Cortical dysplastic lesions (CDLs) are usually identified by magnetic resonance imaging (MRI). Clinical, electrographic and histologic findings suggest that focal CDLs (FCDLs) are highly epileptogenic, often involve the rolandic cortex, and can present variable degrees of histopathologic abnormalities. An ictal or "ictal-like" bursting pattern of electrographic activity was recorded over dysplastic cortex in 65% of our patients. Resective surgery can eliminate or significantly reduce seizure frequency in many medically intractable patients, depending on lesion location, degree, and extent of histopathologic abnormalities. Best results are achieved when complete or major excision of both the MRI-visible lesion and the cortical areas displaying ictal electrographic activity can be performed. This is more likely when the degree of histopathologic abnormality is mild to moderate or when the lesion is in a temporal lobe. More severe histopathologic abnormalities and central insular or multilobar lesions usually lead to less favorable results: either major excision of the visualized lesion is impractical or the lesion is microscopically more extensive than shown by MRI. Multilobar resection or hemispherectomy for patients with infantile spasms associated with CDLs and for patients with hemimegalencephaly are often associated with dramatic improvement in seizure control. Callosotomy can be performed in selected patients with diffuse CDLs who have intractable drop attacks.

The purpose of this study was to assess the cortical representation of sensorimotor functions in patients undergoing perirolandic epilepsy surgery, focusing on somatotopy, mosaicism, and variability of function in relation to the classic motor homunculus. The authors studied 36 patients in whom intraoperative or extraoperative electrical cortical stimulation to map motor functions was performed. A computer program was devised to register electrode number, stimulation parameters, and response to each stimulus. Electrode position was represented graphically whenever a stimulus was delivered. A total of 43 maps from 36 patients were analyzed. The authors found variations in the organization of M1 (primary motor cortex) in seven patients (19.4%). Four patients (11.1%) presented mosaicism (overlapping of functional areas), two (5.6%) presented variability (inverted disposition of M1 functional areas), and one (2.8%) had both. The results of this study challenge the notion of orderly topographic relationships between the human sensorimotor functions and their representation in the primary motor cortex. These results confirm those of other studies with animals and humans using novel imaging techniques, suggesting that the motor homunculus may not always be considered a definite and absolute representation of M1.

Glioblastoma (GBM) is a very aggressive tumor that has not had substantial therapeutic improvement since the introduction of temozolomide (TMZ) in combination with radiotherapy. Combining TMZ with other chemotherapeutic agents is a strategy that could be further explored for GBM. To search for molecular predictors of TMZ resistance, the TCGA (The Cancer Genome Atlas) database was utilized to assess the impact of specific genes on TMZ response. Patients whose tumors expressed low levels of FGFR3 and AKT2 responded poorly to TMZ. Combination treatment of vinblastine (VBL) plus mebendazole (MBZ) with TMZ was more effective in reducing cell number in most cultures when compared to TMZ alone, especially in cells with low expression levels of FGFR3 and AKT2. Cell cycle distribution and nuclear morphometric analysis indicated that the triple combination of TMZ, VBL and MBZ (TVM) was able to induce polyploidy and senescence, in addition to increasing the Notch3 RNA level in patient-derived gliomas. Thus, this set of data suggests that the triple combination of TMZ, VBL and MBZ may be a considerable therapeutic alternative for the TMZ-tolerant gliomas that harbor low expression of FGFR3/AKT2.

-Hippocampal sclerosis (HS) is the commonest pathology in epileptic patients undergoing temporal lobe epilepsy surgery. Beside, there are an increased density of corpora amylacea (CA) founded in 6 to 63% of those cases. Objective: verify the presence of CA and the clinical correlates of their occurrence in a consective series of patients undergoing temporal surgery with diagnosis of HS. Method: We reviewed 72 hippocampus specimens from January 1997 to July 2000. Student's t test for independent, samples, ANOVA and Tukey test were performed for statistical analysis. Results: CA were found in 35 patients (49%), whose mean epilepsy duration (28.7 years) was significantly longer than that group of patients without CA (19.5 years, p= 0.001). Besides, when CA were found, duration was also significantly correlated with distribution within hippocampus: 28.7 years with diffuse distribution of CA, 15.4 with exclusively subpial and 17.4 years with distribution subpial plus perivascular (p= 0.001). Conclusion: Our findings corroborate the presence of CA in patients with HS and suggest that a longer duration of epilepsy correlate with a more distribution of CA in hippocampus.KEY WORDS: hippocampal sclerosis, corpora amylacea, temporal lobe epilepsy. Corpos amiláceos associados à esclerose hipocampal na epilepsia do lobo temporalRESUMO -A esclerose hipocampal (EH) é a patologia mais observada em lobectomias temporais de pacientes com epilepsia intratável. Além dos achados histopatológicos clássicos existe a presença de corpos amiláceos (CA) em até 60% dos hipocampos ressecados. Objetivo: Verificar a presença de corpos amiláceos em hipocampos de pacientes submetidos a cirurgia para tratamento de epilepsia e verificar se havia diferenças clínicas entre pacientes que apresentavam CA e aqueles em que eles não foram encontrados. Método: Foram revisados 80 hipocampos ressecados entre janeiro de 1997 a dezembro de 2000 e, posteriormente, os prontuários de 72 dos pacientes. Foi realizado o teste t de Student para amostras independentes, ANOVA e posteriormente o teste de Tukey. Resultados: Dos setenta e dois pacientes estudados, 40 eram homens (55,6%) e trinta e dois mulheres (44,4%). Trinta e cinco (48,6%) apresentavam CA e em trinta e sete (51,4%) não foram encontrados. Houve diferença estatisticamente significativa entre a média de tempo de evolução da epilepsia: o grupo com CA apresentava tempo maior de evolução (28,97 anos) em relação ao grupo que não apresentava CA (19,54 anos), com p= 0,001. Também observou-se diferença significativa quando foi comparada a localização de corpos amiláceos com o tempo de evolução da epilepsia: os pacientes com CA presentes difusamente no hipocampo apresentavam maior tempo de epilepsia (p= 0,001). Conclusão: Observamos que o nosso estudo confirma a presença de corpos amiláceos em hipocampos de pacientes com EH e sugerimos que quanto maior o período de epilepsia maior é a distribuição de CA no hipocampo PALAVRAS-CHAVE: esclerose hipocampal, corpora amylacea, epilepsia de lobo temporal.