Detection of seizures with ictal tachycardia, using heart rate variability and patient adaptive logistic regression machine learning methods: A hospital-based validation study.

OBJECTIVE: Automated seizure detection of focal epileptic seizures is needed for objective seizure quantification to optimize the treatment of patients with epilepsy. Heart rate variability (HRV)-based seizure detection using patient-adaptive threshold with logistic regression machine learning (LRML) methods has presented promising performance in a study with a Danish patient cohort. The objective of this study was to assess the generalizability of the novel LRML seizure detection algorithm by validating it in a dataset recorded from long-term video-EEG monitoring (LTM) in a Brazilian patient cohort. METHODS: Ictal and inter-ictal ECG-data epochs recorded during LTM were analyzed retrospectively. Thirty-four patients had 107 seizures (79 focal, 28 generalized tonic-clonic [GTC] including focal-to-bilateral-tonic-clonic seizures) eligible for analysis, with a total of 185.5 h recording. Because HRV-based seizure detection is only suitable in patients with marked ictal autonomic change, patients with >50 beats/min change in heart rate during seizures were selected as responders. The patient-adaptive LRML seizure detection algorithm was applied to all elected ECG data, and results were computed separately for responders and non-responders. RESULTS: The patient-adaptive LRML seizure detection algorithm yielded a sensitivity of 84.8% (95% CI: 75.6-93.9) with a false alarm rate of .25/24 h in the responder group (22 patients, 59 seizures). Twenty-five of the 26 GTC seizures were detected (96.2%), and 25 of the 33 focal seizures without bilateral convulsions were detected (75.8%). SIGNIFICANCE: The study confirms in a new, independent external dataset the good performance of seizure detection from a previous study and suggests that the method is generalizable. This method seems useful for detecting both generalized and focal epileptic seizures. The algorithm can be embedded in a wearable seizure detection system to alert patients and caregivers of seizures and generate objective seizure counts helping to optimize the treatment of the patients.

Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients.

BACKGROUND: Pupil reactivity and the Glasgow Coma Scale (GCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients. OBJECTIVE: We evaluated the accuracy of the GCS-Pupil score (GCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining GCS and pupil response with additional clinical and radiological prognostic factors. METHODS: Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of GCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the GCS-P score by multivariate binary logistic regression. RESULTS: Eighty-five percent (n = 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70-0.77) for the model using the GCS-P score and 0.80 (0.77-0.83) for the model including clinical and radiological variables. The GCS-P score showed similar accuracy in predicting the mortality reported for the patients with severe TBI derived from the International Mission for Prognosis and Clinical Trials in TBI (IMPACT) and the Corticosteroid Randomization After Significant Head Injury (CRASH) studies. CONCLUSION: Our results support the external validation of the GCS-P to predict hospital mortality following a severe TBI. The predictive value of the GCS-P for long-term mortality, functional, and neuropsychiatric outcomes in Brazilian patients with mild, moderate, and severe TBI deserves further investigation.

ANTECEDENTES: A reatividade pupilar e o escore da Escala de Coma de Glasgow (ECG) representam as informações clínicas mais relevantes para predizer a sobrevivência de pacientes com traumatismo cranioencefálico (TCE). OBJETIVO: Avaliar a acurácia da ECG com resposta pupilar (ECG-P) como índice prognóstico para predizer mortalidade hospitalar em pacientes brasileiros acometidos por TCE grave e compará-lo com um modelo combinando ECG e resposta pupilar com fatores prognósticos radiológicos. MéTODOS: Foram analisados dados de 1.066 pacientes com TCE grave de 5 estudos prospectivos. Foi determinada a associação entre mortalidade hospitalar e a combinação de ECG, reatividade pupilar, idade, níveis glicêmicos, tomografia computadorizada (TC) de crânio ou o escore ECG-P por regressão logística binária multivariada. RESULTADOS: Oitenta e cinco por cento (n = 908) dos pacientes eram homens. A média de idade foi de 35 anos e a mortalidade hospitalar geral foi de 32,8%. A AUROC (em português, Curva Característica de Operação do Receptor) foi de 0,73 (0,70­0,77) para o modelo utilizando o escore ECG-P e de 0,80 (0,77­0,83) para o modelo incluindo variáveis clínicas e radiológicas. O escore ECG-P mostrou acurácia semelhante na previsão da mortalidade relatada para pacientes com TCE grave derivados dos estudos International Mission for Prognosis and Clinical Trials in TBI (IMPACT, na sigla em inglês) e Corticosteroid Randomization After Significant Head Injury (CRASH, na sigla em inglês). CONCLUSãO: Nossos resultados apoiam a validação externa da ECG-P para prever a mortalidade hospitalar após um TCE grave. O valor preditivo da ECG-P para mortalidade a longo prazo, resultados funcionais e neuropsiquiátricos em pacientes brasileiros com TCE leve, moderado e grave precisam ser investigados.

