Epileptogénesis y corteza piriforme: entendiendo a la epilepsia del lóbulo temporal más allá del hipocampo / Epileptogenesis and the piriform cortex: understanding temporal lobe epilepsy beyond the hippocampus

Introducción: Con la experiencia de los registros electroencefalográficos invasivos y el fracaso quirúrgico después de la cirugía, se ha hecho evidente que la epilepsia del lóbulo temporal es mucho más compleja de lo que se creía, y en la actualidad es considerada una enfermedad de redes anatomofuncionales y no de lesiones estructurales. Contenido: La información neurofisiológica e imagenológica actual permite concluir que en esta epilepsia están involucradas varias redes neuronales temporales y extratemporales que contribuyen a la extensión de la zona epileptógena. Una forma de entender el concepto de red epiléptica en la epilepsia del lóbulo temporal es a partir del conocimiento de la corteza piriforme. Varios estudios clínicos han mostrado que en pacientes con epilepsia del lóbulo temporal asociada a esclerosis hipocampal existe una disfunción interictal del procesamiento olfatorio que es más significativa, en comparación con pacientes con epilepsia focal extrahipocampal y controles sanos. Esta alteración es, probablemente, la consecuencia de una red neuronal disfuncional que se extiende más allá del hipocampo y que afecta a otras estructuras cercanas, incluida la corteza piriforme. Conclusión: En este artículo llevamos a cabo una revisión narrativa de la literatura con el objetivo de establecer un vínculo entre la corteza piriforme y la epileptogénesis del lóbulo temporal, y demostramos que esta enfermedad es la consecuencia de una disfunción de redes neuronales que no depende exclusivamente de una anormalidad estructural en el hipocampo o en estructuras cercanas.

Introduction: With the experience of invasive EEG recordings and surgical failure after surgery, it has become clear that temporal lobe epilepsy is much more complex than previously thought, and currently, is conceptualized as a disease of anatomical networks instead of structural lesions. Content: The current neurophysiological and imaging information allows us to conclude that several temporal and extratemporal anatomical networks are involved in this type of epilepsy. One way of understanding the concept of the epileptic network in temporal lobe epilepsy is from the knowledge of the piriform cortex. Several clinical studies have shown that in patients with temporal lobe epilepsy associated with hippocampal sclerosis exists an interictal dysfunction of olfactory processing that is more significant compared to patients with focal extra-hippocampal epilepsy and healthy controls. This alteration is probably the consequence of a dysfunctional neural network that extends beyond the hippocampus and affects other nearby structures, including the piriform cortex. Conclusion: In this article, we carry out a narrative review of the literature with the aim of establishing a link between the piriform cortex and temporal lobe epileptogenesis, demonstrating that this disease is the consequence of a dysfunctional network that does not depend exclusively of a hippocampal structural abnormality.

Riesgo neuropsicológico en epilepsia del lóbulo temporal / Neuropsychological risk in temporal lobe epilepsy

Introducción: Los síntomas neuropsicológicos son una preocupación importante para los pacientes con epilepsia y pueden llegar a ser muy influyentes en la percepción de calidad de vida. En el caso de la epilepsia del lóbulo temporal, existen muchas variables que influyen en el desempeño cognitivo de los pacientes, entre las más importantes se encuentran la etiología, la edad de inicio, la duración de la enfermedad y la frecuencia de crisis; sin embargo, una de las variables más importantes es la lateralidad de la epilepsia. Está claramente demostrado que los síntomas cognitivos de la epilepsia del lóbulo temporal varían en función del hemisferio cerebral afectado. Contenido: La epilepsia del lóbulo temporal es una de las principales epilepsias focales que es susceptible de manejo quirúrgico, y, en este sentido, el tipo de procedimiento también tiene una gran importancia en el desenlace cognitivo de estos pacientes. En este artículo, realizamos una revisión narrativa de la literatura, con el objetivo de describir el riesgo neuropsicológico relacionado no solamente con la epilepsia del lóbulo temporal per se, sino también con las intervenciones quirúrgicas que se realizan en pacientes refractarios a la medicación. Conclusiones: Es importante conocer los conceptos sobre las implicaciones del impacto cognitivo en los pacientes con epilepsia del lóbulo temporal antes de tomar decisiones quirúrgicas en pacientes refractarios, así como entender que el tipo de cirugía también influye en su desempeño cognitivo. Se debe buscar un equilibrio entre la libertad de crisis y las posibles secuelas neuropsicológicas posquirúrgicas.

Introduction: Neuropsychological symptoms are a major concern for patients with epilepsy and can highly influence the perception of quality of life. In the case of temporal lobe epilepsy, there are many variables that impact the cognitive performance of these people, among the most important are the etiology, the age of onset, the duration of the disease and the frequency of seizures, however, one of the most important variables is the lateralization of the seizure. It has been demonstrated that the cognitive symptoms of temporal lobe epilepsy vary depending on the affected cerebral hemisphere. Contents of the review: Temporal lobe epilepsy is one of the main focal epilepsies that is susceptible to surgical management, and the type of surgery also has great importance in the cognitive outcomes of these patients. In this article, we carry out a narrative review of the literature in order to describe the neuropsychological risk related not only to temporal lobe epilepsy per se, but also to surgical interventions performed in drug-resistant patients. Conclusions: It is important to know the concepts about the implications of cognitive impact in patients with temporal lobe epilepsy before making surgical decisions in refractory patients and to understand that the type of surgery also influences the cognitive performance of these patients. A balance must be sought between the freedom of seizures and the possible postoperative neuropsychological sequelae.

