No description available.

No description available.

No description available.

Psychosis has intrigued and confused neuroscientists for many years, yet there seems to be no clear explanation for why and how it occurs. There is also not just one disorder of psychosis, such as schizophrenia, some epileptic patients experience the same symptoms.That is called schizophrenia-like psychosis of epilepsy (SLPE), which is similar to primary schizophrenia but also very different. This systematic review will explain SLPE as a disorder in itself, compare it to other psychotic disorders, provide research findings and conclude what we can learn from better understanding psychosis in general.

A epilepsia do lobo temporal (ELT), além de ser o tipo de epilepsia focal mais comum, também é a que tem maior refratariedade à farmacoterapia, correspondendo à 30% dos casos. Se não tratada pode levar à piora da qualidade de vida, déficits cognitivos e risco de morte (ENGEL, 1998). O tratamento padrão para ELT farmacorresistente é a remoção cirúrgica das estruturas envolvidas (ENGEL, 1996), com taxas de cura que podem chegar a 80% (ENGEL, 2001a). Os benefícios da cirurgia são: diminuição da frequência e severidade das crises, diminuição da mortalidade, melhores índices de qualidade de vida. Recomenda-se que pacientes com ELT farmacorresistentes sejam referenciados a um centro de cirurgia de epilepsia para avaliar a possibilidade de intervenção cirúrgica (ENGEL et al., 2003). Em nosso estudo, avaliamos 621 pacientes com epilepsia mesial do lobo temporal, com confirmação histopatológica de esclerose hipocampal, que realizaram ressecção do lobo temporal no Centro de Cirurgia de Epilepsia de Ribeirão Preto (CIREP) entre os anos de 1994 até 2011. Avaliamos os principais fatores preditores que influenciam no sucesso cirúrgico relacionados ao controle das crises epilépticas, através de um estudo longitudinal e retrospectivo. Realizamos o acompanhamento clínico desses pacientes por até 23 anos, com média de 11,6 anos (± 5,3) e encontramos que 73,6% dos pacientes ficaram livres de crises com alteração da consciência (Engel I) e 84,7% tiveram um bom prognóstico cirúrgico (Engel I + II). Esse prognóstico foi relativamente mantido ao longo do tempo em 65 % dos pacientes, após 20 a 23 anos da cirurgia. Encontramos que a história de crise febril foi um fator de bom prognóstico, enquanto que a aura dismnésica e olfatória foram fatores de mau prognóstico. Em relação ao tipo de técnica cirúrgica, a lobectomia temporal anteromesial (com ressecção do polo temporal), obteve significativo melhor prognóstico (78,6% Engel I) em relação à cirurgia que poupa o polo temporal (67,2% Engel I), p=0,002*, sugerindo que as conexões neurais envolvidas na zona epileptogênica podem estar além das estruturas mesiais. Concluímos que a cirurgia para epilepsia é um procedimento seguro, com baixos índices de complicações pós-operatórias e bons resultados em longo prazo. / Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy and the one that has greater refractoriness to pharmacotherapy, corresponding to 30% of the cases. If untreated, it can lead to worsening of quality of life, cognitive deficits and risk of death (ENGEL, 1998). The standard treatment for medically refractory TLE is the surgical removal of the structures involved (ENGEL, 1996), with good outcomes rates that can reach to 80% (ENGEL, 2001a). The benefits of the surgery are: decrease in frequency and severity of seizures, decrease in mortality, better indexes of quality of life and higher rates of return to school and work. It is recommended that medically refractory TLE patients should be referred to an epilepsy surgery center to evaluate the possibility of surgical intervention (ENGEL et al., 2003). In our study, we evaluated 621 patients with mesial temporal lobe epilepsy secondary to hippocampal sclerosis (MTLE-HS), who underwent a temporal lobectomy at our epilepsy surgery center (CIREP) between the years 1994 to 2011. We evaluated the main predictive factors that influence the surgical outcome, through a longitudinal and retrospective study. We performed the clinical follow-up for up to 23 years and the mean follow-up was 11,6 years (± 5,3). We found that 73,6 % of the patients were free of disabling seizures and 84,7% had a good surgical outcome (Engel I + II). This prognosis was relatively maintained over the time in 65% of patients after 20 to 23 years of surgery. We found that history of febrile seizure was a good prognostic factor, whereas the dysmnesic and olfactory aura were factors of poor outcome. Regarding the type of surgical technique, the anteromesial temporal lobe resection obtained significant better outcomes (78,6% Engel I) in relation to the surgery who preserve the temporal pole (67,2% Engel I), p value = 0,002*, suggesting that the neuronal networks involved in the epileptogenic zone may be beyond mesial structures. We conclude that epilepsy surgery is a safe procedure, with low rates of postoperative complications and good long-term results.

