-This is a retrospective study of 21 surgically treated patients with temporal lobe tumors and epilepsy. Evaluation included clinical data, EEG findings, structural scans, pathological diagnosis and postsurgical follow-up. There were 9 cases of ganglioglioma, 5 pilocytic astrocytoma, 3 ganglioneuroma, 2 dysembryoplastic neuroepithelial tumor, 1 pleomorphic xantoastrocytoma, and 1 meningioangiomatosis. Mean follow-up time was 22 months and outcome was evaluated according to Engel's classification; 76.2% were classified in class I and 23.8% in II and III. All patients classes II and III had been submitted to mesial and neocortical resections. There were no differences related to clinical characteristics, pathological diagnosis or duration of follow-up in patients seizure-free or not. All patients had abnormal MRI and ten of these had normal CT; the MRI characteristics were compared to pathological diagnosis and specific histological characteristics of the tumors were not discernible by MRI. We concluded that MRI was essential for the diagnosis and precise location of TL tumors. Ganglioglioma was the most frequent tumor and lesionectomy associated to mesial resection doesn't guarantee a better prognosis.KEY WORDS: epilepsy, temporal tumor, clinical aspects, surgical outcome, MRI.Características clínicas, de neuroimagem estrutural e prognóstico cirúrgico de pacientes com tumor do lobo temporal e epilepsia RESUMO -Este é um estudo retrospectivo de 21 pacientes com epilepsia e tumores do lobo temporal tratados cirurgicamente. A avaliação incluiu dados clínicos, eletrencefalográficos, de neuroimagem, anatomia patológica e seguimento pós-operatório. Eram 9 casos de ganglioglioma, 5 de astrocitoma pilocítico, 3 de ganglioneuroma, 2 de tumor neuroectodérmico disembrioplástico, 1 de xantoastrocitoma pleomórfico e 1 de meningoangiomatose. A média de tempo de seguimento pós-operatório foi 22 meses e o prognóstico foi avaliado de acordo com a classificação de Engel; 76,2% encontravam-se na classe I e o restante nas classes II e III. Todos os pacientes que se encontravam nas classes II e III haviam sido submetidos a ressecção do tumor e de estruturas mesiais temporais. Não encontramos diferenças entre os grupos quanto as características clínicas, histológicas e tempo de seguimento. Dez pacientes apresentavam TC normal; os achados na RM foram comparados ao diagnóstico patológico, mas não encontramos características específicas relacionadas ao tipo de tumor. O estudo por RM foi essencial para o diagnóstico e localização precisa da lesão. Ganglioglioma foi o tumor mais freqüente e lesionectomia associada a ressecção mesial não proporcionou melhor prognóstico. PALAVRAS-CHAVE: epilepsia, tumor do lobo temporal, clínica, prognóstico cirúrgico e ressonância magnética.New neuroimaging techniques, especially MRI, have allowed more frequent detection of structural abnormalities, such as discrete neuronal migration disorders, gliosis and slow growing tumors in patients with medically refractory epilepsy 1 . Small growing tumors ...
-The analysis of the temporal lobe seizures through video-EEG systems shows that they often consist of a sequence of clinical and EEG features which may suggest the localization and the lateralization of the epileptogenic lobe. We analyzed clinical and EEG features of 50 temporal lobe seizures which were separated in group 1 with 25 patients (related to mesial temporal sclerosis) and group 2 with 25 patients (other neocortical temporal lesions). Among the auras, the epigastric type was the most frequent and predominated in group 1. There were differences between the two groups, considering dystonic and tonic posturing and versive head and eye movements. Dystonic posturing was always contralateral to the ictal onset and was considered the most useful lateralizing clinical feature. Ictal speech, spitting and blinking automatisms, prolonged disorientation for place and a greatest percentage of postictal language preservation occurred in right temporal seizures. Postictal aphasia and global disorientation predominated in left temporal seizures. EEG was important for lateralizing the epileptogenic lobe, specially considering rhythmic ictal activity and postictal findings.KEY WORDS: temporal lobe epilepsy, complex partial seizures, video-EEG.Análise clínica e eletrencefalográfica de crises epilépticas temporais de origem mesial e lateral RESUMO -As crises epilépticas do lobo temporal tendem a seguir uma sequência previsível de eventos clínicos e eletrencefalográficos, cuja análise, preferencialmente através de sistemas de vídeo-EEG, sugere a localização e a lateralização do lobo epileptogênico. Para este estudo, foram analisadas 50 crises epilépticas do lobo temporal, do ponto de vista clínico e eletrencefalográfico, sendo 25 relacionadas a esclerose mesial (grupo 1) e 25 a patologias neocorticais (grupo 2). Auras abdominais foram as mais frequentes, predominando no grupo 1. Houve diferenças entre os dois grupos, quanto à instalação e duração da postura distônica, à postura tônica e à versão oculocefálica. Postura distônica unilateral foi o mais importante fenômeno clínico lateralizatório, sempre contralateral à área epileptogênica. Verbalização crítica, automatismo de cuspir, piscamento palpebral bilateral, desorientação espacial prolongada e maior percentual de preservação da linguagem no período pós-crítico foram relacionados a crises temporais direitas. Afasia pós-crítica e desorientação global, a crises temporais esquerdas. O EEG teve importante acurácia lateralizatória em ambos os grupos, especialmente quanto à atividade crítica rítmica e achados pós-críticos. PALAVRAS-CHAVE: epilepsia do lobo temporal, crises parciais complexas, vídeo-EEG.According to the International Classification of Epilepsies and Epileptic Syndromes 1 , these can be divided in partial, generalized, epilepsies and syndromes undetermined whether focal or generalized and special syndromes. Temporal lobe epilepsy (TLE) is responsible for 60% of all the partial epileptic seizures 2 and it has been extensively studied clinically, electr...
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