Temporal lobe epilepsy: A never-ending story.

INTRODUCTION: Semiology and anatomo-electroclinical correlations remain invaluable for maintaining the level of excellence in temporal lobe epilepsy (TLE) surgery, in parallel to the constantly evolving technical progress. The aim of this study was to address semiological frequent and not so frequent signs, rarities and red flags in a long follow-up surgical series of patients suffering from TLE. METHODS: Patients operated within the boundaries of the TL at our center, with presurgical video-EEG recorded seizures and seizure free after a postoperative follow-up of at least 24 months were included. Ictal semiology was systematically described and new red flags were explored by comparing with a second group of patients with the same inclusion criteria but whose outcome had been unfavorable (Engel II-IV). RESULTS: Sixty-two patients were included, 46 seizure free and 16 with outcome Engel II-IV. Most seizure-free patients had a classical semiological presentation including aura (69.6%, abdominal the most frequent), followed by loss of responsiveness (90.2%) oral automatisms (90.7%), ipsilateral gestural automatisms (53.5%), contralateral upper limb dystonia (37.5%) or immobility (39.1%), and early ipsilateral non-versive head orientation (33.3%). More infrequent presentations were also present in the group of seizure-free patients: ictal language disturbance (13%), maintenance of responsiveness during seizures (9.8%), and contralateral rhythmic non manipulative automatism (6.9%). The presence of an isolated viscerosensory and/or psychic aura was significantly more frequent in the seizure-free group (p = 0.017), as well as oroalimentary automatisms (p = 0.005). Two signs were only present in the group with outcome Engel II-IV, constituting possible red flags (0.06 < p < 0.07): inferior limbs stepping-like automatisms and postictal dysarthria. CONCLUSION: An adequate clinical exam during seizures and a careful analysis of video recordings allow to recognize infrequent but well-characterized ictal signs that are part of the range of semiology in TLE, together with the most frequent and classical ictal presentations. Special attention to the localization hypothesis must be paid in the absence of oroalimentary automatisms or when the signs classified as possible red flags emerge.

Malignant but not maleficent: acute leukaemia as a possible explanation of disease and death in vampire victims.

BACKGROUND: A considerable amount of research has been put into the explanation of the origin of the vampire myth by focussing on possible symptoms of the vampire; however, very little attention has been given to the victims. AIMS: To elucidate whether the myth of vampire victims follows the course of disease of acute leukaemia. METHOD: We studied three classical vampire novels published 1819-1897, focusing on 8 victims and their symptoms. The novels were chosen based on their iconic status in classic vampire literature, which defined the vampire genre and the symptoms of the victims for many years. The symptoms and course of disease following vampire attacks described in these novels were then compared with symptoms commonly seen in untreated acute leukaemia and other contemporary disorders. RESULTS: The earliest novel (1819) did not provide a sufficient description of any symptoms in detail; however, the later novels (1872 and 1897) both provided elaborate portrayals of symptoms and course of the disease. The patients studied were all factitious-explaining the variation in symptoms; however, they share common features. One case, a young woman named Lucy Westenra, described by Bram Stoker, 1897, mirrors a textbook example of an acute leukaemia patient-despite being described before the time of common acknowledgment of the diagnosis. CONCLUSION: Victims in the gothic vampire novels from the nineteenth century could very likely be inspired by real-life acute leukaemia patients.

Ictal kissing in a patient with right frontal lobe epilepsy.

When performing pre-surgical evaluation of patients with refractory epilepsy, the analysis of seizure semiology is one of the key elements used to generate a hypothesis about the location of the epileptogenic zone. Ictal kissing is a very rarely observed ictal automatism described in patients with temporal lobe epilepsy. We present a 62-year-old man who was referred to our epilepsy centre for comprehensive evaluation. During prolonged video-EEG monitoring, six focal-onset hyperkinetic seizures were registered. In five seizures, the patient repeatedly produced sonorous kisses "into the air". Initial ictal EEG pattern consisted of rhythmic theta or alpha activity at the right fronto-polar and fronto-medial electrodes. MRI depicted focal cortical dysplasia located in the right prefrontal medial cortex. This case suggests that ictal kissing can also occur in the setting of right frontal lobe epilepsy; we therefore believe that this observation expands the anatomo-clinical correlation for this rare ictal automatism. [Published with video sequences].

