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S Arroyo

Publications and source records attributed to S Arroyo.

At least 37 records · Page 2Linked to original sources
PubMed1999

The Spanish Version of the Quality-of-Life in Epilepsy Inventory (QOLIE-31): translation, validity, and reliability.

PURPOSE: Spanish adaptation of the Quality of Life in Epilepsy Inventory (QOLIE-31). METHODS: Internal consistency and construct validity of the Spanish translation of the QOLIE-31 were tested in 252 patients with epilepsy. Patients also were administered the General Health Questionnaire (GHQ-28), and the Nottingham Health Profile (NHP). Two weeks after the first test, a subgroup of randomly selected patients were readministered the QOLIE-31 along with a new five-option question about change in health status. Patients reporting no change in health status were included in the study of temporal stability. Sensitivity to clinical change was assessed in 31 additional patients who had successfully undergone epilepsy surgery. RESULTS: The QOLIE-31 was highly correlated with the GHQ-28 (r = -0.63) and the NHP (r = -0.69), demonstrating construct validity. Cronbach's alpha coefficient was 0.92, showing the items of the QOLIE-31 to be interdependent and homogeneous. For a 2-week test retest, both Pearson product-moment correlation and intraclass correlation coefficients were 0.90, indicating temporal stability. Sensitivity to clinical change was suggested by a significant mean difference between the global scores both before and after epilepsy surgery (-21.87, p<0.0001; 95% CI, -28.08 to -15.66). The standardized response mean of the global score was 1.67, and the effect size was 1.35, both indicating large clinical change as a result of seizure relief. CONCLUSIONS: The similarity of psychometric properties between the English and the Spanish versions of the QOLIE-31 supports their conceptual equivalence. The questionnaire's responsiveness to clinical change suggests its utility in outcome assessment of drug trials and epilepsy surgery.

Adult↗
PubMed1999

[New treatments in epilepsy].

In recent years the treatment of epilepsies has significantly evolved. The launching of six new antiepileptic drugs--vigabatrin, lamotrigine, felbamate, gabapentin, topiramate and tiagabin--has considerably increased the available therapeutic options. On the other hand, the use of no pharmacologic treatments such as surgery of epilepsy, the implantation of the vagal stimulator or cetogenic diets has increased. In the next decade new antiepileptic drugs will probably be available with different mechanisms of actions which will improve the treatment of epilepsy.

Anticonvulsants↗
PubMed1998

Ictal smile.

PURPOSE: Smiling is sometimes manifested during partial seizures. Its value for localizing the epileptogenic focus is not known. We analyzed smiling as an ictal manifestation possibly useful for seizure localization. METHODS: We reviewed patients referred to the video-EEG monitoring unit who presented a smile as part of their critical symptoms. Ictal smile was defined as an accordant expression accompanied by other characteristic epileptic symptoms and ictal EEG activity. RESULTS: Five of 86 patients experienced partial seizures with an ictal smile. We observed smiling during parietal (two patients) and temporal lobe (three patients) seizures. The right hemisphere appeared to be involved with greater frequency. CONCLUSIONS: Ictal smile is an uncommon manifestation of partial seizures involving temporal or parietal lobes, localized mainly on the right hemisphere.

Adult↗
PubMed1998

Single photon emission computed tomography (SPECT) in a patient with bilateral temporal seizures: correlation between ictal EEG and postictal/ictal SPECT.

We report a patient with bilateral independent temporal lobe seizures in whom two [99mTc]HMPAO single photon emission computed tomograph (SPECT) scans were performed during two different seizures. In the first periictal SPECT, [99mTc]HMPAO was injected in the interval between two closely spaced seizures (one localized in the left temporal lobe and the other in the right temporal lobe). SPECT images showed hypoperfusion in the left lateral temporal lobe, hyperperfusion of the left mesial temporal region, and pronounced hyperperfusion in the right anterior temporal lobe. These results suggest both a postictal left temporal SPECT pattern and an ictal right temporal pattern. In the second periictal SPECT, [99mTc]HMPAO was injected immediately after a right temporal lobe seizure and showed right lateral temporal lobe hypoperfusion and right mesial hyperperfusion, suggesting a postictal right temporal SPECT pattern. Interpretation of the periictal SPECT should take into account EEG changes at the time or in the minutes immediately after injection of [99mTc]HMPAO.

