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1.
Ann Neurol ; 92(3): 400-410, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35688801

RESUMO

OBJECTIVE: Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal transcranial direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. METHODS: This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to the Behavior Inattention Test-Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 minutes of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale), autonomy (Barthel Index, Functional Independence Measure), and quality of life (EuroQol Group 5-Dimension Self-Report Questionnaire). Outcomes were analyzed using an analysis of covariance model corrected by age, baseline NIHSS, and baseline BIT-C. Pairwise post hoc comparisons were performed using Bonferroni correction. RESULTS: In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (mean difference [MD] = 18.4, 95% confidence interval [CI] = 3.9-32.8, p = 0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD = 13.9, 95% CI = -0.3 to 28.1, p = 0.057), or C-tDCS and sham (MD = 4.5, 95% CI = -9.7 to 18.8, p = 0.99). There were no significant differences between groups in terms of secondary outcomes. INTERPRETATION: A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase 3 trial. ANN NEUROL 2022;92:400-410.


Assuntos
Transtornos da Percepção , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Encéfalo , Humanos , Transtornos da Percepção/etiologia , Transtornos da Percepção/terapia , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Resultado do Tratamento
2.
Cerebellum ; 19(4): 536-543, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32367276

RESUMO

Spinocerebellar ataxias type 3 (SCA3) and type 10 (SCA10) are the most prevalent in southern Brazil. To analyze the relationships between volumetric MRI changes and clinical and genetic findings in SCA3 and SCA10 patients. All patients in the study had a confirmed genetic diagnosis. Demographic data, ataxia severity (SARA score), and the size of the expanded alleles were evaluated. Nineteen SCA3 and 18 SCA10 patients were selected and compared with a similar number of healthy controls. Patient and control groups underwent the same MRI protocol. The standard FreeSurfer pipeline was used for the morphometric data. Our results show more affected brain structures (volume reductions) in SCA3 patients than in SCA10 patients (15 vs. 5 structures). Volume reductions in brain structures were also greater in the former. The main areas with significant volumetric reductions in the former were the cerebellum, basal ganglia, brain stem, and diencephalon, whereas in the latter, significant volume reductions were observed in the cerebellum and pallidum. While SARA scores and disease duration were more correlated with volume reduction in SCA10, in SCA3, the expansion length (CAGn) correlated positively with cerebellar WM, thalamus, brain stem, and total GM volumes. There was no correlation between expansion length (ATTCTn) and neuroimaging findings in SCA10. Neuroimaging results differed significantly between SCA3 and SCA10 patients and were compatible with the differences in clinical presentation, disease progression, and molecular findings.


Assuntos
Encéfalo/diagnóstico por imagem , Doença de Machado-Joseph/diagnóstico por imagem , Ataxias Espinocerebelares/diagnóstico por imagem , Adulto , Encéfalo/patologia , Expansão das Repetições de DNA , Feminino , Humanos , Doença de Machado-Joseph/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ataxias Espinocerebelares/patologia
3.
Epilepsia ; 60(4): 679-688, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30854641

RESUMO

OBJECTIVE: To analyze the lifetime trajectories in genetic generalized epilepsies (GGEs) and investigate the impact of symptoms of anxiety and depression on resting state functional connectivity (FC). METHODS: Seventy-four GGE patients were classified according to the pharmacological response as seizure-free (12 patients), pharmacoresistant (PhR; 14 patients), and fluctuating (FL; 48 patients). Fifty-four subjects completed both the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and 38 also underwent 3-T resting state functional magnetic resonance imaging. These 38 patients were subdivided into a positive group (13 patients with concurrent symptoms of depression and anxiety) and a negative group (21 asymptomatic patients and four with mild anxiety or depression symptoms). For FC analysis of resting state networks, we matched 38 healthy asymptomatic volunteers and used the UF2C toolbox running on MATLAB2017/SPM12. RESULTS: The PhR group presented shorter duration of epilepsy (P = 0.016) and follow-up (P < 0.001) compared to the FL group. The PhR group showed higher levels (median = 20) on the BAI and BDI. Myoclonic seizures were the most difficult to control, as 50% of subjects persisted with them at last appointment, compared to generalized tonic-clonic seizures and absence seizures (<40%). Patients with concurrent anxiety and depression symptoms were 7.7 times more likely to exhibit pharmacoresistant seizures, although an increase of 1 year of epilepsy duration was associated with a decrease in the odds of presenting pharmacoresistance by a factor of 0.9. Overall, FC was altered between default mode network (DMN) and visuospatial/dorsal attention. However, only the positive group displayed abnormal FC between DMN and left executive control network, and between salience and visuospatial/dorsal attention. SIGNIFICANCE: Our findings may help clinicians to have a better understanding of GGE clinical course and increase attention to the potential relationship of psychopathologies and brain connectivity.