Lower limb automatism in surgically treated temporal lobe epilepsy patients: Clinical and electrophysiological features.

Lower limb automatism has not been known well in temporal lobe epilepsy (TLE) patients. This study investigated the distribution of risk factors, EEG features, and pathology types in surgically treated TLE patients. We also made a comparison of this group to surgically treated TLE patients with isolated hand automatism. Twenty TLE patients with lower limb automatism (Group 1) and 20 TLE patients with isolated hand automatisms (Group 2) of similar age/sex distribution were enrolled in our study. Male/female ratio was 14/6 in both groups. Demographical characteristics, risk factors, pathology types and EEG features were compared between two groups. 15 and 8 patients out of Group 1 (75%) and Group 2 (40%) respectively, were undergone right-sided surgery. Ipsilateral lower limb automatism was seen in 80% of patients. The age of epilepsy onset was earlier in patients with lower limb automatism (p = 0.02). There was no significant difference between the groups in terms of the risk factors and other demographical characteristics. Although, EEG features were not different, onset of ictal EEG changes in the first 10 seconds were seen less frequently in Group 1(6 vs 9 patients) (p = 0.31). Hippocampal sclerosis as a pathology type was detected in 11 patients (55%) of Group 1, whereas in 16 patients (80%) of Group 2. TLE patients with lower limb automatism have an earlier age of epilepsy onset and the onset of ictal EEG changed in the first 10 seconds of clinical seizure and pure HS pathology was rarer than in TLE patients with hand automatisms. Further studies are needed to shed more light on the pathophysiology of lower extremity automatisms in TLE patients.

A hierarchical multimodal system for motion analysis in patients with epilepsy.

During seizures, a myriad of clinical manifestations may occur. The analysis of these signs, known as seizure semiology, gives clues to the underlying cerebral networks involved. When patients with drug-resistant epilepsy are monitored to assess their suitability for epilepsy surgery, semiology is a vital component to the presurgical evaluation. Specific patterns of facial movements, head motions, limb posturing and articulations, and hand and finger automatisms may be useful in distinguishing between mesial temporal lobe epilepsy (MTLE) and extratemporal lobe epilepsy (ETLE). However, this analysis is time-consuming and dependent on clinical experience and training. Given this limitation, an automated analysis of semiological patterns, i.e., detection, quantification, and recognition of body movement patterns, has the potential to help increase the diagnostic precision of localization. While a few single modal quantitative approaches are available to assess seizure semiology, the automated quantification of patients' behavior across multiple modalities has seen limited advances in the literature. This is largely due to multiple complicated variables commonly encountered in the clinical setting, such as analyzing subtle physical movements when the patient is covered or room lighting is inadequate. Semiology encompasses the stepwise/temporal progression of signs that is reflective of the integration of connected neuronal networks. Thus, single signs in isolation are far less informative. Taking this into account, here, we describe a novel modular, hierarchical, multimodal system that aims to detect and quantify semiologic signs recorded in 2D monitoring videos. Our approach can jointly learn semiologic features from facial, body, and hand motions based on computer vision and deep learning architectures. A dataset collected from an Australian quaternary referral epilepsy unit analyzing 161 seizures arising from the temporal (n = 90) and extratemporal (n = 71) brain regions has been used in our system to quantitatively classify these types of epilepsy according to the semiology detected. A leave-one-subject-out (LOSO) cross-validation of semiological patterns from the face, body, and hands reached classification accuracies ranging between 12% and 83.4%, 41.2% and 80.1%, and 32.8% and 69.3%, respectively. The proposed hierarchical multimodal system is a potential stepping-stone towards developing a fully automated semiology analysis system to support the assessment of epilepsy.