Alta prevalência, farmacorresistência e bom prognóstico cirúrgico são algumas das características clínicas que tornam a epilepsia do lobo temporal mesial com esclerose hipocampal (ELTM-EH) uma das mais importantes formas de epilepsia. Ela é o modelo da epilepsia cirurgicamente curável. Infelizmente, cerca de 10% dos pacientes evoluem com resultado cirúrgico insatisfatório. A ELTM-EH está associada a alterações amplas do perfil de expressão dos microRNAs (miRNAs) do hipocampo. Recentemente, constatou-se a existência de miRNAs estáveis no sangue periférico e em outros fluidos corporais, comprovadamente aplicáveis como biomarcadores, cuja abrangência vai do diagnóstico à resposta terapêutica. Tendo isso em vista, a pesquisa partiu do seguinte questionamento: é possível a identificação, no sangue periférico, de assinaturas moleculares por miRNAs que predigam o resultado do tratamento cirúrgico da ELTM-EH? Por meio de técnicas de biologia molecular, avaliaram-se amostras de sangue e hipocampo de pacientes submetidos à lobectomia temporal anterior em consequência de ELTMEH farmacorresistente. As amostras eram representativas de indivíduos com resultado cirúrgico favorável (Engel IA) e desfavorável (Engel III e IV). Com a técnica de microarray obteve-se o perfil de expressão de miRNAs das amostras triadas e chegou-se a um conjunto de seis miRNAs candidatos a biomarcadores de prognóstico cirúrgico: miR-92b-3p; miR-1238-3p; miR-1181; miR-636; miR- 1229-3p e miR-486-5p. Em seguida, com a técnica de PCR em tempo real, quantificou-se a expressão destes seis miRNAs e, a partir da otimização de um ponto de corte na escala de expressão, cada miRNA circulante foi apreciado como preditor de resultado cirúrgico. Assim, constatou-se hiperexpressão sanguínea dos seis miRNAs, sem distinção estatística entre os grupos Engel IA e Engel III-IV, hiperexpressão hipocampal do miR-486-5p no grupo Engel IA e hipoexpressão hipocampal do miR-636 nos grupos Engel IA e Engel III-IV. Na análise dos miRNAs circulantes como preditores de sucesso cirúrgico, o miR- 1238-3p exibiu uma sensibilidade de 40,00%, especificidade de 92,86% e acurácia de 65,52%. O conjunto miR-1238/miR1181 mostrou sensibilidade de 46,67%, especificidade de 85,71% e acurácia de 65,52%. O único miRNA circulante sondado como preditor de insucesso cirúrgico, o miR-636, revelou sensibilidade de 21,43%, especificidade de 93,33% e acurácia de 58,62% / A high prevalence, drug resistance and good surgical prognosis are some of the clinical characteristics that cause mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) to be one of the most important forms of epilepsy. This condition is the model of surgically curable epilepsy, although unfortunately about 10% of the patients exhibit an unsatisfactory surgical outcome. MTLE-HS is associated with extensive changes in the expression profile of hippocampal microRNAs (miRNAs). It has been recently observed that stable miRNAs exist in peripheral blood and in other body fluids which have been proved to be applicable as biomarkers from diagnosis to therapeutic response. On this basis, the present investigation was based on the following question: is it possible to identify molecular signatures by peripheral blood miRNAS that predict the outcome of surgical treatment of MTLE-HS? Molecular biology techniques were used to evaluate blood and hippocampal samples of patients submitted to anterior temporal lobectomy as a consequence