RESUMO
OBJECTIVE: Drug-resistant temporal lobe epilepsy (TLE) often requires thorough investigation to define the epileptogenic zone for surgical treatment. We used simultaneous interictal scalp EEG-fMRI to evaluate its value for predicting long-term postsurgical outcome. METHODS: 30 patients undergoing presurgical evaluation and proceeding to temporal lobe (TL) resection were studied. Interictal epileptiform discharges (IEDs) were identified on intra-MRI EEG and used to build a model of haemodynamic changes. In addition, topographic electroencephalographic correlation maps were calculated between the average IED during video-EEG and intra-MRI EEG, and used as a condition. This allowed the analysis of all data irrespective of the presence of IED on intra-MRI EEG. Mean follow-up after surgery was 46â months. International League Against Epilepsy (ILAE) outcomes 1 and 2 were considered good, and 3-6 poor, surgical outcome. Haemodynamic maps were classified according to the presence (Concordant) or absence (Discordant) of Blood Oxygen Level-Dependent (BOLD) change in the TL overlapping with the surgical resection. RESULTS: The proportion of patients with good surgical outcome was significantly higher (13/16; 81%) in the Concordant than in the Discordant group (3/14; 21%) (χ(2) test, Yates correction, p=0.003) and multivariate analysis showed that Concordant BOLD maps were independently related to good surgical outcome (p=0.007). Sensitivity and specificity of EEG-fMRI results to identify patients with good surgical outcome were 81% and 79%, respectively, and positive and negative predictive values were 81% and 79%, respectively. INTERPRETATION: The presence of significant BOLD changes in the area of resection on interictal EEG-fMRI in patients with TLE retrospectively confirmed the epileptogenic zone. Surgical resection including regions of haemodynamic changes in the TL may lead to better postoperative outcome.
Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/cirurgia , Imageamento por Ressonância Magnética , Oxigênio/sangue , Adolescente , Adulto , Mapeamento Encefálico , Criança , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Lobo Temporal/irrigação sanguínea , Lobo Temporal/cirurgia , Gravação em Vídeo , Adulto JovemAssuntos
Artérias Cerebrais/anatomia & histologia , Veias Cerebrais/anatomia & histologia , Lobo Frontal/cirurgia , Microcirurgia/métodos , Lobo Temporal/cirurgia , Adulto , Lobo Frontal/anatomia & histologia , Lobo Frontal/irrigação sanguínea , Humanos , Procedimentos Neurocirúrgicos , Condutos Olfatórios/irrigação sanguínea , Condutos Olfatórios/cirurgia , Lobo Temporal/anatomia & histologia , Lobo Temporal/irrigação sanguíneaAssuntos
Adulto , Humanos , Artérias Cerebrais/anatomia & histologia , Veias Cerebrais/anatomia & histologia , Lobo Frontal/cirurgia , Microcirurgia/métodos , Lobo Temporal/cirurgia , Lobo Frontal/anatomia & histologia , Lobo Frontal/irrigação sanguínea , Procedimentos Neurocirúrgicos , Condutos Olfatórios/irrigação sanguínea , Condutos Olfatórios/cirurgia , Lobo Temporal/anatomia & histologia , Lobo Temporal/irrigação sanguíneaRESUMO
PURPOSE: We report the cultural adaptation and psychometric properties of the Quality of Life in Epilepsy-31 Inventory (QOLIE-31) for the Portuguese language and Brazilian culture. METHODS: This study involved 150 outpatients: 50 presurgical patients with refractory temporal lobe epilepsy (TLE) related to mesial temporal sclerosis (MTS), 50 patients with juvenile myoclonic epilepsy (JME), and 50 seizure-free patients with TLE. They completed the QOLIE-31, Nottingham Health Profile (NHP), Beck Depression Inventory (BDI), and Adverse Events Profile (AEP) and underwent a neuropsychological evaluation (NE). Internal consistency reliability, interrater and test-retest reliability, and construct validity were assessed. RESULTS: QOLIE-31 mean scores were 33.1 (Social Function), 68.9 (Overall Quality of Life), 56.5 (Seizure Worry), 64.1 (Emotional Well-Being), 63.7 (Energy/Fatigue), 38.9 (Cognitive Function), and 49.7 (Medication Effects). Internal consistency was high (Cronbach's alpha), as were the associations between QOLIE-31 and the BDI, NHP, AEP, and NE. CONCLUSION: The Portuguese/Brazilian version of the QOLIE-31 inventory showed good reliability, validity, and construct validity.
