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SPECT cerebral interictal em pacientes com epilepsia do lobo temporal de difícil controle
Andraus Maria Emilia Cosenza,Cosenza Carlos Alberto Nunes,Fonseca Léa Mirian Barbosa da,Andraus Cesar Fantezia
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: O objetivo desse estudo foi avaliar a utilidade do SPECT cerebral interictal na localiza o do foco epileptogênico em 23 pacientes do Ambulatório de Epilepsias do Hospital Universitário Clementino Fraga Filho (HUCFF/UFRJ), com epilepsia do lobo temporal (ELT) de difícil controle e tomografia computadorizada (TC) do cranio normal, estudando a correla o entre SPECT interictal, eletrencefalograma (EEG) e, em 11 casos, ressonancia magnética (RM) do cranio, e comparar os resultados com os de outras seis séries da literatura. Doze (52,2%) pacientes apresentaram SPECT anormal. Entre esses, cinco (41,6% dos SPECTs anormais) apresentaram altera o unilateral ao SPECT do mesmo lado do EEG (hipoperfus o em 4 e hiperperfus o em 1), três (25% dos SPECTs anormais) apresentaram hipoperfus o bilateral ao SPECT e altera es também bilaterais ao EEG e 4 (33,3% dos SPECTs anormais) apresentaram hipoperfus o unilateral ao SPECT e EEG bilateral. A análise estatística fundamentou-se na lógica fuzzy. Os índices de correla o entre SPECT X EEG, SPECT X RM e SPECT X EEG X RM foram altamente significativos, com níveis de significancia de 0,01, p < 0,0005 e intervalo de 99% de confian a em todas as correla es. Os estudos de correla o entre as séries estudadas apresentaram resultados semelhantes entre si.
Doen a de Alzheimer e espectroscopia por ressonancia magnética do hipocampo  [cached]
Engelhardt Eliasz,Moreira Denise M.,Laks Jerson,Marinho Valeska M.
Arquivos de Neuro-Psiquiatria , 2001,
Abstract: OBJETIVOS: Obten o de dados do espectro de metabolitos por ressonancia magnética da forma o hipocampal no idoso normal e com doen a de Alzheimer (DA). MéTODO: Os indivíduos foram pareados por idade, sendo 20 na amostra normal, CDR=0 e 40 com DA 3 CDR=1 e 2. Utilizou-se aparelho Signa Horizon LX-GE, 1.5T, 1H-ERM com aplicativo automatizado PROBE/SV, VOI: hc (direito e esquerdo); voxel único (2x2x2cm); TR 1500ms/TE 50ms; PRESS; metabolitos: N-acetilaspartato (Naa), colina (Cho), creatina (Cr), mio-inositol (mI). RESULTADOS: Os presentes dados se referem aos quocientes de Naa, Cho e mI, com Cr tomada como referência e rela o mI/Naa. O estudo mostrou o Naa reduzido, o mI e a rela o mI/Naa aumentados e os resultados em rela o à Cho foram variados. Os resultados da amostra global dos pacientes com DA em compara o à média ± dp da amostra normal foram significativos para Naa, mI e mI/Naa (p<0,01). A precis o, tomando os valores de modo individual das duas amostras, mostrou sensibilidade, especificidade e valor preditivo positivo satisfatórios. CONCLUS O: Os presentes resultados podem ser usados como ferramenta útil para detectar altera es patológicas no hipocampo de pacientes com DA, permitindo diagnóstico de maior precis o e mais precoce da doen a.
Análises visual e volumétrica por ressonancia magnética das forma es hipocampais em um grupo de pacientes com diagnóstico clínico de epilepsia do lobo temporal
ROGACHESKI êNIO,MAZER SéRGIO,RODRIGUES DIRCEU,BITTENCOURT PAULO ROGéRIO MUDROWICH DE
Arquivos de Neuro-Psiquiatria , 1998,
Abstract: Visando comparar a sensibilidade da avalia o volumétrica com a análise visual na avalia o por ressonancia magnética (RM) das forma es hipocampais de pacientes com epilepsia do lobo temporal refratária e candidatos à lobectomia temporal, estudamos 153 casos com diagnóstico clínico de epilepsia do lobo temporal, utilizando um equipamento de 0,5 Tesla, com técnica de inversion-recovery ponderada em T1, com cortes de 5 mm no plano coronal. Houve boa concordancia entre a análise visual prospectiva e outra retrospectiva, realizada por dois observadores independentes (C=0,748 e 0,720). Houve também concordancia entre a análise retrospectiva dos dois observadores (C=0,733). Houve ainda concordancia genuína (C=0,788) entre os resultados das análises quantitativa e qualitativa realizadas prospectivamente. A análise quantitativa demonstrou uma tendência n o-significativa a lateralizar mais casos de atrofia hipocampal presumida clinicamente. Nossos resultados confirmam a confiabilidade da análise visual qualitativa e indicam a utilidade da volumetria hipocampal como uma medida suplementar, objetiva e quantitativa, de esclerose hipocampal.
