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1.
J Clin Neurophysiol ; 37(3): 271-273, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31977570

RESUMO

This case report will provide further evidence for the fact that breach rhythm is not the effect of a bone abnormality only. We present the case of an 84-year-old woman, who had a craniotomy 14 month before admission to our emergency department with a focal inhibitory status epilepticus. Even after clinical recovery, electroencephalography revealed frequent subclinical seizure patterns. When seizure activity was suppressed by anticonvulsive medication with levetiracetam, breach rhythm appeared. Breach rhythm develops usually some months after craniotomy and therefore should have been established in our patient at the time of admission. Therefore, it is reasonable to assume that it was in some way suppressed by the seizure activity in our primary EEG recordings. The appearance of the breach rhythm after the complete suppression of seizure activity by antiepileptic drug treatment shows that breach rhythm is not purely the result of a skull defect but is related to the functional state of the brain tissue beneath.


Assuntos
Craniotomia/efeitos adversos , Epilepsias Parciais/etiologia , Paralisia/fisiopatologia , Convulsões/tratamento farmacológico , Convulsões/etiologia , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Eletroencefalografia , Feminino , Humanos , Levetiracetam/uso terapêutico
2.
Epilepsy Behav ; 103(Pt A): 106578, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31680025

RESUMO

OBJECTIVE: The objective of the study was to describe the electroclinical features, seizure semiology, and the long-term evolution of gelastic seizures (GS) not associated with hypothalamic hamartoma (HH). METHODS: We reviewed video-electroencephalogram (video-EEG) recordings from pediatric patients with GS without HH admitted to 14 Italian epilepsy centers from 1994 to 2013. We collected information about age at onset, seizures semiology, EEG and magnetic resonance imaging (MRI) findings, treatment, and clinical outcome in terms of seizure control after a long-term follow-up. RESULTS: A total of 30 pediatric patients were stratified into two groups according to neuroimaging findings: group 1 including 19 children (63.3%) with unremarkable neuroimaging and group 2 including 11 children with structural brain abnormalities (36.7%). At the follow-up, patients of group 1 showed better clinical outcome both in terms of seizure control and use of AED polytherapy. Our patients showed remarkable clinical heterogeneity, including seizure semiology and epilepsy severity. Electroencephalogram recordings showed abnormalities mainly in the frontal, temporal, and frontotemporal regions without relevant differences between the two groups. Overall, carbamazepine showed good efficacy to control GS. CONCLUSIONS: Patients with nonlesional GS have a more favorable outcome with better drug response, less need of polytherapy, and good long-term prognosis, both in terms of seizure control and EEG findings.


Assuntos
Eletroencefalografia , Epilepsias Parciais/etiologia , Hamartoma/complicações , Doenças Hipotalâmicas/complicações , Convulsões/etiologia , Adolescente , Criança , Pré-Escolar , Progressão da Doença , Epilepsias Parciais/diagnóstico , Feminino , Seguimentos , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Convulsões/diagnóstico , Gravação em Vídeo
3.
Neuroimage Clin ; 24: 102072, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734529

RESUMO

Epilepsy, including the type with focal onset, is increasingly viewed as a disorder of the brain network. Here we employed the functional connectivity (FC) metrics estimated from the resting state functional MRI (rsfMRI) to investigate the changes of brain network associated with focal epilepsy caused by single cerebral cavernous malformation (CCM). Eight CCM subjects and 21 age and gender matched controls were enrolled in the study. Seven of 8 CCM subjects underwent surgical resection of the CCM and became seizure free and 4 of the surgical subjects underwent a repeat rsfMRI study. We showed that there was both regional and global disruption of the FC values among the CCM subjects including decreased in homotopic FC (HFC) and global FC (GFC) in the regions of interest (ROIs) where the CCMs were located. There was also the disruption of the default mode network (DMN) especially the FC between the middle prefrontal cortex (MPFC) and the right lateral parietal cortex (LPR) among these individuals. We observed the trend of alleviation of these disruptions after the individual has become seizure free from the surgical resection of the CCM. Using a voxel-based approach, we found the disruption of the HFC and GFC in the brain tissue immediately adjacent to the CCM and the severity of the disruption appeared inversely proportional to the distance of the brain tissue to the lesion. Our findings confirm the disruption of normal brain networks from focal epilepsy, a process that may be reversible with successful surgical treatments rendering patients seizure free. Some voxel-based metrics may help identify the epileptogenic zone and guide the surgical resection.