Rehabilitación neuropsicológica en pacientes pre y posquirúrgicos de lobectomía temporal por epilepsia fármaco resistente / Neuropsychological rehabilitation in pre- and post-surgical temporal lobectomy patients for drug-resistant epilepsy

Introducción. La epilepsia del lóbulo temporal suele producir déficits mnésicos, atencionales y del lenguaje. En la mayoría de los casos, se trata con fármacos an-tiepilépticos, pero falla en un tercio de ellos. Por tal razón, una opción terapéutica es la lobectomía temporal, que contribuye a menguar las crisis. Sin embargo, los procedimientos quirúrgicos pueden conllevar secuelas, entre ellas consecuencias a nivel cognitivo. Para contrarrestar dichos efectos, se acostumbra llevar a cabo una rehabilitación neuropsicológica que va en pro de recuperar, fortalecer y sostener en el tiempo habilidades que ya venían afectándose desde antes de la cirugía. Objetivo. Brindar una reflexión en torno a la intervención neuropsicológica de la epilepsia en el lóbulo temporal. Método. La reflexión sobre el tema parte de un interés clínico y posteriormente se fue ampliando a partir de la revisión de la literatura en diferentes bases de datos como PubMed, Medline y Scopus entre los años 2000 y 2021. Reflexión. Son amplias las opciones terapéuticas a nivel neuropsicológico y pueden contribuir de manera positiva en la recuperación del paciente, por lo cual los profe-sionales requieren conocer las posibilidades de ello para poder utilizar las estrategias más adecuadas según cada caso y brindar opciones que beneficien la calidad de vida, teniendo en cuenta que ninguna es más efectiva que otra. Conclusión. Como resultado, se presenta un panorama general de la rehabilitación neuropsicológica en pacientes pre y posquirúrgicos con lobectomía, haciendo énfasis en la rehabilitación neuropsicológica tradicional y la rehabilitación basada en inteli-gencia artificial, realidad virtual y computación

Introduction. Temporal lobe epilepsy usually produces mnestic, attentional, and language deficits. In most cases, it is treated with antiepileptic drugs, but one third of them fail, so one therapeutic option is temporal lobectomy, which helps to reduce seizures. However, surgical procedures can have sequelae, including cognitive con-sequences. To counteract these effects, neuropsychological rehabilitation is usually carried out in order to recover, strengthen, and sustain in time skills that were already affected before the surgery. Objective. To provide a reflection on the neuropsychological intervention of tem-poral lobe epilepsy. Method. The reflection on the subject starts from a clinical interest and was sub-sequently expanded from the review of the literature in different databases such as PubMed, Medline, and Scopus between 2000 and 2021. Reflection. There are many therapeutic options at the neuropsychological level and they can contribute positively to the patient's recovery, so professionals need to know the possibilities in order to use the most appropriate strategies according to each case and provide options that benefit the quality of life, taking into account that none is more effective than the other one.Conclusion. As a result, an overview of neuropsychological rehabilitation in pre- and post-surgical patients with lobectomy is presented, with emphasis on traditional neuropsychological rehabilitation and rehabilitation based on artificial intelligence, virtual reality, and computation

Pleomorphic Xanthoastrocytoma with Oligodendroglioma-Like Areas with Negative 1p19q Co-Deletion

The most common mixed glioma encountered in routine surgical practice is oligoastrocytoma (OA); however, its is currently considered a vanishing entity. The 2016 classification of the World Health Organization (WHO) discourages the diagnosis of tumors as mixed glioma. The recommendations are that diffuse gliomas, including those withmixed or ambiguous histological features, should be subjected tomolecular testing. Dual-genotype OAs are not yet a distinct entity or variant in the classification. We report a case ofmixed glioma: a pleomorphic xanthoastrocytoma (PXA)mixed with an oligodendroglioma. The immunohistochemistry (IHC) pattern of isocitrate dehydrogenase 1 (IDH1) negativity with retained nuclear expression of the alpha-thalassemia x-linked intellectual disability syndrome (ATRX) protein, and 1p19q co-deletion negativity in both the components enabled its identification as a mixed glioma rather than a collision tumor. To the best of our knowledge, the case herein presented is the fourth case of PXA with oligodendroglioma. Out of the other three reported cases, only one was of a collision tumor with a dual genotype, and the other two showed similar molecular signatures in both components. The present article discusses the histological, immunohistochemical and molecular features of the aforementioned case.

