Exames subsidiários preditivos de crises epilépticas após acidente vascular cerebral isquêmico

Fukujima, Márcia Maiumi; Cardeal, José Osmar

doi:10.1590/S0004-282X1997000100007

Resumos

Na tentativa de detectar fatores preditivos para ocorrência de crises epilépticas após acidente vascular cerebral isquêmico (AVCI), estudamos exames laboratoriais de glicemia, hematócrito, colesterol total e frações e triglicérides, além de eletrocardiograma, eletrencefalograma (EEG), líquido cefalorraquiano e tomografia computadorizada do crânio (TC) em 35 pacientes com AVCI que evoluíram com crises epilépticas após pelo menos 24 horas a partir da instalação do AVCI (grupo 1 ou G1), que foram comparados a 35 pacientes com AVCI que evoluíram sem crises epilépticas (grupo 2 ou G2). Encontramos significância na análise EEG na comparação dos grupos, sendo a alteração mais freqüente o alentecimento focai da atividade elétrica cerebral no G1. A presença de lesão extensa na TC também associou-se ao G1. A associação de EEG anormal e lesão extensa na TC pode ser considerado elemento preditivo para ocorrência de crises epilépticas após AVCI com coeficiente de concordância de 34%. Os demais exames estudados não mostraram significância na comparação entre os grupos G1 e G2.

doença cerebrovascular; infarto cerebral; epilepsia; eletrencefalograma; tomografia

We studied subsidiary laboratorial tests such as serum glucose, red blood cell count, total cholesterol, HDL and LDL cholesterol and triglycerides, eletrocardiogram, eletroencephalogram (EEG), cerebrospinal fluid, and CT scan of 35 patients with cerebral infarction who developed epileptic seizures (group 1 or G1), and compared them to a group of 35 patients who had cerebral infarction but have not developed epileptic seizures (group 2 or G2). The EEG analysis showed significance in the comparison between the groups; focal lentification of the electrical cerebral activity was the most frequent abnormality found in G1. Extensive infarcts were also more frequent in G1. The association of abnormal EEG and extensive lesion on CT may be considered a preditive factor for occurrence of epileptic seizures after cerebral infarction. The analysis of the other tests showed no significance on the comparison between the groups.

stroke; cerebral infarction; epilepsy; epileptic seizures; eletroencephalography; tomography

Exames subsidiários preditivos de crises epilépticas após acidente vascular cerebral isquêmico

Epileptic seizures after ischemic stroke: are there any preditive laboratory test?

Márcia Maiumi Fukujima^I; José Osmar Cardeal^II

^INeurologista pela EPM - UNIFESP

^IIProfessor Adjunto da Disciplina de Neurologia da EPM - UNIFESP

RESUMO

Na tentativa de detectar fatores preditivos para ocorrência de crises epilépticas após acidente vascular cerebral isquêmico (AVCI), estudamos exames laboratoriais de glicemia, hematócrito, colesterol total e frações e triglicérides, além de eletrocardiograma, eletrencefalograma (EEG), líquido cefalorraquiano e tomografia computadorizada do crânio (TC) em 35 pacientes com AVCI que evoluíram com crises epilépticas após pelo menos 24 horas a partir da instalação do AVCI (grupo 1 ou G1), que foram comparados a 35 pacientes com AVCI que evoluíram sem crises epilépticas (grupo 2 ou G2). Encontramos significância na análise EEG na comparação dos grupos, sendo a alteração mais freqüente o alentecimento focai da atividade elétrica cerebral no G1. A presença de lesão extensa na TC também associou-se ao G1. A associação de EEG anormal e lesão extensa na TC pode ser considerado elemento preditivo para ocorrência de crises epilépticas após AVCI com coeficiente de concordância de 34%. Os demais exames estudados não mostraram significância na comparação entre os grupos G1 e G2.

