Abstracts
A 32 years old woman who had postural limbic and primarily generalized tonic-clonic seizures since the age of 11 presented to us with a CT image strongly suggestive of a mesial meningeoma near the right cingulum. Her ictal EEG pattern was characterized by regular 1.5-2.0 Hz sharp and slow wave complexes. A right craniotomy was performed under general anesthesia and intraoperative electroencephalographic and electrocorticographic recordings were obtained by means of scalp steel electrodes and modified cerebellar stimulation electrodes, respectively. These recordings demonstrated that surface spikes were often independent from the electrocorticographically recorded ones. Before tumor excision, electrical stimulation of the peritumoral mesial cortex resulted in an increase in the epileptic activity. The stimulation of the cavity left after tumor excision led to a prolonged electrographic seizure and neurophysiological procedures were stopped. Post-operatively, the patient has remained seizure free for 6 months and her EEG was normal. The pre-, intra- and post-operative findings in this case suggest that the gliotic peritumoral mesial cortex was at least involved in the epileptogenic process.
Uma paciente, com 32 anos de idade, com crises posturais e tônicoclônicas primariamente generalizadas, realizou TC de crânio que sugeria fortemente um meningioma mesial, sobre o cíngulo direito. Seu padrão elietrográfico ictal era caracterizado por complexos de onda aguda e onda lenta associadas na frequência de 1,5-2,0 Hz, difusamente distribuídos. Craniotomia frontal direita foi realizada sob anestesia geral e registros electrencefalográficos e eletrocorticográficos foram obtidos por eletrodos de aço subgaleais e eletrodos de estimulação cerebelar modificados, respectivamente. Estes registros demonstraram que as espículas registradas na convexidade eram frequentemente independentes daquelas registradas na profundidade. Antes da exérese tumoral, a estimulação elétrica do córtex mesial peritumoral resultou em aumento da atividade epiléptica. A estimulação da cavidade deixada pela retirada do tumor originou crise electrográfica prolongada e os procedimentos neurofisiológicos foram interrompidos. Nos primeiros meses pós operatórios a paciente manteve-se sem crises. A seguir, apresentou episódio psicótico associado a surto de crises, voltando depois ao controle clínico inicial. Os achados pré-, intra- e pós-operatórios neste caso sugerem que o córtex mesial estava envolvido no processo epileptogênico da sincronia bilateral secundária.
CONTENTS CONTEÚDO
A. Cukiert; G. Gronich; R. Marino Jr.
Division of Functional Neurosurgery and Department of Neurology, The São Paulo University School of Medicine. Grants by FAPESP, FINEP, CNPq, I-LIMs.
SUMMARY
A 32 years old woman who had postural limbic and primarily generalized tonic-clonic seizures since the age of 11 presented to us with a CT image strongly suggestive of a mesial meningeoma near the right cingulum. Her ictal EEG pattern was characterized by regular 1.5-2.0 Hz sharp and slow wave complexes. A right craniotomy was performed under general anesthesia and intraoperative electroencephalographic and electrocorticographic recordings were obtained by means of scalp steel electrodes and modified cerebellar stimulation electrodes, respectively. These recordings demonstrated that surface spikes were often independent from the electrocorticographically recorded ones. Before tumor excision, electrical stimulation of the peritumoral mesial cortex resulted in an increase in the epileptic activity. The stimulation of the cavity left after tumor excision led to a prolonged electrographic seizure and neurophysiological procedures were stopped. Post-operatively, the patient has remained seizure free for 6 months and her EEG was normal. The pre-, intra- and post-operative findings in this case suggest that the gliotic peritumoral mesial cortex was at least involved in the epileptogenic process.