Efeito do bilinguismo no resgate automático das palavras nos anos iniciais do ensino fundamental / Effect of bilingualism on automatic word retrieval in the first years of elementary school

RESUMO Objetivo Investigar, em escolares das séries iniciais do ensino fundamental (EF), efeitos do bilinguismo na velocidade e precisão do acesso ao léxico mental, conforme o tempo de exposição ao segundo idioma. Métodos Participaram 83 crianças entre 6 e 8 anos de idade, matriculadas nos dois primeiros anos do EF de escolas particulares, uma bilíngue (Português/Inglês), outra monolíngue (Português), com currículos pareados. Os professores indicaram os participantes que não apresentavam problemas sensoriais, motores, neurológicos, ou psiquiátricos. Todos tinham, como língua materna, o Português Brasileiro. Foram agrupados por escola e ano escolar (1o e 2o). Constituíram-se dois grupos: Grupo Bilíngue - GB - 43 escolares (53,3% meninas) com, pelo menos, dois anos de exposição ao Inglês, média de idade = 6,6 e Grupo Monolíngue - GM - 40 escolares (46,7% meninas), média de idade = 6,9. Foram avaliados em prova de nomeação rápida de objetos, quanto à velocidade e precisão de acesso ao léxico mental. O GB foi avaliado em Português e Inglês (um mês de intervalo) e o GM, em Português. As distribuições foram comparadas pelo teste Qui-quadrado e as médias corrigidas pelo teste de Bonferroni (nível de significância fixado em p<0,05). As comparações entre GB e GM foram feitas por análise de variância. Resultados As amostras pareadas apresentaram, nas condições de nomeação rápida (Português ou Inglês), efeito geral para grupo e ano escolar, quanto à velocidade e precisão. A ANOVA mostrou melhor desempenho em tempo do GM, somente na comparação com GB, em Inglês. Conclusão A exposição ao Inglês não interferiu na velocidade ou precisão de nomeação em Português, no GB. A progressão escolar influenciou positivamente os grupos.

ABSTRACT Purpose Investigate the effects of bilingualism on the speed and accuracy of access to the mental lexicon, according to the time of exposure to the second language, in students of the first years of elementary school. Methods Eighty-three children between six and eight years old (M = 6.8y, SD = 0.72), in the first two years of elementary school in private schools with matching curricula, were assessed: bilingual (Portuguese/English), monolingual (Portuguese). Teachers indicated that they did not present sensory, motor, neurological, or psychiatric problems. Participants had Brazilian Portuguese (L1) as their native language and were grouped by school and grade (1st and 2nd). Bilingual Groups (BG: schoolchildren with at least two years of exposure to English; N = 44, 57% girls) and Monolingual Groups (MG: N = 40, 52.5% girls) were considered. A Rapid Automatized Naming task was used to evaluate the speed and accuracy of access to the mental lexicon. BG was evaluated in Portuguese and English (01 month interval); MG, in Portuguese. A MANOVA was conducted, and Wilks lambda (l) used to verify the effect of each variable (significance level: p <0.05). Results The paired samples (c2 (1) = 0.310, p = 0.577) showed a general effect for group and grade (L1 or L2) for speed and accuracy. Differences in speed were observed between MG and BG for L2. Conclusion L2 exposure did not interfere with the speed or accuracy in rapid naming of L1 in BG. School progression had a positive influence on both groups.

Intermittent catatonia and complex automatisms caused by frontal lobe epilepsy in dementia.

