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33AB33 - 35 I'1 ,," r -,"1,*..*37. 3e FLÉ . LllI .,,i . . .,r1 -,r3BI! . I45-47 , ., ..' rlf.-- ,- *--r ! ilhrljlirt :49-5151-5353-5557-5959-6161 -63v-----+_r- !. {rFIGURA óA. Registro ictiÌl obtido atfavés <strong>de</strong> eletrodos intracranianos ('subdural sh.ips,)iÌrplantiìdos nas regiõcs 1ÌontiÌis lateral e Dìesiiìl dc arnbos os hernistërios, crnpacieÌlte <strong>com</strong> crìscs tônicas sugestivas dc Origern ou acoÌÌtetiÌnento pr.ccoce <strong>de</strong>iirea motora suplementar. EEGs interictais cle esctlpo mostraviÌÌÌt cJescirrgirsbifrontais ora in<strong>de</strong>penclentes, oru síncronas, e os fegistros ictais não perrnrrrlmlocìliziìção intra ou inter-hemistérica. Note nítida lateraìizlção ilo início clascnses em estruturiìs do Ìobo Íìontal esqucrdo; B. Registro ictal intracranrano entl]iÌciente colll clises têmponr-límbicas n0 qual 'strips' sLtbdurais Íbramirìrplantados na supertÌcie íntèro-mesial <strong>de</strong> ambos os lobos temporais. EEGsintcrictajs clc cscalpo lìlostriìvam <strong>de</strong>scargas biternporais inclepen<strong>de</strong>ntes e EEGictal clc esculpo não evi<strong>de</strong>ncìou latelulização satistata) a. Crises Íbranr registradasconr origent excl sivarÌlente no lobo tempoÌal es(luerdo (note intensiì iìtenLlaçãoclu ativiclaclelétrica no início da crise ern TE l-2 [contatos nriris mesjaisÌ)..t*.FrÌÌìpoltiÌnte, pols n]ult s vezcs oEEG rnostra rla ativicla<strong>de</strong> ictalenqLl!Ìnto o paciente não iìll[esentrLuma crise cliniciÌrlente clclirricla rru,pol outra, uma crise obselvacla n0vícleo pocle iniciar-se viiriossegunclos iÌntes quc se ìclentilicltre irspÍiÌneifas alteraça]es ictilis ao EECì.Este tÍ](im(l cenlr|i c \l ìit \U-efiÌ(llte r (rise inici:r-.e,le ìltrì:r trrl.r,corticiÌl quc Ììão estii scndo a<strong>de</strong>qurÌdiìrnente[egistrada pelos eletlotlos<strong>de</strong> superfícic.Em diversas ocas iircs. pr.incrp!ÌlÌnentenas epilepsias e x triÌtüìlpolaise em iìlguns piìcieÌltes corÌìepiÌepsias teÌnporais rnas clescltrgusinterictais biIatelais in<strong>de</strong>pen<strong>de</strong>ntcs,os registros ictais obtidos atriìvós clcEEGs cle superfície sÍo lìltürreÍìteinsatjsfiìtórios para ir localizaçiLo rliizona <strong>de</strong> origern clas crises. lsso se<strong>de</strong>ve sc.j à ri4rida propagaçao clir" tivìda<strong>de</strong> ictiÌl paÍiÌ oLltr!Ìs iireas, sejalt sttlr rtti--em ern (:tttrll il\ ( i,tlicili\Ì'ìão-rì valiadiÌs aprop riiìcllÌDÌe D te corìlr'lctr,'dor Jc superlíL iL (c rìrrì ( ,,caso d s legiões f|ontais olbitais en]es iaìs, do ca)rtex parieto-occiltitaImesial e da porçÍo infèrior clos Iobostenìporais). Assin. lrinça-sc rtrão dceletÌ odos intractiìnianos. conl ointuito <strong>de</strong> rcgistriìr-se diretartrelì1crlo\ !Cì.1(l(ìfe\(lil\ C \ei tlìi.:UIiì í';r. h). O plohlr.ntir e LIr.,.i,lrrlrr;ri.[egiõcs corticiìis <strong>de</strong>lìtfo da zolÌiìirritativa clefinida ao EEG <strong>de</strong> escalpo(ou iÌté Ìresrììo fbra clela) que cleveltser rvaliadas pof estcs eletr