Somatosensory aura in mesial temporal lobe epilepsy: semiologic characteristics, MRI findings and differential diagnosis with parietal lobe epilepsy

Somatosensory aura in mesial temporal lobe epilepsy: semiologic characteristics, MRI findings and differential diagnosis with parietal lobe epilepsy

Alternative title Auras somatossensoriais em epilepsia mesial temporal: características semiológicas, achados neurorradiológicos e diagnóstico diferencial com epilepsia de lobo parietal
Author Rahal, Márcio Andriani Autor UNIFESP Google Scholar
Araujo Filho, Gerardo Maria de Autor UNIFESP Google Scholar
Caboclo, Luís Otávio Sales Ferreira Autor UNIFESP Google Scholar
Rosa, Vivianne Pellegrino Autor UNIFESP Google Scholar
Centeno, Ricardo Silva Autor UNIFESP Google Scholar
Carrete Junior, Henrique Autor UNIFESP Google Scholar
Garzon, Eliana Autor UNIFESP Google Scholar
Sakamoto, Américo Ceiki Autor UNIFESP Google Scholar
Yacubian, Elza Márcia Targas Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract INTRODUCTION: Somatosensory auras (SSAs) are more usually described in patients with parietal lobe epilepsy (PLE), producing more commonly a localized cutaneous tingling sensation, involving hands and fingers followed by tonic or clonic focal seizures. These usually originate in the contralateral hemisphere. Etiology includes dysplasias, tumours, ischemic or postencephalitic gliosis. However, other focal epilepsies, such as frontal and temporal, may also originate SSAs. Although this type of aura is reported as rare in patients with mesial temporal lobe epilepsy (MTLE), this association has not been systematically studied. OBJECTIVES: The aim of this article was to describe the cases of four patients with refractory MTLE and SSAs, reporting their clinical characteristics and MRI findings. We discuss the localizing and lateralizing value of SSAs, particularly in the context of MTLE. METHODS AND RESULTS: Four patients with refractory MTLE and SSAs followed-up in the outpatient's clinic at the Epilepsy Section, Universidade Federal de São Paulo (UNIFESP), were submitted to presurgical evaluation and corticoamygdalohippocampectomy. MRI in all cases showed unilateral mesial temporal sclerosis (MTS). Regarding seizure semiology, tingling sensation involving the upper extremity was the most prevalent symptom. Three of the four patients had SSAs contralateral to the MTS. Following the SSAs all patients most of the time presented other symptoms such as autonomic or psychic auras evolving to psychomotor seizures. After surgical treatment, two of the patients presented infrequent auras, and two were rendered seizure-free. CONCLUSION: Although rare, SSAs can be present in MTLE. The characteristics of autonomic or psychic auras, psychomotor seizures, neuropsychological deficits, and typical neurophysiologic and MRI findings may help differentiate patients with MTLE from those with PLE.

INTRODUÇÃO: Auras somatossensoriais (AS) são mais frequentemente descritas em pacientes com epilepsia de lobo parietal (ELP), produzindo sensação de formigamento cutâneo envolvendo mão e dedos seguida de sinais motores focais tônicos ou clônicos. Estas crises habitualmente originam-se no hemisfério cerebral contralateral. Displasias, tumores, patologias vasculares ou gliose pós encefalite constituem as etiologias mais prováveis. Outras epilepsias focais, como as de lobo frontal e temporal podem também originar (AS). Embora este tipo de aura seja considerada rara em pacientes com epilepsia mesial do lobo temporal (EMLT), esta associação ainda não foi sistematicamente estudada. OBJETIVOS: A proposta deste artigo foi descrever quatro casos de EMLT refratária ao tratamento clínico, apresentando AS, reportar as características clínicas comuns, achados de neuroimagem e estudar o valor localizatório e lateralizatório das mesmas. MÉTODOS E RESULTADOS: Quatro pacientes com EMLT refratária e AS acompanhados no ambulatório de Epilepsia, Universidade Federal de São Paulo (UNIFESP), foram submetidos a avaliação pré-cirúrgica. Sensação de formigamento envolvendo a extremidade superior foi o sintoma predominante em todos. Em três (75%) as auras foram contralaterais à esclerose mesial temporal (EMT). Em todos as AS eram, com maior freqüência, seguidas por outras auras autonômicas e psiquícas e evoluiam para crises parciais complexas (crises psicomotoras). CONCLUSÃO: Embora raras, AS podem estar presentes em EMLT. A associação de auras autonômicas e psíquicas, presença de crises parciais complexas (psicomotoras), déficits neuropsicológicos distintos, além de achados neurofisiológicos e de neuroimagem podem diferenciar pacientes com EMLT daqueles com ELP.
Keywords somatosensorial auras
temporal lobe epilepsy
mesial temporal sclerosis
parietal epilepsy
auras somatossensoriais
epilepsia mesial do lobo temporal
esclerose mesial temporal
epilepsia de lobo parietal
Language English
Date 2006-09-01
Published in Journal of Epilepsy and Clinical Neurophysiology. Liga Brasileira de Epilepsia (LBE), v. 12, n. 3, p. 155-160, 2006.
ISSN 1676-2649 (Sherpa/Romeo)
Publisher Liga Brasileira de Epilepsia (LBE)
Extent 155-160
Origin http://dx.doi.org/10.1590/S1676-26492006000500008
Access rights Open access Open Access
Type Article
SciELO ID S1676-26492006000500008 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/3250

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