Yacubian, Elza Márcia T.; Valério, Rosa Maria F.; Jorge, Carmem Lisa; Fiore, Lia A.; Cukiert, Arthur; Assis, Luís Marques De

doi:10.1590/S0004-282X1994000200001

Resumos

Analisamos as manifestações clínicas de 27 crises parciais complexas do lobo temporal registradas em vídeo-EEG com ênfase nas manifestações motoras, principalmente postura distônica, paresia crítica e versão forçada dos olhos e cabeça. A origem das crises no lobo temporal foi baseada na concordância dos exames pré cirúrgicos, que incluiam vários EEGs intercríticos e críticos, alterações na TC e RM do crânio, SPECT intercríticos e, em alguns pacientes, também críticos. 8 pacientes tiveram ressecções temporais; em 7 foi feita lobectomia temporal sendo demonstrada esclerose mesial temporal em 5; 1 paciente foi submetido a amígdalo-hipocampectomia seletiva e o achado anátomo-patológico consistiu de hemossiderose e gliose hipocampal, possivelmente decorrentes de sangramento de um aneurisma gigante da artéria cerebral posterior. Todos os pacientes estão sem crises após a cirurgia. Enquanto postura distônica e paresia crítica, presentes em 18(66.6%) das crises, foram sempre contralaterals à área epileptogênica e assim, de valor indiscutível para lateralização, versão de olhos e cabeça ocorreu tanto ipso como contralateralmente.

epilepsia temporal; crises parciais complexas; vídeo-EEG

We analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the EEG emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). The temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal EEG recordings, CT and MRI findings, interictal and, in some patients, ictal SPECT studies. 8 patients had surgery. In 5 from 7 patients who had temporal lobectomy, mesial temporal sclerosis was the anatomopathological finding and in one patient who had selective amigdalohippocampectomy,.hemosiderosis and gliosis probably due to bleeding of a posterior cerebral artery giant aneurysm was found. All patients have been seizure free after surgery. While dystonic posturing and ictal paresis, present in 18 seizures(66.6%), were excellent as lateralizing seizure signs, since they were always contralateral to the ictal onset, contralateral and ipsilateral versive head and eye movements were observed.

Temporal epilepsy; complex partial seizures; video-EEG

Manifestações clínicas de crises parciais complexas do lobo temporal: um estudo vídeo-eletrencefalográfico

Clinical manifestations in complex partial seizures of temporal lobe onset: a video-EEG analysis

Elza Márcia T. Yacubian^I; Rosa Maria F. Valério^II; Carmem Lisa Jorge^III; Lia A. Fiore^III; Arthur Cukiert^IV; Luís Marques De Assis^V

^IClínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP): Assistente Doutora

^IIClínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP): Médica Estagiária

^IIIClínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP): Pós-Graduanda

^IVClínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP): Preceptor de Neurocirurgia

^VClínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP): Docente Livre de Clínica Neurológica

RESUMO

Analisamos as manifestações clínicas de 27 crises parciais complexas do lobo temporal registradas em vídeo-EEG com ênfase nas manifestações motoras, principalmente postura distônica, paresia crítica e versão forçada dos olhos e cabeça. A origem das crises no lobo temporal foi baseada na concordância dos exames pré cirúrgicos, que incluiam vários EEGs intercríticos e críticos, alterações na TC e RM do crânio, SPECT intercríticos e, em alguns pacientes, também críticos. 8 pacientes tiveram ressecções temporais; em 7 foi feita lobectomia temporal sendo demonstrada esclerose mesial temporal em 5; 1 paciente foi submetido a amígdalo-hipocampectomia seletiva e o achado anátomo-patológico consistiu de hemossiderose e gliose hipocampal, possivelmente decorrentes de sangramento de um aneurisma gigante da artéria cerebral posterior. Todos os pacientes estão sem crises após a cirurgia. Enquanto postura distônica e paresia crítica, presentes em 18(66.6%) das crises, foram sempre contralaterals à área epileptogênica e assim, de valor indiscutível para lateralização, versão de olhos e cabeça ocorreu tanto ipso como contralateralmente.

Palavras-chave: epilepsia temporal, crises parciais complexas, vídeo-EEG.

SUMMARY

We analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the EEG emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). The temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal EEG recordings, CT and MRI findings, interictal and, in some patients, ictal SPECT studies. 8 patients had surgery. In 5 from 7 patients who had temporal lobectomy, mesial temporal sclerosis was the anatomopathological finding and in one patient who had selective amigdalohippocampectomy,.hemosiderosis and gliosis probably due to bleeding of a posterior cerebral artery giant aneurysm was found. All patients have been seizure free after surgery. While dystonic posturing and ictal paresis, present in 18 seizures(66.6%), were excellent as lateralizing seizure signs, since they were always contralateral to the ictal onset, contralateral and ipsilateral versive head and eye movements were observed.