Cognitive Performance of Brazilian Patients With Favorable Outcomes After Severe Traumatic Brain Injury: A Prospective Study.

OBJECTIVE: The aim of this study was to investigate the cognitive performance of patients with favorable outcomes, determined by the Glasgow Outcome Scale, 1 yr after hospital discharge due to severe traumatic brain injury. DESIGN: This was a prospective case-control study. From 163 consecutive adult patients with severe traumatic brain injury included in the study, 73 patients had a favorable outcome (Glasgow Outcome Scale score of 4 or 5) 1 yr after hospital discharge and were eligible for the cognitive evaluation, of which 28 completed the evaluations. The latter were compared with 44 healthy controls. RESULTS: The average loss of cognitive performance among participants with traumatic brain injury varied between 13.35% and 43.49% compared with the control group. Between 21.4% and 32% of the patients performed below the 10th percentile on three language tests and two verbal memory tests, whereas 39% to 50% performed below this threshold on one language test and three memory tests. Longer hospital stay, older age, and lower education were the most important predictors of worse cognitive performance. CONCLUSION: One year after a severe traumatic brain injury, a significant proportion of Brazilian patients with the favorable outcome determined by Glasgow Outcome Scale still showed significant cognitive impairment in verbal memory and language domains.

Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients / Escala de coma de Glasgow com resposta pupilar (ECC-P) e mortalidade hospitalar em traumatismo cranioencefálico grave: análise de 1.066 pacientes brasileiros

Abstract Background Pupil reactivity and the Glasgow Coma Scale (CCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients. Objective We evaluated the accuracy of the CCS-Pupil score (CCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining CCS and pupil response with additional clinical and radiological prognostic factors. Methods Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of CCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the CCS-P score by multivariate binary logistic regression. Results Eighty-five percent (n = 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70-0.77) for the model using the CCS-P score and 0.80 (0.77-0.83) for the model including clinical and radiological variables. The CCS-P score showed similar accuracy in predicting the mortality reported for the patients with severe TBI derived from the International Mission for Prognosis and Clinical Trials in TBI (IMPACT) and the Corticosteroid Randomization After Significant Head Injury (CRASH) studies. Conclusion Our results support the external validation of the CCS-P to predict hospital mortality following a severe TBI. The predictive value of the CCS-P for long-term mortality, functional, and neuropsychiatric outcomes in Brazilian patients with mild, moderate, and severe TBI deserves further investigation.

Resumo Antecedentes A reatividade pupilar e o escore da Escala de Coma de Glasgow (ECC) representam as informações clínicas mais relevantes para predizer a sobrevivência de pacientes com traumatismo cranioencefálico (TCE). Objetivo Avaliar a acurácia da ECC com resposta pupilar (ECC-P) como índice prognóstico para predizer mortalidade hospitalar em pacientes brasileiros acometidos por TCE grave e compará-lo com um modelo combinando ECC e resposta pupilar com fatores prognósticos radiológicos. Métodos Foram analisados dados de 1.066 pacientes com TCE grave de 5 estudos prospectivos. Foi determinada a associação entre mortalidade hospitalar e a combinação de ECC, reatividade pupilar, idade, níveis glicêmicos, tomografia computadorizada (TC) de crânio ou o escore ECC-P por regressão logística binária multivariada. Resultados Oitenta e cinco por cento (n = 908) dos pacientes eram homens. A média de idade foi de 35 anos e a mortalidade hospitalar geral foi de 32,8%. A AUROC (em português, Curva Característica de Operação do Receptor) foi de 0,73 (0,70-0,77) para o modelo utilizando o escore ECC-P e de 0,80 (0,77-0,83) para o modelo incluindo variáveis clínicas e radiológicas. O escore ECC-P mostrou acurácia semelhante na previsão da mortalidade relatada para pacientes com TCE grave derivados dos estudos International Mission for Prognosis and Clinical Trials in TBI (IMPACT, na sigla em inglês) e Corticosteroid Randomization After Significant Head Injury (CRASH, na sigla em inglês). Conclusão Nossos resultados apoiam a validação externa da ECC-P para prever a mortalidade hospitalar após um TCE grave. O valor preditivo da ECC-P para mortalidade a longo prazo, resultados funcionais e neuropsiquiátricos em pacientes brasileiros com TCE leve, moderado e grave precisam ser investigados.

