ABSTRACT
The purpose of this study was to describe the methodology necessary for simultaneous recording of intracranial EEG (ICEEG) and magnetoencephalography (MEG) and to assess the sensitivity of whole-head MEG versus depth electrode EEG in the detection and localization of epileptic spikes. Interictal MEG and depth electrode activities from the temporal mesial and occipital lobes were simultaneously recorded from four candidates for epilepsy surgery. Implanted depth electrodes identified neocortical and mesial structures of ictal onset. Interictal spikes detected by these same depth electrodes were compared with simultaneous MEG events. MEG detections of ICEEG spikes, ICEEG versus MEG spike amplitudes, number of ICEEG contacts involved in the spike, and anatomic locations of MEG equivalent current dipoles were analyzed. MEG detected and localized 95% of the neocortical spikes, but only 25% to 60% of spikes from mesial structures. Mesial temporal spikes resulted in lower MEG spike amplitudes, when compared with neocortical spikes. Equivalent current dipoles of MEG spikes localized to the ictal onset zones in all four patients. MEG can detect and localize interictal epileptiform spikes that are recorded from depth electrodes in both neocortical and mesial structures, despite the lesser amplitude of spikes of mesial origin.
Subject(s)
Brain/physiopathology , Electroencephalography/methods , Epilepsy/physiopathology , Magnetoencephalography/methods , Adolescent , Child , Electrodes, Implanted , Female , Humans , Male , Sensitivity and SpecificityABSTRACT
A prospective study on the effects of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder (OCD) is presented. A total of 18 procedures were performed in 15 patients. The mean duration of the OCDs was 18.1 +/- 5.6 years (range 11-26 years). The mean total Yale-Brown Scale (Y-BOCS) score was 29.67 and mean Global Assessment of Functioning was 43.61. The results throughout the follow-up period remained the same as at 1 month postoperatively. The observed mean recovery on the Y-BOCS was 33.2% (p = 0.017). 52.9% of the patients showed a 33% recovery, 29.4% of the cases showed a 50% recovery and 17% showed a 66% recovery. Global Assessment of Functioning recovered by 19% (p = 0.111). No cognitive deficit was disclosed by neuropsychological screening tests. Complications were observed in 3 cases, 1 with transitory hallucinations, 1 with a single epileptic seizure and 1 case who developed a progressive behavior disorder that became permanent. We conclude that bilateral anterior capsulotomy is a safe and effective procedure.
Subject(s)
Internal Capsule/surgery , Obsessive-Compulsive Disorder/surgery , Adult , Female , Humans , Male , Middle Aged , Neurosurgical Procedures , Psychosurgery , Stereotaxic Techniques , Treatment OutcomeABSTRACT
Introducción. En pacientes trasplantados, los fármacos inmunodepresores provocan un enmascaramiento de enfermedades habituales, lo que hace difícil su diagnóstico y tratamiento. La enfermedad abdominal tiene lugar en un 2-20 por ciento, siendo quirúrgica en un 50 por ciento, con una mortalidad de 10-40 por ciento. Las enfermedades más frecuentemente detectadas son: pancreatitis aguda, ulcus péptico y obstrucción intestinal. Objetivos. Determinar los parámetros de alarma, los procesos diagnósticos más adecuados y las causas de morbimortalidad más frecuentes para intentar evitarlas. Métodos. En nuestro centro se practicaron 225 trasplantes cardíacos entre mayo 1984 y octubre 1997. Se valoraron las complicaciones abdominales graves en estos pacientes, momento de aparición, implicación de fármacos inmunodepresores y presencia de rechazo agudo. Resultados. Se detectaron 35 complicaciones abdominales graves (incidencia del 12,9 por ciento), siendo la mayoría diferidas (> 1 año postrasplante). Las enfermedades más frecuentemente detectadas fueron las hemorragias digestivas y las perforaciones. Las pancreatitis ocurrieron en un 11 por ciento de los casos. Los fármacos inmunodepresores usados fueron prednisona, ciclosporina y azatioprina. En 12 de 29 pacientes la complicación abdominal tuvo lugar en el contexto de rechazo agudo. Conclusiones. Ante la aparición de una clínica abdominal inespecífica en estos pacientes es obligatorio descartar enfermedades graves, como pancreatitis o perforación de víscera hueca. La detección de amilasas y lipasas en sangre y una ecografía o tomografía abdominal deben practicarse de forma temprana. Ante una hemorragia digestiva es obligatorio practicar una endoscopia. Si la intervención quirúrgica parece inminente, no se debe dudar, ya que se ha demostrado que es peor la demora que el probable rechazo (AU)
