Evaluating subjective cognitive decline: a systematic review of tools available for evaluating cognitive complaints in Portuguese.

BACKGROUND: Subjective cognitive decline (SCD) is a perception that is not objectively measured in screening tests. Although many tools are available for evaluating SCD, no single gold standard is available for classifying individuals as presenting SCD, in the Portuguese-speaking population. The aim of this study was to systematically review the literature for tools used to evaluate SCD in the Portuguese-speaking population. METHODS: Four databases (Web of Science, SciELO, LILACS and MEDLINE) were primarily utilized in this study (Phase 1). Subsequently, we conducted a manual search of the literature (Phase 2). We then retrieved tools for critical evaluation (Phase 3). Studies that matched the inclusion criteria were analyzed. We summarized the features of each tool in terms of the number of questions, scoring system, benefits and deficiencies, translation and validity. RESULTS: A total of 30 studies utilizing four questionnaires and seven different single questions were found. The tools retrieved were the Memory Assessment Questionnaire (MAC-Q; 12/30 studies), single-question methods (7/30 studies), Subjective Memory Complaint Scale (SMC scale; 5/30 studies), Prospective and Retrospective Memory Questionnaire (PRMQ; 3/30 studies) and Memory Complaint Scale (MCS; 3/30 studies). Only two were formally translated and validated for the Portuguese speaking population (PRMQ and MCS). CONCLUSIONS: In summary, SCD is still underinvestigated in Portuguese-speaking countries. The MAC-Q was the most commonly used tool in Portuguese, despite its lack of formal translation and validation for the Portuguese-speaking population. Further studies are required in order to develop and validate a screening tool that includes questions for detecting SCD-plus features and affective symptoms, so as to improve its predictive value.

Evaluating subjective cognitive decline: a systematic review of tools available for evaluating cognitive complaints in Portuguese / Avaliação de declínio cognitivo subjetivo: uma revisão sistemática de instrumentos disponíveis para avaliar queixa cognitiva em português

ABSTRACT Background: Subjective cognitive decline (SCD) is a perception that is not objectively measured in screening tests. Although many tools are available for evaluating SCD, no single gold standard is available for classifying individuals as presenting SCD, in the Portuguese-speaking population. The aim of this study was to systematically review the literature for tools used to evaluate SCD in the Portuguese-speaking population. Methods: Four databases (Web of Science, SciELO, LILACS and MEDLINE) were primarily utilized in this study (Phase 1). Subsequently, we conducted a manual search of the literature (Phase 2). We then retrieved tools for critical evaluation (Phase 3). Studies that matched the inclusion criteria were analyzed. We summarized the features of each tool in terms of the number of questions, scoring system, benefits and deficiencies, translation and validity. Results: A total of 30 studies utilizing four questionnaires and seven different single questions were found. The tools retrieved were the Memory Assessment Questionnaire (MAC-Q; 12/30 studies), single-question methods (7/30 studies), Subjective Memory Complaint Scale (SMC scale; 5/30 studies), Prospective and Retrospective Memory Questionnaire (PRMQ; 3/30 studies) and Memory Complaint Scale (MCS; 3/30 studies). Only two were formally translated and validated for the Portuguese speaking population (PRMQ and MCS). Conclusions: In summary, SCD is still underinvestigated in Portuguese-speaking countries. The MAC-Q was the most commonly used tool in Portuguese, despite its lack of formal translation and validation for the Portuguese-speaking population. Further studies are required in order to develop and validate a screening tool that includes questions for detecting SCD-plus features and affective symptoms, so as to improve its predictive value.

RESUMO Introdução: Declínio cognitivo subjetivo (DCS) é uma percepção não objetivamente mensurada em testes de rastreio. Apesar de muitos instrumentos estarem disponíveis para avaliação de DCS, nenhum padrão-ouro único é capaz de classificar um indivíduo com DCS em população falante de português. Este estudo objetivou revisar sistematicamente a literatura para instrumentos usados, para avaliar DCS em falantes de português. Métodos: Quatro bases de dados (Web of Science, SciELO, LILACS e MEDLINE) foram inicialmente usadas neste estudo (Fase 1). Em seguida, conduzimos uma busca manual (Fase 2) e os instrumentos coletados foram criticamente avaliados (Fase 3). Estudos que correspondiam aos critérios de inclusão foram analisados. Nós resumimos as características de cada instrumento em termos de números de questões, sistema de pontuação, vantagens e desvantagens, tradução e validação. Resultados: O total de 30 estudos utilizou 4, questionários e 7 diferentes questões para avaliar DCS. Os instrumentos avaliados foram Memory Assessment Questionnaire (MAC-Q, 12/30 estudos), método de questão única (7/30 estudos), Subjective Memory Complaint Scale (SMC-scale, 5/30 estudos), Prospective and Retrospective Memory Questionnaire (PRMQ, 3/30 estudos) e Memory Complaint Scale (MCS, 3/30 estudos). Apenas dois instrumentos foram formalmente traduzidos e validados para falantes de português (PRMQ e MCS). Conclusões: Em suma, DCS é ainda sub-representado em países lusofônicos. O MAC-Q foi o instrumento mais utilizado em português, apesar de sua falta de tradução e validação formal para a população falante de português. Mais estudos são necessários para desenvolver e validar um instrumento de rastreio que inclua questões sobre DCS-plus e sintomas afetivos, para aumentar seu poder preditivo.