of drug-resistant MTLE-HS. The samples were representative of patients with a favorable (Engel IA) and unfavorable (Engel III and IV) surgical outcome. The microarray technique was used to obtain the expression profile of miRNAs in the samples, with a set of six miRNAs being reached as candidate biomarkers for surgical prognosis: miR-92b-3p, miR-1238- 3p, miR-1181, miR-636, miR-1229-3p, and miR-486-5p. Next, real-time PCR was used to quantitate the expression of these six miRNAs and, based on the optimization of a cut-off point on the expression scale, each circulating miRNA was evaluated as surgical outcome predictor. We observed blood hyperexpression of the six miRNAs with no significant difference between the Engel IA and Engel IIIIV groups, hippocampal hyperexpression of miR-486-5p in the Engel IA group, and hippocampal hypoexpression of miR-636 in the Engel IA and Engel III-IV groups. Analysis of circulating miRNAs as predictors of surgical success revealed that miR-1238-3p exhibited 40.00% sensitivity, 92.86% specificity and 65.52% accuracy. The miR-1238/miR1181 set showed 46.67% sensitivity, 85.71% specificity and 65.52% accuracy. The only circulating miRNA evaluated as a predictor of surgical failure, miR-636, showed 21.43% sensitiviy, 93.33% specificity, and 58.62% accuracy

Este estudo teve como objetivo avaliar a expressão hipocampal de proteínas e de RNAm das Cx43 e Cx36 no modelo de epilepsia do lobo temporal (ELT) induzido por pilocarpina. Além disso, os efeitos do bloqueador de canais de junções comunicantes (CJC), carbenoxolona (CBX), foram avaliados por eletrofisiologia durante o período de status epilepticus. Os dados referentes à Cx43 demonstraram redução dos níveis proteicos no período latente (p<0,05) e aumento no período crônico do modelo (p<0,01). Os níveis de RNAm de Cx43 não sofreram alterações. Tanto os níveis proteicos quanto os de RNAm de Cx36 não se alteraram. Os dados eletrofisiológicos mostraram redução da potência na banda de frequência entre 15 e 30 Hz no eletrocortigrama, além de redução da amplitude relativa dos potenciais epileptiformes. Foi observado ainda que o grupo tratado com CBX passou a apresentar períodos flat antecipadamente. Os dados deste estudo sugerem um importante papel dos CJC na ELT induzida por pilocarpina, contribuindo para o conhecimento da regulação destes canais na epilepsia. / In this study, the hippocampal protein and mRNA levels of Cx43 and Cx36 were investigated in the pilocarpine model of temporal lobe epilepsy (TLE). In addition, the effects of a gap junction (GJ) blocker (carbenoxolone-CBX) on pilocarpine-induced status epilepticus (SE) were also evaluated by electrophysiological recordings. Our results on Cx43 showed reduction of protein levels in the latent period (p<0.05) and increase in the chronic period of the model (p<0.01), whereas no changes were observed in the mRNA levels. Both protein and mRNA levels of Cx36 showed no changes. The electrophysiological recordings indicated that CBX promoted a marked reduction of power in the 15-30 Hz electrocorticographic frequency. Decrease in the amplitude of the epileptiform potentials was also seen, in addition to anticipation of occurrence of flat periods in the group treated with CBX. Data obtained from this study suggest an important role for GJ channels in the pilocarpine-induced TLE, contributing to a greater understanding of the regulation of these channels in the epilepsy.