Assuntos
Encéfalo/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Epilepsias Parciais/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Vias Neurais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Estudos de Casos e Controles , Neoplasias do Sistema Nervoso Central/complicações , Neoplasias do Sistema Nervoso Central/fisiopatologia , Neoplasias do Sistema Nervoso Central/cirurgia , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsia Resistente a Medicamentos/cirurgia , Epilepsias Parciais/etiologia , Epilepsias Parciais/fisiopatologia , Epilepsias Parciais/cirurgia , Feminino , Neuroimagem Funcional , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/fisiopatologia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vias Neurais/fisiopatologia , Procedimentos Neurocirúrgicos , Adulto Jovem
4.
Brain Behav ; 9(11): e01412, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31578831

RESUMO

INTRODUCTION: Clinical manifestations of the hypothalamic hamartoma-epilepsy syndrome (HH-ES) in adulthood are variable. Efficacy of therapeutic options and outcome are diverse. METHODS: Retrospective study of adult patients diagnosed with a HH in magnetic resonance imaging and epilepsy who attended our tertiary Epilepsy Unit between 2003 and 2018. We report the clinical and electroencephalographic features of a series of adult patients with HH and related epilepsy seen in our center together with the treatments and seizure outcome. RESULTS: We describe a series of eight patients. Five males (62.5%), median age at evaluation was 28.5 years (IQR: 15.5). Clinical manifestations included focal with preserved and impaired awareness emotional seizures (gelastic seizures [GS]) in six patients (75%), focal tonic, atonic with impaired awareness and focal to bilateral tonic-clonic seizures. Mild GS were the only symptom in one patient. Three patients (37.5%) had endocrinological disturbances such as obesity and hypothyroidism. Fifty percent of the patients showed psychiatric comorbidity such as anxiety disorder and aggressiveness, and two patients had psychomotor delay. Seven patients (87.7%) had drug-resistant seizures and three of them were treated with radiosurgery. Out of the treated group, only one (33.3%) became seizure-free 2 years after surgery but developed psychiatric problems. The other two patients had an Engel IV outcome and received a vagal nerve stimulation (VNS) implant. VNS did not lead to changes either in intensity nor in seizure frequency. CONCLUSIONS: Hypothalamic hamartoma-epilepsy syndrome clinical manifestations in adult patients are as variable as at pediatric age. Outcome of therapeutic options such as radiosurgery or VNS may be poorer at this stage.


Assuntos
Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsias Parciais/fisiopatologia , Hamartoma/fisiopatologia , Doenças Hipotalâmicas/fisiopatologia , Adulto , Agressão , Anticonvulsivantes/uso terapêutico , Transtornos de Ansiedade , Comorbidade , Epilepsia Resistente a Medicamentos/epidemiologia , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia Resistente a Medicamentos/terapia , Eletroencefalografia , Epilepsias Parciais/epidemiologia , Epilepsias Parciais/etiologia , Epilepsias Parciais/terapia , Epilepsia , Feminino , Hamartoma/complicações , Hamartoma/epidemiologia , Hamartoma/terapia , Humanos , Doenças Hipotalâmicas/complicações , Doenças Hipotalâmicas/epidemiologia , Doenças Hipotalâmicas/terapia , Hipotireoidismo/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Transtornos Psicomotores/epidemiologia , Radiocirurgia , Estudos Retrospectivos , Convulsões , Resultado do Tratamento , Estimulação do Nervo Vago , Adulto Jovem
5.
Epilepsia ; 60(10): e104-e109, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31489630

RESUMO

Periventricular nodular heterotopia (PNH) is a common structural malformation of cortical development. Mutations in the filamin A gene are frequent in familial cases with X-linked PNH. However, many cases with sporadic PNH remain genetically unexplained. Although medically refractory epilepsy often brings attention to the underlying PNH, patients are often not candidates for surgical resection. This limits access to neuronal tissue harboring causal mutations. We evaluated a patient with PNH and medically refractory focal epilepsy who underwent a presurgical evaluation with stereotactically placed electroencephalographic (SEEG) depth electrodes. Following SEEG explantation, we collected trace tissue adherent to the electrodes and extracted the DNA. Whole-exome sequencing performed in a Clinical Laboratory Improvement Amendments-approved genetic diagnostic laboratory uncovered a de novo heterozygous pathogenic variant in novel candidate PNH gene MEN1 (multiple endocrine neoplasia type 1; c.1546dupC, p.R516PfsX15). The variant was absent in an earlier exome profiling of the venous blood-derived DNA. The MEN1 gene encodes the ubiquitously expressed, nuclear scaffold protein menin, a known tumor suppressor gene with an established role in the regulation of transcription, proliferation, differentiation, and genomic integrity. Our study contributes a novel candidate gene in PNH generation and a novel practical approach that integrates electrophysiological and genetic explorations of epilepsy.