Operationalized definition of older adults with high cognitive performance / Definição operacionalizada de idosos com alto desempenho cognitivo

ABSTRACT Recently, there has been an increasing number of studies on exceptional cognitive aging. Herein, we aim to objectively provide the operationalized characterization of older adults with unusually high memory ability. Some authors have defined them as "SuperAgers", individuals aged 80 years or older with memory ability similar or superior to middle-aged subjects. On the other hand, the terminology "high-performing older adults" (HPOA) seems to appropriately conceptualize these individuals without exaggeration. A threshold for age is not a reliable criterion, but may be defined as 75 and 80 years of age for developing and developed countries, respectively. We propose that HPOA may exhibit episodic memory test scores equal to or greater than those of individuals aged 50-60 years, according to the validated tables for the respective country. This group must also have global cognition scores within expected average values for age and education. Executive functioning may play a central role in the exceptional memory performance of this group. Further studies are essential to confirm existing findings and may provide important evidence for cognitive aging theory and the neurobiology of dementia.

RESUMO O número de estudos sobre envelhecimento cognitivo acima da média vem crescendo recentemente. Neste trabalho, nosso objetivo é fornecer a caracterização operacionalizada de idosos com capacidade de memória excepcionalmente alta. Certos autores definem-nos "Superidosos", indivíduos com 80 anos ou mais com habilidade de memória similar a adultos de meia-idade. No entanto, a terminologia "idosos de alto desempenho" parece definir de maneira apropriada esses indivíduos, sem restrição excessiva. Apesar de um limite de idade ser imperfeito, ele pode ser definido como 75 ou 80 anos, em países em desenvolvimento ou desenvolvidos, respectivamente. Nós propomos que os idosos de alto desempenho devam ter escores em testes de memória episódica de indivíduos entre 50 a 60 anos, de acordo com tabelas validadas para o país. Esse grupo também deve ter escores de cognição global dentro da média para idade e educação. O funcionamento executivo pode ter um papel central no desempenho excepcional de memória desse grupo. Mais estudos são essenciais para confirmar a existência desses achados e podem fornecer evidência importante para teoria de envelhecimento cognitivo e a neurobiologia das demências.

Using the Reduced Uterine Perfusion Pressure model of preeclampsia to study the blood brain barrier permeability / Uso do modelo de Redução da Pressão de Perfusão Uterina de pré-eclâmpsia para estudar a permeabilidade da barreira hematoencefálica

AIMS: To use the Reduced Uterine Perfusion Pressure (RUPP) model for preeclampsia to describe and evaluate the blood brain barrier permeability in pregnant rats. METHODS: Forty-one pregnant Wistar rats were divided into different intervention groups between 13 to 15 days of gestation: PregnantControl (PC; n=12), Reduced Uterine Perfusion Pressure (RUPP; n=15), Invasive Blood Pressure-Control (IBP; n=7) and Reduced Uterine Perfusion Pressure and Invasive Blood Pressure (RUPP-IBP; n=7). The 14 rats of groups IBP and RUPP-IBP had their mean arterial pressure measured at day 21. All animals were then sacrificed, administered Evans Blue dye through the tail vein and perfused with paraformaldehyde 4%. Brains were removed and evaluated by a blinded pathologist. Results are presented as means and standard errors. Comparisons between the groups were performed using Student's t-test for continuous variables and Fisher's exact test for categorical variables. Statistical significance was set as a p value less than 0.05. RESULTS: Mean arterial pressure averaged 85.4±2.2 mmHg in the IPB group and 102.5±8.3 mmHg in the RUPP-IPB group (p=0.002). Among all the RUPP rats (RUPP and RUPP-IBP groups), 82% had a positive staining with Evans Blue dye for at least one of the brain hemispheres, while none of the pregnant control rats (PC and IBP groups) had brain staining (p<0.001). CONCLUSIONS: In this study, altered permeability of the blood brain barrier was successfully reproduced in pregnant rats exposed to the RUPP protocol. Therefore, we concluded that the RUPP model is a valid surrogate to study blood brain barrier abnormalities.