An 82-year-old man was admitted to the emergency department following bizarre behaviour. Police had noticed him driving erratically through his village. He did not stop when instructed, drove slowly home and appeared 'vacant' on questioning. While in hospital, he had approximately 15 episodes of catatonia, involving rigidity, negativism, mutism except echolalia and perseveration, automatic obedience and utilisation phenomena, lasting 2-20 min each. Between episodes, he was amnestic but otherwise well. Electroencephalography demonstrated bifrontal slowing with left-sided emphasis, and captured two focal onset partial seizures with the clinical correlate of the syndrome described above. He improved rapidly on levetiracetam and lorazepam, was discharged and received a diagnosis of dementia by his community mental health team shortly afterwards, based on chronic short-term memory loss, functional decline and MRI changes. This case has implications for our understanding of the neural correlate of catatonia, specifically frontal lobe pathway dysfunction.

Tradição clínica da psiquiatria, psicanálise e práticas atuais em saúde mental / Psychiatry's clinical tradition, psychoanalysis and tradition clinique de la psychiatrie, psychanalyse et pratiques actuelles en santé mentale / Tradición clínica de la psiquiatría, psicoanálisis y prácticas actuales en salud mental / Psychiatry's clinical tradition, psychoanalysis and current practices in mental health

Este artigo aborda a clínica da psicose no campo da saúde mental propondo uma retomada de categorias da psiquiatria clássica pela psicanálise, especialmente o automatismo mental. Seu objetivo é demonstrar a utilidade do que pode ser considerado um programa de trabalho para o campo de tratamento da psicose na saúde mental, polarizado hoje entre o reducionismo biológico e a atenção psicossocial. A riqueza clínica dessas descrições psiquiátricas clássicas, em sua releitura pelo viés da teorização lacaniana, possibilita reconhecer o funcionamento complexo da psicose e, em particular, o trabalho do sujeito para fazer face às dificuldades impostas por essa condição. Como conclusão, o automatismo mental de Clérambault é analisado visando a demonstrar a dependência estrutural de todo sujeito em relação à linguagem e ao significante, fato primeiro do qual deriva a subjetividade como efeito.

L'article discute la clinique de la psychose dans le domaine de la santé mentale proposant un repris par la psychanalyse des catégories de la psychiatrie classique tel que l'automatisme mental. Son objectif est de démontrer l'utilité de ce qu'on peut considérer un programme de travail pour le champ du traitement de la psychose dans la santé mentale, polarisé aujourd'hui entre le réductionnisme biologique et la réhabilitation psychosociale. La richesse clinique de ces descriptions psychiatriques classiques, repris par le biais de la théorie lacanienne, permet de reconnaître la complexité de la psychose et surtout le travail du sujet pour faire face aux difficultés imposées par cette condition. En conclusion, l'automatisme mentale de Clérambault est analysé pour démontrer la dépendance structurelle de tous les sujets par rapport au langage et au signifiant, fait premier duquel la subjectivité dérive comme un effet.

Este texto trata de la clínica de la psicosis y propone que se retomen, a través del psicoanálisis, las categorías de la psiquiatría clásica, principalmente el automatismo mental. El objetivo es demonstrar la utilidad de este programa de trabajo para el tratamiento de la psicosis en los servicios de salud mental, hoy polarizado entre el reduccionismo biológico y la rehabilitación psicosocial. La riqueza clínica de tales descripciones clásicas, desde la teoría de Lacan, permite reconocer el funcionamiento complejo de la psicosis y el trabajo hecho por el sujeto para enfrentar las dificultades impuestas por esta condición. A modo de conclusión, se analiza el automatismo mental de Clérambault con el fin de demostrar la dependencia estructural de todo sujeto en cuanto al lenguaje y al significante, hecho que produce la subjetividad como efecto.

The paper analyzes the clinic of psychosis in the mental health field by revisiting classical psychiatry categories through psychoanalysis, especially mental automatism. This paper aims to demonstrate the usefulness of what may be considered a working plan for the clinic of psychosis, which is today polarized into biological reductionism and psychosocial care. The accuracy of these classical psychiatric descriptions, revisited through Lacan's theory, enables the recognition of the complexity of psychosis and especially the subject's efforts to tackle the difficulties that result from this condition. In the conclusion, we analyze Clérambault's syndrome called "mental automatism" so as to demonstrate every subject's structural dependency on language and on the signifier, from which the subjectivity as an effect is derived.