Assuntos
Epilepsia/psicologia , Qualidade de Vida , Adulto , Brasil , Circulação Cerebrovascular/fisiologia , Cognição/fisiologia , Cultura , Emoções/fisiologia , Epilepsia do Lobo Temporal/etiologia , Epilepsia do Lobo Temporal/psicologia , Medo/psicologia , Feminino , Humanos , Idioma , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Psicometria , Reprodutibilidade dos Testes , Esclerose/complicações , Esclerose/psicologia , Comportamento Social , Lobo Temporal/irrigação sanguíneaRESUMO
INTRODUCTION: The cortex of medial temporal lobe is a group of different allocortical fields which included the hippocampal formation (dentate gyrus, hippocampus proper, and subicular complex) and extrahippocampal cortices (entorhinal, perirhinal, and parahippocampal). It is widely accepted that both of them play an important role in memory process. In humans, several reports indicates that damage to the hippocampus alone would lead to a clinically significant amnesia; when the injuries are more extensive others cognitive disorders, as those related to visual sphere, make worse the clinic picture, and some of these cases were reported as associative visual agnosias. Nevertheless, although evidence from animal studies points to the importance of the extrahippocampal medial temporal lobe cortices in order to recognise visual stimuli, such involvement has not been demonstrated in humans. CASE REPORT: A 44 year-old male who consulted us because they had lost about of '80% of his vision' after a stroke. Ophthalmological examination was entirely within normal limits, but neuropsychological test put in evidence difficulties in the visuo-verbal naming, discrimination of superposed images, recognition of faces and, mainly, in the test of immediate and deferred visual memory. Anterograde memory impairment was also revealed. Magnetic resonance imaging showed a lesion of left entorhinal, perirhinal and parahippocampal cortices. CONCLUSIONS: We suggest, in relation to anatomical evidences, that isolation of hippocampus is responsible for symptomatollogy of our patient.
Assuntos
Infarto Encefálico/diagnóstico , Lobo Temporal/irrigação sanguínea , Adulto , Agnosia/etiologia , Infarto Encefálico/complicações , Humanos , MasculinoRESUMO
CONCLUSIONS: Bilateral activation of Brodmann area 39 provides functional support for the concept of bilateral cortical activation with auditory stimulation. The observation that when Brodmann area 39 is activated, area 38 of the temporal lobe is simultaneously inhibited (a functional observation that has seemingly not been previously reported) supports the concept that inhibitory as well as excitatory relays play a role in the auditory pathways. In addition, this report helps to establish a functional database for future studies. OBJECTIVES: (i) To determine which areas of the cerebral cortex and basal ganglia are activated when the left and right ears are monaurally stimulated with pure tones, and what type of response (e.g. excitatory or inhibitory) occurs in these different areas. (ii) To determine the degree of ipsi- and/or contralateral cortical activation and/ or inhibition depending on the ear that is stimulated. (iii) To use this information as an initial step to develop a normal functional database for future studies. MATERIAL AND METHODS: A brain perfusion single-photon emission CT (SPECT) evaluation was conducted using auditory monaural stimulation with pure tones in 10 normal volunteers. Both ears were tested independently (20 examinations in total). 99mTc hexamethyl-propylenamine-oxime was injected while pure tones were delivered, and the SPECT imaging was done 1 h later. RESULTS: After delivering pure tones there was bilateral cortical activation in Brodmann areas 39 and 40, regardless of which ear was stimulated. Despite marked hyperperfusion in both areas 39, a more intense response was seen on the left compared to the right side, although this was not statistically significant. There was also activation in the executive frontal cortex areas 9 and 10 as well as in the temporal Brodmann areas 21 and 22. Simultaneously, area 38 of the temporal lobe was deactivated. In the subcortical structures there was also marked activation in both thalami and deactivation of the caudate nuclei without lateralization.
