Mesial Temporal Lobe Epilepsy Syndrome: An Updated Overview

Mesial temporal lobe epilepsy (MTLE) is the most common form of partial epilepsy in young adults and also the most frequent type of epilepsy reported in surgical series worldwide. Mesial temporal lobe sclerosis (MTS) is the major underlying cause of MTLE, and it is present in 60-70% of patients with MTLE who undergo surgery for treatment of medically refractory seizures. Pathogenetic mechanisms underlying this distinct hippocampal pathology remains undetermined. Recent findings suggest a developmental malformation of hippocampus (inherited or acquired) that in association with subsequent injury (e.g. trauma, infection, complex febrile seizures) could develop ongoing seizures, resulting in the full-blown neuropathological features of MTS. Genetic background, age and type of initial precipitating injury, and vulnerability related to programmed cell death pathways are probable mechanisms involved in the development of MTS. Definitions for medical intractability may vary among centers, but usually include failure to achieve seizure control with two or more AEDs with adequate dosage and posology. The decision as to when one should perform surgery in patients with MTLE is a relevant issue that needs more investigation. Recent evidence discussed in this review indicates that longer duration of uncontrolled seizures is associated with an increased risk of unsuccessful surgery.113141144Cendes F, Kahane P, Brodie MJ, Andermann F. The mesio-temporal lobe epilepsy syndrome. In: Roger J, Bureau M, Dravet C, Genton P, Tassinari CA, Wolf P, editors. Epileptic syndromes in infancy, childhood and adolescence. 3 rd ed. Eastleigh UK: John Libbey &ampCo Ltd2002. p.513-30Kobayashi, E., Lopes-Cendes, I., Guerreiro, C.A., Sousa, S.C., Guerreiro, M.M., Cendes, F., Seizure outcome and hippocampal atrophy in familial mesial temporal lobe epilepsy (2001) Neurology, 56, pp. 166-172Gloor, P., Mesial temporal sclerosis: Historical background and an overview from a modern perspective (1991) Epilepsy surgery, pp. 689-703. , Luders H, editor, New York: Raven Press;Meencke, H.J., Veith, G., Hippocampal sclerosis in epilepsy (1991) Epilepsy surgery, pp. 705-715. , Luders H, ed, New York: Raven Press;Bruton, C.J., (1988) The neuropathology of temporal lobe epilepsy, , New York: Oxford University Press;Camfield, C.S., Camfield, P.R., Gordon, K., Wirrell, E., Dooley, J.M., Incidence of epilepsy in childhood and adolecesce - A population-based study in Nova Scotia from 1977 to 1985 (1996) Epilepsia, 37, pp. 19-23Camfield, P., Camfield, C., Gordon, K., Dooley, J., What types of epilepsy are preceded by febrile seizures? A population-based study of children (1994) Dev Med Child Neurol, 36, pp. 887-892Cendes, F., Febrile seizures and mesial temporal sclerosis (2004) Curr Opin Neurol, 17, pp. 161-164VanLandingham, K.E., Heinz, E.R., Cavazos, J.E., Lewis, D.V., Magnetic resonance imaging evidence of hippocampal injury after prolonged focal febrile convulsions (1998) Ann Neurol, 43, pp. 413-426Kobayashi, E., D'Agostino, M.D., Lopes-Cendes, I., Berkovic, S.F., Li, M.L., Andermann, E., Hippocampal atrophy and T2-weighted signal changes in familial mesial temporal lobe epilepsy (2003) Neurology, 60, pp. 405-409Cendes, F., Progressive hippocampal and extrahippocampal atrophy in drug resistant epilepsy (2005) Curr Opin Neurol, 18, pp. 173-177Blumcke, I., Thom, M., Wiestler, O.D., Ammon's horn sclerosis: A maldevelopmental disorder associated with temporal lobe epilepsy (2002) Brain Pathol, 12, pp. 199-211Mathern, G.W., Pretorius, J.K., Babb, T.L., Influence of the type of initial precipitating injury and at what age it occurs on course and outcome in patients with temporal lobe seizures (1995) J Neurosurg, 82, pp. 220-227Mathern, G.W., Babb, T.L., Leite, J.P., Pretorius, K., Yeoman, K.M., Kuhlman, P.A., The pathogenic and progressive features of chronic human hippocampal epilepsy (1996) Epilepsy Res, 26, pp. 151-161Shinoda, S., Schindler, C.K., Meller, R., So, N.K., Araki, T., Yamamoto, A., Bim regulation may determine hippocampal vulnerability after injurious seizures and in temporal lobe epilepsy (2004) J Clin Invest, 113, pp. 1059-1068Kobayashi, E., Li, L.M., Lopes-Cendes, I., Cendes, F., Magnetic resonance imaging evidence of hippocampal sclerosis in asymptomatic, first-degree relatives of patients with familial mesial temporal lobe epilepsy (2002) Arch Neurol, 59, pp. 1891-1894Kim, W.J., Park, S.C., Lee, S.J., Lee, J.H., Kim, J.Y., Lee, B.I., The prognosis for control of seizures with medications in patients with MRI evidence for mesial temporal sclerosis (1999) Epilepsia, 40, pp. 290-293Montenegro, M.A., Ferreira, C.M., Cendes, F., Li, L.M., Guerreiro, C.A., Clobazam as add-on therapy for temporal lobe epilepsy and hippocampal sclerosis (2005) Can J Neurol Sci, 32, pp. 93-96Rodin, E.A., (1968) The prognosis of patients with epilepsy, , Springfield: Charles C. Thomas;Sillanpaa, M., Remission of seizures and predictors of intractability in long-term follow-up (1993) Epilepsia, 34, pp. 930-936Camfield, C., Camfield, P., Smith, B., Gordon, K., Dooley, J., Biologic factors as predictors of social outcome of epilepsy in intellectually normal children: A population-based study (1993) J Pediatr, 122, pp. 869-873Semah, F., Picot, M.C., Adam, C., Broglin, D., Arzimanoglou, A., Bazin, B., Is the underlying cause of epilepsy a major prognostic factor for recurrence? (1998) Neurology, 51, pp. 1256-1262Wiebe, S., Blume, W.T., Girvin, J.P., Eliasziw, M., A randomized, controlled trial of surgery for temporal-lobe epilepsy (2001) N Engl J Med, 345, pp. 311-318Yoon, H.H., Kwon, H.L., Mattson, R.H., Spencer, D.D., Spencer, S.S., Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery (2003) Neurology, 61, pp. 445-450Trevathan, E., Gilliam, F., Lost years: Delayed referral for surgically treatable epilepsy (2003) Neurology, 61, pp. 432-433Gilliam, F., Kuzniecky, R., Meador, K., Martin, R., Sawrie, S., Viikinsalo, M., Patient-oriented outcome assessment after temporal lobectomy for refractory epilepsy (1999) Neurology, 53, pp. 687-694Berg, A.T., Langfitt, J., Shinnar, S., Vickrey, B.G., Sperling, M.R., Walczak, T., How long does it take for partial epilepsy to become intractable? (2003) Neurology, 60, pp. 186-19

