Lineu Corrêa Fonseca

Recomendaçöes para o registro/interpretaçäo do mapeamento topográfico do eletrencefalograma e potenciais evocados: parte II: correlaçöes clínicas

Digital EEG (DEEG) and quantitative EEG (QEEG) are recently developed tools present in many clinical situations. Besides showing didactic and research utility, they may also have a clinical role. Although a considerable amount of scientific literature has been published related to QEEG, many controversies still subsist regarding its clinical utilization. Clinical applications are: 1. DEEG is already an established substitute for conventional EEG, representing a clear technical advance. 2. Certain QEEG techniques are an established addition to DEEG for: 2a) screening for epileptic spikes or seizures in long-term recordings; 2b) Operation room and intensive care unit EEG monitoring. 3. Certain QEEG techniques are considered possible useful additions to DEEG: 3a) topographic voltage and dipole analysis in epilepsy evaluations; 3b) frequency analysis in cerebrovascular disease and dementia, mostly when other tests have been inconclusive. 4. QEEG remains investigational for clinical use in postconcussion syndrome, learning disability, attention disorders, schizophrenia, depression, alcoholism and drug abuse. EEG brain mapping and other QEEG techniques should be clinically used only by physicians highly skilled in clinical EEG interpretation and as an adjunct to traditional EEG work.

Subacute sclerosing leucoencephalitis: an epidemiological, clinical and biochemical study of 31 cases

Thirty-one cases of SSLE are reported. The diagnosis was based on the clinical picture, the marked increase of gammaglobulins in the cerebrospinal fluid, the typical electroencephalographic pattern, and the pathological examination. Intracellular inclusion bodies were found at the postmortem examination of 8 among 13 cases and in 1 of 7 cerebral biopsies. The mean age was 11.7 years, with the limits of 3 and 22 years. Males prevailed markedly over females (23:8). Patients from rural regions were the bulk of the series (77.4%). No definite regional predominance was demonstrated by the analysis of the geographic distribution. A seasonal influence was not evidenced. In 16 patients followed up to death, the average duration of the disease was 7 months, with a range from 2 to 20 months. In the clinical picture the constancy of myoclonus or losses of tonus, and psychiatric disorders was evidenced. The first symptom was the psychiatric alteration in 55.6% of the cases, myoclonus in 35.5% and grand mal seizures in 33.3%. Rigidity and pyramidal signs were very frequent, while the cerebellar syndrome was rare. Ophtalmoscopic alterations (edematous or pale disk, choroidits) were found in a third of the cases. In two cases an epizootic of household chicken was coincident with the onset of the disease. The blood copper concentrations determined in 8 cases were always above the normal range, while ceruloplasmin remained within the normal limits. The blood sulfur levels were high in 3 patients studied. The blood magnesium levels were variable in 6 patients studied.

Crises visuais induzidas e hiperglicemia não-cetótica: relato de caso

Existem poucos relatos na literatura de pacientes com hiperglicemia nao-cetotica e crises visuais induzidas pela movimentacao ocular. Apresentamos o caso de paciente do sexo masculino de 47 anos de idade que iniciou quadro de diabetes mellitus com crises visuais e oculomotoras espontâneas ou desencadeadas pela movimentacao ocular. As crises foram de dificil controle, nao cedendo com fenitoina endovenosa. O paciente evoluiu com deficit motor no hemicorpo esquerdo, que regrediu em uma semana, juntamente com as crises, apos o controle da glicemia. O EEG critico mostrou descargas no hemisferio direito de predominio posterior, com extensao para o hemisferio esquerdo. A tomografia computadorizada de crânio foi normal. Este caso mostra a importância de investigar a inducao de crises e a existencia de diabetes em pacientes com crises visuais de inicio recente.In a 47-years-old male patient, partial visual seizures triggered by movement was an early symptom of nonketotic hyperglycemia. Seizures were resistant to conventional anticonvulsivant therapy. During seizures, EEG showed discharges over the right hemisphere. CT was normal. A search for reflex seizures and hyperglycemia should be routinely carried out in patients with repeated focal visual seizures, as shown in the case reported.

