Navegando por Palavras-chave "epilepsy surgery"
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- ItemAcesso aberto (Open Access)Correlation between temporal pole MRI abnormalities and surface ictal EEG patterns in patients with unilateral mesial temporal lobe epilepsy(W B Saunders Co Ltd, 2007-01-01) Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Garzon, Eliana [UNIFESP]; Oliveira, Pedro A. L.; Carrete Junior, Henrique [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Bianchin, Marino Muxfeldt; Yacubian, Elza Márcia Targas [UNIFESP]; Sakamoto, Américo Ceiki [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Objective: the objective of this retrospective study is to analyze ictal patterns observed during continuous Video-EEG monitoring in patients with temporal Lobe epilepsy (TLE) due to unilateral hippocampal sclerosis (HS), and to correlate these EEG patterns to temporal pole abnormalities observed on magnetic resonance imaging exams.Methods: We analyzed 147 seizures from 35 patients with TLE and unilateral HS. Ictal patterns were classified.,and correlated to signal abnormalities and volumetric measures of the temporal poles. Volume differences over 10% were considered abnormal.Results: the most frequent type of ictal pattern was rhythmic theta activity (RTA), encountered in 65.5% of the seizures. Rhythmic beta activity (RBA) was observed in 11% of the seizures, localized attenuation in 8%, interruption of epileptiform discharges in 6%, repetitive discharges in 5.5%, and rhythmic delta activity (RDA) in 4%. Sixty-six percent of the patients presented signal abnormalities in the temporal pole that were always ipsitateral to the HS. Sixty percent presented significant asymmetry of the temporal poles consisting of reduced volume that was also always ipsitateral to HS. Although patients with RTA as the predominant ictal pattern tended to present asymmetry of temporal poles (p = 0.305), the ictal EEG pattern did not correlate with temporal pole asymmetry or signal abnormalities.Conclusions: RTA is the most frequent initial ictal pattern inpatients with TLE due to unilateral HS. Temporal pole signal changes and volumetric reduction were commonly found in this group of patients, both abnormalities appearing always ipsitateral to the HS. However, neither temporal pole volume reduction nor signal abnormalities correlated with the predominant ictal pattern, suggesting that the temporal poles are not crucially involved in the process of epileptogenesis. (c) 2006 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Long-term evaluation of physical activity habits after epilepsy surgery(Liga Brasileira de Epilepsia (LBE), 2009-12-01) Leite, Adriana; Scorza, Fulvio Alexandre [UNIFESP]; Albuquerque, Marly de [UNIFESP]; Cukiert, Arthur; Baldauf, Cristine; Argentoni-Baldochi, Meire; Baise-Zung, Carla; Arida, Ricardo Mario [UNIFESP]; Universidade de Mogi das Cruzes Núcleo de Pesquisas Tecnológicas Laboratório de Neurociências; Universidade Federal de São Paulo (UNIFESP); Hospital BrigadeiroOBJETIVES: Studies have shown that people with epilepsy have a low degree of participation in physical activities. The purpose of this study was to assess the physical exercise habits in patients after epilepsy surgery using a standardized questionnaire. MMETHODOLOGY: The study population consisted of 102 patients submitted to cortico-amigdalo-hippocampectomy. A questionnaire was designed to assess physical activities participation before and after surgery. Patients were classified as physically active, inadequately active or sedentary. The questionnaire was applied pre-operatively and after a mean of 47 months post-operatively. RESULTS: Forty eight per cent of the patients participated in physical activities before surgery and 56% of them did so post-operatively. No considerable changes in physical activity participation were observed after surgery. Additionally, the frequency they needed supervision during exercise, were advised by a physician not to practice exercise or cautioned by a relative or friend against participation in sports did not change significantly after successful epilepsy surgery. Less exercise-related seizures occurred postoperatively. CONCLUSION: Difficulties adapting to seizure freedom and psychosocial and psychiatric co-morbidity might be important factors interfering in these physical activity habits. A multidisciplinary approach might be the only way to try to alter some aspects of these patients' postoperative life style.