Dual assessment of abnormal cardiac electrical dispersion and diastolic dysfunction for early detection of the epileptic heart condition.

BACKGROUND: People with epilepsy (PWE) are at increased risk for premature death due to many factors. Sudden unexpected death in epilepsy (SUDEP) is among the most important causes of death in these individuals and possibly, sudden cardiac death (SCD) in epilepsy is also as important. The possibility of concurrent derangement in electrical and mechanical cardiac function, which could be a marker of early cardiac involvement in PWE, has not been investigated in that population. METHODS: Electrical dispersion indices (T-wave peak to T-wave end, TpTe; QT dispersion, QTd; QT interval corrected for heart rate, QTc) were analyzed in patients with pharmacoresistant temporal lobe epilepsy and compared to a control group. The electromechanical relationship between those indices and echocardiographic parameters were further assessed in PWE. RESULTS: In 19 PWE and 21 controls, we found greater TpTe and QTd in PWE (TpTe: 91.6 ± 16.4 ms vs. 65.2 ± 12.1 ms, p < 0.0001; and QTd: 45.3 ± 13.1 ms vs. 19 ± 6.2 ms, p < 0.0001, respectively). QTc was similar between PWE and controls (419.2 ± 31.4 ms vs. 435.1 ± 31.4 ms, p = 0.12). In multivariate linear regression, TpTe, QTc, and epilepsy duration were related to left ventricular mass; QTc was associated with left atrial volume; QTc, the number of seizures per month, epilepsy duration and antiseizure medication explained 81% of E/A mitral wave Doppler ratio. CONCLUSIONS: This is the first report to demonstrate concurrent electrical dispersion and diastolic dysfunction in PWE. These noninvasive biomarkers could prove useful in early detection of the "Epileptic Heart" condition.

How predictable is heart rate variability in Brazilian patients with drug-resistant mesial temporal lobe epilepsy?

This study aimed to compare heart rate variability (HRV) in patients with drug-resistant mesial temporal lobe epilepsy (MTLE) with healthy controls and to analyze their clinical and sociodemographic variables predictive for HRV. Thirty-nine consecutive patients with drug-resistant MTLE were included in the study. The control group included twenty-seven healthy participants matched by age and gender. Seven HRV indices (HR, RR, rMSSD, SDNN, LF, HF, and LF/HF) were compared between patients and controls. The clinical and sociodemographic variables independently associated with the HRV indices were identified by multiple linear regression. In comparison with controls, the patients with MTLE showed a significant reduction in RR, rMSSD, SDNN, LF, HF, and LF/HF indices (t value 1.97-5.97, p < 0.05). Multiple regression models showed that disease duration predicted 11-22% of the analyzed HRV indices. Time domain indices showed higher association with disease duration than coefficients in frequency domain. Patients with drug-resistant MTLE present cardiac autonomic tone dysfunction, showing a significant reduction in their HRV indices (RR, SDNN, rMSSD, LF, HF, and LF/HF). Disease duration has a negative association with all HRV indices. This study contributes to understanding the relationship between MTLE and the cardiac autonomic tone, with possible implications for sudden unexpected death in epilepsy.

N2 event-related potential component is associated with cardiac autonomic tone regulation during mental fatigue.

Mental fatigue alters cognitive performance and autonomic regulation. The neurovisceral model proposes that forebrain structures associated to cognitive control abilities influences heart rate variability. Parasympathetic mediated heart rate variability indices reduction during mental fatigue experience is well-described in previous studies, but the contribution of heart-brain axis to cardiac autonomic adaptation remains unknown. This study investigates the association between root mean square of successive differences between RR intervals (rMSSD) and N2 event-related potential component during visual prolonged odd/ball task (≅ 60min.). The comparison between task blocks shows that rMSSD (p = 0.004) and N2 (p = 0.04) decreased with time on task. Pearson correlation shows that ΔrMSSD is associated with ΔN2 (p = 0.007). Our results support the neurovisceral integration model showing that cognitive control contributes to cardiac autonomic tone adaptation during mental fatigue experience.

The ERK phosphorylation levels in the amygdala predict anxiety symptoms in humans and MEK/ERK inhibition dissociates innate and learned defensive behaviors in rats.

