Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal

Sandmann, M.C.; Rogacheski, E.; Mazer, S.; Bittencourt, P.R.M. de

doi:10.1590/S0004-282X1994000300004

Resumos

Métodos especiais de MRI foram utilizados em 5 pacientes com epilepsia do lobo temporal refratários ao tratamento clínico, com a finalidade de localizar a área epileptogênica. Imagens coronais com espessura de 5 mm foram obtidas da borda posterior do tronco cerebral até a base do lobo frontal, utilizando-se as sequências "Inversion Recovery T1" (TR=2500 msec, TE=26 msec, TI=600 msec) para avaliar perda de estrutura interna e atrofia do hipocampo e morfologia do lobo temporal; Spin-echo T2w (TR=2500 msec, TE=120 msec) visando a avaliar sinais de alta intensidade anormais. Em 2 casos com focos esquerdos no EEG, a MRI mostrou atrofia, perda de estrutura interna e aumento de sinal no hipocampo, e atrofia do lobo temporal anterior, ipsilateralmente. Um caso com focos bilaterais independentes no EEG teve atrofia, perda da estrutura interna e aumento de sinal no hipocampo direito. Um caso com EEG focal direito mostrou atrofia em ambos os lobos temporais anteriores. Outro caso não mostrou anormalidades. Concluimos que esta metodologia pode facilitar a indicação cirúrgica em epilepsia do lobo temporal.

epilepsia; epilepsia focal; epilepsia do lobo temporal; crises hipocampais; ressonância magnética (técnicas)

We studied 5 patients with medically refractory temporal lobe epilepsy using special methods of MRI, in order to localize the epileptogenic area. Coronal sequences were obtained with 5 mm sections from the posterior margin of the brainstem to the base of the frontal lobe using: "Inversion recovery T1" (TR=2500 msec, TE=26 msec, T1=600 msec) to analyse loss of internal structure and atrophy of the hippocampus, and morphology of the temporal lobe; and Spin-echo T2w (TR=250 msec, TE=120 msec) looking for abnormal high intensity signal. In two cases with left focal EEG the MRI showed atrophy, loss of internal structure and abnormal high intensity signal in the hippocampus, and atrophy of the anterior temporal lobe, ipsilateraly. One case with independent bilateral foci at the EEG showed atrophy, loss of internal structure and abnormal high intensity signal in the right hippocampus. Other case with right focal EEG showed bilateral atrophy of the anterior temporal lobes. Another case was normal. We conclude that this methodology can facilitate the surgical indication in temporal lobe epilepsy.

epilepsy; focal epilepsy; temporal lobe epilepsy; hippocampal seizures; magnetic resonance imaging (techniques)

Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal

Lateralization of the epileptogenic area by magnetic ressonance imaging in temporal lobe epilepsy

M.C. Sandmann^I; E. Rogacheski^II; S. Mazer^II; P.R.M. de Bittencourt^I

^IServiço de Neurologia do Departamento de Clínica Médica do Hospital N. Sra. das Graças. Curitiba

^IIServiço de Ressonância Magnética da Liga das Senhoras Católicas. Curitiba

RESUMO

Métodos especiais de MRI foram utilizados em 5 pacientes com epilepsia do lobo temporal refratários ao tratamento clínico, com a finalidade de localizar a área epileptogênica. Imagens coronais com espessura de 5 mm foram obtidas da borda posterior do tronco cerebral até a base do lobo frontal, utilizando-se as sequências "Inversion Recovery T1" (TR=2500 msec, TE=26 msec, TI=600 msec) para avaliar perda de estrutura interna e atrofia do hipocampo e morfologia do lobo temporal; Spin-echo T2w (TR=2500 msec, TE=120 msec) visando a avaliar sinais de alta intensidade anormais. Em 2 casos com focos esquerdos no EEG, a MRI mostrou atrofia, perda de estrutura interna e aumento de sinal no hipocampo, e atrofia do lobo temporal anterior, ipsilateralmente. Um caso com focos bilaterais independentes no EEG teve atrofia, perda da estrutura interna e aumento de sinal no hipocampo direito. Um caso com EEG focal direito mostrou atrofia em ambos os lobos temporais anteriores. Outro caso não mostrou anormalidades. Concluimos que esta metodologia pode facilitar a indicação cirúrgica em epilepsia do lobo temporal.