Assuntos
Encéfalo/diagnóstico por imagem , Epilepsias Parciais/cirurgia , Heterotopia Nodular Periventricular/genética , Proteínas Proto-Oncogênicas/genética , Adulto , Eletrodos Implantados , Epilepsias Parciais/diagnóstico por imagem , Epilepsias Parciais/etiologia , Epilepsias Parciais/genética , Humanos , Masculino , Heterotopia Nodular Periventricular/complicações , Heterotopia Nodular Periventricular/diagnóstico por imagem , Sequenciamento Completo do Exoma
6.
World Neurosurg ; 132: 403-407, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493601

RESUMO

BACKGROUND: Choroid plexus papillomas (CPPs) are benign World Health Organization grade I tumors that comprise 2%-4% of all brain tumors among children and less than 1% of brain tumors in adults. Most adult cases occur in the fourth ventricle, with only 1 previous report describing an adult patient with a temporal horn CPP. CASE DESCRIPTION: We report a rare case of a temporal horn CPP presenting in an adult with seizures. We performed a minimally invasive subtemporal approach for gross total resection of the lesion. CONCLUSIONS: CPP presenting in the temporal horn is rare among adults. We discuss the surgical nuances of the subtemporal approach for resection and review the literature regarding adult presentation of CPP and the treatment strategies for adult CPP.


Assuntos
Neoplasias do Plexo Corióideo/complicações , Neoplasias do Plexo Corióideo/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/métodos , Papiloma do Plexo Corióideo/complicações , Papiloma do Plexo Corióideo/cirurgia , Convulsões/etiologia , Lobo Temporal/cirurgia , Adulto , Neoplasias do Plexo Corióideo/patologia , Epilepsias Parciais/etiologia , Feminino , Quarto Ventrículo/patologia , Humanos , Imagem por Ressonância Magnética , Papiloma do Plexo Corióideo/patologia , Lobo Temporal/patologia , Resultado do Tratamento
7.
Mymensingh Med J ; 28(3): 712-715, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391451

RESUMO

The prevalence of seizures in individuals with Down Syndrome (DS) is higher than in the general population. Rates of epilepsy in DS range from 1-13%. Forty percent of individuals develop seizures before 1 year of age and another 40% develop in their thirties or later. Boys have an earlier age of onset. The prevalence of epilepsy increases with age. Types of seizures are: 47% partial seizures, 32% infantile spasms and 21% generalized tonic-clonic seizures. Sex distribution for epilepsy in children with DS varies. Males have a younger age at onset. Trisomy 21 is common among epileptic children with DS but mosaicism or translocation has also been documented. The mechanisms underlying the increased seizure susceptibility in DS have not yet been completely explained. Seizures in infancy may be due to inherent structural brain abnormalities, like fewer inhibitory neurons, abnormal cortical lamination, persistent fetal dendritic morphology, underdeveloped synaptic profiles. Concentrations of carbonic anhydrase II are increased in the brains of young children with DS. It potentially increases seizure susceptibility. The pharmacological treatment of epilepsy in DS is same as that of other patients diagnosed with epilepsy. Individuals with DS have an unusually high number of side-effects from phenytoin. The diagnosis, classification and treatment of epilepsy in DS follow the guidelines applied to the general population. Review of literatures from 1960 to 2017 and electronically identified articles on epilepsy in Down syndrome in children in English are searched from internet and pub med to describe features of seizures in children with DS.


