Clinical relevance of interictal dysphoric disorder and its impact on quality of life in drug-resistant epilepsy.

OBJECTIVE: This study aims to assess the prevalence of Interictal Dysphoric Disorder (IDD) in drug-resistant epilepsy (DRE) and to describe its clinical and psychopathological profile, including personality, as well as its impact on quality of life (QOL). METHOD: A retrospective cross-sectional study from an Epilepsy Unit from January 2007 to December 2017. All patients were diagnosed with DRE. Patients underwent a battery of tests (HADS, SCL-90R, PDQ-4+, QOLIE-31) and a psychiatrist assessed the presence of Axis-I disorders and IDD. Statistical procedures were carried out using R-4.0.1 software. RESULTS: A total of 282 patients were included. A statistically significant association was found between IDD and mood and anxiety disorders (p < 0.001 and p < 0.05 respectively), and between IDD and higher scores in all HADS and SCL-90-R items compared to subjects without IDD (p < 0.001). A statistically significant association was also found between IDD and obsessive-compulsive, borderline and depressive personality disorder (p < 0.05). Scores in all QOLIE-31 items except for 'medication effects' were significantly lower in subjects with IDD compared with subjects without IDD (p < 0.001). CONCLUSIONS: In DRE, IDD subjects show differences in the psychopathological profile and QOL scores compared to subjects without a diagnosis of IDD. An early diagnosis of IDD could facilitate prompt interventions which might positively impact QOL.

Association between depressive and anxious symptoms with cognitive function and quality of life in drug-resistant epilepsy.

•Depressive/anxious disorders and cognitive impairment are frequent comorbidities in epilepsy and have a more deleterious effect in DRE.•Studies concerning the relationship between anxiety and depression and cognitive performance in DRE are scarce.•Higher scores in HADS are associated with lower QOLIE-31 scores and might be considered as predictors of QOL in DRE.•A relationship between anxious and depressive symptoms -measured with HADS and SCL-90R- and cognition might not exist.•There remains an unexplored study area regarding this relationship which requires more attention to improve the assessment of DRE.

[Imaging in epilepsy: functional studies]. / Imagen en epilepsia: estudios funcionales.

Neuroimaging studies play a fundamental role in the diagnosis and evaluation of epilepsy. Technological advances in neuroimaging techniques have made it possible to obtain functional as well as structural information. The pathophysiology of epilepsy consists of an abnormal increase in cerebral activity that can be appreciated on neuroimaging techniques like functional magnetic resonance imaging (fMRI), PET, and SPECT. In patients with epilepsy that is refractory to drug therapy, the main aim of surgery is to control seizures and thus to improve the quality of life. In the preoperative workup of these patients, fMRI has an increasingly important role, evaluating the location of functional areas that must be safeguarded during surgery.

[Peri-ictal SPECT in temporal lobe epilepsy: post-surgical evaluation]. / SPECT periictal en la epilepsia del lóbulo temporal: valoración tras cirugía.

INTRODUCTION: our aim was to evaluate the usefulness of peri-ictal SPECT in localising the epileptogenic region (ER) in candidates for temporal lobectomy to treat medically refractory complex partial seizures (CPS). Interictal and ictal SPECT, MRI and video-EEG results were compared and the positive predictive value (PPV) was calculated in those patients with good surgical outcome. MATERIALS AND METHODS: 37 patients who had a minimum of 3 years follow-up after surgery were studied retrospectively. Pre-surgical evaluation had included video-EEG monitoring, MRI and interictal and ictal SPECT. These results were compared to the surgically treated ER and successful outcome confirmed by post-surgical clinical follow-up. 29/37 patients remained seizure-free in the post-surgical follow-up. Interictal and peri-ictal SPECT were performed using 740 MBq of 99mTc-HMPAO. Peri-ictal SPECT was ictal in 25 patients and postictal in 12. RESULTS: ER concordance with video-EEG and peri-ictal SPECT was 86% (32/37 patients). It was 84% (31/37) for MRI and 54% (20/37 patients) for interictal SPECT. Peri-ictal SPECT localised the ER in 8/11 patients with discordant MRI and video-EEG results. Ictal SPECT localised the ER in the correct temporal lobe in 23/25 patients (92% concordance). In the 29 patients with a good surgical outcome, the PPV of video-EEG was 95% (27/29) and it was 90% (26/29) for both MRI and peri-ictal SPECT. CONCLUSIONS: peri-ictal brain SPECT is well able to localize ER in patients with temporal lobe epilepsy. Periictal SPECT concordance with ER was as good as video-EEG and MRI and its PPV was as good as that of MRI. We strongly recommend its use in the pre-surgical evaluation of temporal lobe epilepsy, especially when MRI and EEG are discordant.

