Epilepsy surgery and neurocysticercosis: Assessing the role of the cysticercotic lesion in medically-refractory epilepsy.

There is increasing evidence of the existence of refractoriness to treatment with antiepileptic medications in those with NCC-related epilepsy. We performed a systematic review with the objective to determine the role of a cysticercotic lesion in this group of patients. We sought those manuscripts, including case reports, describing patients with NCC-related medically-intractable epilepsy who underwent epilepsy surgery and were seizure-free a year after. Only 10 manuscripts fulfilled inclusion and exclusion criteria. Three different clinical presentations were identified: 1) the cysticercotic lesion was epileptogenic, 2) there was dual pathology, including the cysticercotic lesion, with the other lesion usually being hippocampal sclerosis, and 3) the cysticercotic lesion was not related to the epileptogenic focus. In the case of an epileptogenic cysticercotic lesion, the presence of gliosis appeared to be the culprit for epileptogenicity. More studies using large cohorts of patients might be able to confirm our findings. This article is part of a Special issue entitled "Neurocysticercosis and Epilepsy".

HaNDL syndrome and seizures: An unusual presentation.

The Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis syndrome (HaNDL) is a rare, benign and self-limited entity of unknown cause, diagnosed by exclusion. It usually presents with neurological deficits such as hemiparesthesia, dysphasia and hemiparesis. However, seizures are not usually associated with the clinical spectrum of this syndrome. Here we report a case of a 35 year-old male patient with multiple episodes of moderate-severe headaches with transient hemiparesthesia, dysarthria, confusion, visual hallucinations, disinhibited behavior, and a bilateral tonic-clonic seizure. HaNDL diagnosis was made after clinical improvement and CSF evolution. Clinicians should consider HaNDL syndrome in patients presenting with headache, seizures, and confusion, when all other etiologies are ruled out.

Clinical topography relationship in patients with parenchymal neurocysticercosis and seizures.

OBJECTIVE: Discordances between imaging findings of parenchymal neurocysticercosis and seizure expression have been reported, and as such the possibility that neurocysticercosis and seizures may frequently coexist by chance has been raised. In this study, we evaluate the topographic relationship between seizure foci based on semiology and electroencephalography with the location of parenchymal neurocysticercotic lesions. METHODS: Seizure information, neuroimaging (computed tomography and magnetic resonance imaging [MRI]) and electroencephalographic data from three randomized clinical trials of individuals with parenchymal neurocysticercosis and focal seizures were analyzed. Blinded epileptologists defined a potential seizure onset zone and a symptomatogenic zone for each individual based on semiology. The topographic relationship between semiology, either lesion location or areas of perilesional edema on baseline MRI, and electroencephalographic abnormalities were assessed. RESULTS: Fifty-eight patients with one or two parenchymal neurocysticercotic lesions were included in this study. From them, 50 patients (86%; 95% CI, 75%-93%) showed a clinical-topography relationship with the potential seizure onset zone, and 44 (76%) also with the symptomatogenic zone. From the eight patients with no topographic relationship, five had focal seizures 30 days before or after the baseline MRI and showed perilesional edema. All of these five patients showed a clinical-topography relationship between such seizures and an area of perilesional edema, making a total of 55 patients (95%; 95% CI, 85%-99%) with clinical-topography relationship when perilesional edema is considered. Most patients with focal epileptiform discharges (7/8, 88%) had a topographic association between electroencephalographic focality, the potential seizure onset zone and a cysticercotic lesion. CONCLUSION: Seizure semiology and focal epileptiform discharges are topographically related to neurocysticercotic lesions in most patients. These data strongly support seizure origin in the cortex surrounding these lesions.

Epilepsy and mortality in Latin America.

PURPOSE: To assess the mortality related to epilepsy in Latin America. METHODS: We searched MEDLINE, EMBASE, and LILACS from inception to December 2013 for articles evaluating mortality in patients with epilepsy in Latin America. Studies were included if they evaluated any mortality outcome, included a population of subjects with recurrent seizures or epilepsy, and contained original data analysis. RESULTS: The search strategy yielded 177 publications in MEDLINE and EMBASE, and 59 publications in LILACS; of which 18 met inclusion criteria for our overall review of epilepsy and mortality in Latin America. Most excluded studies did not report the mortality or lacked original data. We also included two references obtained from 2 non-systematic reviews fulfilling our inclusion criteria, and able to provide data for our analyses. Five studies reported Standardized Mortality Ratio (SMR), and demonstrated that people with epilepsy had a higher risk of death than the general population. The SMRs reported in two community-based studies were 1.34 and 2.45. CONCLUSION: The information about mortality in epilepsy in Latin America is very scarce. Comparisons cannot be made among studies due to methodological differences. More studies are needed.

