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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.55 no.3B São Paulo Sept. 1997

http://dx.doi.org/10.1590/S0004-282X1997000400004 

Epilepsy surgery without invasive EEG: early results of a new program

 

Cirurgia de epilepsia sem EEG invasivo: resultados preliminares de um novo programa

 

 

Paulo R. M. de BittencourtIII; João C. AraújoII; Paulo J. M. LeiteI; Marlus S. MoroII; Edson R. PianaI; Marcos C. SandmannI

IProgram of Epilepsy Surgery, Hospital Nossa Senhora da Graças, Curitiba: Neurology Service
IIProgram of Epilepsy Surgery, Hospital Nossa Senhora da Graças, Curitiba: Neurosurgery Service

IIIProgram of Epilepsy Surgery, Hospital Nossa Senhora da Graças, Curitiba: Head of Neurology and Neurophysiology Services

 

 


ABSTRACT

A total of 42 patients were submitted to a clinical, behavioural and neuropsychological evaluation with the objective of eventual surgical treatment of epilepsy refractory to the usual clinical therapies. Prolonged video-EEG monitoring, MRI hippocampal volume measurement, lateralization of speech and memory using the amobarbital (Wada) test were used. Of 18 operated cases, 12 were submitted to temporal lobectomy, with a follow-up of 6-30 months; 8 patients had significant improvement in seizures control; 2 patients had partial improvement in seizure frequency and intensity; 2 patients had no improvement in seizure control. One patient underwent right frontal lobectomy with total remission of seizures and 5 had callosotomy with varying degrees of success. There was no mortality. Morbidity included one subdural hematoma, one transient hemiparesis, one episode of mania, one lobar pneumonia and frequent immediately post-operative muscular tension headaches. These early results indicate good results of temporal lobectomy patients investigated through a non-invasive presurgical evaluation.

Key-words: epilepsy, epilepsy surgery.


RESUMO

No total, 42 pacientes foram submetidos a avaliação clínica, comportamental e neuropsicológica com o objetivo de eventual tratamento cirúrgico de epilepsia refratária aos tratamentos clínicos usuais. Monitorização de vídeo-EEG digital prolongado, avaliação do volume hipocampal por RM, lateralização de fala e memória pelo teste do Amobarbital (teste de Wada) foram utilizados. Dos 18 pacientes operados 12 foram submetidos a lobectomia temporal, com seguimento de 6-30 meses (média 17 meses), sendo que 8 encontram-se com melhora significativa do controle de crises, 2 com melhora parcial e em 2 não foi observada mudança substancial na intensidade e frequência de crises. Uma paciente foi submetida a lobectomia frontal direita com remissão total de crises. Cinco pacientes foram submetidos a calosotomia com graus variáveis de sucesso. Não houve mortalidade. A morbidade incluiu um hematoma subdural, uma hemiparesia transitória, um episódio de mania, uma pneumonia lobar e cefaléia tensional muscular frequente no pós-operatório imediato. Estes resultados preliminares indicam uma boa resposta do tratamento cirúrgico de epilepsia em um novo centro, com pacientes selecionados através de monitorização não invasiva.

Palavras-chave: epilepsia, cirurgia de epilepsia


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

REFERENCES

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Aceite: 30-maio-1997.

 

 

Dr. Paulo R. M. de Bittencourt - Hospital Nossa Senhora das Graças- Rua Alcides Munhoz 443 - 80810-010 - Curitiba PR - Brasil.