Schwannoma intraparenquimatoso con calcificación focal en lóbulo temporal. Reporte de caso y revisión de literatura / Intraparenchymal schwannoma with focal calcification in the temporal lobe. Case report and literature review

Los schwannomas intraparenquimatosos son tumores con una muy baja incidencia en el sistema nervioso central. Actualmente, no se conoce su verdadero origen. Sin embargo, con el paso de los años se han descripto múltiples teorías. Son tumores que afectan principalmente a niños y adultos jóvenes. El síntoma principal es la cefalea; y se ubican principalmente en el compartimiento supratentorial. El Gold Standard para su estudio es la resonancia magnética donde suelen presentarse como lesiones hipointensas en T1, hiperintensas en T2 que captan contraste de forma homogénea. Una vez diagnosticado debe plantearse la resolución quirúrgica ya que en la mayoría de los casos representan una lesión benigna, y su exéresis completa significa la resolución de la enfermedad. El diagnóstico definitivo se obtiene mediante la anatomía patológica. A continuación, presentaremos el caso de una paciente de 46 años con antecedente de cefalea en cuyo contexto, mediante una resonancia magnética, se descubre una lesión en el lóbulo temporal siendo el diagnóstico de la misma: schwannoma intraparenquimatoso con calcificación focal

Intraparenchymal schwannomas have a very low incidence in the central nervous system. Currently, its true origin is not known, however, over the years, multiple theories have been described. This pathology mainly affects children and young adults. The main symptom is headache; and usually it is located in the supratentorial compartment. The Gold Standard is MRI where they usually present as hypointense lesions in T1, hyperintense in T2 that capture contrast in a homogeneous way. Once diagnosed, surgical resolution should be considered, since in most cases they represent a benign lesion, and their complete excision means resolution of the disease. The definitive diagnosis is obtained by pathological anatomy. We present a case of a 46-year-old patient with history of headache, its magnetic resonance revealed an extra axial lesion in the temporal lobe with considerable surrounding edema, the diagnosis was Intraparenchymal schwannoma with focal calcification in the temporal lobe

Reconstruction of complex tissue defects in temporal region: report of 3 cases / 中华耳鼻咽喉头颈外科杂志

Objective: To discuss the techniques and repairing methods of various degree of compound tissue defects in the auriculotemporal region. Methods: Retrospective analysis was conducted on three cases of different repairing methods for huge compound tissue defects in different degrees in the auriculotemporal region after the resection of the malignant tumor or sinus tract due to repeated infection in our hospital. Results: Following total removal of the tumors or sinus tract in all patients, we applied retroauricular lingual flap transfer repairing, latissimus dorsi flap free transfer repairing and vascular anastomosis, scalp tissue expansion in stage Ⅰ, then repairing the lesion with expanded scalp and filling the huge mastoid cavity with abdominal fat in stage Ⅱ, respectively, according to the characteristics of compound tissue defects in the auriculotemporal region. All free flaps survived well. Conclusions: The anatomy of the auricular-temporal area is complex and involves important vascular and neural structures of head and neck and lateral skull base. The huge composite tissue defect following auriculotemporal region surgery, which is composed of skin, muscle and bone tissue, needs to be repaired in one stage. Therefore, flexible repairing methods should be chosen based on different situations, for attaining the goal of completely removing tumor and lesions, and then, covering the operation cavity.

Temporal processing skills in people who stutter / Habilidades do processamento temporal em pessoas que gaguejam

ABSTRACT Purpose: to investigate the auditory skills of temporal resolution and ordering in people who stutter. Methods: an observational, cross-sectional, analytical, and comparative research between study and control groups conducted at a speech-language-hearing teaching clinic of an academic institution, comprising people who stutter (who attended a public outreach program) and volunteers without communicative disorders, for 13 months. The procedures used were auditory perception anamnesis, acoustic immittance, and pure-tone and speech audiometry to discharge hearing changes. The participants who met the eligibility criteria had their resolution and ordering skills assessed with the Gaps-in-Noise, Random Gap Detection, Pitch Pattern Sequence, and Duration Pattern Sequence tests and the data obtained were entered into a spreadsheet for descriptive and inferential statistical analyses. Results: the study group presented changes in temporal resolution and ordering. A statistically significant difference was also verified comparing the assessment findings of the study and control groups, in all the assessment tests. Conclusion: temporal resolution and ordering changes were observed in the people presented with stuttering, regardless of sex or chronological age.

RESUMO Objetivo: investigar as habilidades auditivas de resolução e ordenação temporal em pessoas que gaguejam. Métodos: estudo observacional transversal analítico e comparativo entre o grupo estudo e o controle. Realizado numa Clínica-Escola de Fonoaudiologia de uma instituição de ensino com pessoas que gaguejam atendidos em projeto de extensão universitária, bem como por voluntários sem distúrbio de comunicação, no período de 13 meses. Os procedimentos realizados foram anamnese de percepção auditiva, imitanciometria, audiometria tonal e vocal para descartar alteração na audição. Para os participantes que atenderam aos critérios de elegibilidade, realizou-se a avaliação das habilidades de resolução e ordenação com os seguintes testes: Gaps in Noise; Random Gap Detection Test; Pitch Pattern Sequence; e Duration Pattern Sequence. Após a realização dos testes descritos acima, os dados obtidos foram alocados em planilha digital para análise estatística descritiva e inferencial. Resultados: o grupo estudo apresentou alteração nas habilidades de resolução e ordenação temporal. Verificou-se, também, a diferença estatisticamente significante nos achados avaliativos dos grupos estudo e controle, quando comparados, para todos os testes realizados nas avaliações. Conclusão: observou-se alteração das habilidades de resolução e ordenação temporal nos indivíduos com gagueira, independentemente do gênero ou idade cronológica.

