[Laterality of musical functions in partial epilepsy]. / Lateralização das funções musicais na epilepsia parcial.

Fourteen right handed patients with partial epilepsy (Epileptic Group) and with a median age of 31 years were divided into two groups (Right and Left), according the laterality of paroxystic activity in the electroencaphalogram. Of the 14 patients, 42.8% (6/14) presented a focus at the right side while the others 57.2% (8/14) presented a focus at the left. The Control Group consisted of 31 right handed individuals with a median age of 30 years and with no previous history of neurological disease or epileptic seizures. All the individuals had no musical skills. They carried out Music Abilities Tests including Spontaneous Rhythm, Elemental Music Functions Perception (tone color, duration, pitch, intensity and rhythm) and Complex Strutures Tests (recognition and reproduction of corporal rhythmic movements). We concluded that the focus at the right and the left cerebral hemisphere affect the development of the melodic recognition functions while in cases with focus at the left cerebral hemisphere, rhythmic reproduction and organization are more impaired when compared to the Control Group.

[Surgical treatment of cerebral vascular pathologies in epileptic patients]. / Tratamento cirúrgico das patologias vasculares cerebrais nos pacientes epilépticos.

Surgery of arteriovenous malformations (AVM) and of cavernous angiomas (cavernoma) in the majority of cases is indicated subsequently to episodes of bleeding. With the development of techniques for diagnosis and surgery for epilepsy of difficult control, indication for surgery of these vascular lesions has become greater. We present nine patients with cerebral vascular lesions and very frequent crises in spite of adequate clinical treatment. Ages ranged from 12 to 42 years with an average of 25 years; there was a prevalence of the male sex (2:1). Surgery consisted of exercises of the lesion in all cases and in four there was also resection of the perilesional irritative area shown by electrocorticography. The pathologic study of lesions showed five cases of cavernoma, three cases of AVM, and one case of venous angioma. As to localization, we observed three lesions in the temporal lobe, four in the frontal, and two in the parietal region. Outpatient follow-up showed a reduction in crises in all of the patients, and seven evolved seizure free following surgery.

[Temporal lobe epilepsy. Surgical treatment]. / Epilepsia do lobo temporal. Tratamento cirúrgico.

The authors report the surgical management of 32 patients with medically intractable seizures. In all cases the epileptiform focus present in the temporal region was demonstrated by electroencephalography. Our report was made up of 14 male patients and 18 female patients. Their ages ranged from 9 to 62 years. The material was divided into two groups. The first, with eighteen patients with cerebral lesion (like gliomas, arteriovenous malformation, epidermoid tumor) demonstrated on the CT scan and MR imaging underwent to lesion resection: in some cases with adjacent irritative area (guided by electrocorticography) out of eloquent zone, the removal of this irritative area was done. The second, with fourteen patients without cerebral expansive lesion; the MR imaging showed mesial temporal sclerosis in eight cases; all the patients of this group underwent to temporal lobectomy; the histopathologic exam showed temporal sclerosis in nine cases and normal brain in five. The postoperative follow-up showed better results in the cases with expansive cerebral lesion (83.4% seizure free) than the cases without that lesion (71.4% seizure free).

[Hemispheric functional specialization in motor aphasia. Neurophysiologic findings with computerized electroencephalographic brain mapping during musical and oral sound stimulation. Study of 2 cases]. / Especialização funcional hemisférica na afasia motora. Achados neurofisiológicos ao mapeamento eletrencefalográfico computadorizado sob estimulação sonora musical e verbal. Estudo de dois casos.

This study concerns about brain electrical activity during auditory stimulation in 2 aphasic patients, one with classical (left hemisphere lesion) and another with cross aphasia (right hemisphere lesion). Both cases were submitted to dichotic listening test (consonant-vowel-consonant task) and music audition (gregorian chant), during brain mapping examination. We found, in both cases, a great proportion in delta frequency and power in non-lesional hemisphere during dichotic and musical stimulation. Besides, increasing in frequency of alpha activity was observed only in the non-lesional hemisphere restricted to temporal lobe region. Such findings suggest an interesting field of research about measurements of neurophysiological correlates of auditory stimulation and brain electrical activity in aphasia.