Palavras-chave: epilepsia, epilepsia focal, epilepsia do lobo temporal, crises hipocampais, ressonância magnética (técnicas).

SUMMARY

We studied 5 patients with medically refractory temporal lobe epilepsy using special methods of MRI, in order to localize the epileptogenic area. Coronal sequences were obtained with 5 mm sections from the posterior margin of the brainstem to the base of the frontal lobe using: "Inversion recovery T1" (TR=2500 msec, TE=26 msec, T1=600 msec) to analyse loss of internal structure and atrophy of the hippocampus, and morphology of the temporal lobe; and Spin-echo T2w (TR=250 msec, TE=120 msec) looking for abnormal high intensity signal. In two cases with left focal EEG the MRI showed atrophy, loss of internal structure and abnormal high intensity signal in the hippocampus, and atrophy of the anterior temporal lobe, ipsilateraly. One case with independent bilateral foci at the EEG showed atrophy, loss of internal structure and abnormal high intensity signal in the right hippocampus. Other case with right focal EEG showed bilateral atrophy of the anterior temporal lobes. Another case was normal. We conclude that this methodology can facilitate the surgical indication in temporal lobe epilepsy.

Key words: epilepsy, focal epilepsy, temporal lobe epilepsy, hippocampal seizures, magnetic resonance imaging (techniques)

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Agradecimento - Os autores reconhecem o auxílio inestimável do Dr. John P. Duncan (National Hospitais for Neurology and Neurosurgery, London, UK) no planejamento da técnica de obtenção de imagens do lobo temporal.

Aceite: 23-dezembro-1993.

Dr. Paulo R. M. de Bittencourt - Unidade de Neurologia Clínica, Hospital N. Sra. das Graças - Rua Alcides Munhoz 433 - 80810 - 040 Curitiba PR - Brasil.

1. Babb TL, Brown WJ, Pretorius J et al. Temporal lobe volumetric cell densities in temporal lobe epilepsy. Epilepsia 1984, 25: 729-740.
2. Babb TL, Brown WJ. Pathological findings in epilepsy. In Engel J Jr (ed). Surgical treatment of the epilepsies. New York: Raven Press, 1987, p 511-540.
3. Bittencourt PRM. Epileptogênese, estrutura e função cerebral na epilepsia do lobo temporal: um estudo prospectivo e controlado. Tese aprovada em concurso para Professor Titular. Universidade Federal do Paraná. Curitiba, 1991.
4. Cascino GD, Jack CR Jr, Parisi JE et al. MRI-based volume studies in temporal lobe epilepsy: pathological correlations. Ann Neurol 1991, 30: 31-36.
5. Daly DD. Epilepsy and syncope. In Daly DD, Pedley TA (eds). Current practice of clinical electroencephalography. New York: Raven Press, 1992, p 269-334.
6. Dam AM. Epilepsy and neuron loss in the hippocampus. Epilepsia 1980, 21: 617-629.
7. Engel J Jr, Rausch R, Lieb J et al. Correlation criteria used for localizing epileptic foci in patients considered for surgical therapy of epilepsy. Ann Neurol 1981, 9: 215-224.
8. Jack CR Jr, Twoney CK, Zinsmeister AR et al. Anterior temporal lobes and hippocampal formations: normative volumetric measurements from MRI images in young adults. Radiology 1989, 172: 549-554.
9. Jack CR Jr, Sharbrough FW, Twomey CK et al. Temporal lobe seizures: lateralization with MR volume measurements of hippocampal formation. Radiology 1990, 175: 423-429.
10. Jack CR Jr, Bentley MD, Twomey CK, Zinsmeister AR. MR imaging-based volume measurements of the hippocampal formation and anterior temporal lobe: validation studies. Radiology 1990, 176: 205-209.
11. Jack CR Jr, Sharbrough FW, Cascino GD et al. Magnetic resonance image-based hippocampal volumetry: correlation with outcome after temporal lobectomy. Ann Neurol 1992, 31: 138-146.
12. Jackson GD, Berkovic SF, Tress BM et al. Hippocampal sclerosis can be reliably detected by magnetic resonance imaging? Neurology 1990, 40: 1869-1875.
13. Kuzniecky R, de la Sayette V, Ethier R et al. Magnetic resonance imaging in temporal lobe epilepsy: pathological correlations. Ann Neurol 1987, 22: 341-347.
14. Sperling MR, Wilson G, Engel J Jr et al. Magnetic resonance imaging in intractable partial epilepsy: correlative studies. Ann Neurol 1985, 20: 57-62
15. Theodore WH, Katz D et al. Pathology of the temporal lobe foci: correlation with CT, MRI and PET. Neurology 1990, 40: 797-803.