Key words: Temporal epilepsy, complex partial seizures, video-EEG.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 6-outubro-1993.

Dra. Elza Márcia Targas Yacubian - Divisão de Clínica Neurológica, Hospital das Clínicas da FMUSP - Avenida Dr. Enéas de Carvalho Aguiar, 255 - 05403-900 São Paulo SP - Brasil.

1. Beikovic SF, Bladin PF. An electroclinical study of complex partial seizures. Epilepsia 1984, 25:668-669.
2. Bossi L, Munari C, Stoffels C, Bonis A, Bacia T, Talairach J, Bancaud J. Somatomotor manifestations in temporal lobe seizures. Epilepsia 1984, 25:70-76.
3. Feindel W. Temporal lobe seizures. In: Vinken PJ, Bruyn GW, eds. The epilepsies. Amsterdam: North Holland 1974, Handbook of Clinical Neurology, Vol 15: 87-106.
4. Delgado Escueta AV, Enrile Bacsal F, Treiman DM. Complex partial seizures on closed-circuit television and EEG: a study of 691 attacks in 79 patients. Ann Neurol 1982, 11:292-300.
5. Escueta AV, Kunze U, Waddell G, Boxley J, Nadel A. Lapse of consciousness and automatisms in temporal lobe epilepsy: a videotape analysis. Neurology 1977, 27:144-155.
6. Feindel W, Penfield W. Localization of discharge in temporal lobe automatism. Arch Neurol Psychiat 1954, 72:605-630.
7. Geier S, Bancaud J, Talairach J, Hossard-Bouchaud H, Enjelvin M. Ictal tonic postural changes and automatisms of the upper limb during epileptic parietal lobe discharges. Epilepsia 1977,18:517-524.
8. Kotagal P. Seizure symptomatology of temporal lobe epilepsy. In Lüders H, ed. Epilepsy Surgery. New York: Raven Press, 1991, 143-156.
9. Kotagal P. Psychomotor seizures: clinical and EEG findings. In Wyllie E, ed. The treatment of epilepsy: principles and practice. Philadelphia: Lea & Febiger, 1993, p 378-392.
10. Kotagal P, Lüders H, Williams G, Wyllie E, Nichols T, McPherson J. Temporal lobe complex partial seizures: analysis of symptom clusters and sequences. Epilepsia 1988, 29:661.
11. Kotagal P, Lüders H, Morris HH, Dinner DS, Wyllie E, Godoy J, Rothner AD. Dystonic posturing in complex partial seizures of temporal lobe onset: a new lateralizing sign. Neurology 1989,39:196-201.
12-Maldonado HM, Delgado-Escueta AV, Walsh GO, Swartz BE, Rand RW. Complex partial seizures of hippocampal and amygdalar origin. Epilepsia 1988, 29:420-433.
13. McLachlan RS. The significance of head and eye turning in seizures. Neurology 1987, 37:1617-1619.
14. Newton MR, Berkovic SF, Austin MC, Reutens DC, McKay WJ, Bladin PF. Dystonia, clinical lateralization, and regional blood flow changes in temporal lobe seizures. Neurology 1992, 42:371-377.
15. Ochs R, Gloor P, Quesney F, Ives J, Olivier A. Does head-turning during a seizure have lateralizing or localizing significance? Neurology 1984, 34:884-890.
16. Palmini ALF. Padrões eletroclínicos e neuro-radiológicos nas epilepsias do lobo temporal e frontal refratárias ao tratamento medicamentoso: critérios de seleção e prognóstico de tratamento cirúrgico. JLBE 1991, 4:23-35.
17. Palmini A, Gloor P. The localizing value of auras in partial seizures: a prospective and retrospective study. Neurology 1992, 42: 801-808.
18. Robillard A, Saint-Hilaire JM, Mercier M, Bouvier G. The lateralizing and localizing value of adversión in epileptic seizures. Neurology 1983, 33:1241-1242.
19. Salanova V, Andermann F, Olivier A, Rasmussen T, Quesney LF. Occipital lobe epilepsy: electroclinical manifestations, electrocorticography, cortical stimulation and outcome in 42 patients treated between 1930 and 1991. Brain 1992, 115:1655-1680.
20. Theodore WH, Porter RJ, Penry JK. Complex partial seizures: clinical characteristics and differencial diagnosis. Neurology 1983, 33:1115-1121.
21. Walker EB, Sharbrough FW. The significance of lateralized ictal paresis ocurring during complex partial seizures. Epilepsia 1988, 29:665.
22. Wyllie E, Lüders H, Morris HH, Lesser RP, Dinner DD. The lateralizing significance of versive head and eye movements during epileptic seizures. Neurology 1986, 36:606-611.