[Neuroimaging and cerebral palsy]. / Neuroimagen y parálisis cerebral.

INTRODUCTION: A high percentage of subjects with cerebral palsy (CP) present brain injuries, which are revealed by neuroimaging techniques. On the whole the pattern of brain damage is heterogeneous. DEVELOPMENT: We review the studies that have described the brain damage in CP using structural and functional neuroimaging techniques. Brain damage is considered according to the type of CP and taking the gestational age into account. CONCLUSIONS: According to structural neuroimaging studies carried out in spastic diplegia, the brain pattern differs with the gestational age. In early subjects with spastic diplegia it is the periventricular white matter that is mainly affected. In spastic quadriplegia, cortico subcortical lesions and hypoplasia of the corpus callosum are also observed. Unilateral lesions predominate in the case of hemiplegia. Hemiplegic subjects may also present damage to the white matter, cortico subcortical lesions and congenital brain malformations. In these subjects, some of the injury patterns observed seem to be related with the clinical features they display. Dyskinetic CP is characterised by the absence of lesions and alteration of the basal ganglia and the thalamus. Very few studies have been conducted that take the different types of CP into account in comparing the findings of structural and functional neuroimaging.

[Epilepsy surgery in a reference centre]. / Cirugía de la epilepsia en un centro de referencia.

INTRODUCTION: Patients with drug resistant epilepsy are potential candidates for surgery. The pre surgical study of these patients involves a multidisciplinary approach. PATIENTS AND METHODS: We included patients who had been submitted to EEG video monitoring in our centre (a tertiary university hospital) between April 1995 and May 2000. The evaluation protocol included magnetic resonance (MR) brain scan (according to a specific protocol), neuropsychological and psychiatric evaluation, and ictal/interictal SPECT, when possible. Patients who underwent surgery were followed up at regular intervals until at least two years after surgery. RESULTS: Of the 299 patients with EEG video monitoring, 87 had been submitted to surgery up to June 2000. Nine of these patients required invasive subdural studies or studies of the foramen ovale using electrodes. Of the patients who underwent surgery, 44.8% had sclerosis of the hippocampus in the MR and in 10% it was found to be normal. The results of pathological anatomy revealed: 49.3% with sclerosis of the hippocampus, 15.1% with benign tumours, 13.7% with gliosis, 4.1% heterotopias and 4.1% cavernomas. Just one patient has been submitted to surgery again because of badly controlled seizures. Eight patients have presented post surgical complications (four with permanent morbidity). Of the 73 patients who were followed up for at least a year, 83.6% are in Engel class I, 9.6% in class II, 2.7% in class III and 4.1% in class IV. Among patients who underwent a temporal resection, 88.7% were in class I and 0% in class IV. CONCLUSIONS: Epilepsy surgery, in selected patients, has a very low morbidity/mortality rate and the chances that seizures will disappear or greatly improve are high.

Imagen en epilepsia: estudios funcionales / Imaging in epilepsy: functional studies

Los estudios de neuroimagen tienen un papel fundamental en la evaluación y diagnóstico de la epilepsia. Los avances tecnológicos que se han producido en las técnicas de neuroimagen permiten en la actualidad obtener información no solo estructural, sino también funcional. La fisiopatología de la epilepsia consiste en un aumento anómalo de la actividad cerebral que puede llegar a apreciarse mediante técnicas de neuroimagen, como por ejemplo la RM funcional (RMf), la tomografía por emisión de positrones (PET) y la tomografía por emisión de fotón simple (SPECT). En pacientes con epilepsia farmacorresistente, la cirugía tiene como objetivo principal el control de las crisis, y por tanto mejorar la calidad de vida. La RMf juega un papel cada vez más relevante en la valoración prequirúrgica de estos pacientes, evaluando la localización de áreas funcionales que deben evitar lesionarse durante el acto quirúrgico (AU)

