Refractory epilepsy associated with cerebral tumor of slow growth

REFRACTORY EPILEPSY ASSOCIATED WITH CEREBRAL TUMOR OF SLOW GROWTH (ABSTRACT)^*. DISSERTATION. RECIFE, 1999.

PAULO THADEU BRAINER DE QUEIROZ LIMA^**

Refractory epilepsy is a problem of serious consequences for the patient, his family and the community. The technological progress provided the diagnosis of a group of tumors of the brain that are mainly responsible for epileptic crises without control, characteristically in children and young adults, the cerebral tumor of slow growth.

Thirty four patients with refractory epilepsy associated with cerebral tumor of slow growth were operated between June of 1992 and September of 1997 in the services of Hospital das Clinicas da Universidade de São Paulo, in the Neurology Institute of São Paulo, and at Hospital da Restauração of Recife.

The patients were divided according pathologic results in two groups: Group A - gangliogliomas, with 15 patients (44.1%) and Group B -other tumors, i.c., astrocytomas (12), oligodendrogliomas (5), pleomorphic xantoastrocytoma (1) and desembryoblastic neuroepithelial tumor (1).

Patients of group A showed different clinical behavior, with beginning of the epileptic crises before age of 8 years (p<0.005) and seizures frequency lower than 16 monthly (p<0.002), differentiating with ganglioglioma. The epileptic crises of the complex partial type prevailed (88.2%) and the neurological exam was normal in 67.7% of all patients.

Magnetic resonance image showed the tumors in all cases, while the computerized tomography was considered normal in 5 patients. The use of contrast did not increase the sensibility of the computerized tomography in relation to magnetic resonance. Group A did not show edema or calcifications in the images, with a smaller captation of contrast in the magnetic resonance when compared with group B (20% and 42%). Mass effect was observed in 20% of the exams in group A against 52% in group B. The electroencephalogram was inexact in just 17.6% of the patients, without any repercussion on the final result.

Electrocorticography, cortical stimulation and stereotaxy were necessary in the patients' surgery, increasing the safety of the resecion of the tumor and of the cerebral cortex generator of epileptic crises. The surgical removal of the tumors was total in 85.3% of the patients. Most of them (91.2%) remained without epileptic crises in the follow up minimum of 24 months (average of 34.2 months).

KEY WORDS: refractory epilepsy, glioma, electrocorticography, cortical stimulation.

*

Epilepsia refratária associada a tumor cerebral primário de crescimento lento (Resumo).Dissertação de Mestrado, Universidade Federal de Pernambuco (Área: Neuropsiquiatria). Orientador: Luiz Ataíde Júnior.

Publication Dates

• Publication in this collection
  28 Nov 2001
• Date of issue
  Dec 2001