[Sex differences of visual attention in cryptogenic partial epilepsy]. / Diferenças sexuais da atenção visual na epilepsia parcial criptogênica.

The performance in visual verbal and non-verbal attentional tests was studied in 14 male and 18 female control subjects and 33 patients with cryptogenic partial epilepsy. The epileptic group was formed of 17 men and 16 women with no evidence of brain damage in CT scan examinations. Interictal epileptiform activity was observed only unilaterally, either in the right (8 male, 8 female) or left (9 male, 8 female) temporal lobes. The performance of epileptic men in visual tests was similar to that of normal men. On the other hand, the performance of epileptic women was worse than that of normal women. These results seem in accordance with the literature that suggests that visual attention in women depends on the functional integrity of both cerebral hemispheres. In men, verbal visual attention is suggested to occur in the left cerebral hemisphere while non-verbal processes, predominantly in the right cerebral hemisphere. Further studies are necessary for the understanding of these sexual differences in cerebral hemispheric asymmetry.

Epilepsy and anxiety.

We have analyzed 155 subjects with STAI (State-Trait Anxiety Inventory): 75 epileptic patients and 80 normal subjects used as a control group. A higher trait-anxiety score (chronic anxiety) than that of controls was found for the epileptic group. For the epileptic group higher levels of the A-trait occurred in patients with EEG abnormalities with left temporal localization. We have also observed that the shorter the epilepsy lasts (less than two years), the higher the trait-anxiety levels. Convulsions and awareness loss during epileptic seizures do not modify state and trait-anxiety scores.

Hemispheric specialization in partial epilepsy. Role of dichotic listening CV task and central audiological evaluation in the neuropsychological assessment.

We studied 49 patients with partial epilepsy divided into lesional cases (i.e. with lesions on CT scan) and non-lesional cases (i.e. without CT scan lesions), in relation to the Wechsler Intelligence Scale subtests (Coding, Digit span), dichotic listening CV task and Central Auditory Test (SSI, PSI). The aim of this paper was to study the hemispheric prevalence in dichotic listening task with regard to cognitive performance, as well as the presence or absence of central auditory dysfunction. Lesional cases presented a hemisphere prevalence in dichotic listening task with regard to cognitive performance, as well as the non-lesional cases tend to report the stimuli in the same side of EEG focus. Significant differences were found among the lesional and non lesional cases in relation to the digit span score and Coding subtest in right lesional cases versus right non-lesional cases. Both lesional and non-lesional group showed signs of central auditory dysfunction. We suggest that the dichotic listening and SSI and PSI test can be useful for a best comprehension of asymmetric neuropsychological performance in partial epilepsy.

[Analysis of functional hemispheric asymmetry in children with partial epilepsy and normal IQ by performance in WISC subtests]. / Análise da assimetria funcional hemisférica de criancas com epilepsia parcial e QI normal pelo desempenho nos subtestes do WISC.

We studied 87 normal IQ children, 26 partial epileptic (epileptic group) and 61 non-epileptic children (control group) with mean age of 9 years in relation to cognitive performance in Wechsler Infant Scale for Children (WISC) battery. The epileptic group showed lower score in IQ performance and in three verbal subtests (Information, Digit span, Arithmetic) and three performance subtests (Block Design, Object Assembly and Coding). Patients with right hemisphere EEG focus showed low score in subtests related to spatial ability and non-verbal attention, whereas patients with left hemisphere EEG focus showed low score only in Digit span subtest (related to immediate memory and verbal attention). The authors suggest that cognitive deficits in partial non-lesional epileptic children is related to the side of EEG interictal abnormalities, even in children with normal IQ.

[Sexual differences in functional hemispheric asymmetry: verbal tachistoscopic evaluation using microcomputers]. / Diferenças sexuais na assimetria funcional hemisférica. Avaliação taquistoscópica verbal utilizando microcomputador.