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Jun 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Beikovic SF, Bladin PF. An electroclinical study of complex partial seizures. Epilepsia 1984, 25:668-669.

[2] 2. Bossi L, Munari C, Stoffels C, Bonis A, Bacia T, Talairach J, Bancaud J. Somatomotor manifestations in temporal lobe seizures. Epilepsia 1984, 25:70-76.

[3] 3. Feindel W. Temporal lobe seizures. In: Vinken PJ, Bruyn GW, eds. The epilepsies. Amsterdam: North Holland 1974, Handbook of Clinical Neurology, Vol 15: 87-106.

[4] 4. Delgado Escueta AV, Enrile Bacsal F, Treiman DM. Complex partial seizures on closed-circuit television and EEG: a study of 691 attacks in 79 patients. Ann Neurol 1982, 11:292-300.

[5] 5. Escueta AV, Kunze U, Waddell G, Boxley J, Nadel A. Lapse of consciousness and automatisms in temporal lobe epilepsy: a videotape analysis. Neurology 1977, 27:144-155.

[6] 6. Feindel W, Penfield W. Localization of discharge in temporal lobe automatism. Arch Neurol Psychiat 1954, 72:605-630.

[7] 7. Geier S, Bancaud J, Talairach J, Hossard-Bouchaud H, Enjelvin M. Ictal tonic postural changes and automatisms of the upper limb during epileptic parietal lobe discharges. Epilepsia 1977,18:517-524.

[8] 8. Kotagal P. Seizure symptomatology of temporal lobe epilepsy. In Lüders H, ed. Epilepsy Surgery. New York: Raven Press, 1991, 143-156.

[9] 9. Kotagal P. Psychomotor seizures: clinical and EEG findings. In Wyllie E, ed. The treatment of epilepsy: principles and practice. Philadelphia: Lea & Febiger, 1993, p 378-392.

[10] 10. Kotagal P, Lüders H, Williams G, Wyllie E, Nichols T, McPherson J. Temporal lobe complex partial seizures: analysis of symptom clusters and sequences. Epilepsia 1988, 29:661.

[11] 11. Kotagal P, Lüders H, Morris HH, Dinner DS, Wyllie E, Godoy J, Rothner AD. Dystonic posturing in complex partial seizures of temporal lobe onset: a new lateralizing sign. Neurology 1989,39:196-201.

[12] 12-Maldonado HM, Delgado-Escueta AV, Walsh GO, Swartz BE, Rand RW. Complex partial seizures of hippocampal and amygdalar origin. Epilepsia 1988, 29:420-433.

[13] 13. McLachlan RS. The significance of head and eye turning in seizures. Neurology 1987, 37:1617-1619.

[14] 14. Newton MR, Berkovic SF, Austin MC, Reutens DC, McKay WJ, Bladin PF. Dystonia, clinical lateralization, and regional blood flow changes in temporal lobe seizures. Neurology 1992, 42:371-377.

[15] 15. Ochs R, Gloor P, Quesney F, Ives J, Olivier A. Does head-turning during a seizure have lateralizing or localizing significance? Neurology 1984, 34:884-890.

[16] 16. Palmini ALF. Padrões eletroclínicos e neuro-radiológicos nas epilepsias do lobo temporal e frontal refratárias ao tratamento medicamentoso: critérios de seleção e prognóstico de tratamento cirúrgico. JLBE 1991, 4:23-35.

[17] 17. Palmini A, Gloor P. The localizing value of auras in partial seizures: a prospective and retrospective study. Neurology 1992, 42: 801-808.

[18] 18. Robillard A, Saint-Hilaire JM, Mercier M, Bouvier G. The lateralizing and localizing value of adversión in epileptic seizures. Neurology 1983, 33:1241-1242.

[19] 19. Salanova V, Andermann F, Olivier A, Rasmussen T, Quesney LF. Occipital lobe epilepsy: electroclinical manifestations, electrocorticography, cortical stimulation and outcome in 42 patients treated between 1930 and 1991. Brain 1992, 115:1655-1680.

[20] 20. Theodore WH, Porter RJ, Penry JK. Complex partial seizures: clinical characteristics and differencial diagnosis. Neurology 1983, 33:1115-1121.

[21] 21. Walker EB, Sharbrough FW. The significance of lateralized ictal paresis ocurring during complex partial seizures. Epilepsia 1988, 29:665.

[22] 22. Wyllie E, Lüders H, Morris HH, Lesser RP, Dinner DD. The lateralizing significance of versive head and eye movements during epileptic seizures. Neurology 1986, 36:606-611.