Síndrome de encefalitis crónica localizada y epilepsia-síndrome de Rasmussen. Acerca de 2 nuevos casos / Syndrome of localized chronic encephalitis and epilepsy-Rasmussen syndrome. Two new cases

A raíz de observaciones personales, se describieron dos casos de "encefalitis localizada crónica y epilepsia", llamada actualmente sindrome de rasmussen en honor de quien lo describió en 1958. Se trata de un cuadro poco común, pero muy monomorfo en su sintomatología, caracterizado por comienzo en la infancia, entre los 14 meses y 5 años preferentemente, siguiendo a menudo a un cuadro infeccioso banal respiratorio o digestivo. Comienza con crisis epilépticas de tipo tónico-clónico generalizadas, a las que pronto se asocian crisis motoras o sensitivas parciales con o sin marcha jaksoniana y característicamente episodios de epilepsia parcial contínua de tipo kojevnicov. Las crisis son frecuentes y suelen no responder a ninguna droga antiepiléptica. Después de varios años se instala un deterioro mental progresivo y un déficit neurológico a predominio motor (hemiparesia). Finalmente la evolución se detiene, pero ya habiendo producido un daño neurológico irreversible. El EEG suele mostrar enlentecimiento difuso generalizado inespecífico, con o sin actividad focal. La TAC de cráneo, normal al inicio, muestra luego una atrofia sobre todo unilateral. La RNM suele ser normal. Histológicamente corresponde a una encefalitis localizada. La etiología no se conoce. Probablemente sea viral, habiéndose recientemente aislado un virus de Epstein-Barr de las piezas operatorias. Del punto de vista terapéutico, basado en la probable causa viral, se ha ensayado, con poco éxito, distintas drogas antivirales, inmunosupresores y corticosteroides. En etapas avanzadas, cuando ya la hemiplejía impide la utilización de la mano, se plantea la hemisferectomía parcial, que segun Rasmussen suele producir una importante mejoría de la epilepsia. Las resecciones más económicas ("king size biopsy"), hechas más precozmente, son poco eficaces. Dada la severidad de la afección y los escasos recursos terapéuticos, se plantea su profilazis mediante un mejor control de las afecciones infecciosas banales de la infancia.

Síndrome de encefalitis crónica localizada y epilepsia-síndrome de Rasmussen. Acerca de 2 nuevos casos / Syndrome of localized chronic encephalitis and epilepsy-Rasmussen syndrome. Two new cases

A raíz de observaciones personales, se describieron dos casos de "encefalitis localizada crónica y epilepsia", llamada actualmente sindrome de rasmussen en honor de quien lo describió en 1958. Se trata de un cuadro poco común, pero muy monomorfo en su sintomatología, caracterizado por comienzo en la infancia, entre los 14 meses y 5 años preferentemente, siguiendo a menudo a un cuadro infeccioso banal respiratorio o digestivo. Comienza con crisis epilépticas de tipo tónico-clónico generalizadas, a las que pronto se asocian crisis motoras o sensitivas parciales con o sin marcha jaksoniana y característicamente episodios de epilepsia parcial contínua de tipo kojevnicov. Las crisis son frecuentes y suelen no responder a ninguna droga antiepiléptica. Después de varios años se instala un deterioro mental progresivo y un déficit neurológico a predominio motor (hemiparesia). Finalmente la evolución se detiene, pero ya habiendo producido un daño neurológico irreversible. El EEG suele mostrar enlentecimiento difuso generalizado inespecífico, con o sin actividad focal. La TAC de cráneo, normal al inicio, muestra luego una atrofia sobre todo unilateral. La RNM suele ser normal. Histológicamente corresponde a una encefalitis localizada. La etiología no se conoce. Probablemente sea viral, habiéndose recientemente aislado un virus de Epstein-Barr de las piezas operatorias. Del punto de vista terapéutico, basado en la probable causa viral, se ha ensayado, con poco éxito, distintas drogas antivirales, inmunosupresores y corticosteroides. En etapas avanzadas, cuando ya la hemiplejía impide la utilización de la mano, se plantea la hemisferectomía parcial, que segun Rasmussen suele producir una importante mejoría de la epilepsia. Las resecciones más económicas ("king size biopsy"), hechas más precozmente, son poco eficaces. Dada la severidad de la afección y los escasos recursos terapéuticos, se plantea su profilazis mediante un mejor control de las afecciones infecciosas banales de la infancia. (AU)

Problemas psicosociales y laborales del paciente epileptico. / Psychosocial and work problems of patients with epilepsy