Study of sexual differences for the hemispheric prevalence on visual verbal stimuli using a microcomputer-based tachistoscope technic. Seventeen right-handed individuals, 10 males and 7 females (mean age 32 years old), without neurological or visual abnormalities were studied. The subjects performed a verbal trigram tachistoscope test, using a IBM PC microcomputer compatible. The trigram consists of 80 consonant-vowel-consonant pairs of stimuli presented randomly to right and left visual fields. The evaluation was made through two conditions: T1 and T2. In T1 Experiment stimuli exposition time was 260 ms, and in T2 Experiment the stimuli exposition time was 160 ms. In T1 Experiment 80% of females showed a Right Hemispherical Preference while 100% of males showed a Left Hemispherical Preference. In T2 Experiment, both sexes showed Left Hemispheric Preference. A close relationship between sexual difference and hemispheric preference was found. We point out the importance of stimuli exposition time in determination of sexual differences in lateral hemispherical asymmetry.

[Compliance in epilepsy. I. Concept factors and influence factors]. / Aderência em epilepsias. I. Aspectos conceituais e fatores de influência.

The aim of this paper is to introduce compliance concept and to classify technicals, biologicas, socials and mixed factors that may influence compliance. The importance of conscious attitudes in a good patient compliance is emphasized.

[Compliance in epilepsy. II. Practical aspects]. / Aderência em epilepsias. II. Aspectos práticos.

Therapeutic regimen compliance was assessed in 84 epileptic patients. The compliance measurement was based on two interviews, one has been taken by the physician and the other by the nurse. Most patients (72.6%) were detected as non-compliance by the nurse's interview. The forgetfulness of drugs intake was found in 50% subjects. The treatment length and changes from Medical Centers were negatively associated with compliance. Our findings point out the important role of detailed interview in order to detect the most influencing factors in compliance.

[Rolandic epilepsy: report of 53 cases]. / Epilepsia rolândica: relato de 53 casos.

The clinical and EEG features of 53 out-patients with benign partial epilepsy of childhood with rolandic spikes were studied. The age mean (years) of seizures onset was 5.5 +/- 3.2. Simple partial seizures with speech arrest were more frequent than other seizure types. In seven cases (13.2%) cognitive disabilities were present. In the left-side foci a expected correlation between the interictal EEG focus and clinical lateralization of seizure was observed; in the right-side foci, the right-side interictal focus was correlated with ipsilateral seizures.

Photoparoxysmal responses.

Sixty-five outpatients with photoparoxysmal response (PPR) during routine EEG were studied. The PPR showed prevalence in women (75.4%). Seizures were found in 66.1% of cases. The rest recordings were abnormal in 41.8% with prevalence of generalized paroxysm. Eight patterns of PPR were observed, being polyspike mixed to slow wave the most frequent (53%). The epileptic group showed a bimodal distribution in the several bands of photic stimulation, near 8 and 20-24 Hz. A sustained paroxysmal abnormality persisting after the photic stimulation was present in 6 epileptic patients.

[Photosensitive epilepsy: report of 2 cases]. / Epilepsia fotossensível: relato de dois casos.

Reports on photosensitive epilepsy are uncommon. The authors review the literature, and special attention is given to television epilepsy. Two cases are reported and discussed.

[Refractory epilepsies]. / Epilepsias de difícil tratamento.

STUDY OBJECTIVE: To describe the role of multidisciplinary evaluation and general aspects of intractable epilepsies such as age at the onset, etiologic factors, CT scan findings, electroencephalographic abnormalities, types of epileptic seizures, adherence, and crisis-triggering factors. TYPE OF STUDY: Retrospective. SITE: Department of Epilepsy Research and Treatment (SITE)--São Paulo, Brazil. PATIENTS: Analysis encompassed 80 epileptic patients registered with the SITE, who had one or more crises per week, with a minimum follow-up of one year, older than 13 and seen between August and October 1989. INVESTIGATIONS: psychologic, social, nursing, and neurologic evaluations. Treatment performed with antiepileptic drugs. MEASUREMENTS AND RESULTS: Mean age at onset of epilepsy = 12.6 years; 70% of patients have symptomatic partial epilepsy; 66.2% had epilepsy onset after 5 years of age; 80% have had epilepsy for more than 10 years; etiology was not determined in 47.5% of the cases and, in 22.5%, it was due to neurocysticercosis; 88.7% of the patients were having anti-epileptic polytherapy; 50% of the patients did not adhere to the treatment; 56.25% reported emotional originating factors; 60% were socially non-adjusted; 30% had abnormal EEG in the right temporal lobe; 26.2% in the left temporal lobe; 21.2% had normal EEG plotting, and the remainder had their EEG with focal abnormalities in other locations. CONCLUSIONS: The authors accept the fact that a patient who does not lead a balanced social, affective, and emotional life should be classified as a probable case of intractable epilepsy. The authors observed that a large portion of the patients could be seen as pseudodifficult treatment cases, since 50% were non-adherent to treatment, and 56.25% reported the presence of emotional originating factors. As most of these patients have social and psychological maladjustments, perhaps due to their high incidence of epileptic crises, they may be cases of intractable epilepsies.

