Cuerpos amiláceos en la neocorteza de pacientes con epilepsia del lóbulo temporal y displasia cortical focal / Corpora amylacea in the neocortex in patients with temporal lobe epilepsy and focal cortical dysplasia

Introducción: Los cuerpos amiláceos (CoA) se presentan en aproximadamente el 60% de los hipocampos atróficos resecados de pacientes con epilepsia del lóbulo temporal farmacorresistente (ELTFR). Su presencia en la neocorteza temporal lateral ha sido observada con menor frecuencia. Objetivo: El objetivo es evaluar la presencia, la distribución y la densidad de CoA en el lóbulo temporal lateral de pacientes con ELTFR y displasia cortical focal (DCF) y la relación de su densidad con variables demográficas y clínicas. Métodos: Analizamos histológicamente el tejido resecado de 35 pacientes con ELTFR. La densidad de los CoA fue evaluada con una escala semicuantitativa según los criterios de Cherian et al. Resultados: La presencia de CoA en la neocorteza de 9 pacientes estuvo asociada a esclerosis hipocampal (DCF tipo IIIa, 7 casos), tumor neuroepitelial disembrioplásico (DCF tipo IIIb, un caso) y angioma cavernoso (DCF tipo IIIc, un caso). Todos los pacientes tuvieron afectación de la superficie meníngea (SM) y en 8 casos se localizaron en el parénquima cerebral (sustancia blanca) y alrededor de los vasos sanguíneos. La densidad de los CoA en SM tuvo una correlación negativa con la edad de inicio de las crisis (r = -0,828, p < 0,05) y positiva con la duración de la enfermedad (r = 0,678, p < 0,05) pero no con la evolución clínica postquirúrgica. Conclusiones: En pacientes con ELTFR con lesión principal (EH, tumor, malformación vascular) asociada a DCF ligeras se constata la acumulación de CoA en la neocorteza. No se encontró una asociación entre la presencia de CoA y la evolución clínica al año de la cirugía

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

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.

Relación entre los resultados del Electroencefalograma digital y la evaluación clínica, neuropsicológica e imagenológica en pacientes con diagnóstico clínico de Parálisis Cerebral / Relation between digital Electroencephalogram clinic results, neuropsychological and imagenologic evaluation in patients with cerebral palsy clinic diagnostic

Objetivo: Evaluar la relación existente entre los resultados del Electroencefalograma (EEG) digital y las anomalías clínicas, neuropsicológicas e imagenológicas detectadas en pacientes con el diagnóstico clínico de Parálisis Cerebral (PC). Sujetos y Métodos: Se realizó un estudio descriptivo longitudinal retrospectivo de los informes de EEG emitidos por un especialista en Neurofisiología clínica en 64 pacientes con el diagnóstico clínico de PC. Los datos fueron registrados desde enero del año 2000 hasta diciembre del año 2005 en el Laboratorio de Neurofisiología Clínica del CIREN. Incluimos a pacientes con edades entre 2 y 15 años, con diagnóstico revisado de la historia clínica de PC. Se tabularon las variables evaluadas en los registros de EEG, y se relacionaron con variables clínicas, neuropsicológicas e imagenológicas. Todos los registros se realizaron en un Equipo MEDICID 4 Neuronic SA de producción cubana con el software Track Walker 2. Resultados: Se obtuvo que el 79 % del los registros electroencefalográficos fueron patológicos. Predominó la actividad epileptiforme en un 58%. El tipo de PC en nuestra casuística fue la espástica para un 50%. La causa de la PC fue perinatal en un 43%. Las enfermedades asociadas fueron Retardo del desarrollo psicomotor (RDP), Retraso mental (RM) y epilepsia. Se evidenció una asociación estadísticamente significativa entre la presencia de actividad epileptiforme y la epilepsia, entre los resultados del EEG y la presencia de lesión bilateral, así como entre la actividad epileptiforme y la presencia de RM, RDP y epilepsia. Conclusiones: Se constata una asociación estadísticamente significativa entre las anomalías epileptiformes y el diagnóstico clínico de epilepsia en pacientes con PC. Las anomalías del EEG se asocian mayormente con la extensión bilateral de la afectación motora, y con las lesiones detectadas mediante los estudios de Resonancia Magnética Nuclear (RMN). Existe una tendencia a la asociación entre las alteraciones Electroencefalográficas, el tipo de PC y la presencia de retardo en el desarrollo psicomotor y retraso mental. El EEG es un medio diagnóstico útil en la evaluación funcional de los pacientes con PC (AU)