1. Interaktion zwischen entorhinalem Kortex und Hippokampus Lernen und Gedächtnis sind auf das engste mit dem Hippokampus und dem entorhinalen Kortex (EC) verbunden. Allerdings sind diese Hirnstrukturen auch an einer der häufigsten und medikamentös oftmals nur schwer therapierbaren fokalen Epilepsien beteiligt: der mesialen Temporallappenepilepsie (TLE). Der EC scheint eine wesentliche Bedeutung in der Generierung extrahippokampaler Temporallappenanfälle zu besitzen. Unsere bisherigen Untersuchungen zur Interaktion zwischen dem EC und dem Hippokampus haben gezeigt, daß unter physiologischen Bedingungen die Area dentata eine Filterfunktion übernimmt und die Übertragung epileptiformer Aktivität vom EC zum Hippokampus unterbindet. Im chronisch epileptischen Tier (Kindling-Modell) kommt es allerdings zu einer Aufhebung dieser Filterfunktion und somit zu einer ungehinderten Ausbreitung epileptiformer Aktivität in den Hippokampus. Da der glutamaterge NMDA-Rezeptor eine zentrale Rolle in der Induktion nutzungsabhängiger Plastizität spielt, ist er von wesentlicher Bedeutung in der Epileptogenese. Untersuchungen an Körnerzellen der Area dentata zeigten wenige Stunden nach dem letzten epileptischen Anfall eine Zunahme der über NMDA-Rezeptoren vermittelten Ströme. Diese führte zu einer Faszilitierung hochfrequenter reizevozierter Potentiale. Dieser Befund zeigt, daß im epileptischen Gewebe hochfrequente Entladungen die Area dentata überwinden können und in den Hippokampus weitergeleitet werden. Vier Wochen nach dem letzten Anfallsereignis waren die beschriebenen Veränderungen allerdings nicht mehr nachweisbar. Diese kurzzeitig veränderte synaptische Transmission der NMDA-Rezeptorkanäle scheint demzufolge eher für die Epileptogenese als für die Ictogenese verantwortlich zu sein. Die Bedeutung der Kainat-Rezeptoren im chronisch epileptischen Gewebe ist aufgrund der bis vor wenigen Jahren fehlenden selektiven Agonisten und Antagonisten kaum untersucht worden. Wir haben gezeigt, daß in der Area dentata des chronisch epileptischen Tieres (Kindling-Modell) die Aktivierung von präsynaptischen Kainat-Rezeptoren inhibitorischer Interneurone sowohl die spontane als auch die reizevozierte GABA-Freisetzung reduziert. Über diesen Mechanismus scheint der während eines epileptischen Anfalls vermehrt freigesetzte exzitatorische Neurotransmitter Glutamat die GABAerge Inhibition zu vermindern und somit die Erregbarkeit der Area dentata zu steigern. 2. Die Rolle des Subikulums in der Temporallappenepilepsie Eine wesentliche Aufgabe des Subikulums ist es, hippokampale Informationen zu verarbeiten und in verschiedene kortikale und subkortikale Hirnregionen weiterzuleiten. Zudem scheint es von besonderer Bedeutung für die Generierung und Ausbreitung hippokampaler Anfälle zu sein. Gestützt wird diese Annahme durch folgende Befunde: Zunächst besitzt das Subikulum Netzwerkeigenschaften, die es ihm im in vitro Epilepsiemodell ermöglichen, spontane epileptiforme Aktivität zu generieren. Darüber hinaus verfügt es über einen hohen Anteil sogenannter burst-spiking Zellen. Deren intrinsische Eigenschaften tragen erheblich zu dem epileptogenen Verhalten des Subikulums bei. Weiterhin erhalten subikuläre Pyramidenzellen exzitatorische Eingänge sowohl aus der Area CA1 als auch aus dem EC, welche bereits bei Ruhemembranpotential aktivierbare NMDA-Rezeptorströme zeigen. Schließlich zeigen burst-spiking Zellen im Vergleich zu regular-spiking Zellen eine ausgeprägte über NMDA-Rezeptoren vermittelte synaptische Plastizität (Langzeit-Potenzierung; LTP). Untersuchungen am chronisch epileptischen Tier (Kindling-Modell) ergaben einen unverändert hohen Anteil an burst-spiking Zellen im Subikulum. Wenige Stunden nach dem letzten epileptischen Anfall fällt bei diesen Neuronen eine fehlende, durch Aktionspotentiale induzierte Nachhyperpolarisation auf. Diese supprimierte intrinsische Hemmung ist jedoch 28 Tage nach dem letzten epileptischen Anfall nicht mehr nachzuweisen und spielt demzufolge insbesondere in der Genese, weniger im chronischen Verlauf der Erkrankung eine Rolle. Neben den exzitatorischen und inhibitorischen Neurotransmittern Glutamat und GABA bestimmen auch körpereigene Amine wie Serotonin und Dopamin über subkortikale Afferenzen das funktionelle Gleichgewicht aus Erregung und Hemmung wesentlich mit. Da die TLE nicht selten mit neurologischen und psychiatrischen Erkrankungen einhergeht, die mit in das Dopamin- und Serotoninsystem eingreifenden Pharmaka therapiert werden, haben wir uns in einigen Arbeiten mit deren modulatorischen Wirkungen auf die Membraneigenschaften