[Resection of frontal lobe epileptogenic foci identified after corpus callosotomy: long term results]. / Resección de focos epileptogénicos frontales identificados tras la callosotomía: resultados a largo plazo.

OBJECTIVES: To analyse the results of resective surgery in patients in whom it was possible to identify a frontal epileptogenic focus through corpus callosotomy. MATERIAL AND METHODS: Data from patients suffering drug-resistant epilepsy showing persistence of disabling seizures after undergoing corpus callosotomy and subsequent treatment with frontal lobe resective surgery were prospectively reviewed. Classifications according to Engel's scale before and after each intervention were evaluated, as were the percentages of seizure reduction. Additionally, the satisfaction of family members with surgical outcomes was also assessed. RESULTS: Eleven patients were identified. After a median follow-up period of 7 years (IQR: 3-8 years), 63.6% of patients showed improvement of seizures according to Engel's scale, 27.2% remained unchanged and one worsened. One patient was categorised as class i, 8 as class ii, one as class iii and one as class iv. The percentage reduction in the number of seizures was over 90% in 54.5% of patients, between 50% and 90% in 36.4% and less than 50% in 9.1%. Family satisfaction was reported as good or excellent in 90.9% of cases. CONCLUSIONS: In addition to providing better seizure control, corpus callosotomy also appears to be a diagnostic tool allowing the identification of potential targets for resective surgery. Therefore, it should be considered upon suspicion of a frontal epileptogenic focus which could be surgically treated.

[Vagus nerve stimulation therapy in patients with drug-resistant epilepsy and previous corpus callosotomy]. / Terapia con estimulación del nervio vago en pacientes con epilepsia fármaco-resistente y callosotomía previa.

OBJECTIVE: To analyse the results of vagus nerve stimulation in patients with drug-resistant epilepsy and previous corpus callosotomy. MATERIALS AND METHODS: We prospectively reviewed data from patients with drug-resistant epilepsy who showed persistence of disabling seizures after undergoing corpus callosotomy, in whom it was not possible to identify an epileptogenic focus and who were subsequently treated with vagus nerve stimulation. Variables analysed included: age, gender, aetiology of epilepsy, frequency and characteristics of the crises and Engel scale classification, before and after vagal stimulator implant. Furthermore, the percentage differences in seizure frequency changes were also calculated. RESULTS: Four patients were identified: two male and two female. The total seizure frequency had decreased between 20% and 81% after corpus callosotomy in three patients and one of them did not show any favourable response (Engel IVB). Following implantation of the stimulator they became reduced to between 57% and 100% after a mean follow-up period of 8.3 months (range: 3 to 12 months). Generalised seizures decreased between 71.4% and 100%, and focal seizures between 57.7% and 100%. CONCLUSIONS: Vagus nerve stimulation therapy proved to be an alternative for the reduction of seizure frequency in patients with drug-resistant epilepsy who suffered disabling seizures despite undergoing corpus callosotomy as primary surgery.

Psychiatric alterations after previous temporal lobectomy: Report of cases and review.

INTRODUCTION: Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS: A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS: The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS: Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.

Psychiatric Alterations after Previous Temporal Lobectomy: Report of Cases and Review. / Alteraciones psiquiátricas tras lobectomía temporal anterior: reporte de casos.

INTRODUCTION: Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS: A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS: The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS: Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.

Química y biología del extracto etanólico del epicarpio de Crescentia cujete L. (totumo) / Chemistry and biology of ethanol extract from the epicarp of Crescentia cujete L. (totumo)

Introducción: el árbol de Crescentia cujete L. (Bignonaceae), conocido en Colombia como totumo, es una especie característica de climas tropicales. Su rasgo más distintivo es el fruto, el cual es una calabaza esférica con cáscara dura y leñosa, y una pulpa gelatinosa con numerosas semillas. Objetivo: realizar el estudio químico y biológico sobre el extracto etanólico del epicarpio de Crescentia cujete L. Métodos: se recolectó el material vegetal y se obtuvo el extracto etanólico total. Luego se realizó el tamizaje preliminar fitoquímico, los ensayos físico-químicos directos sobre el material vegetal, la cuantificación de metales pesados y, finalmente, el estudio biológico frente a larvas de Aedes aegypti L. (Culicidae) en estadios III y IV, larvas de Artemia salina Leach. (Artemiidae) y células apicales de raíces de Allium cepa L. (Amaryllidaceae). Resultados: se identificó la presencia de tres grupos de metabólitos secundarios: flavonoides, esteroides y triterpenos. Asimismo, se cuantificó el contenido de agua y cenizas en base seca, y se determinaron las concentraciones de algunos metales pesados como cadmio, cromo, mercurio y plomo. En el estudio biológico se puso de manifiesto que el extracto no presenta toxicidad aguda en ninguno de los sistemas biológicos ensayados, a las concentraciones y tiempos de experimentación. Conclusiones: la información obtenida en la presente investigación, constituye un recurso importante para la comunidad científica porque proporciona elementos relacionados con la naturaleza química y el comportamiento biológico del epicarpio del totumo, antes no reportados.