Assuntos
Córtex Auditivo/metabolismo , Vias Auditivas/metabolismo , Encéfalo/metabolismo , Lateralidade Funcional/fisiologia , Estimulação Acústica , Adulto , Audiometria de Tons Puros , Bases de Dados como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximas , Oxigênio/metabolismo , Compostos Radiofarmacêuticos , Lobo Temporal/irrigação sanguínea , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
BACKGROUND AND PURPOSE: Reduced resting global cerebral blood flow has been previously detected in association with heart failure (HF), but it is not clear whether there are brain regions that could be specifically affected by those brain perfusion deficits. The authors used a fully automated, voxel-based image analysis method to investigate, across the entire cerebral volume, the presence of resting regional cerebral blood flow (rCBF) abnormalities in HF patients compared to healthy controls. METHODS: rCBF was evaluated with 99mTc-single-photon emission computed tomography in 17 HF patients (New York Heart Association functional class II or III) and 18 elderly healthy volunteers. Voxel-based analyses of rCBF data were conducted using the statistical parametric mapping software. RESULTS: Significant rCBF reductions in HF patients relative to controls (P<.05, corrected for multiple comparisons) were detected in 2 foci, encompassing, respectively, the left and right precuneus and cuneus and the right lateral temporoparietal cortex and posterior cingulated gyrus. In the HF group, there was also a significant direct correlation between the degree of cognitive impairment as assessed using the Cambridge Mental Disorders of the Elderly Examination and rCBF on a voxel cluster involving the right posterior cingulate cortex and precuneus, located closely to the site where between-group rCBF differences had been identified. CONCLUSIONS: These preliminary findings indicate that posterior cortical areas of the brain may be particularly vulnerable to brain perfusion reductions associated with HF and suggest that functional deficits in these regions might be relevant to the pathophysiology of the cognitive impairments presented by HF patients.
Assuntos
Encéfalo/diagnóstico por imagem , Baixo Débito Cardíaco/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Exametazima , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Baixo Débito Cardíaco/fisiopatologia , Estudos de Casos e Controles , Transtornos Cognitivos/fisiopatologia , Feminino , Giro do Cíngulo/irrigação sanguínea , Giro do Cíngulo/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Lobo Occipital/irrigação sanguínea , Lobo Occipital/diagnóstico por imagem , Lobo Parietal/irrigação sanguínea , Lobo Parietal/diagnóstico por imagem , Lobo Temporal/irrigação sanguínea , Lobo Temporal/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
Psychosis is commonly observed in patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS). Interictal single photon emission computed tomography (SPECT) was performed to compare regional cerebral blood flow (rCBF) pattern of MTLE-HS patients with psychosis of epilepsy (POE) comorbidity and MTLE-HS patients without any psychiatric disorders (Control group). For this, 21 patients with POE and 23 Control patients were matched by educational level, clinical, demographic, electrophysiological, and MRI data. SPECT scans were acquired using (99m)Tc and interpreted with a semiquantitative method. We analyzed brain regions of interest (ROI) of frontal, temporal, and parietal cortex, in addition to subcortical structures. There were no significant statistical differences of ROI between the POE group and the Control group after Bonferroni adjustment. However, we observed a trend for rCBF increase of right posterior cingulate in the POE Group. This increase would be in accordance with recent findings of cingulate abnormalities in schizophrenia, suggesting that abnormal function in this region might be associated with the psychotic phenomena.