Topography of Visual Features in the Human Ventral Visual Pathway / 神经科学通报·英文版

Visual object recognition in humans and nonhuman primates is achieved by the ventral visual pathway (ventral occipital-temporal cortex, VOTC), which shows a well-documented object domain structure. An on-going question is what type of information is processed in the higher-order VOTC that underlies such observations, with recent evidence suggesting effects of certain visual features. Combining computational vision models, fMRI experiment using a parametric-modulation approach, and natural image statistics of common objects, we depicted the neural distribution of a comprehensive set of visual features in the VOTC, identifying voxel sensitivities with specific feature sets across geometry/shape, Fourier power, and color. The visual feature combination pattern in the VOTC is significantly explained by their relationships to different types of response-action computation (fight-or-flight, navigation, and manipulation), as derived from behavioral ratings and natural image statistics. These results offer a comprehensive visual feature map in the VOTC and a plausible theoretical explanation as a mapping onto different types of downstream response-action systems.

Parte I: Anatomía microquirúrgica tridimensional de la ínsula / Part I: Three-dimensional microsurgical anatomy of the insula

Introducción: El lóbulo de la ínsula, o ínsula, se encuentra oculto en la superficie lateral del cerebro. La ínsula está localizada profundamente en el surco lateral o cisura silviana, recubierta por los opérculos frontal, parietal y temporal. Objetivo: Estudiar la compleja anatomía del lóbulo de la ínsula, una de las regiones de mayor complejidad quirúrgica del cerebro humano, y su correlación anatómica con casos quirúrgicos. Material y Métodos: En la primera parte de este estudio presentamos los resultados de nuestras disecciones microquirúrgicas en fotografías 2 D y 3D; en la segunda parte de nuestro trabajo, la correlación anatómica con una serie de 44 cirugías en pacientes con tumores de la ínsula, principalmente gliomas, operados entre 2007 y 2014. Resultados: Extenso conjunto de fibras subcorticales, incluyendo el fascículo uncinado, fronto-occipital inferior y el fascículo arcuato, conectan la ínsula a las regiones vecinas. Varias estructuras anatómicas responsables por déficits neurológicos severos están íntimamente relacionadas con la cirugía de la ínsula, tales como lesiones de la arteria cerebral media, cápsula interna, áreas del lenguaje en el hemisferio dominante y arterias lenticuloestriadas. Conclusión: El entrenamiento en laboratorio de neuroanatomía, estudio de material impreso en 3D, el conocimiento sobre neurofisiología intra-operatoria y el uso de armamento neuroquirúrgico moderno son factores que influencian en los resultados quirúrgicos

Introduction: The insular lobe, or insula, is the cerebral lobe sitting deep in the sylvian fissure and hidden by the lateral surface of the brain. It is covered by the frontal, parietal and temporal operculum. Objectives: To study the anatomy of the insular lobe, one of the most complex parts of the human brain, and to correlate this anatomy with intraoperative findings. Materials and Methods: In the first part of this article we show the results of our dissections, documented in 2D and 3D, and focus on microsurgical anatomy. In the second part we correlate the anatomical structures with intraoperative findings from 44 insular tumor surgeries, mainly gliomas, of patients operated on from 2007 to 2014. Results: Huge bundles of subcortical fibers, like uncinate, inferior fronto-occipital and arcuate fascicles, connect the insula to the neighboring structures. Several anatomical structures related to neurological disabilities are closely related to insular surgery, like the middle cerebral artery, internal capsule, lenticulostriate arteries and cortical and subcortical language circuits. Conclusions: Microsurgical laboratory training, 3D documentation, knowledge of brain mapping and modern neurosurgical armamentarium are important factors in achieving good results with insular glioma tumors.

Remoção de corpo estranho na região óculo-orbitária. Um caso incomum / Removal of foreign body in the oculo-orbital region. An unusual case

Introdução: Todo tipo de trauma facial requer uma avaliação detalhada, a fim de compreender o histórico da lesão e possíveis sequelas. O trauma óculo-orbital não está entre as lesões mais frequentes na epidemiologia do trauma facial, embora esteja associado a altos índices de morbidade e sequelas graves, sendo necessário um acompanhamento multidisciplinar. O objetivo do presente estudo foi relatar um caso clínico de trauma óculo-orbitário severo ocasionado por arma de fogo. Relato do caso: Paciente de 19 anos foi atendido em um serviço de cirurgia bucomaxilofacial, vítima de trauma por arma de fogo, com a presença de um objeto metálico incomum na órbita esquerda e região temporal. Exame clínico e tomografia computadorizada foram realizados, confirmando uma trajetória extracraniana do objeto. O paciente foi submetido à cirurgia sob anestesia geral, e o objeto foi removido pelo orifício de entrada na região orbitária esquerda. Após avaliação oftalmológica, as funções do olho esquerdo não puderam ser recuperadas. Considerações Finais: O diagnóstico correto e o tratamento rápido são imperativos para restaurar a função e a estética agradável na região traumatizada... (AU)