Assuntos
Anticonvulsivantes , Síndrome de Down , Epilepsias Parciais , Epilepsia Generalizada , Anticonvulsivantes/uso terapêutico , Carbamazepina , Criança , Pré-Escolar , Síndrome de Down/complicações , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/etiologia , Epilepsia Generalizada/tratamento farmacológico , Epilepsia Generalizada/etiologia , Humanos , Convulsões
8.
Can J Neurol Sci ; 46(5): 559-565, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31292009

RESUMO

OBJECTIVE: Focal cortical dysplasia (FCD) is a common cause of refractory, focal onset epilepsy in children. Interictal, scalp electroencephalograph (EEG) markers have been associated with these pathologies and epilepsy surgery may be an option for some patients. We aim to study how scalp EEG and magnetic resonance imaging (MRI) markers of FCD affect referral of these patients for surgical evaluation. METHODS: A single-center, retrospective review of children with focal onset epilepsy. Patients were included if they were between 1 month and 18 years of age, had focal onset seizures, prolonged scalp EEG monitoring, and an MRI conducted after 2 years of age. Statistics were carried out using the chi-squared and student's t-test, as well as a logistic regression model. RESULTS: Sixty-eight patients were included in the study. Thirty-seven of these patients were referred to a comprehensive pediatric epilepsy program (CPEP) for surgical evaluation, and of these 22% showed FCD EEG markers, 32% FCD MRI markers, and 10% had both. These markers were also present in patients not referred to a CPEP. The MRI markers were significantly associated with CPEP referral, whereas EEG markers were not. Neither marker type was associated with epilepsy surgery. CONCLUSION: This study found that children with focal onset epilepsy were more likely to be referred for surgical evaluation if they were medically refractory, or were diagnosed with FCD or tumor on MRI. Scalp EEG markers of FCD were not associated with CPEP referral. The online tool CASES may be a useful physician guide for identifying appropriate children for epilepsy surgery referral.


Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsias Parciais/diagnóstico , Epilepsia/diagnóstico , Malformações do Desenvolvimento Cortical do Grupo I/diagnóstico , Encaminhamento e Consulta , Adolescente , Criança , Pré-Escolar , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia , Epilepsias Parciais/etiologia , Epilepsias Parciais/cirurgia , Epilepsia/complicações , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Malformações do Desenvolvimento Cortical do Grupo I/complicações , Seleção de Pacientes , Estudos Retrospectivos
9.
Saudi Med J ; 40(7): 721-726, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31287134

RESUMO

Parry-Romberg syndrome is a rare disorder with progressive hemifacial atrophy of unknown etiology. We reported 2 cases of progressive hemifacial atrophy with different neurological manifestations from Kuwait. The first case was a 14-year-old boy who initially presented with recurrent transient stroke-like episodes followed by focal seizures and hemifacial atrophy. Magnetic resonance imaging showed significant white matter changes and cerebral hemiatrophy. The second case was a 7-year-old girl who presented with complex partial seizures and hemifacial atrophy, her magnetic resonance imaging scan showed minimal changes in the hemiatrophy of the temporal cerebral lobe. Both patients' disease activity was well controlled with immunosuppressive therapy and anticonvulsants. Parry-Romberg syndrome should be considered in any child with unexplained neurological symptoms.


Assuntos
Cérebro/diagnóstico por imagem , Epilepsias Parciais/fisiopatologia , Hemiatrofia Facial/fisiopatologia , Ataque Isquêmico Transitório/fisiopatologia , Adolescente , Anticonvulsivantes/uso terapêutico , Atrofia , Cérebro/patologia , Criança , Eletroencefalografia , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/etiologia , Hemiatrofia Facial/complicações , Hemiatrofia Facial/diagnóstico por imagem , Hemiatrofia Facial/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Ataque Isquêmico Transitório/etiologia , Kuweit , Imagem por Ressonância Magnética , Masculino , Metotrexato/uso terapêutico , Prednisolona/uso terapêutico
11.
Seizure ; 66: 31-35, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30776698

