Lucas Crociati Meguins

Gross-total resection of temporal low grade gliomas is a critically important factor in achieving seizure-freedom

OBJECTIVEnTo present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome.nnnMETHODnA retrospective study was conducted with patients with temporal low-grade gliomas (LGG).nnnRESULTSnSixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years). The mean age at seizure onset was 25.7 ± 9.2 (11-66 years). Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6%) were Engel I; seventeen (26.2%) Engel II; four (6.2%) Engel III and two (3.1%) Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6%) with total resection and in only 3 (33.3%) patients with partial resection.nnnCONCLUSIONnGross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.

Shorter epilepsy duration is associated with better seizure outcome in temporal lobe epilepsy surgery

OBJECTIVEnTo investigate the influence of patients age and seizure onset on surgical outcome of temporal lobe epilepsy (TLE).nnnMETHODnA retrospective observational investigation performed from a cohort of patients from 2000 to 2012.nnnRESULTSnA total of 229 patients were included. One-hundred and eleven of 179 patients (62%) were classified as Engel I in the group with < 50 years old, whereas 33 of 50 (66%) in the group with ≥ 50 years old group (p = 0.82). From those Engel I, 88 (61%) reported epilepsy duration inferior to 10 years and 56 (39%) superior to 10 years (p < 0.01). From the total of patients not seizure free, 36 (42%) reported epilepsy duration inferior to 10 years and 49 (58%) superior to 10 years (p < 0.01).nnnCONCLUSIONnPatients with shorter duration of epilepsy before surgery had better postoperative seizure control than patients with longer duration of seizures.

Longer epilepsy duration and multiple lobe involvement predict worse seizure outcomes for patients with refractory temporal lobe epilepsy associated with neurocysticercosis.

OBJECTIVEnTo investigate the surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) and neurocysticercosis (NCC).nnnMETHODSnA retrospective investigation of patients with TLE-HS was conducted in a tertiary center.nnnRESULTSnSeventy-nine (62.2%), 37 (29.1%), 6 (4.7%), and 5 (3.9%) patients were Engel class I, II, III, and IV, respectively. Fifty-two (71.2%) patients with epilepsy durations ≤ 10 years prior to surgery were seizure-free 1 year after the operation compared to 27 (50.0%) patients with epilepsy durations > 10 years (p = 0.0121). Forty-three (72.9%) patients with three or fewer lobes affected by NCC were seizure-free one year after the operation, and 36 (52.9%) patients with more than three involved lobes were seizure-free after surgery (p = 0.0163).nnnCONCLUSIONSnLonger epilepsy durations and multiple lobe involvement predicted worse seizure outcomes in TLE-HS plus NCC patients.

Pediatric Multiple Sclerosis—A Challenging Demyelinating Disease: Case Report and Brief Review of the Literature

Multiple sclerosis (MS) is an inflammatory, demyelinating, neurodegenerative disorder of the central nervous system (CNS) of unknown etiology. The peak onset is between age 20 and 40 years and usually affects more women than men. Although much knowledge has been achieved on the diagnosis and treatment of adult patients with MS, it remains a matter of debate and controversy in childhood. We present a case of MS in 9-year-old girl, review the current state of the knowledge on pediatric MS, and discuss the available tools for the diagnosis and treatment.

Auras as a prognostic factor in anterior temporal lobe resections for mesial temporal sclerosis.

Anterior temporal lobectomy for mesial temporal sclerosis (MTS) is a very effective measure for the control of seizures, and the probability of becoming seizure‐free is approximately 70–90%. However, 30% of patients still experience seizures after surgery. An aura is a subjective ictal phenomenon that may precede an observable seizure. However, there are few studies on the prognostic factor aura although, being the initial symptoms of epileptic seizures, many types of auras have significant localizing or lateralizing value. This study hypothesized that the type of pre‐operative aura may predict the post‐surgical outcome in patients with medically refractory temporal lobe epilepsy due to MTS.

CHILDHOOD POSTERIOR CIRCULATION ISCHEMIC STROKE: AN UNCOMMON CEREBROVASCULAR DISEASE. CASE REPORT

Introduction: Stroke is characterized as a sudden onset of neurological deficit that results from a c erebrovascular event. The most commonly identified causes of ischemic stroke in children are cerebral arteriopathies, congenital, or acquired cardiac diseases, sickle cell disease, and thrombophilias. In children, due to the low incidence and absence of specific methods to assess and measure correctly this entity, stroke recognition is usually delayed. Case Report: A 20 months-old girl was admitted to the emergency department presenting a history of two episodes of vomits, irritability, continuous crying, and strabismus that started suddenly. On neurological assessment, it was found divergent strabismus with right medial rectus muscle palsy and reduced right pupillary reflex to light associated with instable gait. Brain magnetic resonance imaging (MRI) showed an ischemic lesion on the right pontomesencephalic region. The patient received clinical support. On the fifth day, she was discharged with a prescription of aspirin, good clinical conditions, stable gait, and persistence of the divergent strabismus. Conclusion: Posterior circulation ischemic stroke is an important cause of morbidity and mortality on pediatric population and must be remembered to avoid diagnosis delay. Descriptors: Stroke; Children; Posterior Circulation Artery Ischemia. Introdução: O Acidente Vascular Encefálico (AVE) é caracterizado por um déficit neurológico súbito, resultado de um evento cerebrovascular. As causas mais comuns de Acidente Vascular Encefálico isquêmico em crianças são arteriopatias cerebrais; doenças cardíacas congênitas ou adquiridas; doença falciforme e trombofilias. Nas crianças, devido à baixa incidência e ausência de métodos específicos para avaliar e medir essa entidade correntemente, o reconhecimento do Acidente Vascular Encefálico é atrasado. Relato de Caso: Uma criança do sexo feminino de 1 ano e 8 meses foi admitida na Emergência apresentando história de dois episódios de vômitos, irritabilidade, choro inconsolável e estrabismo de início súbito. Ao exame neurológico apresentava estrabismo divergente com paralisia do músculo reto medial direito e redução do reflexo pupilas ao estimulo luminoso à direita, associado à marcha instável. Ressonância Magnética do encéfalo (RM) demonstrou lesão isquêmica na região pontomesencefálica à direita. A paciente recebeu suporte clinico e no quinto dia recebeu alta hospitalar com receita de aspirina, em boas condições clínicas, estabilidade da marcha e com persistência do estrabismo divergente. Conclusão: Acidente Vascular Encefálico isquêmico de circulação posterior é uma importante causa de mortalidade e morbidade na população pediátrica e deve ser lembrada para evitar o atraso no diagnóstico. Descritores: Acidente Vascular Encefálico; Criança; Isquemia Arterial da Circulação Posterior. Resumo