Adult↗
PubMed1998

Motor and sensory mapping of the frontal and occipital lobes.

In patients with intractable epilepsy, surgical resections are performed with the primary goal of improving seizure control. The risk is that the resections may also remove tissues crucial for normal activities. The goal of surgical planning is therefore to determine as accurately as possible the regions of seizure onset and the regions controlling important functions, so that one can determine what to remove and what to leave in place. Clinical functional localization has been performed using cortical stimulation for over half a century, using both intraoperative and extraoperative methods. Signal averaging also has been widely used. More recently, techniques based on analysis of EEG in the frequency domain have shown promise. The methods appear to accurately indicate the function of the region assessed but do not necessarily predict functional consequences of resection. We review these methods, their indications, and the results obtained by their use.

Brain Mapping↗
PubMed1998

[Cerebral SPECT in partial epilepsy].

UNLABELLED: Effective surgical treatment of patients with medically intractable complex partial seizures depends on accurate preoperative localization of the seizure focus. 99mTc-HMPAO brain SPECT could assist us in localizing the epileptic foci showing focal hypoperfusion on interictal SPECT and hyperperfusion on ictal SPECT. METHODS: Video-EEG monitoring, MRI, as well as interictal and peri-ictal brain SPECT were performed on 37 patients with refractory epilepsy. Ictal brain SPECT was performed on 14 patients and in the remaining 23 patients a postictal SPECT was obtained. Video-EEG was used as the gold standard procedure for localizing the seizure focus and was compared to the interictal and peri-ictal brain SPECT results. Twenty-four patients suffered from temporal lobe epilepsy and 13 had extratemporal seizures. RESULTS: Interictal brain SPECT correctly localized the seizure focus in 43% of the patients (58.3% of the patients with temporal lobe seizures and 15.4% of the patients with extratemporal seizures). Ictal SPECT correctly identified the seizure focus in the 93% of cases (100% of the patients with temporal lobe seizures and 75% of the patients with extratemporal seizures). Finally, 52% of the patients were correctly identified with postictal SPECT (71.4% of the patients with temporal lobe seizures and 22.2% of the patients with extratemporal seizures). CONCLUSION: Our findings suggest that interictal brain SPECT could assist in the localization of temporal lobe seizures. Tracer injection during seizure or immediately after it (peri-ictal SPECT) is the method of choice for SPECT imaging aimed at the non-invasive localization of seizure focus.

Adolescent↗
PubMed1997

Ictal laughter associated with paroxysmal hypothalamopituitary dysfunction.

PURPOSE: Seizures with ictal laughter (also termed gelastic seizures) have been associated with hypothalamic hamartomas and precocious puberty. It is not known, however, where in the brain such seizures originate. We describe a child with gelastic seizures and a hypothalamic lesion (probably a hamartoma) in whom two dysfunctional phenomena were observed. RESULTS: First, there was a hyperperfusion in the hypothalamopituitary areas shown by ictal [99m]Tc hexamethyl-propyleneamine oxime (HM-PAO) single photon-emission computed tomography (SPECT). Second, there was an ictal pulse of gonadotropins, 17 beta-estradiol, and growth hormone well above the normal limits in one of the seizures. CONCLUSION: These findings suggest that gelastic seizures associated with hypothalamic hamartomas are generated in the hypothalamus or in its neighboring regions and that these seizures may cause paroxysmal dysfunction of the hypothalamopituitary axis.

Adolescent↗
PubMed1997

Neuronal generators of visual evoked potentials in humans: visual processing in the human cortex.

PURPOSE: We wished to define the localization of cortical generators of visual (pattern) evoked potentials (VEP) and the temporal sequence of activation in the occipital region. METHODS: In 4 candidates for epilepsy surgery, a large array of subdural electrodes was placed over occipital areas. Checkerboard pattern reversal stimuli were generated and the epileptogenic focus was localized and functionally mapped. Magnetic resonance imaging did not show any occipital lesions in any of the 4 patients. RESULTS: The area first activated was the lingual gyrus in the mesial occipital lobe (negative potential peaks at approximately 70 ms), followed by an area superior to the calcarine fissure (negative peaks at approximately 80 ms). Later (starting at approximately 90 ms), there were positive potentials over the occipital pole and lingual gyrus, followed by potentials at the lateral occipital lobe. CONCLUSIONS: These data support the idea that VEP are generated in the mesial and lateral occipital cortex by different circumscribed neuronal generators with different latencies of activation. The scalp-recorded N1 and P1 potential peaks most likely derive from the progressive activation of neuronal masses in different regions of the occipital lobe.

