Biomedical subjects

A Cukiert

Publications and source records attributed to A Cukiert.

At least 37 records · Page 2Linked to original sources

PubMed1997

Unilateral mesial temporal atrophy after a systemic insult as a possible etiology of refractory temporal lobe epilepsy. Case report.

Mesial temporal sclerosis is the main pathological substrate present in refractory temporal lobe epilepsy and its presence is often related to the occurrence of febrile seizures in infancy. There is an on-going discussion on the nature of mesial temporal sclerosis as it related to epilepsy: cause or consequence. A previously normal child developed hyperosmolar coma after abdominal surgery at the age of 6. Three months afterwards he developed simple and complex partial seizures with an increasing frequency and refractory to multiple mono- and polytherapic drug regimens. He was evaluated for surgery at the age of 13. Ictal and interictal recordings showed left temporal lobe abnormalities. Early CT scanning suggested left temporal atrophy. MRI showed mesial temporal sclerosis. Neuropsychological testing showed verbal memory deficits and he passed a left carotid artery amytal injection. He was submitted to a cortico-amygdalo-hippocampectomy and has been seizure-free since then. The clinical data obtained from this patient suggest that at least in this case mesial temporal sclerosis would be related to the cause of epilepsy and not resultant from repeated seizure activity.

Adolescent↗

PubMed1996

Monoamines and their metabolites in cerebrospinal fluid and temporal cortex of epileptic patients.

The involvement of monoamines in the initiation or maintenance of epileptic phenomena has been extensively studied in cerebral tissues and in cerebrospinal fluid. The present work was undertaken to study monoamines and their metabolites in human spiking and non-spiking temporal cortex excised from patients with complex partial seizures unresponsive to available anticonvulsants. The same substances were also analyzed by HPLC-ED in cerebrospinal fluid obtained 24 h before the surgical procedure and compared with those from patients with chronic headache and normal neurological evaluation. The results show increased 5-HT, 5-HIAA and HVA levels in spiking compared with non-spiking cortex. Cerebrospinal fluid levels of 5-HIAA and HVA are concomitantly increased in epileptic compared with headache patients.

Adult↗

PubMed1996

Post-traumatic frontal lobe epilepsy with structural changes: excellent results after cortical resection.

BACKGROUND: The observation that resection of structural lesions of the frontal lobe provides an effective treatment of intractable epilepsy has been made by surgeons specializing in this field for over sixty years! However, the excellent results achieved when such resections are coupled with the use of modern diagnostic and operative technologies are not fully appreciated by the modern clinician. METHODS: We review the results of resection of large post traumatic frontal lesions in six patients with intractable frontal seizures. No invasive EEG recording was required pre-operatively. RESULTS: The imaging characteristics of the underlying lesions, usually due to depressed skull fractures are illustrated. Surgical treatment rendered five patients seizure free and the sixth had over 85% improvement in seizure frequency. CONCLUSIONS: Modern imaging permits ready visualization of the post traumatic lesions with cause intractable seizures. It is important to recognize that resection of these post traumatic scars usually leads to excellent seizure control.

Adolescent↗

PubMed1996

Double pathology in Rasmussen's encephalitis: etiologic considerations.

In a 7-year-old girl with epilepsia partialis continua (EPC) involving the left face, arm, and leg for 1 year, serial neuroimaging studies showed progressive, brain atrophy. Because medical treatment was ineffective, she underwent a large fronto-temporal surgical resection. Neuropathological examination showed loss of lamination and dysplastic neurons, gliosis, microglial nodules, and perivascular cuffing. Such "double pathology" (dysgenesia and a chronic inflammatory process) may have implications for the pathophysiology of Rasmussen's syndrome.

Cerebral Cortex↗

PubMed1996

High doses of carbamazepine for refractory partial epilepsy.

Forty-eight patients with partial seizures were analysed during treatment with 1200 mg/d or more of carbamazepine (CBZ). Thirty-three were on monotherapy and fifteen on polytherapy. The other drugs were kept unchanged in the patients on polytherapy. The dose of CBZ was increased if no control was observed and the patient had no side effects. The doses used ranged between 1200 and 1900 mg/day (1200 mg/day, n = 18; 1300 mg/day, n = 1; 1400 mg/day, n = 7; 1600 mg/day, n = 9; 1700 mg/day, n = 4; 1800 mg/day, n = 8; 1900 mg/day, n = 1). Anticonvulsant plasma levels were taken to confirm patient compliance. The average plasma level was 9.6 ug/mL. The period of follow up varied from 3 to 96 months (M = 25.6). Seizure's control was observed in 7 (14.48%) patients taking 1200 mg/day and in 2 (4.16%) patients taking 1400 mg/day of CBZ. Thirty-nine patients did not show any control (81.21%). Ten patients (20.81%) had signs of intoxication. When patients have no improvement with 1400 mg/day, it is difficult to obtain any control despite the use of higher doses of CBZ, which frequently expose the patient to significant side effects.

