Agenesia del cuerpo calloso y crisis epilépticas
Unidad Neuropediatría. Hospital Infantil Virgen del Rocío. Sevilla, España. Correspondencia: Dr. Manuel Nieto-Barrera. Castillo de Utrera, 8, 1.º B. E-41013 Sevilla.
Introduction: The corpus callosum is the major neopallial connection between the two cerebral hemispheres. The corpus callosum agenesis (CCA) is found in 14% of CNS malformations. The diagnosis is based on neuroimaging procedures (ultrasonography, CT, MRI). The CCA is usually associated with facial dysmorphia, developmental delay and epileptic seizures. Two casuistic are studied, one with necropsies material and another with CCA patients alive, on which CCA was frequently associated with other CNS malformations, in order to establish the circumstances in which the epileptic seizures have been observed.
Development: It is commonly admitted that the presenting signs or symptoms in individuals with CCA are due to concurrent brain abnormalities and that isolated CCA is essentially asymptomatic. The CCA is a common component in some malformative syndromes, frequent in another, and occasional in many of them. The CCA has been reported in many chromosomal aberrations and less frequently in inborn errors of metabolism and neurocutaneous diseases. In the casuistic studies of 73 patients alive, 25 (39%) have presented epileptic fits: in 24 of them the CCA was associated to another brain abnormalities; in 17 cases, the first seizures was recorded during the first year, in 6 cases between 1 and 3 years and in cases after 2 years: the type of epileptic seizures is variable: neonatal convulsions in 4 cases, infantile spasms in 5, unilateral fits in 3, and partial seizures in 1 case. In the necropsies casuistic with 26 CCA cases, 6 (23%) suffered epileptic fits, all with another malformations of the CNS; in 3 the onset of the seizures was during the newborn period, 2 had infantile spasms during the first years and 1 case generalized seizures during the second year.
Conclusions: 1. Epileptic seizures were observed in 23%-39% of the CCA cases studied. 2. All cases with CCA, except for one, have also another brain abnormality. 3. In 70% of the cases, the onset of the fits takes place during the first year. 4. The type of seizures is variable with predominance of infantile spasms and unilateral seizures.
Desarrollo Se admite que los signos o síntomas observados en pacientes con ACC son debidos a anomalías cerebrales asociadas y que la ACC aislada es esencialmente asintomática. La ACC es un componente común en algunos síndromes malformativos, frecuente en otros y ocasional en muchos. Se ha observado también en numerosas alteraciones cromosómicas y con menos frecuencia en metabolopatías innatas y enfermedades neurocutáneas. En la casuística de 73 pacientes vivos, 25 (39%) sufrieron crisis epilépticas, estando en 24 de ellos la ACC asociada a otras malformaciones. En los casos de necropsia, de 26 casos con ACC, 6 (23%) tuvieron crisis epilépticas, todos con otras malformaciones asociadas a la ACC; 3 tuvieron la primera crisis en el período neonatal, 2 espasmos infantiles en el primer año y uno crisis generalizadas a los 2 años.
Conclusiones 1. Las crisis epilépticas están presentes en el 23-39% de los casos de ACC estudiados. 2. Excepto en un caso, en el resto la ACC está asociada a otras malformaciones cerebrales. 3. En el 70% de los casos las crisis se inician en el primer año. 4. La tipología crítica es muy variable, predominando los espasmos infantiles y las crisis unilaterales