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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.52 no.2 São Paulo June 1994

http://dx.doi.org/10.1590/S0004-282X1994000200001 

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. YacubianI; Rosa Maria F. ValérioII; Carmem Lisa JorgeIII; Lia A. FioreIII; Arthur CukiertIV; Luís Marques De AssisV

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.

 

 

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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.