Background: In several epilepsy etiologies, the macroscopic appearance of the epileptogenic tissue is identical to the normal, which makes it hard to balance between how much cytoreduction or disconnection and brain tissue preservation must be done. A strategy to tackle this situation is by evaluating brain metabolism during surgery using infrared thermography mapping (IrTM). Methods: In 12 epilepsy surgery cases that involved the temporal lobe, we correlated the IrTM, electrocorticography, and neuropathology results. Results: Irritative zones (IZ) had a lower temperature in comparison to the surrounding cortex with normal electric activity (difference in temperature (ΔT) from 1.2 to 7.1, mean 3.40°C standard deviation ± 1.61). The coldest zones correlated exactly with IZ in 9/10 cortical dysplasia (CD) cases. In case 3, the coldest area was at 1 cm away from the IZ. In 10/10 dysplasia cases (cases 1–4, 6–11), there was a radial heating pattern originating from the coldest cortical point. In 2/2 neoplasia cases, the temporal lobe cortical temperature was more homogeneous than in the CD cases, with no radial heating pattern, and there were no IZ detected. In case 8, we found the coldest IrTM recording in the hippocampus, which correlated to the maximal irritative activity recorded by strip electrodes. The ΔT is inversely proportional to epilepsy chronicity. Conclusion: IrTM could be useful in detecting hypothermic IZ in CD cases. As the ΔT is inversely proportional to epilepsy chronicity, this variable could affect the metabolic thermic patterns of the human brain.

Background: Safety and efficacy are irrebuttable goals in neurosurgery. Methods: We performed a subcortical cavernoma resection in an eloquent area, where we recorded and compared the maximal and minimal brain temperature measured by an infrared thermographic camera and thermometer with the neuronavigation (NN) target location and real anatomical lesion location. Results: The hottest cortical point correlated to the subcortical cavernoma location. The NN located the target at 10 mm away from the hottest point. Conclusion: More studies are needed to better understand the thermic radiation of the brain in health and in disease, but we believe that evaluating brain temperature, it could be possible to improve accuracy in neurosurgery and generate more knowledge about brain metabolism in vivo.

Background: During epilepsy surgery, the gold standard to identify irritative zones (IZ) is electrocorticography (ECoG); however, new techniques are being developed to detect IZ in epilepsy surgery and in neurosurgery in general, such as infrared thermography mapping (ITM), and the use of thermosensitive/thermochromic materials. Methods: In a cohort study of consecutive patients with focal drug-resistant epilepsy of the temporal lobe treated with surgery, we evaluated possible adverse effects to the transient placement of a thermochromic/thermosensitive silicone (TTS) on the cerebral cortex and their postoperative evolution. Furthermore, we compared the precision of TTS for detecting cortical IZ against the gold standard ECoG and with ITM, as proof of concept. Results: We included 10 consecutive patients, 6 women (60%) and 4 men (40%). Age ranges from 15 to 56 years, mean 33.2 years. All were treated with unilateral temporal functional lobectomy. The mean hospital stay was 4 days. There were no immediate or late complications associated with the use of any of the modalities described. In the 10 patients, we obtained consistency in locating the IZ with ECoG, ITM, and the TTS. Conclusion: The TTS demonstrated biosecurity in this series. The accuracy of the TTS to locate IZ was similar to that of ECoG and ITM in this study. More extensive studies are required to determine its sensitivity and specificity.

La epilepsia es una de las afecciones neurológicas más frecuentes en la población pediátrica y adulta; la prevalencia en Latinoamérica es una de las más altas del mundo, 17.8 por 1,000 habitantes. La epilepsia farmacorresistente se asocia a menor calidad de vida, mayor número de medicamentos, mayor impacto económico y mayor morbimortalidad. La cirugía como tratamiento de epilepsia farmacorresistente ha demostrado ser superior en casos adecuadamente seleccionados a los fármacos en el control de las crisis con un menor número de efectos adversos y mejoría significativa en la calidad de vida. Objetivo: Presentar los resultados del grupo de trabajo de la Clínica de Epilepsia del Centro Médico ABC. Material y métodos: Hace tres años se realizaron cambios operativos en el equipo multidisciplinario de la clínica. Y presentamos un estudio descriptivo-analítico, retrospectivo de 23 pacientes manejados quirúrgicamente, en el periodo comprendido entre febrero de 2017 a diciembre de 2019. Resultados: Veintitrés pacientes es un número similar

La importancia que tiene el manejo de los pacientes con epilepsia obliga a conocer cada uno de los principios de la bioética. El objetivo principal es analizar la enfermedad a la luz de estos cuatro principios: beneficencia, no maleficencia, autonomía y justicia, y establecerlos como parte fundamental en el manejo del paciente epiléptico y, particularmente, de aquellos que sufren epilepsia refractaria y que pudiesen ser sometidos a cirugía de epilepsia, así como enfatizar en la importancia de su conocimiento, lo que permitirá una atención de mayor calidad y que esté a favor de estos pacientes.