Se exponen los resultados de estudios efectuados entre 1978 y 1983 sobre aspectos neuropsicologicos, de personalidad, de empleo y empleabilidad de pacientes epilepticos. Se senala la existencia posible de alteraciones neuropsicologicas, sobre todo de la memoria, cuya etiologia parece multifactorial. En cuanto a la personalidad, se hallo, comparando pacientes con epilepsia temporal derecha e izquierda, un predominio de caracter o neurosis histerica en los primeros, y de caracter o neurosis obsesiva en los segundos.Desde el punto de vista laboral se muestra el mayor indice de desocupacion entre los epilepticos que en la poblacion general. Se senala la influencia que en ello tiene la actitud incorrecta de la poblacion hacia el paciente, por un lado, y la falta de autoestima de este ultimo, por otro. Se insiste en la necesidad de programas de rehabilitacion que deben incluir una correcta educacion del publico

Problemas psicosociales y laborales del paciente epileptico. / Psychosocial and work problems of patients with epilepsy

Se exponen los resultados de estudios efectuados entre 1978 y 1983 sobre aspectos neuropsicologicos, de personalidad, de empleo y empleabilidad de pacientes epilepticos. Se senala la existencia posible de alteraciones neuropsicologicas, sobre todo de la memoria, cuya etiologia parece multifactorial. En cuanto a la personalidad, se hallo, comparando pacientes con epilepsia temporal derecha e izquierda, un predominio de caracter o neurosis histerica en los primeros, y de caracter o neurosis obsesiva en los segundos.Desde el punto de vista laboral se muestra el mayor indice de desocupacion entre los epilepticos que en la poblacion general. Se senala la influencia que en ello tiene la actitud incorrecta de la poblacion hacia el paciente, por un lado, y la falta de autoestima de este ultimo, por otro. Se insiste en la necesidad de programas de rehabilitacion que deben incluir una correcta educacion del publico

Prognosis of epilepsy. Remission of seizures and relapse in 808 adult patients.

In a retrospective study of 808 adult epileptic patients undertaken at the Neurological Institute of Montevideo, Uruguay, the rate of remission of seizures (three seizure-free years) was 32%, and that of relapse 39%. Remission occurred mostly during the first years after onset, and relapse during the first years after remission. Patients with generalized or partial seizures alone had a better prognosis than when both types coexisted. Patients with Petit Mal absences persisting after 14 years of age, had the lowest rate of remission. Mental status, abnormal neurological examination and age of onset showed no significant prognosis value. Remission and relapse was similar in cryptogenetic and symptomatic epilepsy. Genetic predisposition did not change the prognosis. Withdrawal of drugs after a minimal seizure-free period of three years produced a higher rate of relapse than when medication was continued. In the first EEG, only the existence of a slow background rhythm had an unfavorable prognosis. These results are compared with those of other series. It is concluded that the differing results can be attributed to a different selection of population and different methods of study. Anyway, several factors showed a similar influence on prognosis in the different series. As to indication for method of drug withdrawal after remission, and its influence on relapse, no definite conclusion can be drawn and a large, multicentric, methodical study on this topic is suggested.

[Post-traumatic epilepsy. Analysis of 70 cases]. / Epilepsia postraumática. Análisis de 70 casos.

A retrospective study of 70 cases of posttramatic epilepsy is undertaken. The clinical and electroencephalographic characteristics are analyzed and it is emphasized: (1) The predominance of generalized seizures over focal fits, and among these last, the higher incidence of motor seizures are stressed. (2) The incidence of early seizures was of 5% in this series. (3) The occurrence of epilepsy usually was within 2 years after head injury. (4) Frequent correlation between the clinical course and the EEG is noted. A brief bibliographical review on the subject is presented, and the importance of a prospective study in the value of anticonvulsive drugs in prevention of posttramatic epilepsy is underlined.

[Somatosensory epileptic crises]. / Crisis epilépticas somatosensitivas.

A retrospective study of 20 patients with somatosensory seizures is undertaken. The cases were obtained from the series of 1000 patient histories from the Division Epilepsy of the Neurological Institute of Montevideo. Several clinical variables are analyzed and especially the etiological factors are studied. A high incidence of surgical treatable causes was found (50%), especially tumor (35%). Similar results are reported by other authors. A comparative study concerning the tumor etiology in somatosensory and in other types of partial seizures is performed. It was found that tumors have the highest incidence of somatosensory seizures. The authors conclude that radiological studies must be undertaken in all cases of somatosensory seizures in seizures in which the underlying etiology is unclear, in order to rule out a surgical process. Computerized Tomography is at present the most important study, excepting those cases in which an arterio-venous malformation is suspected, which should be studied primarily by angiography.