Adolescent↗

PubMed1996

Surgical treatment of refractory epilepsy associated with space occupying lesions. Experience and review.

Surgery for space occupying lesions of the brain associated with intractable epilepsy represents a special problem because relief of the epilepsy in as much an operative goal as excision of the space occupying lesion itself. This study concerns 32 patients with space occupying lesions and intractable epilepsy who underwent excision of the lesion with acute intraoperative electrocorticography guided resection of the epileptogenic focus. Of the 32 patients, 16 formed a subgroup of gangliogliomas alone. The remaining were mixed lesions, predominantly benign. The duration of seizures in these patients ranged from 2 to 30 years, and the seizure frequency varied from 1 to 300 convulsions per month. The operative procedures included temporal corticectomy, amygdalo-hippocampectomy, and extratemporal corticectomies. Twenty nine patients were in Engel class I postoperatively, and three patients were in Engel class II. The findings with gangliogliomas were also considered in a separate group. This study strongly suggests that the operative procedure under electrocorticography guidance improves seizure outcome in space occupying lesions related intractable epilepsy.

Adolescent↗

PubMed1995

Surgical approaches to tumors and epileptogenic zones close to Wernicke's area.

Surgical procedures near to language related brain regions may cause severe morbidity in relation to speech. Operations performed under local anesthesia and intraoperative cortical mapping may minimize these risks. Six patients with tumors near the Wernicke's area were treated (2 low-grade astrocytomas, 1 ganglioglioma, 1 xanthoastrocytoma, 1 metastasis, 1 glioblastoma). Their clinical presentation consisted of epilepsy (n = 4) and dysphasia (n = 2). The skin and periosteum were infiltrated with local anesthetic and an ample craniotomy was performed. Cortical stimulation with an unipolar electrode was then carried out with concomitant speech testing (mainly comprehension and sequential speech). After mapping, the best surgical approach aiming to avoid the mapped area was elected. In 5 cases the resection was total and in 1, partial (glioblastoma). There was a transitory (10 days) worsening of the pre-operative deficit in 1 case (glioblastoma). In 3 patients, the speech areas were displaced: posteriorly (n = 2) or anteriorly (n = 1). Surgical procedures under local anesthesia are safe and may avoid post-operative language disturbances in patients with tumors near to Wernicke's area.

Anesthesia, Local↗

PubMed1995

Results from the intracarotid amytal procedure in patients with uni or bitemporal lobe epilepsy and mesial sclerosis.

This study discusses the results from the IAP and its lateralizing and prognostic value in patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS). Eighteen patients were submitted to the IAP. Fifteen had bitemporal and 3 unitemporal lobe epilepsies. All patients had MTS on MRI and in one there was an unrelated lesion in the contralateral hippocampus. Nine bitemporal patients passed after the injection ipsilateral to the MTS and 4 failed bilaterally. One bitemporal passed bilaterally. Seven of these bitemporal patients passed an injection ipsilateral to MTS and failed on contralateral injection. Two of the unitemporal lobe patients passed the ipsilateral injection and failed the contralateral one. One of the unitemporal lobe patients failed bilaterally the IAP. Overall, 56% of the group disclosed the pass ipsi-/fail contralateral pattern in the IAP. Eight patients were operated, are seizure free and had no additional memory deficit. Many patients with TLE were found to have the pass ipsi-/fail contralateral pattern in the IAP. This might prove to be of lateralizing and prognostic value in such cases.

Amobarbital↗

PubMed1995

Hepatic enzymes' level during chronic use of anticonvulsant drugs.

We studied retrospectively 894 adult epileptic patients treated during the period from 1983 to 1992. Hepatic enzymes abnormal values were seen in 49% (n = 438). In 22.3% (n = 200), at least 2 enzyme levels in different moments were altered. They were divided in three groups: GI with alterations at transaminases (3%, n = 6), GII with alterations at GGT and AP enzymes (72%, n = 144) and GIII with alterations in both groups (25%, n = 50). No patient developed clinical symptoms of liver disease. The increase of gamma-glutamil-transferase (GGT) and alkaline phosphatase (AP) levels is frequent and not necessarily pathological. Slight increase of transaminases can occur with no clinical correlation. The routine screening of hepatic enzymes level during the chronic use of anticonvulsivant drugs in adults has a questionable value.

