ABSTRACT
Epilepsy is a disease with serious consequences for patients and society. In many cases seizures are sufficiently disabling to justify surgical evaluation. In this context, Magnetic Resonance Imaging (MRI) is one of the most valuable tools for the preoperative localization of epileptogenic foci. Because these lesions show a large variety of presentations (including subtle imaging characteristics), their analysis requires careful and systematic interpretation of MRI data. Several studies have shown that 3 Tesla (T) MRI provides a better image quality than 1.5 T MRI regarding the detection and characterization of structural lesions, indicating that high-field-strength imaging should be considered for patients with intractable epilepsy who might benefit from surgery. Likewise, advanced MRI postprocessing and quantitative analysis techniques such as thickness and volume measurements of cortical gray matter have emerged and in the near future, these techniques will routinely enable more precise evaluations of such patients. Finally, the familiarity with radiologic findings of the potential epileptogenic substrates in association with combined use of higher field strengths (3 T, 7 T, and greater) and new quantitative analytical post-processing techniques will lead to improvements regarding the clinical imaging of these patients. We present a pictorial review of the major pathologies related to partial epilepsy, highlighting the key findings of 3 T MRI.
Subject(s)
Humans , Epilepsies, Partial/diagnosis , Magnetic Resonance Imaging/methods , Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Central Nervous System Vascular Malformations/diagnosis , Central Nervous System Vascular Malformations/pathology , Epilepsies, Partial/pathology , Gliosis/diagnosis , Gliosis/pathology , Malformations of Cortical Development/diagnosis , Malformations of Cortical Development/pathology , Sclerosis , Tuberous Sclerosis/diagnosis , Tuberous Sclerosis/pathologyABSTRACT
Objective To analyze the agreement rate of proton magnetic spectroscopy with magnetic resonance image (MRI) and surface electroence-phalography (EEG) in extratemporal neocortical epilepsies. Methods A cross-sectional study, type series of cases included 33 patients, age range 13–59 years old, of both gender, presenting structural alteration identified by MRI (75.8%) or by neurophysiologic techniques (72.7%). The variables were alterations of N-acetyl-aspartate/choline, N-acetyl-aspartate/creatine, choline/creatine, and N-acetyl-aspartate/cho-line+creatine coefficient of asymmetry. Results Agreement rates of lateralization by coefficient of asymmetry of NAA/Cho, NAA/Cr, Co/Cr, and NAA/Cho+Cr with MRI, independent of alteration of surface EEG, were equal to 93.3, 57.9, 15.4, and 93.3%, respectively, modifying to 100, 33.3, 0, and 100%, in 16 patients, with lateralization agreement of MRI and surface EEG. Conclusion Proton magnetic spectroscopy agreed better with MRI to lateralization of epileptogenic zone than with surface EEG. .
Objetivo Analisar a taxa de concordância da espectroscopia de prótons de hidrogênio com imagem de ressonância magnética (IRM) e o eletrencefalograma (EEG) de superfície nas epilepsias neocorticais extratemporais. Métodos Estudo transversal, série de casos, incluiu 33 pacientes, com idade de 13 a 59 anos, de ambos os gêneros, apresentando alteração estrutural à IRM (75,8%) ou neurofisiológica à (72,7%). As variáveis estudadas foram as alterações dos coeficientes de assimetria de N-acetil-aspartato/colina, N-acetil-aspartato/crea-tina, Colina/Creatina e N-acetil-aspartato/colina+creatina. Resultados As taxas de concordância de lateralização dos coeficientes de assimetria de NAA/Co, NAA/Cr, Co/Cr e NAA/Co+Cr com a IRM, independentemente de alterações do EGG de superfície, passaram de 93,3, 57,9, 15,4, 93,3%, respectivamente, para 100, 33,3, zero, 100%, em 16 pacientes, mostrando concordância de lateralização entre IRM e EEG de superfície. Conclusão A espectroscopia de prótons de hidrogênio concordou melhor com a lateralização da zona epileptogênica pela IRM do que com o EEG de superfície. .
