RESUMO
A woman diagnosed with juvenile myoclonic epilepsy for over 30 years presented with stereotyped episodes of abnormal sensations in both arms. Continuous video-EEG monitoring for 14 days and MRI brain revealed that the patient's somatosensory events with associated postictal aphasia, as well as her myoclonic and generalised tonic-clonic seizures, were likely due to a symptomatic left fronto-polar epilepsy. Our case emphasizes the need for clinicians to consider fronto-polar epilepsy as a potential cause of myoclonic seizures, particularly when associated with other semiologic features suggestive of frontal lobe epilepsy. [Published with video sequences].
Assuntos
Epilepsia do Lobo Frontal/diagnóstico , Epilepsia Mioclônica Juvenil/diagnóstico , Anticonvulsivantes/uso terapêutico , Encéfalo/patologia , Carbamazepina/uso terapêutico , Diagnóstico Diferencial , Eletroencefalografia , Epilepsia do Lobo Frontal/patologia , Epilepsia do Lobo Frontal/cirurgia , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/etiologia , Epilepsia Tônico-Clônica/diagnóstico , Epilepsia Tônico-Clônica/etiologia , Feminino , Lobo Frontal/patologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Epilepsia Mioclônica Juvenil/patologia , Epilepsia Mioclônica Juvenil/cirurgia , Procedimentos Neurocirúrgicos , Convulsões/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To analyze findings and acute changes in electrocorticograms (ECoGs) obtained during corpus callosotomy in order to identify any relationships with the postoperative outcome of seizure activity. METHODS: We retrospectively analyzed ECoGs obtained during anterior callosotomy (4-6 cm) in 48 patients with Lennox-Gastaut syndrome (32 boys and 16 girls, age 1-20 years, mean age 7.6 years) who underwent surgery between July 1993 and November 1996 to correlate recording findings with postoperative seizure activity. At the time of analysis, all patients had been followed postoperatively for more than 4 years. RESULTS: Of 48 patients, 31 (64.6%) had significant improvement in seizure control after surgery. In pre-excisional ECoGs, 38 (79.2%) of 48 patients had bisynchronous epileptiform discharges. Patients (23 of 33 patients, 69.7%) with significant blockage of bisynchronous discharges recorded during callosotomy achieved the best postoperative seizure outcomes, but the difference did not reach statistical significance (P>0.05). CONCLUSIONS: Based on our experience, changes in ECoG during callosotomy do not predict postoperative seizure outcome. Insignificant blockage of bisynchronous epileptiform discharges in ECoGs during callosotomy does not predict a worse prognosis than that associated with significant intraoperative blockage.
