Eliseu Paglioli Neto

Operative Strategies for Patients with Cortical Dysplastic Lesions and Intractable Epilepsy

Summary: Cortical dysplastic lesions (CDLs) are usually identified by magnetic resonance imaging (MRI). Clinical, electrographic and histologic findings suggest that focal CDLs (FCDLs) are highly epileptogenic, often involve the rolandic cortex, and can present variable degrees of histopathologic abnormalities. An ictal or “ictal‐like” bursting pattern of electrographic activity was recorded over dysplastic cortex in 65% of our patients. Resective surgery can eliminate or significantly reduce seizure frequency in many medically intractable patients, depending on lesion location, degree, and extent of histopathologic abnormalities. Best results are achieved when complete or major excision of both the MRI‐visible lesion and the cortical areas displaying ictal electrographic activity can be performed. This is more likely when the degree of histopathologic abnormality is mild to moderate or when the lesion is in a temporal lobe. More severe histopathologic abnormalities and central insular or multilobar lesions usually lead to less favorable results: either major excision of the visualized lesion is impractical or the lesion is microscopically more extensive than shown by MRI. Multilobar resection or hemispherectomy for patients with infantile spasms associated with CDLs and for patients with hemimegalencephaly are often associated with dramatic improvement in seizure control. Callosot‐omy can be performed in selected patients with diffuse CDLs who have intractable drop attacks.

Functional variability of the human cortical motor map: Electrical stimulation findings in perirolandic epilepsy surgery

&NA; The purpose of this study was to assess the cortical representation of sensorimotor functions in patients undergoing perirolandic epilepsy surgery, focusing on somatotopy, mosaicism, and variability of function in relation to the classic motor homunculus. The authors studied 36 patients in whom intraoperative or extraoperative electrical cortical stimulation to map motor functions was performed. A computer program was devised to register electrode number, stimulation parameters, and response to each stimulus. Electrode position was represented graphically whenever a stimulus was delivered. A total of 43 maps from 36 patients were analyzed. The authors found variations in the organization of M1 (primary motor cortex) in seven patients (19.4%). Four patients (11.1%) presented mosaicism (overlapping of functional areas), two (5.6%) presented variability (inverted disposition of M1 functional areas), and one (2.8%) had both. The results of this study challenge the notion of orderly topographic relationships between the human sensorimotor functions and their representation in the primary motor cortex. These results confirm those of other studies with animals and humans using novel imaging techniques, suggesting that the motor homunculus may not always be considered a definite and absolute representation of M1.

Corpora amylacea in temporal lobe epilepsy associated with hippocampal sclerosis

UNLABELLED Hippocampal sclerosis (HS) is the commonest pathology in epileptic patients undergoing temporal lobe epilepsy surgery. Beside, there are an increased density of corpora amylacea (CA) founded in 6 to 63% of those cases. OBJECTIVE verify the presence of CA and the clinical correlates of their occurrence in a consecutive series of patients undergoing temporal surgery with diagnosis of HS. METHOD We reviewed 72 hippocampus specimens from January 1997 to July 2000. Students t test for independent, samples, ANOVA and Tukey test were performed for statistical analysis. RESULTS CA were found in 35 patients (49%), whose mean epilepsy duration (28.7 years) was significantly longer than that group of patients without CA (19.5 years, p=0.001). Besides, when CA were found, duration was also significantly correlated with distribution within hippocampus: 28.7 years with diffuse distribution of CA, 15.4 with exclusively subpial and 17.4 years with distribution subpial plus perivascular (p=0.001). CONCLUSION Our findings corroborate the presence of CA in patients with HS and suggest that a longer duration of epilepsy correlate with a more distribution of CA in hippocampus.

Síndrome de West, autismo e displasia cortical temporal: resolução da epilepsia e melhora do autismo com cirurgia

INTRODUCAO: Estima-se que um terco dos casos de pacientes com espectro autista vai apresentar ao menos uma crise epileptica ate a adolescencia. Esta associacao entre transtornos invasivos do desenvolvimento e epilepsia vem sendo amplamente estudada, mas ainda com inumeros questionamentos sem resposta na literatura. OBJETIVO: Os autores apresentam o caso de uma crianca, com quadro de Transtorno Invasivo do Desenvolvimento - espectro autista - e epilepsia de dificil controle submetida a cirurgia, revisando aspectos fundamentais desta associacao. CONCLUSAO: A partir do caso em questao e de estudos existentes, e pertinente questionar quais sao os indicios que nos fazem acreditar que crises epilepticas recorrentes ou uma atividade eletrica anormal sejam responsaveis por alteracoes cognitivas, de linguagem ou de conduta e qual o tratamento ideal para estas criancas nas quais co-existem os dois diagnosticos.