Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal

Métodos especiais de MRI foram utilizados em 5 pacientes com epilepsia do lobo temporal refratários ao tratamento clínico, com a finalidade de localizar a área epileptogênica. Imagens coronais com espessura de 5 mm foram obtidas da borda posterior do tronco cerebral até a base do lobo frontal, utilizando-se as sequências "Inversion Recovery T1" (TR=2500 msec, TE=26 msec, TI=600 msec) para avaliar perda de estrutura interna e atrofia do hipocampo e morfologia do lobo temporal; Spin-echo T2w (TR=2500 msec, TE=120 msec) visando a avaliar sinais de alta intensidade anormais. Em 2 casos com focos esquerdos no EEG, a MRI mostrou atrofia, perda de estrutura interna e aumento de sinal no hipocampo, e atrofia do lobo temporal anterior, ipsilateralmente. Um caso com focos bilaterais independentes no EEG teve atrofia, perda da estrutura interna e aumento de sinal no hipocampo direito. Um caso com EEG focal direito mostrou atrofia em ambos os lobos temporais anteriores. Outro caso não mostrou anormalidades. Concluimos que esta metodologia pode facilitar a indicação cirúrgica em epilepsia do lobo temporal

A proposal to declare neurocysticercosis an international reportable disease

Neurocysticercosis is an infection of the nervous system caused by Taenia solium. It is the most important human parasitic neurological disease and a common cause of epilepsy in Africa, Asia, and Latin America, representing enormous costs for anticonvulsants, medical resources and lost production. Neurocysticercosis is a human-to-human infection, acquired by the faecal-enteric route from carriers of intestinal T. solium, most often in areas with deficient sanitation. Intestinal tapeworms cause few symptoms, but adult taeniae carried by humans release large numbers of infective eggs and are extremely contagious. Ingestion of poorly cooked pig meat infested with T. solium larvae results in intestinal taeniosis but not neurocysticercosis. With a view to hastening the control of taeniosis and neurocysticercosis we propose that neurocysticercosis be declared an international reportable disease. New cases of neurocysticercosis should be reported by physicians or hospital administrators to their health ministries. An epidemiological intervention could then be launched to interrupt the chain of transmission by: (1) searching for, treating and reporting the sources of contagion, i.e. human carriers of tapeworms; (2) identifying and treating other exposed contacts; (3) providing health education on parasite transmission and improvement of hygiene and sanitary conditions; and (4) enforcing meat inspection policies and limiting the animal reservoir by treatment of pigs. We believe that the first step required to solve the problem of neurocysticercosis is to implement appropriate surveillance mechanisms under the responsibility of ministries of health. Compulsory notification also has the major advantage of providing accurate quantification of the incidence and prevalence of neurocysticercosis at regional level, thus permitting the rational use of resources in eradication campaigns

Epidemiology of neurocysticercosis in Brazil Epidemiologia da neurocisticercose no Brasil

A revision of literature was done with the objective of tracing an epidemiologic profile of neurocysticercosis (NCC) in Brazil. The prevalence was 0.12-9% in autopsies. The frequency was 0.03-7.5% in clinical series and 0.68-5.2% in seroepidemiological studies. The disease corresponds to 0.08-2.5% of admissions to general hospitals. Patient origin was rural in 30-63% of cases. The most involved age range (64-100%) was 11 to 60 years, with a predominance (22-67%) between 21 and 40 years. The male sex was the most affected (51-80%). In the severe forms there was a predominance of urban origin (53-62%) and of the female sex (53-75%). The period of hospitalization ranges from 1 to 254 days and 33 to 50% of patients suffer 1.7 &plusmn; 1.4 admissions. The clinical picture was variable, with a predominance of epileptic syndrome (22-92%) and intracranial hypertension (19-89%). Psychiatric manifestations were associated in 9-23% of patients. Lethality was 0.29% in terms of all diseases in general and 4.8-25.9% in terms of neurologic diseases. The asymptomatic form was detected in 6% of patients in clinical serie and in 48.5% of case from autopsies. The racemose form and ventricular localization also was observed as asymptomatic form. Among the patients with cutaneous cysticercosis 65% of them showed neurologic manifestations.<br>Realizou-se revisão da literatura com o objetivo de tentar delinear um perfil epidemiológico da neurocisticercose no Brasil. A prevalência em necrópsias variou de 0,12-9%. A freqüência, nas casuísticas clínicas foi de 0,03-7,5% e, nos estudos soroepidemiológicos, de 0,68-5,2%. Compreendeu 0,08-2,5% das internações em hospitais gerais. A procedência foi rural em 30-63% dos doentes. Comprometeu mais (64-100%) na faixa etária dos 11 aos 60 anos, predominantemente (22-67%) entre 21 e 40 anos. O sexo masculino foi mais atingido (51-80%). Nas formas graves, houve predomínio da origem urbana (53-62%) e do sexo feminino (53-75%). O período de internação variou de 1 -254 dias, com 33 a 50% dos doentes necessitando 1.7 &plusmn; 1,4 admissões. Houve variabilidade no quadro clínico, predominando síndrome epiléptica (22-92%) e hipertensão intracraniana (19-89%). A presença de manifestações psiquiátricas foi observada em 9-23% dos doentes. A letalidade, frente as doenças em geral, foi de 0,29% e, entre as doenças neurológicas, de 4,8-25,9%. A forma assintomática foi detectada em 6% dos doentes de casuística clínica e em 48,5% dos casos de necrópsia. A forma racemosa e a localização ventricular também se apresentaram de maneira assintomática. Entre os doentes com cisticercose cutânea, 65% apresentavam manifestações neurológicas