Tonicarlo R Velasco

• PhD
• Medical Doctor at University of São Paulo

Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy and is frequently drug-resistant (DR) to antiseizure medication (ASM), corresponding to approximately one-third of the cases. When left inadequately treated, it can worsen the quality of life, cognitive deficits, and risk of death. The standard treatment for drug-resistant TLE i...

Objective Drebrins are crucial for synaptic function and dendritic spine development, remodeling, and maintenance. In temporal lobe epilepsy (TLE) patients, a significant hippocampal synaptic reorganization occurs, and synaptic reorganization has been associated with hippocampal hyperexcitability. This study aimed to evaluate, in TLE patients, the...

EEG acquired simultaneously with fMRI (EEG-fMRI) is a multimodal method that has shown promise in mapping the seizure onset zone in patients with focal epilepsy. However, there are many instances when this method is unsuccessful or not applicable, and other data driven fMRI methods may be utilized. One such method is the two-dimensional temporal cl...

Objective: Patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) have episodic memory impairment. Memory has rarely been evaluated using an ecologic measure, even though performance on these tests is more related to patients' memory complaints. We aimed to measure everyday memory of patients with TLE-HS to age- and gender-m...

Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) is one of the most common types of focal epilepsies. This is an epileptic syndrome commonly associated with treatment-resistant seizures, being also the most prevalent form of drug-resistant epilepsy which is treated surgically in most epilepsy surgery centers. Neurocysti...

Objective: Increased T2 relaxation time is often seen in temporal lobe epilepsy (TLE) with hippocampal sclerosis. Water content directly affects the effective T2 in a voxel. Our aim was to evaluate the relation between T2 values and two molecules associated with brain water homeostasis aquaporin 4 (AQP4) and chondroitin sulfate proteoglycan (CSPG)...

Epileptic patients undergoing surgery in the temporal lobe usually present decline in cognitive functions associated to affected structures. In this study, we investigate a way of quantifying the tract loss using available software and tools by the use of Diffusion Tensor Images (DTI) and tractography methods. We hope this quantifying method will b...

The absence of the adhesio interthalamica (AI; also called interthalamic adhesion or massa intermedia) and the presence of a large cavum septum pellucidum (CSP) later in life have been related to neurodevelopmental alterations and have not been systematically investigated in epilepsy to date. This study carried out a MRI evaluation of the AI and CS...

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The simultaneous acquisition of electroencephalography and functional magnetic resonance imaging (EEG-fMRI) is a multimodal technique extensively applied for mapping the human brain. However, the quality of EEG data obtained within the MRI environment is strongly affected by subject motion due to the induction of voltages in addition to artefacts c...

Background Epilepsy is one of the most prevalent neurological disorders. It remains medically intractable for about one-third of patients with focal epilepsy, for whom precise localization of the epileptogenic zone responsible for seizure initiation may be critical for successful surgery. Existing fMRI literature points to widespread network distur...

AIM: The Attenuation Correction (AC) of gamma photons poses a clinical problem in the evaluation of ictal SPECT in Frontal Lobe Epilepsy. The main issue is that mesially located seizure focus may be underestimated. This study aimed to evaluate the impact of the AC on brain SPECT images in patients with Frontal Lobe Epilepsy (FLE). MATERIALS AND MET...

Purpose: To evaluate the efficacy of surgery with neuronavigation compared to conventional neurosurgical treatment of epilepsy in terms of safety and seizure outcomes and to assess the quality of the evidence base of neuronavigation in this clinical context. Method: Systematic review using the electronic databases of Cochrane, CRD, PubMed, Embas...

Objective: To test if chronic calcificed neurocysticercosis (cNCC) and hippocampal sclerosis occur more often than by chance ipsilateral to the same brain hemisphere or brain region in mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) plus neurocysticercosis. This proof-of-concept would provide important evidence of a d...

