a and FCD type 1b, respectively. Only one patient presented FCD type 2a. A statistically significant relation was found between the presence of dual pathology and the existence of an early precipitating injury (p = 0.04). One year after surgery, 72.7% (8/11) patients with dual pathology were classified as belonging to Engel class I. CONCLUSIONS: In patients with MTLE there are microscopic FCD-type alterations in the neocortex. There is an association between these alterations and the existence of an initial precipitating injury. Complete resection of the epileptogenic area, which is guaranteed by the lobectomy tailored by electrocorticography, allows patients to enjoy a favourable post-surgical progression one year after surgery.

Hallazgos patológicos neocorticales en pacientes con epilepsia del lóbulo temporal medial farmacorresistente sometidos a cirugía / Pathological neocortical findings in patients with medication-resistant medial temporal lobe epilepsy submitted to surgery

La patología dual compuesta por esclerosis hipocampal y displasia cortical focal (DCF) se describecon frecuencia en pacientes con epilepsia del lóbulo temporal medial (ELTM) farmacorresistente. Objetivos. Determinar los cambios histopatológicos en la neocorteza de pacientes con ELTM farmacorresistente sometidos a cirugía y evaluar la relación entre los cambios histopatológicos, los antecedentes patológicos y la evolución clínica en los pacientes operados. Materialesy métodos. Se procesó histológicamente el tejido resecado en bloque (neocorteza) de 18 pacientes con ELTM refractaria a tratamiento médico, y se les realizó lobectomía temporal ajustada por electrocorticografía. Resultados. Se diagnóstico patología dual en 13 pacientes (72,2%). Los estudios imagenológicos confirmaron en el 100% de los casos la esclerosis mesialdel temporal y no existieron evidencias de lesión neocortical. Histológicamente, el 46,15% y el 38,46% de los pacientes fueron diagnosticados como DCF tipo 1a y DCF tipo 1b, respectivamente. Sólo un paciente presentó DCF tipo 2a. Se demostró una relación estadísticamente significativa entre la presencia de patología dual y la existencia de una daño precipitante inicial (p = 0,04). El 72,7% (8/11) de los pacientes con patología dual un año después de la cirugía se clasificó en la clase Ide Engel. Conclusiones. En los pacientes con ELTM existen alteraciones microscópicas en la neocorteza del tipo DCF. Estas alteraciones se asocian a la existencia de un daño precipitante inicial. La resección completa de la zona epileptogénica, garantizadapor la lobectomía ajustada por electrocorticografía, permite una buena evolución posquirúrgica un año después de la cirugía

The dual pathology consisting of hippocampal sclerosis plus focal cortical dysplasia (FCD) is oftenreported in patients with medication-resistant medial temporal lobe epilepsy (MTLE). Aims. To determine the histopathological changes that take place in the neocortex of patients with medication-resistant MTLE submitted to surgery and to evaluate the relation between the histopathological changes, pathological background and the clinical course of patients whohad received surgical treatment. Materials and methods. Tissue obtained by en bloc resection from the neocortex of 18 patients with MTLE refractory to medical treatment was processed histologically and a tailored temporal lobectomy was performed with electrocorticography. Results. Dual pathology was diagnosed in 13 patients (72.2%). Imaging studies confirmed the existenceof mesial sclerosis of the temporal in 100% of cases and there was no evidence of neocortical lesions. Histologically, 46.15% and 38.46% of the patients were diagnosed as belonging to FCD type 1a and FCD type 1b, respectively. Only one patient presented FCD type 2a. A statistically significant relation was found between the presence of dual pathology and the existenceof an early precipitating injury (p = 0.04). One year after surgery, 72.7% (8/11) patients with dual pathology were classified as belonging to Engel class I. Conclusions. In patients with MTLE there are microscopic FCD-type alterations in the neocortex.There is an association between these alterations and the existence of an initial precipitating injury. Complete resection of the epileptogenic area, which is guaranteed by the lobectomy tailored by electrocorticography, allows patients to enjoy a favourable post-surgical progression one year after surgery