OBJETIVOS: Usar o modelo de Redução da Pressão de Perfusão Uterina / Reduced Uterine Perfusion Pressure (RUPP) de pré-eclâmpsia para descrever e avaliar a permeabilidade da barreira hematoencefálica. MÉTODOS: Quarenta e uma ratas Wistar prenhes foram estratificadas em diferentes grupos de intervenção entre 13 a 15 dias de gestação: grupo controle (PC; n=12), grupo modelo de redução da pressão de perfusão uterina (RUPP; n=15), grupo monitorização invasiva da pressão arterial (IBP; n=7) e grupo redução da pressão de perfusão uterina e monitorização invasiva da pressão arterial (RUPP-IBP; n=7). As 14 ratas dos grupos IBP e RUPP-IBP tiveram sua pressão arterial média aferida no dia 21. Logo após todos os animais foram sacrificados e foi administrado o corante Azul de Evans pela veia da cauda, seguido de formaldeído 4%. Os cérebros foram removidos e avaliados por um patologista cegado para os grupos. Os resultados são apresentados em médias e erros padrão. As comparações entre os grupos foram realizadas utilizando o teste t de Student para variáveis contínuas e o teste exato de Fisher para variáveis categóricas. A significância estatística foi definida como um valor de p inferior a 0,05. RESULTADOS: As médias e desvios padrões da pressão arterial média foram 85,4±2,2 mmHg no grupo IPB e 102,5±8,3 mmHg no grupo RUPP-IPB (p=0,002). Entre todas as ratas RUPP (grupos RUPP e RUPP-IBP), 82% tiveram marcação positiva pelo corante em pelo menos um dos hemisférios cerebrais, enquanto nenhuma das ratas controle (grupos PC e IBP) teve marcação cerebral positiva (p<0,001). CONCLUSÕES: Neste estudo, a permeabilidade alterada da barreira hematoencefálica foi reproduzida com sucesso em ratas prenhes expostas ao protocolo RUPP. Portanto, concluímos que o modelo RUPP é um substituto válido para estudar anormalidades da barreira hematoencefálica.

Effects of an alternating work shift on air traffic controllers and the relationship with excessive daytime sleepiness and stress.

OBJECTIVE: To evaluate symptoms of stress and excessive daytime sleepiness (EDS) in air traffic control (ATC) officers in Brazil. METHODS: Fifty-two ATC officers participated, based at three air traffic control units, identified as A, B and C. Stress symptoms were assessed using the Lipp Inventory of Stress Symptoms for Adults, and EDS by the Epworth Sleepiness Scale. RESULTS: The sample mean age was 37 years, 76.9% of whom were male. Excessive daytime sleepiness was identified in 25% of the ATC officers, with 84.6% of these based at air traffic control unit A, which has greater air traffic flow, operating a 24-hour alternating work shift schedule. A total of 16% of the ATC officers had stress symptoms, and of these, 62% showed a predominance of physical symptoms. CONCLUSION: The high percentage of ATC officers with EDS identified in group A may be related to chronodisruption due to night work and alternating shifts.

Effects of an alternating work shift on air traffic controllers and the relationship with excessive daytime sleepiness and stress / Efeitos do turno de trabalho alternado em controladores de tráfego aéreo e relação com sonolência diurna excessiva e estresse

ABSTRACT Objective: To evaluate symptoms of stress and excessive daytime sleepiness (EDS) in air traffic control (ATC) officers in Brazil. Methods: Fifty-two ATC officers participated, based at three air traffic control units, identified as A, B and C. Stress symptoms were assessed using the Lipp Inventory of Stress Symptoms for Adults, and EDS by the Epworth Sleepiness Scale. Results: The sample mean age was 37 years, 76.9% of whom were male. Excessive daytime sleepiness was identified in 25% of the ATC officers, with 84.6% of these based at air traffic control unit A, which has greater air traffic flow, operating a 24-hour alternating work shift schedule. A total of 16% of the ATC officers had stress symptoms, and of these, 62% showed a predominance of physical symptoms. Conclusion: The high percentage of ATC officers with EDS identified in group A may be related to chronodisruption due to night work and alternating shifts.