Palavras-chave: doença cerebrovascular, infarto cerebral, epilepsia, eletrencefalograma, tomografia.

ABSTRACT

We studied subsidiary laboratorial tests such as serum glucose, red blood cell count, total cholesterol, HDL and LDL cholesterol and triglycerides, eletrocardiogram, eletroencephalogram (EEG), cerebrospinal fluid, and CT scan of 35 patients with cerebral infarction who developed epileptic seizures (group 1 or G1), and compared them to a group of 35 patients who had cerebral infarction but have not developed epileptic seizures (group 2 or G2). The EEG analysis showed significance in the comparison between the groups; focal lentification of the electrical cerebral activity was the most frequent abnormality found in G1. Extensive infarcts were also more frequent in G1. The association of abnormal EEG and extensive lesion on CT may be considered a preditive factor for occurrence of epileptic seizures after cerebral infarction. The analysis of the other tests showed no significance on the comparison between the groups.

Key words: stroke, cerebral infarction, epilepsy, epileptic seizures, eletroencephalography, tomography.

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Aceite: 25-outubro-1996.

Este estudo faz parte da Tese de Mestrado "Crises epilépticas após acidente vascular cerebral por infarto cerebral: estudo de 35 pacientes"¹⁰, aprovada no Curso de Pós-Graduação de Neurologia da Escola Paulista de Medicina (EPM) da Universidade Federal de São Paulo (UNIFESP) e realizada no Setor de Doenças Neurovasculares da Disciplina de Neurologia da EPM- UNIFESP.

Dra. Mareia Maiumi Fukujima - Disciplina de Neurologia, Escola Paulista de Medicina, UNIFESP - Rua Botucatu 740 - 04023-900 São Paulo SP - Brasil. Fax 011 575 5240. E-mail: Maiumi@sti.com.br