Introduction: Crescentia cujete L. (Bignonaceae) tree known in Colombia as totumo, is a characteristic species of tropical climates. Its most distinctive feature is the fruit, which is a spherical pumpkin with hard and woody peel, and a gelatinous pulp having a lot of seeds. Objective: to conduct the chemical and biological ethanol extract of Crescentia cujete L. epicarp. Methods: vegetal material was harvested and the total ethanol extract was obtained. Then, preliminary phytochemical screening, direct physical and chemical tests on vegetal material, the quantification of heavy metals and finally the biological study against Aedes aegypti L. (Culicidae) larvae in stages III and IV, Artemia salina Leach. (Artemiidae) larvae and apical cells of Allium cepa L. (Amaryllidaceae) roots. Results: the presence of three groups of secondary metabolites, that is, flavonoids, steroids and triterpenes were identified. Likewise, the water and ash content on dry basis was quantified as well as the levels of concentration of some heavy metals such as cadmium, chromium, mercury and lead were estimated. The biological study revealed that the extract did not show acute toxicity either in any of the tested biological systems or at the concentrations and the time of experimentation. Conclusions: the information obtained in this research is an important resource for the scientific community and provides elements associated to the chemical nature and the biological behavior of the totumo ´s epicarp not contained in previous reports.

Evaluación de la memoria declarativa asociada con contenido emocional en pacientes lobectomizados / Evaluation of declarative memory associated with emotional content in lobotomized patients

La participación del lóbulo temporal en la memoria para eventos emocionales, ha sido evaluada utilizando la Prueba auditivo-visual, cuyo contenido emocional es presentado en narrativas complejas. El presente estudio examinó si el desempeño en el Token Test, afectaba la retención a largo plazo de información alertante emocionalmente en pacientes con lobectomía temporal unilateral. Se evaluaron 48 participantes, a quienes se les aplicó: Trail Making Test, Token Test y una Prueba auditivo-visual. De manera general, la ausencia del efecto depotenciación mnemónico encontrado en pacientes con lobectomía temporal izquierda no estuvo correlacionada con el rendimiento en el Token Test. En conjunto, se muestra la importancia de la integridad del lóbulo temporal izquierdo para la potenciación de la memoria declarativa asociada a contenido emocional.

Several studies have demonstrated that long-term declarative memory is enhanced by emotional arousal contents. Additionally, the role of the temporal lobe in memory associatedto emotional stimuli has been evaluated through the audio-visual Emotional Memory Test, where emotional content is presented by complex narratives. The present study examined ifToken Test’s performance influenced the long-term retention associated to emotional arousal in patients undergoing unilateral temporal lobectomy. A sample of 48 volunteers, were evaluated by Trail Making Test, Token Test and audio-visual Test. Patients didn’t show a mnemonic enhancement effect, particularly, those with left lobectomy. Low Token’s performance did not show any correlation with audio-visual Test’s performances. Results highlightthe importance of left temporal lobe for long-term enhancement of declarative memory associated to emotional events.

La Epilepsia en Colombia. Recuento histórico, estado actual al principio del milenio y visión al futuro / Epilepsy in Colombia: Historical aspects, actuality at the millenium beginning and future vision

Se presenta un recuento histórico de la enfermedad en el país desde remotas épocas prehispánicas hasta nuestros días. Se hace aquí un especial énfasis en la famacología, el tratamiento médico y quirúrgico, con una visión actual y futurista. Para comienzos del nuevo siglo los distintos actores de la Salud y por parte del Estado particularmenete deberá haber una conciencia y una acción sobre una población de 800.000 enfermos de epilepsia en Colombia que requieren tratamiento médico permanente y quizá una cirugía. Se hace énfasis en la labor cumplida por la Liga Colombiana contra la Epilepsia que durante 35 años ha desarrolldo con esta población despertando la esperanza en sus familias por un futuro más humano en el manejo de esta patología