La electroencefalografía en el manejo de la epilepsia

Liane Aguilar Fabré, René Francisco Rodríguez Valdés, Hebert Luis Hernández Montiel

Resumen


La epilepsia es la entidad donde probablemente la electroencefalografía posee mayor valor y potencial. A pesar de que el diagnóstico de la epilepsia es clínico, el electroencefalograma (EEG) continúa siendo una evaluación imprescindible para lograr un acertado diagnóstico y la imposición de una terapéutica adecuada. A través de este artículo, se pretende revisar las tendencias actuales del uso de la electroencefalografía en el estudio de las epilepsias. El estudio de la función cerebral mediante el EEG y otras técnicas neurofisiológicas es imprescindible para responder a las interrogantes más comunes ante la evaluación y el diagnóstico de los eventos paroxísticos neurológicos, específicamente en las epilepsias. Entre el 25 y 30% de los pacientes epilépticos no responden al tratamiento con drogas antiepilépticas, para estos casos, la cirugía es una opción terapéutica. Sin embargo, para poder tener resultados satisfactorios en esta cirugía es indispensable localizar la zona epileptógena, que es el área cerebral indispensable para generar las crisis epilépticas y, debe ser resecada o desconectada para dejar al paciente libre de crisis y determinar que su extirpación no causará secuelas inaceptables. Esta zona epileptógena se infiere a partir de la asociación de pruebas diagnósticas: neuroimagenológicas, neuropsicológicas y neurofisiológicas, en ésta última, la electroencefalografía constituye el aspecto principal de estas valoraciones. El avance de la tecnología ha permitido el desarrollo de novedosas técnicas que en la actualidad permiten un abordaje más completo y cada día menos invasivo para la localización óptima de la zona epileptógena y la realización de una cirugía exitosa.

Palabras clave: neurofisiología, electroencefalograma, epilepsia, videoelectroencefalograma.

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Referencias


Trimble M. Cognitive problems of patients with seizure disorders. New issues in

neurosciences basic and clinical approaches. Neuropsychological aspects in epilepsy. P J

Magistretti and M Leonardi (eds.) cap 2. 1992: 17-24.

Deonna T. Cognitive and behavioral disturbance as epileptic manifestations in children: an

overview. Semin-Pediatr-Neurol. 1995; 2(4): 254-60.

Maestu F., Martin P., Sola RG., Ortiz T. Neuropsychology and cognitive deterioration in

epilepsy. Rev. Neurol. 1999; 28(8): 793-8.

Flink R, Pedersen B, Guekht AB, Malogren K, Michelucci R, Neville B et al. Internacional

League Against Epilepsy: Commission Report. Commission on European Affaire:

Subcommission on European Guidelines. Guidelines for the use of EEG methodology in the

diagnosis of epilepsy. Acta Neurol Scand 2002; 106:1-7.

García-Albea RE, García-Albea ME. El auge mundial de las neurociencias: XIV Congreso

Internacional de Medicina. Rev. Neurol 2010; 50:551-557.

Blume WT. History of electroencephalography as a pre-surgical evaluation tool: the pre-

Berger years. In: Textbook of epilepsy surgery. Lüders HO (eds.) Informa Healthcare (ed.).

: 174-76.

Poley EB, Quesada LMM. EEG en las crisis epilépticas y epilepsia. Magnetoencefalografía.

Diagnóstico y tratamiento de la epilepsia en niños y adultos. Guía Andaluza de Epilepsia.

: 65-74.

Gilbert DL, Gartside P. Factors affecting the yield of pediatric EEGs in clinical practice. Clin

Pediatr.2002;41:25-32.

Eeg-Olofsson O, Petersen I, Sellden U. The development of the electroencephalogram in

normal children fron the age of 1 through 15 years. Paroxysmal activity.

Neuropadiatrie.1971;2:375-404.

Cavazzuti GB, Capella L, Nalin A. Longitudinal study of epileptiform EEG patterns in normal

children. Epilepsia.1980;21:43-55.

Velis D, Plouin P, Gotman J, Lopes da Silva F, and members of the ILAE DMC

Subcommittee on Neurophysiology. Recommendations regarding the requirements and

applications for long-term recording in epilepsy. Epilepsia.2007; 48(2):379-384.