Espectroscopia De Fósforo Por Ressonância Magnética Na Investigação De Epilepsia Do Lobo Temporal: lendo Nas Entrelinhas Das Alterações Metabólicas

74899

Striatal and extrastriatal atrophy in Huntington's disease and its relationship with length of the CAG repeat

Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder that affects the striatum most severely. However, except for juvenile forms, relative preservation of the cerebellum has been reported. The objective of the present study was to perform MRI measurements of caudate, putamen, cerebral, and cerebellar volumes and correlate these findings with the length of the CAG repeat and clinical parameters. We evaluated 50 consecutive patients with HD using MRI volumetric measurements and compared them to normal controls. Age at onset of the disease ranged from 4 to 73 years (mean: 43.1 years). The length of the CAG repeat ranged from 40 to 69 (mean: 47.2 CAG). HD patients presented marked atrophy of the caudate and putamen, as well as reduced cerebellar and cerebral volumes. There was a significant correlation between age at onset of HD and length of the CAG repeat, as well as clinical disability and age at onset. The degree of basal ganglia atrophy correlated with the length of the CAG repeat. There was no correlation between cerebellar or cerebral volume and length of the CAG repeat. However, there was a tendency to a positive correlation between duration of disease and cerebellar atrophy. While there was a negative correlation of length of the CAG repeat with age at disease onset and with striatal degeneration, its influence on extrastriatal atrophy, including the cerebellum, was not clear. Extrastriatal atrophy occurs later in HD and may be related to disease duration.1129113

Thalamic metabolic abnormalities in patients with Huntington's disease measured by magnetic resonance spectroscopy

