Navegando por Palavras-chave "hippocampal sclerosis"

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    Characterising subtypes of hippocampal sclerosis and reorganization: correlation with pre and postoperative memory deficit
    (Wiley, 2018) Jardim, Anaclara Prada [UNIFESP]; Liu, Joan; Baber, Jack; Michalak, Zuzanna; Reeves, Cheryl; Ellis, Matthew; Novy, Jan; de Tisi, Jane; McEvoy, Andrew; Miserocchi, Anna; Yacubian, Elza Marcia Targas [UNIFESP]; Sisodiya, Sanjay; Thompson, Pamela; Thom, Maria
    Neuropathological subtypes of hippocampal sclerosis (HS) in temporal lobe epilepsy (The2013 International League Against Epilepsy classification) are based on the qualitativeassessment of patterns of neuronal loss with NeuN. In practice, some cases appear indeterminate between type 1 (CA1 and CA4 loss) and type 2 HS (CA1 loss) and we predicted that MAP2 would enable a more stringent classification. HS subtypes, as well asthe accompanying alteration of axonal networks, regenerative capacity and neurodegeneration have been previously correlated with outcome and memory deficits and may provide prognostic clinical information. We selected 92 cases: 52 type 1 HS, 15 type 2 HS, 18 indeterminate-HS and 7 no-HS. Quantitative analysis was carried out on NeuN and MAP2 stained sections and a labeling index (LI) calculated for six hippocampal subfields. We also evaluated hippocampal regenerative activity (MCM2, nestin, olig2, calbindin), degeneration (AT8/phosphorylated tau) and mossy-fiber pathway re-organization (ZnT3). Pathology measures were correlated with clinical epilepsy history, memory and naming test scores and postoperative outcomes, at 1 year following surgery. MAP2 LI in indeterminate-HS was statistically similar to type 2 HS but this clustering was not shown with NeuN. Moderate verbal and visual memory deficits were noted in all HS types, including 54% and 69% of type 2 HS. Memory deficits correlated with several pathology factors including lower NeuN or MAP2 LI in CA4, CA1, dentate gyrus (DG) and subiculum and poor preservation of the mossy fiber pathway. Decline in memory at 1 year associated with AT8 labeling in the subiculum and DG but not HS type. We conclude that MAP2 is a helpful addition in the classification of HS in some cases. Classification of HS subtype, however, did not significantly correlate with outcome or pre- or postoperative memory dysfunction, which was associated with multiple pathology factors including hippocampal axonal pathways, regenerative capacity and degenerative changes.
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    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.
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    Employment and quality of life in mesial temporal lobe epilepsy with hippocampal sclerosis: is there a change after surgical treatment?
    (Liga Brasileira de Epilepsia (LBE), 2009-06-01) Alonso, Neide Barreira [UNIFESP]; Azevedo, Auro Mauro [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Guilhoto, Laura Maria de Figueiredo Ferreira [UNIFESP]; Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: The aim of this study was to evaluate in patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS): (1) employment patterns before and three years after epilepsy surgery and their impact in Quality of Life (QOL); (2) demographic and clinical variables associated with employment. METHODS: Data from 58 patients with diagnosis of refractory MTLE with HS who had corticoamygdalo-hippocampectomy were analyzed. The subjects answered to Brazilian validated version of the Epilepsy Surgery Inventory (ESI-55) before, and three years after surgery. In a semi-structured interview, sociodemographic and clinical characteristics were obtained. Changes in employment after surgery were classified in one of the three categories: (i) improvement status: those who were unemployed, no-formal employed, students, housewives and subjects who have never worked to employed category; (ii) unchanged status: no change in occupation; this category included subjects who were employed before and after the surgery, housewives, students, and the group who remained unemployed, receiving ill-health benefits or retired after the surgical treatment; and (iii) worsened status: loss of employment. RESULTS: Employment status did not show any significant change after surgery: in 51(87.9%) it remained unchanged, in six (10.3%) it improved, and one patient (1.7%), who was employed before the surgery, retired after that. In a subgroup of 22 patients employed after surgery, ten (45.5%) were seizure-free, seven (31.8%) had only rare auras, and five (22.7%) had seizures. In the group of improvement, 12 patients (70.5%) had no-formal employment and five (29.5%) had a formal job before surgery. After three years, 14 (63.6%) of 22 subjects were formally employed. Our data suggested that the employability was strongly correlated (p<0.05) with a positive perception of health-related quality of life measured by ESI-55, before and after surgical evaluation. CONCLUSION: Our study demonstrated in a homogeneous group of MTLE with HS, a modest, but positive relationship between surgical outcome and work gain, and that QOL had strong correlation with the fact of being employed.