Introduction: Any type of facial trauma requires a detailed evaluation in order to understand lesion history and possible sequelae. Oculoorbital trauma is not between the most frequent injuries within facial trauma epidemiology, although, it is associated to high morbidity rates and severe sequelae, so that a multidisciplinary follow-up is necessary. To report a clinic case of severe oculo-orbital trauma caused by firearm. Case Report: Patient, 19 years-old, attended the oral and maxillofacial surgery service victim of trauma by gunshot with the presence of an unusual metallic object in the left orbit and temporal region. Clinical exam and computed tomography scan were performed, confirming an extra-cranial trajectory of the object. Patient was submitted to surgery under general anesthesia and the object was removed through the entrance orifice in the left orbital region. After ophthalmologic evaluation, functions of the left eye could not be recovered. Final considerations: Correct diagnosis and rapid treatment are imperative to restore function and pleasant esthetics in the traumatized region... (AU)

Riesgo suicida en pacientes con epilepsia de lóbulo temporal mesial farmacorresistente de la clínica de epilepsia entre Mayo de 2019 a Octubre 2019 / Suicidal risk in patients with drug-resistant mesial temporal lobe epilepsy from the epilepsy clinic from May 2019 to October 2019

La presente investigación se realizó en la Clínica de Epilepsia del Instituto Salvadoreño del Seguro Social con el fin de identificar el riesgo suicida que existe en los pacientes con epilepsia de lóbulo temporal Farmacorresistente; identificar las características sociodemográficas de los mismos y determinar según el tiempo de evolución de los síntomas, el inicio de tratamiento farmacológico y la frecuencia de crisis al mes el riesgo suicida de cada paciente. Para esta investigación se utilizó una muestra de 166 pacientes que asistieron a su cita en la clínica de epilepsia a quienes voluntariamente se les aplicó la Escala de Tendencias Suicidas de Pöldinger para medir el riesgo suicida de cada uno. Del total de encuestados hubo una predominancia del sexo femenino correspondiendo a 107 pacientes (64.5%), mientras que del sexo masculino fueron 59 pacientes (35.5%). En esta investigación se observó un porcentaje de 18.7% de pacientes (31), clasificados en las categorías de tendencia y riesgo suicida. A pesar del aparecimiento de las crisis en la infancia temprana y hasta los 18 años (50.6%) de los pacientes, no representó significancia estadística para el riesgo suicida. La única variable con asociación estadística significativa para el riesgo suicida fue el tiempo existente entre el inicio de los síntomas y el inicio de tratamiento farmacológico el cual puede impactar negativamente en el neurodesarrollo. Por tanto, dentro de la población estudiada se detectó un 18.7% de pacientes con tendencia o riesgo suicida, porcentaje que supera el reportado por algunos estudios realizados en población general. La predominancia de sexo femenino, la edad, el estado civil y factores laborales y académicos en la población estudiada no mostraron tener asociación o diferencias estadísticamente significativas con respecto a la tendencia o riesgo suicida al igual que el tiempo de evolución de la enfermedad y la frecuencia de crisis al mes, mientras que el tiempo de inicio del tratamiento farmacológico sí se asoció estadísticamente a tendencia y riesgo suicida.

A Cortical Substrate for Square-Wave Jerks in Progressive Supranuclear Palsy

Neuropsychology of the temporal lobe: Luria's and contemporary conceptions / Neuropsicologia do lobo temporal: concepções contemporâneas e de luria

ABSTRACT Brain lesion studies currently employ techniques such as computed tomography, functional magnetic resonance imaging, single photon emission tomography and positron emission tomography. Famous neuropsychologist Alexander Romanovich Luria's studies on cognition were conducted without the use of imaging technology for many years, in a large number of patients with brain lesions, and explored complex behavior and specific brain functions involving the lobes and subareas. For instance, he carried out several specific studies on memory and mental organization, reported in his books. The objective of this study is to associate recent studies in neuropsychology with Luria's work specifically on the temporal lobe. According to the data studied, Luria's epistemological foundation remains the basis for neuropsychological studies today, but new data on the temporal lobe in relation to epilepsy and hippocampus analysis have been introduced into the scope of neuropsychology. This study focuses on earlier data from Luria's studies on the neuropsychological functions of the temporal lobe, comparing these with more recent data. However, in order to improve clinical aspects, a detailed study on the neuropsychological tests used for the temporal lobe should be performed.

RESUMO Atualmente, estudos de lesão cerebral implementam técnicas como tomografia computadorizada, ressonância magnética funcional, tomografia por emissão de fóton e tomografia por emissão de pósitrons. Estudos sobre cognição do neuropsicólogo Alexander Romanovich Luria foram realizados há vários anos sem o uso de tecnologia de imagem, com uma grande quantidade de pacientes com lesões cerebrais, envolvendo comportamento complexo e funções cerebrais específicas em relação aos lobos e suas subáreas. Por exemplo, ele realizou vários estudos sobre memória e organização mental mostrados em alguns de seus livros. O objetivo deste trabalho é associar estudos recentes em neuropsicologia com o trabalho de Luria sobre o lobo temporal, em específico. De acordo com os dados estudados aqui, a base epistemológica de Luria para os estudos neuropsicológicos atuais é ainda, fundamental, mas novos dados sobre o lobo temporal em relação à análise de epilepsia e hipocampo foram introduzidos no escopo da neuropsicologia. Neste trabalho foram priorizados os estudos das funções neuropsicológicas do lobo temporal dos dados anteriores dos estudos de Luria em relação aos mais recentes, no entanto, para fins de melhoria de aspectos clínicos, um estudo detalhado sobre os testes neuropsicológicos utilizados para o lobo temporal deveria ser realizado.

