ABSTRACT
Introducción. Establecer las diferencias neurocognitivas entre las epilepsias pediátricas parciales del lóbulo frontal y del temporal. Métodos. En una investigación clínica de tipo transversal, descriptiva y prolectiva, se analizaron pacientes pediátricos con epilepsia parcial entre los 6 y 12 años de edad, de ambos sexos, en el Departamento de Neurología del Hospital Infantil de México Federico Gómez. Posterior a dividir a los pacientes en epilepsias parciales del lóbulo frontal y temporal, se aplicaron pruebas neurocognitivas, evaluación del cociente intelectual (CI), atención, memoria de trabajo, funciones ejecutivas y ejecución visuoespacial. Además, se evaluaron con resultados de electroencefalograma, neuroimagen y examen físico. Resultados. Se evaluaron 37 pacientes de ambos sexos (22 hombres, 15 mujeres) con epilepsia parcial del lóbulo frontal (17) y del lóbulo temporal (20). Las principales diferencias cognitivas entre estos dos tipos de epilepsia fueron: CI (promedio 82 en las epilepsias frontales y 97 en las epilepsias temporales) con mayor impacto en la memoria de trabajo y la ejecución vi-suoespacial en pequeños con epilepsia frontal. Los pacientes con epilepsia del lóbulo temporal presentaron mayores problemas en la atención de ejecución y de los test de memoria. Conclusiones. Los pacientes con epilepsia parcial del lóbulo frontal tienen mayor impacto sobre las habilidades neurocognitivas. Se considera muy importante esta evaluación con el fin de iniciar un soporte temprano con abordajes terapéuticos en este grupo de epilepsias, intentando revertir el impacto de crisis sobre las capacidades sociales y académicas.
Introduction. Objective: The purpose of this clinical trial was to differentiate the neurocognitive performance between frontal and temporal seizures in pediatric epilepsy. This is an important issue related to measure the impact of the different type of seizures in the neurodevelopment of children with epilepsy. Methods. We analyzed patients with partial epilepsy between 6 and 12 years old, both genders, in the Neurology Department of the Hospital Infantil de Mexico. After classifying frontal and temporal epilepsies, neurocognitive, IQ, attention, working memory, executive functions and visuospatial performance tests were applied. Likewise, EEG, neuroimaging, social evaluation and physical examination were performed. Results. Thirty-seven patients both genders (22 males; 15 females) with frontal partial seizures (17) and temporal partial seizures (20) were evaluated. The main neurocognitive differences between these 2 types of epilepsy were IQ (mean 82 in frontal epilepsy and 97 in temporal epilepsy) a higher impact on working memory and visuospatial performance was observed in infants with frontal epilepsy. The patients with temporal epilepsy had more problems in executing attention and long memory tests. Conclusion. Frontal partial seizures had more impact on the neurocognitive abilities than temporal partial seizures in the studied patients. This observation should be taken into account for the early treatment of children with epilepsy.
ABSTRACT
BACKGROUND AND OBJECTIVES: Temporal lobe epilepsy is the most common uncontrolled epileptic condition and is increasingly treated with surgery. In the absence of definitive results from noninvasive procedures, patients undergo implantation of intracranial electrodes. Intracranial EEG recordings are more accurate than scalp EEG recordings because of minimal artifact and closer approximation to the area of seizure onset. Intracranial EEG patterns between the medial and the lateral temporal lobe epilepsy were thought to have a little differences. METHODS: The authors compared the morphological pattern of seizure onset area, spread pattern, termination pattern and duration of the intracranial EEG manifestation of spontaneous seizures recorded from combined depth and subdural electrodes in 25 intractable temporal lobe epilepsy patients. RESULTS: Sixteen cases were medial temporal onset, six cases were neocortical onset and three cases were multifocal onset. The morphological onset pattern of medial temporal seizures was more likely to have high frequency rhythmic discharge (>13 Hz) and tended to show repetitive spikes prior to the seizure, whereas neocortical seizures were characterized by slow (4-to 10-Hz) and fast frequencies (>35 Hz), without evidence of repetitive spikes. The mean ictal duration at seizure onset of complex partial seizure of medial onset seizure was 121 seconds and was not different from those of neocortical seizures which were 115 seconds. Neocortical seizures take more time to propagate than medial seizures. Propagation to the opposite side of neocortical onset seizure takes 45.53 seconds, whereas medial temporal onset seizure takes 27.92 seconds. In case of second generalization, neocortical seizures continued longer than medial seizures. Of the medial onset temporal lobe seizures, except the simple partial seizures, the 35.2% of seizures initially spread to ipsilateral neocortex, and the 28.2% of seizures initially spread to the contralateral medial temporal lobe and the 25% of seizures simultaneously propagated to the ipsilateral neocortex and contralateral medial temporal lobe. Among the seizures initiated from the neocortex, 79.3% of seizures initially spread to the ipsilateral medial temporal area, but never initially spread to opposite neocortex. The termination pattern of seizures was divided into three types according to their location. In case of medial temporal lobe seizures, the mean of 31% of seizures was diffusely terminated , 38% of seizures terminated at the onset region and 38% of seizures were elsewhere within onset region. On the other hand, 48.6% of neocortical temporal lobe seizure were terminated at seizure onset region. CONCLUSIONS: The pattern of ictal intracranial EEG provides distinguishable differences between the medial temporal seizure and the neocortical temporal seizure.