Thermosensitive/thermochromic silicone and infrared thermography mapping in 60 consecutive cases of epilepsy surgery.

Background: Epilepsy surgery represents a therapeutic opportunity for those patients who do not respond to drug therapy. However, an important challenge is the precise identification of the epileptogenic area during surgery. Since it can be hard to delineate, it makes it necessary to use auxiliary tools as a guide during the surgical procedure. Electrocorticography (ECoG), despite having shown favorable results in terms of reducing post-surgical seizures, have certain limitations. Brain mapping using infrared thermography mapping and a new thermosensitive/thermochromic silicone (TTS) in epilepsy surgery has introduced a new resource of noninvasive and real-time devices that allow the localization of irritative zones. Methods: Sixty consecutive patients with drug-resistant epilepsy with surgical indications who decided to participate voluntarily in the study were included in the study. We measured brain temperature using two quantitative methods and a qualitative method: the TTS sheet. In all cases, we used ECoG as the gold standard to identify irritative areas, and all brain tissue samples obtained were sent to pathology for diagnosis. Results: In the subgroup in which the ECoG detected irritative areas (n = 51), adding the results in which there was a correlation with the different methods, the efficiency obtained to detect irritative areas is 94.11% (n = 48/51, P ≤ 0.0001) while the infrared thermography mapping method independently has an efficiency of 91.66% (P ≤ 0.0001). The TTS has a sensitivity of 95.71% and a specificity of 97.9% (P ≤ 0.0001) to detect hypothermic areas that correlate with the irritative zones detected by ECoG. No postoperative infections or wound dehiscence were documented, so the different methodologies used do not represent an additional risk for the surgical proceedings. Conclusion: We consider that the infrared thermography mapping using high-resolution infrared thermography cameras and the TTS are both accurate and safe methods to identify irritative areas in epilepsy surgeries.

Localization of irritative zones in epilepsy with thermochromic silicone.

BACKGROUND: During epilepsy surgery, the gold standard to identify irritative zones (IZ) is electrocorticography (ECoG); however, new techniques are being developed to detect IZ in epilepsy surgery and in neurosurgery in general, such as infrared thermography mapping (ITM), and the use of thermosensitive/thermochromic materials. METHODS: In a cohort study of consecutive patients with focal drug-resistant epilepsy of the temporal lobe treated with surgery, we evaluated possible adverse effects to the transient placement of a thermochromic/thermosensitive silicone (TTS) on the cerebral cortex and their postoperative evolution. Furthermore, we compared the precision of TTS for detecting cortical IZ against the gold standard ECoG and with ITM, as proof of concept. RESULTS: We included 10 consecutive patients, 6 women (60%) and 4 men (40%). Age ranges from 15 to 56 years, mean 33.2 years. All were treated with unilateral temporal functional lobectomy. The mean hospital stay was 4 days. There were no immediate or late complications associated with the use of any of the modalities described. In the 10 patients, we obtained consistency in locating the IZ with ECoG, ITM, and the TTS. CONCLUSION: The TTS demonstrated biosecurity in this series. The accuracy of the TTS to locate IZ was similar to that of ECoG and ITM in this study. More extensive studies are required to determine its sensitivity and specificity.

Clinical-etiological and therapeutic profile of 719 Mexican epileptic children.

RATIONALE: We performed this study with the intention of describing the clinical-etiological characteristics and therapeutic responses in a group of epileptic children seen at the Instituto Nacional de Pediatría (INP), a tertiary facility in Mexico City. METHODS: All patients who attended the Epileptic Clinic between March and June 1998 and fulfilled the selection criteria were enrolled in the study. Clinical and therapeutic response data were recorded. Three groups were formed by etiology. Statistical tests were two-tailed, with alpha=0.05. RESULTS: In all, 719 patients were studied. The distribution by etiology was as follows: group I, idiopathic (123 patients); group II, cryptogenic (132); and group III, symptomatic (464). In group I, 56% of the patients were female. Mean age at onset was 5 years 2 months (SD: 3 years 8 months) in group I; 1 year 11 months (SD: 2 years 5 months) in group II; and 2 years 10 months (SD: 3 years 1 month) in group III. The mean evolution time was 5 years 4 months (SD: 4 years) in all groups. The most frequent variety of epilepsy in the three groups was generalized epilepsy, followed by partial epilepsy. The following epileptic syndromes were identified: in group I, 28 patients had epilepsy with generalized tonic-clonic seizures, 15, absence epilepsy, and 6, benign rolandic seizures; in group II, all 32 patients had focal cryptogenic epilepsy; in group III, 235 had generalized symptomatic and 192, focal symptomatic epilepsy. The main etiologies were hypoxic ischemic encephalopathy (24%) and neural infections (22%). Appropriate seizure control was achieved in 108 (87%) patients in group I; 84 (64%) in group II; and 315 (68%) in group III. In group I, no patient needed more than two antiepileptic drugs and 90% had normal psychomotor development. CONCLUSION: When the three groups were compared in terms of appropriate epileptic control and normal psychomotor development, group I differed from the other groups and the difference was statistically significant.