Religiosity and spirituality in patients with epilepsy / Religiosidade e espiritualidade em pacientes com epilepsia

ABSTRACT Religiosity and spirituality (R/S) are widely regarded as important allies against illness and suffering in general. Findings in temporal lobe epilepsy (TLE) suggest the temporal lobe as the anatomical-functional basis of religious experiences. Both R/S are relevant in patients with epilepsy (PWE) since epilepsy can lead to psychosocial issues for a significant portion of patients and their families. Objective: To investigate R/S in PWE, as well as the impact of different epileptic syndromes on patients' R/S. Methods: One hundred PWE and 50 healthy volunteers matched for age, sex and educational level were submitted to an interview, as well as three previously validated questionnaires: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Results: PWE's and control's mean ages were 35.9 ± 12.4 vs. 36.3 ± 18.1 years, mean schooling was 8.9 ± 3.7 vs. 10.1 ± 4.2 years. The mean age of epilepsy onset was 14.5 ± 12.1 and monthly frequency of seizures was 5.9 ± 12.6. INSPIRIT-R's scores were not statistically significantly different between patients and controls (3.0 ± 0.8 vs. 3.0 ± 0.8); however, INSPIRIT-R's scores were significantly higher in TLE patients when compared with other epilepsy syndromes (3.2 ± 0.7 vs. 2.8 ± 0.9; p = 0.04). Conclusion: Temporal lobe epilepsy patients have higher levels of R/S.

Resumo Religiosidade e espiritualidade (R/E) são geralmente consideradas importantes aliadas no enfrentamento de doenças e sofrimento. Estudos na epilepsia do lobo temporal (ELT) sugerem que o lobo temporal é a base anatômico-funcional de experiências religiosas. Além disso, R/E têm impacto na vida de pacientes com epilepsia (PCE), uma vez que a epilepsia frequentemente está associada a distúrbios psicossociais em pacientes e seus familiares. Objetivo: Investigar R/E em PCE, bem como o impacto de diferentes síndromes epilépticas na R/E dos pacientes. Método: Cem PCE e 50 voluntários saudáveis pareados por idade, sexo e nível educacional foram submetidos a uma entrevista, bem como três questionários previamente validados: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), e Quality of Life in Epilepsy Inventory (QOLIE-31). Resultados: As médias de idade de PCE e controles foram de 35,9 ± 12,4 vs. 36,3 ± 18,1 anos, com escolaridade média de 8,9 ± 3,7 vs. 10,1 ± 4,2 anos. A idade média do início da epilepsia foi de 14,5 ± 12,1 e a frequência de crises mensais foi de 5,9 ± 12,6. Os escores do INSPIRIT-R não foram estatisticamente diferentes entre os pacientes e controles (3,0 ± 0,8 vs. 3,0 ± 0,8); entretanto, os escores do INSPIRIT-R foram significativamente maiores em pacientes com ELT quando comparados com outras síndromes epilépticas (3,2 ± 0,7 vs. 2,8 ± 0,9; p = 0,04). Conclusão: Pacientes com epilepsia do lobo temporal possuem níveis mais altos de religiosidade e espiritualidade.

Diferencias en procesamiento cerebral visual temprano en niños con trastorno del déficit de atención / Differences in early visual cerebral processing in children with attention deficit / hyperactivity disorders with predominance of no attention

Para evaluar los procesos atencionales a estímulos visuales que no requieren repuesta motora, se llevó a cabo un estudio con potenciales evocados a 17 niños con trastornos del déficit de atención/ hiperactividad (TDAH-I) con predominio inatento y a 15 controles de edades entre 7 y 11 años. Se analizó la latencia y localización de fuentes de los potenciales evocados visuales tempranos P100 y N100 durante la realización de una tarea oddball visual (20% rayas horizontales y 80% verticales) en que las rayas verticales no exigían respuesta motora. Los resultados indican que los niños con TDAH-I procesan la información visual que no requiere respuesta motora con un mayor aumento de la actividad cerebral y mediante la vía temporal ventral mientras que el grupo control lo hace mediante la vía parietal dorsal. Este proceso neurobiológico de procesamiento de la información visual vía temporal ventral de los niños con TDAH-I podría deberse a alteraciones en los procesos emocionales que influyen directamente en el reconocimiento visual o a un déficit en el control de los procesos atencionales por parte de la vía parietal dorsal.

To evaluate attentional processes to visual stimuli that do not require motor response, a study with evoked potentials was carried out on 17 children with attention deficit disorder predominantly inattentive (ADDH-I) and 15 controls between the ages of 7 and 11 years. The latency and localization of sources of the early visual evoked potentials P100 and N100 were analyzed during the performance of a visual oddball task (20% horizontal and 80% vertical lines) where the vertical lines did not require motor response. The results indicate that ADDH-I group process visual information that does not require motor response with a greater increase in brain activity and through the ventral temporal pathway, while the control group does so by means of the dorsal parietal stream. This neurobiological process of visual information processing by ventral temporal pathway of ADDH-I group could be due to alterations in emotional processes that directly influence visual recognition or as consequence of deficit in the control of attentional processes by the dorsal parietal pathway.