Assuntos
Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Depressão/fisiopatologia , Epilepsia Generalizada/fisiopatologia , Epilepsia Generalizada/psicologia , Adolescente , Adulto , Ansiedade/complicações , Criança , Depressão/complicações , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Vias Neurais/fisiopatologia , Adulto Jovem
4.
World Neurosurg ; 189: e948-e952, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39002773

RESUMO

BACKGROUND: Decompressive craniectomy substantially reduces mortality and disability rates following a malignant stroke. This procedure remains a life-saving option, especially in contexts with little access to mechanical thrombectomy despite downward trends in the performance of decompressive craniectomy due to discussions on the acceptance of living with severe disabilities. However, the outcomes of the surgery in cases involving concomitant occlusion of anterior or posterior cerebral arteries have not been extensively studied. METHODS: In this retrospective cohort study, spanning January 2010 to December 2022 and including patients who underwent decompressive craniectomy, we compared outcomes between patients with and without additional vascular territory involvement. Independent variables included age, sex, comorbidities, admission National Institutes of Health Stroke Scale and Glasgow Coma Scale scores, time elapsed between stroke and surgery, laterality of the stroke, midline shift, and postoperative infarction volume. Outcomes included mortality and modified Rankin Score at the 3-month follow-up. RESULTS: Of the 86 patients analyzed, 61 (70.9%) and 25 (29.1%) demonstrated no territory and additional territory involvement, respectively. Patients with involvement of additional territories exhibited lower admission Glasgow Coma Scale scores, higher National Institutes of Health Stroke Scale scores, and larger postoperative infarction volumes. However, these variables were not associated with poor outcomes. Univariate analyses revealed no differences in mortality or severe disability. Even after adjustment, the differences remained insignificant for mortality and severe disability. Age emerged as the sole variable linked to increased mortality. CONCLUSIONS: Our data suggest that, for patients with malignant stroke undergoing decompressive craniectomy, the outcomes for patients with and without involvement of additional vascular territory are similar.


Assuntos
Craniectomia Descompressiva , Acidente Vascular Cerebral , Humanos , Craniectomia Descompressiva/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento , Estudos de Coortes , Adulto
5.
Epilepsy Behav ; 27(1): 22-8, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23357730

RESUMO

BACKGROUND/PURPOSE: Juvenile myoclonic epilepsy (JME) is the most frequent subsyndrome of the idiopathic generalized epilepsies, and experimental investigations support that the thalamus is a key structure in the mechanisms of JME. Texture analysis (TA) is an image processing technique which can be used to characterize images such as MRI. OBJECTIVE: The goal of this work was to investigate the thalamus of patients with JME using TA, a quantitative neuroimaging technique. METHODS: Patients and controls were submitted to MRI investigation. Images were acquired in a 2-Tesla scanner. The T1 volumetric sequence was used for thalamic segmentation and extraction of texture parameters. Twenty-four patients with a diagnosis of JME and 20 healthy volunteers were investigated. RESULTS: Texture analysis revealed differences between the right thalamus of patients and controls. CONCLUSIONS: The present investigation supports the participation of the thalamus in the disease mechanisms of JME. Texture analysis may be a useful tool in the quantitative neuroimaging investigation of the epilepsies and can be important to understand JME.


