Luís Marques de Assis

Intractable complex partial seizures associated with posterior cerebral artery giant aneurysm: a case report.

Summary: Giant aneurysms have rarely been reported in association with intractable complex partial seizures (CPS). We report a 30‐year‐old man with intractable CPS since age 18 years. Seizure onset was electrically localized to right temporal lobe. Preoperative neuroimaging studies showed a partially thrombosed giant aneurysm of the right posterior cerebral artery. Selective arnygdalo‐ hippocampectomy and occlusion of the posterior cerebral artery did not cause deficits. The patient has been seizure‐free for 15 months after operation. We review the relevant literature on aneurysms as a cause of epilepsy.

DISORDERS OF COPPER METABOLISM IN EPILEPSY.

Except for hepatolenticular degeneration and multiple sclerosis, copper metabolism has not been duly evaluated in nervous diseases. Concerning epilepsy, almost nothing is seen in the literature, ncithcr when the most renowned textbooks (Pen f i e ld & Jasper, 1954; L e n n o x & L e n n o x , 1960; T o w e r , 1960) are reviewed, nor when a survey is made of papers on copper metabolism in various disease processes (McElroy & Glass, 1950; Scheinberg & S t e r n l k b , 1960; Ade l s t e in & Vallee, 1961). Only in some few articles on disorders of copper metabolism in multiple sclerosis ( P l u m & Hansen , 1960) and in mental discases (Hei l ineyer & Ulrich, apud K e u p , 1954; Escobar & Niet to , 1957), or clse in studies on ceruloplasmin (O’ReilIy, 1961), some data regarding epilepsy arc found. On the other hand, in cases of acute or chronic copper intoxication no reference to seizures is made ( A d e l s t e i n & Val lee , 1961). In the present paper we report the results of the determination of copper and ceruloplasmin in the blood and cerebrospinal fluid (CSF) of epileptic patients, either in the interictal period, or immediately after the fit, and also in patients with mental diseases, before and after they were submitted to electroshock.

Disorders of magnesium metabolism in epilepsy

Clinical observations in man (Griffiths, 1947; Randall, Rossmeisl, and Bleifer, 1959; Hanna, Harrison, Maclntyre, and Fraser, 1960; Vallee, Wacker, and Ulmer, 1960) and experimental investigations in animals (Kruse, Orent, and McCollum, 1932) have shown that magnesium (Mg) depletion causes a marked irritability of the nervous system, eventually resulting in epileptic seizures. The possibility that convulsions may occur in Mg deficiency led some investigators to study the metabolism of this metal in the epilepsies, and a trend to low blood concentrations was usually found (Denis and Talbot, 1921; Blumgarten and Rohdenburg, 1927; Hirschfelder and Haury, 1934, 1935; Haury, 1942; Suter and Klingman, 1955). In successive studies, Hirschfelder and Haury (1935, 1938) found a lowering of Mg and a rise of potassium in the blood of epileptic patients, leading to a definite increase in the K/Mg ratio, proportional to the severity of the disease. Concerning the metabolism of magnesium in the cerebrospinal fluid, Cohen (1927), McCance and Watchorn (1931), and Greenberg and Aird (1938) found in epilepsy the same range of magnesium levels as in other nervous diseases. Hirschfelder and Haury (1938) found low concentrations of Mg in the cerebrospinal fluid of epileptic patients, though the levels were higher than in the blood. These findings, associated with the fact that Mg is a known depressor of the central nervous system and is involved in several enzymatic processes, including the synthesis of acetylcholine, were not appreciated by some authorities in the field of epilepsy, even when the neurochemistry of this disease was analysed (Tower, 1960).

Manifestações clínicas de crises parciais complexas do lobo temporal: um estudo vídeo-eletrencefalográfico

We analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the EEG emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). The temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal EEG recordings, CT and MRI findings, interictal and, in some patients, ictal SPECT studies. 8 patients had surgery. In 5 from 7 patients who had temporal lobectomy, mesial temporal sclerosis was the anatomopathological finding and in one patient who had selective amigdalohippocampectomy,.hemosiderosis and gliosis probably due to bleeding of a posterior cerebral artery giant aneurysm was found. All patients have been seizure free after surgery. While dystonic posturing and ictal paresis, present in 18 seizures(66.6%), were excellent as lateralizing seizure signs, since they were always contralateral to the ictal onset, contralateral and ipsilateral versive head and eye movements were observed.

