Dados do Trabalho

Título

EPILEPTIC ENCEPHALOPATIS: IS IT AVOIDABLE?

Apresentação do caso

Female, 8 years old, with onset of seizures at 2 months, evolving with refractory epilepsy. The seizures were characterized by behavioral arrest and vacant gaze, in addition to episodes of loss of tone and head turn to the right with intense salivation. Patient has used topiramate, nitrazepam, carbamazepine and valproate. On examination, he is moderately mentally retarded and does not speak. Prolonged videoelectroencephalogram demonstrated focal seizures in the right cerebral hemisphere and resonance image showed right frontal cortical dysplasia associated with right occipital heterotopic nodule. Surgery was performed with intraoperative monitoring. After complete resection of the lesion and the initial epileptiform discharges, a greater extension of the epileptiform pattern was observed, which became more diffuse with each resection extension. At follow up patient persisted with seizures with only a discrete frequency reduction.

Discussão

Epilepsies in childhood have several causes, including genetic and structural ones, emphasizing the importance of overlapping etiologies. Encephalopathy, characterized by diffuse brain dysfunction, should be considered even in patients with predefined lesions, as it is an important cause of epileptic seizures.

Comentários finais

The case in question shows persistence of epileptiform paroxysms even with resection of the lesion and the initial epileptiform discharges. This finding may be related to the epileptic encephalopathy that patients with early onset epilepsies present. Although it is not possible to absolutely affirm, earlier surgery could have avoided this pattern of secondary epileptogenesis.

Referências (se houver)

Engel J Jr. Evolution of concepts in epilepsy surgery. Epileptic Disord. 2019 Oct 1;21(5):391-409.

Madaan P, Gupta A, Gulati S. Pediatric Epilepsy Surgery: Indications and Evaluation. Indian J Pediatr. 2021 Oct;88(10):1000-1006

Declaração de conflito de interesses de TODOS os autores

Não há.