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    Facial paresis in patients with mesial temporal sclerosis: Clinical and quantitative MRI-based evidence of widespread disease
    (Blackwell Publishing, 2007-08-01) Lin, Katia [UNIFESP]; Carrete Junior, Henrique [UNIFESP]; Lin, Jaime [UNIFESP]; Leite de Oliveira, Pedro Alessandro; Caboclo, Luis Otávio Sales Ferreira [UNIFESP]; Sakamoto, Américo Ceiki [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To assess the frequency and significance of facial paresis (FP) in a well-defined cohort of mesial temporal lobe epilepsy (MTLE) patients.Methods: One hundred consecutive patients with MRI findings consistent with mesial temporal sclerosis (NITS) and concordant electroclinical data underwent facial motor examination at rest, with voluntary expression, and with spontaneous smiling. Hippocampal, amygdaloid, and temporopolar (TP) volumetric measures were acquired. Thirty healthy subjects, matched according to age and sex, were taken as controls.Results: Central-type FP was found in 46 patients. in 41 (89%) of 46, it was visualized at rest, with voluntary and emotional expression characterizing true facial motor paresis. in 33 (72%) of 46 patients, FP was contralateral to the side of NITS. By using a 2-SD cutoff from tile mean of normal controls, we found reduction in TP volume ipsilateral to MTS in 61% of patients with FP and in 33% of those without (p = 0.01). Febrile seizures as initial precipitating injury (IPI) were observed in 34% of the patients and were classified as complex in 12 (26%) of 46 of those with FP and in five (9%) of 54 of those without (p = 0.02). the presence of FP was significantly associated with a shorter latent period and younger age at onset of habitual seizures, in particular, with secondarily generalized tonic-clonic seizures.Conclusions: Facial paresis is a reliable lateralizing sign in MTLE and was associated with history of complex febrile seizures as IPI, younger age at onset of disease, and atrophy of temporal pole ipsilateral to NITS, indicating more widespread disease.
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    Granular 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.
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    Hippocampal sclerosis and status epilepticus - cause or consequence? A MRI study
    (Assoc Arquivos Neuro- Psiquiatria, 2007-12-01) Kuster, Gustavo Wruck [UNIFESP]; Braga-Neto, Pedro [UNIFESP]; Santos-Neto, Denizart [UNIFESP]; Garcia Santana, Maria Teresa [UNIFESP]; Martins Maia, Antonio Carlos; Barsottini, Orlando Graziani Povoas [UNIFESP]; Fleury Inst; Universidade Federal de São Paulo (UNIFESP)
    Background: Transient imaging abnormalities, including changes on diffusion-weighted imaging (DWI), maybe seen in status epilepticus. These abnormalities can be followed by hippocampal sclerosis. Case report: We report a 15-year-old lady with focal non convulsive status epilepticus (NCSE) and focal slowing on EEG. DWI exhibited abnormal hyperintense signals in bilateral temporal and insular cortices. After 3 weeks, MRI performed a localizated hippocampal atrophy. Conclusion: the MRI findings indicated vasogenic and cytotoxic edema during seizure activity and subsequent loss of brain parenchyma.
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    Long-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 Mara
    Object. 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)
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    Spontaneous seizures preferentially injure interneurons in the pilocarpine model of chronic spontaneous seizures
    (Elsevier B.V., 1996-12-01) Mello, LEAM; Covolan, Luciene [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    It is still a question of much debate whether single epileptic seizures can cause cell loss. Despite the clinical impression that epilepsy in generalis a progressive disorder, experimental evidence is not conclusive on this point. Recently, it has been shown that electrically-induced afterdischarges of less than 2 min may induce structural impairments in neurons. Here we evaluated whether spontaneous seizures would lead to similar impairments. Chronic spontaneous recurrent seizures were induced with pilocarpine (320 mg/kg, i.p.). Animals were sacrificed from 1 to 6 h either after single or multiple seizures. A Golgi-like sensitive silver-impregnation procedure was used to reveal injured neurons. Silver-impregnated dark neurons were never found in control animals nor in epileptic animals that had no behavioral seizures in the 8 h prior to sacrifice. After spontaneous seizures (injured) dark neurons were mostly interneurons and were present in hippocampus (CA1 stratum radiatum), amygdala, piriform cortex and other limbic structures. Animals with multiple seizures had a higher number of dark cells than animals with single seizures. Our findings suggest that even single generalized spontaneous tonic-clonic seizures can induce long-lasting morphological changes. Our results favor the idea that epilepsy is a progressive disorder where one seizure begets the next.