Ensaio com sulpiride em esquizofrênicos hospitalizados

Um ensaio terapeutico e feito com sulpiride, substância psicotropica dada como muito ativa e cujas propriedades permitem enquadra-la entre os neurolepticos e os timoanalepticos. Foram tratados 24 pacientes internados, com idades que variavam entre 17 e 48 anos, de ambos os sexos (17 masculinos e 7 femininos), todos com o diagnostico clinico de esquizofrenia e internados em hospital psiquiatrico. O tempo de doenca variava de 30 dias a 18 anos. O sulpiride foi aplicado em doses diarias em torno de 1200 mg, predominantemente por via oral. O tratamento durou em media 6 semanas permanecendo a maioria dos casos em observacao por alguns meses, sob tratamento de manutencao. Os resultados foram em geral favoraveis, principalmente no que tange aos fenomenos psicoticos sensoperceptivos e delirantes. Nao foram assinalados efeitos colaterais ou manifestacoes colaterais molestas.

Metabolismo do cobre nas epilepsias

Partindo do fato de que o metabolismo do cobre esta alterado nas epilepsias, o autor estudou sob que forma essa alteracao se manifesta e, mediante o uso de curare em pacientes mentais submetidos ao eletrochoque, a influencia da hiperatividade muscular propria da crise convulsiva sobre o metabolismo do cobre. Alem disso, o autor estudou as correlacoes entre sexo e idade dos pacientes epilepticos, de um lado, e cupremia e cuprorraquia, do outro, e fez a correlacao entre os niveis de cobre do soro e do LCR desses pacientes. Nos pacientes epilepticos (84) foram colhidas amostras de sangue (81 casos) e de LCR (66 casos) em periodo intercritico para dosagem do cobre total. Nos pacientes mentais (32) foram colhidas amostras de sangue antes e imediatamente apos crise convulsiva determinada pelo eletrochoque simples (22 casos) para dosagem de ceruloplasmina, e imediatamente apos eletrochoque sob acao de curare (10 casos) para dosagem do cobre total. Os resultados foram submetidos a analise estatistica, tendo o autor chegado as seguintes conclusoes: 1) o nivel de cobre do sangue e do LCR dos pacientes epilepticos nao depende do sexo nem da idade; 2) o teor de cobre do LCR esta correlacionado com o do sangue nos pacientes epilepticos; 3) a supressao, mediante o uso de substância curarizante, das manifestacoes musculares da crise produzida pelo eletrochoque acarreta queda nao significativa do nivel de cobre do sangue; 4) a queda do nivel de cobre do sangue apos convulsoes determinadas pelo eletrochoque depende da hiperatividade muscular que caracteriza a crise convulsiva; 5) a queda do nivel de cobre do sangue apos convulsoes determinadas pelo eletrochoque depende principalmente do cobre de reacao direta; 6) a queda dos niveis de cobre do sangue apos convulsoes determinadas pelo eletrochoque e devida a pas* sagem desse elemento para os espacos intracelulares.

Epilepsia mioclônica e dissinergia cerebelar mioclônica: considerações clínicas e eletrencefalograficas a propósito de 8 casos

Registrando 5 casos de dissinergia cerebelar mioclonica e 3 casos de epilepsia mioclonica os autores fazem revisao de alguns problemas referentes a essas afeccoes, especialmente no que se refere as mioclonias que sao analisadas a luz dos conhecimentos anatomo-patologicos e eletrencefalograficos. Sob o ponto de vista anatomo-patologico e chamada a atencao para o carater dinâmico das lesoes, de forma que, num dado momento, surpreende-se um quadro histologico que pode estar em franca evolucao; isso explica a variedade dos achados anatomo-patologicos registrados na literatura, mas sempre com uma base anatomica comum, localizando-se as lesoes produtoras de mioclonias no circuito olivodentorrubrico (triângulo de Guil-lain e Mollaret). Os autores tentam explicar as mioclonias em geral, por lesao de um ou de varios pontos compreendidos nesse circuito, ressaltando a importância, provavelmente fundamental, da substância reticular do tronco cerebral. Na opiniao dos autores, os achados eletrencefalograficos concordam com os dados anatomo-patologicos, no que diz respeito a topografia das lesoes. Pelo estudo eletrencefalografico, durante injecao de substância curari-zante (cloreto de succinilcolina), com consequente supressao dos fenomenos musculares, os autores verificaram que essa substância altera a morfologia das descargas disritmicas e diminui seu numero. A diminuicao da frequencia das descargas e interpretada pelos autores como podendo resultar de um numero maior de estimulos dirigidos aos motoneuronios que ao cortex, partindo de estruturas subcorticais responsaveis pelas mioclonias; durante a acao do cloreto de succinilcolina seriam registrados apenas os estimulos corticais, mais raros. Outra possibilidade aventada pelos autores seria a acao anticonvulsionante do cloreto de succinilcolina, o que ainda nao foi demonstrado. Embora ambas as afeccoes, em certos casos, apresentem um quadro clinico muito semelhante, a histopatologia permite separa-las em entidades clinicas distintas.

