Title (srp)

Analiza karakteristika periiktalnih vegetativnih znakova za lokalizaciju epileptogene zone kod epilepsija temporalnog režnja : doktorska disertacija

Author

Vojvodić, Nikola M., 1969-

Contributor

Sokić, Dragoslav, 1960-

Description (srp)

Cilj: Vegetativni znaci tokom epileptičkih napada (periiktalni vegetativni znaci, PIVZ), predstavljaju prirodni eksperiment koji pruža jedinstven uvid u funkcionisanje ljudskog autonomnog nervnog sistema. Iako vegetativni znaci kod epilepsija nisu retki i mogu čak dominirati kliničkom slikom napada, ove manifestacije se često previde. Glavni cilj našeg istraživanja bio je da se analizira značaj PIVZ za lokalizaciju i lateralizaciju epileptogene zone kod pacijenata sa fokalnom farmakorezistentnom epilepsijom koji su podvrgnuti prehirurškom ispitivanju. Metodologija: Analizirali smo video-EEG zapise kod 170 bolesnika (82 muškarca i 88 žena), starosti 13-66 godina (34,67 ±11,10; Med=35,00) sa farmakorezisetntnom fokalnom epilepsijom. Svi pacijenti su prošli kompletno prehirurško ispitivanje u Centru za epilepsije u Beogradu, koje se sastojalo od višednevne neinvazivne video-EEG telemetrije, snimanja nuklearnom magnetnom rezonancom, interiktalne pozitronske emisione tomografije fluorodeoksiglukozom i interiktalne i/ili iktalne HMPAO jednofotonske emisione kompijuterizovane tomografije. Dijagnoza fokalnog epileptičkog sindroma je postavljena na osnovu korelacije kliničkih karakteristika napada, iktalnih EEG nalaza i neuroradioloških nalaza. Dominantnost hemisfere kod svakog pacijenta je odredjena na osnovu Edinbruškog testa za dominantnost ruke, neuropsihološke procene i funkcionalne nukelarne magnetne rezonance gde je bilo neophodno. Kod svih bolesnika smo analizirali video zapis kliničke semiologije napada sa ciljem odredjivanja učestalosti javljanja i tipova PIVZ kod fokalnih epilepsija, njihovog lokalizacionog značaja za epilepsije temporalnog režnja (TLE) vs. ekstratemporalne epilepsije (ETLE) i njihovog lateralizacionog značaja (epilepsija nedominantne vs. dominantne hemisfere). Takodje smo analizirali evoluciju vegetativnih simptoma (epigastrična aura, AE) u neki od PIVZ i njen prediktivni značaj za dijagnozu mezijalne temporalne epilepsije (MTLE). Rezultati: Uočili smo deset različitih tipova PIVZ kod 69 od ukupno 170 bolesnika (40%). Najčešći PIVZ su bili postiktalno brisanje nosa (28,8%) i periiktalni kašalj (12,9%). Pokazali smo da su PIVZ pouzdan lokalizacioni znak za TLE vs. ETLE (50,0% vs. 23,2%; p=0,001). Najvažniji lokalizacioni znaci su bili postiktalno brisanje nosa (p=0,008), periiktalno pijenje vode (p=0,035) i hipersalivacija (p=0,048). Takodje smo našli da je pojava PIVZ češća kod bolesnika sa epilepsijom nedominantne hemisfere, posebno kod bolesnika sa MTLE, ali ova razlika nije dostigla punu statističku značajnost (64,3% vs. 47,1%; p=0,175). Kod bolesnika sa evolucijom EA u neki od PIVZ, verovatnoća za MTLE je bila veoma visoka (96,77%)...

Description (srp)

Medicina - Medicine Datum odbrane : 26.12.2012

Description (eng)

Purpose: Vegetative signs during epileptic seizures (periictal vegetative signs, PIVS) represent an experiment of nature that provides a unique window on the functioning of the human autonomic nervous system. Although vegetative manifestations of epilepsy are not rare, and may even overshadow other semiological signs, these manifestations are frequently overlooked. The main purpose of our investigation was to analyze localization and lateralization value of PIVS for the epileptogenic zone in patients with focal pharmacoresistant epilepsies who were undergone presurgical evaluation. Methodology: We analyzed video-EEG recordings of 170 patients (82 men and 88 women), age ranged 13-66 years (mean 34.67 ±11.10; Med=35.00) with medically intractable focal epilepsy. All of the patients underwent a complete presurgical evaluation in the Belgrade Epilepsy Center, comprising long-term noninvasive video-EEG telemetry, magnetic resonance imaging, interictal fluorodeoxyglucose positron emission tomography and interictal and/or ictal HMPAO single-photon emission computed tomography. The diagnosis of lobar epilepsy was established according to the correlation of clinical seizure semiology, ictal EEG findings and neuroradiology findings. The hemisphere dominance was determined according to the Edinburgh handedness inventory, neuropsychological assessment and functional magnetic resonance imaging for speech lateralization when needed. In all patients we analyzed video recordings of clinical seizure semiology in order to determine the frequency and types of PIVS in focal epilepsies, their localizing value for temporal lobe epilepsies (TLE) vs. extratemporal lobe epilepsies (ETLE), and their lateralizing value (seizures from nondominant vs. dominant hemisphere). We also evaluated the evolution of seizure semiology from vegetative symptoms (epigastric aura, EA) to PIVS and it's predictive value for the diagnosis of mesial temporal lobe epilepsy (MTLE). Results: Ten different types of PIVS occurred in 69 of the 170 patients (40%). The most frequent PIVS were postictal nose rubbing (28.8%) and periictal cough (12.9%). We found PIVS were reliable localizing signs for TLE vs. ETLE (50.0% vs. 23.2%; p=0.001). The most valuable localizing signs were postictal nose rubbing (p=0.008), periictal water drinking (p=0.035) and hypersalivation (p=0.048). We also found the occurence of PIVS more common among the patients with nondominant hemisphere epilepsy, especially in patients with MTLE, but this difference was not statistically significant (64.3% vs. 47.1%; p=0.175). In patients with EA evolving into any other PIVS, the probability of MTLE was extremely high (96.77%)...

Object languages

Serbian

Date

2012

Rights

Creative Commons License
This work is licensed under a
CC BY 2.0 AT - Creative Commons Attribution 2.0 Austria License.

CC BY 2.0 AT

http://creativecommons.org/licenses/by/2.0/at/

Subject

Focal epilepsies, temporal lobe, periictal vegetative signs

OSNO - Opšta sistematizacija nau?nih oblasti -- Medicina (29) -- Neurologija. Neuropatije (2944)

Identifiers