Epilepsies are the second most common neurological disease. The pathological mechanisms of this disease are not fully unders-tood. Several studies claim that inflammation plays a significant role both in structural and physiological changes that lead to the emergence of seizures. Although in some epilepsies, such as Rasmussen’s encephalitis, the in...

Quantitative MRI evaluation of patients with TLE

Representative images of immunohistochemistries in the temporal cortex from a MTLE patient. After surgery, tissue fragments were maintained in saline solution during 1 hour (A, F, K and P), 4 hours (B, G, L and Q) and 8 hour (C, H, M and R) prior to fixation in formaline. Note that no difference can be seen regardless of waiting time prior to fixat...

Objective: Hippocampal sclerosis is a common finding in patients with temporal lobe epilepsy (TLE), and magnetic resonance imaging (MRI) studies associate the reduction of hippocampal volume with the neuron loss seen on histologic evaluation. Astrogliosis and increased levels of chondroitin sulfate, a major component of brain extracellular matrix,...

Interictal epileptiform discharges (IEDs) can produce haemodynamic responses that can be detected by electroencephalography-functional magnetic resonance imaging (EEG-fMRI) using different analysis methods such as the general linear model (GLM) of IEDs or independent component analysis (ICA). The IEDs can also be mapped by electrical source imaging...

Interictal epileptiform discharges (IEDs) can produce haemodynamic responses that can be detected by electroencephalography-functional magnetic resonance imaging (EEG-fMRI) using different analysis methods such as the general linear model (GLM) of IEDs or independent component analysis (ICA). The IEDs can also be mapped by electrical source imaging...

Objective Characterize the social profile and the need of information from patients with refractory epilepsy. Method A semi-structured questionnaire was applied to 103 patients to investigate sociodemographic aspects, pharmacotherapy and any doubts about epilepsy. Results Patients were highly dependent on having a free and accessible supply of anti...

Pacientes com epilepsia refratária focal, indicados à cirurgia, são submetidos à exames diagnósticos que tem como objetivo a localização da região epileptogênica (região cerebral responsável pelas crises epilépticas) e regiões eloquentes do cérebro. Dentre estes exames, as imagens funcionais por ressonância magnética (fMRI, sigla em inglês) e o EEG...

Sir, We read with interest the study of Coras et al. (2014) re-porting the absence of verbal anterograde episodic memory (AEM) impairment in patients with mesial temporal lobe epilepsy (MTLE) with a hippocampal sclerosis ILAE type 2 classification (HS ILAE 2, i.e. CA1 predominant cell loss). This finding may provide an anatomical basis for the dis-...

Background and purpose: Hemispheric dysplasia (HD) and hemimegalencephaly (HME) are both brain malformations with early clinical manifestation including developmental delay and intractable epilepsy. Sometimes the differentiation of these conditions is not simple. HME is an anomaly of cortical development caused by a combination of neural prolifera...

Electrical Source Imaging (ESI) is a non-invasive technique of reconstructing brain activities using EEG data. This technique has been applied to evaluate epilepsy patients being evaluated for epilepsy surgery, showing encouraging results for mapping interictal epileptiform discharges (IED). However, ESI is underused in planning epilepsy surgery. T...

Introduction The 2D temporal clustering analysis (2dTCA) is a data driven method to localize epileptic activity using fMRI data of patients with epilepsy [1] that does not use a priori information about the

http://circinterventions.ahajournals.org/content/7/1/130.long

AIM: The Attenuation Correction (AC) of gamma photons poses a clinical problem in the evaluation of ictal SPECT in Frontal Lobe Epilepsy. The main issue is that mesially located seizure focus may be underestimated. This study aimed to evaluate the impact of the AC on brain SPECT images in patients with Frontal Lobe Epilepsy (FLE). MATERIALS AND MET...

The cellular prion protein, encoded by Prnp gene, is involved in neuroprotection, neuroplasticity and neurodevelopment. The variant allele Valine at codon 129 of the Prnp was associated with decreased brain volume in healthy volunteers and schizophrenic patients. We investigate the association between the cerebellum volume and the presence of varia...