Objetive: To evaluate the relation between digital Electroencephalogram (EEG) results and clinic, neuropsychological and imagenologic anomaly detected in patients with Cerebral Palsy (CP) diagnosis. Subject and method: Descriptive longitudinal retrospective study was made of EEG informs emitted by a clinical neurophysiologic specialist in 64 patients with CP diagnosis. The information was recorded from January 2000 to December 2005 in a Clinical Neurophysiologist laboratory of the International Center of Neurological Restoration. It included patients between 2 and 15 years old, with CP diagnostic checked in clinical history. The variables assessed were tabulated in EEG records and were associated to clinical, neuropsychology and imagenologic variables. All recordings were performed with the MEDICID 4 Neuronic SA equipment made in Cuba with Track Walker 2 software. Results: 79 % of the electroencephalographic records were pathological. In 58% of the cases there was a predominance of epileptiform activity. 50% suffered from spastic CP. The cause of CP was perinatal in 43%. The other associated conditions were Phychomotor Retardation (PR), Mental Delay (MD) and epilepsy. There was a statistically significant association between the presence of epileptiform activity and epilepsy between the EEG records and bilateral lesion and between the epileptiform activity and the presence of MD, PR and epilepsy. Conclusions: Our results demonstrate the exististence of a statistically significant association between epileptiform anomaly and epilepsy clinical diagnosis. It was confirmed that EEG anomaly is associated with bilateral extension of motor affectation and lesions detected with Magnetic Resonance Image (MRI) studies. There was an association tendency between electroencephalographic alteration, CP type, PR and MD presence. EEG is a useful diagnostic way for the functional evaluation of CP patients (AU)

Estudio prospectivo, abierto, controlado y aleatorizado de clobazam frente a carbamacepina en pacientes con crisis frecuentes de epilepsia rolándica / A prospective, open, controlled and randomised study of clobazam versus carbamazepine in patients with frequent episodes of rolandic epilepsy

Resumen. Introducción. No existen estudios controlados, aleatorizados y con régimen de dosificación flexibles en niños con epilepsia rolándica, por lo que la terapia es aún empírica. Objetivo. Evaluar la eficacia y la tolerabilidad del clobazam (CLB) comparado con la carbamacepina (CBZ) en la epilepsia rolándica. Pacientes y métodos. Estudio prospectivo, abierto, controlado, aleatorizado de CBZ frente a CLB en niños con epilepsia rolándica con seguimiento durante dos años. Se aleatorizaron 45 pacientes y terminaron el estudio 38 sujetos. Se indicó un régimen de dosificación flexible. Se evaluó el control de crisis, el rendimiento escolar, el comportamiento, la adherencia al tratamiento, el grado de satisfacción de los padres y el perfil de efectos adversos. Resultados. Ambos medicamentos fueron igualmente eficaces para controlar las crisis (el 94,1% de pacientes con CLB y el 100% con CBZ estaban libres de crisis al finalizar el estudio; p = 0,26). El CLB logró controlar las crisis más tempranamente (33,3 ± 45 frente a 48,2 ± 72,3 días; p < 0,05) y tuvo menos efectos adversos que la CBZ (aparecieron efectos adversos en tres pacientes con CLB y ocho con CBZ; p = 0). En dos pacientes en régimen de CBZ, las crisis empeoraron y junto con ello aparecieron complicaciones cognitivoconductuales. Conclusiones. La CBZ es un medicamento eficaz en la epilepsia rolándica, pero puede asociarse a un empeoramiento de las crisis, así como a déficit cognitivos y conductuales. El CLB en monoterapia parece ser un fármaco eficaz y mejor tolerado en este tipo de epilepsia (AU)

Summary. Introduction. To date no controlled, randomised studies with flexible dose regimens have been conducted in children with rolandic epilepsy, and therapy is therefore still empirical. Aim. To evaluate the effectiveness and safety of clobazam (CLB) compared with that of carbamazepine (CBZ) in rolandic epilepsy. Patients and methods. A prospective, open, controlled and randomised study was carried out to compare CBZ and CLB in children with rolandic epilepsy with a follow-up over a twoyear period. A random sample of 45 patients was taken and 38 of them finished the study. A flexible dose regimen was indicated. Control of seizures, academic performance, behaviour, adherence to treatment, parents’ degree of satisfaction and side effect profiles were all evaluated. Results. Both drugs were equally effective at controlling seizures (94.1% of patients with CLB and 100% of those with CBZ were free of seizures on ending the study; p = 0.26). CLB controlled seizures earlier (33.3 ± 45 days versus 48.2 ± 72.3; p < 0.05) and had fewer side effects than CBZ (side effects appeared in three patients with CLB and in eight of those on CBZ; p = 0). In two of the patients taking CBZ, the seizures got worse and a series of cognitive-behavioural complications also appeared. Conclusions. CBZ is an effective drug in rolandic epilepsy, but it may be associated with exacerbation of seizures as well as with cognitive-behavioural impairment. CLB in monotherapy seems to be an effective and better tolerated drug in this kind of epilepsy (AU)

