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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.52 no.3 São Paulo Sept. 1994 

Functional significance of MRI defined mesial temporal sclerosis in temporal lobe epilepsy


Significado funcional da esclerose mesial temporal definida por ressonância magnética em epilepsia do lobo temporal



Elza Márcia T. YacubianI; Arthur CukiertI; Paulo CarrilhoI; Carmen Lisa JorgeI; Lia Arno FioreI; Carlos Alberto BuchpiguelII

IHospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP): Divisão de Neurologia
IIHospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP): Instituto de Medicina Nuclear




The functional significance of MRI-defined mesial temporal sclerosis in temporal lobe epilepsy (TLE) is not completely established. In order to study the possible relationship between signals of mesial temporal sclerosis on MRI and interictal SPECT findings we selected 18 patients with complex partial seizures, unilateral temporal EEG focus and normal CT. The EEG focus was defined by the presence of interictal sharp waves and slow background on several scalp EEG obtained during many years of follow up in all patients and by ictal recordings with sphenoidal electrodes in 12 patients. Group I comprised patients (n=11) in whom MRI showed mesial temporal sclerosis; group II patients (n=7) had normal MRIs. All patients were submitted to interictal 99m-Tc HMPAO injections with concomitant EEG monitoring. Lateralized hypoperfusion ipsilateral to the EEG was found in 13 patients (72%). In all Group II and in 6 Group I patients a temporal hypoperfusion was found. This SPECT study showed a higher positivity rate in patients with normal MRI than previously reported. On the other hand, in all these group II patients a neocortical origin of epileptic focus was suspected on clinical or electroencephalographic basis. Positive SPECT findings may be at least as prevalent in neocortical as in mesiolimbic epilepsy.

Key words: epilepsy, temporal lobe epilepsy, SPECT, MRI.


O significado funcional dos sinais de esclerose mesial temporal observados em ressonância magnética ainda não está estabelecido. Para estudar as relações entre sinais de esclerose mesial temporal na ressonância magnética e alterações no SPECT intercrítico, foram selecionados 18 pacientes com epilepsia do lobo temporal cujo diagnóstico foi definido pela presença de descargas de ondas agudas e alentecimento da atividade de base em vários EEG obtidos durante vários anos de seguimento em todos os pacientes e por registros críticos com eletrodos esfenoidais em 12 pacientes. No grupo I foram incluídos pacientes (n=11) com sinais de esclerose mesial temporal na ressonância magnética; no grupo II (n=7), pacientes com ressonância normal. Em todos os casos a injeção do Tc 99 HMPAO foi realizada no período intercrítico com monitorização EEG. Foi observada hipoperfusão lateralizada ipsolateral ao foco definido pelo EEG em 13 pacientes (72%). Todos os pacientes do grupo II e 6 pacientes do grupo I tiveram hipoperfusão temporal. Este estudo mostrou maior positividade de SPECT em pacientes com ressonância magnética normal do que tem sido referido na literatura. Como os pacientes do grupo II tinham sinais clínicos ou eletrencefalográficos sugestivos de origem neocortical de suas crises epilépticas, postulamos que hipoperfusão em estudos de SPECT pode ser demonstrada tanto em epilepsia temporal neocortical como mesiolímbica.

Palavras-chave: epilepsia, epilepsia temporal, SPECT, ressonância magnética.



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Aceite: 4-março-1994.



Estudo parcialmente financiado por FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo.
Dra. Elza Márcia Targas Yacubian - Divisão de Neurologia, Hospital das Clínicas, FMUSP - Av. Dr. Eneas de Carvalho Aguiar 255, Instituto Central - sala 5011 A - 05403-000 São Paulo SP - Brasil.

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