BACKGROUND: CAROTID ARTERY STENTING (CAS) HAS BECOME AN ALTERNATIVE TREATMENT FOR PATIENTS PRESENTING SYMPTOMATIC CAROTID ARTERY STENOSIS. THE IMPROVEMENT IN CLINICAL OUTCOMES WITH CAS HAS BEEN ASSOCIATED WITH THE DEVELOPMENT OF EMBOLIC PROTECTION DEVICES. THE TRIAL AIM IS TO COMPARE FLOW REVERSAL VERSUS FILTER PROTECTION DURING CAS THROUGH FEMORAL...

We report a patient who was diagnosed with opercular myoclonic-anarthric status epilepticus and found to have glutamic acid decarboxylase antibody (GADA)-associated encephalitis, a previously unrecognised aetiology of this condition. The patient was a 23-year-old female admitted for investigation of focal myoclonic status epilepticus in the right s...

Representative images of immunohistochemistries in the temporal cortex from a MTLE patient. After surgery, tissue fragments were maintained in saline solution during 1 hour (A, F, K and P), 4 hours (B, G, L and Q) and 8 hour (C, H, M and R) prior to fixation in formaline. Note that no difference can be seen regardless of waiting time prior to fixat...

Purpose: Increased T2 relaxation time (RT) is a common finding in the hippocampus of patients with drug-resistant temporal lobe epilepsy (TLE). Histopathological examination of the hippocampus often reveals astrogliosis, which is commonly associated with the increased T2 signal. Magnetic resonance imaging (MRI) studies have shown that signal altera...

Where neurocysticercosis (NCC) is endemic, chronic calcified neurocysticercosis (cNCC) can be observed in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). Considering that both disorders cause recurrent seizures or cognitive impairment, we evaluated if temporal lobectomy is cognitively safe and effective...

Patients with left mesial temporal lobe epilepsy (MTLE) have deficits in verbal memory processes, while patients with right MTLE have visuospatial memory impairment. However, atypical cognitive phenotypes among patients with MTLE may occur. In this study, we analyzed preoperative memory deficits in a cohort of 426 right-handed patients with unilate...

Purpose: To investigate the prognostic value of ictal scalp EEG patterns in drug-resistant temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) prior to undergoing temporal lobectomy. Methods: Scalp EEGs of the first seizure recorded during presurgical long-term video-EEG monitoring of 284 patients were reviewed. Patients were...

The main goal of presurgical evaluation in patients with refractory epilepsy is to define the localization and extension of epileptogenic zone (EZ), the brain area responsible for generating seizures and whose resection has the potential to reduce or abolish epileptic seizures. Therefore, there has been an effort to develop diagnostic tests that c...

In the central nervous system, zinc is released along with glutamate during neurotransmission and, in excess, can promote neuronal death. Experimental studies have shown that metallothioneins I/II (MT-I/II), which chelate free zinc, can affect seizures and reduce neuronal death after status epilepticus. Our aim was to evaluate the expression of MT-...

In the central nervous system, zinc is released along with glutamate during neurotransmission and, in excess, can promote neuronal death. Experimental studies have shown that metallothioneins I/II (MT-I/II), which chelate free zinc, can affect seizures and reduce neuronal death after status epilepticus. Our aim was to evaluate the expression of MT-...

Neurocysticercosis (NCC) and mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) are two common worldwide forms of focal epilepsy. In regions where NCC is endemic, both diseases can be observed in the same patient. There is recent and growing evidence suggesting that NCC might contribute to or even cause MTLE-HS. In this a...

EEG real data. Introduction: Electrical source imaging (ESI) is a technique that applies constraint methods to make the attempt of reconstructing the electrical sources of the brain that can be measured by scalp-EEG plausible. ESI has been receiving more attention in the last decades, when a plenty of studies appeared in literature. There are studi...