The Characteristics and Survival Outcomes in Patients Aged 70 Years and Older with Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We aim to examine nasopharyngeal carcinoma (NPC) characteristics and survival outcomes in patients aged 70 years and older in the intensity-modulated radiotherapy (IMRT) era. MATERIALS AND METHODS: From 2006 to 2013, 126 non-metastatic NPC patients aged ≥ 70 years who were treated with IMRT +/‒ chemotherapy were included. Adult Comorbidity Evaluation 27 (ACE-27) was used to measure patient comorbidities. The overall survival (OS) and cancer-specific survival (CSS)were calculatedwith the Kaplan-Meier method, and differenceswere compared using the log-rank test. The Cox proportional hazards model was used to carry out multivariate analyses. RESULTS: For the entire group, only two patients (1.6%) presented stage I disease, and up to 84.1% patients had stage III-IVB disease. All patients had a comorbidity score of 0 in 24 (19.0%), 1 in 45 (35.7%), 2 in 42 (33.3%), and 3 in 15 (11.9%) patients. The main acute grade during radiotherapy was 3-4 adverse events consisting of mucositis (25.4%), bone marrow suppression (16.7%), and dermatitis (8.7%). After treatment, four patients (3.2%) developed temporal lobe injury. Five-year CSS and OS rates were 67.3% (95% confidence interval [CI], 58.6% to 77.4%) and 54.0% (95% CI, 45.6% to 63.9%), respectively. Five-year OS was significantly higher for ACE-27 score 0-1 than ACE-27 score 2-3 (72.9% and 39.9%, respectively; p 0.05). CONCLUSION: Our findings suggest IMRT +/– chemotherapy has a manageable toxicity and provides an acceptable survival in patients aged ≥ 70 years with NPC. ACE-27 score was significantly associated with survival outcomes in this group population.

Ramsay Hunt Syndrome Complicated by Meningoencephalitis and Radiologic findings: a Rare Case Report

Ramsay Hunt syndrome with the complication of encephalitis or meningoencephalitis is rarely reported and uncommon in immunocompetent patients. The radiological manifestations of such cases usually involve the cerebellum and brainstem or exhibit the absence of any abnormality. We report a case of a 78-year-old immunocompetent man hospitalized with Ramsay Hunt syndrome, who later developed meningoencephalitis. The cerebrospinal fluid-study excluded other causes of meningoencephalitis, and the clinical diagnosis indicated varicella zoster virus meningoencephalitis. Magnetic resonance imaging revealed increased signal intensities in the bilateral temporal lobe, midbrain, and pons on T2-weighted imaging, and T2 fluid attenuated inversion recovery and contralateral asymmetric pachymeningeal enhancement. Contrast-enhanced T1-weighted imaging revealed ipsilateral facial nerve enhancement.

Primary Intraparenchymal Central Nervous System Solitary Fibrous Tumor/Hemangiopericytoma Presenting with Intracerebral Hemorrhage: A Case Report

A 53-year old man who had a left hemiparesis from head injury of traffic accident 20 years ago visited an emergency room with suddenly developed semi-comatose mental status. Brain CT showed 8.6-cm sized solid and cystic mass on right temporal lobe that was associated with hemorrhage. Solid lesion showed a strong enhancement after an administration of contrast media. Because of severe mass effect, emergency operation was performed. The mass was an intraparenchymal lesion with yellowish cystic fluid and the firm reddish-brown solid lesion was hemorrhagic. The lesion was totally resected. Pathologically, anaplastic solitary fibrous tumor/hemangiopericytoma was diagnosed with 70/10 high power fields. Postoperative radiotherapy of 50 Gy was done. Postoperative 2 months later, the patient was recovered to alert mental state. We report this unusual case of non-dural based intraparenchymal solitary fibrous tumor/hemangiopericytoma with high mitotic index and acute massive hemorrhage. Rapid tumor growth of hypervascular tumor might have a chance of bleeding.

Epilepsia del lóbulo temporal: una revisión de tema sobre el abordaje diagnóstico / Temporal Lobe Epilepsy: a Topic Review on Diagnostic Approach / Epilepsia do lobo temporal: uma revisão sobre a abordagem diagnóstica

Introducción. Según la Organización Mundial de la Salud (OMS) la epilepsia constituye uno de los trastornos neurológicos más frecuentes en el mundo. Las crisis epilépticas se consideran una manifestación clínica originada por una descarga excesiva de neuronas a nivel cerebral. Su prevalencia es mayor en Latinoamérica y el Caribe que en países desarrollados; las crisis, en la mayoría de los casos, corresponden a la epilepsia del lóbulo temporal, cuya anormalidad anatómica más habitual es la esclerosis del hipocampo. El objetivo es exponer el protocolo básico de epilepsia de manera estandarizada y su utilidad en el planeamiento quirúrgico, y así, conociendo todas las herramientas estudiadas hasta el momento, se realice un adecuado y oportuno diagnóstico. División de los temas tratados. Se realizó una revisión de tema de la literatura existente en las bases de datos Pubmed, Cochrane y Medline desde 1980 hasta 2018 acerca de la epilepsia del lóbulo temporal. Se expone de manera concisa la anatomía, fisiología, fisiopatología, presentación clínica y diagnóstico imaginológico de la patología. Conclusiones. Esta patología se caracteriza por tener el foco epileptogénico en los lóbulos temporales con alta probabilidad de control con técnicas quirúrgicas cada vez menos agresivas. El diagnóstico es inducido a través de la clínica; sin embargo, las nuevas técnicas de imagen estructurales y funcionales son el método diagnóstico de elección en pacientes con sospecha de esta patología y, de esta manera, lograr la realización de un diagnóstico más certero y oportuno. Cómo citar. Araujo-Reyes AT, Sandoval J, Carrasco Ore A, Baquero-Serrano MA. Epilepsia del lóbulo temporal: una revisión de tema sobre el abordaje diagnóstico. MedUNAB. 2019;22(2):228-241.doi:10.29375/01237047.3208