- ItemSomente MetadadadosLong-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients Clinical article(Amer Assoc Neurological Surgeons, 2009-06-01) Elsharkawy, Alaa Eldin; Alabbasi, Abdel Hamid; Pannek, Heinz; Oppel, Falk; Schulz, Reinhard; Hoppe, Mathias; Hamad, Ana Paula [UNIFESP]; Nayel, Mohamed; Issa, Ahmed; Ebner, Alois; Bethel Epilepsy Ctr; Cairo Univ; Universidade Federal de São Paulo (UNIFESP); Krankenhaus MaraObject. the aim of this study was to evaluate the long-term efficacy of temporal lobe epilepsy (TLE) Surgery and potential risk factors for seizure recurrence after surgery.Methods. This retrospective study included 434 consecutive adult patients who underwent TLE surgery at Bethel Epilepsy Centre between 1991 and 2002.Results. Hippocampal sclerosis was found in 62% of patients, gliosis in 17.3%, tumors in 20%, and focal cortical dysplasia (FCD) in 6.9%. Based on a Kaplan-Meier analysis, the probability of Engel Class I outcome for the patients overall was 76.2% (95% CI 71-81%) at 6 months, 72.3% (95% CI 68-76%) at 2 years, 71.1% (95% CI 67-75%) at 5 years, 70.8% (95% CI 65-75%) at 10 years, and 69.4% (95% CI 64-74%) at 16 years postoperatively. the likelihood of remaining seizure free after 2 years of freedom from seizures was 90% (95% CI 82-98%) for 16 years. Seizure relapse Occurred in all subgroups. Patients with FCD had the highest risk of recurrence (hazard ratio 2.15, 95% CI 0.849-5.545). Predictors of remission were the presence of hippocampal atrophy on preoperative MR imaging and a family history of epilepsy. Predictors of relapse were the presence of bilateral interictal sharp waves and versive seizures. Six-month follow-up electroencephalography predicted relapse in patients with FCD. Short epilepsy duration was predictive of seizure remission in patients with tumors and gliosis; 28.1% of patients were able to discontinue antiepileptic medications without an increased risk of seizure recurrence (hazard ratio 1.05, 95% CI 0.933-1.20).Conclusions. These findings highlight the role of etiology in prediction of long-term Outcome after TLE surgery. (DOI: 10.3171/2008.6.JNS17613)
- ItemSomente MetadadadosParadoxical ictal EEG lateralization in children with unilateral encephaloclastic lesions(John Libbey Eurotext Ltd, 2009-09-01) Garzon, Eliana [UNIFESP]; Gupta, Ajay; Bingaman, William; Sakamoto, Americo C. [UNIFESP]; Luders, Hans; Cleveland Clin Fdn; Universidade Federal de São Paulo (UNIFESP); Univ Hosp ClevelandBackground. Describe an ictal EEG pattern of paradoxical lateralization in children with unilateral encephaloclastic hemispheric lesion acquired early in life. Methods. of 68 children who underwent hemispherectomy during 2003-2005, scalp video-EEG and brain MRI of six children with an ictal scalp EEG pattern discordant to the clinical and imaging data were reanalyzed. Medical charts were reviewed for clinical findings and seizure outcome. Results. Age of seizure onset was 1 day-4 years. the destructive MRI lesion was an ischemic stroke in 2, a post-infectious encephalomalacia in 2, and a perinatal trauma and hemiconvulsive-hemiplegic syndrome in one patient each. Ictal EEG pattern was characterized by prominent ictal rhythms with either 3-7 Hz spike and wave complexes or beta frequency sharp waves (paroxysmal fast) over the unaffected (contralesional) hemisphere. Scalp video-EEG was discordant, however, other findings of motor deficits (hemiparesis; five severe, one mild), seizure semiology (4/6), interictal EEG abnormalities (3/6), and unilateral burden of MRI lesion guided the decision for hemispherectomy. After 12-39 months of post-surgery follow up, five of six patients were seizure free and one has brief staring spells. Conclusion. We describe a paradoxical lateralization of the EEG to the good hemisphere in children with unihemispheric encephaloclastic lesions. This EEG pattern is compatible with seizure free outcome after surgery, provided other clinical findings and tests are concordant with origin from the abnormal hemisphere.