Huntington's disease (HD) is a neurologic disorder that is not completely understood; its fundamental physiological mechanisms and chemical effects remain somewhat unclear. Among these uncertainties, we can highlight information about the concentrations of brain metabolites, which have been widely discussed. Concentration differences in affected, compared to healthy, individuals could lead to the development of useful tools for evaluating the progression of disease, or to the advance of investigations of different/alternative treatments. The aim of this study was to compare the thalamic concentration of metabolites in HD patients and healthy individuals using magnetic resonance spectroscopy. We used a 2.0-Tesla magnetic field, repetition time of 1500 ms, and echo time of 135 ms. Spectra from 40 adult HD patients and 26 control subjects were compared. Quantitative analysis was performed using the LCModel method. There were statistically significant differences between HD patients and controls in the concentrations of N-acetylaspartate+N-acetylaspartylglutamate (NAA+NAAG; t-test, P<0.001), and glycerophosphocholine+phosphocholine (GPC+PCh; t-test, P=0.001) relative to creatine+phosphocreatine (Cr+PCr). The NAA+NAAG/Cr+PCr ratio was decreased by 9% and GPC+PCh/Cr+PCr increased by 17% in patients compared with controls. There were no correlations between the concentration ratios and clinical features. Although these results could be caused by T1 and T2 changes, rather than variations in metabolite concentrations given the short repetition time and long echo time values used, our findings point to thalamic dysfunction, corroborating prior evidence.72272

Late Onset Temporal Lobe Epilepsy With Mri Evidence Of Mesial Temporal Sclerosis Following Acute Neurocysticercosis: Case Report.

The objective of this case report is to describe magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS) in a patient with new onset temporal lobe epilepsy (TLE) and acute neurocysticercosis with multiple cysts. A 56 years old man with new onset headache, Simple Partial Seizures and Complex Partial Seizures underwent CT scan and lumbar puncture as diagnose proceeding. Multiple cysts and meningitis were identified, with a positive immunology for cysticercosis. Seizures were recorded over the left temporal region in a routine EEG. Treatment with albendazole was performed for 21 days, with clinical improvement and seizure remission after 4 months. An MRI scan 11 months after treatment, showed complete resolution of those cystic lesions and a left hippocampal atrophy (HA) with hyperintense T2 signal. The presence of HA and hyperintense T2 signal in this patient has not, to date, been associated with a poor seizure control. This patient presented with MRI evidence of left MTS after new onset partial seizures of left temporal lobe origin. Although we did not have a previous MRI scan, it is likely that this hippocampal abnormality was due to the acute inflammatory response to cysticercosis associated to repeated partial seizures. This suggests that acute neurocysticercosis associated with repeated seizures may cause MTS and late onset TLE.59255-

The Importance Of Accurate Anatomic Assessment For The Volumetric Analysis Of The Amygdala.

There is a wide range of values reported in volumetric studies of the amygdala. The use of single plane thick magnetic resonance imaging (MRI) may prevent the correct visualization of anatomic landmarks and yield imprecise results. To assess whether there is a difference between volumetric analysis of the amygdala performed with single plane MRI 3-mm slices and with multiplanar analysis of MRI 1-mm slices, we studied healthy subjects and patients with temporal lobe epilepsy. We performed manual delineation of the amygdala on T1-weighted inversion recovery, 3-mm coronal slices and manual delineation of the amygdala on three-dimensional volumetric T1-weighted images with 1-mm slice thickness. The data were compared using a dependent t-test. There was a significant difference between the volumes obtained by the coronal plane-based measurements and the volumes obtained by three-dimensional analysis (P < 0.001). An incorrect estimate of the amygdala volume may preclude a correct analysis of the biological effects of alterations in amygdala volume. Three-dimensional analysis is preferred because it is based on more extensive anatomical assessment and the results are similar to those obtained in post-mortem studies.38409-1