Cirugía en epilepsia refractaria debida a neurocisticercosis / Epilepsy surgery for refractory neurocysticercosis-related epilepsy

Introducción. La neurocisticercosis es una causa frecuente de crisis epiléptica en el mundo, y en algunos casos puede llegar a ser farmacorresistente, por lo cual las opciones quirúrgicas deben estar presentes y la lesionectomía, con o sin lobectomía temporal, es la cirugía de elección. Casos clínicos. De la serie de pacientes con epilepsia farmacorresistente entre los años 2008 a 2018, se seleccionaron los que tenían una o varias lesiones sugerentes de neurocisticercosis y que se sometieron a cirugía de la epilepsia. Tres pacientes cumplían los criterios de selección, dos de ellos mujeres, con una edad media de 39,33 años. La edad media de inicio de la epilepsia fue a los 17,33 años, con diagnóstico de cisticercosis confirmado a la edad de 30. Uno de los casos tenía múltiples lesiones de neurocisticercosis junto con esclerosis mesial temporal, y los otros dos, lesiones únicas en el lóbulo temporal. En todos los pacientes, la zona epileptógena se localizó en el lóbulo temporal correspondiente. Por lo tanto, en dos casos se realizó una lesionectomía, y en el otro, con múltiples lesiones, una lobectomía temporal. La patología de las lesiones sugiere estadios crónicos de neurocisticercosis. Todos los pacientes están libres de crisis en el momento actual. Conclusión. La evaluación para cirugía de la epilepsia en pacientes con epilepsia refractaria debida a neurocisticercosis está recomendada y puede ser eficaz en el control y tratamiento de las crisis

Introduction. Neurocysticercosis is one of the most frequent causes of epilepsy worldwide, with some cases going into refractoriness. For that reason, surgical treatment should be considered, particularly lesionectomy, with or without temporal lobectomy. Case reports. From our series of patients with drug-resistant epilepsy from 2008 to 2018, we selected all cases with one or more lesions suggestive of neurocysticercosis who underwent epilepsy surgery. Three patients fulfilled the inclusion criteria, with an average age of 39.33 year-old, two were female, epilepsy onset was at a mean age of 17.33 years. One case had multiple neurocysticercosis lesions and mesial temporal sclerosis, the other two cases had single neurocysticercosis lesions in the temporal region. In all cases, the epileptogenic zone was located in the temporal lobe. One patient underwent a temporal lobectomy, while the other two underwent lesionectomy. Pathology confirmed neurocysticercosis granuloma. All three cases remain seizure free. Conclusion. Evaluation of patients with neurocysticercosis-related refractory epilepsy for potential surgery is indicated, as this procedure can be quite successful

Estimulación bilateral del núcleo subtalámico en enfermedad de Parkinson avanzada: resultados clínicos de una serie de casos en el Hospital Nacional Edgardo Rebagliati Martins / Bilateral stimulation of the subthalamic nucleus in advanced ParkinsonÆs disease: Clinical outcomes of a case series in the Edgardo Rebagliati Martins Hospital

Objetivo. Describir los resultados clínicos de los primeros pacientes con Enfermedad de Parkinson avanzada y complicaciones motoras tratados por estimulación bilateral crónica del núcleo subtalámico en el Hospital Nacional Edgardo Rebagliati Martins. Material y Métodos. Se revisaron las historias de los pacientes registrados en la base de datos de la Unidad de Trastornos del Movimiento del Departamento de Neurología del Hospital Nacional Edgardo Rebagliati Martins. Se consideraron los datos demográficos, los puntajes de la parte III del Unified Parkinson´s Disease Rating Scale (UPDRS) antes y después de la estimulación, las dosis de levodopa usadas y los eventos adversos reportados. Resultados. Diez pacientes fueron identificados. La edad media fue 54,5 ± 10 años, con un tiempo de enfermedad de 13,2 ± 7,9 años. En la condición medicación off, la estimulación redujo en un 45,5% el puntaje en la parte III del UPDRS. La dosis media de levodopa fue reducida en una tercera parte. Dos pacientes tuvieron infecciones del dispositivo. Conclusiones. La estimulación bilateral del núcleo subtalámico produce mejoría importante en los síntomas motores de los pacientes con Enfermedad de Parkinson avanzada mientras ellos están sin los efectos de la medicación.

Objective. Describe the clinical outcomes of the first patients with advanced ParkinsonÆs disease and motor complications treated by chronic bilateral stimulation of the subthalamic nucleus at the Edgardo Rebagliati Martins Hospital. Material and Methods. The Movement Disorders Unit database and patient medical records were reviewed. Demographic data regarding the timing of the procedure, Unified ParkinsonÆs Disease Rating Scale (UPDRS) part III scores before and after stimulation, levodopa doses and adverse events were considered. Results.Ten patients were identified with a mean age of 54.5± 10years, and a mean duration of disease of 13,2 ± 7,9 years. Off medication mean UPDRS part III score was decreased by 45.54%. The mean dose of levodopa was reduced by one third. Two patients had infections of the device. Conclusion. Bilateral stimulation of the subthalamic nucleus in our country produces improvement in motor function of patients with advanced ParkinsonÆs disease as they are without the effects of medication.