Clinical symptoms and radiologic characteristics of gliomatosis cerebri (GC) are non-specific and the condition may be confused with other central nervous system diseases. We report three patients with GC; all the three patients had involvement of more than three lobes and the deep white matter, as well as bilateral involvement. Differentiation of GC from other neurologic diseases involving diffuse white matter may be difficult. However, the diagnosis can be based on the combination of radiologic and histopathologic features.
Background Temporal lobe epilepsy (TLE) is a high prevalence neurological disorder. Surgery has emerged as a promising treatment. Objective The objective of this work is to compare the surgical results of anterior temporal lobectomy (ATL) versus selective amygdalohippocampectomy (SAH) in a cohort of 132 patients. Methods We performed a retrospective study of 146 patients operated for TLE from 2008 to 2019. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. One patient was excluded from the analysis of the results due to death in the first postoperative week. We used the ILAE scale to classify seizure control after surgery. In patients with left hippocampal sclerosis, SAH was performed and in right temporal lobe epilepsy, ATL was the approach of choice. Results The mean follow-up time after surgery was 57.2 months (12–137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57.1% versus 31%) and a higher rate of satisfactory seizure control (88.6% versus 69.3%) p = 0,006, when compared with patients undergoing SAH. Conclusion The literature is still controversial about seizure control concerning the technique used due to the lack of a robust methodology. Our data analysis identified the superiority of ATL over SAH in seizure outcomes. ATL may be the best option for adequately controlling seizures with minimal additional morbidity in countries with a cost limitation for extended propaedeutics.
IntroductionTemporal Lobe Epilepsy (TLE) is a high prevalence neurological disorder and tends to drug refractoriness. Surgery has emerged as a promising treatment for managing crises and a better quality of life for these patients. The objective of this work is to compare the surgical results in terms of seizures control concerning the surgical technique performed (Anterior temporal lobectomy (ATL) vs. Selective amygdalohippocampectomy (SAH)) in a cohort of 132 patients operated in an epilepsy reference center.Materials and methodsWe performed a retrospective study based on the review of medical records of 146 patients operated for TLE from 2008 to 2019 at the Santa Casa de Misericordia in Belo Horizonte, Brazil. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. We used the ILAE (International League Against Epilepsy) scale to classify seizure control after surgery. We compared the surgical groups using the survival and Kaplan-Maier curves.ResultsA total of 132 patients were evaluated in this study, with a mean follow-up time after surgery of 57.2 months (12-137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57,1% vs. 31%) and a higher rate of satisfactory seizure control (88,6% vs. 69,3%) p =0.006.ConclusionThe literature is still controversial about seizure control results concerning the surgical technique used due to the lack of studies with a robust methodology for an adequate comparison. In our data analysis, we identified the superiority of ATL over SAH in seizure outcomes.
Context: Progressive myoclonic epilepsy (PMS) begins in childhood or during adolescence, being a heterogeneous group of symptomatic progressive progressive generalized epilepsy. Composed of cortical myoclonus, multiple epileptic seizures, delayed or regressed neuropsychomotor development and cerebellar manifestations. Genetics is heterogeneous with a similar clinical presentation, which makes etiological definition difficult. Report a clinical case of generalized epilepsy, myoclonus, cerebellar condition and severe mental impairment. Analysis of medical records of a patient at Santa Casa de Belo Horizonte. Case report: MVPP, 17 years old, previously healthy, adopted son, normal neuropsychomotor development, first generalized tonic-clonic seizure at 8 years old, recurrence at 12 years old, being initiated by Valproato and Clobazam. In 2018 there was a worsening of the crises, perceived myoclonus, added Lamotrigine and Oxcarbazepine. EEG with continuous diffuse epileptic activity of subclinical epilepticus status and unchanged skull MRI. In 2019 he started with gait ataxia, balance changes, dysarthria, dysmetria, cognitive decline, loss of functionality and refractoriness to treatment. Valproate reduced and oxcarbazepine suspended. Video- EEG with ictal pattern of generalized wave polyspicle. Deteriorated cerebellar condition with extensive propaedeutic without alterations. There was no feasibility of genetic testing at the time. Methylprednisolone pulse therapy with partial improvement. Unsuccessful attempt to levetiracetam due to psychotic symptom. He presented lowering of the sensorium, bronchoaspiration and orotracheal intubation. He evolved with myoclonic status, adjusted for anti-crisis drugs, midazolam, thiopental, tracheostomy and gastrostomy. He maintained super- refractory status, being opted for callosotomy. He died within weeks of the procedure. Conclusion: The early diagnosis of PMS is a challenge, and its evolution is usually debilitating, with a poor prognosis and scarce specific treatment. Whenever possible, a genetic study is needed to define an etiological diagnosis.
INTRODUCTION Temporal Lobe Epilepsy (TLE) is a high prevalence neurological disorder and tends to drug refractoriness. Surgery has emerged as a promising treatment for managing crises and a better quality of life for these patients. The objective of this work is to compare the surgical results in terms of seizure control concerning the surgical technique performed (Anterior temporal lobectomy (ATL) vs. Selective amygdalohippocampectomy (SAH)) in a cohort of 132 patients operated in an epilepsy reference center. MATERIALS AND METHODS We performed a retrospective study based on the review of medical records of 146 patients operated for TLE from 2008 to 2019 at the Santa Casa de Misericordia in Belo Horizonte, Brazil. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. One patient was excluded from the analysis of the results due to death in the first postoperative week. We used the ILAE scale to classify seizure control after surgery. In patients with left hippocampal sclerosis, the most selective approach was performed (SAH), and in right temporal lobe epilepsy, ATL was the approach of choice. We compared the surgical groups using the survival and Kaplan-Maier curves. RESULTS A total of 132 patients were evaluated in this study, with a mean follow-up time after surgery of 57.2 months (12-137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57.1% vs. 31%) and a higher rate of satisfactory seizure control (88.6% vs. 69.3%) p =0,006, when compared to patients undergoing SAH. CONCLUSION The literature is still controversial about seizure control results concerning the surgical technique used due to the lack of studies with a robust methodology for an adequate comparison. In our data analysis, we identified the superiority of ATL over SAH in seizure outcomes. In countries with a cost limitation for extended propaedeutics, ATL may be the best option for the proper control of seizures with minimal additional morbidity.
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