Adolescent↗

PubMed1994

[Clinical manifestations in complex partial crisis of the temporal lobe: a video-electroencephalographic study].

We analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the EEG emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). The temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal EEG recordings, CT and MRI findings, interictal and, in some patients, ictal SPECT studies. 8 patients had surgery. In 5 from 7 patients who had temporal lobectomy, mesial temporal sclerosis was the anatomopathological finding and in one patient who had selective amigdalohippocampectomy, hemosiderosis and gliosis probably due to bleeding of a posterior cerebral artery giant aneurysm was found. All patients have been seizure free after surgery. While dystonic posturing and ictal paresis, present in 18 seizures (66.6%), were excellent as lateralizing seizure signs, since they were always contralateral to the ictal onset, contralateral and ipsilateral versive head and eye movements were observed.

Adult↗

PubMed1994

MRI and brain spect findings in patients with unilateral temporal lobe epilepsy and normal CT scan.

26 patients with temporal lobe epilepsy clinically documented by several abnormal interictal surface EEGs with typical unitemporal epileptiform activity and a normal CT scan were studied. Interictal 99mTC HMPAO brain SPECT and MRI were performed in all subjects. Abnormalities were shown in 61.5% of MRI (n = 16) and 65.4% of SPECT (n = 17). Hippocampal atrophy associated to a high signal on T2-weighted MRI slices suggesting mesial temporal sclerosis was the main finding (n = 12; 75% of abnormal MRI). MRI correlated well to surface EEG in 50% (n = 13). There was also a good correlation between MRI and SPECT in 30.7% (n = 8). SPECT and EEG were in agreement in 57.7% (n = 15). MRI, SPECT and EEG were congruent in 26.9% (n = 7). These results support the usefulness of interictal brain SPECT and MRI in detecting lateralized abnormalities in temporal lobe epilepsy. On the other hand, in two cases, interictal SPECT correlated poorly with surface EEG. This functional method should not be used isolately in the detection of temporal lobe foci. MRI is more useful than CT as a neuroimaging technique in temporal lobe epilepsy. It may detect small structural lesions and mesial temporal lobe sclerosis which are not easily seen with traditional CT scanning.

Adolescent↗

PubMed1994

Dichotic words listening test. Technical aspects and results in normal right-handed individuals.

Dichotic listening tests have been being used in an increasing frequency to determine in a non-invasive way the cerebral dominance in right- and left-handed patients. This is especially relevant when surgery in eloquent brain areas is being contemplated. A Portuguese version of the dichotic words listening test was developed based mainly on Wexler's protocol. It consisted of 15 pairs of words with a stimulus dominance lower than 50%. They were recorded using natural voice and time and intensity synchronization by means of a specialized software. Each pair of words was presented twice in different channels within each block. The items were randomized and presented with a 300 msec interval between each trial. Four blocks of 30 pairs of words each were created, totalizing 120 trials. In the scoring process, the words heard over the right and left ears were wrote down. The number of times each word was heard over each ear was computed and their values subtracted yielding a partial score for each specific word pair. This process was repeated for all stimuli pair and a final score for right and left predominance was then reached. Thirty-two right handed normal individuals underwent the test. 93.8% showed a right ear advantage. These results are very similar to the actual left hemisphere dominance rate in a right-handed population.

Adult↗

PubMed1994

Congruence of the topography of intracranial calcifications and epileptic foci.

Nodular intracranial calcifications (NIC) are frequent findings in CT scans of epileptic patients in countries where granulomatous central nervous disease such as neurocysticercosis is endemic. In 34 consecutive epileptic patients with NIC submitted to EEG, CT and CSF analysis, the correlation between the electroclinical localization of the focus and the topography of the NIC was studied. Twenty-nine patients had partial (Group I) and 5 had primarily generalized seizures (Group II). Twenty group I and 1 group II patients showed abnormal EEGs. CSF abnormalities consisted of increased protein content (n = 3) and positive Weinberg's reaction (n = 2). In 2 cases, viable neurocysticercotic vesicles were seen. Twenty-one patients had single NICs. No correlation could be established in group II patients. Within group I, 15 patients had a positive and 14 a negative correlation. Sixty-six percent of the patients with single NICs had negative correlations. These findings strongly suggest that the calcifications themselves are not the epileptogenic lesions in at least 50% of the studied cases.

Adolescent↗

PubMed1994

Functional significance of MRI defined mesial temporal sclerosis in temporal lobe epilepsy.