We demonstrate that the rate of extracellular signal-related kinase phosphorylation (P-ERK1,2/Total-ERK1,2) in the amygdala is negatively and independently associated with anxiety symptoms in 23 consecutive patients with drug-resistant mesial temporal lobe epilepsy that was surgically treated. In naive Wistar rats, the P-ERK1,2/Total-ERK1,2 ratio in the amygdala correlates negatively with innate anxiety-related behavior on the elevated plus maze (n = 20) but positively with expression of defensive-learned behavior (i.e., freezing) on Pavlovian aversive (fear) conditioning (n = 29). The microinfusion of ERK1/2 inhibitor (FR180204, n = 8-13/group) or MEK inhibitor (U0126, n = 8-9/group) into the basolateral amygdala did not affect anxiety-related behavior but impaired the evocation (anticipation) of conditioned-defensive behavior (n = 9-11/group). In conclusion, the P-ERK1,2/Total-ERK1,2 ratio in the amygdala predicts anxiety in humans and the innate anxiety- and conditioned freezing behaviors in rats. However, the ERK1/2 in the basolateral AMY is only required for the expression of defensive-learned behavior. These results support a dissociate ERK-dependent mechanism in the amygdala between innate anxiety-like responses and the anticipation of learned-defensive behavior. These findings have implications for understanding highly prevalent psychiatric disorders related to the defensive circuit manifested by anxiety and fear. HIGHLIGHTS: The P-ERK1,2/Total-ERK1,2 ratio in the amygdala (AMY) correlates negatively with anxiety symptoms in patients with mesial temporal lobe epilepsy. The P-ERK1,2/Total-ERK1,2 in the amygdala correlates negatively with the anxiety-like behavior and positively with freezing-learned behavior in naive rats. ERK1,2 in the basolateral amygdala is required for learned-defensive but not for the anxiety-like behavior expression in rats.

Faux Pas Recognition Test: transcultural adaptation and evaluation of its psychometric properties in Brazil.

Introduction: Many neuropsychiatric and neurodegenerative disorders produce Theory of Mind impairment. We aimed to implement a Brazilian Portuguese version of the Faux Pas Recognition Test (FPRT) and evaluate its psychometric properties.Methods: We first completed an English-Brazilian Portuguese translation and adaptation to obtain an FPRT Brazilian Portuguese version. We performed a multicentric study with 153 healthy participants (68.6% women), mean age of 38.8 years (SD = 14.6) and 12.9 years of schooling (SD = 4.5). Linear regression analysis was performed to evaluate the association of social class, age, schooling, and FPRT scores. The psychometric analyses comprised item analysis, exploratory factor analysis, reliability, and validity analysis.Results: Normative data in a Brazilian population is presented. A positive correlation of scores with years of schooling, social class, and an inverse relation with age was found. The exploratory factorial analysis found a two-component structure, one component, consisting of questions 1 through 6 (Eigenvalue 5.325) and another component, consisting of questions 7 and 8 (Eigenvalue 1.09). Cronbach's alpha of the 20 stories was .72. All control stories had a poor discriminative index.Conclusion: The FPRT Brazilian Portuguese version demonstrated good internal consistency and, psychometric properties and is adequate for use even in lower educational contexts in Brazil.

Ultra-short heart rate variability reliability for cardiac autonomic tone assessment in mesial temporal lobe epilepsy.

Autonomic dysfunction in epilepsy is well-described. Heart rate variability (HRV) is a useful method to evaluate autonomic cardiac tone. Cardiac dysfunction may be involved in sudden unexpected death in epilepsy (SUDEP). HRV is a promising biomarker to enlighten the heart-brain axis role in SUDEP, but the required duration for a proper HRV recording in clinical routine remains unknown. This study aimed to verify the reliability of ultra-short HRV indices to evaluate cardiac autonomic tone in patients with epilepsy (PWE). Thirty-nine patients with mesial temporal lobe epilepsy (MTLE) had electrocardiogram recordings during the first day of video-EEG. Pearson's correlations were performed to evaluate the association between ultra-short HRV indices (five 1-min and five 30-s epochs) with standard time recording (5-min) and ANOVA compared the differences between mean HRV indices across epochs. Time domain (TD) indices showed higher mean r values when compared to frequency domain (FD) indices in 1-min (TD: r 0.80-0.99, FD: r 0.61-0.95) and 30-s epochs (TD: r 0.69-0.99, only high frequency: mean r values of 0.96). ANOVA evidenced that standard deviation of RR intervals and very low frequency means had at least 3 epochs significantly different for 1-min and 30-s epochs. Root mean square of the successive differences of RR intervals (rMSSD) presented higher Pearson's coefficient values and lower percentage of variation at 1-min or 30-s epochs in comparison to other HRV indices. In conclusion, rMSSD is the most reliable ultra-short HRV index for cardiac autonomic tone assessment in MTLE. The prognostic value of ultra-short HRV for cardiovascular risk evaluation in epilepsy remains to be determined in future studies.