- ItemSomente MetadadadosPatients with epileptic seizures and cerebral lesions who underwent lesionectomy restricted to or associated with the adjacent irritative area(Lippincott Williams & Wilkins, 1999-07-01) Rassi Neto, Aziz [UNIFESP]; Ferraz, Fernando Patriani [UNIFESP]; Campos, Carlos R.; Braga, Fernando Menezes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To analyze the best surgical procedure for patients with epileptic seizures and cerebral lesions-i.e., resection restricted to the lesion or resection associated with the adjacent irritative area-based on the clinical evolution of patients' seizure outcome and electroencephalographic (EEG) and electrocorticographic (ECoG) findings.Methods: This study comprised 37 patients with epileptic seizures and cerebral lesions, ranging in age from 9 to 66 years. Patients were divided into two groups: Group 1 consisted of 21 patients with medically intractable epilepsy, Group 2 of 16 patients with medically controlled epilepsy. Eleven of the 21 patients in Group 1 (Subgroup A) underwent surgical resection of the cerebral lesion and adjacent irritative area as shown by ECoG. for the remaining 10 patients in Group 1 (Subgroup B), the resection was restricted to the lesion. the 16 patients in Group 2 all underwent lesionectomies.Results: of the 11 patients in group 1 who underwent resection of the cerebral lesion and adjacent irritative area, 91% became seizure free. Sixty percent of the remaining patients in group 1 whose resections were restricted to the lesion also became seizure free, as did all the patients in group 2. An overall analysis of the EEGs for all patients showed a statistically significant decrease in paroxysmal activity.Conclusions: in patients with uncontrolled seizures, resection of the cerebral lesion associated with the irritative area shows a tendency to obtain better seizure-outcome results than restricted lesionectomy.
- ItemAcesso aberto (Open Access)Pre-surgical mood disorders associated to worse post-surgical seizure outcome in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis(Liga Brasileira de Epilepsia (LBE), 2012-03-01) Araujo Filho, Gerardo Maria de [UNIFESP]; Gomes, Francinaldo Lobato [UNIFESP]; Mazetto, Lenon [UNIFESP]; Marinho, Murilo Martinez [UNIFESP]; Tavares, Igor Melo [UNIFESP]; Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: This study aims at verifying the impact of pre-surgical PD on seizure outcome in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS). METHODS: After previous consent, retrospective data from 115 surgically treated (corticoamygdalohyppocampectomy) TLE-MTS patients (65 females; 56.5%) were analyzed. Psychiatric evaluations were performed through DSM-IV criteria. Engel IA was established as a favorable prognosis. RESULTS: Forty-five patients (41.6%) were classified as Engel IA, while 47 (40.8%) presented pre-surgical PD. Depression (OR=5.11; p=0.004) appeared as a risk factor associated to a non-favorable seizure outcome. CONCLUSION: In patients with refractory TLE-MTS, the presence of depression predicts an unfavorable outcome.
- ItemSomente MetadadadosSurgically amenable epilepsies in children and adolescents: clinical, imaging, electrophysiological, and post-surgical outcome data(Springer, 2005-07-01) Terra-Bustamante, V. C.; Fernandes, RMF; Inuzuka, L. M.; Velasco, T. R.; Alexandre, V; Wichert-Ana, L.; Funayama, S.; Garzon, E.; Santos, A. C.; Araujo, D.; Walz, R.; Assirati, J. A.; Machado, H. R.; Sakamoto, A. C.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Background and purpose: A large number of patients with epilepsy in the pediatric population have medically intractable epilepsy. in this age group seizures are usually daily or weekly, and response to antiepileptic therapy is poor, especially for those with neurological abnormalities and symptomatic epilepsies. However, several authors have already demonstrated similarly favorable long-term post-surgical seizure control when comparing pediatric and adult populations. in this article we aim to report the experience of the Ribeirao Preto Epilepsy Surgery Program in pediatric epilepsy surgery. Patients and methods: We analyzed 107 patients with medically intractable epilepsy operated on between July 1994 and December 2002, considering age at surgery, seizure type, pathological findings, and seizure outcome. All data were prospectively collected according to protocols previously approved by the institution ethics committee. Results: We analyzed a total of 115 operations performed in 107 patients. There was no difference in sex distribution. Complex partial seizures occurred in 31.4% of the patients, followed by tonic seizures (25.9%), focal motor seizures (15.4%), and infantile spasms (13.3%). the most common etiologies were cortical developmental abnormalities (25.2%), tumors (16.8%), mesial temporal sclerosis (15.9%), Rasmussen syndrome (6.5%), and tuberous sclerosis (6.5%). Overall post-surgical seizure outcome showed 67.2% of the patients within Engel classes I and II, reaching 75.0% when patients with callosotomies were excluded. Conclusions: Post-surgical seizure control in the pediatric population is similar to that in adult patients, despite the fact that epilepsies in this age group are more frequently of extratemporal origin, suggesting that surgery should be considered in children as soon as intractability is determined.