RESUMO Objetivo: Avaliar sintomas de estresse e sonolência diurna excessiva (SDE) em controladores de tráfego aéreo (CTA) do Brasil. Métodos: Participaram 52 controladores pertencentes a 3 órgãos de controle de tráfego aéreo, denominados de A, B e C. Os sintomas de estresse, foram avaliados pelo Inventário de Sintomas de Estresse para Adultos, a SDE pela Escala de Sonolência Epworth. Resultados: 76,9% da amostra são do sexo masculino, com média de idade de 37 anos. SDE foi identificada em 25% dos controladores, desses 84,6%, pertencem aos órgãos de controle de tráfego aéreo A, caracterizado por maior movimento de aeronaves, funcionamento 24 horas e escala de serviço em turnos alternantes. Um total de 16% dos controladores apresentam sintomas de estresse, desses, 62% mostraram o predomínio de sintomas físicos. Conclusão: A porcentagem elevada de CTA com SDE identificada no grupo A pode estar relacionada a cronodisrupção devido ao trabalho noturno e alternado.

Sudden cardiac death in epilepsy disappoints, but epileptologists keep faith.

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP.

Sudden cardiac death in epilepsy disappoints, but epileptologists keep faith / Apesar do desapontamento com a morte súbita cardíaca nas epilepsias, os epileptologistas mantêm a fé

ABSTRACT Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP.

RESUMO A morte súbita nas epilepsias (SUDEP) é a causa mais comum de morte em indivíduos com epilepsia refratária. Provavelmente, o controle das crises epilépticas irá evitar algumas dessas mortes. Resumidamente, nós descrevemos nesse artigo alguns dados sobre a epidemiologia, fatores de risco, etiologia e medidas preventivas na SUDEP.

Microcephaly and Zika virus: a clinical and epidemiological analysis of the current outbreak in Brazil / Microcefalia e vírus Zika: um olhar clínico e epidemiológico do surto em vigênciano Brasil

Abstract Objective: This study aimed to critically review the literature available regarding the Zika virus outbreak in Brazil and its possible association with microcephaly cases. Sources: Experts from Instituto do Cérebro do Rio Grande do Sul performed a critical (nonsystematic) literature review regarding different aspects of the Zika virus outbreak in Brazil, such as transmission, epidemiology, diagnostic criteria, and its possible association with the increase of microcephaly reports. The PubMed search using the key word “Zika virus” in February 2016 yielded 151 articles. The manuscripts were reviewed, as well as all publications/guidelines from the Brazilian Ministry of Health, World Health Organization and Centers for Disease Control and Prevention (CDC – United States). Summary of findings: Epidemiological data suggest a temporal association between the increased number of microcephaly notifications in Brazil and outbreak of Zika virus, primarily in the Brazil's Northeast. It has been previously documented that many different viruses might cause congenital acquired microcephaly. Still there is no consensus on the best curve to measure cephalic circumference, specifically in preterm neonates. Conflicting opinions regarding the diagnosis of microcephaly (below 2 or 3 standard deviations) that should be used for the notifications were also found in the literature. Conclusion: The development of diagnostic techniques that confirm a cause–effect association and studies regarding the physiopathology of the central nervous system impairment should be prioritized. It is also necessary to strictly define the criteria for the diagnosis of microcephaly to identify cases that should undergo an etiological investigation.

Resumo Objetivos: O objetivo deste estudo foi realizar uma revisão crítica da literatura sobre o surto de vírus Zika no Brasil e sua possível associação com casos de microcefalia. Fonte de dados: Especialistas em áreas afins do Instituto do Cérebro do Rio Grande do Sul realizaram uma revisão crítica (não sistemática) da literatura sobre o vírus Zika, suas formas de transmissão, a epidemia no Brasil, critérios diagnósticos e a possível associação com os casos crescentes de microcefalia. O uso da palavra chave “Zika virus” na base de dados do PubMed em fevereiro de 2016, retorna 151 publicações. Estes textos foram revisados assim como todas as publicações e recomendações do Ministério da Saúde, Organização Mundial da Saúde e Centro de Controle de Doenças (CDC – USA). Síntese dos dados: Os dados epidemiológicos sugerem uma relação temporal entre aumento da notificação de casos de microcefalia e o surto de vírus Zika, principalmente no Nordeste do Brasil. Agentes virais comprovadamente podem ser causadores de microcefalia congênita adquirida. Não existe um consenso sobre a melhor curva de perímetro cefálico a ser utilizada, principalmente nos prematuros. Assim como também existem divergências sobre a definição de microcefalia (abaixo de 2 ou 3 desvios padrões) a ser padronizada nas notificações. Conclusão: Deve-se priorizar o desenvolvimento de técnicas diagnósticas que confirmem uma relação causa–efeito e estudos sobre mecanismos da patogênese da infecção pelo Zika no sistema nervoso central. Também é necessário definir e universalizar os critérios diagnósticos para a identificação dos casos de microcefalia que devem ser submetidos à investigação etiológica.