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Electroencephalography/methods , Epilepsies, Partial/pathology , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy , Aspartic Acid/analysis , Aspartic Acid/analogs & derivatives , Brain Chemistry , Cross-Sectional Studies , Choline/analysis , Creatine/analysis , Epilepsies, Partial/physiopathology , Functional LateralityABSTRACT
PURPOSE: We investigated the localizing and lateralizing values of auras in patients with lesional partial epilepsy on an outpatient basis. MATERIALS AND METHODS: A total of 276 subjects were retrospectively selected for this study if they had a unilateral single lobar lesion based on magnetic resonance image (MRI) results, and their scalp electroencephalography (EEG) findings were not discordant with the MRI-defined lobar localization and lateralization. According to the lesion locations, subjects were considered as having mesial temporal (MTLE), lateral temporal (LTLE), frontal (FLE), parietal (PLE), or occipital (OLE) lobe epilepsies. Auras were classified into 13 categories. RESULTS: A hundred and seventy-six subjects (63.8%) had experienced at least one aura. FLE subjects had the fewest number of auras. Epigastric and psychic auras were frequent among MTLE subjects, while visual auras were common in those with PLE and OLE. Somatosensory auras and whole body sensations were more frequent in the subjects with PLE than those without. Autonomic auras were more common in MTLE subjects than in LTLE subjects. Dysphasic auras were more frequently found in left-sided epilepsies. Five pairs of aura categories showed concurrent tendencies, which were the epigastric and autonomic auras, autonomic and emotional auras, visual and vestibular auras, auditory and vestibular auras, and whole-body sensation and auditory auras. Autonomic and emotional auras had a concurrent tendency in left-sided epilepsies, but not in right-sided epilepsies. CONCLUSION: Our results support the previously known localizing value of auras, and suggest that dysphasic auras and the association of emotional and autonomic auras may have a lateralizing value.
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Epilepsies, Partial/pathology , Epilepsy/pathology , Magnetic Resonance Imaging , Retrospective StudiesABSTRACT
This study was performed to assess the usefulness of magnetoencephalography (MEG) as a presurgical evaluation modality in Korean pediatric patients with lesional localization-related epilepsy. The medical records and MEG findings of 13 pediatric patients (6 boys and 7 girls) with localization-related epilepsy, who underwent epilepsy surgery at Seoul National University Children's Hospital, were retrospectively reviewed. The hemispheric concordance rate was 100% (13/13 patients). The lobar or regional concordance rate was 77% (10/13 patients). In most cases, the MEG spike sources were clustered in the proximity of the lesion, either at one side of the margin (nine patients) or around the lesion (one patient); clustered spike sources were distant from the lesion in one patient. Among the patients with clustered spike sources near the lesion, further extensions (three patients) and distal scatters (three patients) were also observed. MEG spike sources were well lateralized and localized even in two patients without focal epileptiform discharges in the interictal scalp electroencephalography. Ten patients (77%) achieved Engel class I postsurgical seizure outcome. It is suggested that MEG is a safe and useful presurgical evaluation modality in pediatric patients with lesion localization-related epilepsy.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Brain/diagnostic imaging , Brain Diseases/pathology , Epilepsies, Partial/pathology , Ganglioglioma/pathology , Magnetic Resonance Imaging , Magnetoencephalography , Malformations of Cortical Development/pathology , Neoplasms, Neuroepithelial/pathology , Positron-Emission Tomography , Retrospective Studies , Seizures/diagnosisABSTRACT
El objetivo del presente trabajo fue caracterizar un grupo de pacientes con epilepsias focales, según aspectos clínicos y electroencefalográficos. Se realizó un estudio descriptivo y prospectivo de 185 niños con diagnóstico de epilepsia focal (2 o más crisis epilépticas no provocadas), con edades entre un mes y 14 años, que fueron hospitalizados en el Departamento de Neuropediatría del Hospital William Soler entre diciembre de 2001 y diciembre de 2003. La edad media de inicio de la primera crisis epiléptica fue de 5 años. El tipo de crisis epiléptica focal más frecuente fue la simple (49,2 por ciento). El 48,6 por ciento de los niños presentó etiología idiopática y el 33,0 por ciento sintomática. Los factores de la etiología sintomática más frecuentes fueron los prenatales (56,2 por ciento). El 91,4 por ciento de los pacientes presentó electroencefalogramas iniciales interictales anormales. El electroencefalograma focal se observó en el 37,3 por ciento de los niños y el multifocal en el 24,9 por ciento. El síndrome epiléptico más frecuente fue la epilepsia benigna con puntas centrotemporales (5,9 por ciento). Los niños con epilepsia focal tienen variadas manifestaciones clínicas y electroencefalográficas, y en la mayoría de los pacientes no es posible identificar un síndrome epiléptico.