AMPAr GluA1 Phosphorylation at Serine 845 in Limbic System Is Associated with Cardiac Autonomic Tone.

The central autonomic network, which is connected to the limbic system structures including the amygdala (AMY) and anterior hippocampus (aHIP), regulates the sympathetic and parasympathetic modulation of visceromotor, neuroendocrine, pain, and behavior manifestations during stress responses. Heart rate variability (HRV) is useful to estimate the cardiac autonomic tone. The levels of phosphorylation on the Ser831 and Ser845 sites of the GluA1 subunit of the AMPAr (P-GluA1-Ser845 and P-GluA1-Ser831) are useful markers of synaptic plasticity. The relation between synaptic plasticity in the human limbic system structures and autonomic regulation in humans is unknown. This study investigated the association between HRV and neurochemistry biomarkers of synaptic plasticity in AMY and aHIP. HRV indices were obtained from the resting state electrocardiogram of patients with drug-resistant mesial temporal lobe epilepsy (MTLE, n = 18) and the levels of P-GluA1-Ser845 and P-GluA1-Ser831 in the AMY and aHIP resected during the epilepsy surgery. A backward stepwise multiple linear regression models were used to analyze the association between HRV and synaptic plasticity biomarkers controlling for imbalances in the distribution of sociodemographic, clinical, neuroimaging, and neurosurgical variables. P-GluA1-Ser845 levels in AMY show a negative association (p < 0.05) with the 3 investigated parasympathetic autonomic HRV indices (SDNN, rMSSD, and HF) predicting 24 to 40% of their variation. The final multiple linear regression models include disease duration and levels of P-GluA1-Ser845 and predict 24 to 56% of cardiac autonomic tone variation (p < 0.01). P-GluA1-Ser845 levels in AMY and aHIP are negatively associated with the resting HRV in MTLE-HS indicating that increased synaptic efficiency in amygdala is associated with a parasympathetic cardiac autonomic tone impairment. The results suggest that specific changes in synaptic plasticity may be involved in the brain-heart axis regulation by the limbic system.

Early Alpha Reactivity is Associated with Long-Term Mental Fatigue Behavioral Impairments.

The quantitative analysis of electroencephalogram (qEEG) is a suitable tool for mental fatigue (MF) assessment. Here, we evaluated the effects of MF on behavioral performance and alpha power spectral density (PSD) and the association between early alpha PSD reactivity and long-term behavioral MF impairments. Nineteen right-handed adults (21.21 ± 1.77 years old) had their EEG measured during five blocks of the visual oddball paradigm (~ 60 min). A paired t-test was used to compare first and last block values of cognitive performance and alpha PSD. The sample was divided into high (HAG) and low alpha group (LAG) by early alpha PSD median values. The behavioral performance of the HAG and LAG was compared across the blocks by a two-way ANOVA with repeated measures (groups and blocks). MF impairs general behavioral performance and increases alpha PSD. The HAG presents more behavioral impairment when compared to LAG across the task. Simple linear regression between early alpha PSD and behavioral performance across the task can predict 19 to 39% of variation in general behavior impairment by MF. In conclusion, MF induction impairs general behavioral and increases alpha PSD. The other finding was that higher alpha PSD reactivity is associated to higher long-term behavioral impairments of MF. This work contributes to existing knowledge of MF by providing evidence that the possibility of investigating early electrophysiological biomarkers to predict long-term MF impairments.

Ictal fear is associated with anxiety symptoms and interictal dysphoric disorder in drug-resistant mesial temporal lobe epilepsy.