[Photosensitivity in primary and secondary epilepsies]. / Fotossensibilidade em epilepsias primárias e secundárias.

A retrospective study was performed on 34 patients with photosensitivity detected on the electroencephalogram. This group was compared to an aleatory sample, with 218 patients. The objectives were to evaluate the photosensitivity and: type of epilepsy, age of onset of seizures, sex ratio, frequency of seizures, and family history.

Auditory extinction and dichotic listening CV task in cerebral infarction: preliminary report.

Six stroke patients were studied using a dichotic listening CV task, 4 with left hemisphere infarction, 2 with right hemisphere infarction. It was observed a "lesion-effect", a shift of hemisphere prevalence to the side opposite a brain lesion. The authors suggest that the lesion-effect can be explained by the auditory extinction phenomenon at the linguistic level.

[Binswanger's subcortical arteriosclerotic encephalopathy: a special form of dementia associated with systemic arterial hypertension]. / Encefalopatia subcortical arteriosclerótica de Binswanger: forma especial de demência associada a hipertensão arterial sistêmica.

The encephalopathy is characterized by an important arteriosclerotic involvement of the vessels of the cerebral white matter and a diffuse subcortical demyelination, sparing the cortex. The diagnosis is presently possible, ante mortem, by connecting the clinical picture with the CT scan findings, which are essential. Three cases with Binswanger encephalopathy are reported and the following picture was found: age 50 to 70 years old at the onset; dementia with scanty neurological signs; systemic arterial hypertension; subacute course of the disease; and a CT scan, highly characteristic, that shows bilateral and symmetric subcortical hypodensity. In one of the patients, that eventually died, an angiography disclosed a right internal carotid thrombosis and a diminished flow in the thalamic striate arteries in both sides. The other two patients are apparently stabilized with anti-hypertensive medication. Binswanger encephalopathy is still seldom described in spite of being a very well defined entity. This diagnosis should be considered much more frequently because it is possible to prevent the encephalopathy avoiding systemic hypertension that is probably intimately linked with the genesis of the disease.

Catecholaminergic influences on induced hippocampal paroxysmal activity in rats.

Brain catecholamines (noradrenaline and dopamine) seem to suppress certain forms of epileptic activity. In this paper we report the catecholaminergic influences on hippocampal paroxysmal activity in rats induced through hippocampal electrical stimulation via stereotaxic electrode placements. The experiments included: (1) systemic injections of clonidine (0.10 mg/kg); phenoxybenzamine (10 mg/kg); propranolol (10 mg/kg); apomorphine (1 mg/kg) and haloperidol (1 mg/kg) and (2) electrolytic lesions of the locus coeruleus ipsilateral to the stimulated hippocampus. The clonidine group showed a great reduction, while animals which received phenoxybenzamine showed a significant increase in the electrographic seizure activity. Propranolol produced only a transient reduction of epileptic activity. We did not observe any significant change in the epileptic discharges following apomorphine and haloperidol injections. Electrolytic lesions of the locus coeruleus induced a clear enhancement of the epileptiform activity. The results presented here support the view that noradrenergic, but not dopaminergic systems, may exert a tonic inhibitor effect on hippocampal epileptic activity.