[A prospective, open, controlled and randomised study of clobazam versus carbamazepine in patients with frequent episodes of Rolandic epilepsy]. / Estudio prospectivo, abierto, controlado y aleatorizado de clobazam frente a carbamacepina en pacientes con crisis frecuentes de epilepsia rolándica.

INTRODUCTION: To date no controlled, randomised studies with flexible dose regimens have been conducted in children with rolandic epilepsy, and therapy is therefore still empirical. AIM: To evaluate the effectiveness and safety of clobazam (CLB) compared with that of carbamazepine (CBZ) in rolandic epilepsy. PATIENTS AND METHODS: A prospective, open, controlled and randomised study was carried out to compare CBZ and CLB in children with rolandic epilepsy with a follow-up over a two-year period. A random sample of 45 patients was taken and 38 of them finished the study. A flexible dose regimen was indicated. Control of seizures, academic performance, behaviour, adherence to treatment, parents' degree of satisfaction and side effect profiles were all evaluated. RESULTS: Both drugs were equally effective at controlling seizures (94.1% of patients with CLB and 100% of those with CBZ were free of seizures on ending the study; p = 0.26). CLB controlled seizures earlier (33.3 +/- 45 days versus 48.2 +/- 72.3; p < 0.05) and had fewer side effects than CBZ (side effects appeared in three patients with CLB and in eight of those on CBZ; p = 0). In two of the patients taking CBZ, the seizures got worse and a series of cognitive-behavioural complications also appeared. CONCLUSIONS: CBZ is an effective drug in rolandic epilepsy, but it may be associated with exacerbation of seizures as well as with cognitive-behavioural impairment. CLB in monotherapy seems to be an effective and better tolerated drug in this kind of epilepsy.

Microscopic mild focal cortical dysplasia in temporal lobe dual pathology: an electrocorticography study.

BACKGROUND: Associations between electrophysiological and histological findings might provide an insight into the epileptogenicity of mild focal cortical dysplasia (FCD) in patients with temporal lobe epilepsy (TLE) and a dual pathology. SUBJECTS AND METHODS: A total of 22 patients with pharmacoresistant TLE were included in the study, 16 of them with histologically confirmed hippocampal sclerosis (HS) associated with neocortical temporal mild Palmini Type-I FCD subtypes and 6 with HS. Intraoperative electrocorticography (ECoG) recordings were analysed for epileptiform discharge frequency and morphology. Associations between histological, and electrocorticography pattern findings in these patients were analysed. Electroclinical outcomes in these patients were also evaluated. RESULTS: Neocortical areas with mild Palmini Type-I FCD showed a significantly higher spike frequency (SF) recorded in the inferior temporal gyrus than those neocortical areas in patients with HS. There was a tendency to higher spike frequency and lower amplitude in neocortical areas with histopathologic subtype IB FCD in relation with IA during intraoperative ECoG. Post-SF excision and amplitude were significantly lower during neocortical post-excision intraoperative ECoG than during neocortical pre-excision recording. There was no difference found in the clinical outcome between patients with and without FCD. CONCLUSIONS: Intraoperative electrocorticographic interictal spike frequency recorded in the neocortical inferior temporal gyrus may help to characterize the histopathologic subtypes of mild Palmini Type-I FCD in patients with temporal lobe epilepsy (TLE) and a dual pathology. Our data support the epileptogenicity of neocortical mild FCD in TLE and assessments of ECoG patterns are relevant to determine the extent of the resection in these patients which can influence the electroclinical outcome.

