Relation of Structural and Functional Changes in Auditory and Visual Pathways after Temporal Lobe Epilepsy Surgery.

Auditory and visual pathways may be affected as a consequence of temporal lobe epilepsy surgery because of their anatomical relationships with this structure. The purpose of this paper is to correlate the results of the auditory and visual evoked responses with the parameters of tractography of the visual pathway, and with the state of connectivity between respective thalamic nuclei and primary cortices in both systems after the surgical resection of the epileptogenic zone in drug-resistant epileptic patients. Tractography of visual pathway and anatomical connectivity of auditory and visual thalamus-cortical radiations were evaluated in a sample of eight patients. In general, there was a positive relationship of middle latency response (MLR) latency and length of resection, while a negative correlation was found between MLR latency and the anatomical connection strength and anatomical connection probability of the auditory radiations. In the visual pathway, significant differences between sides were found with respect to the number and length of tracts, which was lower in the operated one. Anatomical connectivity variables and perimetry (visual field defect index) were particularly correlated with the latency of P100 wave which was obtained by quadrant stimulation. These results demonstrate an indirect functional modification of the auditory pathway and a direct traumatic lesion of the visual pathway after anterior temporal lobectomy in patients with drug resistant epilepsy.

Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program.

The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE) patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG) and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA) and absolute spike frequency (ASF) were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28) class I, 10% (4) class II and 19% (8) class III-IV; at 24 months after surgery 55.2% (21) of the patients were class I, 28.9% (11) class II and 15.1% (6) class III-IV. After one- year follow up 23 (57.7%) patients were seizure and aura-free (Engel class IA). These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish "satisfactory" from "unsatisfactory" seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well.

Psicosis interictal: presentación de un caso / Interictal psychosis: presentation of the case

La psicosis epiléptica es un tema debatido desde hace más de medio siglo. La clasificación de Ponds publicada en 1957 aún tiene vigencia con algunas modificaciones, a nuestro juicio, porque relaciona los numerosos síntomas de una entidad tan estudiada como controvertida, de manera que quedan implicados y en la práctica se observa, más que una co-morbilidad psiquiátrica, un cuadro que requiere de cuidadosos estudios clínicos. Dicha clasificación agrupa las manifestaciones psiquiátricas en trastornos ictales, trastornos interictales, y trastornos postictales. Los trastornos ictales están tan relacionados con la semiología de la epilepsia pues son las manifestaciones de toma de conciencia que se producen en el ictus. Los trastornos interictales se ajustan al período intercrisis donde una serie de entidades psiquiátricas concomitantes con la epilepsia se presentan, y la controvertida personalidad epiléptica se enuncia. Los trastornos posictales son considerados de uno a dos días del ictus. En la práctica, la clásica pregunta de si es orgánico o funcional un cuadro sintomático, está tan interiorizado en el quehacer médico que aunque hayamos conceptualizado un diagnóstico, los criterios dualistas y de sindromología nos lleva frecuentemente a la duda. La presentación del caso de una joven de 19 años que asiste para que sea precisado su diagnóstico con un cortejo de síntomas y signos psiquiátricos, su evolución durante un año y tratamiento así como consideraciones etiológicas son los objetivos de este trabajo(AU)