Coprolalia as a manifestation of epileptic seizures.

OBJECTIVE: The aim of this study was to investigate the lateralizing and localizing value of ictal coprolalia and brain areas involved in its production. METHODS: A retrospective search for patients manifesting ictal coprolalia was conducted in our EMU database. Continuous video-EEG recordings were reviewed, and EEG activity before and during coprolalia was analyzed using independent component analysis (ICA) technique and was compared to the seizures without coprolalia among the same patients. RESULTS: Nine patients were evaluated (five women), eight with intracranial video-EEG recordings (icVEEG). Four had frontal or temporal lesions, and five had normal MRIs. Six patients showed impairment in the language functions and five in the frontal executive tasks. Two hundred six seizures were reviewed (60.7% from icVEEG). Ictal coprolalia occurred in 46.6% of them, always associated with limbic auras or automatisms. They arose from the nondominant hemisphere in five patients, dominant hemisphere in three, and independently from the right and left hippocampus-parahippocampus in one. Electroencephalographic activity always involved orbitofrontal and/or mesial temporal regions of the nondominant hemisphere when coprolalia occurred. Independent component analysis of 31 seizures in seven patients showed a higher number of independent components in the nondominant hippocampus-parahippocampus before and during coprolalia and in the dominant lateral temporal region in those seizures without coprolalia (p=0.009). Five patients underwent surgery, and all five had an ILAE class 1 outcome. SIGNIFICANCE: Ictal coprolalia occurs in both males and females with temporal or orbitofrontal epilepsy and has a limited lateralizing value to the nondominant hemisphere but can be triggered by seizures from either hemisphere. It involves activation of the paralimbic temporal-orbitofrontal network.

Ictal movements mimicking Islamic praying rituals: localizing value in a series of 12 patients.

The aim of this study was to determine the lateralizing value of the ictal praying gesture and of ictal religious speech in patients who are candidates for epilepsy surgery. We retrospectively searched video/EEG data of 1430 patients who were evaluated at an epilepsy center from 1999 to 2014. Twelve patients were found to have demonstrated ictal praying during their complex partial seizures. Among all patients, the ictal focus was in the right temporal region. Ictal behavior simulating prayer, which includes both hands as in the Islamic ritual tradition is a rare automatism that lateralizes the ictal focus.

Reforming automatism and insanity: Neuroscience and claims of lack of capacity for control.

This paper examines some of the issues raised by the current criminal law defence of automatism and the related defence of insane automatism, and considers what neuroscience may contribute to the reform discussion. It also considers some of the claims made in relation to the impact of neuroimaging in the courtroom. It examines an American medical case report in which an individual's criminal behaviour is linked to a brain tumour, and considers how the reformed law as presented in the Law Commission for England and Wales' Discussion Paper might treat such claims. It concludes by examining what assistance the law may gain from a deeper understanding of how a sense of agency emerges from brain states, and the implications of this scientific knowledge for the reform of the law.

A paixão pelo autômato: a clínica para o cuidado em saúde no templo da tecnologia / The passion for the automaton: clinics for health care in the technology temple

A paixão pelo autômato é a expressão que procura problematizar a cultura contemporânea a partir dos efeitos da tecnologia e da ciência no modo de vida capitalista. Inspirado nos trabalhos da atividade de extensão universitária coordenada pelos autores em 2013, na Universidade Federal do Rio Grande do Sul (UFRGS), em que clássicos cinematográficos de ficção científica operavam como mote para as problematizações, este ensaio procura desenvolver o recorte acerca da escuta e do tratamento clínico no contexto de práticas contemporâneas do cuidado em saúde. Ao final, ao trabalhar o problema de saber o que parece elevar o autômato ao status de ideal humano, procura-se traçar uma diferenciação entre técnica e tecnologia para encaminhar série de estudos acerca da automatização nas práticas e relações humanas.