The aim of present paper was to characterize a group of patients presenting with focal epilepsies by clinical and electroencephalographic features. Authors made a descriptive and cross-sectional study in 185 children diagnosed with focal epilepsy (two or more non-provoked epilepsy crises), aged from one month to 14, admitted in Neurology Department of William Soler Children Hospital between December 2001 to December 2003. Mean age of the first epilepsy crisis was at 5 years. The more frequent type of focal epilepsy crisis was the simple one (49, 2 percent). The 48, 6 percent of children presented with a idiopathic origin, and the 33, 0 percent if symptomatic one. The more frequent factors of symptomatic origin were the prenatal ones (56, 2 percent). The 91, 4 percent of patients had abnormal interictal initial electroencephalograms. The focal electroencephalogram was observed in the 37, 3 percent of children, and the multifocal one in the 24, 9 percent. The more frequent epileptic syndrome was the benign epilepsy with central-temporal waves (5, 9 percent). Children presenting with epilepsy have many clinical and electroencephalographic manifestations and in most of patients it is not possible to identify an epilepsy syndrome.
Subject(s)
Humans , Male , Adolescent , Female , Infant, Newborn , Infant , Child, Preschool , Child , Electroencephalography/methods , Epilepsies, Partial/epidemiology , Epilepsies, Partial/pathology , Epidemiology, Descriptive , Prospective StudiesABSTRACT
Fazemos uma análise das alterações neuropatológicas encontradas em 300 casos consecutivos de cirurgia da epilepsia realizadas durante período de 6 anos. O material foi predominantemente de lobo temporal (70,33 por cento), sendo a esclerose hipocampal o diagnóstico mais frequente (44 por cento), seguido das neoplasias (15 por cento) e dos distúrbios da migração neuronal (10 por cento). Os tumores mais frequentes foram o ganglioglioma (42,22 por cento) e tumor neuroepitelial disembrioplástico (20 por cento). Segue revisão dos diagnósticos mais comuns em epilepsia baseados nessa série e relatados na literatura.
Subject(s)
Humans , Epilepsies, Partial/pathology , Cerebral Cortex/pathology , Epilepsies, Partial/surgery , Hippocampus/pathology , SclerosisABSTRACT
Há controvérsias sobre a existência de uma epilepsia parcial benigna parietal distinta de epilepsia com pontas rolândicas. Estudamos 164 crianças com epilepsia e focos restritos às regiöes centrais, temporais médias e parietais, sendo excluídas as que apresentavam elementos indicativos de lesäo cerebral. Foram analisados a idade dos pacientes, a idade do início, o tipo e o número das crises, antecedentes familiares para epilepsia e a reatividade à percussäo dos pés e mäos ao EEG. As pontas foram de localizaçäo central e/ou temporal média (PCT) em 111 casos (temporal média em 56, centrotemporal em 29, central em 26) e parietal (PP) em 53 casos. A idade dos pacientes e idade de início das crises predominaram na faixa até 6 anos de idade no grupo com PP e acima dos 6 anos no grupo com PCT. As crises orofaríngeas e motoras da face corresponderam a 44,1 por cento das crianças com PCT e, apenas, a 16,9 por cento daquelas com PP. Pontas evocadas por estímulos somatossensoriais, ao EEG, foram registradas em proporçäo mais elevada de casos com PP (39,5 por cento) do que no grupo com PCT (3,5 por cento). Nossos achados mostram que epilepsia, na ausência de sianis lesionais, em crianças com PP, é relativamente frequente e tanto a idade dos pacientes, idade de início e perfil das crises, quanto a reatividade do EEG à percussäo de pés e mäos, mostram diferenças significativas em relaçäo ao observado nas crianças com PCT