Interictal dysphoric disorder (IDD) is a poorly understood psychiatric disorder of epilepsy patients. Interictal dysphoric disorder is characterized by depressive, somatoform, and affective symptoms observed in up to 5.9% of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This study aimed to evaluate the association between ictal fear (IF) and the psychiatric symptoms and diagnosis in MTLE-HS patients. We included 116 (54.3% male) consecutive adult patients (36 ±â€¯11 years) with MTLE-HS. Anxiety and depression symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS) and the psychiatric diagnosis were according to Fourth Edition of the Diagnosis and Statistical Manual of Mental Disorders (DSM-IV). The independent association between the occurrence of IF aura and the psychiatric diagnosis was determined by binary regression. When compared to those with other auras or without aura, patients reporting IF have higher HADS anxiety, but not HADS depression, scores. Ictal fear was independently associated with the diagnosis of interictal dysphoric disorder (OR, IC 95% = 7.6, 1.3-43.2, p = 0.02), but not with the diagnosis of anxiety (OR, CI 95% = 0.72, 0.08-6.0, p = 0.73), depression (OR, CI 95% = 0.94, 0.19-4.8, p = 0.94) or psychotic disorders (p = 0.99). Only patients with drug-resistant MTLE-HS were included and the small number of cases with DD diagnosis in the sample. In MTLE-HS patients, the occurrence of IF is associated with higher levels of anxiety symptoms and IDD. The results provide insights about fear-related neural network connections with anxiety symptoms and the IDD in MTLE-HS.

How predictable is cognitive performance in Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy?

OBJECTIVE: The objective of the study was to investigate the independent association between clinical, demographic, psychiatric, radiologic, electrophysiological, and pharmacologic variables and cognitive performance of Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy (MTLE). METHODS: Ninety-three patients with pharmacoresistant MTLE related to hippocampal sclerosis (HS) were included in the study. Multiple linear regressions were done to identify predictor variables for 24 cognitive tests. Independent variables analyzed were sex, hand dominance, age, years of education, marital status, work activity, history for an initial precipitant injury (IPI), family history of epilepsy, lesion side, antiseizure medication (ASM) treatment type, ASM serum levels, benzodiazepine (BDZ) treatment, age at epilepsy onset, disease duration, monthly frequency of seizures, and Hospital Anxiety and Depression Scale (HADS) scores. RESULTS: Years of education was an independent and positive predictor in 22 of the 24 cognitive tests evaluated. Male sex was also a positive predictor of one cognitive test. Variables negatively associated with cognitive performance were left side lesion (10 tests), disease duration (5 tests), polytherapy (3 tests), ASM serum levels (3 tests), and BDZ treatment or not working (1 test each). The regression model explained between 6% and 44% of the cognitive test scores variation. SIGNIFICANCE: In Brazilian patients with pharmacoresistant MTLE-HS, up to 44% of cognitive test scores variation is predictable by clinical, demographic, psychiatric, radiologic, electrophysiology, and pharmacological variables. The identification of predictors of cognitive performance may be helpful for better planning of patient care.

Resting Cardiac Vagal Tone is Associated with Long-Term Frustration Level of Mental Workload: Ultra-short Term Recording Reliability.

Excessive mental workload represent a critical risk factor for workplace accidents. Heart rate variability (HRV) is a non-invasive low cost electrophysiological autonomic biomarker related to emotional and cognitive regulation. Several studies report that mental overload impairs parasympathetic-mediated HRV indices (e.g. rMSSD). However, the influence of resting state HRV as a predictor of long-term mental workload impairments remains unknown. Thirty participants (22 males; 8 females) had their HRV measured (5-min period) before performing the number search task. After the task, the mental load was accessed by the NASA-TLX questionnaire. A simple linear regression model between HRV and NASA-TLX dimensions showed that resting state rMSSD is associated to physical demand (ND-2, R2 = 0.143, p = 0.03) and frustration level (ND-6, R2 = 0.175, p = 0.02) dimensions of mental workload. The comparison between 1 and 5-min epochs suggests that regression models remain reliable even using the ultra-short term HRV (< 1 min) recording values (R2 values from 0.11 to 0.15 for ND-2 and R2 values from 0.16 to 0.19 for ND-6). These results suggest that resting state HRV is associated to long-term effects of mental workload on physical and emotional demands. In addition, the ultra-short term HRV indices remains reliable to assess ND-2 and ND-6 dimensions of mental workload when compared to gold-standard time interval (> 5 min). The resting state cardiac autonomic tone assessment optimizes the physiological approach with a quick, non-invasive and low-cost assessment that can provide insights about mental load adjustments to prevent work-related accidents.

Coping e padrões biológicos de sono em expedicionários antárticos / Coping and biological standards of sleeping in Antarctic expedicionaries

O objetivo deste estudo foi avaliar a variação das estratégias de coping e padrões de sono em 13 expedicionários do sexo masculino da aviação naval no início e ao final de uma expedição de verão à Antártica. Para investigar as variáveis de coping e de sono foram utilizadas a escala BriefCOPE, um questionário de ritmos biológicos e um formulário sociodemográfico para controle de variáveis. As estratégias de coping focadas na emoção do tipo disfuncional aumentaram de maneira significativa ao longo da exposição, e não houve relação entre as alterações nos padrões de sono e as estratégias de coping no início e no fim da exposição ao ambiente. A atenção a fatores psicológicos em ambientes polares pode prevenir acidentes no contexto.

