Temporal Lobectomy in Early Childhood

Children with medically resistant temporal lobe seizures that persist into adolescence often experience psychosocial deterioration and medical morbidity. It is therefore especially important to evaluate the contribution of surgical therapy in preadolescent children. We describe our experience with temporal lobectomy in 16 children <12 years (mean age 7 years) who had intractable seizures of temporal lobe origin. Structural lesions were identified on neuroimaging studies in 11 patients. In all patients, the standard anterior temporal lobectomy was tailored according to the extent of the lesion and epileptogenic field. At follow‐up, 11 children were seizure‐free, three were 90% improved, one was 50% improved, and one was unchanged. Neuropathological abnormalities were identified in virtually all children. Prenatally acquired abnormalities of neurogenesis were the most common, whereas mesial temporal sclerosis was found in only two children. We conclude that tailored temporal lobectomy in the first decade of life is highly beneficial in carefully selected children with medically refractory seizures. RESUMEN Los niños con ataques del lóbulo temporal resistentes al tratamiento médico que persisten durante la adolescencia presentan con frecuencia un deterioro psicosocial y morbilidad médica. Es pues especialmente importante la valoración de la contribución de la terapia quirúrgica en los ni˜oacute;s preadolescentes. Los autores describen su experiencia con lobectomia temporal en 16 niños por debajo de los 12 años (edad media = 7 años) que tenian ataques intratables originados en lóbulo temporal. Las lesiones estructurales se identificaron mediante estudio de neuroimagen en 11 pacientes. En todos los enfermos se practicó una lobectomía temporal anterior standard cuantificada de acuerdo con la extensión de la lesión o del foco epileptogénico. Durante el seguimiento, 11 niños no presentaron más ataques, 3 mostraron una mejoría del SO%, 1 mejoró en un 50% y en 1 no se observó ningún cambio. Las anomalías neuropatológicas fueron identificadas en la mayoría de los niños. Las anomalías prenatales de neurogénesis fueron las más comunes mientras que la esclerosis temporal medial se encontró solamente en 2 niños. Los autores concluyen que la lobectomía temporal adecuada a cada caso y practicada en la primera década de la vida es altamente beneficiosa en ni˜oacute;s cuidadosamente seleccionados con ataques refractarios a tratamiento médico. ZUSAMMENFASSUNG Kinder mit therapieresistenten Temporallappenanfällen, die bis zur Adoleszenz fortbestehen, erfahren häufig einen psychosozialen Abbau. Es ist deshalb besonders wichtig, den Beitrag der chirurgischen Therapie bei praeadoleszenten Kindern zu werten. Wir schildern unsere Erfahrung mit temporaler Lobektomie bei 16 Kindern unter 12 Jahren (mittleres Alter 7 Jahre) mit therapieresistenten Anfällen temporalen Ursprungs. Bei 11 Patienten wurden strukturelle Läsionen durch bildgebende Verfahren festgestellt. Bei allen Patienten wurde eine übliche anterior‐temporale Lobektomie entsprechend der Ausdehnung der Läsion und des epileptogenen Feldes durchgeführt. Bei der Folgeuntersuchung waren 11 Kinder anfallsfrei, 3 zeigten eine 80%‐ige Besserung, 1 Kind eine 50%‐ige Besserung und 1 Kind zeigte keine änderung. Neuropathologische Auffälligkeiten waren praktisch bei allen Kindern vorhanden. Pränatal entstandene Abnormalitäten der Neurogenese waren am häufigsten, eine mesiale temporale Sklerose wurde nur bei 2 Kindern gefunden. Wir schluβfolgern, daβ eine angepasste temporale Lobektomie in der ersten Lebensdekade von groβem Nutzen bei sorgfältig ausgewählten Kindern mit therapie resistenten Anfällen ist

As aljamias hebraicas, sistemas de escrita híbridos

As aljamias hebraicas são o resultado da mistura do sistema de escrita latino e do sistema de escrita hebraico, juntamente à criação de regras intrínsecas a essa nova escrita. Objetiva-se compreendê-las com maior clareza, tomando-se como ponto de referência o manuscrito judaico do século 15 De magia (Ms. Laud Or. 282, Bodleian Library). Para tal, o sistema de chegada – a aljamia hebraica – será comparada com os sistemas de partida – o hebraico e o português. Verifica-se que o sistema latino é o mais redundante, o mais completo, porém o menos econômico dos sistemas de escrita. Já o hebraico é o menos redundante, o menos completo e o mais econômico dentre eles, ficando a aljamia em um ponto intermediário entre os dois extremos. Sistema híbrido, porém eficaz meio de comunicação, permitindo a legibilidade satisfatória do texto aljamiado

Cognitive outcome of children with epilepsy and malformations of cortical development

Objective: To assess intellectual functioning (IQ) in 54 children and adolescents with intractable epilepsy who later underwent cortical resection due to unilateral malformations of cortical development acquired in utero.Methods: Lesion type was classified into circumscribed mass lesions and diffuse cortical dysplasia based on histopathologic analysis of surgical tissue. Cortical dysplastic lesions were further graded as mild, moderate, or severe according to specific microscopic features. Laterality of lesion was determined through neurologic examination and electrophysiologic and neuroradiologic procedures. Classification of lesion type was corroborated by its significant relationship with other disease-related variables known to be related to clinical severity (age at seizure onset, age at resection, and extent of lesion).Results: Analyses of covariance revealed that circumscribed lesions had a less deleterious effect on nonverbal IQ than did diffuse cortical dysplasia, after controlling for age at seizure onset and extent of lesion. This effect was also found on verbal IQ measures, but only in subjects with right-sided lesions. Subjects with left-sided lesions performed significantly more poorly on verbal IQ measures than those with right-sided lesions. Additionally, younger age at onset and greater extent of lesion were associated with poorer cognitive outcome.Conclusions: Cortical dysplasia and early left hemisphere lesions have a significantly worse impact on cognitive functioning than circumscribed lesions or right hemisphere developmental lesions in children with epilepsy.</jats:p