und die synaptische Transmission befaßt. Die Wirkungen von Dopamin auf die Neurotransmission sind vielfältig, abhängig von den beteiligten Rezeptoren in der entsprechenden Hirnregion. Das Subikulum, das eine ausgeprägte mesenzephale, dopaminerge Projektion vom ventralen Tegmentum erhält, expremiert sowohl D1- als auch D2-Rezeptoren. Wir konnten zeigen, daß Dopamin primär die glutamaterge synaptische Transmission über einen präsynaptisch lokalisierten D1-Dopaminrezeptor unterdrückt und sekundär über die verminderte Erregung inhibitorischer Interneurone die polysynaptische GABAerge Hemmung reduziert. / 1. Interaction between the entorhinal cortex and the hippocampus The hippocampus and the entorhinal cortex are crucially involved in the acquisition, consolidation and retrieval of long-term memory traces. However, both structures play a critical role in pharmacologically intractable temporal lobe epilepsy. The entorhinal cortex provides the main input to the hippocampus. We have shown that kindling facilitates the propagation of epileptiform activity through the dentate gyrus. Our data are consistent with the normal function of the dentate gyrus as a filter limiting the spread of epileptiform activity within the entorhinal-hippocampal complex. This gating mechanism breaks down after chronic epilepsy induced by kindling. In the mammalian brain, the NMDA subclass of glutamate receptors plays a central role in the induction of several forms of use-dependent plasticity. However, synaptic plasticity can potentially underlie pathological situations, notably in animal and human forms of epilepsy. The enhanced excitability of the kindled dentate gyrus several hours after the last seizure, as well as the breakdown of its gating function, appear to result from transiently enhanced NMDA receptor activation that provides significantly slower EPSC kinetics than those observed in control slices and in slices from kindled animals with a four weeks seizure-free interval. Therefore, NMDA receptors seem to play a critical role in the acute throughput of seizure activity and in the induction of the kindled state but not in the persistence of enhanced seizure susceptibility. The functional involvement of kainate receptors in epileptogenesis gets more and more elucidated. We found that in chronic epileptic rats (kindling-model), activation of presynaptic kainate receptors of inhibitory interneurons depresses spontaneous and stimulus-induced GABA release. The kindling-induced sensitivity of GABA release to kainate receptor activation may produce a use-dependent hyperexcitability in the epileptic dentate gyrus facilitating the spread of limbic seizures through the entorhinal-hippocampal complex in temporal lobe epilepsy. 2. The role of the subiculum in temporal lobe epilepsy The subiculum controls most of the entorhinal-hippocampal output. It receives strong excitatory input from area CA1 and the entorhinal cortex and relays information to a variety of distant cortical and subcortical structures. The subiculum seems to be crucially involved in the generation and propagation of hippocampal seizures. The seizure susceptibility of the subiculum relies (a) on a high fraction of burst-firing principle cells that a capable to undergo synaptic plasticity and (b) on an epilepsy-prone network to generate spontaneous seizures. In both, control and kindled preparations the subiculum contains an extensive sub-population of bursting cells expressing amplifying membrane characteristics. Subicular cells showed a transient depression of the fast and slow afterhyperpolarization in the course of kindling that may contribute to the induction but not permanence of the kindled state. Apart from the excitatory and inhibitory neurotransmission physiological amines like 5-HT and dopamine (DA) may offset the frail balance between excitation and inhibition in the hippocampus. As temporal lobe epilepsy is often associated with diseases that are treated with drugs affecting the 5-HT and DA system, we investigated the effect of these transmitters on intrinsic and synaptic properties of subicular principle cells. The subiculum receives a dense mesencepahalic dopaminergic projection from the ventral tegmental area and expresses high levels of D1- and D2-like DA receptors. Our results indicate that DA strongly suppresses glutamatergic hippocampal and entorhinal neurotransmission onto subicuar neurons by activation of presynaptic D1-like DA receptors. In addition, DA decreases polysynaptic inhibition by attenuating the glutamatergic drive onto subicular interneurons.