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    Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome
    (Academia Brasileira de Neurologia - ABNEURO, 2012-05-01) Jardim, Anaclara Prada [UNIFESP]; Neves, Rafael Scarpa da Costa [UNIFESP]; Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Lancellotti, Carmen Lucia Penteado; Marinho, Murilo Martinez [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Cavalheiro, Esper Abrão [UNIFESP]; Scorza, Carla Alessandra [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Department of Pathology; Associação Fundo de Incentivo à Pesquisa Department of Pathology, Medical Diagnosis
    OBJECTIVE: To analyze retrospectively a series of patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS), and the association of patterns of hippocampal sclerosis with clinical data and surgical prognosis. METHOD: Sixty-six patients with medically refractory TLE with unilateral MTS after anterior temporal lobectomy were included. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patient's clinical data and surgical outcome were reviewed. RESULTS: Occurrence of initial precipitating insult (IPI), as well as better postoperative seizure control (i.e. Engel class 1), were associated with classical and severe patterns of hippocampal sclerosis (MTS type 1a and 1b, respectively). CONCLUSION: Quantitative evaluation of hippocampal neuronal loss patterns predicts surgical outcome in patients with TLE-MTS.
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    Temporal lobe epilepsy with unilateral hippocampal sclerosis and contralateral temporal scalp seizure onset: report of four patients with burned-out hippocampus
    (Liga Brasileira de Epilepsia (LBE), 2005-01-01) Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Garzon, Eliana [UNIFESP]; Miyashira, Flávia Saori [UNIFESP]; Carrete Junior, Henrique [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Sakamoto, Américo Ceiki [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    ABSTRACT OBJECTIVES: Patients with temporal lobe epilepsy (TLE) and unilateral severe hippocampal sclerosis (HS) may have contralateral temporal scalp ictal onset. This has recently been called burned-out hippocampus, which is believed to be a rare entity. In this study we report four patients with unilateral hippocampal sclerosis and contralateral ictal onset registered by scalp electrodes. We discuss the importance of such cases in presurgical evaluation of patients with TLE, as well as possible strategies used for evaluation of these particular cases. PATIENTS AND METHODS: We reviewed charts from all patients with TLE submitted to pre-surgical evaluation, which included high resolution MRI and prolonged video-electroencephalogram (video-EEG) monitoring with scalp and sphenoidal electrodes, during a three-year period (2002-2004). We looked for patients who only had seizures that were clearly contralateral in location to the atrophic hippocampus. RESULTS: Four patients fulfilled the criteria above. Two of these patients had semi-invasive video-EEG monitoring with foramen ovale (FO) electrodes, which revealed seizures originating from the temporal lobe with the atrophic hippocampus, hence confirming false lateralization in the scalp-sphenoidal EEG. These patients were submitted to surgical treatment and had favorable prognosis after surgery. CONCLUSIONS: Burned-out hippocampus syndrome may not be as rare as it was previously believed. Further studies will be necessary before one can affirm that patients with unilateral HS and scalp ictal EEG showing contralateral ictal onset may be operated without confirmation of the epileptogenic zone by invasive monitoring. In these patients, semi-invasive monitoring with FO electrodes might be an interesting alternative.
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    Temporal pole signal abnormality on MR imaging in temporal lobe epilepsy with hippocampal sclerosis: a fluid-attenuated inversion-recovery study
    (Academia Brasileira de Neurologia - ABNEURO, 2007-09-01) Carrete Junior, Henrique [UNIFESP]; Abdala, Nitamar [UNIFESP]; Lin, Katia [UNIFESP]; Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Sakamoto, Américo Ceiki [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Nogueira, Roberto Gomes [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To determine the frequency and regional involvement of temporal pole signal abnormality (TPA) in patients with hippocampal sclerosis (HS) using fluid-attenuated inversion-recovery (FLAIR) MR imaging, and to correlate this feature with history. METHOD: Coronal FLAIR images of the temporal pole were assessed in 120 patients with HS and in 30 normal subjects, to evaluate gray-white matter demarcation. RESULTS: Ninety (75%) of 120 patients had associated TPA. The HS side made difference regarding the presence of TPA, with a left side prevalence (p=0.04, chi2 test). The anteromedial zone of temporal pole was affected in 27 (30%) out of 90 patients. In 63 (70%) patients the lateral zone were also affected. Patients with TPA were younger at seizure onset (p=0.018), but without association with duration of epilepsy. CONCLUSION: Our FLAIR study show temporal pole signal abnormality in 3/4 of patients with HS, mainly seen on the anteromedial region, with a larger prevalence when the left hippocampus was involved.