The passion for the automaton is the expression that tries to problematize contemporary culture from the effects of technology and science in the capitalist mode of life. Inspired by the works of university extension activities coordinated by the authors in 2013, at the Federal University of Rio Grande do Sul (UFRGS), in which science fiction classic films were theme for problematization, this essay brings the clipping of listening and clinical treatment questionings regarding the context of health care practices. At the end, when working the problem of knowing what seems to elevate the status of the automaton as a human ideal, it traces the differentiation between technique and technology to route series of studies on the automation practices and human relations.

The relationship between smoking motives and smoking urges experienced in response to a negative affect induction.

INTRODUCTION: The present study attempted to further elucidate the relationship between self-reported smoking motives and affect in college students. METHOD: Smoking motives were measured via self-report, and following a laboratory negative affect (NA) mood induction, urge to smoke was assessed via three questions. Participants were college students (N=84) who reported smoking an average of 8.74 (SD=5.36) cigarettes per day. RESULTS: Results indicated that smoking motives for Positive Reinforcement and Automaticity significantly predicted participants' responses on two measures of urge to smoke immediately following the NA induction. Positive Reinforcement motives were predictive of urge to smoke, and Automaticity motives were predictive of the number of cigarettes participants stated that they would smoke if cigarettes were provided for free. CONCLUSIONS: These findings indicate that (1) the association between NA and smoking is perhaps more complex than previously thought; and (2) merely two (Positive Reinforcement, Automaticity) of possibly thirteen smoking motives were identified as predictive of smoking urges. It is particularly surprising that other smoking motives (e.g., Negative Reinforcement) were not significant predictors of urge following the NA induction. Implications for relapse risk and treatment considerations among smokers experiencing elevated NA are considered.

Acessibilidade crônica e agenda setting: interface entre a psicologia e a comunicação no estudo da beleza / Accesibilidad crónica y agenda setting: interface entre la psicología y la comunicación en el estudio de la belleza / Chronic accessibility and agenda setting: interface between psychology and communication in a study about beauty

O objetivo deste trabalho foi estudar o automatismo e a acessibilidade crônica, por meio da comparação entre a comunicação formal (mídia) e a informal (discurso verbal), testando a hipótese do agenda setting como uma possibilidade de investigação. O Estudo 1 foi realizado por meio de entrevistas semiestruturadas a grupos diferentes de mulheres. O Estudo 2 foi de análise de conteúdo de revistas femininas baseado nas categorias encontradas no Estudo 1. Os resultados suportam parcialmente a proposta teórica de agendamento e sugerem três dimensões discursivas: Finalidades da Beleza, Aspectos que Impactam no Cuidado, Tipos de Cuidado. A mídia não influenciou como se esperava. As frequências são diferentes entre o discurso midiático e o verbal.

El objetivo de este trabajo es estudiar el automatismo y la accesibilidad crónica, mediante la comparación entre la comunicación formal (medios de comunicación) y la informal (discurso verbal), testando la hipótesis del agenda setting como una posibilidad de investigación. El Estudio 1 fue realizado con entrevistas semiestructuradas a grupos diferentes de mujeres. El Estudio 2 fue de análisis de contenido de revistas femeninas, embasado en las categorías encontradas en el Estudio 1. Los resultados corroboraran parcialmente la propuesta teórica del agendamiento y sugirieran tres dimensiones discursivas: Finalidades de la Belleza, Aspectos que impactan el Cuidado y Tipos de Cuidado. Los medios de comunicación no influenciaran como se esperaba. Las frecuencias son diferentes entre el discurso verbal y el de los medios de comunicación.

The present research aims to investigate automatism and chronic accessibility, through a comparison between formal (media) and informal (verbal discourse) communication styles, providing evidences for the agenda setting as mean for investigation. In Study 1, semi-structured interviews were made in different groups of women. In the second study, the content of feminine magazines was analyzed, based on the categories found in the latter. Results partially support the theoretical proposal of agenda setting, and suggest three discursive dimensions: Beauty Finality, Aspects that impact in Care, Types of Cares. Results also suggest that media does not have the expected influence. Different frequencies were found for the meiotic and verbal discourses.