The Effects Of Epileptic Seizures Upon Quality Of Life

Objective: Understand the psychological considerations of the relationship between the effect of seizures upon the patients' perception of seizure control, depression, anxiety and quality of life (QoL). Methods: 151 adult patients with epilepsy diagnosed for over two years were interviewed and responded the 31-Item Quality of Life in Epilepsy (QOLIE-31), the Trait Form of the State/Trait Anxiety Inventory (STAI II) and the Beck Depression Inventory (BDI). Results: 45 patients were depressed (29.8%) and 29 (19.2%) had anxiety. Depression scores ranged from 0 to 49 (M=7.4; SD=8.9) and anxiety scores ranged from 19 to 69 (M=41.5, SD=11.9). Total QoL score was correlated to seizure control (p<0.001), perception of epilepsy control (p<0.001), anxiety (p<0.001), and depression (p=0.003). The perception of epilepsy control was correlated to seizure control (p<0.001), seizure frequency (p=0.001), anxiety (p<0.001) and depression (p<0.001). Seizure control was associated to anxiety (p=0.033) and depression (p<0.001). There was co-morbidity between anxiety and depression (p<0.001). Conclusion: This study highlights the importance of the seizure frequency and control to the evaluation of perception of epilepsy control and shows that anxiety and depression in epilepsy are predicted by seizure-related (seizure frequency and control) and psychosocial aspects (perception of control and QoL) together.153110113Tracy, J.I., Dechant, V., Sperling, M.R., Cho, R., Glosser, D., The association of mood with quality of life ratings in epilepsy (2007) Neurology, 68 (14), pp. 1101-1107Choi-Know, S., Ching, C., Kim, H., Factors affecting the quality of life in patients with epilepsy in Seoul, South Korea (2003) Acta Neurol Scand, 108 (6), pp. 428-434Loring, D.W., Meador, K.J., Lee, G.P., Determinants of quality of life in epilepsy (2004) Epilepsy Behav, 5 (6), pp. 976-980Johnson, E.K., Jones, J.E., Seindenberg, M., The relative impact of anxiety, depression and clinical seizure features on health-related quality of life in epilepsy (2005) Epilepsia, 45, pp. 544-550Cramer, J.A., Brandenburg, N., Xu, X., Differentiating anxiety and depression symptoms in patients with partial epilepsy (2005) Epilepsy Behav, 6, pp. 563-569Hermann, B.P., Whitman, S., Psychopathology in epilepsy: A multietiological model (1986) Psychopathology in epilepsy: Social dimensions, pp. 5-37. , Whitman S, Hermann BP, eds, Oxford: Oxford University Press;Suurmeijer, T.P.B.M., Reuvekamp, M.F., Aldenkamp, B.P., Social functioning, psychological functioning, and quality of life in epilepsy (2001) Epilepsia, 42 (9), pp. 1160-1168Devins, G.M., Seland, T.P., Klein, G., Stability and determinants of psychosocial well-being in multiple sclerosis (1993) Rehab Psychol, 38, pp. 11-26da Silva, T.I., Ciconelli, R.M., Alonso, N.B., Azevedo, A.M., Westphal-Guitti, A.C., Pascalicchio, T.F., Marques, C.M., Yacubian, E.M., Validity and reliability of the Portuguese version of the quality of life in epilepsy inventory (QOLIE-31) for Brazil (2007) Epilepsy Behav, 10 (2), pp. 234-241Gorenstein, C., Andrade, L., Beck depression inventory: Psychometric properties to the Brazilian cross-cultural version (1998) Rev Psiq Clin, 25, pp. 245-250Biaggio AM, Natali?cio D, Spielberger CD. Desenvolvimento da forma experimental em português do Inventário de Ansiedade Traço e Estado, Arq Br Psic Ap 1977;29:31-44Engel Jr, J., International League Against Epilepsy (ILAE). A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: Report of the ILAE Task Force on Classification and Terminology (2001) Epilepsia, 42 (6), pp. 796-803Souza EAP, Salgado PCB. A psychosocial view of anxiety and depression in epilepsy. Epilepsy Behav 2006;8(1):232:8Souza, E.A.P., Questionário de qualidade de vida na epilepsia - resultados preliminares. (2001) Arq Neuropsiq, 59 (3), pp. 541-544Meador, K.J., Research use of the new quality of life of epilepsy inventory (1993) Epilepsia, 34 (SUPPL. 4), pp. S34-S38Salgado, P.C.B., Souza, E.A.P., Qualidade de vida em epilepsia e percepção de controle de crises. (2001) Arq Neuropsiquiatr, 59, pp. 537-540Birbeck, G.L., Hays, R.D., Cui, X., Vickrey, B.G., Seizure reduction and quality of life improvements in people with epilepsy (2002) Epilepsia, 43 (5), pp. 535-538Attarian, H., Vahle, V., Carter, J., Relation between depression intractability of seizures (2003) Epilepsy Behav, 4, pp. 298-301Cramer, J.A., Blum, D., Reed, M., The influence of comorbid depression on quality of life for people with epilepsy (2003) Epilepsy Behav, 4 (5), pp. 515-521Johnson, E.K., Jones, J.E., Seidenberg, M., Hermann, B.P., The relative impact of anxiety, depression, and clinical seizure features on health-related quality of life in epilepsy (2004) Epilepsia, 45 (5), pp. 544-55

