SUMMARY -Nodular intracranial calcifications (NIC) are frequent findings in CT scans of epileptic patients in countries where granulomatous central nervous disease such as neurocysticercosis is endemic. In 34 consecutive epileptic patients with NIC submitted teo EEG, CT and CSF analysis, the correlation between the electroclinical localization of the focus and the topography of the NIC was studied. Twenty-nine patients had partial (Group I) and 5 had primarily generalized seizures (Group II). Twenty group I and 1 group II patients showed abnormal EEGs. CSF abnormalities consisted of increased protein content (n=3) and positive Weinberg's reaction (n=2). In 2 cases, viable neurocysticercotic vesicles were seen. Twenty-one patients had single NICs. No correlation could be stablished in group II patients. Within group 1,15 patients had a positive and 14 a negative correlation. Sixty-six percent of the patients with single NICs had negative correlations. These findings strongly suggest that the calcifications themselves are not the epileptogenic lesions in at least 50% of the studied cases.KEY WORDS: epilepsy, calcifications, CT, EEG. Congruência da topografia de calcificações intracranianas e focos epilépticosRESUMO -Calcificações nodulares intracranianas (CIN) representam achado frequente em pacientes epilépticos de países onde doenças granulomatosas do SNC (p.e.: neurocisticercose) são endêmicas. Trinta e quatro pacientes epilépticos consecutivos com CINs foram submetidos a exame de EEG, TC e LCR. A correlação entre a topografia do foco e das calcificações foi estudada em cada caso. Vinte e nove pacientes tinham crises parciais (Grupo I) e 5 crises primariamente generalizadas (Grupo II). Vinte pacientes do Grupo I e 1 do grupo II tinham EEGs anormais. Hiperproteinorraquia (n=3) e reação de Weinberg positiva foram as alterações encontradas no LCR. Em 2 casos, vesículas neurocisticercóticas íntegras foram vistas na tomografia. Vinte e um pacientes possuíam CIN única. Não foi possível realizar a correlação clínica nos pacientes do Grupo II. No grupo I, 15 pacientes apresentaram correlação positiva e 14 negativa. Sessenta e quatro por cento dos pacientes com calcificação única apresentaram correlação negativa. Estes achados sugerem fortemente que as calcificações não são epileptogênicas em ao menos 50% dos casos estudados.

26 patients with temporal lobe epilepsy clinically documented by several abnormal interictal surface EEGs with typical unitemporal epileptiform activity and a normal CT scan were studied. Interictal 99mTC HMPAO brain SPECT and MRI were performed in all subjects. Abnormalities were shown in 61.5% of MRI (n = 16) and 65.4% of SPECT (n = 17). Hippocampal atrophy associated to a high signal on T2-weighted MRI slices suggesting mesial temporal sclerosis was the main finding (n = 12; 75% of abnormal MRI). MRI correlated well to surface EEG in 50% (n = 13). There was also a good correlation between MRI and SPECT in 30.7% (n = 8). SPECT and EEG were in agreement in 57.7% (n = 15). MRI, SPECT and EEG were congruent in 26.9% (n = 7). These results support the usefulness of interictal brain SPECT and MRI in detecting lateralized abnormalities in temporal lobe epilepsy. On the other hand, in two cases, interictal SPECT correlated poorly with surface EEG. This functional method should not be used isolately in the detection of temporal lobe foci. MRI is more useful than CT as a neuroimaging technique in temporal lobe epilepsy. It may detect small structural lesions and mesial temporal lobe sclerosis which are not easily seen with traditional CT scanning.

Lafora's disease is included among the progressive myoclonic epilepsies. Despite the fact that dementia is a constant finding in this disease only a few papers have studied the timing of mental deterioration. We have performed wide neuropsychological testing in two cases early diagnosed as Lafora disease. The initial neuropsychological testing was carried out by the time there were no complaints of mental deterioration in both cases. In the first case consecutive neuropsychological testing demonstrated the rapidly progressive dementia. All neuropsychological testings in these cases showed severe impairment of right parietal lobe functions. Higher cortical functions related to language and intellectual processes were best preserved in both cases. The functions related to constructional praxis, memory and abstract concepts and processes were severely impaired. Our data suggest that mental deterioration is an early manifestation in Lafora disease, even by the time normal social life is not yet disturbed. Dominant hemisphere cognitive functions have been less impaired than the non-dominant ones. How a diffuse illness such as Lafora disease can cause such an asymmetrical higher cortical function deficit is not yet clear.

SUMMARY -Eating epilepsy is a rare type of reflex epilepsy. A 24 years-old male with eating reflex complex partial seizures was submitted to clinical, neurological, neuroradio-¬ logical and EEG studies. Neurologic and CT examinations were normal. EEG recordings including video-EEG monotoring during meals disclosed focal abnormalities related to both temporal lobes prevailing at the left side and secondary bilateral synchrony mainly in more anterior regions. Ictal findings were similar to the interictal secondary bilateral synchrony except for its longer duration. PB, VPA and DPH monotherapies were ineffective. High dose CBZ monotherapy yielded good but uncomplete seizure control. Since a big number of precipitants could be involved, no specific physiopathological basis could be stablished. Epilepsia ao comerRESUMO -A epilepsia reflexa ao comer é forma rara de epilepsia reflexa. Um paciente de 24 anos com crises parciais complexas reflexas ao comer foi submetido a avaliações clí-nica, neurológica, neurorradiológica e eletrencefalográfica. O exame, neurológico e a tomografia de crânio foram normais. Registros de EEG, incluindo monitorização vídeo-EEG durante a refeição, mostraram presença de anormalidades focais relacionadas a ambos os lobos temporais, predominando à esquerda, e sincronia bilateral secundária, predominando em regiões anteriores. Os achados ictais são semelhantes à sincronia bilateral secundária interictal exceto por sua maior duração. Monoterapias com PR, DPH e VPA não surtiram efeito. Monoterapia com altas doses de CBZ trouxe bons resultados porém com controle incompleto das crises. Como grande número de fatores precipitantes estava potencialmente envolvido, não foi possível determinar com precisão a base fisiopatológica das crises reflexas neste oaso.The reflex epilepsies include those epileptic syndromes consisting of seizures that are triggered by specific stimuli usually a clearly recognized somatosensitive or sensory one. Eating epilepsy is an uncommon form of these 5 . Several physiopathological mechanisms involved in the genesis of these seizures have already been discussed !.2 . 4 . 6 . We present a case of eating epilepsy, its therapeutical evaluation and clinical follow-up. METHODSA 24 years-old man (PHC) presenting with atonic, tonic-clonic and complex partial seizures during meals was submitted to clinical, electroencephalographic (EEG), computerized tomography (CT) and cerebrospinal fluid (CSF) examinations and blood biochemistry. EEG studies included routine 16-channel EEG, sphenoidal electrodes recordings and video-EEG monitoring during meals.