Expertise in automatism study: An application in the consumption of esthetics / Expertise no estudo de automatismo: Uma aplicação em consumo de estética / Expertise en el estudio de automatismo: Una aplicación en el consumo de estética

Expertise is one of the ways one can make one’s behaviors become automatic, and with consumption it is no different. Explanatory models of this sort of behavior described in the literature up to now have considered only conscious or rational buying, and do not apply to automatic buying. The model proposed here is inspired by, and adapted from, the behavior analyses, integrating variables that have typically been neglected in the traditional models, such as contextual variables. This study aimed to describe the relationship between the reports of behavior linked to the consumption of esthetics (operationalized in four variables: commenting, getting information, using cosmetic products and services) and the individual variables and those of the setting where purchases related to beauty were made. In order to do so, 953 Brazilian women responded to an online questionnaire. The model was tested and partially confirmed. Contextual social-psychological variables were the only ones to predict routine buying. Demographic and individual variables did not account for the variance explanation of the behaviors measured. It is suggested that further studies should use and contribute to this model to enhance the understanding of automatic buying...

A rotina é uma das formas de automatizar comportamentos e em consumo não é diferente. Os modelos explicativos de compra descritos na literatura partem de compras conscientes ou racionais e não se aplicam às automáticas. O modelo proposto aqui é inspirado e adaptado da análise do comportamento e trata de integrar outras variáveis tipicamente negligenciadas nos modelos tradicionais, incluindo variáveis contextuais. O objetivo deste estudo foi descrever a relação entre os relatos de comportamentos ligados ao consumo de beleza (operacionalizados em quatro variáveis: comentar, informar-se, usar produtos e serviços cosméticos) e as variáveis individuais e de cenário de compra direcionadas à beleza. Para isso, responderam a um questionário online 953 mulheres brasileiras. O modelo foi testado e parcialmente confirmado. As variáveis psicológicas contextuais sociais foram as únicas que predisseram os comportamentos de compra rotineira. As variáveis demográficas e as individuais não entraram como variáveis explicativas em nenhum dos comportamentos mensurados. Sugere-se que novos estudos utilizem e contribuam para este modelo no intuito de auxiliar no entendimento da compra automática...

La rutina es una de las formas de automatizar la conducta y en consumo no es diferente. Los modelos explicativos de compra descritos en la literatura son de compras conscientes o racionales y no se aplican a las automáticas. El modelo propuesto aqui es inspirado y adaptado de la análise de la conducta y trata de integrar otras variables tipicamente negligenciadas en los modelos tradicionales, incluyendo variables contextuales. La finalidad de este estudio fue describir la relación entre los relatos de conductas vinculadas al consumo de estética (operacionalizadas en cuatro variables: comentar, informarse, usar productos y servicios cosméticos) y las variables individuales y de contexto de compra dirigidas a la estética. Contestaron a un cuestioário online 953 mujeres brasileñas. El modelo fue testado y parcialmente confirmado. Las variables psicológicas contextuales sociales fueron las únicas que predijeron las conductas de compra rutinera. Las variables demograficas e individuales no entraron como variables explicativas en ninguno de las conductas medidas. Sugiérese que nuevos estúdios utilicen y contribuyan para este modelo en el intuito de auxiliar en el entendimento de compra automática...

Tratamento cirúrgico para automatismos sexuais em crises parciais complexas: relato de caso e revisão da literatura / Surgical treatment for sexual automatisms in complex partial seizures: case report and literature review

Relatamos caso raro de crises parciais complexas com automatismos genitais secundárias a tumor temporal. Paciente foi submetida à lobectomia temporal direita com remissão completa dos sintomas. Após revisão da literatura, fica evidenciado que crises podem ser originadas tanto no lobo frontal quanto temporal.