Ictal and interictal SPECT in patients with frontal lobe epilepsy.- This paper was awarded the ADAC Prize at the Brazilian Congress of Nuclear Medicine, Recife, Brazil, December 1998.  [cached]
Wichert-Ana, Lauro.,Kato, Mery .,Terra Bustamante, Vera Cristina.,Rodrigues Velasco, Tonicarlo.
Alasbimn Journal , 1999,
Abstract: The frontal lobe seizures present variable clinical and electroencephalographic features that play some difficulties in the presurgical work-up for epilepsy. The aim of the present study is to determine the role of ictal and interictal SPECT in the localization of the epileptogenic zone in frontal lobe epilepsies. We evaluated 13 patients, 6 men and 7 women, with mean age of 16yr, and with medically intractable frontal lobe seizures. All patients were submitted to ictal SPECT and 11 also to interictal scans. Ictal SPECT studies were contributive in 54% of patients, and nonlateralized and nonlocalized, or contralateralized in the remaining patients. Interictal SPECT showed normal perfusion in 45,5% of patients, hypoperfusion localized in the suspected epileptogenic zone in 45,5%, and diffuse findings in the other 9%. We conclude that the sensitivity of ictal and interictal SPECT studies in frontal lobe epilepsies is lower than that for temporal lobe seizures, thus confirming previous data.
First true initial ictal SPECT in partial epilepsy verified by electroencephalography  [cached]
Jesús Pastor,Luis Domínguez-Gadea,Rafael G Sola,Virgilio Hernando
Neuropsychiatric Disease and Treatment , 2008,
Abstract: Jesús Pastor1, Luis Domínguez-Gadea2, Rafael G Sola3, Virgilio Hernando3, María Luisa Meilán4, Eva De Dios4, José Luis Martínez-Chacón4, Marcos Martínez51Clinical Neurophysiology; 2Nuclear Medicine; 3Neurosurgery; 4Anaesthesiology and Reanimation; Hospital Universitario “La Princesa”, Madrid, Spain; 5Anaesthesiology and Reanimation, Cardiovascular Unit of Adults, Hospital Ramón y Cajal, Madrid, SpainAbstract: Drug-resistant epilepsy can sometimes be treated by surgery. In these cases, an accurate identification of the epileptogenic area must be addressed before resection. Ictal SPECT is one of the presurgical evaluations that can be performed, but usually, the increase in the regional cerebral perfusion observed is produced by diffusion of ictal activity. Here we describe a patient studied with v-EEG and foramen ovale electrodes that suffered a seizure after intravenous infusion of etomidate. The sequence of etomidate administration, followed by radiotracer and seizure was good enough for us to suspect that a true initial ictal SPECT was observed. We have implemented a kinetic model with four compartments, previously described (Andersen 1989), in order to estimate the fraction of hydrophilic radiotracer in the brain during the pre-ictal and ictal periods. This model has shown that the fraction of hydrophilic radiotracer during the seizure into the brain would be between 18.9% and 42.3% of total infused. We show the first true initial ictal SPECT demonstrated by bioelectrical recordings of the brain activity, obtained by a correct succession of events and compatible with theoretical data obtained from the kinetic model.Keywords: etomidate, foramen ovale electrodes, mathematical model, temporal lobe epilepsy
Statistical voxel-wise analysis of ictal SPECT reveals pattern of abnormal perfusion in patients with temporal lobe epilepsy
Amorim, Bárbara Juarez;Etchebehere, Elba Cristina Sá de Camargo;Camargo, Edwaldo Eduardo;Rio, Pablo Augusto;Bonilha, Leonardo;Rorden, Chris;Li, Li Min;Cendes, Fernando;
Arquivos de Neuro-Psiquiatria , 2005, DOI: 10.1590/S0004-282X2005000600014
Abstract: objective: to investigate the pattern of perfusion abnormalities in ictal and interictal brain perfusion spect images (bsi) from patients with temporal lobe epilepsy (tle). method: it was acquired interictal and ictal bsi from 24 patients with refractory tle. bsis were analyzed by visual inspection and statistical parametric mapping (spm2). statistical analysis compared the patients group to a control group of 50 volunteers. the images from patients with left-tle were left-right flipped. results: it was not observed significant perfusional differences in interictal scans with spm. ictal bsi in spm analysis revealed hyperperfusion within ipsilateral temporal lobe (epileptogenic focus) and also contralateral parieto-occipital region, ipsilateral posterior cingulate gyrus, occipital lobes and ipsilateral basal ganglia. ictal bsi also showed areas of hypoperfusion. conclusion: in a group analysis of ictal bsi of patients with tle, voxel-wise analysis detects a network of distant regions of perfusional alteration which may play active role in seizure genesis and propagation.