RESUMO

PURPOSE: Late-onset non-lesional focal epilepsy, defined as new-onset seizures in patients older than 60 years, is diagnosed increasingly more often in relation to aging of the population. It has been attributed mainly to occult cerebral small vessel disease (SVD), although high levels of evidence to support this notion are lacking. This study aimed to evaluate the burden of leukoaraiosis, a marker of cerebral SVD, and hippocampal atrophy in patients with late-onset epilepsy (LOE). METHODS: Brain magnetic resonance imaging (MRI) studies were retrospectively analyzed by two blinded radiologists. The Fazekas and Scheltens scales were used to assess the degree of leukoaraiosis and hippocampal atrophy in 33 patients with non-lesional LOE, 41 patients with clinical signs of SVD (eg, recent history of transient ischemic attack [TIA] or lacunar stroke), and 26 healthy controls, all >60 years of age. RESULTS: Mean age in epilepsy patients was 70.9 (±6.6) years; 57.6% were men. The history of vascular risk factors was similar in all groups. Median (interquartile range) Fazekas score was 1 (0-1) in the epilepsy group, 1 (0-2) in TIA/lacunar stroke patients, and 0 (0-1) in the healthy group. Degree of leukoaraiosis was milder in epilepsy patients compared to the TIA/lacunar stroke group (p = 0.004), and similar to that of healthy controls (p = 0.593). Hippocampal atrophy was significantly greater in patients with epilepsy (p < 0.005). CONCLUSION: These findings suggest that the etiology of LOE is not exclusively related to cerebrovascular disease. Hippocampal atrophy may contribute to the origin of the seizures.


Assuntos
Transtornos Cerebrovasculares/complicações , Epilepsias Parciais/etiologia , Idoso , Idoso de 80 Anos ou mais , Atrofia/etiologia , Atrofia/patologia , Transtornos Cerebrovasculares/diagnóstico por imagem , Epilepsias Parciais/diagnóstico por imagem , Feminino , Hipocampo/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Leucoaraiose/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Epileptic Disord ; 21(1): 102-107, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30767896

RESUMO

Epileptic visual auras are elementary to complex and sometimes occur as colourful visual phenomena located close to or within the central part of the contralateral hemi-field. They typically last from seconds to a few minutes, which discriminates them from the usually longer-lasting visual auras (5-30 minutes) of patients suffering from migraine. We present an adult patient with occipital lobe epilepsy whose visual aura under epilepsy monitoring lasted for more than 30 minutes with almost no propagation, demonstrating a rare, but remarkable, sustained local epileptic network activity associated with resection of an occipital arterio-venous malformation.


Assuntos
Fístula Arteriovenosa/patologia , Epilepsias Parciais/fisiopatologia , Malformações Arteriovenosas Intracranianas/patologia , Lobo Occipital/patologia , Estado Epiléptico/fisiopatologia , Percepção Visual/fisiologia , Adulto , Fístula Arteriovenosa/cirurgia , Eletroencefalografia , Epilepsias Parciais/etiologia , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Imagem por Ressonância Magnética , Lobo Occipital/cirurgia , Estado Epiléptico/etiologia
14.
Childs Nerv Syst ; 35(6): 1055-1058, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30783755

RESUMO

INTRODUCTION: Gelastic seizures are the type of seizures that are most commonly seen in childhood and should be excluded definitely in the differential diagnosis of hypothalamic hamartomas. This seizure type may be accompanied by refractory seizures, cognitive decline, and early puberty. However, etiology may also include other causes different than hypothalamic hamartomas. The seizure may also arise from temporal and frontal region, in addition to hypothalamus. Different clinical findings may be observed based on origin and areas of spread. CONCLUSIONS: In this article, we report a case of gelastic seizure that has been observed by a different cause other than hypothalamic hamartoma which was reported for the first time in the literature.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Epilepsias Parciais/etiologia , Criança , Humanos , Masculino , Pia-Máter/patologia
15.
Rev Neurol ; 68(2): 59-65, 2019 Jan 16.
Artigo em Espanhol | MEDLINE | ID: mdl-30638255

RESUMO

INTRODUCTION: Primary lymphoma of the central nervous system is a variety of non-Hodgkin's lymphoma that accounts for 4-5% of intracranial tumours and 5% of all lymphomas. It has its origin in the brain, the eyes, the leptomeninges and the spinal cord with no systemic evidence of lymphomatoid activity; the subtype of lymphoma is predominantly of B-type cells. PATIENTS AND METHODS: We conducted a descriptive study of the patients diagnosed with primary brain lymphoma who were attended to at third-level centres in Mexico between the years 1980 and 2016. Patients who had been screened for systemic lymphoma were included. The results were analysed by means of simple frequencies, and disease-free and overall survival time was analysed by Kaplan-Meier curves; the differences among curves were analysed by means of log rank. RESULTS: Of a total of 215 patients, there were only 74 cases. By sex, 45% were females and 55% were males. Regarding age, 36.7% were over 60 years old. The most frequent clinical manifestations were motor loss (60%) and cognitive disorders (52%). Most patients received some form of chemotherapy (89%). The only significant factor for radiological response and clinical prognosis was the combined use of radiochemotherapy (p = 0.04493). CONCLUSION: Lymphoma is a tumorous condition with a high clinicoradiological response to treatment, although the response is not long-lasting. Its early identification and multidisciplinary management are essential for a more favourable prognosis in these patients.