Life Adjustment After Surgical Treatment For Temporal Lobe Epilepsy

Objective: The purpose of this study was to evaluate the patients' life adjustment after epilepsy surgery, through instruments of quality of life (QoL), anxiety, depression, preoperative expectations and postoperative life changing. Methods: Thirty-six adults who underwent temporal lobe epilepsy surgery were interviewed before surgery, and 6 and 12 months after surgery. Results: For all patients, epilepsy surgery gave rise to an evolving process of postoperative adjustment, what means that they were satisfied with surgery results, and that their expectations were reached. The improvement was seen in their QoL (p=0.004), anxiety (p=0.019) and depression (p=0.001), which was associated to their perception of positive life changing. The inexistence of depressive and anxiety symptoms and the good QoL after surgery predicted the perception of positive life changing. This study could predict a total of 56.5% of aspects involved in the perception of positive life changing after epilepsy surgery, what seems that other variables may be involved in this process. The patients' status before surgery (expectations, QoL, anxiety, depression and seizures frequency) did not predict the life satisfaction after surgery, what means that when patients evaluate their actual lives they do it looking for daily aspects and do not tend to compare to their lives before surgery. Conclusion: The findings of the present study have implications for the evaluation of life adjustment postsurgery, calling attention to measures of preoperative expectations, anxiety, depression and QoL. The strength of these contributions highlights the importance of registering the patients' feelings and opinions during the presurgical evaluation and may help the health providers to understand the aspects necessary to improve the patients' quality of life.1527175Aydemir, N., Ozkara, C., Canbeyli, R., Tekcan, A., Changes in quality of life and self-perspective related to surgery in patients with temporal lobe epilepsy (2004) Epilepsy and Behavior, 5 (5), pp. 735-742. , DOI 10.1016/j.yebeh.2004.06.022, PII S1525505004002100Beck, A.T., Assessment of depression: The depression inventory. Psychological measurement in Psychopharmacology (1974) Mod Probl Pharmacopsychiatry, 7, pp. 151-169Boylan, L.S., Flint, L.A., Labovitz, D.L., Jackson, S.C., Starner, K., Devinsky, O., Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy (2004) Neurology, 62 (2), pp. 258-261Cankurtaran, E.S., Ulug, B., Saygi, S., Tiryaki, A., Akalan, N., Psychiatric morbidity, quality of life, and disability in mesial temporal lobe epilepsy patients before and after anterior temporal lobectomy (2005) Epilepsy and Behavior, 7 (1), pp. 116-122. , DOI 10.1016/j.yebeh.2005.03.019, PII S1525505005001290Cramer, J.A., Perrine, K., Devinsky, O., Bryant-Comstock, L., Meador, K., Hermann, B., Development and cross-cultural translations of a 31-item quality of life in epilepsy inventory (1998) Epilepsia, 39 (1), pp. 81-88. , DOI 10.1111/j.1528-1157.1998.tb01278.xDevinsky, O., Barr, W.B., Vickrey, B.G., Berg, A.T., Bazil, C.W., Pacia, S.V., Langfitt, J.T., Spencer, S.S., Changes in depression and anxiety after resective surgery for epilepsy (2005) Neurology, 65 (11), pp. 1744-1749. , DOI 10.1212/01.wnl.0000187114.71524.c3, PII 0000611420051213000013Gaitatzis, A., Trimble, M.R., Sander, J.W., The psychiatric comorbidity of epilepsy (2004) Acta Neurol Scand, 110, pp. 207-220Gilliam, F., Hecimovic, H., Sheline, Y., Psychiatric comorbidity, health, and function in epilepsy (2003) Epilepsy and Behavior, 4 (SUPPL. 