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3-17-05 Focal cortical dysplasia in temporal lobe epilepsy
S162 3-l 7-03
Epilepsy Utilization of the international syndromes of 1999
classification
E. Centuri6n, P. Saidbn, D. Consalvo, W. Silva, S. Kochen. of Epilepsy, Neurology Division, Buenos Aires, Argentina
Municipal
of Center
The thousand and seventy eight patients, selected between 1963 and August 1996, at Ft. M. Hospital Epilepsy Municipal Center (E.M.C.), were classified according to the international Classification of Seizure Types (I.L.A.E. 1961). The data were complete with a full description of the ictal semiology and the hypothesis of the epileptogenic zone. The Epi-Info was used to store all the data. With the aim of considering the prognosis, we used the international Classification of Epilepsy and Epileptic Syndromes of 1969. On the basis all the recorded data, it was possible to reclassify 1756 patients (66%): Group I: Epilepsies and syndromes related to a localization: 1246 p (70.67%). Idiopathic: 6 p. (0.46%). Symptomatic: 232 p. (16.61%). Cryptogenie: 1006 p. (57.3%). Group II: Generalized epilepsies and epileptic syndromes: 422 p (24.%). Idiopathic: 401 p. (22.6%). Cryptogenic: 14 p. (0.6%) Symptomatic: 7 p. (0.4%). Group Ill: Epilepsies and epileptic syndromes in which it is not possible to determine whether they are generalized or focal: 19 p. (1 .I%). Group IV: Special Syndromes: 73 p. (4.15%). The most important group was the one related to a localization, with cryptogenie epilepsy were predominant, with a topographic hypothesis in the temporal lobe. The data supplied by our protocol of Clinical History specifying the ictal semiology and the possible epileptogenic zone allowed us to reclassify the patients and to obtain more information about the prognosis of their epilepsy.
3-l 7-04
Mesial temporal
sclerosis syndrome:
D. Consalvo, Ft. Giobellina, W. Silva, C. Rugilo, P. Said6n, E. Centuri6n G. Schuster, S. Kochen. Municipal Center of Epilepsy, Neuro/ogy Division, FEMIEN Foundation, lfaliano Hospital Wrdoba, CONlCn; Buenos Aires, Argentina Magnetic resonance (MR) has become an essential tool in the work-up of epilepsy patients because since its appearance it has been possible to identify pathologies. such as hippooampal sclerosis (HS), that had previously only been detected in histopathological examinations. We analyzed clinical manifestations, EEG, video-EEG and the epilepsy outcome in patients who had been diagnosed HS by MR. We selected randomly outpatient who had a MR study. Out 364 studies, 225 (56.6%) were abnormal. Thirty-five showed HS (15.5%). In this group, the mean age was 27.1 years (range 4-60); 20 were females and 15 males. The mean evolution time of the disease was 15.6 years (O-39). Fifteen subjects had had febrile convulsions (42.6%). They had partial seizures in all cases (ILAE 61). Their attacks were: 5 aphasic disturbances, 6 fear, 6 epigastric rising, 27 automatism, 17 secondarily generalized seizures. The neurological examination was normal in all subjects. EEG focal abnormalities were coincident with MR in 11 patients (SO%), discordant in 2 (9.1%) and normal in 5 (22.7%). Bilateral independent spikes were found in 4 (16.2%) subjects. Sixteen patients (45.7%) showed affected right sides in MR, 17, left sides (46.6%) and 2 bilateral (5.7%). Twenty-two patients (62.6%) had medically intractable epilepsy. Anterior temporal lobectomy was performed in two subjects. Febrile convulsions, partial seizures and intractable epilepsy in these patients were coincident with the literature. These clinical features provide an opportunity to define a syndrome of HS even more accurately. Its identification will benefit patients in their prognosis and specific treatment.