Assuntos
Neoplasias do Sistema Nervoso Central/epidemiologia , Linfoma não Hodgkin/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Nervoso Central/complicações , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/terapia , Quimiorradioterapia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Irradiação Craniana , Doenças dos Nervos Cranianos/epidemiologia , Doenças dos Nervos Cranianos/etiologia , Epilepsias Parciais/epidemiologia , Epilepsias Parciais/etiologia , Humanos , Estimativa de Kaplan-Meier , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/terapia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Transtornos dos Movimentos/epidemiologia , Transtornos dos Movimentos/etiologia , Neuroimagem , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
16.
J Clin Neurophysiol ; 36(3): 242-245, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30531428

RESUMO

There are very few randomized controlled trials studying treatment of super refractory status epilepticus (SE), despite estimated occurrence in about 15% of SE cases and its association with high morbidity and mortality rates. Small case series and case reports have described use of neurostimulation, including vagal nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation, to treat super refractory SE when medical interventions have failed. To our knowledge, this is the first reported case of responsive neurostimulation being used to successfully treat a case of super refractory SE. A 37-year-old man with refractory focal epilepsy and a known focal cortical dysplasia involving motor cortex was implanted with an RNS System device after being in super refractory SE for 20 days. Responsive neurostimulation strip and depth electrodes were placed targeting the cortical dysplasia. Detection and stimulation parameters were adjusted over a 14-day period, as medications were gradually weaned. Seizures abated 15 days after implant, 24 hours after stimulation parameters were configured to mimic seizure offset pattern. Seizure remission was sustained, allowing the patient to be weaned off sedating medications and discharged to a rehabilitation facility. At 6 weeks of follow-up, the patient was near his neurologic baseline with no focal deficits.


Assuntos
Estimulação Encefálica Profunda/instrumentação , Epilepsia Resistente a Medicamentos/terapia , Estado Epiléptico/terapia , Adulto , Epilepsia Resistente a Medicamentos/etiologia , Epilepsias Parciais/etiologia , Epilepsias Parciais/terapia , Humanos , Masculino , Malformações do Desenvolvimento Cortical/complicações , Estado Epiléptico/etiologia
17.
J Clin Neurophysiol ; 36(2): 166-170, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30589767

RESUMO

PURPOSE: We reported the presence of interictal slow and high-frequency oscillations (HFOs) (IIS + HFO) and its temporal change so as to elucidate its clinical usefulness as a surrogate marker of epileptogenic zone in a patient with intractable focal epilepsy. METHODS: We focused on one of the core electrodes of epileptogenicity, and investigated IIS + HFO in the pre- and post-segment of 30 minutes to all the 6 seizures. We adopted interictal slow in duration of 0.33 to 10 seconds, amplitude ≥50 µV and co-occurring with HFOs, and then divided into 5 groups depending on the amplitude of slow wave. RESULTS: Before and after all the 6 seizures, the number of IIS + HFO was 2,890 at one electrode in the core epileptogenic zone. The number of IIS + HFO significantly decreased for 30 minutes after seizures. Furthermore, the number of IIS + HFO with the amplitude of 200 to 399 µV significantly decreased after seizures. CONCLUSIONS: IIS + HFO with the amplitude of 200 to 399 µV was influenced by and decreased after seizures. It may reflect the core part of epileptogenic area as similarly as ictal direct current shifts and ictal HFOs do. IIS + HFO could be called as the term "red slow," which may be useful to delineate at least a part of the epileptogenic zone.


