ABSTRACT
Cortical laminar necrosis (CLN) is radiologically defined as high intensity cortical lesions on T1 weighted MRI images following a gyral distribution. Histopathologically, CLN is characterised by pannecrosis of the cortex involving neurones, glial cells, and blood vessels. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present two patients who developed CLN and permanent neurological deficits after prolonged and repeated focal status epilepticus. The possible mechanisms leading to CLN in these patients are discussed, together with the implications of prompt and aggressive treatment in similar cases.
Subject(s)
Cerebral Cortex/pathology , Necrosis/etiology , Necrosis/pathology , Status Epilepticus/complications , Status Epilepticus/physiopathology , Adult , Anticonvulsants/therapeutic use , Aphasia, Wernicke/diagnosis , Aphasia, Wernicke/etiology , Brain Diseases/diagnostic imaging , Brain Diseases/etiology , Brain Diseases/pathology , Cerebral Cortex/diagnostic imaging , Functional Laterality , Hemianopsia/diagnosis , Hemianopsia/etiology , Humans , Levetiracetam , Magnetic Resonance Imaging , Male , Middle Aged , Necrosis/diagnostic imaging , Paresis/diagnosis , Paresis/etiology , Phenytoin/therapeutic use , Piracetam/analogs & derivatives , Piracetam/therapeutic use , Status Epilepticus/drug therapy , Tomography, Emission-Computed, Single-PhotonABSTRACT
Complex motor behaviors differing from typical automatisms were found in 12 of 502 patients with temporal lobe epilepsy. Movements involved proximal limb segments (6) or body axis (6) and were often preceded by auras and followed by automatisms. Seven of 12 patients are seizure free after surgery. The other 5 patients declined surgery.
Subject(s)
Automatism/etiology , Automatism/physiopathology , Epilepsy, Temporal Lobe/complications , Epilepsy, Temporal Lobe/physiopathology , Movement Disorders/etiology , Movement Disorders/physiopathology , Adolescent , Adult , Brain/pathology , Brain/physiopathology , Electroencephalography , Epilepsy/diagnosis , Epilepsy/etiology , Epilepsy/physiopathology , Epilepsy, Temporal Lobe/diagnosis , Extremities/innervation , Extremities/physiopathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Muscle, Skeletal/physiopathologyABSTRACT
INTRODUCTION: The reversible electrochemical effects of electroconvulsive therapy (ECT) on specific areas of the brain enable the neuroanatomical bases of some cognitive functions to be studied. In research carried out on memory systems, a selective alteration of the declarative ones has been observed after treatment with ECT. Little work has been done to explore the differential alteration of the memory subsystems in patients with a high number of ECT sessions. AIM. To study the declarative and non declarative memory system in psychiatric patients submitted to maintenance ECT treatment, with a high number of previous ECT sessions. PATIENTS AND METHODS: 20 patients submitted to treatment with ECT (10 diagnosed as having depression and 10 with schizophrenia) and 20 controls, who were paired by age, sex and psychopathological diagnosis. For the evaluation of the declarative memory system, the Wechsler Memory Scale (WMS) logical memory test was used. The Hanoi Tower procedural test was employed to evaluate the non declarative system. RESULTS: Patients treated with ECT performed worse in the WMS logical memory test, but this was only significant in patients diagnosed as suffering from depression. No significant differences were observed in the Hanoi Tower test. CONCLUSIONS: A selective alteration of the declarative systems was observed in patients who had been treated with a high number of ECT sessions, while the non declarative memory systems remain unaffected.
Subject(s)
Electroconvulsive Therapy/adverse effects , Memory/physiology , Adolescent , Adult , Aged , Depression/therapy , Humans , Middle Aged , Neuropsychological Tests , Schizophrenia/therapyABSTRACT
Introducción. Los efectos electroquímicos reversibles de la terapia electroconvulsiva (TEC) sobre zonas cerebrales específicas permiten el estudio de las bases neuroanatómicas de algunas funciones cognitivas. Los estudios sobre los sistemas de memoria observan una alteración selectiva de los declarativos después de un tratamiento con TEC. Pocos trabajos han estudiado la alteración diferencial de los subsistemas de memoria en pacientes con un elevado número de sesiones de TEC. Objetivo. Estudiar el sistema declarativo y no declarativo de memoria en pacientes psiquiátricos sometidos a un tratamiento de TEC de mantenimiento, con un elevado número de sesiones de TEC previas. Pacientes y métodos. 20 pacientes sometidos a tratamiento con TEC (10 diagnosticados de depresión y 10 de esquizofrenia) y 20 pacientes controles apareados por edad, sexo y diagnóstico psicopatológico. Para la evaluación del sistema declarativo de memoria se utilizó la prueba de memoria lógica Wechsler Memory Scale (WMS). La prueba procedimental de la Torre de Hanoi se utilizó para valorar el sistema no declarativo. Resultados. Se observa un peor rendimiento de la prueba de memoria lógica de la WMS en pacientes tratados con TEC, que sólo es significativo en los pacientes diagnosticados de depresión. No se observan diferencias significativas en la Torre de Hanoi. Conclusiones. Se detecta una alteración selectiva de los sistemas declarativos en pacientes tratados con un número elevado de sesiones de TEC, mientras que los sistemas no declarativos de memoria se preservan (AU)