Brain Mapping↗
PubMed1997

What is the relationship between arachnoid cysts and seizure foci?

PURPOSE: Arachnoid cysts are sometimes encountered in MRIs performed for a variety of reasons. In patients with epilepsy, particularly those with refractory epilepsy, arachnoid cysts are often assumed to be related to their seizure focus. We conducted a study to investigate this putative relationship. METHODS: A retrospective study on the incidence of arachnoid cysts was performed in patients seen in our Epilepsy Clinic who had CT or MRI scans, interictal EEGs or ictal EEGS. Locations of seizure foci in these patients were defined from clinical and electrophysiologic data. RESULTS: Seventeen of 867 patients had arachnoid cysts. Twelve patients had temporal lobe cysts and only 3 of them had temporal lobe seizures. Four patients had frontal lobe cysts and only 1 had frontal lobe seizures ipsilateral to the cyst. One patient had a cerebello-pontine angle cyst and frontal lobe seizures. Thus, clinical manifestations of seizures and EEG findings (interictal and/or ictal) indicated that the seizure focus was adjacent to the cysts in only 4 patients (23.5%). CONCLUSIONS: Our findings suggest that arachnoid cysts are often an incidental finding in patients with epilepsy and do not necessarily reflect the location of the seizure focus.

Adolescent↗
PubMed1997

[Differential traits of non-convulsive status epilepticus].

Non convulsive status epilepticus (NCSE) is defined by prolonged loss of awareness and epileptiform activity on electroencephalogram. There are several types of NCSE depending of the clinical and electroencephalographic manifestations: generalized (typical or atypical absence status, status epilepticus during sleep) and partial (complex partial and simple partial status epilepticus). NCSE diagnosis and treatment should be performed early due to the potential brain damage associated to it, specially in complex partial NCSE. Accurate differential diagnosis from other imitators of NCSE (psychogenic seizures, metabolic encephalopaties or antiepileptic drug intoxication) is necessary for early treatment.

Anticonvulsants↗
PubMed1996

[Diagnosis and treatment of drug-resistant epilepsy].

Important progress has been made in the treatment of drug-resistant epilepsy in recent years as the result of the introduction of new antiepileptic drugs and surgical procedures. Drug resistance can be the result of a variety of factors: incorrect diagnosis, lack of compliance with treatment, inappropriate antiepileptic therapy, as well as drug resistance per se. Appropriate drug therapy for epileptic syndromes, or symptomatic treatment of the type of seizure, are in general the most effective treatments for the patients whose conditions remain uncontrolled. Dose should be the highest tolerated by the patients without side effects, regardless of plasma levels reached. New antiepileptic drugs are indicated as alternatives for complementary therapy in drug-resistant patients, though their use is still experimental. Surgery is not the last option, but rather constitutes yet another valid alternative. In certain cases of temporal mesial syndrome, for example, early surgery may be indicated.

Anticonvulsants↗
PubMed1996

[Surgery for epilepsy: evaluation and indication].

Surgery for epilepsy is effective for the controlling of seizures in patients with pharmacoresistant forms. To screen candidates for surgery, diagnosis must be certain sure and the form must be drug resistant. Seizures must interfere with quality of life and the patient must be medically and psychologically stable. Selecting patients for surgery demands meticulous evaluation, including prolonged video-EEG to record seizures, magnetic resonance and, often, additional function imaging tests and neuropsychological examination. The most frequently performed surgery and the type with the best results is temporal lobectomy in patients with complex partial seizures arising in the mesial temporal lobe. Other techniques, such as hemispherectomy, callostomy or reduced cortical or extratemporal lobar resection, can yield improved or total control over seizures in certain patients.

Brain↗
PubMed1994

Proton MR spectroscopy in patients with seizure disorders.

