Análise de padrões ictais em epilepsia mesial do lobo temporal e correlação com alterações do polo temporal na ressonância magnética
Nenhuma Miniatura disponível
Arquivos
Data
2004
Autores
Caboclo, Luís Otávio Sales Ferreira [UNIFESP]
Orientadores
Sakamoto, Américo Ceiki [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Em pacientes com epilepsia mesial do lobo temporal (EMLT) secundária a esclerose hipocampal (EH), o tratamento cirúrgico – lobectomia temporal anterior (LTA) – é superior ao tratamento medicamentoso, no que diz respeito ao controle de crises e à qualidade de vida. Apesar dos bons resultados obtidos com a LTA, o prognóstico pós-operatório com relação ao controle de crises varia entre diferentes séries. Os dados da avaliação neurofisiológica e de neuroimagem são freqüentemente usados como fatores prognósticos.
Em nosso estudo, analisamos 147 crises de 35 pacientes com EMLT e EH unilateral submetidos a tratamento cirúrgico. As crises foram analisadas com relação ao padrão de início ictal e à lateralização das descargas iniciais. Estudamos as alterações encontradas na RM de encéfalo desses pacientes, com particular atenção àquelas observadas no polo temporal (alteração de sinal e assimetria entre os volumes dos dois polos). Os dados referentes aos padrões ictais e às anormalidades do polo temporal foram comparados entre si e com o prognóstico pós-operatório.
O padrão ictal inicial mais freqüente foi a atividade teta rítmica, observada em 96 crises (65%). Freqüentemente, entretanto, os pacientes apresentaram mais de um tipo de padrão ictal. Dois terços dos pacientes apresentaram alteração do sinal do polo temporal detectado pela RM. Sessenta por cento apresentaram assimetria significativa (>10%) entre os volumes dos dois polos temporais. Em todos os casos, as alterações observadas no polo temporal foram ipsilaterais à EH. Não foi observada relação entre as alterações dos polos temporais e o tipo de padrão ictal apresentado pelos pacientes, nem tampouco entre alterações dos polos temporais e prognóstico pós-operatório com relação ao controle de crises, embora o tamanho da amostra tenha impedido análise estatística mais detalhada.
Nesse estudo nós concluímos que o padrão ictal mais comumente observado em pacientes com EMLT e EH unilateral é a atividade rítmica na faixa teta. Concluímos também que alterações do polo temporal são comuns nesses pacientes, são ipsilaterais à EH e, portanto, podem auxiliar na detecção de anormalidades estruturais lateralizadas.
In patients with mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) surgical treatment – anterior temporal lobectomy (ATL) – is superior to medical treatment with respect of seizure control and quality of life. In spite of generally good surgical results, post surgical prognosis with respect to seizure control varies among different series. Data obtained in neurophysiological evaluation as well as neuroimaging data are frequently used as prognostic factors. In our study, we analyzed 147 seizures from 35 patients with MTLE and unilateral HS who were submitted to surgical treatment. Data concerning initial ictal pattern as well as lateralizing features were analyzed. We analyzed the MRI exams, with particular attention to abnormalities detected in the temporal poles (abnormal signal and volumetric asymmetry between the two poles). Rhythmic theta activity was the most frequent ictal pattern, and was observed in 96 seizures (65%). However, patients frequently presented more than one initial ictal pattern. Two thirds of the patients had abnormal signal in the temporal pole diagnosed by MRI. Sixty percent of the patients had significant (>10%) volumetric asymmetry between the two temporal poles. Abnormalities diagnosed in the temporal poles were ipsilateral to the HS in all cases. These abnormalities were neither associated to the type of ictal pattern presented by the patients, nor to post surgical prognosis with respect to seizure control. The size of the sample, however, impeded more detailed statistical analysis. In this study we concluded that rhythmic theta activity is the most frequent initial ictal pattern in patients with MTLE and unilateral HS. We also concluded that temporal pole abnormalities are often observed among these patients, these abnormalities are ipsilateral to HS, and therefore may be helpful in detection of lateralized structural abnormalities.
In patients with mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) surgical treatment – anterior temporal lobectomy (ATL) – is superior to medical treatment with respect of seizure control and quality of life. In spite of generally good surgical results, post surgical prognosis with respect to seizure control varies among different series. Data obtained in neurophysiological evaluation as well as neuroimaging data are frequently used as prognostic factors. In our study, we analyzed 147 seizures from 35 patients with MTLE and unilateral HS who were submitted to surgical treatment. Data concerning initial ictal pattern as well as lateralizing features were analyzed. We analyzed the MRI exams, with particular attention to abnormalities detected in the temporal poles (abnormal signal and volumetric asymmetry between the two poles). Rhythmic theta activity was the most frequent ictal pattern, and was observed in 96 seizures (65%). However, patients frequently presented more than one initial ictal pattern. Two thirds of the patients had abnormal signal in the temporal pole diagnosed by MRI. Sixty percent of the patients had significant (>10%) volumetric asymmetry between the two temporal poles. Abnormalities diagnosed in the temporal poles were ipsilateral to the HS in all cases. These abnormalities were neither associated to the type of ictal pattern presented by the patients, nor to post surgical prognosis with respect to seizure control. The size of the sample, however, impeded more detailed statistical analysis. In this study we concluded that rhythmic theta activity is the most frequent initial ictal pattern in patients with MTLE and unilateral HS. We also concluded that temporal pole abnormalities are often observed among these patients, these abnormalities are ipsilateral to HS, and therefore may be helpful in detection of lateralized structural abnormalities.
Descrição
Citação
CABOCLO, Luís Otávio Sales Ferreira. Análise de padrões ictais em epilepsia mesial do lobo temporal e correlação com alterações do polo temporal na ressonância magnética. 2004. 138 f. Dissertação (Mestrado) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2004.