Ictal patterns in children: an illustrated review
Spinosa, M?nica Jaques;Liberalesso, Paulo Breno de Noronha;Mehl, Larissa;L?hr Júnior, Alfredo;
Journal of Epilepsy and Clinical Neurophysiology , 2011, DOI: 10.1590/S1676-26492011000400008
Abstract: detailed knowledge of electroencephalographic patterns accompanying epileptic seizures in children is paramount to the correct identification of epileptic seizures and syndromes. in this article, we present a review of ictal patterns of different seizure types in children, illustrating with examples collected in our video-eeg laboratory at pequeno príncipe hospital.
The hazards of lack of co-registration of ictal brain SPECT with MRI: A case report of sinusitis mimicking a brainstem seizure focus
Tracy Butler, Lawrence J Hirsch, Jan Claassen
BMC Medical Physics , 2004, DOI: 10.1186/1471-2385-4-2
Abstract: A young woman with encephalitis and refractory seizures underwent brain SPECT during a period of frequent seizure-like episodes, and during a seizure-free period. A focal area of increased radiotracer uptake present only when she was experiencing frequent seizure-like episodes was originally localized to the brainstem, but with later computerized co-registration of SPECT to MRI, was found to lie outside the brain, in the region of the sphenoid sinus.Low-resolution SPECT images present difficulties in interpretation, which can be overcome through co-registration to higher-resolution structural images.Radiotracers used for brain single photon emitted computed tomography (SPECT) pass the blood-brain barrier and bind intracellularly on their first pass through the circulation, providing a "snapshot" of cerebral perfusion at a particular timepoint. When injected during a focal epileptic seizure, an area of significantly increased radiotracer uptake typically corresponds to the region of maximal abnormal activity, often the seizure focus. This ictal pattern of cerebral blood flow can be compared to an interictal/baseline pattern obtained when the patient is not having a seizure, to provide unique information about the nature and location of a patient's epileptic focus, which can be used to guide therapy [See [1] for a review of the use of SPECT in epilepsy].A previously-healthy young woman developed behavioral changes followed by seizures and refractory status epilepticus. She was diagnosed with encephalitis and treated with antiviral and multiple antiepileptic agents. She required nasotracheal intubation and mechanical ventilation for respiratory support. She experienced persistent episodes of facial twitching resembling seizures. These episodes were not however associated with an ictal EEG pattern on continuous video/EEG monitoring. To clarify the nature of these episodes, 99mTc-HMPAO was injected during a period of frequent twitching. Brain SPECT showed a prominent foc
Defini o do limite anterolateral do lobo occipital em pe as anat micas e exames de imagem  [cached]
Gusm?o Sebasti?o,Reis Cassius,Tazinaffo Uedson,Mendon?a Celso
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: Com o objetivo de definir o limite anterolateral do lobo occipital foram estudados sete segmentos cefálicos de cadáveres humanos, 103 exames de tomografia computadorizada e 104 exames de ressonancia magnética do encéfalo considerados normais. Foram encontradas uma prega da dura-máter sobre o seio transverso (plica tentorial pré-occipital) e uma protuberancia óssea relacionadas diretamente com a incisura pré-occipital. Foi calculada, também, a distancia média entre o sulco parieto-occipital e a sutura lambdóide. Nos exames de imagem, especialmente na ressonancia magnética, foi possível identificar a incisura pré-occipital e/ou a protuberancia na parede craniana relacionada a ela, bem como o sulco parieto-occipital e a sutura lambdóide, referências que permitem a defini o do limite anterolateral do lobo occipital.
Manifesta??es clínicas de crises parciais complexas do lobo temporal: um estudo vídeo-eletrencefalográfico
Yacubian, Elza Márcia T.;Valério, Rosa Maria F.;Jorge, Carmem Lisa;Fiore, Lia A.;Cukiert, Arthur;Assis, Luís Marques De;
Arquivos de Neuro-Psiquiatria , 1994, DOI: 10.1590/S0004-282X1994000200001
Abstract: we analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the eeg emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). the temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal eeg recordings, ct and mri findings, interictal and, in some patients, ictal spect studies. 8 patients had surgery. in 5 from 7 patients who had temporal lobectomy, mesial temporal sclerosis was the anatomopathological finding and in one patient who had selective amigdalohippocampectomy,.hemosiderosis and gliosis probably due to bleeding of a posterior cerebral artery giant aneurysm was found. all patients have been seizure free after surgery. while dystonic posturing and ictal paresis, present in 18 seizures(66.6%), were excellent as lateralizing seizure signs, since they were always contralateral to the ictal onset, contralateral and ipsilateral versive head and eye movements were observed.
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