Estudio prospectivo, abierto, controlado y aleatorizado de clobazam frente a carbamacepina en pacientes con crisis frecuentes de epilepsia rolándica / A prospective, open, controlled and randomised study of clobazam versus carbamazepine in patients with frequent episodes of Rolandic epilepsy

No existen estudios controlados, aleatorizados y con régimen de dosificación flexibles en niños con epilepsia rolándica, por lo que la terapia es aún empírica. Objetivo. Evaluar la eficacia y la tolerabilidad del clobazam (CLB) comparado con la carbamacepina (CBZ) en la epilepsia rolándica. Pacientes y métodos. Estudio prospectivo, abierto, controlado, aleatorizado de CBZ frente a CLB en niños con epilepsia rolándica con seguimiento durante dos años. Se aleatorizaron 45 pacientes y terminaron el estudio 38 sujetos. Se indicó un régimen de dosificación flexible. Se evaluó el control de crisis, el rendimiento escolar, el comportamiento, la adherencia al tratamiento, el grado de satisfacción de los padres y el perfil de efectos adversos. Resultados. Ambos medicamentos fueron igualmente eficaces para controlar las crisis (el 94,1por ciento de pacientes con CLB y el 100 por ciento con CBZ estaban libres de crisis al finalizar el estudio; p = 0,26). El CLB logró controlar las crisis más tempranamente (33,3 ± 45 frente a 48,2 ± 72,3 días; p < 0,05) y tuvo menos efectos adversos que la CBZ (aparecieron efectos adversos en tres pacientes con CLB y ocho con CBZ; p = 0). En dos pacientes en régimen de CBZ, las crisis empeoraron y junto con ello aparecieron complicaciones cognitivoconductuales. La CBZ es un medicamento eficaz en la epilepsia rolándica, pero puede asociarse a un empeoramiento de las crisis, así como a déficit cognitivos y conductuales. El CLB en monoterapia parece ser un fármaco eficaz y mejor tolerado en este tipo de epilepsia(AU)

To date no controlled, randomised studies with flexible dose regimens have been conducted in children with rolandic epilepsy, and therapy is therefore still empirical.To evaluate the effectiveness and safety of clobazam (CLB) compared with that of carbamazepine (CBZ) in rolandic epilepsy. A prospective, open, controlled and randomised study was carried out to compare CBZ and CLB in children with rolandic epilepsy with a follow-up over a two-year period. A random sample of 45 patients was taken and 38 of them finished the study. A flexible dose regimen was indicated. Control of seizures, academic performance, behaviour, adherence to treatment, parents' degree of satisfaction and side effect profiles were all evaluated. Both drugs were equally effective at controlling seizures (94.1 percent of patients with CLB and 100 percent of those with CBZ were free of seizures on ending the study; p = 0.26). CLB controlled seizures earlier (33.3 +/- 45 days versus 48.2 +/- 72.3; p < 0.05) and had fewer side effects than CBZ (side effects appeared in three patients with CLB and in eight of those on CBZ; p = 0). In two of the patients taking CBZ, the seizures got worse and a series of cognitive-behavioural complications also appeared. CBZ is an effective drug in rolandic epilepsy, but it may be associated with exacerbation of seizures as well as with cognitive-behavioural impairment. CLB in monotherapy seems to be an effective and better tolerated drug in this kind of epilepsy(AU)

[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.

[Volumetric measurement and digital electroencephalography in patients with medication-resistant medial temporal lobe epilepsy submitted to surgery]. / Volumetria y electroencefalografía digital en pacientes con epilepsia del lobulo temporal medial farmacorresistente sometidos a cirugía.

AIM: To assess the value of volumetric measurement by means of magnetic resonance imaging (MRI) and interictal electroencephalogram (EEG) in pre- and post-operative assessment of patients with medication-resistant medial temporal lobe epilepsy (MTLE) who were submitted to surgery. PATIENTS AND METHODS: We evaluated 12 volumetric studies carried out using MRI and 24 digital EEG records for six patients suffering from complex partial seizures that were resistant to medical treatment and had their origin in the temporal lobe. A volumetric analysis was performed using MRI to study the epileptogenic region and the frequencies at which interictal epileptiform discharges (IED/minute) appeared before, at six months and at one year after surgery were calculated; a correlation was observed between the volumetric analysis and the irritative and epileptogenic region. RESULTS: The volumes of both the ipso and contralateral hippocampuses were smaller in comparison to the increased frequency of the IED in the mesial regions. The inferior temporal lobes and the parahippocampal cortex have reduced volumes ipsolateral to the epileptogenic region. At six months after performing the temporal lobectomy, the IED frequency decreased with respect to the pre-operative IED. A negative correlation was found between the resected volume of the parahippocampal cortex and the inferior temporal lobe, and the post-operative IED frequency at one year. CONCLUSIONS: In patients with medication resistant MTLE the volumes of other structures in the medial temporal lobe are diminished, in addition to the hippocampus, and they are seen to have a smaller volume on the side that is ipsolateral to the epileptogenic region. There is a relation between the volume of the resected hippocampus and the post-operative IED frequency in patients with MTLE who successfully underwent a temporal lobectomy. Volumetric analysis of the epileptogenic lesion using MRI provides localising information that is valuable in the pre-operative assessment of patients with medication resistant MTLE who are submitted to 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