Assuntos
Mapeamento Encefálico , Encéfalo/patologia , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Epilepsia Mioclônica Juvenil/patologia , Adulto , Meios de Contraste , Feminino , Análise de Fourier , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
6.
J Clin Neurophysiol ; 39(6): 466-473, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394821

RESUMO

PURPOSE: Triphasic waves (TWs), a common EEG pattern, are considered a subtype of generalized periodic discharges. Most patients with TWs present with an altered level of consciousness, and the TW pattern is believed to represent thalamocortical dysfunction. However, the exact meaning and mechanism of TWs remain unclear. The objective of the current study was to evaluate the source of TWs using EEG source imaging and computerized tomography. METHODS: Twenty-eight patients with TWs were investigated. Source analysis was performed on the averaged TWs for each individual, and source maps were extracted. Normalization and automatic segmentation of gray matter were performed on computerized tomography scans before analysis. Finally, voxelwise correlation analyses were conducted between EEG source maps and gray matter volumes. RESULTS: Source analyses showed that the anterior cingulate cortex was mainly involved in TWs (16/28 patients, 57%). Correlation analyses showed moderate positive and negative correlations between source location and gray matter volumes for the posterior cingulate ( T = 2.85; volume = 6,533 mm 3 ; r = 0.53; P = 0.002) and the superior frontal gyrus ( T = 2.54; volume = 18,167 mm 3 ; r = -0.48; P < 0.0001), respectively. CONCLUSIONS: The results suggest that the anterior cingulate is involved in the origin of TWs. Furthermore, the volumes of posterior brain regions were positively correlated with TWs, indicating a possible preservation of these structures. Conversely, the volumes of anterior regions were negatively correlated with TWs. These findings may indicate a structural pattern necessary for the generation of the abnormal network responsible for TWs.


Assuntos
Córtex Cerebral , Neuroimagem , Encéfalo/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos
7.
Codas ; 33(4): e20200019, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34231751

RESUMO

PURPOSE: Aphasia is a common and debilitating manifestation of stroke. Transcranial electrical stimulation uses low-intensity electric currents to induce changes in neuronal activity. Recent evidence suggests that noninvasive techniques can be a valuable rehabilitation tool for patients with aphasia. However, it is difficult to recruit patients with aphasia for trials, and the reasons for this are not well understood. This study aimed to elucidate the main difficulties involved in patient's recruitment and inclusion in a randomized clinical study of neuromodulation in aphasia. METHODS: We evaluated the reasons for the exclusion of patients in a pilot, randomized, double-blinded clinical trial in which patients diagnosed with motor aphasia after stroke were recruited from March to November 2018. A descriptive statistical analysis was performed. RESULTS: Only 12.9% (4) of patients with ischemic stroke were included in the clinical trial. A total of 87.1% (27) of the 31 recruited patients were excluded for various reasons including: sensory aphasia (32.2%), dysarthria (25.8%), spontaneous clinical recovery (16.1%), previous stroke (6.4%), and death or mutism (3.2%). CONCLUSION: The presence of other types of aphasia, dysarthria, spontaneous recovery, deaths, and mutism were barriers to recruiting patients evidenced in this neuromodulation study.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Afasia de Broca , Humanos , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações
8.
Neuroimage ; 49(1): 71-9, 2010 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-19683060