Long-term behavioral and cognitive outcomes following clipping for incidental unruptured intracranial aneurysms.

OBJECTIVE: Recent advances in neuroimaging techniques have resulted in more frequent detection of unruptured intracranial aneurysms. Regardless of the method employed, most interventions to treat lesions have low morbidity and mortality rates. Recently, some studies have suggested that changes in cognitive status are one complication of microsurgical treatments. However, no study to date has performed any behavioral analysis. Moreover, cognitive assessment beyond 12 months after surgical intervention is missing. The current study sought to evaluate the long-term impact of clipping on the behavioral and cognitive functions of patients with unruptured intracranial aneurysms. METHOD: A within-subjects prospective clinical trial was performed to evaluate 40 patients who underwent microsurgical clipping for incidental unruptured intracranial aneurysms. The participants underwent a full neuropsychological evaluation during the preoperative period, at 3 months after surgery and at 3 years after surgery. Paired Student's t tests and an ANOVA, followed by a Bonferroni post hoc test, were used to examine group differences. RESULTS: The cognitive and behavioral test performance of the patients did not deteriorate during either the short or the long term following intervention. Moreover, the patients' clinical and demographic characteristics did not predict behavioral or cognitive changes, and neither the surgical approach nor the topography, multiplicity, or size of the aneurysms affected the results. CONCLUSIONS: In either the short or the long term following clipping for patients with incidental unruptured intracranial aneurysms, behavioral and cognitive functions had no significant change from baseline. The intervention demonstrated high efficacy and was associated with a low morbidity rate.

Two intrathecal transplants of bone marrow mononuclear cells produce motor improvement in an acute and severe model of spinal cord injury / Recuperação motora após dois transplantes de células mononucleares da medula óssea administrados no espaço subaracnóideo utilizando modelo de lesão traumática grave da medula espinal / Recuperación motora después de dos trasplantes de células mononucleares de la médula ósea, administrados en el espacio subaracnoideo, utilizando modelo de lesión aguda y grave de la médula espinal

OBJECTIVE: We studied transplants of bone marrow mononuclear cells (BMMC) by lumbar puncture (LP) in a severe model of spinal cord injury (SCI) using clip compression. METHODS: BMMCs or saline solution were transplanted by LP 48 hours and 9 days post injury. Motor function was evaluated by BBB scale, histological analysis by Nissl technique and the verification of cell migration by PCR analysis. RESULTS: The BBB had significantly improved in rats treated with BMMCs by LP compared with controls (p<0.001). The histological analysis did not showed difference in the lesional area between the groups. The PCR analysis was able to found BMMCs in the injury site. CONCLUSIONS: two BMMC transplants by LP improved motor function in a severe model of SCI and BMMC was found in the injury site.

OBJETIVO: Estudamos transplantes de células mononucleares da medula óssea (CMMO) por punção lombar (PL) em um modelo de lesão da medula espinal (LME) grave usando compressão por clipe. MÉTODOS: CMMOs ou solução salina foram transplantadas por PL 48 horas e 9 dias após a LME. A função motora foi avaliada pela escala de BBB, a análise histológica pela técnica de Nissl e a migração celular pela análise de reação em cadeia da polimerase (PCR). RESULTADOS: A BBB demonstrou melhora significativa nos animais tratados com CMMOs por PL, em comparação com os controles (p < 0,001). A análise histológica não apresentou diferença entre as áreas de lesão dos grupos. CMMOs foram encontradas no local da lesão na análise de PCR. CONCLUSÃO: Dois transplantes de CMMOs por PL melhoraram a função motora em um modelo de LME grave. CMMOs foram encontradas no local da lesão.

OBJETIVO: Estudiamos trasplantes de células mononucleares de la médula ósea (CMMO) por punción lumbar (PL) en un modelo de lesión de la médula espinal (LME) grave, usando compresión por clip. MÉTODOS: CMMOs o solución salina fueron trasplantadas por PL, 48 horas y 9 días después de la LME. La función motora fue evaluada por la escala de BBB, el análisis histológico por la técnica de Nissl y la migración celular por el análisis de reacción en cadena de la polimerasa (PCR). RESULTADOS: La BBB demostró mejoría significativa en los animales tratados con CMMOs por PL, en comparación con los controles (p < 0,001). El análisis histológico no presentó diferencia entre las áreas de lesión de los grupos. CMMOs fueron encontradas en el lugar de la lesión en el análisis de PCR. CONCLUSIÓN: Dos trasplantes de CMMOs por PL mejoraron la función motora en un modelo de LME grave. CMMOs fueron encontradas en el área de la lesión.