Assuntos
Circulação Cerebrovascular , Epilepsia do Lobo Temporal/fisiopatologia , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Estudos de Casos e Controles , Comorbidade , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/epidemiologia , Feminino , Lobo Frontal/anatomia & histologia , Lobo Frontal/irrigação sanguínea , Lobo Frontal/fisiopatologia , Lateralidade Funcional/fisiologia , Giro do Cíngulo/anatomia & histologia , Giro do Cíngulo/irrigação sanguínea , Giro do Cíngulo/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Lobo Parietal/anatomia & histologia , Lobo Parietal/irrigação sanguínea , Lobo Parietal/fisiopatologia , Cuidados Pré-Operatórios , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Fluxo Sanguíneo Regional/fisiologia , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Lobo Temporal/anatomia & histologia , Lobo Temporal/irrigação sanguínea , Lobo Temporal/fisiopatologiaRESUMO
UNLABELLED: Intermittent photic stimulation (IPS) may produce epileptiform discharges and seizures, most of which are generalized. There are several cases of focal seizures of occipital origin induced by IPS and only five reported cases originating from the temporal lobe (TL). We report an unusual case of TL epilepsy, supported by electroclinical and neuroimaging data, with rhythmic focal TL discharges precipitated by photic stimulus. CASE REPORT: A 37 year old male with refractory epilepsy due to a right mesial temporal sclerosis presented a focal right TL photoparoxysmal response during IPS. A routine, interictal SPECT study obtained with injection of HMPAO, carried out during continuous pulses of the photic stimulus at 16 Hz, disclosed hyperperfusion over the right TL. Presurgical ictal studies demonstrated seizures arising from the same region. A temporal lobectomy rendered the patient seizure-free and further EEGs with IPS were normal. CONCLUSION: To our knowledge, this is the sixth case in medical literature showing evidence of photosensitivity associated with a TL lesion and it is the first in which photic stimulation induced a focal electrographic response of the involved TL. We hypothesize that in rare cases, photosensitivity may be related to a mesial TL lesion without occipital cortex involvement.
Assuntos
Epilepsia Reflexa/complicações , Epilepsia do Lobo Temporal/complicações , Adulto , Circulação Cerebrovascular/fisiologia , Eletroencefalografia , Epilepsia Reflexa/diagnóstico por imagem , Epilepsia Reflexa/cirurgia , Epilepsia do Lobo Temporal/diagnóstico por imagem , Epilepsia do Lobo Temporal/cirurgia , Humanos , Masculino , Memória/fisiologia , Testes Neuropsicológicos , Procedimentos Neurocirúrgicos , Estimulação Luminosa , Compostos Radiofarmacêuticos , Esclerose , Tecnécio Tc 99m Exametazima , Lobo Temporal/irrigação sanguínea , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/patologia , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
OBJECTIVE: To investigate the relation between atrophy of the hippocampal region and brain functional patterns during episodic memory processing in Alzheimer's disease. PATIENTS AND METHODS: Whole brain structural magnetic resonance imaging (MRI) data and single photon emission computed tomography (SPECT) measures of regional cerebral blood flow (rCBF) were obtained during a verbal recognition memory task in nine subjects with mild Alzheimer's disease and 10 elderly healthy controls. Using the statistical parametric mapping approach, voxel based comparisons were made on the MRI data to identify clusters of significantly reduced grey matter concentrations in the hippocampal region in the Alzheimer patients relative to the controls. The mean grey matter density in the voxel cluster of greatest hippocampal atrophy was extracted for each Alzheimer subject. This measure was used to investigate, on a voxel by voxel basis, the presence of significant correlations between the degree of hippocampal atrophy and the rCBF SPECT measures obtained during the memory task. RESULTS: Direct correlations were detected between the hippocampal grey matter density and rCBF values in voxel clusters located bilaterally in the temporal neocortex, in the left medial temporal region, and in the left posterior cingulate cortex during the memory task in the Alzheimer's disease group (p < 0.001). Conversely, measures of hippocampal atrophy were negatively correlated with rCBF values in voxel clusters located in the frontal lobes, involving the right and left inferior frontal gyri and the insula (p < 0.001). CONCLUSIONS: Hippocampal atrophic changes in Alzheimer's disease are associated with reduced functional activity in limbic and associative temporal regions during episodic memory processing, but with increased activity in frontal areas, possibly on a compensatory basis.