The objective of this study was to evaluate the variation of coping strategies and sleep patterns in 13 male naval aviation expeditioners at the beginning and end of a summer expedition to Antarctica. To investigate the coping and sleep variables, the BriefCOPE scale was used, a biological rhythm questionnaire and a sociodemographic form to control variables. Emotion-focused coping strategies of the dysfunctional type increased significantly throughout the exposure and there was no relationship between changes in sleep patterns and coping strategies between the onset and end of exposure to the environment. Attention to psychological factors in polar environments can prevent accidents in context.

Mapeamento de Estressores no Trabalho de Expedicionários do Programa Antártico Brasileiro (PROANTAR) / Mapping of Stressors in the Work of Expeditionary Brazilian Antarctic Program (PROANTAR)

RESUMO O programa Antártico Brasileiro (PROANTAR) realiza expedições à Antártica, onde militares e civis são expostos a estressores. A presente pesquisa mapeou os estressores ambientais, ocupacionais e interpessoais percebidos por participantes do PROANTAR. Uma amostra de 38 pessoas, separadas em dois grupos, foi avaliada no início e final de uma expedição. Os resultados obtidos por meio de questionários e entrevistas indicaram prevalência de estressores ambientais (60,71%), ocupacionais (23,80%) e interpessoais (15,47%) no início, e de estressores interpessoais (55,97%), ambientais (32,08%) e ocupacionais (11,94%) ao final. Os resultados sugerem que a convivência forçada gera a percepção de estressores interpessoais se sobrepondo aos ambientais. Fenômenos psicológicos deveriam ser considerados no planejamento de futuras expedições, pois estão relacionados à saúde e desempenho das atividades.

ABSTRACT The Brazilian Antarctic Program (PROANTAR) conducts expeditions to Antarctica, where military and civilian are exposed to stressors. The present research mapped the environmental, occupational and interpersonal stressors perceived by PROANTAR participants. A sample of 38 people, separated into two groups, was evaluated at the beginning and end of an expedition. The results obtained through questionnaires and interviews indicated the prevalence of environmental (60.71%), occupational (23.80%) and interpersonal (15.47%) stressors at the beginning, and interpersonal (55.97%), environmental (32.08%) and occupational (11.94%) stressors at the end. The results suggest that the forced coexistence generates the perception of interpersonal stressors overlapping environmental ones. Psychological phenomena should be considered in the planning of future expeditions, as they are related to health and performance of activities.

Adaptações do cérebro durante uma tarefa de longa duração: Um estudo de Potencial Relacionado a Evento / Brain adaptations during a long-time task: An Event-Related Potential (ERP) study

Resumo O objetivo deste estudo é investigar o efeito da demanda cognitiva prolongada na modulação do Potencial Relacionado a Evento (ERP) em um paradigma de controle inibitório. Os dados foram coletados em 19 voluntários destros, com a média de idade de 21,21 (±1,77) anos, que realizaram o paradigma do Go/NoGo durante 50 minutos, com gravação sincronizada do eletroencefalograma para obtenção dos ERPs. O efeito do tempo de realização da tarefa provocou alterações significativas nas variáveis subjetivas, de desempenho cognitivo e nas amplitudes máximas dos componentes N2 e P3. Nossos resultados sugerem que quando nosso cérebro está submetido a demandas cognitivas extensas, ocorrem adaptações para a manutenção do desempenho comportamental através da estratégia de realocação de recursos energéticos.

Abstract The aim of this study is to investigate the effect of prolonged cognitive demand in Event Related Potential (ERP) modulation in inhibitory control paradigm. Data were collected in 19 right-handed volunteers with mean age of 21.21 (±1,77) years who performed the Go/NoGo paradigm for 50 minutes, with synchronized electroencephalogram recording to obtain the ERPs. The time on task effect induced significant changes in subjective variable, cognitive performance and maximum amplitudes of the N2 and P3 component. Our results suggest that when our brain is subjected to extensive cognitive demands, there are adaptations to maintain the behavioral performance through strategy reallocation of energy resources.