PURPOSE: To evaluate the ability of proton MR spectroscopy to detect metabolic abnormalities in the seizure focus of humans with epilepsy. METHODS: Single-voxel MR spectroscopy and MR imaging was performed in a group of 13 patients with a variety of seizure disorders and in the temporal lobes of 14 healthy volunteers. Signals from choline, creatine, N-acetyl-L-aspartate, and lactate were quantitated in both the epileptogenic focus and the contralateral brain region. RESULTS: In normal temporal lobe, concentrations of choline, creatine, and N-acetyl-L-aspartate were 2.0 +/- 0.7, 7.8 +/- 1.9, and 11.0 +/- 2.1 mumol/g wet weight, respectively, with no detectable lactate. In all patients, a reduction in the N-acetyl-L-aspartate signal was observed in the electrically defined (scalp electroencephalogram) seizure focus compared with the mirror-image contralateral side. Lactate was elevated only in patients who had seizures during or immediately before the MR examination. Seven of 13 patients studied had normal MR examinations. CONCLUSIONS: Proton spectroscopy demonstrates alterations in N-acetyl-L-aspartate and lactate levels that can be used to locate the epileptogenic focus and may be a useful adjunctive diagnostic technique for the evaluation of patients with seizures who are eligible for resective surgery.

Adolescent↗
PubMed1993

Superior cerebral protection with profound hypothermia during circulatory arrest.

The optimal temperature for cerebral protection during hypothermic circulatory arrest is not known. This study was undertaken to test the hypothesis that deeper levels of cerebral hypothermia (< 10 degrees C) confer better protection against neurologic injury during prolonged hypothermic circulatory arrest ("colder is better"). Twelve male dogs (20 to 25 kg) were placed on closed-chest cardiopulmonary bypass via femoral artery and femoral/external jugular vein. Using surface and core cooling, tympanic membrane temperature was lowered to 18 degrees to 20 degrees C (deep hypothermia, n = 6) or 5 degrees to 7 degrees C (profound hypothermia, n = 6). After 2 hours of hypothermic circulatory arrest, animals were rewarmed to 35 degrees to 37 degrees C on cardiopulmonary bypass. All were mechanically ventilated and monitored in an intensive care unit setting for 20 hours. Neurologic assessment was performed every 12 hours using a species-specific behavior scale that yielded a neurodeficit score ranging from 0% to 100%, where 0 = normal and 100% = brain dead. After 72 hours, animals were sacrificed and examined histologically for neurologic injury. Histologic injury scores were assigned to each animal (range, 0 [normal] to 100 [severe injury]). At the end of the observation period, profoundly hypothermic animals had better neurologic function (neurodeficit score, 5.7% +/- 4.0%) compared with deeply hypothermic animals (neurodeficit score, 41% +/- 9.3%; p < 0.006). Every animal had histologic evidence of neurologic injury, but profoundly hypothermic animals had significantly less injury (histologic injury score, 19.2 +/- 1.2 versus 48.3 +/- 1.5; p < 0.0001).

Animals↗
PubMed1993

EEG and prognosis of neurologic recovery of dogs under profound hypothermic circulatory arrest.

Deep hypothermia (18-20 degrees C) (DH) during prolonged circulatory arrest and cardiopulmonary bypass is used to repair complex intracardiac lesions and vascular neurosurgical lesions. DH diminishes the risk of ischemic damage and multiorgan failure after circulatory arrest. Profound hypothermia (PH) to 6-7 degrees C has recently been reported to improve the neurological outcome of dogs after 2 h of circulatory arrest. There are no reports of the possible utility of EEG activity to predict the neurological outcome. As a part of a controlled study of cardiopulmonary bypass and 2 h of circulatory arrest we compared EEG recovery to the neurological outcome in 2 groups of dogs: 4 under DH and 4 under PH. All of the dogs under PH had a good outcome: mean neurodeficit score was 6.25/500 in PH and 139.25/500 in DH dogs (P < 0.03); mean histopathological score was 19.25/100 for DH and 47.75/100 in PH dogs (P < 0.03). EEG activity 2 h after reperfusion and starting of rewarming correlated with eventual neurological outcome. EEG variables associated with good outcome were: main final frequency and degree of rhythmicity of the activity. We conclude that PH exerted a protective effect for animals undergoing 2 h of circulatory arrest. EEG was a useful tool for predicting neurological outcome under the studied conditions.

Animals↗