Summary:Purpose: To analyze the results of surgical treatment of intractable epilepsy in patients with subcortical band heterotopia, or double cortex syndrome, a diffuse neuronal migration disorder.Methods: We studied eight patients (five women) with double cortex syndrome and intractable epilepsy. All had a comprehensive presurgical evaluation including prolonged video-EEG recordings and magnetic resonance imaging (MRI).Results: All patients had partial seizures, with secondary generalization in six of them. Neurologic examination was normal in all. Three were of normal intelligence, and five were mildly retarded. Six patients underwent invasive EEG recordings, three of them with subdural grids and three with stereotactic implanted depth electrodes (SEEG). Although EEG recordings showed multilobar epileptic abnormalities in most patients, regional or focal seizure onset was recorded in all. MRI showed bilateral subcortical band heterotopia, asymmetric in thickness in three. An additional area of cortical thickening in the left frontal lobe was found in one patient. Surgical procedures included multiple subpial transections in two patients, frontal lesionectomy in one, temporal lobectomy with amygdalohippocampectomy in five, and an additional anterior callosotomy in one. Five patients had no significant improvement, two had some improvement, and one was greatly improved.Conclusion: Our results do not support focal surgical removal of epileptogenic tissue in patients with double cortex syndrome, even in the presence of a relatively localized epileptogenic area.
Summary:Purpose: Controversy persists about when EEG became a fundamental tool in the preoperative investigation for epilepsy surgery. We revisit Penfield's first use of invasive EEG monitoring, emphasizing its historical importance for the evolution of epilepsy surgery.Methods: Patients' hospital charts and articles published before 1940 regarding EEG and epilepsy or EEG and cerebral lesions were reviewed to evaluate the historical context of the surgery.Results: In April 1939, Penfield performed trephination over both temporal regions and placed electrodes on the dura, intending to lateralize seizure origin in a patient with bitemporal epilepsy. The patient underwent serial EEGs with this technique. The final report of the recordings from epidural leads was "continued random delta activity in the left temporal region indicating a cortical lesion on this side." The pneumoencephalogram showed "the presence of diffuse cerebral atrophy, particularly in the left cerebral hemisphere." Based on these findings, the patient underwent surgery on April 21, revealing a meningocerebral scar in the posterior part of the left temporal lobe. Brain stimulation and electrocorticography delineated the extent of resection, while preserving the speech area. Seizures did not improve.Conclusions: We revisit the first case of epidural EEG monitoring for epilepsy surgery and show that the concept of EEGdirected surgery was already present at the Montreal Neurological Institute in the late 1930s. Key Words: EpilepsyHistory-Neurosurgery-Penfield-Jasper.Engel divides surgery for epilepsy into three historical phases: lesion-directed surgery, EEG-directed surgery, and imaging (lesion)-directed surgery (1). In the first phase, operations were aimed at resection of brain lesions diagnosed by a detailed review of seizure pattern and by neurologic examination. The second phase started when clinicians acknowledged EEG as a tool of prime importance for localization of epileptogenic areas in the brain (2). A monograph by Penfield and Erickson in 1941 contains a chapter by Jasper, in which he remarks, "that a consistently localized random spike or sharp-wave focus worked out on the scalp surface is a faithful guide to a focal cortical epileptic discharge" (3). Nevertheless, the article written by Bailey and Gibbs in 1951 (4) has been considered the milestone between the first and second phases (1). The advent of new methods of imaging brought new perspectives to the understanding of the interaction between lesions and epileptogenic areas in epilepsy.
Universidade do Vale do Rio dos Sinos 2 Resumo: Este artigo trata sobre a motivação de estudantes para participarem das suas aulas de Educação Física no Ensino Médio. Para tanto, foi realizada uma pesquisa de cunho qualitativo envolvendo 20 estudantes do 3° ano do Ensino Médio de uma Escola da cidade de Porto Alegre/RS. O estudo em questão teve como objetivo geral identificar os fatores motivacionais dos estudantes nas aulas de Educação Física no Ensino Médio na referida Escola. A coleta dos dados nos revelou que a maioria dos estudantes são motivados intrinsecamente, porém há também a motivação extrínseca, principalmente pela nota a ser atingida. Quanto à desmotivação, esta foi percebida em alguns estudantes devido à falta de variedade nas aulas aplicadas. Conclui-se então que o professor, suas aulas e os conteúdos desenvolvidos nelas têm influência direta na motivação dos estudantes em participar das aulas de Educação Física.
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