Foco epileptógeno parassagital com reversão de fase no vertex: correlações clínico-eletrencefalográficas

Mega, Décio; Lison, Michel P.

doi:10.1590/S0004-282X1967000400005

Resumos

Foram estudados, do ponto de vista clínico e eletrencefalográfico, 22 pacientes que apresentavam foco convulsiógeno parassagital com reversão de fase no vértex. O critério adotado na seleção dos casos foi puramente eletrencefalográfico. Desse estudo os autores concluem: 1. Descargas focais primárias ao nível da região parassagital são raras (0,5% aproximadamente) na ausência de processo medicamentoso de ativação; predominam nitidamente na infância. 2. Através de centros subcorticais (provavelmente a formação reticular talâmica medial), podem determinar o aparecimento de descargas síncronas difusas e bilaterais ("sincronismo bilateral secundário"), que, em nosso material, esteve presente em 6 casos (27%). 3. Estas descargas, às vezes semelhantes ao sincronismo bilateral primário da Epilepsia Pequeno Mal clássica, caracterizaram-se por 3 elementos fundamentais: a) irregularidade das descargas; b) reversão simples de fase na linha média; c) assimetria de voltagem em torno do vértex. 4. Do ponto de vista clínico houve predomínio das crises adversivas (45%) e das crises acinéticas (18%) sobre as demais. 5. Sincronismo bilateral secundário pode ser acompanhado de crises de ausência (em nosso material presente em apenas 2 casos) que diferem daquelas típicamente "centrencefálicas" pela variabilidade de manifestações que as acompanham. 6. Lesões epiletógenas localizadas na superfície mesial de um dos hemisférios cerebrais poderiam ser responsabilizadas pelo aparecimento de crises acinéticas. Essas crises estiveram presentes em 4 casos e, em todos eles, a descarga focal esteve representada por ondas lentas (1 a 4 c/s), de elevado potencial e com reversão de fase no vértex.

The authors studied, from the clinical and electroencephalographic points of view, 22 patients with parasagittal convulsive focal activity with a phase reversal at the vertex. The selection of cases was purely electroencephalographic. The authors conclude: 1. Primary focal discharges in the parasagittal region are rare (0,5%) when the EEG is not activated; they are more frequently found in infancy and childhood. 2. The parasagittal focus may lead to bilateral diffuse synchronous discharges (secondary bilateral synchronism) through some subcortical centers (presumably the thalamic reticular formation). Those discharges were present in 6 cases. 3. Those discharges can be similar to the primary bilateral synchronism found in the P.M. epilepsy and can be characterized by three fundamental aspects: a) irregularity of discharges; b) a single phase reversal at the midline; c) asymmetry at the vertex region. 4) From the clinical point of view the adversive (45%) and akinetic seizures (18%) were the most frequently found. 5. Secondary bilateral synchronism can be associated with absence seizures (observed in 2 cases only); these seizures however are very different from these called "centrencephalic" for they are associated with several types of clinical, signs. 6. Epileptogenic lesion in the mesial aspect of cerebral cortex could be responsible for akinetic seizures. The authors found these seizures in 4 patients and in all of them the focal discharge was represented by slow waves (1 to 4 c/sec) of high voltage and with a phase reversal at the vertex.

Foco epileptógeno parassagital com reversão de fase no vertex: correlações clínico-eletrencefalográficas

Parasagittal epileptogenic focus with a phase reversal at the vertex: clinical and electroencephalographic correlations

Décio Mega^I; Michel P. Lison^II

^IDepartamento de Neurologia da Faculdade de Medicina de Ribeirão Prêto da Universidade de São Paulo (Prof. J. Armbrust Figueiredo): Instrutor

^IIDepartamento de Neurologia da Faculdade de Medicina de Ribeirão Prêto da Universidade de São Paulo (Prof. J. Armbrust Figueiredo): Professor Assistente

RESUMO

Foram estudados, do ponto de vista clínico e eletrencefalográfico, 22 pacientes que apresentavam foco convulsiógeno parassagital com reversão de fase no vértex. O critério adotado na seleção dos casos foi puramente eletrencefalográfico. Desse estudo os autores concluem:

1. Descargas focais primárias ao nível da região parassagital são raras (0,5% aproximadamente) na ausência de processo medicamentoso de ativação; predominam nitidamente na infância.

2. Através de centros subcorticais (provavelmente a formação reticular talâmica medial), podem determinar o aparecimento de descargas síncronas difusas e bilaterais ("sincronismo bilateral secundário"), que, em nosso material, esteve presente em 6 casos (27%).