RESUMO

BACKGROUND: The reasons for surgical failure in 30% of patients with unilateral mesial temporal lobe epilepsy (MTLE) are still unclear. We investigated if different outcomes could be associated to different patterns of subtle gray matter atrophy (GMA) and white matter atrophy (WMA), and searched for postoperative magnetic resonance imaging (MRI) changes. METHODS: We studied 69 controls and 67 operated patients with refractory unilateral MTLE. Patients were grouped as seizure-free (SF) group (34 patients Engel's IA), worthwhile improvement group (23 patients, Engel's IB-IIA) and failure group (10 patients Engel's IIB-IV). We created a voxel-based morphometry/MATLAB code to mask the surgical lacuna, and performed t-test and paired t-test to evaluate preoperative and postoperative MRI scans. RESULTS: Failure group showed a widespread pattern of preoperative GMA. On SF and improvement groups we identified a more restricted pattern of GMA. The three groups presented a widespread, bilateral pattern of WMA. In contrast, postoperative analyses showed bilateral hemispheric recovery (a relative increase of WM concentration) on SF and improvement groups, but few changes on failure group. We also identified areas with relative postoperative increase of GM on both SF and improvement groups, more widespread on SF group. CONCLUSION: Areas of subtle GMA may be related to poorer surgical outcome. In addition, we demonstrated a postoperative relative increase of WM and GM concentration associated with seizure control. These changes may represent neuroplasticity related to improvement of brain function after seizure control. Further studies with a multimodal approach may help to predict surgical outcome and improve selection of patients for surgical treatment of MTLE.


Assuntos
Encéfalo/patologia , Encéfalo/cirurgia , Epilepsia do Lobo Temporal/patologia , Epilepsia do Lobo Temporal/cirurgia , Procedimentos Neurocirúrgicos , Adulto , Encéfalo/diagnóstico por imagem , Eletroencefalografia , Epilepsia do Lobo Temporal/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18 , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/patologia , Período Pós-Operatório , Convulsões/patologia , Convulsões/cirurgia , Resultado do Tratamento
9.
Front Neurol ; 11: 569943, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33324321

RESUMO

Objective: Investigate areas of correlation between gray matter volumes by MRI and interictal EEG source maps in subtypes of mesial temporal lobe epilepsy (MTLE). Method: 71 patients and 36 controls underwent 3T MRI and and routine EEG was performed. Voxel-based morphometry (VBM) was used for gray matter analysis and analysis of interictal discharge sources for quantitative EEG. Voxel-wise correlation analysis was conducted between the gray matter and EEG source maps in MTLE subtypes. Results: The claustrum was the main structure involved in the individual source analysis. Twelve patients had bilateral HA, VBM showed bilateral hippocampal. Twenty-one patients had right HA, VBM showed right hippocampal and thalamic atrophy and negatively correlated involving the right inferior frontal gyrus and insula. Twenty-two patients had left HA, VBM showed left hippocampal atrophy and negatively correlated involving the left temporal lobe and insula. Sixteen patients had MTLE without HA, VBM showed middle cingulate gyrus atrophy and were negatively correlated involving extra-temporal regions, the main one located in postcentral gyrus. Conclusions: Negative correlations between gray matter volumes and EEG source imaging. Neuroanatomical generators of interictal discharges are heterogeneous and vary according to MTLE subtype. Significance: These findings suggest different pathophysiological mechanisms among patients with different subtypes of MTLE.

10.
PLoS One ; 15(6): e0231169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502204

RESUMO

Known as a degenerative and progressive dementia, Alzheimer's disease (AD) affects about 25 million elderly people around the world. This illness results in a decrease in the productivity of people and places limits on their daily lives. Electroencephalography (EEG), in which the electrical brain activity is recorded in the form of time series and analyzed using signal processing techniques, is a well-known neurophysiological AD biomarker. EEG is noninvasive, low-cost, has a high temporal resolution, and provides valuable information about brain dynamics in AD. Here, we present an original approach based on the use of quantile graphs (QGs) for classifying EEG data. QGs map frequency, amplitude, and correlation characteristics of a time series (such as the EEG data of an AD patient) into the topological features of a network. The five topological network metrics used here-clustering coefficient, mean jump length, betweenness centrality, modularity, and Laplacian Estrada index-showed that the QG model can distinguish healthy subjects from AD patients, with open or closed eyes. The QG method also indicates which channels (corresponding to 19 different locations on the patients' scalp) provide the best discriminating power. Furthermore, the joint analysis of delta, theta, alpha, and beta wave results indicate that all AD patients under study display clear symptoms of the disease and may have it in its late stage, a diagnosis known a priori and supported by our study. Results presented here attest to the usefulness of the QG method in analyzing complex, nonlinear signals such as those generated from AD patients by EEGs.