4), pp. S26-S30Johnson, E.K., Jones, J.E., Seidenberg, M., Hermann, B.P., The Relative Impact of Anxiety, Depression, and Clinical Seizure Features on Health-related Quality of Life in Epilepsy (2004) Epilepsia, 45 (5), pp. 544-550. , DOI 10.1111/j.0013-9580.2004.47003.xMattsson, P., Tibblin, B., Kihlgren, M., Kumlien, E., A prospective study of anxiety with respect to seizure outcome after epilepsy surgery (2005) Seizure, 14 (1), pp. 40-45. , DOI 10.1016/j.seizure.2004.02.009, PII S1059131104000494Mikati, M.A., Comair, Y.G., Rahi, A., Normalization of quality of life three years after temporal lobectomy: A controlled study (2006) Epilepsia, 47 (5), pp. 928-933. , DOI 10.1111/j.1528-1167.2006.00523.xParadiso, S., Hermann, B.P., Blumer, D., Davies, K., Robinson, R.G., Impact of depressed mood on neuropsychological status in temporal lobe epilepsy (2001) Journal of Neurology Neurosurgery and Psychiatry, 70 (2), pp. 180-185. , DOI 10.1136/jnnp.70.2.180Pintor, L., Bailles, E., Fernandez-Egea, E., Sanchez-Gistau, V., Torres, X., Carreno, M., Rumia, J., Setoain, X., Psychiatric disorders in temporal lobe epilepsy patients over the first year after surgical treatment (2007) Seizure, 16 (3), pp. 218-225. , DOI 10.1016/j.seizure.2006.12.004, PII S1059131106002408Salgado, P.C., Fernandes, P.T., Cendes, F., Pre-surgery expectations and post-surgery life-changing validation process (2008) Epileptic Disord, 10 (4), pp. 290-296. , DecSouza, E.A.P., Salgado, P.C.B., A psychosocial view of anxiety and depression in epilepsy (2006) Epilepsy Behav, 8 (1), p. 232. , 8Spielberger, C.D., Gorsuch, R.L., Luschene, R.E., (1970) Manual for the State-Trait Anxiety Inventory, , Palo Alto, CA: Consulting Psychologist PressTellez-Zenteno, J.F., Dhar, R., Hernandez-Ronquillo, L., Wiebe, S., Long-term outcomes in epilepsy surgery: Antiepileptic drugs, mortality, cognitive and psychosocial aspects (2007) Brain, 130 (2), pp. 334-345. , DOI 10.1093/brain/awl316Wheelock, I., Peterson, C., Buchtel, H.A., Presurgery expectations, postsurgery satisfaction, and psychosocial adjustment after epilepsy surgery (1998) Epilepsia, 39 (5), pp. 487-494. , DOI 10.1111/j.1528-1157.1998.tb01410.xWilson, S.J., Saling, M.M., Lawrence, J., Bladin, P.F., Outcome of temporal lobectomy: Expectations and the prediction of perceived success (1999) Epilepsy Research, 36 (1), pp. 1-14. , DOI 10.1016/S0920-1211(99)00016-9, PII S0920121199000169Wilson, S.J., Bladin, P.F., Saling, M.M., Paradoxical results in the cure of chronic illness: The "burden of normality" as exemplified following seizure surgery (2004) Epilepsy Behav, 5, pp. 13-21Wilson, S.J., Bladin, P.F., Saling, M.M., Pattison, P.E., Characterizing psychosocial outcome trajectories following seizure surgery (2005) Epilepsy Behav, 6, pp. 570-580Wrench, J., Wilson, S.J., Bladin, P.F., Mood Disturbance before and after Seizure Surgery: A Comparison of Temporal and Extratemporal Resections (2004) Epilepsia, 45 (5), pp. 534-543. , DOI 10.1111/j.0013-9580.2004.48803.

Cysticidal Therapy: Impact On Seizure Control In Epilepsy Associated With Neurocysticercosis

Objective: To evaluate the clinical features and seizure control of epilepsy related to neurocysticercosis. Method: 18 patients with partial epilepsy and neurocysticercosis were treated with albendazol or praziquantel and followed from 3 months to 12 years. We analyzed results from the CSF exam, interietal electroencephalogram (EEG), head computerized tomography and/or magnetic resonance imaging. Results: The patients' mean age was 36.4 years. The mean duration of epilepsy was 16 years. 83% patients had simple partial seizures ; 17% had complex partial seizures. All patients underwent routine EEGs: 62% had abnormalities and 38% were normal. A relationship was observed between focal EEG abnormality and the location of cyst in 28% of the patients. The CSF exams showed pleocytosis in 33% of the patients, and 28% had elevated protein levels. Only 22% of patients had positive titer for cysticercosis in the CSF. In all patients who had somatosensory and special sensory seizures there was a relationship between location of the cysts and seizure semiology (n=11). After cysticidal therapy, 83% patients had a significant improvement in controlling seizures. Conclusion: In this group, we found a predominance of simple partial seizures and a relationship between somatosensory and special sensory seizures and the location of the cysts. 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