Epilepsia com pontas centrotemporais e com pontas parietais: estudo comparativo

: There are controversies about the existence of a benign parietal epilepsy distinct from the benign partial epilepsy with centro-temporal spikes. We studied 164 children with no neurological or neuroradiological evidence of brain damage and with epilepsy and spikes restricted to the centro-temporal (CTS) or to the parietal regions (PS). The subjects age, age at onset and type of seizures and the presence of spikes evoked by consecutive taps applied to both hands and feet were compared between 111 patients with CTS and 53 patients with PS. Age of patients and age at onset of seizures predominated until 6 years in the PS group and after 6 years in the CTS group. The occurrence of oropharyngeal or facial motor seizures was statistically more frequent among the patients with CTS (44.1%) as opposed to PS group (16.9%). In 39.5% of the children with PS and only in 3.5% of those with CTS, the EEG showed high voltage potentials, similar to the habitual spikes in clinical EEG, evoked by the stimulation of one or both feet or hands. Our findings suggest that in neurologically normal children with epilepsy, the group with PS differs from those with CTS in the age, age at onset and type of seizures and EEG reactivity to percussion of hands and feet.Ha controversias sobre a existencia de uma epilepsia parcial benigna parietal distinta da epilepsia com pontas rolândicas. Estudamos 164 criancas com epilepsia e focos restritos as regioes centrais, temporais medias e parietais, sendo excluidas as que apresentavam elementos indicativos de lesao cerebral. Foram analisados a idade dos pacientes, a idade de inicio, o tipo e o numero das crises, antecedentes familiares para epilepsia e a reatividade a percussao dos pes e maos ao EEC As pontas foram de localizacao central e/ou temporal media (PCT) em 111 casos (temporal media em 56, centrotemporal em 29, central em 26) e parietal (PP) em 53 casos. A idade dos pacientes e idade de inicio das crises predominaram na faixa ate 6 anos de idade no grupo com PP e acima dos 6 anos no grupo com PCT. As crises orofaringeas e motoras da face corresponderam a 44,1% das criancas com PCT e, apenas, a 16,9% daquelas com PP. Pontas evocadas por estimulos somatossensoriais, ao EEG, foram registradas em proporcao mais elevada de casos com PP (39,5%) do que no grupo com PCT (3,5%). Nossos achados mostram que epilepsia, na ausencia de sinais lesionais, em criancas com PP, e relativamente frequente e tanto a idade dos pacientes, idade de inicio e perfil das crises, quanto a reatividade do EEG a percussao de pes e maos, mostram diferencas significativas em relacao ao observado nas criancas com PCT.

Paroxismos occipitais após o fechamento dos olhos: correlações clínico-eletrencefalográficas em 24 casos

Paroxysms of high-amplitude spike-waves or sharp waves recurring rhythmically on the occipital areas when the eyes are closed (POEC) are primarily observed in childhood epilepsy with occipital paroxysms (CEOP). An association of this electroencephalographic (EEG) pattern with idiopathic epilepsy has been disputed. We studied EEG and clinical features in 24 patients (age ranging from 3 to 25 years) with POEC. The EEG showed generalized discharges in 8 cases, rolandic spikes in 4 and background abnormalities in 4 cases. Eigtheen (75%) patients manifested epileptic seizures. The nonfebrile seizures (16 cases) were partial (9 cases), generalized (6 cases) and unclassified (one patient). Two children had neurological examination or computed tomography abnormalities. Clinical and EEG data allowed for the following epileptic syndromes diagnosis: CEOP, 7 cases; benign childhood epilepsy with centrotemporal spikes, one case; CEOP or benign childhood epilepsy with centrotemporal spikes, one case; partial symptomatic/cryptogenic epilepsy, 4 cases; generalized idiopathic, 2 cases; febrile convulsions, 2 cases. We conclude that POEC may be observed in cases with different types of idiopathic partial, cryptogenic/symptomatic and idiopathic generalized epilepsies and may also occur in patients with no seizures.Paroxysms of high-amplitude spike-waves or sharp waves recurring rhythmically on the occipital areas when the eyes are closed (POEC) are primarily observed in childhood epilepsy with occipital paroxysms (CEOP). An association of this electroencephalographic (EEG) pattern with idiopathic epilepsy has been disputed. We studied EEG and clinical features in 24 patients (age ranging from 3 to 25 years) with POEC. The EEG showed generalized discharges in 8 cases, rolandic spikes in 4 and background abnormalities in 4 cases. Eighteen (75%) patients manifested epileptic seizures. The nonfebrile seizures (16 cases) were partial (9 cases), generalized (6 cases) and unclassified (one patient). Two children had neurological examination or computed tomography abnormalities. Clinical and EEG data allowed for the following epileptic syndromes diagnosis: CEOP, 7 cases; benign childhood epilepsy with centrotemporal spikes, one case; CEOP or benign childhood epilepsy with centrotemporal spikes, one case; partial symptomatic/cryptogenic epilepsy, 4 cases; generalized idiopathic, 2 cases; febrile convulsions, 2 cases. We conclude that POEC may be observed in cases with different types of idiopathic partial, cryptogenic/symptomatic and idiopathic generalized epilepsies and may also occur in patients with no seizures.