1. Avrahami E, Drory MJ, Rabey MJ, Cohn DF. Generalized epileptic seizures as presenting symptom of lacunar infarction in the brain. J Neurol 1988;235:472-474.
2. Barolin GS. The cerebrovascular epilepsies. Eletroenceph Clin Neurophysiol 1982;35 (Suppl):287- 295.
3. Blandin CF, Johnston PJ, Norris JW. Stroke Research Unit, University of Toronto, Canada for The Seizures after Stroke Study Group (Canada, Australia, Israel, Italy). Strokel993;24:49.
4. Chatrian GE, Shaw CM, Leffman H. The significance of periodic lateralized epleptiform discharges in EEG: an electrographic, clinical and pathological study. Eletroenceph Clin Neurophysiol 1964; 17:177-193.
5. Chusid JG, Kopeloff LM. Epileptogenic effects of pure metals implanted in motor cortex of monkeys. J Appl Physiol 1962;17:696-700.
6. Cochran WG. Some methods for strenghtering the common x² test. Biometrics 1954; 10:417-451.
7. Cocito L, Favale E, Reni L. Epileptic seizures in cerebral arterial occlusive disease. Stroke 1982;13:189-195.
8. De la Sayette V, Cosgrove R, Melanson D, Ethier R. CT findings in late-onset epilepsy. Can J Neurol Sci 1987; 14:286-289.
9. Fentz V. Epileptískche Anfaldsfaenomener Patienten mit Apoplexia cerebri. Nord Med 1971 ;86:1023-1025.
10. Fukujima MM. Crises epilépticas após acidente vascular cerebral por infarto cerebral: estudo de 35 pacientes. Tese de Mestrado, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, 1994.
11. Fukujima MM, Cardeal JO, Lima JGC. Estudo de fatores clínicos preditivos para crises epilépticas após acidente vascular cerebral isquêmico. Arq Neuropsiquiatr 1996;54:207-211.
12. Gupta SR, Naheedy MH, Elias D, Rubino FA. Postinfarction seizures: a clinical study. Stroke 1988,19:1477-1481.
13. Holmes GL. The electroencephalogram as a predictor of seizures following cerebral infarctions. Clin Electroencephalogr 1980;11:83-86.
14. Landis JR, Kock GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-1744.
15. Lesser R, Luders H, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985;26:622-630.
16. Levitt P, Wilson WP, Wildins RH. The effects of subarachnoid blood on the electrocorticogram of the cat. J Neurosurg 1971;35:185-191.
17. Louis S, Mcdowell F. Epileptic seizures in nonembolic cerebral infarction. Arch Neurol 1967;17:414-418.
18. Markand ON, Daly DD. Pseudoperiodic lateralized paroxismal discharge in electroencephalogram. Neurology 1971;21:975-981.
19. Moskowitz E, Lightbody FEH, Freitag NS. Long-term follow-up of the poststroke patient. Arch Phys Med Rehab 1972;53:167-172.
20. Olsen TS, Hogenhaven H, Thage O. Epilepsy after stroke. Neurology 1987;37:1209-1211.
21. Reis JB, Bei A, Reis Filho JB. Líquido cefalorraquiano. São Paulo: Sarvier, 1980:167-196.
22. Remington RD, Shork MA. Statistics with applications to the biological and health sciences. New Jersey: Prentice-Hall, 1970.
23. Richardson EP, Dodge PR. Epilepsy in cerebral vascular disease: a study of the incidence and nature of 104 consecutive proven cases of cerebral infarction and hemorrhage. Epilepsia 1954;3:49-74.
24. Scharwartz MS, Prior PF, Scott DF. The occurrence and evolution in the EEG of a lateralized periodic phenomenon. Brain 1973;96:613-622.
25. Shinton RA, Gill JS, Melnick SC, Gupta AK, Beevers DG. The frequency, characteristics and prognosis of epileptic seizure at the onset of stroke. J Neurol Neurosurg Psychiatry 1988;51:273-276.
26. Siegel S. Estadistica no parametrica. México: Ed Trillas, 1975:346.
27. Sung CY, Chu NS. Epileptic seizures in thrombotic stroke. J Neurol 1990;237:166-170.
28. Whisnant JP, Basford JR, Bernstein EF, Cooper ES, Dyken ML, Easton JD, Little JR, Marler JR, Millikan CH, Petito CK, Price TR, Raichle ME, Robertson JT, Thiele B, Walker MD, Zimmerman RA. Special report from the National Institute of Neurological Disorders and Stroke: classification of cerebrovascular disease III. Stroke 1990;21:637-676.
29. Willmore LJ, Herd RW, Sypert GW. Epileptiform activity initiated by pial iontophoresis of ferrous and ferric chlorid on rat cerebral cortex. Brain Res 1978;152:406-410.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Avrahami E, Drory MJ, Rabey MJ, Cohn DF. Generalized epileptic seizures as presenting symptom of lacunar infarction in the brain. J Neurol 1988;235:472-474.

[2] 2. Barolin GS. The cerebrovascular epilepsies. Eletroenceph Clin Neurophysiol 1982;35 (Suppl):287- 295.

[3] 3. Blandin CF, Johnston PJ, Norris JW. Stroke Research Unit, University of Toronto, Canada for The Seizures after Stroke Study Group (Canada, Australia, Israel, Italy). Strokel993;24:49.

[4] 4. Chatrian GE, Shaw CM, Leffman H. The significance of periodic lateralized epleptiform discharges in EEG: an electrographic, clinical and pathological study. Eletroenceph Clin Neurophysiol 1964; 17:177-193.

[5] 5. Chusid JG, Kopeloff LM. Epileptogenic effects of pure metals implanted in motor cortex of monkeys. J Appl Physiol 1962;17:696-700.

[6] 6. Cochran WG. Some methods for strenghtering the common x² test. Biometrics 1954; 10:417-451.

[7] 7. Cocito L, Favale E, Reni L. Epileptic seizures in cerebral arterial occlusive disease. Stroke 1982;13:189-195.