RESUMO
Uma paciente, com 32 anos de idade, com crises posturais e tônicoclônicas primariamente generalizadas, realizou TC de crânio que sugeria fortemente um meningioma mesial, sobre o cíngulo direito. Seu padrão elietrográfico ictal era caracterizado por complexos de onda aguda e onda lenta associadas na frequência de 1,5-2,0 Hz, difusamente distribuídos. Craniotomia frontal direita foi realizada sob anestesia geral e registros electrencefalográficos e eletrocorticográficos foram obtidos por eletrodos de aço subgaleais e eletrodos de estimulação cerebelar modificados, respectivamente. Estes registros demonstraram que as espículas registradas na convexidade eram frequentemente independentes daquelas registradas na profundidade. Antes da exérese tumoral, a estimulação elétrica do córtex mesial peritumoral resultou em aumento da atividade epiléptica. A estimulação da cavidade deixada pela retirada do tumor originou crise electrográfica prolongada e os procedimentos neurofisiológicos foram interrompidos. Nos primeiros meses pós operatórios a paciente manteve-se sem crises. A seguir, apresentou episódio psicótico associado a surto de crises, voltando depois ao controle clínico inicial. Os achados pré-, intra- e pós-operatórios neste caso sugerem que o córtex mesial estava envolvido no processo epileptogênico da sincronia bilateral secundária.
Dr. Arthur Cukiert - Rua Baltazar da Veiga 367 apto. 151 - 04510 São Paulo SP - Brasil.
- 1. Avila JO, Radvany J, Huck FR, Camargo CH, Marino R Jr, Ragazzo PC, Riva 1). Anterior callosotomy as a substitute of hemispherectomy. Acta Neurochir 1980 (Suppl) 30:137.
- 2. Bancaud J, Talairach J, Morel P, Bresson M, Geier BS, Hemon E, Buser P. «Generalised» epileptic seizures elicited by electrical stimulation of the frontal lobe in man. Electroenceph Clin Neurophysiol 1974, 37:275.
- 3. Commission on Classification land Terminology of the ILAE. Proposal for revised clinical classification of epileptic seizures. Epilepsia 1981, 22:489.
- 4. Fegersten L, Roger A. Frontal epileptogenic foci and their clinical correlations. Electroenceph Clin Neurophysiol 1961, 13:905.
- 5. Gloor P. Consciousness as a neurologic concept in epileptology: a critical review. Epilepsia 1986, (Suppl 2) 27:S14.
- 6. Huck FR, Radvany J, Avila JO, Camargo CH, Marino R Jr, Ragazzo PC, Riva D. Anterior callosotomy in epileptics with multiform seizures and bilateral synchronous spike and wave EG pattern. Acta Neurochir 1980, (Suppl) 30:127.
- 7. Kennedy WA. CLnical and electroencephalographic aspects of epileptogenic lesions of the medial surface and superior border of the cerebral hemisphere. Brain 1959, 82:147.
- 8. Ludwig B, Ajmone-Marsan C, Van Buren J. Cerebral seizures of probable orbitofrontal origin. Epilepsia 1975, 16:141.
- 9. Marino R Jr, Ragazzo PC. Selection criteria and results of selective partial callosotomy. In Reeves AG (ed) : Epilepsy and the Corpus Callosum. New York: Plenum Press, 1985, p 281-301.
- 10. Mazars G. Criteria for identifying cingulate epilepsies. Epilepsia 1970, 11:41.
- 11. Pedley TA, Tharp BR, Herman K. Clinical and electroencephalographic characteristics of midline parasagittal foci. Ann Neurol 1981, 9:142.
- 12. Ralston BL. Cingulate epilepsy and secondary bilateral synchrony. Electroenceph Clin Neurophysiol 1961, 13:591.
- 13. Spencer SS, Spencer DD, Glaser GH, Willianson PD, Mattson RH. More intense focal seizure types after callosal section : the role of inhibition. Ann Neurol 1984, 16:686.
- 14. Tharp BR. Orbitofrontal seizures: an unique electroencephalographic and clinical syndrome. Epilepsia 1972, 13:627.
- 15. Tukel K, Jasper H. The electroencephalogram in parasagittal lesions. Electroenceph Clin Neurophysiol 1952, 4:481.
- 16. Van Wagenen WP, Herren RY. Surgical division of comissural pathways in the corpus callosum: relation to spread of an epileptic attack. Arch Neurol Psychiat 1940, 44:740.
Secondary bilateral synchrony associated to a parasagittal tumor case report
Publication Dates
-
Publication in this collection
22 Feb 2011 -
Date of issue
Sept 1991