Assuntos
Encéfalo/fisiopatologia , Eletrocorticografia , Epilepsias Parciais/diagnóstico , Epilepsias Parciais/fisiopatologia , Encéfalo/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Epilepsias Parciais/etiologia , Epilepsias Parciais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Convulsões/diagnóstico , Convulsões/etiologia , Convulsões/fisiopatologia , Convulsões/cirurgia
18.
Brain Dev ; 41(1): 116-120, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30077508

RESUMO

PURPOSE: Tuberous sclerosis complex (TSC) is a leading cause of epilepsy, with seizures affecting almost 80-90% of children. We used the concordance between magnetic resonance imaging (MRI) and dense array electroencephalography (dEEG) findings to detect epileptic focus in a patient with TSC. METHODS: A 9-year-old boy with TSC exhibited daily choking spells. As we could not detect the seizure onset area with conventional scalp electroencephalogram (EEG) and long-term video monitoring, we performed dEEG and captured his regular seizures. RESULTS: dEEG estimated that the clinical seizure activities from the right frontal region. This patient underwent focus removal, tuberectomy of the right frontal lobe, and removal of a subependymal giant cell astrocytoma. He has been seizure free for 7 years and 10 months. CONCLUSION: dEEG was useful for estimation of the placement of intracranial electrodes in a patient with TSC. This method may be useful for pre-surgical evaluation of epilepsy treatment.


Assuntos
Eletroencefalografia/métodos , Epilepsias Parciais/diagnóstico , Epilepsias Parciais/fisiopatologia , Esclerose Tuberosa/complicações , Astrocitoma/complicações , Astrocitoma/diagnóstico , Astrocitoma/fisiopatologia , Astrocitoma/cirurgia , Mapeamento Encefálico/instrumentação , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Criança , Eletroencefalografia/instrumentação , Epilepsias Parciais/etiologia , Epilepsias Parciais/cirurgia , Humanos , Masculino , Cuidados Pré-Operatórios , Esclerose Tuberosa/diagnóstico , Esclerose Tuberosa/fisiopatologia , Esclerose Tuberosa/cirurgia
20.
Brain ; 141(10): 2966-2980, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30107499

RESUMO

Drug-refractory focal epilepsies are network diseases associated with functional connectivity alterations both during ictal and interictal periods. A large majority of studies on the interictal/resting state have focused on functional MRI-based functional connectivity. Few studies have used electrophysiology, despite its high temporal capacities. In particular, stereotactic-EEG is highly suitable to study functional connectivity because it permits direct intracranial electrophysiological recordings with relative large-scale sampling. Most previous studies in stereotactic-EEG have been directed towards temporal lobe epilepsy, which does not represent the whole spectrum of drug-refractory epilepsies. The present study aims at filling this gap, investigating interictal functional connectivity alterations behind cortical epileptic organization and its association with post-surgical prognosis. To this purpose, we studied a large cohort of 59 patients with malformation of cortical development explored by stereotactic-EEG with a wide spatial sampling (76 distinct brain areas were recorded, median of 13.2 per patient). We computed functional connectivity using non-linear correlation. We focused on three zones defined by stereotactic-EEG ictal activity: the epileptogenic zone, the propagation zone and the non-involved zone. First, we compared within-zone and between-zones functional connectivity. Second, we analysed the directionality of functional connectivity between these zones. Third, we measured the associations between functional connectivity measures and clinical variables, especially post-surgical prognosis. Our study confirms that functional connectivity differs according to the zone under investigation. We found: (i) a gradual decrease of the within-zone functional connectivity with higher values for epileptogenic zone and propagation zone, and lower for non-involved zones; (ii) preferential coupling between structures of the epileptogenic zone; (iii) preferential coupling between epileptogenic zone and propagation zone; and (iv) poorer post-surgical outcome in patients with higher functional connectivity of non-involved zone (within- non-involved zone, between non-involved zone and propagation zone functional connectivity). Our work suggests that, even during the interictal state, functional connectivity is reinforced within epileptic cortices (epileptogenic zone and propagation zone) with a gradual organization. Moreover, larger functional connectivity alterations, suggesting more diffuse disease, are associated with poorer post-surgical prognosis. This is consistent with computational studies suggesting that connectivity is crucial in order to model the spatiotemporal dynamics of seizures.10.1093/brain/awy214_video1awy214media15833456182001.


Assuntos
Encéfalo/fisiopatologia , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsias Parciais/fisiopatologia , Vias Neurais/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Epilepsia Resistente a Medicamentos/etiologia , Eletroencefalografia , Epilepsias Parciais/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Malformações do Desenvolvimento Cortical/complicações , Malformações do Desenvolvimento Cortical/fisiopatologia , Rede Nervosa/fisiopatologia , Técnicas Estereotáxicas , Adulto Jovem
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