[Epidemiologic study of 500 adult epileptics from a hospital population]. / Estudio epidemiológico de 500 epilépticos adultos procedentes de una población hospitalaria.

An epidemiology analysis is carried out in a hospital population of 500 epileptic patients older than 14 years of age, pertaining to the outpatient department of the Instituto de Neurología, Hospital de Clínicas, Monevideo". This information gathered, corresponds to the period, 1966-1975. Specially formulated records of precoded-type data were used for this research and the data was processed by automation. This work deals fundamentally with a descriptive study in which the character of the population and of its epilepsy is studied by means of 20 items. Analyzed from within the social aspects, the school attendance and the occupation of the patients, amounts, similar to those of the general population of the country, were found. An elevated incidence of family epilepsy antecedents (17%) in the group and also of perinatal pathology (19%), is emphasized. An analytic study of the clinical type of crisis and of the factors unleashed by the attacks is made. Dividing the population into two groups, according to the beginning of epilepsy, before or after the 25 years, the different etiology for both groups is specially pointed out, the juvenile epilepsy predominating in the unknown etiology, genetics and that which is produced by perinatal pathology, while in the tary epilepsy, the vascular and tumoral etiology, above all, is most frequent.

Epileptic seizures as an early complication of neurosurgery.

The appearance of epileptic seizures in the early postoperative period (first 10 days) after neurosurgery is an uncommon complication. A retrospective study of 600 patients operated on for glioma, meningioma, metastatic tumor, hydatid cyst, cerebral hemorrhage and head injury (100 cases each) is the subject of this report. In 6% of the total group, seizures were found during the first 10 days following surgery. They usually appeared during the first 48 hours. In most cases (78%), fits were of the partial motor type, originating in the frontoparietal (central) region. The clinical course was benign in most cases. Good control of seizures was usually obtained by common anticonvulsants and except for a few cases, the prognosis was not worsened by the appearance of these early fits. The pathophysiology of early seizures, which are not related to cerebral scarring, is discussed. It is concluded that they are related to biochemical alterations produced by surgery, similar to what happens in early post traumatic epilepsy or in cases of seizures appearing in the early stages of cerebrovascular accidents.

[Epidemiology of 500 adult epileptics from a hospital population]. / Estudio epidemiológico de 500 epilépticos adultos procedentes de una población hospitalaria.

On the basis of 500 epileptic patients treated in the Out-Patient Department of the "Instituto de Neurología", Hospital de Clínicas, Montevideo, Uruguay, an epidemiological study is undertaken. Data obtained correspond to the period extending between 1965 and 1975. A precodified data registering system was used and the analysis was done by mechanical processes. It is mainly a descriptive analysis of the group of patients and their seizures, including 20 items. As far as social aspects are concerned, education levels and occupation are analyzed, encountering similar levels as those of the general population in this country. As to etiological factors, a high incidence of familiar history of epilepsy (17%) and of perinatal pathology (19%) is found. An analytical study of the seizures and their provoking factors is performed. Etiological factors are analyzed dividing the patients in two groups according to the age of beginning of seizures (before or after 25 years) and in the younger groups perinatal factors and epilepsy of unknown origin predominate, while in the older group vascular and tumoral causes are more frequent.

[Comparative study of the cognitive functions and symbolic order in temporal and centerencephalic epilepsy of long development of difficult therapeutic control]. / Estudio comparativo de las funciones cognitivas y de orden simbólico en las epilepsias temporales y centrencefálicas de larga evolución y difícil control terapéutico

The paper is centered in the comparative study of three groups of long-term epileptic patients in which therapeutic control is difficult to achieve, by means of several neuropsychological tests evaluating levels of intelligence, memory, language and praxis. Paget's tests of conservation of physical quantities revealed no significant differences in results obtained from the exploration of operative levels between epileptics with right temporal, left temporal or centrencephalic electroencephalographic foci. There is no parallel decrease of operative level when present, and deficit of mnesic functions, which is constantly observed in the three groups and usually evidenced in short-term memory. The graphic representation of projective space (Cube, house), is parallel to operative weakening. No significant relationship between lateralization of focus and graphic performance is observed. Language exploration by means of Benton and Spreen's battery of tests shows distinctly similar results in the three groups of patients. The location of the epileptic focus shows no relevance with respect to language disturbances. The most outstanding pathologic phenomenon is a certain degree of anomia observed in the naming of objects. Its significance is discussed (Slight degree of amnesic aphasia, deficit of evocative memory, or a lexical level in accordance with the operative deficit). The deficit of the repetition of sentences test and in others including a time element should not be ascribed to a specific language deficit. True aphasia was present in only three patients of the left temporal group after prolonged status epilepticus.