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Set 1994

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

[1] 1. Babb TL, Brown WJ, Pretorius J et al. Temporal lobe volumetric cell densities in temporal lobe epilepsy. Epilepsia 1984, 25: 729-740.

[2] 2. Babb TL, Brown WJ. Pathological findings in epilepsy. In Engel J Jr (ed). Surgical treatment of the epilepsies. New York: Raven Press, 1987, p 511-540.

[3] 3. Bittencourt PRM. Epileptogênese, estrutura e função cerebral na epilepsia do lobo temporal: um estudo prospectivo e controlado. Tese aprovada em concurso para Professor Titular. Universidade Federal do Paraná. Curitiba, 1991.

[4] 4. Cascino GD, Jack CR Jr, Parisi JE et al. MRI-based volume studies in temporal lobe epilepsy: pathological correlations. Ann Neurol 1991, 30: 31-36.

[5] 5. Daly DD. Epilepsy and syncope. In Daly DD, Pedley TA (eds). Current practice of clinical electroencephalography. New York: Raven Press, 1992, p 269-334.

[6] 6. Dam AM. Epilepsy and neuron loss in the hippocampus. Epilepsia 1980, 21: 617-629.

[7] 7. Engel J Jr, Rausch R, Lieb J et al. Correlation criteria used for localizing epileptic foci in patients considered for surgical therapy of epilepsy. Ann Neurol 1981, 9: 215-224.

[8] 8. Jack CR Jr, Twoney CK, Zinsmeister AR et al. Anterior temporal lobes and hippocampal formations: normative volumetric measurements from MRI images in young adults. Radiology 1989, 172: 549-554.

[9] 9. Jack CR Jr, Sharbrough FW, Twomey CK et al. Temporal lobe seizures: lateralization with MR volume measurements of hippocampal formation. Radiology 1990, 175: 423-429.

[10] 10. Jack CR Jr, Bentley MD, Twomey CK, Zinsmeister AR. MR imaging-based volume measurements of the hippocampal formation and anterior temporal lobe: validation studies. Radiology 1990, 176: 205-209.

[11] 11. Jack CR Jr, Sharbrough FW, Cascino GD et al. Magnetic resonance image-based hippocampal volumetry: correlation with outcome after temporal lobectomy. Ann Neurol 1992, 31: 138-146.

[12] 12. Jackson GD, Berkovic SF, Tress BM et al. Hippocampal sclerosis can be reliably detected by magnetic resonance imaging? Neurology 1990, 40: 1869-1875.

[13] 13. Kuzniecky R, de la Sayette V, Ethier R et al. Magnetic resonance imaging in temporal lobe epilepsy: pathological correlations. Ann Neurol 1987, 22: 341-347.

[14] 14. Sperling MR, Wilson G, Engel J Jr et al. Magnetic resonance imaging in intractable partial epilepsy: correlative studies. Ann Neurol 1985, 20: 57-62

[15] 15. Theodore WH, Katz D et al. Pathology of the temporal lobe foci: correlation with CT, MRI and PET. Neurology 1990, 40: 797-803.