Frontal lobe disfunction in children and adolescents with temporal lobe epilepsy and possible correlation with psychiatric disorders

Introduction: There is evidence that individuals with certain types of epilepsy may present cognitive disorders, and that these disorders can be more debilitating than seizures proper. Frontal lobe disorders are reported in adults with temporal lobe epilepsy, carachterized by executive disfunction. Rationale: Literary revision of work concerning the occurence of frontal lobe dysfunction in children and adolescents with temporal lobe epilepsy. Methods: Systematic revision of published literature in PUBMED. Results: Frontal lobe dysfunction has been poorly studied in children with epilepsy, especially in temporal lobe epilepsy. In the only study on the subject, executive deficit was demonstrated. Moreover, children with mesial sclerosis had more deficit in execution/planning than those with frontal or temporal neocortical lesions. Presence of frontal lobe dysfunction, in patients with partial and generalized epilepsy, may corroborate evidence that epilepsy and psychiatric disorders are epiphenomena and not cause effect related phenomena. Conclusion: There are few articles on frontal lobe dysfunction in children with temporal lobe epilepsy. It would be interesting to find out if, and how much this occurs, and if patients with distinct etiologies present different levels of functional disability.Introdução: Há evidências de que pessoas com alguns tipos de epilepsia podem apresentar prejuízos cognitivos, sendo que para alguns pacientes, tais déficits cognitivos podem ser mais debilitantes do que suas crises epilépticas. A disfunção do lobo frontal é relatada em adultos com epilepsia do lobo temporal, caracte­rizada pela disfunção executiva. Objetivo: Rever a literatura sobre a ocorrência de disfunção de lobo frontal em crianças e adolescentes com epilepsia do lobo temporal. Métodos: Revisão sistemática da literatura compulsada no PUBMED. Resultados: A disfunção do lobo frontal tem sido pouco estudada em crianças com epilepsia, em especial com epilepsia do lobo temporal. No único estudo sobre este assunto, demonstrou­se que há um déficit executivo, sendo que as crianças com esclerose mesial têm maiores déficits de execução/ planejamento do que aquelas com lesões neocorticais temporais ou frontais. A presença de uma disfunção do lobo frontal nos pacientes com epilepsia parcial e generalizada pode corroborar as evidências de que epilepsia e transtorno psiquiátrico são epifenômenos e não fenômenos com relação causa efeito. Conclu­sões: Há uma escassez de artigos sobre a disfunção do lobo frontal em crianças com epilepsia do lobo tempo­ral, sendo de interesse saber se esta ocorre e se pacientes com etiologias distintas apresentam diferentes graus de comprometimento destas funções.13113

Phosphorus magnetic resonance spectroscopy in malformations of cortical development

Purpose: The aim of this study was to evaluate phospholipid metabolism in patients with malformations of cortical development (MCDs).Methods: Thirty-seven patients with MCDs and 31 control subjects were studied using three-dimensional phosphorus magnetic resonance spectroscopy ((31)P-MRS) at 3.0 T. The voxels in the lesions and in the frontoparietal cortex of the control subjects were compared (the effective volumes were 12.5 cm(3)). Robust quantification methods were applied to fit the time-domain data to the following resonances: phosphoethanolamine (PE); phosphocholine (PC); inorganic phosphate (Pi); glycerophosphoethanolamine (GPE); glycerophosphocholine (GPC); phosphocreatine (PCr); and alpha-, beta-, and gamma-adenosine triphosphate (ATP). Wealso estimated the total ATP (ATP(t) = alpha-+ beta-+ gamma-ATP), phosphodiesters (PDE = GPC+ GPE), phosphomonoesters (PME = PE+ PC), and the PME/PDE, PCr/ATP(t) and PCr/Pi ratios. The magnesium (Mg 2+) levels and pH values were calculated based on PCr, Pi, and b-ATP chemical shifts.Key Findings: Compared to controls and assuming that a p-value < 0.05 indicates statistical significance, the patients with MCDs exhibited significantly lower pH values and higher Mg(2+) levels. In addition, the patients with MCDs had lower GPC and PDE and an increased PME/PDE ratio.Significance: Mg(2+) and pH are important in the regulation of bioenergetics and are involved in many electrical activity pathways in the brain. Our data support the idea that neurometabolic impairments occur during seizure onset and propagation. The GPC, PDE, and PME/PDE abnormalities also demonstrate that there are membrane turnover disturbances in patients with MCDs.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Clinical characteristics of psychogenic nonepileptic seizures across the lifespan:An international retrospective study