Alteraciones inmunológicas en pacientes epilépticos asociadas a la localización del foco epileptogénico. Réplica / Immunological disorders in epileptic patients linked to the localisation of the epileptogenic focus. Reply

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Réplica. Alteraciones inmunológicas en pacientes epilépticos asociadas a la localización del foco epileptogénico / Reply. Immunological disorders in epileptic patients are associated to the epileptogenic focus localization

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[Immunological disorders in epileptic patients are associated to the epileptogenic focus localization]. / Alteraciones inmunológicas en pacientes epilépticos asociadas a la localización del foco epileptogénico.

OBJECTIVE: Clinical and experimental data support the role of immune mechanisms in the pathogeny of epilepsy. The purpose of this work was to study the immunological aspects in 30 epileptic patients with complex partial crisis resistant to antiepileptic drugs. PATIENTS AND METHODS: The patients were evaluated by EEG-Video and they were grouped attending to epileptogenic focus localization in: temporals (n = 16), lateralized (n = 6) and extratemporals (n = 4). We also studied a group with psychogenic epilepsy (n = 4), this group was diagnosed after EEG-video evaluation. The following immunological evaluations has been carried out: levels of serum immunoglobulins (IgG, IgM e IgA) by radial immunodiffusion test and lymphocytic subpopulations using immunocytochemical methods. We measured the percent of T and B lymphocytes (CD3 and CD20), helper/inductor lymphocyte T (CD4), suppressor/cytotoxic (CD8), interleukine-2 receptor (CD25) and human leukocyte antigen (HLA-DR). RESULTS: The results show a significant increase of CD8+ lymphocytes (p < 0.05) and in the activation markers (CD25+ and HLA-DR+ cells). The evaluation of immunological parameters applied to different group of epileptogenic focus localization shown that the increase of CD8+ lymphocytes is limited to temporal and lateralized patients (p < 0.01). The patients with extratemporal localization of focus and the psychogenic cases shown normal values for the evaluated immunological lymphocyte markers. We did not find a deficit in the humoral immunological aspects. CONCLUSIONS: Taking into account that patients diagnosed as psychogenic received an antiepileptic drug treatment identical to that of the other group, the observed immunological changes might be related with the patogeny of certain epilepsy variants associated with the focus localization and not with the medication.

Características clinico epidemiológicas de un grupo de donantes multiorgánicos utilizados para trasplante de órganos en Cuba / Epidemiological characteristics of a group of multi-organ donors used to transplant organs in Cuba

Introducción. En la trasplantología actual el donante de órganos es un eslabón fundamental. Objetivos. Determinar las características demográficas de los donantes utilizados en el programa de trasplante hepático en Cuba, las principales causas de muerte cerebral, aminas más utilizadas y patrón serológico, así como presentar los trasplantes realizados. Pacientes y métodos. Se revisaron los expedientes clínicos de los donantes reales procesados entre julio de 1999 y julio de 2000. Resultados. En el período de estudio se trabajó con 13 donantes reales de órganos: 9 varones (69,2 por ciento) y 4 mujeres (30,8 por ciento), distribuidos en los siguientes grupos de edades: 15-30 años: 3 casos (23 por ciento), 31-45 años: 4 casos (30,8 por ciento), 46-60 años: 5 casos (38,5 por ciento) y mayores de 60 años: 1 caso (7,7 por ciento). Se realizaron 42 trasplantes: 12 de hígado, incluyendo el primero en nuestro país hepatorrenal, 18 de riñón, 10 de córnea y 1 de corazón. Las causas de muerte fueron: traumatismo craneoencefálico: 10 (76,9 por ciento) y accidente vascular cerebral hemorrágico: 3 (23,1 por ciento). Sólo 3 casos (23,1 por ciento) no requirieron de apoyo con aminas vasoactivas, los otros 10 (76,9 por ciento) sí las utilizaron; las más empleadas fueron la dopamina y la epinefrina en 6 casos, respectivamente (46,1 por ciento). Respecto a los estudios serológicos, las inmunoglobulinas G para citomegalovirus fueron positivas en los 13 casos: Epstein Barr Virus 6 (46,1 por ciento), toxoplasma: 12 (92,3 por ciento), herpes virus I: 13, herpes virus II: 13. Conclusiones. El donante tipo fue un varón de entre 46 y 60 años con muerte cerebral por traumatismo craneoencefálico secundario a accidente de tráfico. En un alto porcentaje de los donantes es necesario el apoyo con aminas para lograr una estabilidad hemodinámica, y existe un alto porcentaje de positividad para los estudios serológicos microbiológicos (AU)