Introduction. According to the World Health Organization (WHO), epilepsy is one of the world's most frequent neurological disorders. Epileptic seizures are considered to be a clinical manifestation caused by an excessive discharge of neurons in the brain. Its prevalence is higher in Latin America and the Caribbean than in developed countries. In most cases, seizures correspond to temporal lobe epilepsy, whose most common anatomic abnormality is hippocampal sclerosis. The objective is to present the basic epilepsy protocol in a standardized form and its usefulness in surgical planning, in order to perform a correct and timely diagnosis, knowing all of the tools that have been studied until now. Division of Covered Topics. A topic review of the existing literature in the Pubmed, Cochrane and Medline databases from 1980 to 2018 was performed on temporal lobe epilepsy. The anatomy, physiology, physiopathology, clinical presentation and imaging diagnosis of the pathology are concisely presented. Conclusions. This pathology is characterized by having an epileptogenic focus in the temporal lobes, with a high probability of control with surgical techniques that are becoming less aggressive. Diagnoses are made through clinics. However, new structural and functional imaging techniques are the diagnosis method of choice for patients suspected to have this pathology in order to make a more accurate and timely diagnosis. Cómo citar. Araujo-Reyes AT, Sandoval J, Carrasco Ore A, Baquero-Serrano MA. Epilepsia del lóbulo temporal: una revisión de tema sobre el abordaje diagnóstico. MedUNAB. 2019;22(2):228-241. doi:10.29375/01237047.3208

Introdução. Introdução. Segundo a Organização Mundial da Saúde (OMS) a epilepsia é um dos distúrbios neurológicos mais frequentes do mundo. As crises epilépticas são consideradas uma manifestação clínica causada por uma descarga excessiva de neurônios no nível cerebral. Sua prevalência é maior na América Latina e no Caribe do que nos países desenvolvidos; as crises, na maioria dos casos, correspondem à epilepsia do lobo temporal, cuja anormalidade anatômica mais comúm é a esclerose do hipocampo. O objetivo deste trabalho é expor o protocolo básico de epilepsia de forma padronizada e sua utilidade no planejamento cirúrgico, e assim, conhecendo todas as ferramentas estudadas até o momento, seja feito um diagnóstico adequado e oportuno. Divisão dos tópicos discutidos. Foi realizada uma revisión da literatura existente nas bases de dados Pubmed, Cochrane e Medline desde 1980 até 2018 sobre a epilepsia do lobo temporal. Apresenta concisamente a anatomia, fisiologia, fisiopatologia, apresentação clínica e diagnóstico por imagem da patologia. Conclusão. A patologia é caracterizada por ter o foco epileptogênico nos lobos temporais, com alta probabilidade de controle, com técnicas cirúrgicas cada vez menos agressivas. O diagnóstico é induzido pela clínica; no entanto, as novas técnicas de imagem estruturais e funcionáis são o método diagnóstico de maior escolha em pacientes com suspeita dessa patología e, assim, conseguem um diagnóstico mais preciso e oportuno. Cómo citar. Araujo-Reyes AT, Sandoval J, Carrasco Ore A, Baquero-Serrano MA. Epilepsia del lóbulo temporal: una revisión de tema sobre el abordaje diagnóstico. MedUNAB. 2019;22(2):228-241. doi:10.29375/01237047.3208

Clinical Pearls and Advances in Molecular Researches of Epilepsy-Associated Tumors

Brain tumors are the second most common type of structural brain lesion that causes chronic epilepsy. Patients with low-grade brain tumors often experience chronic drug-resistant epilepsy starting in childhood, which led to the concept of long-term epilepsy-associated tumors (LEATs). Dysembryoplastic neuroepithelial tumor and ganglioglioma are representative LEATs and are characterized by young age of onset, frequent temporal lobe location, benign tumor biology, and chronic epilepsy. Although highly relevant in clinical epileptology, the concept of LEATs has been criticized in the neuro-oncology field. Recent genomic and molecular studies have challenged traditional views on LEATs and low-grade gliomas. Molecular studies have revealed that low-grade gliomas can largely be divided into three groups : LEATs, pediatric-type diffuse low-grade glioma (DLGG; astrocytoma and oligodendroglioma), and adult-type DLGG. There is substantial overlap between conventional LEATs and pediatric-type DLGG in regard to clinical features, histology, and molecular characteristics. LEATs and pediatric-type DLGG are characterized by mutations in BRAF, FGFR1, and MYB/MYBL1, which converge on the RAS-RAF-MAPK pathway. Gene (mutation)-centered classification of epilepsy-associated tumors could provide new insight into these heterogeneous and diverse neoplasms and may lead to novel molecular targeted therapies for epilepsy in the near future.