3. Estas descargas, às vezes semelhantes ao sincronismo bilateral primário da Epilepsia Pequeno Mal clássica, caracterizaram-se por 3 elementos fundamentais: a) irregularidade das descargas; b) reversão simples de fase na linha média; c) assimetria de voltagem em torno do vértex.

4. Do ponto de vista clínico houve predomínio das crises adversivas (45%) e das crises acinéticas (18%) sobre as demais.

5. Sincronismo bilateral secundário pode ser acompanhado de crises de ausência (em nosso material presente em apenas 2 casos) que diferem daquelas típicamente "centrencefálicas" pela variabilidade de manifestações que as acompanham.

6. Lesões epiletógenas localizadas na superfície mesial de um dos hemisférios cerebrais poderiam ser responsabilizadas pelo aparecimento de crises acinéticas. Essas crises estiveram presentes em 4 casos e, em todos eles, a descarga focal esteve representada por ondas lentas (1 a 4 c/s), de elevado potencial e com reversão de fase no vértex.

SUMMARY

The authors studied, from the clinical and electroencephalographic points of view, 22 patients with parasagittal convulsive focal activity with a phase reversal at the vertex. The selection of cases was purely electroencephalographic. The authors conclude:

1. Primary focal discharges in the parasagittal region are rare (0,5%) when the EEG is not activated; they are more frequently found in infancy and childhood.

2. The parasagittal focus may lead to bilateral diffuse synchronous discharges (secondary bilateral synchronism) through some subcortical centers (presumably the thalamic reticular formation). Those discharges were present in 6 cases.

3. Those discharges can be similar to the primary bilateral synchronism found in the P.M. epilepsy and can be characterized by three fundamental aspects: a) irregularity of discharges; b) a single phase reversal at the midline; c) asymmetry at the vertex region.

4) From the clinical point of view the adversive (45%) and akinetic seizures (18%) were the most frequently found.

5. Secondary bilateral synchronism can be associated with absence seizures (observed in 2 cases only); these seizures however are very different from these called "centrencephalic" for they are associated with several types of clinical, signs.

6. Epileptogenic lesion in the mesial aspect of cerebral cortex could be responsible for akinetic seizures. The authors found these seizures in 4 patients and in all of them the focal discharge was represented by slow waves (1 to 4 c/sec) of high voltage and with a phase reversal at the vertex.

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1. AJMONE-MARSAN, C. & RALSTON, B. L. The Epileptic Seizure. Its Functional Morphology and Diagnostic Significance. Charles C. Thomas,. Springfield (Illinois), 1957.
2. BANCAUD, J. COLOMB, H. & DELL, M. B. Rolandic spikes: an EEG sign typical for childhood. EEG Clin. Neurophysiol. 10:346, 1958.
3. CHAO, D. DRUCKMAN, R. & KELLAWAY, P. Convulsive Disorders of Children. W. B. Saunders Co., Philadelphia-Montreal, 1958.
4. COURJON, J. & FAVEL, P. L'aspect electrographique des crises akinétiques. Rev. Neurol. 105:211-212, 1961.
5. GASTAUT, Y. Les pointes negatives évoquées sur le vertex. Leur signification psychophysiologique et pathologique. Rev. Neurol. 89:382-399, 1953.
6. JASPER, H. Étude anatomo-physiologique des epilepsies. EEG Clin. Neurophysiol. Suppl. 2:99-111, 1951.
7. JASPER, H. The ten twenty system of the international federation. EEG Clin. Neurophysiol. 10:371-375, 1958.
8. KELLAWAY, P. & PETERSEN, I. Neurological and Electroencephalographic Correlative Studies in Infancy. Grune & Stratton, New York-London, 1960.
9. KENNEDY, W. A. Clinical and electroencephalographic aspects of epileptogenic lesions of the mesial surface and superior border of the cerebral hemisphere. Brain 82:147-161, 1959.
10. LENNOX, M. A. & ROBINSON, F. Cingulate cerebellar mechanisms in the physiological pathogenesis of epilepsy. EEG Clin. Neurophysiol. 3:197-205, 1951.
11. LENNOX, W. G. Epilepsy and Related Disorders. Little Brown Co., Boston, 1960.
12. LIVINGSTON, S. The Diagnosis and Treatmerit of Convulsive Disorders in Children. Charles C. Thomas, Springfield (Illinois), 1954.
13. MAROSSERO, F. MASPES, P. E. & RIVOLTA, A. Post-traumatic focal epilepsy with parasagital focus; clinical, electroencephalographic, electrocarticographic observations. EEG Clin. Neurophysiol. 6:533, 1954.
14. MAZARS, Y. MAZARS, G. GOTUSSO, C. & MERIENNE, L. Place de l'épilepsie cingulaire dans le cadre des epilepsies focales corticales. Rev. Neurol. 114:225-242, 1966.
15. PENFIELD, W. & JASPER, H. Highest level seizures. Proc. Res. Publ. Ass. Nerv. Ment. Dis. 26:252-271, 1946.
16. PENFIELD, W. & WELCH, K. The supplementary motor area of the cerebral cortex. A. M. A. Arch. Neurol. & Psychiat. 66:289-317, 1951.
17. PENFIELD, W. & JASPER, H. Epilepsy and the Functional Anatomy of the Human Brain. Little Brown Co., Boston, 1954.
18. RALSTON, B. L. Cingulate epilepsy and secondary bilateral synchrony. EEG Clin. Neurophysiol. 13:591-598, 1961.
19. TÜKEL, K. & JASPER, H. The electroencephalogram is parasagital lesions. EEG Clin. Neurophysiol. 4:481-494, 1952.

