Navegando por Palavras-chave "refractory epilepsy"
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- ItemSomente MetadadadosGranular cell dispersion and bilamination: two distinct and bilamination, histopathological patterns in epileptic hippocampi?(John Libbey Eurotext Ltd, 2007-12-01) Silva, Alexandre Valotta da [UNIFESP]; Houzel, Jean-Christophe; Croaro, Ingrid [UNIFESP]|Yacubian, Elza Márcia Targas [UNIFESP]; Stávale, João Norberto [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Cavalheiro, Esper Abrão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)Cytoarchitectural modifications of the dentate gyrus are among the most obvious abnormalities observed in the hippocampal sclerosis associated with refractory epilepsy. Here, we examined the morphological changes of granular cells (dispersion, bilamination and cell loss) in sclerotic hippocampi from nine TLE patients, comparing abnormal and preserved areas. A total of 2 577 granular cells were analyzed with respect to four different histopathological patterns: areas with bilamination (n = 936), areas with dispersion (n = 905), areas with neuronal loss (n = 279), and preserved areas (n = 457). Quantitative parameters included somatic perimeter (P), area (A) and form factor (ff).Although different patterns were often observed in the same patient, highly significant differences were observed (p < 0.0001) when patterns were compared to one another. Since granular cell dispersion and bilamination have different morphological aspects in sclerotic hippocampi from TLE patients, we suggest that these patterns should be considered separately. Future studies are needed to determine the frequency with which these patterns occur in the general population and whether each one can interfere with seizure susceptibility.
- ItemAcesso aberto (Open Access)Neurocysticercosis and microscopic hippocampal dysplasia in a patient with refractory mesial temporal lobe epilepsy(Academia Brasileira de Neurologia - ABNEURO, 2006-06-01) Silva, Alexandre Valotta da [UNIFESP]; Martins, Heloise Helena [UNIFESP]; Marques, Carolina Mattos [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Sakamoto, Américo Ceiki [UNIFESP]; Carrete Junior, Henrique [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Stávale, João Norberto [UNIFESP]; Cavalheiro, Esper Abrão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Epidemiologic studies suggest that neurocysticercosis (NC) is the main cause of symptomatic epilepsy in developing countries. The association between NC and mesial temporal lobe epilepsy (MTLE) has been reported by several authors. Recent data have shown that the presence of NC does not influence the clinical and pathological profile in MTLE patients and suggest that not all cysticercotic lesions are inevitably epileptogenic. We describe a 50-years-old woman with partial seizures due to NC which evolve to MTLE. The patient was submitted to a corticoamygdalohippocampectomy to treat refractory epilepsy. An immunohistochemical study using neuronal markers was made on hippocampal formation. Besides the typical aspects of Ammon's horn sclerosis (AHS), the microscopic examination demonstrates cellular features of hippocampal malformation including dysmorphic neurons and focal bilamination of granular cell layer. We suggest that, in this case, a developmental disorder lowered the threshold for the NC-induced seizures and contributed to the establishment of refractory epilepsy.
- ItemSomente MetadadadosThe oral glucose tolerance test is frequently abnormal in patients with uncontrolled epilepsy(Elsevier B.V., 2006-08-01) Vianna, J. B. M.; Atallah, A. N.; Prado, G. F.; Valente, O.; Duarte-Barros, M. L.; Vianna, E. C. S.; Mello, L. E. A. M.; Universidade Federal de São Paulo (UNIFESP); Fac Med ItajubaPurpose. the clinical efficacy of the ketogenic diet as therapy for patients with difficult-to-treat epilepsy prompted us to investigate the glucose metabolism of these patients under an oral overload of glucose, that is, in the oral glucose tolerance test (OGTT).Methods. Thirty patients (12 males, 18,females; age range: 17-59, mean: 35.1) with difficult-to-treat epilepsy, 23 patients with controlled epilepsy (11 males, 12 females; age range: 14-66, mean: 36.9), and 39 control subjects (18 males, 21 females; age range: 16-58, mean: 33.3) were evaluated with the OGTT. for patients with epilepsy, we also measured C-peptide and glycosylated hemoglobin in the fasting state. Glucose levels lower than 70 mg/dL at any point of the curve were considered to be abnormal.Results. All subjects in the control group and the group with controlled epilepsy had a normal OGTT. in contrast, all 30 patients with difficult-to-treat epilepsy had at least one point on the OGTT curve below the normal range (P < 0.001), most often 180 and 240 minutes after the oral glucose load (P < 0.001). C-peptide levels were significantly lower in the group with difficult-to-treat epilepsy as compared with the group with controlled epilepsy. Fasting glycohemoglobin and insulin levels did not differ between the two patient groups.Conclusions. We suggest that undiagnosed metabolic disturbances in patients with difficult-to-treat epilepsy may somehow contribute to their refractoriness to conventional pharmacological therapy. We propose the hypothesis that calorie-restricted diets aimed at correcting OGTT curves may prove beneficial in treating patients with difficult-to-treat epilepsy. Our hypothesis generates a clear endpoint for the diet, and its demonstration would provide new standards for diet-based antiepileptic regimens. Accordingly, our results may help in understanding the positive consequences of ketogenic or calorie-restricted diets in persons with seizures. (C) 2006 Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)SPECT cerebral interictal em pacientes com epilepsia do lobo temporal de difícil controle(Academia Brasileira de Neurologia - ABNEURO, 2002-09-01) Andraus, Maria Emilia Cosenza; Cosenza, Carlos Alberto Nunes; Fonseca, Léa Mirian Barbosa Da; Andraus, Cesar Fantezia; D'andrea, Isabela [UNIFESP]; Alves-leon, Soniza Vieira; Universidade Federal do Rio de Janeiro Faculdade de Medicina; Universidade Federal do Rio de Janeiro Coordenação dos Programas de Pós-Graduação em Engenharia; Laboratoire d'Analyse et d'Architecture de Systèmes de Toulouse; Universidade Federal do Rio de Janeiro; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro HUCFF Serviço de Neurologia; Universidade do Rio de Janeiro Serviço de NeurologiaThe objective of this study was to evaluate the utility of interictal brain SPECT in localizing the epileptogenic focus in a population of patients of Epilepsy Clinic of Hospital Universitário Clementino Fraga Filho (HUCFF/UFRJ), with medically refractory temporal lobe epilepsy (TLE) and normal computed tomography (CT) scans, studying the correlation between SPECT, electroencephalogram (EEG) and, in 11 cases, brain magnectic resonance imaging (MRI), and to compare the results to the other six literatura series. Twelve (52.2%) patients presented abnormal SPECT. Among these, five (41.6% of abnormal SPECTs) presented unilateral SPECT changes at the same side of EEG (hypoperfusion in four and hyperperfusion in one), three (25% of abnormal SPECTs) presented bilateral hypoperfusion and bilateral EEG changes too, and four (33.3%) presented unilateral hypoperfusion and bilateral EEG changes. The statistical analysis was based on fuzzy logic. The correlation index among SPECT X EEG, SPECT X MRI and SPECT X EEG X MRI were highly significant, with signifcance levels at 0.01, p < 0.0005 and trust interval at 99% in all correlations. The correlation studies between the series presented similar results.