3-l 7-05
Focal cortical dysplasia
in temporal
lobe epilepsy
D. Consalvo, W. Silva. C. Rugilo, P. Said6n, E. Centuridn, G. Schuster, S. Kochen. Municipal Center of Epilepsy; Neurology Division, FEMIEN Foundation, CONICET, Buenos Aires, Argentina Focal cortical dysplasia (FCD) was described by Taylor et al. They had reported histological abnonalities in tissue obtained during surgery from patients with intractable partial epilepsy. These abnormalities consisted of “cortical dyslamination” associated with abnormal giant neurons. The aim of the study was to analyze clinical manifestations, EEG, video-EEG and the epilepsy outcome in patients whose diagnosis by magnetic resonance (MR) had been FCD. Seven patients with FCD and temporal lobe epilepsy (TLE) were analyzed by MR using a protocol to optimize the diagnosis. Mean age was 19.2 years (range 3 to 40). One patient had meningitis and another craneoencefalic trauma before having epilepsy. No history of febrile convulsions was seen. They had partial seizures in all cases (ILAE 61). Their attacks were: 2 epigastric rising, 2 oculccefalic deviation, 7 automatism,
3 secondarily generalized seizure. EEG focal abnormalities were seen in 4 cases, coincident with MR. In one case the EEG was normal. The most common feature in MR was gyral thickening and poor gray-white matter differentiation without mass effect in the anterfor temporal lobe. The left side was affected in all cases. In seven cases MR showed hippocampal abnormalities, and in one of these, the affected side was contralateral to the hippocampal damage. FCD represents a maturational brain disturbance characterized by abnormal conical formation and organization. Its identification in patients with TLE and refractory epilepsy will benefit the patients in view of the prognosis and the specific treatment.
3 17 06 Lx-l
Early ICTAL SPECT in partial epilepsies: advances using g9mTc-ECD
Recent
Arielle Crespel, Philippe Coubes, Jeannine Chevalier’, Michel Zanca’ , Michel Baldy-Moulinier. Epilepsy Unit, Gui de Chauliac Hospital, Montpelier, France, ’ Nuclear Medicine, Gui de Chauliac Hospital, Montpellier. France ltial SPECT is a performed method to localize the epileptogenic zone by an hyperperfused zone. The highest difficulty of this method is the delay between the onset of the seizure and the end of the injection of the tracer. Most of the time the examinations carried out are post i&l. The 99mTc-ECD is a recently introduced SPECT tracer, with radiochemical properties preserved during 6 hours, so it allows very early injection at the onset of the seizure. Seventeen i&l SPECT with g9mT~-ECD were carried out in patients, with a refractory partial epilepsy and candidates for surgery. Seven had a mesial temporal lobe epilepsy, 10 an extra-temporal lobe epilepsy. The average of the delay between the onset of seizure and the end of the ECD injection was 14.5 f 1.4 seconds. The mean duration of the injected seizure was 29.5 f 3.6 seconds. In temporal lobe epilepsies 6 hyperperfusions and one hypoperfusion were observed. In extra temporal lobe epilepsies there were 5 hyperperfusions, 1 normal SPECT and 4 hypoperfusions. Ten hyperperfusions corresponded to ictal EEG abnormalities. When there was an hyperperfusion the mean duration of seizure was 34.9 seconds, and the time remaining after the injection of ECD was 20 seconds. For the hypoperfusions the mean duration of seizures was 19.5 seconds and the time remaining was 4 seconds. A significant difference (p < 0.02) is found between the type of ictal perfusion (hyper versus hypo) and the length of the injected seizure. Hyperperfusion reflects an i&l activity. These results show the necessity of a very early injection to determine the epileptogenic zone in relation to hyperperfused zone.
3-l 7-07
EEG background activity In epileptic monotherapy with Carbamazepine
E. Cvetkovska, R. Naumovski, Medicine, Skopje, Macedonia
M. Pashu.
Clinic of Neurolog):
patients in Faculty
of
This study evaluates the effects of Carbamszepine (CBZ) on the EEG background activity after introduction and short-term application of the drug in 15 previously untreated epileptic patients. The group studied consisted of 9 females and 6 males, aged 15-51 years, the mean age 26.3 + 11.6, representing the complex partial seizures with or without secondary generalization. Patients showing any other neurologic or somatic diseases were excluded from the study. Computed analysis of percent of delta + theta and alpha + beta activity were performed in serial recordings. Serum CBZ levels were in the lower third of therapeutic range (therapeutic range 4-10 ~rn/ml). Our results showed that CBZ causes: (1) Increase of the percent of delta + theta activity (statistically significant over frontal, central and temporal regions) (2) Decrease of the percent of alpha + beta activity (although not statistically significant over all regions recorded). These changes were already established after 7 days of CBZ application, and remained significantly unchanged one and six months of the beginning of the treatment.