The functional significance of MRI-defined mesial temporal sclerosis in temporal lobe epilepsy (TLE) is not completely established. In order to study the possible relationship between signals of mesial temporal sclerosis on MRI and interictal SPECT findings we selected 18 patients with complex partial seizures, unilateral temporal EEG focus and normal CT. The EEG focus was defined by the presence of interictal sharp waves and slow background on several scalp EEG obtained during many years of follow up in all patients and by ictal recordings with sphenoidal electrodes in 12 patients. Group I comprised patients (n = 11) in whom MRI showed mesial temporal sclerosis; group II patients (n = 7) had normal MRIs. All patients were submitted to interictal 99m-Tc HMPAO injections with concomitant EEG monitoring. Lateralized hypoperfusion ipsilateral to the EEG was found in 13 patients (72%). In all Group II and in 6 Group I patients a temporal hypoperfusion was found. This SPECT study showed a higher positivity rate in patients with normal MRI than previously reported. On the other hand, in all these group II patients a neocortical origin of epileptic focus was suspected on clinical or electroencephalographic basis. Positive SPECT findings may be at least as prevalent in neocortical as in mesiolimbic epilepsy.

Adolescent↗

PubMed1994

Frameless stereotaxy for surgery of the epilepsies: preliminary experience. Technical note.

Frameless stereotactic techniques used in conjunction with three-dimensional images allow accurate planning and performance of a variety of neurosurgical procedures. The authors have used the frameless stereotactic Allegro Viewing Wand system to provide real-time correlation of the operating field and computerized images in 42 neurosurgical operations, including 31 epilepsy procedures. The system consists of an image-processing computer that creates three-dimensional and triplanar images; a mobile computer to display reformatted magnetic resonance images; and a hand-guided, articulated, position-sensing arm with a probe. At the start of the operation, the probe identifies the patient's facial and scalp features and correlates these with the computerized images. The position-sensing arm can then guide the operation and locate anatomical structures and lesions of interest. This system can be used to advantage in performing smaller craniotomies and intraoperatively locating anatomical structures and lesions to be removed. Postoperative magnetic resonance images demonstrate that this technique was accurate to within 3 mm in measuring the anteroposterior resection of fixed structures, such as hippocampus and corpus callosum. Disadvantages include longer preoperative preparation for data analysis and lack of both real-time computer analysis of tissue removal and angiographic data display. Preliminary experience suggests that the viewing wand system's advantages outweigh the disadvantages, and it is most helpful as an adjunctive navigational device in the microsurgical treatment of epilepsy.

Adolescent↗

PubMed1993

Increased neocortical spiking and surgical outcome after selective amygdalo-hippocampectomy.

We studied the electrocorticogram (ECoG) before and immediately after transcortical selective amygdalo-hippocampectomy, prospectively in 13 consecutive patients and retrospectively in three others. ECoG was performed with surface and two depth electrodes inserted through T2 aimed at the amygdala and anterior hippocampus. Before resection the ECoG showed a variable amount of interictal spiking, recorded either independently from the depth and surface, or synchronously. A small cortical incision (2-3 cm) was made in T2. The hippocampus, amygdala and parahippocampal gyrus were removed subpially. After the resection, increased epileptiform abnormality was observed in all 16 patients and a different ECoG pattern emerged. It consisted of repetitive, high amplitude spikes and polyspikes, separated by attenuated background, recorded from the most anterior temporal area. Similar observations were reported by Niemeyer in 1958. The outcome was comparable to that of standard anterior temporal resection: 62.5% class I and 25% class II (Engel's scale). ECoG is often used to tailor the amount of resection, and the persistence of epileptic abnormalities correlates with worse outcome. This is not the case in selective amygdalo-hippocampectomy, suggesting that a different underlying mechanism is responsible for the increased interictal spiking following this procedure.

Adolescent↗

PubMed1992

Brain SPECT in the pre-surgical evaluation of epileptic patients. Preliminary results.

Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n = 10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.

Adult↗

PubMed1992

Traumatic callosotomy.

In a 33 years-old epileptic woman with a traumatic impact to the vertex, clinical and radiological studies (skull X-R, CT and MRI) disclosed an extensive callosal section under the topography of the falx, associated to fronto-basal contusions. There was a significant improvement in the epileptic syndrome. No interhemispheric disconnection syndrome could be determined, which is compatible with the posterior regions of the corpus callosum having been spared. This is, to the best of our knowledge, the most extensive callosal injury documented by MRI to date.

Accidental Falls↗