Top-down vs. Bottom-up: alterações no processamento de informações durante a indução de fadiga mental / Top-down vs. bottom-up: alterations in information processing during mental fatigueinduction

A Fadiga Mental (FM) ocorre durante ou após um período prolongado de demandacognitiva repetitiva somado a recompensas insatisfatórias. Este estudo pretendeinvestigar alterações no processamento de informações top-down e bottom-up nocontrole inibitório durante a indução de FM através do protocolo de tarefacognitiva por tempo prolongado. Participaram do experimento 19 sujeitos (9homens) com idades entre 18 e 24 anos (M=21,21 DP=1,77), submetidos aoparadigma Go/NoGo contendo cinco blocos de 250 tentativas com intervalos de 30segundos entre blocos, totalizando 50 minutos de atividade. A ANOVA paramedidas repetidas sugere efeito significativo do tempo de realização da tarefa noaumento no tempo de reação do processamento top-down, F4,15 = 3,66, p<0,05, nonúmero de erros por omissão, F4,15 = 4,75, p<0,05, e uma redução no tempo deresposta do processamento bottom-up, F4,15 = 5,39, p<0,05. Estes achadossugerem que a realização de uma tarefa cognitiva durante um período prolongadoprovoca prejuízo significativo no desempenho cognitivo, com ênfase noprocessamento de informações top-down, não impedindo a realização de umcomportamento, mas prejudicando sua qualidade de execução.

Mental Fatigue (FM) occurs during or after a prolonged period of repetitivecognitive demand coupled with unsatisfactory rewards. This study intends toinvestigate changes in the processing of top-down and bottom-up information oninhibitory control during FM induction through the cognitive task protocol for aprolonged time. A total of 19 subjects (9 males) aged 18 to 24 years (M = 21.21 SD= 1.77) were submitted to the Go / NoGo paradigm containing five blocks of 250trials with 30-second intervals between blocks, totalizing 50 minutes of activity.The ANOVA for repeated measures suggests a significant effect of the time ofaccomplishment of the task in the increase in the time of reaction of the top-downprocessing, F4,15 = 3.66, p <0.05, in the number of errors by default, F4,15 = 4.75, p<0.05, and a reduction in response time of bottom-up processing, F4.15 = 5.39, p<0.05. These findings suggest that performing a cognitive task over a prolongedperiod causes significant impairment in cognitive performance, with an emphasison top-down information processing, not hindering the performance of a behaviorbut impairing its quality of execution.

Top-down vs. Bottom-up: alterações no processamento de informações durante a indução de fadiga mental / Top-down vs. bottom-up: alterations in information processing during mental fatigue induction

A Fadiga Mental (FM) ocorre durante ou após um período prolongado de demanda cognitiva repetitiva somado a recompensas insatisfatórias. Este estudo pretende investigar alterações no processamento de informações top-down e bottom-up nocontrole inibitório durante a indução de FM através do protocolo de tarefa cognitiva por tempo prolongado. Participaram do experimento 19 sujeitos (9 homens) com idades entre 18 e 24 anos (M=21,21 DP=1,77), submetidos ao paradigma Go/NoGo contendo cinco blocos de 250 tentativas com intervalos de 30 segundos entre blocos, totalizando 50 minutos de atividade. A ANOVA para medidas repetidas sugere efeito significativo do tempo de realização da tarefa no aumento no tempo de reação do processamento top-down, F4,15 = 3,66, p<0,05, no número de erros por omissão, F4,15 = 4,75, p<0,05, e uma redução no tempo de resposta do processamento bottom-up, F4,15 = 5,39, p<0,05. Estes achados sugerem que a realização de uma tarefa cognitiva durante um período prolongado provoca prejuízo significativo no desempenho cognitivo, com ênfase no processamento de informações top-down, não impedindo a realização de um comportamento, mas prejudicando sua qualidade de execução.

Mental Fatigue (FM) occurs during or after a prolonged period of repetitivecognitive demand coupled with unsatisfactory rewards. This study intends toinvestigate changes in the processing of top-down and bottom-up information oninhibitory control during FM induction through the cognitive task protocol for aprolonged time. A total of 19 subjects (9 males) aged 18 to 24 years (M = 21.21 SD= 1.77) were submitted to the Go / NoGo paradigm containing five blocks of 250trials with 30-second intervals between blocks, totalizing 50 minutes of activity.The ANOVA for repeated measures suggests a significant effect of the time ofaccomplishment of the task in the increase in the time of reaction of the top-downprocessing, F4,15 = 3.66, p <0.05, in the number of errors by default, F4,15 = 4.75, p<0.05, and a reduction in response time of bottom-up processing, F4.15 = 5.39, p<0.05. These findings suggest that performing a cognitive task over a prolongedperiod causes significant impairment in cognitive performance, with an emphasison top-down information processing, not hindering the performance of a behaviorbut impairing its quality of execution.