Perfil epidemiológico do Transtorno do Espectro Autista na população pediátrica em um hospital terciário do estado do Rio de Janeiro / Epidemiological profile of Autism Spectrum Disorder in the pediatric population of a tertiary hospital in the state of Rio de Janeiro

O transtorno do espectro autista (TEA) é uma desordem complexa do neurodesenvolvimento que abrange alterações relacionadas ao convívio social, prejuízos na comunicação e presença de movimentos repetitivos ou estereotipados. Os sinais clínicos são manifestados em quantidades e intensidades variadas e geralmente aparecem até o terceiro ano de vida. Sua etiologia ainda é mal definida, mas sabe-se que é multifatorial e envolve alterações genéticas, imunológicas e ambientais. O diagnóstico é exclusivamente clínico, através da anamnese, exame físico e neurológico do paciente. Quanto mais precoce for o diagnóstico e o manejo terapêutico, melhores serão as chances de reabilitação do indivíduo, a fim de favorecer a independência para realização de atividades de vida diária (AVDs) e inserção social. O processo terapêutico é multidisciplinar constituído por equipe médica integrada por pediatra, neurologista e psiquiatra, além de psicólogo, terapeuta ocupacional, psicopedagogo, fisioterapeuta, fonoaudiólogo, musicoterapeuta, psicomotricista, equoterapeuta, entre outros, estando o tratamento medicamentoso reservado para amenizar comportamentos agressivos, agitação excessiva, insônia e outras comorbidades que possam estar presentes no paciente portador do TEA. O presente trabalho propôs descrever o perfil epidemiológico do paciente com TEA na população pediátrica em um hospital terciário do estado do Rio de Janeiro, a fim de conhecer esta clientela e oferecer acompanhamento individualizado caso a caso, assim como evidenciar as necessidade de implantação de políticas públicas eficazes para o usuário e seus familiares.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that encompasses changes related to social interaction, communication impairments, and the presence of repetitive or stereotyped movements. The clinical signs are manifested at varying intensities and usually appear until the third year of life. Its etiology is still poorly defined, but it is known to be multifactorial and involves genetic, immunological, and environmental changes. The diagnosis is exclusively clinical, through anamnesis, physical and neurological examination of the patient. The earlier the diagnosis and the therapeutic management, the better the chances of rehabilitation of the individual in order to favor the independence to perform activities of daily living (ADLs) and social insertion. The therapeutic process is multidisciplinary consisting of a medical team composed of a pediatrician, neurologist and psychiatrist, as well as a psychologist, occupational therapist, psychopedagogue, physiotherapist, speech therapist, music therapist, psychomotrician, equiterapist, among others. Medicinal treatment is reserved to attenuate aggressive behaviors, agitation insomnia and other comorbidities that may be present in the patient with ASD. The present work proposed to describe the epidemiological profile of the patient with ASD in the pediatric population in a tertiary hospital in the state of Rio de Janeiro, in order to know this clientele and to offer individualized follow-up on a case-by-case basis as well as to demonstrate the needs to implement effective public policies for the user and their family members.

Neurophysiological and behavioral correlates of alertness impairment and compensatory processes in ADHD evidenced by the Attention Network Test.

In Attention Deficit Hyperactivity disorder (ADHD), fMRI studies show asymmetric alterations: widespread hypoactivation in anterior cortical areas and hyperactivation in some posterior regions, and the latter is considered to be related to compensatory processes. In Posner's attentional networks, an important role is attributed to functional interhemispheric asymmetries. The psychophysiological Attention Network Test (ANT), which measures the efficiency of the alerting, orienting, and executive networks, seems particularly informative for ADHD. Potentials related to ANT stimuli (ANT-RPs) have revealed reduced cognitive potential P3 in ADHD. However, there are no studies associated with asymmetry of ANT-RPs. In the present study, conducted with 20 typically developing boys and 19 boys with ADHD, aged 11-13 years, the efficiency of the three Posner's networks regarding performance and amplitude asymmetries in ANT-RPs was evaluated according to the arithmetic difference of these parameters between different cue and target presentation conditions. The results were correlated to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) scores. Regarding accuracy and intraindividual variation in reaction time, ADHD subjects showed lower efficiency of executive and alerting network, and this effect was correlated with DSM. Regarding alerting network, ANT-RPs in ADHD did not have the right-side amplitude prevalence in the temporal regions, which was observed in controls. In all ANT conditions, significantly higher asymmetries were observed in ADHD than in controls in the occipital regions 40-200 ms after target onset. Their amplitude in ADHD subjects was inversely proportional to DSM scores of inattentiveness and directly proportional to accuracy and efficiency of the executive network. The results suggest impaired alerting and executive networks in ADHD and compensatory occipital mechanisms.

Neurological manifestations of congenital Zika virus infection.

INTRODUCTION: In 2015, it was observed a rise in the number of microcephalic newborns associated with a history of non-specific febrile sickness and rash during pregnancy in Brazil. Since then, microcephaly has emerged as a public health concern. A few months after, the causal relation between congenital microcephaly and the Zika virus was discovered. Zika virus, an arbovirus, is a new TORCH member that leads to congenital infection through vertical transmission and harms the developing brain, disrupting synaptogenesis, and causing other central nervous system lesions. OBJECTIVE: The purpose of this article is to report the congenital Zika syndrome (CZS) and to emphasize the need for follow-up of the affected children to better know the evolutionary history of this new agent and to optimize the provision of healthcare and improve the quality of life of these patients. METHODS: We review the most relevant literature about clinical manifestations and neuroimaging findings related to neurotropism of Zika virus to characterize the congenital Zika syndrome and suggest the systematization of some exams and procedures to evaluate children exposed to ZIKV with or without microcephaly, according to the author's own experience. CONCLUSIONS: Vertical ZIKV infection can cause a wide spectrum of neurological manifestations that go beyond microcephaly, and even the non-microcephalic child should be followed during the first years of life, because infection may be asymptomatic or lead to neuropsicomotor delay, epilepsy, and visual abnormalities. The appropriate prospective multidisciplinary follow-up of these patients aims to understand the natural history of this new agent and to provide a better development and quality of life for them and their families.