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Biomedical subjects

A Altuzarra-Corral

Publications and source records attributed to A Altuzarra-Corral.

9 recordsLinked to original sources
PubMedDate not supplied

[The surgery of epilepsy].

INTRODUCTION: At the present time the surgery of epilepsy is a safe, effective therapeutic option which should be offered to the patient with drug resistant epilepsy at the right moment to prevent the irreversible negative consequences of uncontrolled seizures. DEVELOPMENT: All patients with drug resistant epilepsy should be surgically assessed. In recent years the concept of surgically remediable syndrome has been introduced to refer to conditions in which surgical treatment gives excellent results: mesial temporal sclerosis, circumscribed neocortical lesions, Sturge Weber syndrome and infantile hemiplegic epilepsy are good examples in which prolonged, unnecessary delay of surgery should not occur. This type of surgery should be undertaken in centres with suitable trained multi disciplinary teams with adequate resources and preestablished guidelines. The clinical history, surface electroencephalogram monitoring, directed magnetic resonance, functional neuroimaging with SPECT and PET and neuropsychological studies are the basis for pre surgical diagnosis. These and other investigations should be done following the guidelines of each centre and the complexity of the disorder in each case. CONCLUSION: Anteromesial resection of the temporal lobe, selective amigdalo hippocampectomy, neocortical resection, hemispherectomy or a variation of it, section of the corpus callosum and multiple sub pial transection are the most usual surgical techniques since good results are obtained with them in suitable cases.

Adult↗
PubMedDate not supplied

[Defects in the visual field in resective surgery for temporal lobe epilepsy].

INTRODUCTION: Temporal lobe resection is the most used procedure in epilepsy surgery. Visual field defects after resection are frequent. AIM. We try to detect the frequency and severity of visual field defect after anterior temporal lobectomy (ATL) and to study the functional consequences. PATIENTS AND METHODS: We studied 30 patients with refractory temporal lobe epilepsy (15 men, 12 51 years, m= 32.9), in which ATL was performed (11 right, 19 left). The neocortical and hippocampal resection was variable. Visual field was studied with computerized campimetry type Humphrey. Our survey was filled to study the campimetric consequence, seizures incidence, quality of life and surgery satisfaction. RESULTS: Some campimetric disturb was found in 27 patients (90 %), superior or minor homonimus quadantapnosia in 18 (60 %), major one 8 and homonimus hemianopsia in one. Incongruent defects appeared in 19. The bigger neocortical and hippocampal resection was, the bigger defect, with exceptions. Only patient with a hemianopsia was conscious the deficit. 20 patients (66.6 %) were seizures free in the last year. 28 had better quality of life and 29 (96.6 %) would have chosen surgery again. CONCLUSION: Visual field defects after ATL, although frequent, have little functional consequences and in quality of life. The quality of life is better when seizures stopped. After ATL patients are very glad with their decision.

Adolescent↗
PubMedDate not supplied

[Patient aged 45 with refractory epilepsy of the temporal lobe since early childhood].

INTRODUCTION: Temporal lobe epilepsy is the most frequent of the epilepsies related with localization and one of the most refractory to pharmacological treatment. Temporal lobectomy curbs seizures in many of these patients, which improves their quality of life. CASE REPORT: Patient aged 45 who, during early infancy, started to suffer simple partial seizures that later went on to become generalised. These were well under control by adolescence but at 23 they became complex partial seizures that were resistant to different antiepileptic drugs. The patient was submitted to a complete presurgical evaluation and a left anterior temporal lobectomy was performed at the age of 44. After surgery he evolved favourably. The final diagnosis was that he was suffering from mesial temporal sclerosis, associated with a subcortical neuronal heterotopy of the parahippocampal region. We discuss the semiology and the aetiology with regard to this patient and in a general sense, and we also define the foundations upholding the decision to perform surgery, the areas that make up the epileptogenic zone, and the neurophysiological and neuropsychological tests, and the structural and functional neuroimaging that are used to measure those areas. Likewise, the different techniques that can be used in resection of the temporal lobe are analysed. We also set out an etiopathogenic hypothesis according to the histopathological results and comment on a number of related general aspects. CONCLUSIONS: Progress in physiopathological knowledge, the development of diagnostic and surgical techniques, and its high efficiency and low morbidity have consolidated temporal lobectomy as a radical form of treatment for temporal lobe epilepsy that should be performed as early as possible once resistance to medication has been observed.

Diagnosis, Differential↗
PubMedDate not supplied

[Changes in episodic and semantic memory associated with temporal lobectomy].

INTRODUCTION: Temporal lobectomy (TL) is an effective treatment for drug refractory temporal lobe epilepsy. The main neuropsychological consequences of the intervention are changes in episodic and semantic memory. Aim. To study the consequences of right temporal lobectomy (RTL) and left temporal lobectomy (LTL) on episodic and semantic mnemonic functioning. PATIENTS AND METHOD: 27 patients who had undergone TL in the Hospital Universitario Virgen de las Nieves in Granada were submitted to pre and post surgical evaluation by means of a battery of neuropsychological tests that included episodic and semantic memory tests for both verbal and visual material. RESULTS AND CONCLUSIONS: ANOVA analysis was employed to analyse the pre and post surgical changes for the whole group of patients, and Student s t and Wilcoxon s non parametric test were used for each group of RTL and LTL. No deterioration was found in ipsilateral memory after the intervention, that is to say, in the verbal memory of the patients submitted to LTL and in the visual memory of RTL patients. With regard to contralateral memory, that is, the visual memory of patients submitted to LTL and the verbal memory of RTL patients, the ANOVA analyses of the whole group revealed a statistically significant improvement. The analyses performed for the whole group (LTL and RTL), however, did not reveal any statistically significant changes.

Adult↗
PubMedDate not supplied

[Clinical neuropsychology of the surgery of temporal lobe epilepsy].

INTRODUCTION AND OBJECTIVES: The surgery of epilepsy has become a real alternative for the treatment of patients with drug resistant epilepsy. In this study we review the part played by Clinical Neuropsychology in programmes of surgery for epilepsy, particularly in operations designed to treat drug resistant temporal lobe epilepsy. DEVELOPMENT: Firstly we describe the function of the clinical neurologist in relation to these patients. Then we consider the main national and international forms of assessment. Finally we describe the main findings of neuropsychological investigation regarding the approach to temporal lobectomy. Thus we describe the main presurgical characteristics of candidates for surgery regarding cognition and personality. Similarly we describe what is known of the possibilities of finding the site of the epilepetogenic focus and prognosis of the results and neuropsychological consequences of the operation. Finally, we describe the cognitive results, particularly memory, after temporal lobectomy. CONCLUSIONS: Review of the literature shows how important it is for the clinical neuropsychologist to be involved in programmes of the surgery of epilepsy, studying the patients before and after surgery and assessing prognosis. Clinical neuropsychology is also important for predicting the post surgical neuropsychological results.

Amobarbital↗
PubMedDate not supplied

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: I. Criteria for starting and discontinuing and the pharmacological bases of antiepileptic treatment].

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Anticonvulsants↗
PubMedDate not supplied

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: II. Chronic therapy with antiepileptic drugs in adults and in children].

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Adult↗
PubMedDate not supplied

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: III. Antiepileptic therapy in special situations].

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: IV. General principles of antiepileptic polytherapy and therapeutic strategies in refractory epilepsy].

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Anticonvulsants↗