Selective posterior callosotomy for drop attacks: A new approach sparing prefrontal connectivity.

OBJECTIVE: To evaluate a novel approach to control epileptic drop attacks through a selective posterior callosotomy, sparing all prefrontal interconnectivity. METHODS: Thirty-six patients with refractory drop attacks had selective posterior callosotomy and prospective follow-up for >4 years. Falls, episodes of aggressive behavior, and IQ were quantified. Autonomy in activities of daily living, axial tonus, and speech generated a functional score ranging from 0 to 13. Subjective effect on patient well-being and caregiver burden was also assessed. RESULTS: Median monthly frequency of drop attacks decreased from 150 to 0.5. Thirty patients (83%) achieved either complete or >90% control of the falls. Need for constant supervision decreased from 90% to 36% of patients. All had estimated IQ below 85. Median functional score increased from 7 to 10 (p = 0.03). No patient had decrease in speech fluency or hemiparesis. Caregivers rated the effect of the procedure as excellent in 40% and as having greatly improved functioning in another 50%. Clinical, EEG, imaging, and cognitive variables did not correlate with outcome. CONCLUSIONS: This cohort study with objective outcome assessment suggests that selective posterior callosotomy is safe and effective to control drop attacks, with functional and behavioral gains in patients with intellectual disability. Results are comparable to historical series of total callosotomy and suggest that anterior callosal fibers may be spared. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that selective posterior callosotomy reduces falls in patients with epileptic drop attacks.

Bilateral Rasmussen's encephalitis associated with type II focal cortical dysplasia: Dormant 'second' epileptogenic zone in contralateral disease.

Rasmussen's encephalitis (RE) is an inflammatory, probably autoimmune disorder manifested by refractory seizures and progressive deterioration of one cerebral hemisphere [1]. Here, we describe the unfortunate history of a girl with a progressive disorder which, upon clinical, neuroimaging, and histopathological evaluation, proved to be bilateral RE associated with type II focal cortical dysplasia. Whether the second pathology is relevant for the extent of the disease is discussed. We demonstrated histopathological evidence of RE and type II FCD in the left hemisphere, which led to EPC on the right hemibody at presentation. In addition, there was unequivocal progressive cortical and subcortical atrophy of the right hemisphere, which accounted for the EPC on the left hemibody. This is highly compatible with RE (+/- FCD) in the right hemisphere as well. Although the association of FCD and RE - as well as the occasional occurrence of bilateral RE - has already been reported [3-5], this is the first such case in which bilateral RE and FCD co-occur.

Mensurações em radiologia e suas principais utilizações na elucidação diagnóstica / Measurements in radiology and its main uses in diagnosis

A imaginologia mostrou ser uma ferramenta essencial para padronizar e objetivar os critérios diagnósticos e prognósticos, tanto na predição de malignidade quanto na avaliação de resposta ao tratamento de uma lesão sabidamente maligna. Esta padronização é importante para comparação de utilizar as modalidades radiológicas para auxiliar na elucidação diagnóstica em diversas situações clinicas.

Differentiating attention-deficit/hyperactivity disorder inattentive and combined types: a (1)H-magnetic resonance spectroscopy study of fronto-striato-thalamic regions.

Despite the implication of fronto-striatal circuits in attention-deficit/hyperactivity disorder (ADHD), there is a lack of information on the role of these regions, especially the thalamus, in the heterogeneity of ADHD. We assessed the (1)H-magnetic resonance spectroscopy profile in ventromedial prefrontal cortex (VMPFC)-thalamic-striatal regions bilaterally in three groups of subjects (age range 18-24 years old): ADHD inattentive type (ADHD-I; n = 9), ADHD combined type (ADHD-C; n = 10) and non-ADHD controls (n = 12). The peaks of N-acetylaspartate, Choline (Cho), myo-inositol (mI), creatine (Cr) and glutamate-glutamine-GABA (Glx) to Cr were calculated. Subjects with ADHD-C showed lower mI/Cr ratio in the right VMPFC than controls, higher Cho/Cr ratio in the left thalamus-pulvinar than the ADHD-I group and higher Glx/Cr ratio in left putamen than individuals with ADHD-I and controls. This metabolic profile suggests a disruption of fronto-striato-thalamic structures in the ADHD-C as a result of lower neuronal energetic metabolism.

Avaliando o procedimento da expansão rápida da maxila através da tomografia computadorizada helicoidal / Evaluation of rapid maxillary expansion by means od spiral computed tomography

Este artigo tem como objetivo avaliar, por meio de imagens obtidas em tomógrafo computadorizado helicoidal, as alterações transversais ocorridas durante a expansão rápida da maxila com o uso do disjuntor de Haas modificado, em um paciente na dentadura mista, comparando ainda estes achados com aqueles obtidos pelos métodos convencionais de tomadas radiográficas. Através dos resultados observados pelas imagens tomográfica com reconstrução 3D, constatou-se que a sobrecorreção da expansão constitui uma atitude clínica de bom senso, visto que a amplitude real de abertura da sutura intermaxilar é menor quando comparada ao grau de abertura observado nas imagens radiográficas convencionais