The objectives of the study were to translate and adapt the Subjective Handicap of Epilepsy (SHE) instrument to Brazilian Portuguese and to determine its psychometric properties for the evaluation of quality of life in patients with epilepsy. A sample of 448 adult patients with epilepsy with different clinical profiles (investigation, preoperative...

Temporal lobe epilepsy (TLE) is the most common form of partial epilepsy and affects 40% of the patients. Seizures arising from the mesial temporal lobe structures (i.e., amygdala and hippocampus) are common, whereas neocortical seizures are rare. In recent years, many studies aimed to identify the pattern of gene expression of neurotransmitters in...

Refractory frontal lobe epilepsy (FLE) remains one of the most challenging surgically remediable epilepsy syndromes. Nevertheless, definition of independent predictors and predictive models of postsurgical seizure outcome remains poorly explored in FLE. We retrospectively analyzed data from 70 consecutive patients with refractory FLE submitted to s...

MTS is characterized by gliosis and atrophy of the hippocampus and related limbic structures. However, the damage is not limited to those structures with atrophy and has been reported in extratemporal regions. Because volumetric studies are nonspecific, the pathophysiology of the brain damage remains to be solved. MTI is an MR imaging technique mor...

We read with interest the Review by Duncan (Imaging in the surgical treatment of epilepsy. Nat. Rev. Neurol. 6, 537–550; 2010

In This study, we used Fractional anisotropy (FA), mean diffusivity (D), parallel diffusivity (D//) and perpendicular diffusivity (D), to localize the regions where occur axonal lesion and demyelization. TBSS was applied to analyze the FA data. After, the regions with alteration were studied with D, D// and D maps. Patients exhibited widespread deg...

Patients with refractory epilepsy often have impaired quality of life (QOL) as a consequence of seizures and adverse effects of antiepileptic drugs. We assessed the impact of adverse effects on QOL and the utility of a structured instrument to help the physician manage adverse effects in patients with refractory epilepsy. Clinical characteristics,...

BACKGROUND: The development of newer diagnostic technologies has reduced the need for invasive electroencephalographic (EEG) studies in identifying the epileptogenic zone, especially in adult patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). OBJECTIVE: To evaluate ictal single photon emission computed tomography (SPEC...

The development of newer diagnostic technologies has reduced the need for invasive electroencephalographic (EEG) studies in identifying the epileptogenic zone, especially in adult patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). To evaluate ictal single photon emission computed tomography (SPECT) in the evaluation an...

Epilepsy neurosurgery is a treatment option for children with refractory epilepsy. Our aim was to determine if outcomes improved over time. Pediatric epilepsy surgery patients operated in the first 11 years (1986-1997; pre-1997) were compared with the second 11 years (1998-2008; post-1997) for differences in presurgical and postsurgical variables....

Ictal behavior coupled with SPECT findings during 28 seizures in patients with temporal lobe epilepsy (TLE) with unilateral hippocampal sclerosis (13 left; 15 right) was displayed as flowcharts from right-sided (RTLE) plus left-sided (LTLE) seizures. Ictal SPECT was classified blind to neuroethology. Behaviors were categorized as ipsilateral to the...

INTRODUCTION: In the central nervous system, neuronal communication is accomplished by structures called synapses: electrical or chemical. Electrical synapses are formed by the apposition of plasmatic membranes at gap junctions and the interaction of connexin subunits from two neurons. At this site, connexin complexes create intercellular pores tha...

Recent findings on the clinical, electroencephalography (EEG), neuroimaging, and surgical outcomes are reviewed comparing patients with Palmini type I (mild) and type II (severe) cortical dysplasia. Resources include peer-reviewed studies on surgically treated patients and a subanalysis of the 2004 International League Against Epilepsy (ILAE) Surve...

Clinical and demographic presurgical variables may be associated with unfavorable postsurgical neurological outcome in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). However, few reports include preoperative psychiatric disorders as a factor predictive of long-term postsurgical MTLE-HS neurological outcome. We use...