Primary progressive aphasia patients evaluated using diffusion tensor imaging and voxel based volumetry-preliminary results.

UNLABELLED: There are individuals who have a progressive language deficit without presenting cognitive deficits in other areas. One of the diseases related to this presentation is primary progressive aphasia (PPA). OBJECTIVE: Identify by means of diffusion tensor imaging (DTI) and measurements of cortical volume, brain areas that lead to dysphasia when presenting signs of impaired connectivity or reduced volume. METHOD: Four patients with PPA were evaluated using DTI, and measurements of cortical volumes in temporal areas. These patients were compared with two normal volunteers. RESULTS: There is a trend to a difference in the number and volume of related fibers between control group and patients with PPA. Comparing cortical volumes in temporal areas between groups yielded a trend to a smaller volume in PPA patients. CONCLUSION: Patients with PPA have a trend to impairment in cortical and subcortical levels regarding relevant areas.

Pattern of P50 suppression deficit in patients with epilepsy and individuals with schizophrenia.

OBJECTIVE: To identify P50 suppression in patients with epilepsy, to investigate the effect of seizure control on P50 suppression, and to compare epilepsy patients with individuals with schizophrenia and healthy volunteers. METHOD: P50 evoked potential parameters and P50 suppression were studied crossectionally in patients with uncontrolled or controlled epilepsy, in individuals with schizophrenia and in healthy volunteers. RESULTS: Individuals with schizophrenia had significantly smaller conditioning stimulus (S1) amplitude, and patients with epilepsy had larger test stimulus (S2) amplitude. Mean S2/S1 ratio was 0.71 ± 0.33 for patients with uncontrolled epilepsy; 0.68 ± 0.36 for patients with controlled epilepsy; 0.96 ± 0.47 for individuals with schizophrenia, and 0.42 ± 0.24 for healthy volunteers. CONCLUSION: The sensory filter of patients with epilepsy is altered, and this alteration is not associated with seizure control. Also, it works differently from the sensory filter of individuals with schizophrenia.

Primary progressive aphasia patients evaluated using diffusion tensor imaging and voxel based volumetry-preliminary results / Avaliação de pacientes com afasia primária progressiva com imagem tensor de difusão e volumetria baseada em voxels

There are individuals who have a progressive language deficit without presenting cognitive deficits in other areas. One of the diseases related to this presentation is primary progressive aphasia (PPA). OBJECTIVE: Identify by means of diffusion tensor imaging (DTI) and measurements of cortical volume, brain areas that lead to dysphasia when presenting signs of impaired connectivity or reduced volume. METHOD: Four patients with PPA were evaluated using DTI, and measurements of cortical volumes in temporal areas. These patients were compared with two normal volunteers. RESULTS: There is a trend to a difference in the number and volume of related fibers between control group and patients with PPA. Comparing cortical volumes in temporal areas between groups yielded a trend to a smaller volume in PPA patients. CONCLUSION: Patients with PPA have a trend to impairment in cortical and subcortical levels regarding relevant areas.

Existem indivíduos que apresentam deterioração progressiva da linguagem sem apresentar déficits em outros domínios cognitivos; estes pacientes em geral apresentam afasia primária progressiva (APP). OBJETIVO: Identificar, pela imagenologia, áreas cerebrais que quando sofrem atrofia, ou quando seu sistema de conexões apresenta alterações, levam a disfasia. MÉTODO: Foram avaliados quatro pacientes com APP, utilizando-se ressonância magnética com as técnicas de imagem por tensores da difusão (DTI) e medida do volume cortical em áreas de interesse previamente definidas. Estes pacientes foram comparados com um grupo controle constituído por dois voluntários. RESULTADOS: Redução da média dos volumes dos giros temporais esquerdos no grupo de pacientes, em relação ao grupo controle, e alterações quanto ao volume e número de fibras nos tratos correspondentes. CONCLUSÃO: Pacientes com APP têm tendência a apresentar danos tanto ao nível cortical quanto subcortical.

Pattern of P50 suppression deficit in patients with epilepsy and individuals with schizophrenia / Padrão do déficit de supressão do P50 em pacientes com epilepsia e em indivíduos com esquizofrenia

OBJECTIVE: To identify P50 suppression in patients with epilepsy, to investigate the effect of seizure control on P50 suppression, and to compare epilepsy patients with individuals with schizophrenia and healthy volunteers. METHOD: P50 evoked potential parameters and P50 suppression were studied crossectionally in patients with uncontrolled or controlled epilepsy, in individuals with schizophrenia and in healthy volunteers. RESULTS: Individuals with schizophrenia had significantly smaller conditioning stimulus (S1) amplitude, and patients with epilepsy had larger test stimulus (S2) amplitude. Mean S2/S1 ratio was 0.71±0.33 for patients with uncontrolled epilepsy; 0.68±0.36 for patients with controlled epilepsy; 0.96±0.47 for individuals with schizophrenia, and 0.42±0.24 for healthy volunteers. CONCLUSION: The sensory filter of patients with epilepsy is altered, and this alteration is not associated with seizure control. Also, it works differently from the sensory filter of individuals with schizophrenia.