Purpose: Previous studies from a few countries have reported semiological differences in younger children compared with adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesis that semiological, demographic, and historical risk factors vary with different ages of PNES onset in a large cohort from different countries. Methods: In this retrospective study, we investigated patients consecutively referred for PNES, who were admitted to epilepsy monitoring units in Iran, Brazil, Venezuela, Canada, Argentina, and USA. Age, gender, age at seizure onset, seizure semiology, and factors predisposing to PNES (abuse, stressors) were documented according to routine diagnostic practices at each center. Participants were grouped according to their age at onset (i.e., childhood, adolescence, or adulthood). Results: A total of 448 patients were studied. Female predominance was associated with adolescent- (85/122, 70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p = 0.011). Event frequency in the month preceding the diagnosis was higher in the childhood- [x¯ = 50, standard deviation (sd) = 82, p = 0.025] versus adolescent- (x¯ = 24, sd = 36) or adult-onset groups (x¯ = 29, sd = 61). Significant between-group differences were observed for generalized body movements (p = 0.0001) and ictal injury (p = 0.027), suggesting more severe ictal presentations in adult-onset PNES compared with younger ages. Adult-onset patients were also more likely to be taking an unnecessary antiepileptic medication (p = 0.010). Conclusion: While PNES may present at any age, there appear to be notable differences across the lifespan with respect to some of the clinical characteristics. Further international and cross-cultural studies may reveal other interesting characteristics of PNES.Fil: Sawchuk, Tyson. Alberta Children's Hospital. Children's Comprehensive Epilepsy Center; Canadá. University of Nicosia. School of Social Sciences. Department of Psychology; ChipreFil: Asadi Pooya, Ali A.. Shiraz University of Medical Sciences. Shiraz Medical School; Irán. Thomas Jefferson University. Jefferson Comprehensive Epilepsy Center. Department of Neurology; Estados UnidosFil: Myers, Lorna. Northeast Regional Epilepsy Group; Estados UnidosFil: Valente, Kette D.. Universidade de Sao Paulo; BrasilFil: Restrepo, Anilu Daza. Universidade de Sao Paulo; BrasilFil: D'Alessio, Luciana. La Trinidad Medical Center. Epilepsy Unit; VenezuelaFil: Homayoun, Maryam. Shiraz University of Medical Sciences. Shiraz Medical School; IránFil: Bahrami, Zahra. Shiraz University of Medical Sciences. Shiraz Medical School; IránFil: Alessi, Rudá. Universidade de Sao Paulo; BrasilFil: Paytan, Angélica Aroni. La Trinidad Medical Center. Epilepsy Unit; VenezuelaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Taha, Firas. Northeast Regional Epilepsy Group; Estados UnidosFil: Lazar, Lorraine M.. Northeast Regional Epilepsy Group; Estados Unidos. Hackensack University Medical Center. Hackensack Meridian School of Medicine; Estados UnidosFil: Pick, Susannah. King's College London; Reino UnidoFil: Nicholson, Timothy R.. Kings' College London. Institute of Psychiatry, Psychology and Neuroscience. Section of Cognitive Neuropsychiatry; Reino UnidoFil: Buchhalter, Jeffrey. Alberta Children's Hospital. Children's Comprehensive Epilepsy Center; Canadá. University of Nicosia. School of Social Sciences. Department of Psychology; Chipre. University of Calgary; Canad

Pediatric-onset psychogenic nonepileptic seizures: A retrospective international multicenter study

Purpose: We compared various clinical characteristics of pediatric-onset psychogenic nonepileptic seizures(PNES) between patients from fie countries. The purpose of this study was to advance our understanding ofpediatric-onset PNES cross-culturally.Methods: In this retrospective study, we compared consecutive patients with PNES with an age at onset of 16years and younger from epilepsy monitoring units in Iran, Brazil, the USA, Canada, and Venezuela. Age, gender,age at seizure onset, seizure semiology, predisposing factors, and video-EEG recordings of all patients wereextracted. Pearson Chi-Square, one-way ANOVA and Bonferroni correction tests were used for statistical analyses.Results: Two hundred twenty-nine patients were studied (83 from Iran, 50 from Brazil, 39 from Canada, 30 fromthe USA, and 27 from Venezuela). Mean age at the onset of seizures was 12.1 ± 3.2 years (range: 4?16 years).The sex ratio of the patients was 1.83: 1 (148 females and 81 males). Clinical characteristics of pediatric-onsetPNES showed some signifiant diffrences among the nations. However, factors associated with pediatric-onsetPNES in these fie nations were similar.Conclusion: This study underscores how international cross-cultural studies can make important contributions toour understanding of PNES. Patients with pediatric-onset PNES from diffrent countries were similar on manyrisk factors associated with PNES. This suggests universality in many features of PNES. However, intriguingdiffrences were also noted with regard to seizure semiology, which might be the result of cultural factors.Fil: Asadi Pooya, Ali A.. Universidad de Ciencias Médicas, Shiraz; Irán. Universidad Thomas Jefferson; Estados UnidosFil: Myers, Lorna. Grupo regional de epilepsia del noreste; Estados UnidosFil: Valente, Kette. Universidad de Sao Paulo; BrasilFil: Sawchuk, Tyson. Hospital de niños de Alberta, Calgary; Canadá. Universidad de Nicosia; ChipreFil: Daza Restrepo, Anilu. Centro Médico La Trinidad; VenezuelaFil: Homayouna, Maryam. Universidad de Ciencias Médicas, Shiraz; IránFil: Buchhalter, Jeffey. Universidad de Nicosia; Chipre. Universidad de Calgary; CanadáFil: Bahramia, Zahra. Universidad de Ciencias Médicas, Shiraz; IránFil: Taha, Firas. Grupo regional de epilepsia del noreste; Estados UnidosFil: Lazar, Lorraine M.. Grupo regional de epilepsia del noreste; Estados UnidosFil: Aroni Paytan, Angélica. Centro Médico La Trinidad; VenezuelaFil: D`alessio, Luciana. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina; ArgentinaFil: Alessi, Rudá. Universidad de Sao Paulo; BrasilFil: Pick, Susannah. Instituto de Psiquiatría, Psicología y Neurociencia, King's College London; Reino UnidoFil: Nicholson, Timothy R.. Instituto de Psiquiatría, Psicología y Neurociencia, King's College London; Reino Unid