[Epidemiological characteristics of a group of multi organ donors used to transplant organs in Cuba]. / Características clinicoepidemiológicas de un grupo de donantes multiorgánicos utilizados para trasplante de órganos en Cuba.

INTRODUCTION: For current transplants, the organ donor is a basic factor. OBJECTIVES: To determine the demographic characteristics of the donors used in the Cuban liver transplant programme, the main causes of brain death, most widely used amines and serology pattern. To report the transplants carried out. PATIENTS AND METHODS: We reviewed the clinical histories of the actual donors processed between July 1999 and July 2000. RESULTS: During the period studied 13 actual donors were used: 9 men (69.2%) and 4 women (30.8%) distributed in the following age groups: 15 30 years: 3 cases (23%); 31 45 years : 4 cases (30.8%); 46 60 years: 5 cases (38.5%), and over 60 years: 1 case (7.7%). We did 42 transplants: 12 liver, including the first hepato renal in Cuba, 18 kidney, 10 cornea, and 1 heart. The causes of death were: head injury: 10 (76.9%), and hemorrhagic cerebral vascular accident: 3 (23.1%). Only 3 cases (23.1%) did not require the use of vasoactive amines. These were used in the other 10 (76.9%). The most commonly used were dopamine and epinephrine, in 6 cases each (46.1%). In the serological studies for immunoglobulin G for cytomegalovirus all 13 were positive, Epstein Barr virus 6 (46.1%), toxoplasma 12 (92.3%), herpes virus 1: 13, herpes virus 11: 13. CONCLUSIONS: The typical donor was a man aged 46 60 years with brain death due to head injury following a road traffic accident. A large proportion of donors required the use of amines to maintain hemodynamic stability. There was a large proportion of patients who were found on microbiological serology studies to test positive.

[Influence of early stimulation in cerebral palsy]. / Influencia de la estimulación temprana en la parálisis cerebral.

INTRODUCTION: Early stimulation is known to be useful, necessary treatment aimed at developing as much as possible the social psychophysical potential of any child at high environmental and/or biological risk. This group includes children with cerebral palsy, a disorder of the nervous system which may cause retardation in the processes of maturation of the central nervous system and be expressed from the earliest months of the child's life as retardation of psychomotor development. OBJECTIVE: To show the efficiency of early stimulation in children diagnosed as having cerebral palsy and retardation of psychomotor development. PATIENTS AND METHODS: A retrospective study was made of 20 children aged between 9 and 41 months with this diagnosis, in the hospital of CIREN (Cuba). They were treated for a period of 1 to 3 months by a multi-disciplinary team and participated in the programme for Early Stimulation. Assessment was made by the Neuropsychology Department at the start and end of the treatment period, using the first part of the Brunet-Lezine scale for the measurement of psychomotor development in early childhood. RESULTS: In all patients there was a favorable course and new abilities were acquired. There was better performance than before the treatment was started and accelerated rate of development during the period of treatment. CONCLUSION: Patients with cerebral palsy and psychomotor retardation benefit from application of a programme of Early Stimulation.