Binnie CD, Stefan H. Modern electroencephalography: its role in epilepsy management. Clin

Neurophysiol 1999;110: 1671-97.

Fountain NB, Kim JS, Lee SI: Sleep deprivation activates epileptiform discharges

independent of the activating effects of sleep. J Clin Neurophysiol 1998;15:69-75.

Fernández IS, Peters J, Takeoka M, Rotenmerg A, Prabho S, Gregas M et al. Patients with

electrical status epilepticus in sleep share similar clinical features regardless of their focal or

generalized sleep potentiation of epileptiform activity. Journal of child Neurology 2012:1-7.

Sammaritano M, Gigli GL, Gotman J. Interictal spiking during wakefulness and sleep and the

localization of foci in temporal lobe epilepsy: Neurology 1991.41:290-97.

Rodriguez AJ. Paediatric sleep and epilepsy. Current Neurology and Neuroscience Reports

, 7:342-347.

Walczak TS, Jayakar P. Interictal EEG. In: Engel Jr J, Pedley TA, editors. Epilepsy a

comprehensive textbook; vol,1. Philadelphia; Lippincott-Raven Publishers; 1997:821-48.

Goodin DS, Aminoff Mj. Does the interictal EEG have a role in the diagnosis of epilepsy?

Lancet.1984; 1:837-9.

Salinsky M, Kanter R, Dasheiff RM. Effectiveness of multiple EEG in supporting the

diagnosis of epilepsy: an operational curve. Epilepsia; 1987;28:331-4.

Malow BA, Lin X, Kushwaha R and Aldrich MS. Interictal spiking increases with sleep depth

in temporal lobe epilepsy. Epilepsia 1998; 39(12):1309-16.

Méndez M, Radtke RA. Interactions between sleep and epilepsy. J. Clin. Neurophysiol. 2001

Mar; 18(2):106-27.

Badawy RA, Curatolo JM, Newton M, Berkovic SF, Macdonell RA. Sleep deprivation

increases cortical excitability in epilepsy: syndrome-specific effects. Neurology 2006;

:1018-22.

Gotman J, Marciani MG. Electroencephalographic spiking activity, drug levels, and seizure

occurrence in epileptic patients. Ann Neurol 1985:17:597-603.

Sundaram M, Hogan T, Hiscock M, Pillay N. Factors affecting interictal spike discharges in

adults with epilepsy. Electroencephalogr Clin Neurophysiol 1990; 75:358-60.

Janszky J, Hoope M, Clemens Z et al. Spike frequency is dependet on epilepsy duration and

seizure frequency in temporal lobe epilepsy. Epileptic Disorders 2005, 7:355-9.

Krendll R, Lurger S, Baumgartner C. Absolute spike frequency predicts surgical outcome in

TLE with unilateral hippocampal atrophy. Neurology 2008; 71:4138.

Quero J, Valverde E, Pellicer A, Cabañas F: Convulsiones neonatales. An Esp Pediat. Libro

de Actas Vol 52, 2000; 339-349.

Hahn JS, Tharp BR. Neonatal and Pediatric Electroencephalography. In: Aminoff MJ

(ed).Electrodiagnosis in clinical neurology. New York: Churchill Livingstone1992:93-141.

Laureta E, Mizrahi EM, Moshé SL. Seizures and epilepsies in the preterm and term neonate.

In: Shomer DL, da Silva FL (eds.) Niedermeyer´s Electroencephalography: Basic principles,

clinical applications, and related fields. Lippincott Williams & Wilkins,2011: 465-479.

Watemberg N, Tziperman B, Dabby R, Hassan M, Zehavi L, Lerman-Sagie T. Adding video

recording increase the diagnostic yield of rutine electroencephalograms in children with

frequent paroxysmal events. Epilesia. 2005;46:716-19.

Carreno M, Lüders H. General priciples of presurgical evaluation. In: Lüders H, Comair YG,

editors. Epilepsy surgery. Philadelphia: Lippincott Williams & Wilkins, 2001: 185-199.

