ABSTRACT
Developmental malformations are brain abnormalities that occur during embryogenesis. Neuronalmigration disorders, including heterotopic lesions, constitute one type of such abnormalities. Theaim of the study was to compare the epileptic clinical patterns of patients with periventricular nodular heterotopia(PNH) (G1) with those affected by subcortical heterotopia (SCH) (G2) looking for differences between bothgroups which, eventually, might suggest the type of the underlying malformation. The variables studied in bothgroups were: type of the heterotopia depicted on MRI studies, sex, age, age at seizure onset, annual seizure frequency,localization of the ictal symptomatogenic zone, characteristics of the EEG, other associated anomalies onthe magnetic resonance images (MRI) besides the heterotopia, and response to treatment. The only differencefound between both groups was the type of heterotopia as shown by MRI studies. The other assessed variablesdid not significantly (p>0.05) differ between groups. No differences in the clinical features characterizing epilepsycould be found in patients with PNH or SCH, being the images the only tool able to differentiate them.
Heterotopía neuronal nodular y subcortical en pacientes adultos con epilepsia. Las malformacionesde la corteza cerebral son un grupo de entidades que se producen durante las etapasdel desarrollo embrionario y cuya manifestación clínica puede ser la epilepsia. Estas malformaciones puedenser diagnosticadas in vivo a través de las imágenes por resonancia magnética (IRM). Un subtipo particular deéstas lo constituyen los trastornos en la migración neuronal, dentro de los cuales se ubican las heterotopías(HT). El objetivo del estudio fue comparar enfermos portadores de HT periventriculares (G1) con aquellos portadoresde HT subcorticales (G2). Se analizaron las variables sexo, edad y edad de inicio de la epilepsia (EI) enaños, antecedentes familiares (AF) o prenatales (AP), frecuencia anual de crisis (FAC) y característicassemiológicas de las crisis, hallazgos en el EEG e IRM y respuesta al tratamiento farmacológico. G1 (n=13): 8mujeres (61.5%), edad promedio 32.9 ± 11.5 (rango 20-59), EI 13.7 ± 7.6 (rango 2-23), AF 1 caso (7.7%), AP en1 (7.7%), FAC 28.3 ± 31.4 (rango 0-120), crisis multifocales en 5 (38.5%), crisis temporales en 5 pacientes (38.5%),EEG epileptiforme (EEGE) en 7 casos (53.8%), anomalías asociadas en las IRM (AAIRM) en 8 sujetos (61.5%) y4 casos refractarios al tratamiento (30.7%). G2 (n=8): 6 mujeres (75%), edad promedio 30 ± 9.7 (rango 13-43), EI11.1 ± 6.3 (rango 1-19), AP 2 (25%), FAC 30 ± 39.5 (rango 0-120), crisis multifocales en 4 sujetos (50%), crisistemporales en 5 pacientes (62.5%), EEGE en 7 casos (87.5%), AAIRM en 3 casos (37.5%) y 1 caso refractario altratamiento (12.5%). El análisis de las diferentes variables clínicas analizadas no mostró diferencias significativasentre ambos grupos, siendo las imágenes el único elemento que permitió su diferenciación.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Cerebral Cortex/abnormalities , Choristoma/pathology , Epilepsy/diagnosis , Neurons , Analysis of Variance , Cerebral Cortex/pathology , Electroencephalography , Epilepsy/etiology , Magnetic Resonance Imaging , Neurons/metabolism , Neurons/pathology , Retrospective Studies , Sex Distribution , Seizures/diagnosisABSTRACT
Magnetic Resonance Imaging (MRI) is the method of choice to search for epileptogenic lesions. We correlated MRI findings with the epileptogenic zone (EZ) depicted by clinical and electroencephalographic (EEG) data. We studied 400 clinical records of patients who had been submitted to MRI studies and we analyzed, retrospectively, their ictal semiology, EEG characteristics and response to treatment. They were classified into 3 groups: A) temporal lobe epilepsy, B) frontal lobe epilepsy and C) parieto-occipital epilepsy. We included 155 patients: Group A) 68 cases (43.9 per cent), 28 men (41.1 per cent), mean age 32 +/- 11 years old, abnormal IMR in 44 (64.7 per cent), refractory to treatment 48 (70.5 per cent). Group B) 68 cases (43.9 per cent), 38 men (55.8 per cent), mean age 30 +/- 15 years old, abnormal IMR in 26 (38.2 per cent), refractory to treatment 30 (44.1 per cent). Group C) 19 cases (12.2 per cent), 13 men (68.4 per cent), mean age 27 +/- 11 years old, abnormal IMR in 11 (57.8 per cent), refractory to treatment 12 (63.1 per cent). Results showed that there were higher possibilities of detecting lesions which correlate with EZ in temporal than in frontal or parieto-occipital lobes epilepsy. The chances to find abnormalities on the MRI were 5 times higher in refractory patients than in those who were non-refractory.