13-l 7-08 ( Randomized 39-month comparative study of valproic acid (VPA), phenytoin (PHT), phenobarbital (PB) and carbamazepine (CBZ) efficacy in patients with newly diagnosed epllepsy with partial complex seizures Piotr Czapinski ‘, Artur Terczynski ’ , Ewa Czapinska *. ’ Neuro/ogy Collegium Medicurn, Jagiellonian UniversiQ Kmkdw. Poland, *Polish-American Children’s Hospital Krak6w, Poland The recent comparative similar successfulness
Clinic,
studies on antiepileptic drugs efficacy indicate their regardless of the type of seizures and the age of pa-
Epilepsy Utilization of the international syndromes of 1999
classification
E. Centuri6n, P. Saidbn, D. Consalvo, W. Silva, S. Kochen. of Epilepsy, Neurology Division, Buenos Aires, Argentina
Municipal
of Center
The thousand and seventy eight patients, selected between 1963 and August 1996, at Ft. M. Hospital Epilepsy Municipal Center (E.M.C.), were classified according to the international Classification of Seizure Types (I.L.A.E. 1961). The data were complete with a full description of the ictal semiology and the hypothesis of the epileptogenic zone. The Epi-Info was used to store all the data. With the aim of considering the prognosis, we used the international Classification of Epilepsy and Epileptic Syndromes of 1969. On the basis all the recorded data, it was possible to reclassify 1756 patients (66%): Group I: Epilepsies and syndromes related to a localization: 1246 p (70.67%). Idiopathic: 6 p. (0.46%). Symptomatic: 232 p. (16.61%). Cryptogenie: 1006 p. (57.3%). Group II: Generalized epilepsies and epileptic syndromes: 422 p (24.%). Idiopathic: 401 p. (22.6%). Cryptogenic: 14 p. (0.6%) Symptomatic: 7 p. (0.4%). Group Ill: Epilepsies and epileptic syndromes in which it is not possible to determine whether they are generalized or focal: 19 p. (1 .I%). Group IV: Special Syndromes: 73 p. (4.15%). The most important group was the one related to a localization, with cryptogenie epilepsy were predominant, with a topographic hypothesis in the temporal lobe. The data supplied by our protocol of Clinical History specifying the ictal semiology and the possible epileptogenic zone allowed us to reclassify the patients and to obtain more information about the prognosis of their epilepsy.
3-l 7-04
Mesial temporal
sclerosis syndrome:
D. Consalvo, Ft. Giobellina, W. Silva, C. Rugilo, P. Said6n, E. Centuri6n G. Schuster, S. Kochen. Municipal Center of Epilepsy, Neuro/ogy Division, FEMIEN Foundation, lfaliano Hospital Wrdoba, CONlCn; Buenos Aires, Argentina Magnetic resonance (MR) has become an essential tool in the work-up of epilepsy patients because since its appearance it has been possible to identify pathologies. such as hippooampal sclerosis (HS), that had previously only been detected in histopathological examinations. We analyzed clinical manifestations, EEG, video-EEG and the epilepsy outcome in patients who had been diagnosed HS by MR. We selected randomly outpatient who had a MR study. Out 364 studies, 225 (56.6%) were abnormal. Thirty-five showed HS (15.5%). In this group, the mean age was 27.1 years (range 4-60); 20 were females and 15 males. The mean evolution time of the disease was 15.6 years (O-39). Fifteen subjects had had febrile convulsions (42.6%). They had partial seizures in all cases (ILAE 61). Their attacks were: 5 aphasic disturbances, 6 fear, 6 epigastric rising, 27 automatism, 17 secondarily generalized seizures. The neurological examination was normal in all subjects. EEG focal abnormalities were coincident with MR in 11 patients (SO%), discordant in 2 (9.1%) and normal in 5 (22.7%). Bilateral independent spikes were found in 4 (16.2%) subjects. Sixteen patients (45.7%) showed affected right sides in MR, 17, left sides (46.6%) and 2 bilateral (5.7%). Twenty-two patients (62.6%) had medically intractable epilepsy. Anterior temporal lobectomy was performed in two subjects. Febrile convulsions, partial seizures and intractable epilepsy in these patients were coincident with the literature. These clinical features provide an opportunity to define a syndrome of HS even more accurately. Its identification will benefit patients in their prognosis and specific treatment.
3-l 7-05
Focal cortical dysplasia
in temporal
lobe epilepsy
D. Consalvo, W. Silva. C. Rugilo, P. Said6n, E. Centuridn, G. Schuster, S. Kochen. Municipal Center of Epilepsy; Neurology Division, FEMIEN Foundation, CONICET, Buenos Aires, Argentina Focal cortical dysplasia (FCD) was described by Taylor et al. They had reported histological abnonalities in tissue obtained during surgery from patients with intractable partial epilepsy. These abnormalities consisted of “cortical dyslamination” associated with abnormal giant neurons. The aim of the study was to analyze clinical manifestations, EEG, video-EEG and the epilepsy outcome in patients whose diagnosis by magnetic resonance (MR) had been FCD. Seven patients with FCD and temporal lobe epilepsy (TLE) were analyzed by MR using a protocol to optimize the diagnosis. Mean age was 19.2 years (range 3 to 40). One patient had meningitis and another craneoencefalic trauma before having epilepsy. No history of febrile convulsions was seen. They had partial seizures in all cases (ILAE 61). Their attacks were: 2 epigastric rising, 2 oculccefalic deviation, 7 automatism,
3 secondarily generalized seizure. EEG focal abnormalities were seen in 4 cases, coincident with MR. In one case the EEG was normal. The most common feature in MR was gyral thickening and poor gray-white matter differentiation without mass effect in the anterfor temporal lobe. The left side was affected in all cases. In seven cases MR showed hippocampal abnormalities, and in one of these, the affected side was contralateral to the hippocampal damage. FCD represents a maturational brain disturbance characterized by abnormal conical formation and organization. Its identification in patients with TLE and refractory epilepsy will benefit the patients in view of the prognosis and the specific treatment.