Parra J, Iriarte J, Kanner AM, Gil-Nagel A. How often can video/EEG telemetry change the

initial clinical diagnosis of Epilepsy? Epilepsia. 1996;37:157.

Chagasirisalbon S, Griggs L, Westmoreland S, Kim CS. The usefulness of one to two hour

video EEG monitoring in patients with refractory seizures. Clin Electroencephalogr.

;24:78-84.

Logar C, Walzl B, Lechner H. Role of long-term EEG monitoring in diagnosis and treatment

of epilepsy. Eur Neurol. 1994;34 (Suppl1):29-32.

Pierelli F, Chatrian GE, Erdly WW, Swanson PD. Long-term EEG-video-audio monitoring:

Detection of partial epileptic seizures and psychogenic episodes by 24-hour EEG record

review. Epilepsia. 1989;30:513-23.

Connolly MB, Wong PK, Karim Y, Smith S, Farrell K. Outpatient video-EEG monitoring in

children. Epilepsia. 1994;35:477-81.

Foley CM, Legido A, Miles DK, Grover WD. Diagnostic value of pediatric outpatient video-

EEG. Pediatr Neurol. 1995;12:120-4.

Aguilar-Fabré L, Rodríguez-Valdés RF, Morgade-Fonte RF, Valdivia-Álvarez I, García-

García R, Quesada-Bonet E. Experiencia en el uso del video-electroencefalograma en el

servicio de neurofisiología clínica. Rev Cubana Pediatr 2012;84: 234-243.

Boon P, de Reuck J, Drieghe C, de Bruycker K, Aers I, Pengel J. Long-term video-EEG

monitoring revisited. The value of interictal and ictal video-EEG recording, a follow-up study.

Eur Neurol. 1994;34(Suppl 1):33-9

Lancman ME, O’Donovan C, Dinner D, Coelho M, Luders HO. Usefulness of prolonged

video-EEG monitoring in the elderly. J Neurol Sci. 1996;142:54-8.

Arroyo S. Cirugía de la epilepsia: evaluación e indicaciones. Neurología. 1996;11 (supl

:122-8.

Bye AM, Flanagan D. Spatial and temporal characteristics of neonatal seizures. Epilepsia.

;36:1009-16.

Parnell K, Cascino GD, So EL, Cicora K. Long-term EEG monitoring in patients with spells:

clinical characteristics and predictive factors. Neurology. 1999;52:A371-2.

Park KL, Nordli DR. Special considerations in pediatric monitoring. In: Fisch JB (eds).

Epilepsy and Intensive care monitoring. New York: Principles and Practice. Demosmedical,

:91-104.

Castillo AG, Subirana PAQ. Monitorización vídeo-EEG en el diagnóstico de las crisis

epilépticas y epilepsia. Diagnóstico y tratamiento de la epilepsia en niños y adultos. Guía

Andaluza de Epilepsia.2009: 75-82.

Guideline twelve: Guidelines for Long-term monitoring for epilepsy. J Clin Neuroph 2008; 25:

-180.

Nordli D. Usefulness of Video-EEG Monitoring. Epilepsia 2006; 47: 26-30.

Kochen S, Thomson A, Silva W, García M, Grupo de Trabajo de Epilepsia de la Sociedad

Neurológica Argentina. Rev Neurol Arg 2006; 31: 117-22.

Whiting P, Gupta R, Burch J et al. A systemic review of the effectiveness sand costeffectiveness

of neuroimaging assessments used to visualise the seizure focus in people

with refractory epilepsy being considered for surgery. Health Technology Assessment 2006;

:4.

Kanner AM, Parra J, Gil-Nagel A, et al. The localizing yield of sphenoidal and anterior

temporal electrodes in ictal recordings: a comparison study. Epilepsia 2002 43:1189-96.

Yoshinaga H, Hattori J, Ohta H, Asano T, Ogino T, Kobayashi K, Oka E. Utility of the scalprecorded

ictal EEG in childhood epilepsy. Epilepsia. 2001; 42:772-77.

Tallawy HN, Fukuyama H, Kader AAA, Kamel NF, Badry R. Role of short-term outpatient

video electroencephalography in diagnosis of paroxysmal disorders. Epilepsy Research

; 88:179-82.

