Complete remission of epileptic psychosis after temporal lobectomy: case report.

We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

[Single photon emission tomography in temporal epilepsy: interictal and ictal studies with visual and semi quantitative analysis]. / Tomografia por emissão de fóton único em epilepsia temporal: estudos intercríticos e críticos com análise visual e semi quantitativa.

Single photon emission tomography (SPECT) was performed in 27 patients with refractory complex partial seizures from the temporal lobes due to mesial temporal sclerosis. Independent blinded observers assessed the 28 interictal studies and 9 ictal/postictal studies. Visual analysis of interictal studies detected hypoperfusion in 22, ipsilateral to the epileptogenic zone in 19 (67%) and contralateral in 3 (10.7%). Quantified temporal lobe asymmetry, greater than a previously derived normal range, correctly identified the epileptogenic zone in 16 (61.5%) with false lateralization in 4 (15.3%). In all 9 cases in which they were performed, ictal/postictal studies showed hyperperfusion at the region of epileptic focus. In 3 patients with complex partial seizures followed by symmetric generalized tonic-clonic seizures, hyperperfusion restricted to the temporal lobe was demonstrated. In 5 of these patients the interical studies were unable to demonstrate localized changes. There were no significant correlations between SPECT findings and clinical parameters or EEG slowing in the temporal lobes.

Functional significance of MRI defined mesial temporal sclerosis in temporal lobe epilepsy.

The functional significance of MRI-defined mesial temporal sclerosis in temporal lobe epilepsy (TLE) is not completely established. In order to study the possible relationship between signals of mesial temporal sclerosis on MRI and interictal SPECT findings we selected 18 patients with complex partial seizures, unilateral temporal EEG focus and normal CT. The EEG focus was defined by the presence of interictal sharp waves and slow background on several scalp EEG obtained during many years of follow up in all patients and by ictal recordings with sphenoidal electrodes in 12 patients. Group I comprised patients (n = 11) in whom MRI showed mesial temporal sclerosis; group II patients (n = 7) had normal MRIs. All patients were submitted to interictal 99m-Tc HMPAO injections with concomitant EEG monitoring. Lateralized hypoperfusion ipsilateral to the EEG was found in 13 patients (72%). In all Group II and in 6 Group I patients a temporal hypoperfusion was found. This SPECT study showed a higher positivity rate in patients with normal MRI than previously reported. On the other hand, in all these group II patients a neocortical origin of epileptic focus was suspected on clinical or electroencephalographic basis. Positive SPECT findings may be at least as prevalent in neocortical as in mesiolimbic epilepsy.

[Clinical manifestations in complex partial crisis of the temporal lobe: a video-electroencephalographic study]. / Manifestações clínicas de crises parciais complexas do lobo temporal: um estudo vídeo-eletrencefalográfico.

We analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the EEG emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). The temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal EEG recordings, CT and MRI findings, interictal and, in some patients, ictal SPECT studies. 8 patients had surgery. In 5 from 7 patients who had temporal lobectomy, mesial temporal sclerosis was the anatomopathological finding and in one patient who had selective amigdalohippocampectomy, hemosiderosis and gliosis probably due to bleeding of a posterior cerebral artery giant aneurysm was found. All patients have been seizure free after surgery. While dystonic posturing and ictal paresis, present in 18 seizures (66.6%), were excellent as lateralizing seizure signs, since they were always contralateral to the ictal onset, contralateral and ipsilateral versive head and eye movements were observed.

MRI and brain spect findings in patients with unilateral temporal lobe epilepsy and normal CT scan.

