RESUMO
Status epilepticus (SE) represents a medical emergency that annually affects 60,000--150,000 individuals in the United States. Selective neuronal loss in vulnerable areas has been pathologically demonstrated following convulsive SE primarily affecting the limbic system, thalamus and cerebellum. Morbidity in those cases that follow refractory SE (RSE) is poorly documented. There have been anecdotal reports of surgical treatment for this condition, especially secondary to brain lesions. We report a 6-year-old patient who was in RSE for 60 days, without a brain lesion documented by MRI. The patient underwent multiple subpial transection (MST) of the sensorimotor cortex, which by ictal EEG and ictal SPECT proved to be the epileptogenic zone. We conclude that MST should be considered as an alternative treatment for refractory partial SE.
Assuntos
Córtex Motor/cirurgia , Estado Epiléptico/cirurgia , Criança , Eletrocardiografia/métodos , Eletroencefalografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Monitorização Intraoperatória/métodos , Córtex Motor/patologia , Pia-Máter/cirurgia , Estado Epiléptico/diagnóstico , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
The authors present two patients with dementia who displayed recurrent transient episodes of amnestic wandering and disorientation characterized by getting lost in familiar environments. At other times these patients did not wander or become disoriented. The inability to recall any information during these episodes, and the marked difference of the episodic amnesia exacerbations from the progressive amnesia characteristic of Alzheimer disease seen in these patients led to their evaluation. These clinical episodes and the bilateral interictal epileptiform electroencephalographic changes found in both patients led to the diagnosis of transient epileptic amnesia, a syndrome that can be diagnostically elusive. These transient amnestic wandering events subsided after treatment with antiepileptic drugs in both patients. The authors suggest that transient wandering of this type may be caused by ictal events or postictal confusional states. This report emphasizes the importance of recognizing transient epileptic amnesia as an easily treatable cause of episodic behavioral abnormalities responsive to antiepileptic therapy, especially in those patients who have a markedly inconsistent pattern of wandering, disorientation in familiar settings, and amnesia exacerbation manifested by no recall of the emotional stress of getting lost or of any information during these episodes. Recognition of this type of behavioral disruption and its proper treatment can lead to improved quality of life for these patients, maintain these patients in their homes and out of chronic care institutions longer, and facilitate the community's and caretaker's interactive roles with the patient.
Assuntos
Doença de Alzheimer/complicações , Amnésia/etiologia , Anticonvulsivantes/uso terapêutico , Demência por Múltiplos Infartos/complicações , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Idoso , Feminino , Humanos , Fatores de TempoRESUMO
We assessed in 15 consecutive patients the best route and time of administration for phenytoin (PHT) prophylaxis in neurosurgical procedures. We also correlated PHT levels in serum and cerebrospinal fluid after oral and parenteral loading doses. The mean PHT level was 13.9 micrograms/ml in serum and 2.03 micrograms/ml in cerebrospinal fluid (CSF), with a significant correlation between levels in both compartments (r = 0.73, p < 0.01). Mean PHT levels among the different groups were not statistically significant. We conclude that therapeutic levels of PHT in CSF can be achieved independently of the route of administration, as long as accepted loading doses are used.
Assuntos
Anticonvulsivantes/administração & dosagem , Procedimentos Neurocirúrgicos/métodos , Fenitoína/administração & dosagem , Administração Oral , Adulto , Idoso , Aneurisma/cirurgia , Anticonvulsivantes/sangue , Anticonvulsivantes/líquido cefalorraquidiano , Malformações Arteriovenosas/cirurgia , Neoplasias Encefálicas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Vias de Administração de Medicamentos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Fenitoína/sangue , Fenitoína/líquido cefalorraquidiano , Convulsões/prevenção & controleRESUMO
An attempt was made to identify guidelines to help establish epilepsy monitoring units in developing countries. We assessed the time distribution of seizures during video-EEG monitoring and we also estimated the minimum time required for such a procedure and the impact of these variables upon the health insurance system. Mean time for recording five stereotyped clinical events was 72 hours, with a significant number of events recorded between midnight and 0600 hours (P < 0.05). This pilot study may help to establish local policies that will warrant an adequate work-up for our patients.
Assuntos
Países em Desenvolvimento , Eletroencefalografia , Epilepsia/diagnóstico , Programas Nacionais de Saúde , Polissonografia , Gravação em Vídeo , Adolescente , Anticonvulsivantes/uso terapêutico , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/fisiopatologia , Criança , Eletroencefalografia/efeitos dos fármacos , Epilepsia/tratamento farmacológico , Epilepsia/fisiopatologia , Feminino , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos de Tempo e MovimentoRESUMO
PURPOSE: Single photon emission computed tomography (SPECT) is widely used to evaluate functional abnormalities during the epileptic event. Changes in regional cerebral blood flow (rCBF) are well defined in patients with temporal lobe epilepsy (TLE) undergoing surgical resection. Nonetheless, the interpretation of ictal abnormalities in CBF beyond the temporal lobes has not been carefully addressed. METHODS: We assessed 4 patients with pathologically proven unilateral TLE who had significant ipsilateral frontal hypoperfusion in ictal studies with no other abnormalities but chronic epilepsy accounting for such findings. Patients were assessed as candidates for surgery by interictal EEG, neuropsychological studies, brain magnetic resonance imaging, scalp electrode video-EEG monitoring, and ictal SPECT. RESULTS: Characteristic hyperperfusion was evident over the temporal lobe ipsilateral to the EEG focus, with significant hypoperfusion over the frontal region in 3 patients. In patient 4, frontal hypoperfusion was not statistically significant. CONCLUSIONS: SPECT demonstrated relative rCBF changes beyond the epileptogenic zone in unilateral TLE. Our findings provide further insight into the pathophysiological changes underlying this condition.