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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

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

https://doi.org/10.1590/S0004-282X1994000300004 

Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal

 

Lateralization of the epileptogenic area by magnetic ressonance imaging in temporal lobe epilepsy

 

 

M.C. SandmannI; E. RogacheskiII; S. MazerII; P.R.M. de BittencourtI

IServiço de Neurologia do Departamento de Clínica Médica do Hospital N. Sra. das Graças. Curitiba
IIServiço de Ressonância Magnética da Liga das Senhoras Católicas. Curitiba

 

 


RESUMO

Métodos especiais de MRI foram utilizados em 5 pacientes com epilepsia do lobo temporal refratários ao tratamento clínico, com a finalidade de localizar a área epileptogênica. Imagens coronais com espessura de 5 mm foram obtidas da borda posterior do tronco cerebral até a base do lobo frontal, utilizando-se as sequências "Inversion Recovery T1" (TR=2500 msec, TE=26 msec, TI=600 msec) para avaliar perda de estrutura interna e atrofia do hipocampo e morfologia do lobo temporal; Spin-echo T2w (TR=2500 msec, TE=120 msec) visando a avaliar sinais de alta intensidade anormais. Em 2 casos com focos esquerdos no EEG, a MRI mostrou atrofia, perda de estrutura interna e aumento de sinal no hipocampo, e atrofia do lobo temporal anterior, ipsilateralmente. Um caso com focos bilaterais independentes no EEG teve atrofia, perda da estrutura interna e aumento de sinal no hipocampo direito. Um caso com EEG focal direito mostrou atrofia em ambos os lobos temporais anteriores. Outro caso não mostrou anormalidades. Concluimos que esta metodologia pode facilitar a indicação cirúrgica em epilepsia do lobo temporal.

Palavras-chave: epilepsia, epilepsia focal, epilepsia do lobo temporal, crises hipocampais, ressonância magnética (técnicas).


SUMMARY

We studied 5 patients with medically refractory temporal lobe epilepsy using special methods of MRI, in order to localize the epileptogenic area. Coronal sequences were obtained with 5 mm sections from the posterior margin of the brainstem to the base of the frontal lobe using: "Inversion recovery T1" (TR=2500 msec, TE=26 msec, T1=600 msec) to analyse loss of internal structure and atrophy of the hippocampus, and morphology of the temporal lobe; and Spin-echo T2w (TR=250 msec, TE=120 msec) looking for abnormal high intensity signal. In two cases with left focal EEG the MRI showed atrophy, loss of internal structure and abnormal high intensity signal in the hippocampus, and atrophy of the anterior temporal lobe, ipsilateraly. One case with independent bilateral foci at the EEG showed atrophy, loss of internal structure and abnormal high intensity signal in the right hippocampus. Other case with right focal EEG showed bilateral atrophy of the anterior temporal lobes. Another case was normal. We conclude that this methodology can facilitate the surgical indication in temporal lobe epilepsy.

Key words: epilepsy, focal epilepsy, temporal lobe epilepsy, hippocampal seizures, magnetic resonance imaging (techniques)


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

Agradecimento - Os autores reconhecem o auxílio inestimável do Dr. John P. Duncan (National Hospitais for Neurology and Neurosurgery, London, UK) no planejamento da técnica de obtenção de imagens do lobo temporal.

 

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Aceite: 23-dezembro-1993.

 

 

Dr. Paulo R. M. de Bittencourt - Unidade de Neurologia Clínica, Hospital N. Sra. das Graças - Rua Alcides Munhoz 433 - 80810 - 040 Curitiba PR - Brasil.

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