Malformations of cortical development and epilepsy in adult patients.

OBJECTIVE: To describe clinical features of epilepsy secondary to Malformation of Cortical Development (MCD) in a series of adult patients. MATERIALS AND METHODS: We searched our database for all cases with confirmed epilepsy and MCD and included in the study only those with complete data. Mean age, sex, age at seizure onset (ASO), seizure types, abnormal neurological exam (ANE), mental retardation, family history, gestational or perinatal insults (G-PI), interictal EEG and response to treatment were analyzed. Cases were classified into the 3 main groups (G) according to the Barkovich classification (BC) and then compared: (G1) "malformations due to abnormal cell proliferation", (G2) "malformations due to abnormal migration" and (G3) "malformations due to abnormal cortical organization". RESULTS: We identified 152 (5.06%) patients with MCD from a total of 3000 with epilepsy. In total, 138 patients with complete medical data were included in this study. The mean age of patients was 36.2 years, 52.2% were female, the mean ASO was 12.3 years, 5.1% of cases had a positive family history and 21% had G-PI. An ANE was observed in 21% and mental retardation in 31.9%. Most of the patients (84.8%) had refractory epilepsy. The distribution of cases according to the BC was: 51.4% in G1, 28.9% in G2 and 19.6% in G3. Comparing the 3 groups, we found that an ANE was statistically more frequent in G3 and was present in 70.4% of cases. CONCLUSION: Our series of adult patients with epilepsy and MCD suggests that MCD are identified as commonly in a developing country as in previous "first world" series. Neurological deficits were more common in the subgroup of patients with polymicrogyria and schizencephaly (BC Group 3).

Análisis de los trastornos psicóticos en pacientes con epilepsia parcial refractaria, diagnóstico psiquiátrico y características clínicas / Analysis of psychotic disorders in patients with refractory partial epilepsy, psychiatric diagnoses and clinical aspects

Introducción. La asociación entre trastornos psicóticos y epilepsia ha sido motivo de controversias. Actualmente se describen en la literatura diferentes subtipos de trastornos psicóticos en los pacientes con epilepsia de acuerdo con la relación temporal con las crisis: las psicosis postictales (PPI), interictales (PII) y bimodales (PB).Objetivos. Determinar las características clínicas de pacientes con epilepsia parcial refractaria y psicosis y compararlos hallazgos con un grupo control de pacientes con epilepsia parcial refractaria sin psicosis. Métodos. Se estudiaron 57 pacientes con epilepsia parcial refractaria y trastornos psicóticos (GP) y 56 pacientes con epilepsia parcial refractaria sin psicosis (GnP) de acuerdo con los criterios del DSM-IV. En todos los pacientes se realizó una evaluación neurológica completa, estudios neurofisiológicos, neuroimágenes y evaluaciones psiquiátricas DSM-IV y SCID-I. Las variables clínicas, demográficas y psiquiátricas fueron comparadas entre los pacientes GP y GnP.Resultados. En el GP 15 pacientes (26%) cumplían criterios para PPI, 29 pacientes (51 %) para PII y 13 pacientes(23 %) para PB. Encontramos una duración más prolongada de la epilepsia y una mayor incidencia de esclerosis hipocámpica bilateral en los pacientes GP. Los pacientes de GP presentaron un mayor tiempo de evolución de la epilepsia y una mayor incidencia de esclerosis hipocámpica bilateral (p < 0,05).No se observaron diferencias entre los distintos subtipos de psicosis. Conclusiones. El mayor tiempo de evolución de las crisis epilépticas y la presencia de una esclerosis hipocámpica bilateral podrían incrementar el riesgo de desarrollar psicosis en pacientes con epilepsia parcial refractaria (AU)

