Caso clinico de crisis epilepticas

A 24-year-old woman, right-handed, who had complex partial seizures and secondarily generalized from 15 years old. A presurgical CT scan detected a 2 mm. calcification in left posterior parietallobe. A MRI scan showed increased T2 signal of 2 x 1 cm. in the left parietal region, suggesting a dysplasic lesion. Subdural electrodes localized the epileptogenic region in the left parietal withvariable propagation to the left mesial temporal region. Cortical stimulation was performed. Preoperative neuropsychological assesment revealed a FQI=100, memory performance on the average level and anaming ability impaired. She underwent a left parietal resection guided by subdural electrodes to excise the lesion. After surgery, seizures were partially controled by reducing the frecuency of complexpartial seizures and eliminating the generalized ones.NEUROPSYCHOLOGICAL FOLLOW-UP: Postsurgical assessment 1 week after surgery revealed a significant decrease on the memory performance, fingeragnosia, dysgraphia, alexia and dyscalculia.
The examination 6 months after surgery showed that the cognitive defects still remained but finger agnosia. At this point, it was started a rehatilitationprogram to improve automatic mechanisms in reading, writing and arithmetic abilities.
One year after surgery, the patient exhibited an improvement in writing and arithmetic skills, and also some gainsin memory functioning. The impairment in reading still remained.

CONCLUSION: The cognitive sequelae following surgery suggest overlap betwwen epileptogenic region and functional cortex. Theneuropsychological rehabilitation program focused on specific domains produce moderate improvements in calculation and writing abilites and only slight gains in reading.


Resumen
OBJETIVO: Presentarla evolución neuropsicológica de un paciente con epilepsia fármacorresistente tras lesionectomía parietal izquierda.
CASO CLÍNICO: Mujer de 24 años de edad, diestra, con crisis parciales...