Neurocisticercosis en la edad pediátrica: Perfil social y clínico en 122 pacientes / Neurocysticercosis in children. Social and clinical profile in 122 Mexican patients

La neurocisticercosis (NC) es un problema de salud pública en México. Existe poca información sobre esta enfermedad en la edad pediátrica. El objetivo del presente trabajo es conocer las características clínicas y sociales en pacientes con NC tratados en el servicio de Neurología del I.N.P. en los últimos 10 años. Fueron 122 pacientes, 58 por ciento del sexo femenino, la edad promedio fue ocho años. El 50 por ciento de los pacientes vive en áreas hurbanas; 77 familias cuentan sólo con escolaridad básica. Las principales manifestaciones clínicas son epilepsia en 78 por ciento, hipertensión intracraneana en 20 por ciento y cefalea en 18 por ciento. En todos los pacientes se hizo TAC cerebral; en 20 se realizó IRM. Se encontró reacción positiva para cisticercosis en el LCR en 76 por ciento. La evolución de los pacientes fue inadecuada en 26 por ciento y la mortalidad de 1.2 por ciento

Infusión continua de diazepam para el manejo de estado epiléptico refractario / Continuous infusion of diazepam in the management of refractory status epilepticus

El estado epiléptico es una urgencia neurológica con elevada morbimortalidad, más aún cuando es refractario al tratamiento habitual. Se presenta la experiencia con 20 pacientes con estado epiléptico, tratados con infusión continua de diazepam. La fluctuó entre dos meses y 13 años. Hubo cinco niñas y quince niños. Quince tenían estado epiléptico generalizado y cinco con estado epiléptico parcial. Dieciocho tenían diagnóstico de epilepsia sintomátic y dos, criptogénica. La respuesta a la infusión fue favorable en 17 casos; en ninguno se requirió ventilación asistida o uso de aminas presoras en forma simultánea. Este tratamiento no causó morbilidad asociada

Muerte Encefálica en Niños: experiencia clínica en 76 casos / Bain Death in children: clinical experience in 76 cases

El diagnóstico de muerte encefálica (ME) en edad pediátrica implica ciertas peculiaridades. En nuestro medio no hay informes al respecto de esta entidad. Se presenta la experiencia clínica en 76 casos con ME. En nuestra población el grupo aterio más frecuentemente afectado fue el de los lactantes. El 68 por ciento de nuestros pacientes fueron del sexo masculino. Las causas que condicionaron el estado de ME en nuestras series son: infecciosas, neoplásicas y traumáticas. Se revisan las características clínicas de esta entidad y de los estudios de gabinete confirmatorios.

Muerte cerebral en niños: experiencia clínica en 61 pacientes / Brain death in children: clinical experience in 61 patients

La muerte cerebral (MC) es una entidad clínica que afecta todas las edades. Su diagnóstico en la edad pediátrica reviste ciertas peculiaridades. En nuestro medio no existen informes al respecto. Se presenta la experiencia con 61 niños con MC. El 77 por ciento de nuestra población fueron varones, y los lactantes, los más afectados. Las causas de MC difieren de las descritas en la literatura internacional; las infecciones, las neoplasias y los traumas son las más frecuentes. Se revisan las características clínicas de esta entidad y la utilidad de los estudios confirmatorios.

Intoxicación por raticida y status epilepticus / Intoxication with raticide and status epilepticus

La intoxicación por raticidas (Fosfuro de Zinc) es potencialmente letal y cuando existen manifestaciones clínicas del sistema nervioso central, la mortalidad alcanza hasta el 70%de los casos. Se presenta el caso de un preescolar con intoxicación por fosfuro de zinc. La ingestión de este tóxico causó estado epiléptico, cuya evolución fué satisfactoria, con recuperación neurológica completa.