Avaliação psico-social em epilepsia: Experiência com uma versão do WPSI

Epilepsy has frequently been associated with important psycho-social problems. Washington Psychosocial Seizure Inventory is a inventory developed to identify the psycho-social problems in epilepsy. In this study we applied a WPSI version for a psychosocial evaluation of Brazilian patients: 54 epileptic patients answered a questionnaire in a period of 7 months. The application of WPSI showed difficulties in the scales: adjustment to seizures, financial status, vocational adjustment, emotional and interpersonal adjustment. The scores of problems were lower in the scales of family background, medicine and medical management. Level of schoolarity, employment status, seizure type, duration of epilepsy, control of seizures were factors influencing WPSI results. Difficulties were noticed in the comprehension of some words by the illiterate patients, and in high scores for validity scales. Our initial results were comparable to the literature. However, it should be necessary an adaptation of some language aspects and validity scales, and a further application in a larger number of epileptic patients to validate our WPSI version.Epilepsy has frequently been associated with important psycho-social problems. Washington Psychosocial Seizure Inventory is a inventory developed to identify the psycho-social problems in epilepsy. In this study we applied a WPSI version for a psychosocial evaluation of Brazilian patients: 54 epileptic patients answered a questionnaire in a period of 7 months. The application of WPSI showed difficulties in the scales: adjustment to seizures, financial status, vocational adjustment, emotional and interpersonal adjustment. The scores of problems were lower in the scales of family background, medicine and medical management. Level of schoolarity, employment status, seizure type, duration of epilepsy, control of seizures were factors influencing WPSI results. Difficulties were noticed in the comprehension of some words by the illiterate patients, and in high scores for validity scales. Our initial results were comparable to the literature. However, it should be necessary an adaptation of some language aspects and validity scales, and a further application in a larger number of epileptic patients to validate our WPSI version.

Somatosensory Evoked Potential and EEG in Children with Focal Idiopathic Epilepsies with and without Evoked Spikes by Tapping of the Feet or Hands

The characteristics of SEP cortical components were studied in 40 children with focal idiopathic epilepsies of childhood. Twenty children had focal idiopathic epilepsies and evoked spikes (FIE-ES) on the EEG and 20 had benign focal epilepsy of childhood with centrotemporal spikes (CTE) but without evoked spikes (ES). These data were compared with those of a control group of 20 normal children. N35 high-amplitude component was more frequent in the CTE group than in the control group (p<0.001). P98 showed high amplitude in 50% of the children of FIE-ES group, and in none of the CTE and control groups (p<0.001). The P98 high amplitude component was more common in the FIE-ES group than in the other groups, and so was the N35 high amplitude component in the CTE group. Lateralization of high-amplitude components of N35 in the CTE group and of P98 in FIE group was not correlated with lateralization of epileptiform activity and evoked spikes. Based on our findings, there are SEPs cortical component differences in childhood focal idiopathic epilepsies according to occurrence or absence of ES.