We report a rare case of sexual automatism in complex partial seizures secondary to temporal tumor. Patient underwent a right temporal lobectomy with complete remission of symptoms. After reviewing the literature, it is evident that the crisis can arise in both the frontal and temporal.

Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: a randomized controlled trial.

OBJECTIVE: We hypothesized that novices will perform better in the operating room after simulator training to automaticity compared with traditional proficiency based training (current standard training paradigm). BACKGROUND: Simulator-acquired skill translates to the operating room, but the skill transfer is incomplete. Secondary task metrics reflect the ability of trainees to multitask (automaticity) and may improve performance assessment on simulators and skill transfer by indicating when learning is complete. METHODS: Novices (N = 30) were enrolled in an IRB-approved, blinded, randomized, controlled trial. Participants were randomized into an intervention (n = 20) and a control (n = 10) group. The intervention group practiced on the FLS suturing task until they achieved expert levels of time and errors (proficiency), were tested on a live porcine fundoplication model, continued simulator training until they achieved expert levels on a visual spatial secondary task (automaticity) and were retested on the operating room (OR) model. The control group participated only during testing sessions. Performance scores were compared within and between groups during testing sessions. RESULTS: : Intervention group participants achieved proficiency after 54 ± 14 and automaticity after additional 109 ± 57 repetitions. Participants achieved better scores in the OR after automaticity training [345 (range, 0-537)] compared with after proficiency-based training [220 (range, 0-452; P < 0.001]. CONCLUSIONS: Simulator training to automaticity takes more time but is superior to proficiency-based training, as it leads to improved skill acquisition and transfer. Secondary task metrics that reflect trainee automaticity should be implemented during simulator training to improve learning and skill transfer.

Automatic stimulus-induced medial premotor cortex activation without perception or action.

Who has ever been surprised to return to the bowl of salted peanuts without realizing it, even after having eating a moderate number and deciding to stop? Using rapid event-related functional magnetic resonance imaging (fMRI) in healthy volunteers, we investigated the neural correlates of automatic processes induced by subliminal stimuli. We demonstrated that the automatic activation of motor programs elicited unconsciously in the medial premotor cortex was normally restricted to specific contexts set by the environment, but can occur below the threshold of awareness even when no movement was executed. This novel finding expands our view on brain mechanisms underlying unconscious motor control and provides new evidence that activation of the motor preparation system and consciousness are not obligatory linked.

Gestural automatisms during syncope related to cervical malignancy.

Cervical malignancies are a rare but well-known cause of syncope. Gestural automatisms during syncope have only rarely been reported. We describe a patient presenting with bimanual automatisms during syncopal episodes caused by parapharyngeal carcinoma involving the right laterocervical region. Ictal phenomenology was strongly suggestive of focal seizures and only video-polygraphic recording including EEG and ECG allowed the correct diagnosis to be established. Syncopal episodes ceased after partial removal of the mass. Although gestural automatisms in the context of a sudden spell with loss of consciousness are strongly suggestive of focal (mainly frontal or temporal) seizures, the diagnosis of syncope must be taken in account and confirmed or excluded by appropriate neurophysiological investigations.

La repetición y lo real: de Aristóteles a Lacan / Repetition and real: from Aristotle to Lacan

El presente trabajo tiene por fin indagar la referencia que introduce Lacan en El Seminario 11, aquella relacionada con las causas accidentales propias de la teoría aristotélica. Es el interés que las mismas revisten el que le permite conceptualizar de un modo inédito el estatuto de la repetición. Fundamentalmente en lo que respecta a esta última, es pasible afirmar que tanto tyché como automatón posibilitan dilucidar de manera innovadora las coordenadas problemáticas que comporta el concepto freudiano de repetición, al abordarla no sólo desde la insistencia significante, marcada por la lógica que rige la dimensión simbólica, sino precisamente a partir de lo real puesto allí en juego.