[8] 8. De la Sayette V, Cosgrove R, Melanson D, Ethier R. CT findings in late-onset epilepsy. Can J Neurol Sci 1987; 14:286-289.

[9] 9. Fentz V. Epileptískche Anfaldsfaenomener Patienten mit Apoplexia cerebri. Nord Med 1971 ;86:1023-1025.

[10] 10. Fukujima MM. Crises epilépticas após acidente vascular cerebral por infarto cerebral: estudo de 35 pacientes. Tese de Mestrado, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, 1994.

[11] 11. Fukujima MM, Cardeal JO, Lima JGC. Estudo de fatores clínicos preditivos para crises epilépticas após acidente vascular cerebral isquêmico. Arq Neuropsiquiatr 1996;54:207-211.

[12] 12. Gupta SR, Naheedy MH, Elias D, Rubino FA. Postinfarction seizures: a clinical study. Stroke 1988,19:1477-1481.

[13] 13. Holmes GL. The electroencephalogram as a predictor of seizures following cerebral infarctions. Clin Electroencephalogr 1980;11:83-86.

[14] 14. Landis JR, Kock GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-1744.

[15] 15. Lesser R, Luders H, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985;26:622-630.

[16] 16. Levitt P, Wilson WP, Wildins RH. The effects of subarachnoid blood on the electrocorticogram of the cat. J Neurosurg 1971;35:185-191.

[17] 17. Louis S, Mcdowell F. Epileptic seizures in nonembolic cerebral infarction. Arch Neurol 1967;17:414-418.

[18] 18. Markand ON, Daly DD. Pseudoperiodic lateralized paroxismal discharge in electroencephalogram. Neurology 1971;21:975-981.

[19] 19. Moskowitz E, Lightbody FEH, Freitag NS. Long-term follow-up of the poststroke patient. Arch Phys Med Rehab 1972;53:167-172.

[20] 20. Olsen TS, Hogenhaven H, Thage O. Epilepsy after stroke. Neurology 1987;37:1209-1211.

[21] 21. Reis JB, Bei A, Reis Filho JB. Líquido cefalorraquiano. São Paulo: Sarvier, 1980:167-196.

[22] 22. Remington RD, Shork MA. Statistics with applications to the biological and health sciences. New Jersey: Prentice-Hall, 1970.

[23] 23. Richardson EP, Dodge PR. Epilepsy in cerebral vascular disease: a study of the incidence and nature of 104 consecutive proven cases of cerebral infarction and hemorrhage. Epilepsia 1954;3:49-74.

[24] 24. Scharwartz MS, Prior PF, Scott DF. The occurrence and evolution in the EEG of a lateralized periodic phenomenon. Brain 1973;96:613-622.

[25] 25. Shinton RA, Gill JS, Melnick SC, Gupta AK, Beevers DG. The frequency, characteristics and prognosis of epileptic seizure at the onset of stroke. J Neurol Neurosurg Psychiatry 1988;51:273-276.

[26] 26. Siegel S. Estadistica no parametrica. México: Ed Trillas, 1975:346.

[27] 27. Sung CY, Chu NS. Epileptic seizures in thrombotic stroke. J Neurol 1990;237:166-170.

[28] 28. Whisnant JP, Basford JR, Bernstein EF, Cooper ES, Dyken ML, Easton JD, Little JR, Marler JR, Millikan CH, Petito CK, Price TR, Raichle ME, Robertson JT, Thiele B, Walker MD, Zimmerman RA. Special report from the National Institute of Neurological Disorders and Stroke: classification of cerebrovascular disease III. Stroke 1990;21:637-676.

[29] 29. Willmore LJ, Herd RW, Sypert GW. Epileptiform activity initiated by pial iontophoresis of ferrous and ferric chlorid on rat cerebral cortex. Brain Res 1978;152:406-410.