Ghougassian Df, d´Souza W, Cook MJ, O´Brien TJ. Evaluating the utility of inpatient video-

EEG monitoring. Epilepsia. 2004; 45: 928-932.

Cascino GD. Video-EEG monitoring in adults. Epilepsia. 2002; 43: (suppl 3):80-93.

Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000; 342:314-

Sheth RD. Epilepsy surgery. Presurgical evaluation.Neurol Clin 2002 Nov, 20 (4):1195-215.

Engel JJ. Surgery for seizures. N Engl J Med 1996; 334(10):647-652.

Obeid M, Wyllie E, Rahi AC, Mikati MA. Approach to paediatric surgery: state of the art, Part

II. Approach specific epilepsy syndromes and etiologies. European Journal of Paediatric

Neurology 2009;13:115-127.

Obeid M, Wyllie E, Rahi AC, Mikati MA. Approach to paediatric surgery: state of the art, Part

I. General priciples and presurgical workup. European Journal of Paediatric Neurology 2009;

:102-114.

Lesser RP. Psychogenic seizures. Neurology 1996; 46:1499-1507.

Pierelli F, Chatrian GE, Erdly WW, Swanson PD. Long-term EEG video-audio monitoring:

detection of partial epileptic seizures and psychogenic episodies by 24 hour EEG record

review. Epilepsia 1989; 30(5):513-523.

Centeno RS, Yacubia EM, Sakamoto AC, Ferraz AFP, Carrete JH, Cavalherio S. Presurgical

evaluation and surgical treatment in children with extratemporal epilepsy. Childs

Nerv. Syst 2006; 22: 945-959.

Holmes MD, Wilensky AJ, Ojemann GA, Ojemann LM. Hippocampal or neocortical lesions

on resonance imaging do not necessarily indicate site of onsets in partial epilepsy. Ann

Neurol 1999; 45:461-465.

Lüders H, Lesser RP, Dinner DS, et al. Localization of cortical function: new information from

extraoperative monitoring of patients with epilepsy. Epilepsia 1988;29 (Suppl. 2):S56–65.

Sperling MR. Clinical challenges in invasive monitoring in epilepsy surgery. Epilepsia 1997;

Suppl 4:S6-12:S6-12.

Spencer SS, Guimaraes P, Katz A, Kim J, Spencer D. Morphological patterns of seizures

recorded intracranially. Epilepsia 1992; 33(3):537-545.

Sinhn SR, Crone NE, Lesser RP. Indications for invasive electroencephalography

evaluation. In: Textbook of epilepsy surgery. Lüders HO (eds.) Informa Healthcare (ed.).

: 614-622.

Van Loo P, Carrette E, Meurs A, Goossens L, Van Roost D, Vonck K, Boon P. Surgical

successes and failures of invasive video-EEG monitoring in the presurgical evaluation of

epilepsy. Panminerva Med 2011:53:227-40.

Blount JP, Cormier J, Kim H, Kankirawatana P, Riley KO, Knowlton RC. Advances in

intracranial monitoring. Neurosug Focus 2008;25:E18.

Simon MV, Jason LG, Eskandar EN. Electrocorticography. In: Intraoperative clinical

neurophysiology. A comprehensive guide to monitoring and mapping. Simon MV (Eds).

Demosmedical, N. York (ed.) 2010:95

Skarpas TL, Morrell M. Intracranial stimulation. In: Epilepsy and Intensive care monitoring.

Principles and Practice. Fisch BJ (ed.) Demosmedical. N. York (ed). 2010:237-246

Francesco C, Cossu M, Castana L, Casaceli G, Schiariti MP, Miserocchi A, et al.

“StereoElectroEncephaloGraphy: Surgical Methodology, Safety and Stereotactic Application

Accuracy in Five Hundred Procedures.” Neurosurgery 2012.

Kahane P, Francione S. Stereoelectroencephalography. In: Textbook of epilepsy surgery.

Lüders HO (eds.) Informa Healthcare (ed.). 2008: 649-658.

