Request PDF on ResearchGate | On 1, , L. D'Incerti and others published Alterazioni transitorie di risonanza magnetica nell'epilessia del lobo temporale. Request PDF on ResearchGate | On 1, , A. Citterio and others published La RM nell'epilessia del lobo temporale: Correlazione tra caratteristiche. Alterazioni transitorie di risonanza magnetica nell'epilessia del lobo temporale Article Information, PDF download for Alterazioni transitorie di.
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Download PDF [PDF] transitorie di risonanza magnetica nell'epilessia del lobo temporale PDF download for Alterazioni transitorie di risonanza magnetica. Von Rüden, Neuroscience_HSP70 genetic forfindsebullperf.gae di desacyl-ghrelin in un modello d'epilessia del lobo temporalemore. Disturbi cognitivi nell'epilessia del lobo temporale in età forfindsebullperf.ga Questa pagina è stata visitata 18 volte dal 16 Aprile Fonte: Google Analytics.
Neuropsychological testing disclosed a non-dominant fronto-temporal dysfunction. MRI showed an anterior insular cavernoma Fig 1, left. Cerebral angiography was normal. This patient was submitted to a right fronto-temporal craniotomy under general anesthesia. After the opening of the dura, the sylvian fissure was widely split and electrocorticography electrodes were placed over the exposed surface of the insula and over the frontal and temporal lobes. This referential recording disclosed the presence of independent insular and temporal lobe spiking and of discharges clearly originating from the insula and spreading into the temporal lobe Fig 2.
The insular cavernoma and its surrounding gliotic and hemosiderotic tissue were removed using microsurgical techniques. The temporal lobe was left in place and there was no damage to any of its surfaces. A post-resection ECoG recording disclosed a pattern similar to the pre-resection one but with an obvious reduction of the spikes' frequency. There was no post-operative complications. A post-operative MRI documented the complete removal of the cavernoma and the absence of surgically induced temporal lobe lesions Fig 1, right.
This patient is seizure free 6 months after surgery. Many of the clinical features would suggest temporal lobe epilepsy and actually, may be the result of the spread of the ictal insular activity directly into the temporal lobe or through arcuate and uncinate bundles' fibers4.
The simple partial autonomic seizures were similar to those described by temporal lobe epilepsy patients. This type of autonomic seizures has been described by the stimulation of both the amigdala within the temporal lobe 1,6 and the insula2,3,9, but has been said to be more frequently obtained from the mesial temporal lobe structures. This is also true for the ictal complex partial seizures phenomena of ipsilateral automatisms and contralateral upper limb paresis which have been documented to be present in many patients with temporal lobe seizures arising from the hippocampus.
Involvement of the insular cortex in temporal lobe epilepsy has also been considered in the early days of temporal lobe epilepsy surgery5. It has been shown that insular cortex removal in patients with temporal lobe epilepsy did not increase the surgical success rate in relation to seizures and that this procedure carried out an unacceptable morbidity and mortality rates8.
On the other hand, the involvement of the temporal lobe in insular epilepsy has been poorly studied and virtually nothing is known about it. The presence of independent temporal lobe spiking during ECoG would suggest that this lobe was involved in the epileptogenic proccess in this patient with insular epilepsy. Many cavernomas, especially the smaller ones, are not seen in regular CT scans and are only detected by MRI scanning.
This may also be true for some low-grade gliomas.
This raises the intriguing question of how many insular epilepsies were misdiagnosed as temporal lobe epilepsy in the past and how this eventual misdiagnosis influenced the surgical results in the pre-MRI period. Insular epilepsy shares many clinical and EEG features with temporal lobe epilepsy.
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