Datas de Publicação

Publicação nesta coleção
21 Maio 2013
Data do Fascículo
Dez 1967

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

[1] 1. AJMONE-MARSAN, C. & RALSTON, B. L. The Epileptic Seizure. Its Functional Morphology and Diagnostic Significance. Charles C. Thomas,. Springfield (Illinois), 1957.

[2] 2. BANCAUD, J. COLOMB, H. & DELL, M. B. Rolandic spikes: an EEG sign typical for childhood. EEG Clin. Neurophysiol. 10:346, 1958.

[3] 3. CHAO, D. DRUCKMAN, R. & KELLAWAY, P. Convulsive Disorders of Children. W. B. Saunders Co., Philadelphia-Montreal, 1958.

[4] 4. COURJON, J. & FAVEL, P. L'aspect electrographique des crises akinétiques. Rev. Neurol. 105:211-212, 1961.

[5] 5. GASTAUT, Y. Les pointes negatives évoquées sur le vertex. Leur signification psychophysiologique et pathologique. Rev. Neurol. 89:382-399, 1953.

[6] 6. JASPER, H. Étude anatomo-physiologique des epilepsies. EEG Clin. Neurophysiol. Suppl. 2:99-111, 1951.

[7] 7. JASPER, H. The ten twenty system of the international federation. EEG Clin. Neurophysiol. 10:371-375, 1958.

[8] 8. KELLAWAY, P. & PETERSEN, I. Neurological and Electroencephalographic Correlative Studies in Infancy. Grune & Stratton, New York-London, 1960.

[9] 9. KENNEDY, W. A. Clinical and electroencephalographic aspects of epileptogenic lesions of the mesial surface and superior border of the cerebral hemisphere. Brain 82:147-161, 1959.

[10] 10. LENNOX, M. A. & ROBINSON, F. Cingulate cerebellar mechanisms in the physiological pathogenesis of epilepsy. EEG Clin. Neurophysiol. 3:197-205, 1951.

[11] 11. LENNOX, W. G. Epilepsy and Related Disorders. Little Brown Co., Boston, 1960.

[12] 12. LIVINGSTON, S. The Diagnosis and Treatmerit of Convulsive Disorders in Children. Charles C. Thomas, Springfield (Illinois), 1954.

[13] 13. MAROSSERO, F. MASPES, P. E. & RIVOLTA, A. Post-traumatic focal epilepsy with parasagital focus; clinical, electroencephalographic, electrocarticographic observations. EEG Clin. Neurophysiol. 6:533, 1954.

[14] 14. MAZARS, Y. MAZARS, G. GOTUSSO, C. & MERIENNE, L. Place de l'épilepsie cingulaire dans le cadre des epilepsies focales corticales. Rev. Neurol. 114:225-242, 1966.

[15] 15. PENFIELD, W. & JASPER, H. Highest level seizures. Proc. Res. Publ. Ass. Nerv. Ment. Dis. 26:252-271, 1946.

[16] 16. PENFIELD, W. & WELCH, K. The supplementary motor area of the cerebral cortex. A. M. A. Arch. Neurol. & Psychiat. 66:289-317, 1951.

[17] 17. PENFIELD, W. & JASPER, H. Epilepsy and the Functional Anatomy of the Human Brain. Little Brown Co., Boston, 1954.

[18] 18. RALSTON, B. L. Cingulate epilepsy and secondary bilateral synchrony. EEG Clin. Neurophysiol. 13:591-598, 1961.

[19] 19. TÜKEL, K. & JASPER, H. The electroencephalogram is parasagital lesions. EEG Clin. Neurophysiol. 4:481-494, 1952.