Kelm GH, Nehamkin S. Invasive electrodes in long-term monitoring. In: Textbook of epilepsy

surgery. Lüders HO (eds.) Informa Healthcare (ed.). 2008: 623-628.

Cossu M, Cardinale F, Catana L, Nobili L, Sartori I, Lo Russo G. Stereo-EEG in children.

Childs Nerv Syst. 2006; 22:766-68.

Cossu M, Schiariti M, Fraciones S, Fuschillo D, Gozzi F, Nobili L, Cardinale F, Castana L, Lo

Russo G. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy in

infancy and early childhood. J. Neurosurg Pediatr 2012; 9:290-300.

Cossu M, Cardinale F, Citterio A, Franciones S, tassi L, Benabid AL, Lo Russo G.

Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: a retrospective

analysis of 215 procedures. Neurosurgery 2005; 57:706-18.

Placantonakis DG, Sharitt S, Lafaille F, Labar D, Harden C, Hosain S, Kandula P, Schaul N,

Kolesnik D, Schwartz TH. Bilateral intracranial electrodes for lateralizing intractable epilepsy:

efficacy, risk, and outcome. Neurosurgery 2010; 66: 274-83.

Cossu M, Lo Russo G, Francione S, Mai R, Nobili L, Sartori I, Tassi L, Citterio A, Colombo

N, Bramerio M, Galli C, Castana L, Cardinale F. Epilepsy surgery in children: results and

predictors of outcome on siezures. Epilepsia 2008; 49:65-72.

Urretarazu E, Iriarte J. Análisis matemáticos en el estudio de señales

electroencefalográficos. Rev Neurol 2005;41(7):423-434.

Cho JH, Hong SB, Jung YJ, Kang HC, Kim HD, Suh M, Jung KY, Im CH. Evaluation of

algorithms for intracranial EEG (iEEG) source imaging of extended sources: feasibility of

using. EEG source imaging for localizing epileptogenic zones in secondary generalized

epilepsy. Brain topography 2011; 24: 91-104.

Cosandier-Rimélé D, Merlet I, Badier JM, Chauvel P, Wendling F. The neuronal sources of

intracerebral recordings in epilepsy. Neuroimage 2008;42:135-46.

Grech R, Cassar T, Muscat J, Camilleri KP, Fabri SG, Zervakis M, Xanthopoulos P, Sakkalis

V, Vanrumste B. Review on solving the inverse problem in EEG source analysis. Journal of

Neuroengineering and rehabilitation 2008;5:25.

Koessler L, Benar C, Maillard L, Badier JM, Vigmal JP, Bartolomei F, Chauvel P, Gavaret M.

Source localization of ictal epileptic activity investigated by high resolution EEG and

validated by SEEG. Neuroimage 2010; 51:642-53.

Plummer C, Harvey AS, Cook M. EEG source localization in focal epilepsy: where are we

now? Epilepsia 2008; 42:201-18.

Dannhauer M, lanfer B, Wolters CH, Knösche TR. Modeling of human skull in EEG source

analysis. Human Brain Mapping 2011; 32:1383-99.

Barkley GL, Baumgartner C. MEG and EEG in epilepsy. J Clin Neurophysiol 2003; 20: 163-

Pastor-Gómez J, Pulido-Rivas P, Sola RG. Revisión bibliográfica sobre la ultilidad de la

magnetoencefalografía en la epilepsia. Rev Neurol 2003;37(10): 951-61.

Pastor-Gómez J, Sola RG. Fundamentos biofísicos de la magnetoencefalografía. Rev

Neurol 2002; 34: 865-70.

Funke ME, Moore K, Orrison WW, Lewine JD. The role of magnetoencephalography in

¨nonlesional¨epilepsy. Epilepsia 2011; 52:10-14.

Knowlton RC, Shih J. Magnetoencephalography in epilepsy. Epilepsia 2004;45: 61-71.

Knowlton RC. Can magnetoenecephalography aid epilepsy surgery? Epilepsy Curr

;8:1-5.

Ray A, Bowyer SM. Clinical applications of magnetoencephalography in epilepsy. Ann Indian

Acad Neurol 2010; 13:14-22.


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