26 patients with temporal lobe epilepsy clinically documented by several abnormal interictal surface EEGs with typical unitemporal epileptiform activity and a normal CT scan were studied. Interictal 99mTC HMPAO brain SPECT and MRI were performed in all subjects. Abnormalities were shown in 61.5% of MRI (n = 16) and 65.4% of SPECT (n = 17). Hippocampal atrophy associated to a high signal on T2-weighted MRI slices suggesting mesial temporal sclerosis was the main finding (n = 12; 75% of abnormal MRI). MRI correlated well to surface EEG in 50% (n = 13). There was also a good correlation between MRI and SPECT in 30.7% (n = 8). SPECT and EEG were in agreement in 57.7% (n = 15). MRI, SPECT and EEG were congruent in 26.9% (n = 7). These results support the usefulness of interictal brain SPECT and MRI in detecting lateralized abnormalities in temporal lobe epilepsy. On the other hand, in two cases, interictal SPECT correlated poorly with surface EEG. This functional method should not be used isolately in the detection of temporal lobe foci. MRI is more useful than CT as a neuroimaging technique in temporal lobe epilepsy. It may detect small structural lesions and mesial temporal lobe sclerosis which are not easily seen with traditional CT scanning.

MRI and brain SPECT findings in patients with unilateral temporal lobe epilepsy and normal CT scan

Foram estudados 26 pacientes com epilepsia do lobo temporal clinicamente documentada por vários EEGs com atividade epileptiforme intercrítica e TC de crânio normal SPECT com TC HMPAO e ressonância magnética (RM) foram realizados em todos os casos 61,5 por cento (n=17) dos SPECTs revelaron algum tipo de anormalidade. Atrofia hipocampal, nas imagens enfatizadas em T1 e presença de hipersinal nas imagens enfatizadas em T2, sugerindo esclerose mesial temporal, foram o principal achado (n=12,75 por cento das RM anormais). RM correlacionou-se ao ECG em 50 por cento (n=13). Concordância entre RM e SPECT ocorreu em 30.7 por cento (n=8) e entre SPECT e EEG em 57.7 por cento (n=15), RM, SPECT e EEG foram congruentes em 26.9 por cento (n=7). Estes resultados refletem o valor do SPECT intercrítico e RM na detecçäo e lateralizaçäo de anormalidades em epilepsia do lobo temporal. Por outro lado, em dois casos, o SPECT correlacionou-se mal com o EEG. Este método funcional näo deve ser utilizado isoladamente na detecçäo de focos temporais. RM é mais útil do que a TC como recurso de neuroimagem na epilepsia do lobo temporal. Ela pode detectar pequenas lesöes estruturais e esclerose mesial temporal, näo facilmente identificáveis pela TC

Características clínicas de pacientes com epilepsia temporal e esclerose mesial / Clinical characteristcs of patients with temporal lobe epilepsies and mesial sclerosis

Entre as epilepsias do lobo temporal, a síndrome temporal mesial é caracterizada por manifestaçöes clínicas homogêneas e achados específicos em exames paraclínicos. Descrevemos características clínicas de 22 pacientes, com 14 a 51 anos de idade (média 31,8 anos) e duraçäo da epilepsia de 6 a 41 anos (média 22,08 anos), com epilepsia do lobo temporal e sinais de esclerose mesial na RM e/ou no estudo anátomo-patológico. Crises epilépticas nos primeiros anos de vida estavam presentes em 19 (86,3 por cento ) dos pacientes; dentre estas, 11 foram convulsöes febris (em 10 complicados), as quais, quando apresentaram manifestaçöes motoras dimidiadas, constituíram importante dado para a lateriazaçäo da área epileptogênica, sendo sempre contralaterais ao lado da esclerose mesial temporal. Ocoreu intervalo livre de 8 meses a 24 anos (média 7,58 anos) entre o possível fator etiológico e o aparecimento de crises recorrentes sugestivas de epilepsia temporal, que incluiam crises parciais simples, com manifestaçöes viscerais, e crises parciais complexas, durante as quais sinais motores lateralizados foram importantes na lateralizaçäo do lobo epileptogênico de 9/71 pacientes. Crises tônico-clônicas generalizadas infreqüentes foram relatadas por 13 pacientes (59 por cento ), ocorrendo geralmente no início da epilepsia