Neuroimaging studies play a fundamental role in the diagnosis and evaluation of epilepsy. Technological advances in neuroimaging techniques have made it possible to obtain functional as well as structural information. The pathophysiology of epilepsy consists of an abnormal increase in cerebral activity that can be appreciated on neuroimaging techniques like functional magnetic resonance imaging (fMRI), PET, and SPECT. In patients with epilepsy that is refractory to drug therapy, the main aim of surgery is to control seizures and thus to improve the quality of life. In the preoperative workup of these patients, fMRI has an increasingly important role, evaluating the location of functional areas that must be safeguarded during surgery (AU)

SPECT periictal en la epilepsia del lóbulo temporal: valoración tras cirugía / Peri-ictal SPECT in temporal lobe epilepsy: post-surgical evaluation

Introducción: el objetivo de este trabajo fue valorar la utilidad de la tomografía computarizada por emisión monofotónica (SPECT) periictal para localizar la región epileptógena (RE) en pacientes con crisis parciales complejas (CPC) del lóbulo temporal. Material y métodos: de forma retrospectiva se ha evaluado a 37 pacientes con CPC del lóbulo temporal a quienes se realizó una lobectomía temporal completa o selectiva. Para ello, se comparó la concordancia de la RE quirúrgica con los hallazgos de la resonancia magnética (RM), el videoelectroencefalograma (vídeo-EEG) y las SPECT cerebrales interictal y periictal. En segundo lugar, se valoró el valor predictivo positivo (VPP) de estas exploraciones en los 29 pacientes que presentaron un buen control de las crisis tras la cirugía. La SPECT se realizó tras la inyección de 740 MBq de 99mTc-HMPAO. Resultados: la concordancia de la RE quirúrgica con el vídeo-EEG, la RM, la SPECT icterictal y la SPECT periictal fue del 86% (32/37 pacientes), el 84% (31/37 pacientes), el 54% (20/37 pacientes) y el 86% (32/37 pacientes), respectivamente. En los 11 casos con RM y vídeo-EEG discordante o normal, la SPECT periictal fue decisivo en 8 (73%). En los 29 pacientes con evolución favorable tras la cirugía, el VPP del vídeo-EEG fue del 95% (27/29) y el de la RM y la SPECT periictal fue del 90% (26/29). Conclusiones: la concordancia de la RE quirúrgica con la SPECT periictal fue similar al del vídeo-EEG y la RM y tuvo el mismo VPP que la RM. Por ello, creemos que la SPECT periictal debe emplearse de forma sistemática en la evaluación prequirúrgica de la epilepsia del lóbulo temporal, especialmente cuando vídeo-EEG y RM son discordantes o normales(AU)

Introduction: our aim was to evaluate the usefulness of peri-ictal SPECT in localising the epileptogenic region (ER) in candidates for temporal lobectomy to treat medically refractory complex partial seizures (CPS). Interictal and ictal SPECT, MRI and video-EEG results were compared and the positive predictive value (PPV) was calculated in those patients with good surgical outcome. Materials and methods: 37 patients who had a minimum of 3 years follow-up after surgery were studied retrospectively. Pre-surgical evaluation had included video-EEG monitoring, MRI and interictal and ictal SPECT. These results were compared to the surgically treated ER and successful outcome confirmed by post-surgical clinical follow-up. 29/37 patients remained seizure-free in the post-surgical follow-up. Interictal and peri-ictal SPECT were performed using 740 MBq of 99mTc-HMPAO. Peri-ictal SPECT was ictal in 25 patients and postictal in 12. Results: ER concordance with video-EEG and peri-ictal SPECT was 86% (32/37 patients). It was 84% (31/37) for MRI and 54% (20/37 patients) for interictal SPECT. Peri-ictal SPECT localised the ER in 8/11 patients with discordant MRI and video-EEG results. Ictal SPECT localised the ER in the correct temporal lobe in 23/25 patients (92% concordance). In the 29 patients with a good surgical outcome, the PPV of video-EEG was 95% (27/29) and it was 90% (26/29) for both MRI and peri-ictal SPECT. Conclusions: peri-ictal brain SPECT is well able to localize ER in patients with temporal lobe epilepsy. Periictal SPECT concordance with ER was as good as video-EEG and MRI and its PPV was as good as that of MRI. We strongly recommend its use in the pre-surgical evaluation of temporal lobe epilepsy, especially when MRI and EEG are discordant(AU)