Introduction. The association between psychotic disorders and epilepsy has been controversial. Different subtypes of psychotic disorders in epilepsy patients have been described according to temporal relationship with seizures-postictal (PIP), interictal (IIP) and bimodal (BP) psychoses are described in literature. Objectives. Determine clinical characteristics of patients with refractory partial epilepsy and psychoses and compare the results with a control group of patients with refractory partial epilepsy without psychoses. Methods. A total of 57 patients with refractory partial epilepsy and psychotic disorders (psychotic group [PG]) and 56 patients with refractory partial epilepsy and without psychoses (control group, CG) were evaluated according to DSM-IV criteria and SCID-I. All patients underwent complete neurological, neuroimaging, neuropsychological, and psychiatric assessment. Clinical, demographic and neuroimaging data were compared between patients in CG and PG. Results. In PG 15 patients (26%) had criteria for PIP,29 patients (51 %) for IIP and 13 patients (23 %) for BP. Epilepsy time duration and bilateral hippocampal sclerosis were significantly more frequent in patients with psichosis.PG patients had a longer evolution time of epilepsy and greater frequency of bilateral hippocampal sclerosis (p < 0.05). No differences were found between psychoses subtypes. Conclusions. Longer evolution of seizures and the presence of bilateral hippocampal sclerosis may increase propensity to develop psychoses in patients with refractory partial epilepsy (AU)

[Analysis of psychotic disorders in patients with refractory partial epilepsy, psychiatric diagnoses and clinical aspects]. / Análisis de los trastornos psicóticos en pacientes con epilepsia parcialrefractaria, diagnóstico psiquiátrico y características clínicas.

INTRODUCTION: The association between psychotic disorders and epilepsy has been controversial. Different subtypes of psychotic disorders in epilepsy patients have been described according to temporal relationship with seizures-postictal (PIP), interictal (IIP) and bimodal (BP) psychoses are described in literature. OBJECTIVES: Determine clinical characteristics of patients with refractory partial epilepsy and psychoses and compare the results with a control group of patients with refractory partial epilepsy without psychoses. METHODS: A total of 57 patients with refractory partial epilepsy and psychotic disorders (psychotic group [PG]) and 56 patients with refractory partial epilepsy and without psychoses (control group, CG) were evaluated according to DSM-IV criteria and SCID-I. All patients underwent complete neurological, neuroimaging, neuropsychological, and psychiatric assessment. Clinical, demographic and neuroimaging data were compared between patients in CG and PG. RESULTS: In PG 15 patients (26 %) had criteria for PIP, 29 patients (51%) for IIP and 13 patients (23%) for BP. Epilepsy time duration and bilateral hippocampal sclerosis were significantly more frequent in patients with psichosis. PG patients had a longer evolution time of epilepsy and greater frequency of bilateral hippocampal sclerosis (p < 0.05). No differences were found between psychoses subtypes. CONCLUSIONS: Longer evolution of seizures and the presence of bilateral hippocampal sclerosis may increase propensity to develop psychoses in patients with refractory partial epilepsy.

Clinical spectrum and difficulties in management of hypothalamic hamartoma in a developing country.

AIM: We describe the clinical features, treatment and prognosis in a series of patients with epilepsy secondary to hypothalamic hamarthomas (HH) in a developing country. MATERIALS AND METHODS: Eight patients with epilepsy and HH were included between 1997 and 2006. We analyzed gender, age, age at seizure onset (ASO), seizure types (ST), mental retardation (MR), precocious puberty (PP), electroencephalogram (EEG)-magnetic resonance imaging (MRI) features and response to treatment. RESULTS: Mean age 25.1 years, 2/6 female/male, none had PP, ASO 4.5 years. Complex partial seizure were the most frequent (100%), mean similar to those seen in temporal (62.5%) or frontal lobe epilepsy (37.5%). Exactly 87.5% developed gelastic seizures (GS). Half of the patients showed MR. Mild-to-severe MR was associated with the presence of multiple ST including atonic and complex partial seizures with frontal semiology. Interictal EEG was abnormal in 87.5% patients. Video EEG was performed in three cases with unspecific findings. HH were small and sessile in seven patients whereas large and pedunculated in one. All patients were refractory to medical treatment. In five, an additional procedure was performed without any significant improvement. CONCLUSION: These series show the heterogeneous spectrum of this entity and the difficulties in its treatment in a developing country.