Eletrencefalograma nos traumatismos cranio-encefalicos

: The 551 electroencephalograms of 387 patients with head injury are analysed. The electroencephalographic findings are correlated to the following clinical data: age, time after the trauma, duration of unconsciousness, presence of localizing neurological signs, existence of open wounds or hematoma, bloody cerebrospinal fluid and post-traumatic epilepsy. The autor came to the following conclusions: 1--there is a clear correlation between the electroenecephalographic abnormalities and the degree of cerebral injury characterized by the duration of unconsciousness, presence of localizing neurological signs, presence of bloody cerebrospinal fluid and post-traumatic epilepsy; 2 - slow wave activity over the parieto-occipital area is more frequent in the age group up to 10 years; 3 - the proportion of abnormal electroencephalograms decreases particularly after the 1st month post-trauma; 4 - diffuse or focal slow activity decreased principally after the 1st month post-trauma; 5 - paroxysmal abnormalities increase proportionaly after the 6th month post-trauma; 6 - patients with intracranial hematoma present great proportion of abnormalities, particularly depressions. This study demonstrates the importance of electroencephalographic tracings as a complementation to the clinical evaluation of head injury cases, chiefly early, and late follow-up tracings.The 551 electroencephalograms of 387 patients with head injury are analysed. The electroencephalographic findings are correlated to the following clinical data: age, time after the trauma, duration of unconsciousness, presence of localizing neurological signs, existence of open wounds or hematoma, bloody cerebrospinal fluid and post-traumatic epilepsy. The autor came to the following conclusions: 1 — There is a clear correlation between the electroencephalographic abnormalities and the degree of cerebral injury characterized by the duration of unconsciousness, presence of localizing neurological signs, presence of bloody cerebrospinal fluid and post-traumatic epilepsy; 2 — slow wave activity over the parieto-occipital area is more frequent in the age group up to 10 years; 3 — the proportion of abnormal electroencephalograms decreases particularly after the 1st month post-trauma; 4 — diffuse or focal slow activity decreased principally after the 1st month post-trauma; 5 — paroxysmal abnormalities increase pro¬ portionaly after the 6th month post-trauma; 6 — patients with intracranial hematoma present great proportion of abnormalities, particularly depressions. This study demonstrates the importance of electroencephalographic tracings as a complementation to the clinical evaluation of head injury cases, chiefly early, and late follow-up tracings.

P219 Dementia, mild cognitive impairment and quantitative EEG in patients with Parkinson's Disease

Previous studies indicated that intra-hippocampal injections of Naltrexone as a classic antagonist of opioid receptor blocked glucocorticoid-induced deficit in memory retrieval, but the sort of opioid receptor that interaction with glucocorticoids were not known. The present study examined whether the kappa opioid receptors in the hippocampus interact with glucocorticoid effects on memory retrieval in a water maze (WM). 140 young rats (250-300 gr) carrying bilateral cannulae aimed at the hippocampus were trained in a WM task with six trials per day for six consecutive days. Retention of the spatial training was assessed 24h after the last training session with a 60-s probe trial. Corticosterone (1mg/kg) was injected 30 min before retention testing with or without prior bilateral intra-hippocampal injections of U111 (0.8, 2, 5 μg/0.5 μl per site) as a kappa opioid receptor agonist or N-BNI (0.75, 1.5 and 3 μg/0.5 μl per site) as a kappa opioid receptor antagonist. The results show that corticosterone-induced impairment of memory retrieval. But U111 and N-BNI donot effects on corticostron’s effects significantly (P>0.05). These findings provide evidence for the view those glucocorticoids havenot interact with the hippocampal kappa opioid receptors in influencing long-term memory retrieval.

P049 Benign childhood epilepsy with centrotemporal spikes: a longitudinal neuropsychological and electroencephalographic study

36 weeks: I: 1,96±0,32; III: 4,82±0,33; V: 7,20±0,38; I-III: 2,85±0,3; III-V: 2,37±0,18; I-V: 5,23±0,37 37 weeks: I: 2,00±0,15; III: 4,77±0,33; V: 7,06±0,34; I-III: 2,77±0,27; III-V: 2,28±0,19; I-V: 5,05±0,29 38 weeks: I: 1,92±0,24; III: 4,71±0,24; V: 7,04±0,25; I-III: 2,82±0,29; III-V: 2,29±0,28; I-V: 5,11±0,32 39 weeks: I: 1,90±0,23; III: 4,66±0,29; V: 6,89±0,29; I-III: 2,75±0,23; III-V: 2,22±0,22; I-V: 4,99±0,26 40 weeks: I: 1,81±0,11; III: 4,52±0,22; V: 6,65±0,27; I-III: 2,70±0,23; III-V: 2,23±0,21; I-V: 4,94±0,32 Pearson’s Correlation Test showed a statistically significant (p<0,01) negative correlation between corrected age and latencies of waves I, III and V, and III-V and I-V interpeak intervals Conclusions: BAEP latencies shorten with increasing gestational age. This could be used to assess the maturational development of peripheral and central auditory pathway, either by serial recordings or comparing patient results with our proposed normal values