Neuroimagen y parálisis cerebral / Neuroimaging and cerebral palsy

Introducción. En un considerable número de sujetos con parálisis cerebral (PC) observamos lesiones cerebrales evidenciadas mediante técnicas de neuroimagen. En general, existe un patrón de alteración cerebral heterogéneo. Desarrollo. Se revisan los estudios que han descrito la alteración cerebral en la PC mediante el uso de técnicas de neuroimagen estructural y funcional. Se describen las lesiones cerebrales observadas en función del tipo de PC y de la edad de gestación. Conclusiones. Según los estudios de neuroimagen estructural en la diplejía espástica, existe un patrón cerebral diferenciado dependiendo de la edad de gestación. En los sujetos prematuros con diplejía espástica se observa una notable afectación de la sustancia blanca periventricular. En la tetraplejía espástica destacan, además, las lesiones corticosubcorticales y la hipoplasia del cuerpo calloso. En la hemiplejía hay un predominio de lesiones unilaterales. Los sujetos con hemiplejía pueden padecer afectación de la sustancia blanca, lesiones corticosubcorticales y malformaciones cerebrales congénitas. En estos sujetos, algunos de los patrones lesionales observados parecen relacionarse con la clínica que presentan. La PC discinética se caracteriza por la ausencia de lesión y la alteración de los ganglios basales y del tálamo. Son pocos los estudios realizados que comparen los hallazgos de neuroimagen estructural y funcional según los distintos tipos de PC (AU)

Cirugía de la epilepsia en un centro de referencia / Epilepsy surgery in a reference centre

Introducción. Los pacientes con epilepsia farmacorresistente son potencialmente candidatos a cirugía. El estudio prequirúrgico de estos pacientes implica un abordaje multidisciplinario. Pacientes y métodos. Se incluyeron los pacientes a los que realizamos en nuestro centro (hospital universitario terciario) registro vídeo-EEG, entre abril de 1995 y mayo de 2000. El protocolo de evaluación incluyó resonancia magnética (RM) craneal (según un protocolo específico), evaluación neuropsicológica, valoración psiquiátrica y SPECT ictal/interictal, cuando fue posible. Aquellos pacientes intervenidos se siguieron a intervalos regulares, hasta como mínimo dos años tras la cirugía. Resultados. De los 299 pacientes con registro vídeo-EEG, 87 se han intervenido hasta junio de 2000. Nueve de estos pacientes precisaron estudios invasivos con electrodos de foramen ovale o subdurales. De los pacientes intervenidos, 44,8 por ciento tenían esclerosis del hipocampo en la RM y en el 10 por ciento ésta fue normal. Los resultados de anatomía patológica mostraron: 49,3 por ciento con esclerosis del hipocampo, 15,1 por ciento con tumores benignos, 13,7 por ciento con gliosis, 4,1 por ciento heterotopías y 4,1 por ciento de cavernomas. Un sólo paciente se ha reintervenido por mal control de sus crisis. Ocho pacientes han presentado complicaciones posquirúrgicas (cuatro con morbilidad permanente). De los 73 pacientes con seguimiento mínimo de un año, 83,6 por ciento están en clase I de Engel, 9,6 por ciento en clase II, 2,7 por ciento en clase III y 4,1 por ciento en clase IV. Entre los pacientes intervenidos con resección temporal, 88,7 por ciento están en clase I y 0 por ciento en clase IV. Conclusiones. La cirugía de la epilepsia, en pacientes seleccionados, tiene una morbimortalidad mínima y ofrece una elevada esperanza de desaparición o mejoría importante de las crisis (AU)