3 17 06 Lx-l
Early ICTAL SPECT in partial epilepsies: advances using g9mTc-ECD
Recent
Arielle Crespel, Philippe Coubes, Jeannine Chevalier’, Michel Zanca’ , Michel Baldy-Moulinier. Epilepsy Unit, Gui de Chauliac Hospital, Montpelier, France, ’ Nuclear Medicine, Gui de Chauliac Hospital, Montpellier. France ltial SPECT is a performed method to localize the epileptogenic zone by an hyperperfused zone. The highest difficulty of this method is the delay between the onset of the seizure and the end of the injection of the tracer. Most of the time the examinations carried out are post i&l. The 99mTc-ECD is a recently introduced SPECT tracer, with radiochemical properties preserved during 6 hours, so it allows very early injection at the onset of the seizure. Seventeen i&l SPECT with g9mT~-ECD were carried out in patients, with a refractory partial epilepsy and candidates for surgery. Seven had a mesial temporal lobe epilepsy, 10 an extra-temporal lobe epilepsy. The average of the delay between the onset of seizure and the end of the ECD injection was 14.5 f 1.4 seconds. The mean duration of the injected seizure was 29.5 f 3.6 seconds. In temporal lobe epilepsies 6 hyperperfusions and one hypoperfusion were observed. In extra temporal lobe epilepsies there were 5 hyperperfusions, 1 normal SPECT and 4 hypoperfusions. Ten hyperperfusions corresponded to ictal EEG abnormalities. When there was an hyperperfusion the mean duration of seizure was 34.9 seconds, and the time remaining after the injection of ECD was 20 seconds. For the hypoperfusions the mean duration of seizures was 19.5 seconds and the time remaining was 4 seconds. A significant difference (p < 0.02) is found between the type of ictal perfusion (hyper versus hypo) and the length of the injected seizure. Hyperperfusion reflects an i&l activity. These results show the necessity of a very early injection to determine the epileptogenic zone in relation to hyperperfused zone.
3-l 7-07
EEG background activity In epileptic monotherapy with Carbamazepine
E. Cvetkovska, R. Naumovski, Medicine, Skopje, Macedonia
M. Pashu.
Clinic of Neurolog):
patients in Faculty
of
This study evaluates the effects of Carbamszepine (CBZ) on the EEG background activity after introduction and short-term application of the drug in 15 previously untreated epileptic patients. The group studied consisted of 9 females and 6 males, aged 15-51 years, the mean age 26.3 + 11.6, representing the complex partial seizures with or without secondary generalization. Patients showing any other neurologic or somatic diseases were excluded from the study. Computed analysis of percent of delta + theta and alpha + beta activity were performed in serial recordings. Serum CBZ levels were in the lower third of therapeutic range (therapeutic range 4-10 ~rn/ml). Our results showed that CBZ causes: (1) Increase of the percent of delta + theta activity (statistically significant over frontal, central and temporal regions) (2) Decrease of the percent of alpha + beta activity (although not statistically significant over all regions recorded). These changes were already established after 7 days of CBZ application, and remained significantly unchanged one and six months of the beginning of the treatment.
13-l 7-08 ( Randomized 39-month comparative study of valproic acid (VPA), phenytoin (PHT), phenobarbital (PB) and carbamazepine (CBZ) efficacy in patients with newly diagnosed epllepsy with partial complex seizures Piotr Czapinski ‘, Artur Terczynski ’ , Ewa Czapinska *. ’ Neuro/ogy Collegium Medicurn, Jagiellonian UniversiQ Kmkdw. Poland, *Polish-American Children’s Hospital Krak6w, Poland The recent comparative similar successfulness
Clinic,
studies on antiepileptic drugs efficacy indicate their regardless of the type of seizures and the age of pa-