RESUMO
BACKGROUND: Traumatic brain injury (TBI) is an important cause of focal epilepsy. Animal experiments indicate that disruption of the blood-brain barrier (BBB) plays a critical role in the pathogenesis of post-traumatic epilepsy (PTE). OBJECTIVE: To investigate the frequency, extent and functional correlates of increased BBB permeability in patient with PTE. METHODS: 32 head trauma patients were included in the study, with 17 suffering from PTE. Patients underwent brain MRI (bMRI) and were evaluated for BBB disruption, using a novel semi-quantitative technique. Cortical dysfunction was measured using electroencephalography (EEG), and localised using standardised low-resolution brain electromagnetic tomography (sLORETA). RESULTS: Spectral EEG analyses revealed significant slowing in patients with TBI, with no significant differences between patients with epilepsy and those without. Although bMRI revealed that patients with PTE were more likely to present with intracortical lesions (p = 0.02), no differences in the size of the lesion were found between the groups (p = 0.19). Increased BBB permeability was found in 76.9% of patients with PTE compared with 33.3% of patients without epilepsy (p = 0.047), and could be observed years following the trauma. Cerebral cortex volume with BBB disruption was larger in patients with PTE (p = 0.001). In 70% of patients, slow (delta band) activity was co-localised, by sLORETA, with regions showing BBB disruption. CONCLUSIONS: Lasting BBB pathology is common in patients with mild TBI, with increased frequency and extent being observed in patients with PTE. A correlation between disrupted BBB and abnormal neuronal activity is suggested.
Assuntos
Barreira Hematoencefálica/metabolismo , Lesões Encefálicas/complicações , Lesões Encefálicas/metabolismo , Permeabilidade Capilar/fisiologia , Epilepsia/etiologia , Epilepsia/metabolismo , Adolescente , Adulto , Barreira Hematoencefálica/patologia , Lesões Encefálicas/patologia , Estudos de Casos e Controles , Estudos de Coortes , Eletroencefalografia , Epilepsia/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
The authors describe long-term follow-up (mean, 5 years) in patients with anterior (AN) (n = 6) or centromedian (n = 2) thalamic deep brain stimulation (DBS) for epilepsy. Five patients (all AN) had > or = 50% seizure reduction, although benefit was delayed in two until years 5 to 6, after changes in antiepileptic drugs. DBS electrode implantation in AN patients was followed by seizure reduction 1 to 3 months before active stimulation, raising the possibility of a beneficial microthalamotomy effect.
Assuntos
Estimulação Encefálica Profunda , Epilepsia/terapia , Tálamo , Adolescente , Adulto , Anticonvulsivantes/uso terapêutico , Terapia Combinada , Estimulação Encefálica Profunda/efeitos adversos , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/terapia , Epilepsia/tratamento farmacológico , Epilepsia Generalizada/tratamento farmacológico , Epilepsia Generalizada/terapia , Feminino , Seguimentos , Alucinações/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/etiologia , Método Simples-Cego , Fases do Sono , Falha de TratamentoRESUMO
The authors evaluated the feasibility and source localization utility of H2(15)O or 13NH3 PET and low-resolution electromagnetic tomography (LORETA) in three patients with partial status epilepticus (SE). Results were correlated with findings from intraoperative electrocorticographic recordings and surgical outcomes. PET studies of cerebral blood flow and noninvasive source modeling with LORETA using statistical nonparametric mapping provided useful information for localizing the ictal activity in patients with partial SE.
Assuntos
Córtex Cerebral/diagnóstico por imagem , Eletroencefalografia/métodos , Epilepsia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Estado Epiléptico/diagnóstico por imagem , Tomografia/métodos , Mapeamento Encefálico/métodos , Córtex Cerebral/fisiopatologia , Córtex Cerebral/cirurgia , Circulação Cerebrovascular/fisiologia , Diagnóstico por Computador/métodos , Epilepsia/fisiopatologia , Estudos de Viabilidade , Humanos , Magnetismo , Procedimentos Neurocirúrgicos , Radioisótopos de Nitrogênio , Radioisótopos de Oxigênio , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estado Epiléptico/fisiopatologiaAssuntos
Heterozigoto , Atrofia Muscular Espinal/diagnóstico , Fenótipo , Esteroide Hidroxilases/genética , Xantomatose Cerebrotendinosa/genética , Idade de Início , Alanina/genética , Ácidos e Sais Biliares/sangue , Colestanotriol 26-Mono-Oxigenase , Colestanol/sangue , Colesterol/sangue , Análise Mutacional de DNA , Diagnóstico Diferencial , Erros de Diagnóstico , Diarreia/complicações , Saúde da Família , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Atrofia Muscular Espinal/genética , Mutação , Prolina/genética , Xantomatose Cerebrotendinosa/sangue , Xantomatose Cerebrotendinosa/diagnóstico , Xantomatose Cerebrotendinosa/patologiaRESUMO
Our purpose was to review the current role of invasive and semi-invasive EEG in the presurgical evaluation of candidates for epilepsy surgery. The use of stereotactically implanted intracranial depth (stereo-EEG), subdural strip and grid, and foramen ovale electrodes, as well as intraoperative electrocorticography and electrical brain stimulation ("functional mapping") at the Epilepsy Center University Hospital Zurich, from 1984 to 1998, is analyzed. Advantages and disadvantages of the various intracranial EEG techniques are critically discussed. Out of 422 selective amygdalohippocampectomies performed in Zurich, 54% had non-invasive, 32% had semi-invasive, and 14% had invasive presurgical EEG evaluation. Because patients currently referred to our center increasingly present with a complex history of disease, i.e., constitute so-called "difficult cases", there is trend to combine several invasive and semi-invasive, pre- and intraoperative neurophysiological techniques.
Assuntos
Eletrodos Implantados , Eletroencefalografia/métodos , Epilepsia/diagnóstico , Técnicas Estereotáxicas , Amobarbital , Tonsila do Cerebelo/cirurgia , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Artéria Carótida Interna , Eletroencefalografia/efeitos dos fármacos , Eletroencefalografia/estatística & dados numéricos , Espaço Epidural , Epilepsia/cirurgia , Lateralidade Funcional/efeitos dos fármacos , Lateralidade Funcional/fisiologia , Hipocampo/cirurgia , Humanos , Injeções Intra-Arteriais , Memória/efeitos dos fármacos , Memória/fisiologia , Monitorização Intraoperatória , Osso EsfenoideRESUMO
A patient with Rasmussen's encephalitis underwent a right central resection at the age of 6 as a treatment for status epilepticus. She became seizure free, but suffered a left hemiplegia which improved so that she could walk. Because of the recurrence of seizures an enlargement of the resection to a hemispherectomy was carried out 17 years after the first operation. Various examinations, including H(2)(15)O PET and amytal testing, performed before this second operation indicated that a compensatory reinforcement of the ipsilateral uncrossed corticospinal and spinocortical pathways had taken place. This was confirmed postoperatively. The patient had no new sensorimotor deficits.