Os objetivos deste estudo foram investigar a presença e gravidade de disfunção mnéstica e executiva em crianças com epilepsia do lobo temporal; verificar a influência das variáveis clínicas da epilepsia e o impacto da disfunção executiva sobre a memória. Para tal, comparou-se o desempenho de 32 crianças com epilepsia do lobo temporal e 21 crianças saudáveis com paradigmas de memória, funções atencionais e executivas. Pacientes tiveram pior desempenho do que os controles, em atividades de atenção, memória e funções executivas. Observou-se disfunção mnéstica e executiva grave em 56,25% e 71,88% dos pacientes, respectivamente. A presença de atrofia hipocampal, idade de início precoce, duração e politerapia influenciaram negativamente o desempenho executivo e mnéstico. / The present study aimed to investigate the presence and severity of memory and executive dysfunction in children with temporal lobe epilepsy; evaluate the influence of epilepsy clinical variables and the impact of executive dysfunction in memory. For this purpose, performance on attentional, executive and memory function tests of 32 children with temporal lobe epilepsy were compared to 21 healthy children. Patients had a worse performance than controls in tasks of attention, memory and executive functions. Severe memory and executive dysfunction were demonstrated in 56.25% and 71.88% of patients, respectively. The presence of hippocampus atrophy, early seizure onset, duration, and politherapy negatively influenced executive and mnestic performance.

Resumo ARAÚJO, D Contribuição das medidas volumétricas das estruturas temporais mesiais e neocorticais ao tratamento cirúrgico das epilepsias do lobo temporal. 2003. 120 p. Tese de doutorado. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. A epilepsia do lobo temporal é a forma mais comum de epilepsia focal sintomática e a esclerose mesial temporal a sua causa mais freqüente. A volumetria por ressonância magnética pode ser útil na investigação da epileptogênese na epilepsia temporal, bem como na lateralização das alterações hipocampais em pacientes candidatos à cirurgia, como já relatado em diversas séries. Realizamos a volumetria das estruturas do lobo temporal em 69 pacientes com suspeita clínica de epilepsia mesial temporal, avaliados consecutivamente no Centro de Cirurgia de Epilepsia do Hospital de Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. As estruturas medidas foram o pólo temporal, o lobo temporal, a amígdala, o hipocampo e o giro parahipocampal. Estas medidas foram comparadas às variáveis clínicas e neurofisiológicas dos pacientes, buscando fatores de bom prognóstico para o tratamento cirúrgico, bem como de variáveis clínicas que permitissem a correlação entre comprometimento estrutural e funcional. Nossos resultados mostraram uma importância central do hipocampo na epileptogênses temporal, embora não esteja elucidado se este papel é primário e independente ou secundário a alterações conjuntas com as outras estruturas. Todos os nossos casos apresentaram comprometimento hipocampal absoluto, relativo ou de assimetria. O pólo temporal foi a estrutura neocortical mais comprometida e houve uma correlação entre sua perda volumétrica e o tempo de epilepsia, sugerindo um dano progressivo. Seu comprometimento correlacionou-se ainda a déficits cognitivos, com menor quociente geral de inteligência. A amígdala e o giro parahipocampal estiveram relacionados à presença de crises parciais simples evoluindo para complexas, correlacionando dados clínicos e estruturais. Palavras chave: Epilepsia temporal; Volumetria; Tratamento cirúrgico. / Temporal lobe epilepsy is the most commom form of focal epilepsy. Mesial temporal sclerosis is the usual etiology. Magnetic resonance volumetry may be a useful research tool, and may be used to lateralize hippocampal changes in surgical candidates, according to several reports. We performed temporal lobe volumetry in 69 consecutive patients of the Epilepsy Surgery Center of the Hospital of Ribeirão Preto of the University of São Paulo. We measured temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus. The volumes were compared to clinical and neurophysiologic variables, as an attempt to find variables that could predict surgical outcome. We also sought correlations between structural (volume), and functional (epileptogenesis and clinical features) changes. Our data suggest that the hippocampus has a very important role in temporal lobe epilepsy. The question as to wether this role is primary or secundary to changes in other structures remains to be solved. In all of our cases the hippocampal volume was altered, either as absolute or relative volumes, or as asymmetry index. The only variable that correlated with postsurgical outcome was the hippocampal asymmetry index, being greater in the group with best postsurgical evolution. The most involved neocortical structure was the temporal pole. There was a correlation between temporal pole and amygdala volume and duration of epilepsy. This suggests a progressive damabe, added to the initial precipitating injury (IPI). There was also significant difference between mesial structures contralateral to the surgery side and those of the controls. These data shows more widespread and bilateral damage, even in patients with unilateral epilepsy by EEG and clinical criteria.