Drug-resistant epilepsy in a patient with frontal oligodendroglioma and history of varicella encephalitis

espanolINTRODUCCION: La epilepsia farmacorresistente se plantea cuando han fracasado dos ensayos de farmacos antiepilepticos tolerados, apropiadamente elegidos y empleados de forma adecuada, para conseguir la ausencia mantenida de crisis. Dicha situacion es mas significativa en las crisis de inicio focal y por causas adquiridas.CASO CLINICO: Varon que a los cinco anos fue hospitalizado por fiebre, cefalea, vomitos, inestabilidad de la marcha y dificultad para la bipedestacion, tras haber presentado erupcion varicelosa hacia siete dias. La serologia en suero fue positiva para la IgM del virus varicela zoster. Se diagnostico encefalitis aguda varicelosa y la evolucion fue favorable con el tratamiento de aciclovir. Con este antecedente, a los catorce anos se presentan crisis epilepticas. Se indico tratamiento con diferentes antiepilepticos durante un ano y medio hasta concluirlo como una epilepsia farmacorresistente. En el informe de las imagenes de resonancia magnetica (IRM) cerebral se describio una lesion hiperintensa en la secuencia T2 a nivel frontal parasagital derecha cortico-subcortical de forma irregular de 17 mm de diametro, informada como compatible con gliosis residual de encefalitis por varicela. Se considero al paciente candidato a cirugia de epilepsia, solicitandosele video-EEG que mostraba ritmos reclutantes que parecian originarse en la region frontal derecha. Se intervino quirurgicamente realizandose lesionectomia y la pieza anatomo-patologica fue informada como oligodendroglioma NOS. El paciente esta libre de crisis desde hace un ano, y en pauta de lenta discontinuacion del tratamiento antiepileptico.CONCLUSION: Este paciente al principio se diagnostico la causa de la epilepsia en relacion al antecedente de encefalitis viral por varicela, que puede producir como secuela crisis epilepticas. Sin embargo, en la epilepsia a partir de los datos clinicos, del EEG, las IRM de cerebro y la evolucion se debe siempre realizar el diagnostico diferencial con otras causas, y especialmente las neoplasicas de evolucion lenta. EnglishINTRODUCTION: Drug-resistant epilepsy is considered when two tolerated antiepileptic drugs trials, appropriately chosen and adequately employed have failed, to achieve a sustained absence of seizures. This situation is more significant in patients with focal onset seizures and in seizures due to acquired causes.CLINICAL CASE: A male who was hospitalized at five years old for a clinical profile of fever, cephalea, vomiting, instability to the gait and difficulty standing, after suffering from a varicella rash seven days ago. Varicella zoster virus IgM was positive in serum. He was diagnosed with acute varicella encephalitis, and the evolution was favorable with an acyclovir treatment. Given this medical history, the patient began suffering from seizures at fourteen and a half years old. He was treated with several antiepileptics, for one and a half years until it was concluded that the epilepsy was drug-resistant. A cerebral MRI showed a 17 mm in diameter hyperintense lesion, irregular in shape, at the level of the right parasagittal frontal cortico-subcortical region, and was reported as compatible with varicella zoster residual glyosis. Since the patient was still having seizures, he was considered as a candidate for epilepsy surgery. The video electroencephalogram showed recruiting rhythms, which seemed to originate in the right frontal region. The lesionectomy was performed, and the anatomopathological piece was reported as NOS oligodendroglioma. At present, and after one year post surgery, the patient has been seizures free and is following a discontinuous pattern of antiepileptic treatment.CONCLUSION: The cause of the epilepsy was diagnosed in this patient, at first, with regard to the history of varicella zoster virus encephalitis, which can produce seizures as a consequence. Nevertheless in epilepsy, from clinical data, an electroencephalogram, a cerebral MRI and evolution, it must always make a differential diagnosis with other causes, among them long term evolution neoplasm.