Introducción. 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 (72,2por ciento). Los estudios imagenológicos confirmaron en el 100por ciento de los casos la esclerosis mesial del temporal y no existieron evidencias de lesión neocortical. Histológicamente, el 46,15 por ciento y el 38,46 por ciento de los pacientesfueron 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 72,7por ciento (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, garantizada por la lobectomía ajustada por electrocorticografía, permite una buena evolución posquirúrgica un año después de la cirugía(AU)

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 (72.2percent). Imaging studies confirmed the existence of mesial sclerosis of the temporal in 100 percent of cases and there was no evidence of neocortical lesions. Histologically, 46.15 percent and 38.46 percent 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, 72.7percent (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(AU)

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

Volumetría y electroencefalografía digital en pacientes con epilepsiadel lóbulo temporal medial farmacorresistente sometidos a cirugía / Volumetric measurement and digital electroencephalography in patients with medication-resistant medial temporal lobe epilepsy submitted to surgery

Objetivo. Evaluar la contribución de la volumetría mediante resonancia magnética (RM) y el electroencefalograma(EEG) interictal en la evaluación pre y posquirúrgica de pacientes con epilepsia del lóbulo temporal medial (ELTM) farmacorresistente sometidos a cirugía. Pacientes y métodos. Se evaluaron 12 estudios volumétricos por RM y 24 registros de EEG digital correspondientes a seis pacientes con crisis parciales complejas refractarias a tratamiento médico de origen temporal.Se realizó el análisis volumétrico por RM, para el estudio de la zona epileptogénica, y se calculó la frecuencia de aparición de descargas epileptiformes interictales (DEI/minuto) antes, a los seis meses y al año de la cirugía, y se correlacionó el análisis volumétrico con la zona irritativa y epileptogénica. Resultados. Los volúmenes de los hipocampos tanto ipsi como contralaterales están disminuidos de tamaño en comparación con el aumento de la frecuencia DEI en las zonas mesiales. Loslóbulos temporales inferiores y la corteza parahipocámpica se encontraron disminuidos de volumen ipsilaterales a la zona epileptogénica. La frecuencia de DEI disminuye a los seis meses de realizada la lobectomía temporal respecto a las DEI prequirúrgica.Se encontró correlación negativa entre el volumen resecado de la corteza parahipocámpica y el lóbulo temporalinferior con la frecuencia DEI posquirúrgica al año. Conclusiones. En pacientes con ELTM farmacorresistente se encuentran disminuidos los volúmenes de otras estructuras del lóbulo temporal medial, además del hipocampo, y se constata un menorvolumen de éstas, en el lado ipsilateral a la zona epileptogénica. El volumen de hipocampo resecado se relaciona con la frecuencia de DEI posquirúrgica de los pacientes con ELTM sometidos a lobectomía temporal exitosa. El análisis volumétrico mediante RM de la lesión epileptogénica aporta información localizadora de utilidad en la evaluación prequirúrgica de pacientes........(AU)

Aim. To assess the value of volumetric measurement by means of magnetic resonance imaging (MRI) and interictalelectroencephalogram (EEG) in pre- and post-operative assessment of patients with medication-resistant medial temporal lobe epilepsy (MTLE) who were submitted to surgery. Patients and methods. We evaluated 12 volumetric studies carried out using MRI and 24 digital EEG records for six patients suffering from complex partial seizures that were resistant to medicaltreatment and had their origin in the temporal lobe. A volumetric analysis was performed using MRI to study the epileptogenic region and the frequencies at which interictal epileptiform discharges (IED/minute) appeared before, at six months and at oneyear after surgery were calculated; a correlation was observed between the volumetric analysis and the irritative andepileptogenic region. Results. The volumes of both the ipso and contralateral hippocampuses were smaller in comparison to the increased frequency of the IED in the mesial regions. The inferior temporal lobes and the parahippocampal cortex havereduced volumes ipsolateral to the epileptogenic region. At six months after performing the temporal lobectomy, the IED frequency decreased with respect to the pre-operative IED. A negative correlation was found between the resected volume of the parahippocampal cortex and the inferior temporal lobe, and the post-operative IED frequency at one year. Conclusions. In patients with medication resistant MTLE the volumes of other structures in the medial temporal lobe are diminished, inaddition to the hippocampus, and they are seen to have a smaller volume on the side that is ipsolateral to the epileptogenic region. There is a relation between the volume of the resected hippocampus and the post-operative IED frequency in patients with MTLE who successfully underwent a temporal lobectomy. Volumetric analysis of the epileptogenic lesion using MRIprovides localising information.......(AU)