OBJETIVO: Identificar se existe déficit de supressão do P50 em pacientes com epilepsia, verificar a influência do controle das crises nesse déficit, comparando com pacientes com esquizofrenia e com voluntários saudáveis. MÉTODO: Os parâmetros do potencial evocado P50 e sua supressão foram estudados, com um corte transversal, em pacientes com epilepsia controlada ou não, esquizofrenia e em voluntários saudáveis. RESULTADOS: Indivíduos com esquizofrenia apresentam uma amplitude de S1 significativamente menor que os demais, sendo que os pacientes com epilepsia apresentavam uma resposta S2 de maior amplitude. A média da razão S2/S1 foi de 0,71±0,33 nos pacientes com epilepsia não controlada; 0,68±0,36 naqueles com epilepsia controlada; 0,96±0,47 nos com esquizofrenia e 0,42±0,24 nos controles normais. CONCLUSÃO: O filtro sensitivo de pacientes com epilepsia é alterado, e essa alteração não está associada com o controle das crises. Além disso, ele funciona de forma diferente do filtro sensitivo dos indivíduos com esquizofrenia.

Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization / Incidência de SUDEP numa coorte de pacientes com epilepsia refratária: papel da cirurgia e da localização da lesão

OBJECTIVE: The aim of this study was to verify incidence and characteristics of sudden unexpected death in patients (SUDEP) with refractory epilepsy and its relation to previous surgery and lesion localization. METHOD: A cross sectional study was carried out in a cohort of 550 patients with refractory epilepsy followed up by the Epilepsy Surgery Program of the University Hospital of PUCRS, Porto Alegre, Brazil, between January, 1992 and July, 2002. Patients were allocated in two groups (operated and non operated). Seizure type, distribution of interictal spikes and MRI findings were correlated with the SUDEP outcome. RESULTS: The estimated incidence of probable SUDEP amounted to 29:1000 individuals. Probable SUDEP occurred in 1.2 percent of the 166 patients of the non operated group and in 3.7 percent of the 384 patients who were operated (OR=3.02, 95 percent CI 0.69-13.16) (p=0.11). Comparing patients who died to patients alive in the operated group a significant difference was observed concerning the following variables: SUDEP patients had a predominance of generalized seizures (p=0.002), extratemporal lesion on MRI (p<0.001) and epileptiform activity over extratemporal regions (p=0.001). CONCLUSION: In surgically treated patients with refractory epilepsy, an extratemporal location of the lesion and of the epileptiform discharges significantly correlated to SUDEP. Thus it is possible that in those patients; the underlying disease may play a role in the pathogenesis of SUDEP.

OBJETIVO: O objetivo deste estudo é avaliar a incidência e características de morte súbita em pacientes com epilepsia refratária (SUDEP) e sua relação com cirurgia prévia e localização da lesão. MÉTODO: Estudo de Coorte realizado com 550 pacientes com epilepsia refratária seguidos no Programa de Epilepsia do Hospital Universitário da PUCRS, Porto Alegre, Brasil, entre Janeiro, 1992 e Julho, 2002. Os pacientes foram distribuídos em dois grupos (operados e não operados). Tipo de epilepsia, distribuição das descargas interictais e achados em RNM foram correlacionados com SUDEP. RESULTADOS: A incidência estimada de SUDEP foi 29:1000 indivíduos. A incidência de provável SUDEP nos 166 pacientes do grupo de não operados foi 1,2 por cento e nos 384 pacientes no grupo operado 3,7 por cento (OR=3,02, 95 por cento IC 0,69-13,16) (p=0,11). Comparando os pacientes que morreram com os sobreviventes do grupo operado houve diferença significativa nas seguintes variáveis: pacientes com SUDEP apresentam uma predominância de crises epilépticas generalizadas (p=0,002), lesões extratemporais na RNM (p<0,001) e atividade epileptiforme na região extratemporal (p=0,001). CONCLUSÃO: A localização da lesão e as descargas extratemporais em pacientes tratados cirurgicamente com epilepsia refratária correlacionaram-se significativamente com SUDEP. Então, é possível que nestes pacientes uma doença sobrejacente possa estar envolvida na patogênese da SUDEP.