Concentrações de cloro, sódio, potássio e fósforo no líquido cefalorraqueano durante crises convulsivas

Estudo do comportamento das concentracoes de cloro, sodio, potassio e fosforo inorgânico no LCR de 33 pacientes na vigencia de crises convulsivas e de 17 pacientes epilepticos na interfase de crises convulsivas. Os resultados obtidos foram estudados em comparacao aos valores normais anteriormente relatados. Nao foram encontradas modificacoes quanto as taxas de ions estudados no LCR dos pacientes epilepticos examinados no periodo intercritico. Foram verificadas alteracoes das taxas de ions estudados no LCR entre os pacientes estudados na vigencia de crise convulsiva. As alteracoes encontradas se caracterizavam por aumento das taxas de potassio e de fosforo inorgânico. Os aumentos encontrados foram estatisticamente significantes. A taxa de sodio no LCR dos pacientes cuja crise convulsiva nao se associava a outras manifestacoes de doenca se apresentava, em media, aumentada. Diminuicao das taxas medias de sodio e de cloro foi constatada entre os pacientes cuja crise convulsiva ocorreu durante reidratacao. Os resultados foram discutidos em relacao a dados da literatura quanto as modificacoes do metabolismo ionico envolvidas nos fenomenos de despo- larizacao de membrana, que ocorrem na crise convulsiva. Os aumentos verificados para as concentracoes de potassio e de fosforo inorgânico no LCR durante a crise convulsiva confirmam os dados quanto a passagem desses ions do espaco intracelular para o extracelular nessas condicoes, ja registrados atraves de estudos feitos no sangue e em amostras de cerebro de epilepticos.The concentrations of Cl, Na, K and inorganic P were determined in CSF samples of 50 patients with epilepsy. In 33 patients the sample studied was collected at the occasion of a convulsive seizure (group I). In 17 patients it was collected in the intermediate period between seizures (group II). The patients of group I were children. They were grouped according to conditions associated to the convulsive seizure. In 9, there were no other manifestation of disease (sub-group Ia). In 12, the seizure was associated to hyperthermy (sub-group lb) and in 12 it occurred during rehydration therapy (sub-group Ic). The results were compared statistically to those obtained for a series of 25 non epileptic patients taken as control (group III). The results obtained for the latter fall in the normal range and were reported previously. Results obtained for the patients of the group II did not differ from those found in the control group. The concentrations of K and inorganic P were found to be increased in group I. Their mean differ significantly of those found for control group. There occurred a positive correlation between the concentrations of K and P in group I. The value of the correlation was significant. The findings regarding to the concentration of Na show shiftings that were not uniform. Their mean value was elevated in the sub-group Ia, normal in the sub-group Ib and low in the sub-group Ic. The mean value of the Cl concentration was low in the sub-group Ic. It was normal in the other two sub-groups. Data concerning to the changes in the concentrations of K and inorganic P in the CSF during convulsive seizures were discussed. Bioelectric changes of the cellular membrane during seizures are reported in the literature. They induce the passage of these components through the cellular membrane to the extracellular space thus resulting the elevation of their concentration in this space. The results presented make it possible to evaluate the extension of such changes in the fluid of the extravascular space. The latter is represented in the case by the CSF. The exchange of intracellular K and inorganic P to the extracellular space is accompanied by exchange of Na in the opposite direction. The Na concentration is referred to elevated in the intracellular space in these circumstances. The results reported suggest that Na is not provided by CSF only, for this exchange. Other compartments of the extracellular space and/or of the intracellular space may be more directly involved. This is suggested because the concentrations of Na in the CSF did not show uniform changes in the three sub-groups of patients with seizures that were considered. General changes in the extracellular fluid composition might explain the differences in the concentration of Na which were reported. The concentrations of Na and Cl found in the CSF of patients with convulsion during rehydration therapy are elucidative in this way. They were found to be low, suggesting an excess in the water uptake.

Valor da gamaencefalometria no diagnóstico das epilepsias

The authors study the results of gammaencephalometry in 42 epilepctics over 10 years of age, without focal neurological signs or intracranial hypertension. The importance of this examination in epilepsy is emphasized, because it detects non-tumoral structural alterations. The existence of 33% of gammaencephalometric anormalities in cases with a normal EEG suggests the possibility of using gammaencephalometry in the differential diagnosis between epilepsy and neurosis. Nevertheless, in order to reach a more definite conclusion, it is necessary to study a larger number of cases, inclusively using roentgenography with a contrast medium. Anyway, owing to its hamlessness and feasibility, the authors think that gammaencephalometry is indicated in all cases of epilepsy that require full data.

O eletrencefalograma nas hemorragias uterinas disfuncionais: ação dos estrogênios por via intravenosa

In 10 patients with functional uterine bleeding, the existence of epileptic manifestations (clinical and electroencephalographic) was investigated: 7 among the 10 cases had a previous history and/or symptoms of a nature that was probably Or certainly epileptic; the electroencephalogram showed abnormalities in 5 cases. The action of intravenous Premarin (20 mg) was studied during electroencephalogram recording. There was no change in the normal electroencephalogram and in the patological ones there was not an increase of the abnormalities.