Volumetría y electroencefalografía digital en pacientes con epilepsia del lóbulo temporal medial farmacorresistente sometidos a cirugía / Volumetric measurement and digital electroencephalography in patients with medications-resistant medial temporal lobe epilepsy submitted to surgery

Evaluar la contribución de la volumetría mediante resonancia magnética (RM) y el electroencefalograma(EEG) interictal en la evaluación pre y posquirúrgica de pacientes con epilepsia del lóbulo temporal medial (ELTM) farmacorresistente sometidos a cirugía. Pacientes y métodos. Se evaluaron 12 estudios volumétricos por RM y 24 registros de EEG digital correspondientes a seis pacientes con crisis parciales complejas refractarias a tratamiento médico de origen temporal.Se realizó el análisis volumétrico por RM, para el estudio de la zona epileptogénica, y se calculó la frecuencia de aparición de descargas epileptiformes interictales (DEI/minuto) antes, a los seis meses y al año de la cirugía, y se correlacionóel análisis volumétrico con la zona irritativa y epileptogénica. Resultados. Los volúmenes de los hipocampos tanto ipsi comocontralaterales están disminuidos de tamaño en comparación con el aumento de la frecuencia DEI en las zonas mesiales. Los lóbulos temporales inferiores y la corteza parahipocámpica se encontraron disminuidos de volumen ipsilaterales a la zona epileptogénica. La frecuencia de DEI disminuye a los seis meses de realizada la lobectomía temporal respecto a las DEI prequirúrgica.Se encontró correlación negativa entre el volumen resecado de la corteza parahipocámpica y el lóbulo temporal inferior con la frecuencia DEI posquirúrgica al año. Conclusiones. En pacientes con ELTM farmacorresistente se encuentrandisminuidos los volúmenes de otras estructuras del lóbulo temporal medial, además del hipocampo, y se constata un menor volumen de éstas, en el lado ipsilateral a la zona epileptogénica. El volumen de hipocampo resecado se relaciona con la frecuenciade DEI posquirúrgica de los pacientes con ELTM sometidos a lobectomía temporal exitosa. El análisis volumétricomediante RM de la lesión epileptogénica aporta información localizadora de utilidad en la evaluación prequirúrgica de pacientes con ELTM farmacorresistente sometidos a cirugía

To assess the value of volumetric measurement by means of magnetic resonance imaging (MRI) and interictalelectroencephalogram (EEG) in pre- and post-operative assessment of patients with medication-resistant medial temporal lobe epilepsy (MTLE) who were submitted to surgery. Patients and methods. We evaluated 12 volumetric studies carried out using MRI and 24 digital EEG records for six patients suffering from complex partial seizures that were resistant to medicaltreatment and had their origin in the temporal lobe. A volumetric analysis was performed using MRI to study the epileptogenic region and the frequencies at which interictal epileptiform discharges (IED/minute) appeared before, at six months and at oneyear after surgery were calculated; a correlation was observed between the volumetric analysis and the irritative and epileptogenic region. Results. The volumes of both the ipso and contralateral hippocampuses were smaller in comparison tothe increased frequency of the IED in the mesial regions. The inferior temporal lobes and the parahippocampal cortex havereduced volumes ipsolateral to the epileptogenic region. At six months after performing the temporal lobectomy, the IED frequency decreased with respect to the pre-operative IED. A negative correlation was found between the resected volume of the parahippocampal cortex and the inferior temporal lobe, and the post-operative IED frequency at one year. Conclusions. Inpatients with medication resistant MTLE the volumes of other structures in the medial temporal lobe are diminished, in addition to the hippocampus, and they are seen to have a smaller volume on the side that is ipsolateral to the epileptogenic region. There is a relation between the volume of the resected hippocampus and the post-operative IED frequency in patientswith MTLE who successfully underwent a temporal lobectomy. Volumetric analysis of the epileptogenic lesion using MRI provides localising information that is valuable in the pre-operative assessment of patients with medication resistant MTLE who are submitted to surgery