Displasia cortical focal, aspectos neurofisiológicos, imaginológicos e histológicos / Focal cortical dysplasia, aspects of neurophysiologic, imaginological and histological

INTRODUÇÃO: Displasia cortical focal é uma das formas mais frequentes de malformações do desenvolvimento cortical, estando intimamente relacionada com epilepsia de difícil controle em crianças e adultos. Caracterizam-se por alterações histológicas, imaginológicas e eletrofisiológicas peculiares. OBJETIVO: Fazer uma revisão sucinta dos principais aspectos imaginológicos, histológicos e neurofisiológicos das displasias corticais focais. MÉTODOS: Revisão bibliografia. CONCLUSÃO: As displasias corticais focais têm características clínicas peculiares, A prevalência de epilepsia refrataria entre pacientes com displasia cortical focal é bastante elevada. A RM de crânio apresenta alterações distintas a doença, podendo em muitos casos ser normal e se correlaciona com os achados histológicos. Descargas contínuas e surtos paroxísticos de alta frequência são altamente sugestivos de epilepsia devido à displasia cortical focal.

INTRODUCTION: Focal cortical dysplasia is one of the most common ways of malformation of the cortical development where they are intimate related among hard control epilepsy on children and adults. It's characterized by peculiar histological, imaginological and electrophysiological amendment. PURPOSE: To make a succinct review of the main aspects of imaginological, histological and neurophysiologic focal cortical dysplasias. METHOD: Bibliographic review. CONCLUSION: The focal cortical dysplasias have peculiar clinical features. The prevalence of refractory epilepsy among focal cortical dysplasia patients is highly elevated. The skull magnetic resonance image (MRI) presents specific amendments to the disease that could be normal in many cases and correlates with histological results. Continuous discharges and high frequency paroxistic bursts are highly pointed as epilepsy due the Focal cortical dysplasia.

Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization.

OBJECTIVE: The aim of this study was to verify incidence and characteristics of sudden unexpected death in patients (SUDEP) with refractory epilepsy and its relation to previous surgery and lesion localization. METHOD: A cross sectional study was carried out in a cohort of 550 patients with refractory epilepsy followed up by the Epilepsy Surgery Program of the University Hospital of PUCRS, Porto Alegre, Brazil, between January, 1992 and July, 2002. Patients were allocated in two groups (operated and non operated). Seizure type, distribution of interictal spikes and MRI findings were correlated with the SUDEP outcome. RESULTS: The estimated incidence of probable SUDEP amounted to 29:1000 individuals. Probable SUDEP occurred in 1.2% of the 166 patients of the non operated group and in 3.7% of the 384 patients who were operated (OR=3.02, 95% CI 0.69-13.16) (p=0.11). Comparing patients who died to patients alive in the operated group a significant difference was observed concerning the following variables: SUDEP patients had a predominance of generalized seizures (p=0.002), extratemporal lesion on MRI (p<0.001) and epileptiform activity over extratemporal regions (p=0.001). CONCLUSION: In surgically treated patients with refractory epilepsy, an extratemporal location of the lesion and of the epileptiform discharges significantly correlated to SUDEP. Thus it is possible that in those patients; the underlying disease may play a role in the pathogenesis of SUDEP.

Estudo anatômico da substância branca do cérebro: da técnica de Klingler à dissecção virtual por ressonância magnética (tratografia) / Brain white matter anatomical study: from the Klingler technique to virtual dissection with magnetic resonance (tractography)

A técnica de dissecção de fibras é um método clássico, utilizado por renomados anatomistas do passado, para a demonstração dos tratos e fascículos integrantes da substância branca do cérebro. Esta técnica, utilizada desde o século XVII, envolve a dissecção em camadas da substância branca cerebral para demonstrar passo a passo a organização anatômica interna do parênquima. A complexidade da preparação do cérebro e da dissecção das fibras fez com que esse método fosse negligenciado por décadas. Com a possibilidade contemporânea e inédita de se visualizar os feixes de substância branca do encéfalo in vivo pela ressonância magnética, os fundamentosanatômicos antigos obtidos com a clássica técnica de dissecção de fibras tornam-se, paradoxalmente, ainda mais relevantes e atuais. Este trabalho descreve as principais etapas da técnica de dissecção de fibras, aprimorada por Joseph Klingler e revitalizada na última década por M. G. Yasargil e Ügur Türe, como uma forma de entendimento da anatomia intrínseca tridimensional do encéfalo para o uso clínico. Este estudo também busca explorar as potencialidades dessa verdadeira “dissecção virtual” através da ressonância magnética(tratografia) em reproduzir e complementar o conhecimentoanatômico das fibras obtido pelo método clássico.