To describe the ictal technetium-99 m-ECD SPECT findings in polymicrogyria syndromes (PMG) during epileptic seizures. We investigated 17 patients with PMG syndromes during presurgical workup, which included long-term video-electroencephalographic (EEG) monitoring, neurological and psychiatry assessments, invasive EEG, and the subtraction of ictal-i...

To evaluate the clinical and hippocampal histological features of patients with mesial temporal lobe epilepsy (MTLE) in both familial (FMTLE) and sporadic (SMTLE) forms. Patients with FMTLE (n = 20) and SMTLE (n = 39) who underwent surgical treatment for refractory seizures were studied at the University of São Paulo School of Medicine at Ribeirão...

In temporal lobe epilepsy (TLE) seizures, tonic or clonic motor behaviors (TCB) are commonly associated with automatisms, versions, and vocalizations, and frequently occur during secondary generalization. Dystonias are a common finding and appear to be associated with automatisms and head deviation, but have never been directly linked to generalize...

A ressonância magnética funcional permite uma localização acurada da área da linguagem para fins de cirurgia de epilepsia, mas requer a colaboração do paciente na execução da tarefa proposta, o que pode limitar a sua utilização em pacientes com retardo mental. Nós apresentamos o caso de uma mulher com 34 anos de idade, com retardo mental, que foi s...

Burneo and colleages¹ recently reported that ethnicity and socioeconomic status are not isolate predictors for seizure control in surgical mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). These interesting results perhaps suggest that studies analyzing surgical outcome in MTLE-HS conducted in populations with diverse s...

We report a 29-year-old male patient with right temporal lobe epilepsy who presented with a hot spot at the skull base on ictal SPECT suggesting a neuroglial tumor. The patient had chronic sinusitis and rare episodes of epistaxis. Tc-99m ECD was injected during a generalized seizure complicated by simultaneous nasal bleeding. Hematologic and labora...

INTRODUCTION: Generalized tonic-clonic seizures (GTCS) are among the most dramatic types of epileptic seizures and may be accompanied by rising blood pressure and pulse rate, physical injuries from falling, muscular convulsions, tongue biting, or aspiration pneumonia. Epistaxis is an uncommon complication of generalized seizures and investigations...

We describe the relative frequency, clinical features, neuroimaging and pathological results, and outcome after pharmacological or surgical intervention for a series of pediatric patients with temporal lobe epilepsy (TLE) from an epilepsy center in Brazil. The medical records of children younger than 12 years with features strongly suggestive of TL...

We describe the relative frequency, clinical features, neuroimaging and pathological results, and outcome after pharmacological or surgical intervention for a series of pediatric patients with temporal lobe epilepsy (TLE) from an epilepsy center in Brazil. The medical records of children younger than 12 years with features strongly suggestive of TL...

Neocortical development is a highly complex process encompassing cellular proliferation, neuronal migration and cortical organization. At any time this process can be interrupted or modified by genetic or acquired factors causing malformations of cortical development (MCD). Epileptic seizures are the most common type of clinical manifestation, besi...

We analyze a series of patients with mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) submitted to presurgical investigation with scalp sphenoidal, followed by foramen ovale electrodes (FO), and, when necessary, with depth temporal electrodes. We sought to evaluate the clinical utility of FO in patients with MTLE-HS....

We sought to analyze the contralateral volumes of the temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus in patients with temporal lobe epilepsy (TLE) due to histologically proven mesial temporal lobe sclerosis (MTLS), seizure free for >or=4 years of postsurgical follow-up. Forty-six (23 male) TL...

Carbamazepine (CBZ) is a pharmacological agent used to control epileptic syndromes. In refractory epilepsy patients, however, a second anticonvulsive drug such as lamotrigine (LTG) is often added. This association can reduce the frequency of the epileptic seizures and favour control over them. This study was conducted to evaluate the plasma concent...