Assuntos
Doença de Alzheimer/diagnóstico , Eletroencefalografia , Processamento de Sinais Assistido por Computador , Envelhecimento/fisiologia , Gráficos por Computador , Humanos
11.
Sleep ; 43(2)2020 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-31552419

RESUMO

STUDY OBJECTIVES: Elements impairing upper airway anatomy or muscle function (e.g. pharyngeal neuromyopathy) contribute to obstructive sleep apnea syndrome (OSAS). Structural brain imaging may differ in patients with OSAS according to dilator muscle dysfunction. Magnetic resonance imaging (MRI) with voxel-based morphometry (VBM) and surface-based morphometry (SBM) was used to investigate this hypothesis. METHODS: Eighteen patients with OSAS and 32 controls underwent 3T brain MRI. T1 volumetric images were used for structural analysis. Pharyngeal electroneuromyography was performed; patients with OSAS were classified as with or without neuromyopathy. VBM and SBM analyses were conducted using SPM12 and CAT12 software. Image processing was standard. Cortical surface parameters and gray and white matter volumes from participants with OSAS with and without neuromyopathy were compared with those from controls. RESULTS: Eleven patients had OSAS with neuromyopathy and seven patients had OSAS without neuromyopathy (normal pharyngeal electroneuromyography). Comparing these groups to the controls, VBM revealed: four clusters (total volume 15,368 mm3) for patients with neuromyopathy, the largest cluster in the left cerebellum (9,263 mm3, p = 0.0001), and three clusters (total 8,971 mm3) for patients without neuromyopathy, the largest cluster in the left cerebellum (5,017 mm3, p = 0.002). Patients with OSAS with neuromyopathy showed increased proportion of atrophy (p < 0.0001). SBM showed abnormalities in patients without neuromyopathy (decreased cortical thickness, left precentral gyrus [672 vertices, p = 0.04]; increased cortical complexity, right middle temporal gyrus [578 vertices, p = 0.032]). CONCLUSION: Damaged areas were larger in patients with OSAS with than in those without neuromyopathy, suggesting differences in brain involvement. Patients with OSAS and neuromyopathy may be more susceptible to cerebral damage.


Assuntos
Doenças Musculares , Apneia Obstrutiva do Sono , Encéfalo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Neuroimagem , Faringe , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagem
12.
Front Neurol ; 9: 256, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29720958

RESUMO

BACKGROUND: The crossed leg sign in patients with right hemisphere stroke is thought to be associated with perceptual disorders, such as unilateral spatial neglect (USN). The aim of this study was to compare the crossed leg sign with the severity of USN during the acute phase of stroke. EXPERIMENTAL PROCEDURES: This was an observational and prospective clinical study of individuals with a diagnosis of right parietal stroke, as confirmed by neuroimaging. The occurrence of the crossed leg sign, the time at which this occurred after the stroke, and a clinical diagnosis of USN were measured and recorded. The patients' age, sex, and lesion severity, as determined by the National Institutes of Health Stroke Scale and Glasgow coma scale, were included in the analyses as confounding variables. The outcome of interest was the degree of USN, as measured by the cancellation and bisection tests. Binary logistic regression was used to analyze the effect of crossed leg syndrome on the severity of USN. In the adjusted multiple regression model, a p-value of <0.05 was considered statistically significant. RESULTS: Overall, 60 patients were included in this study. There were no associations between patient demographics and the presence of the crossed leg sign. There was, however, an association between the crossed leg sign and the absolute value of the deviation in the line bisection test (B = -0.234; p = 0.039). The crossed leg sign was not associated with other measures of USN. CONCLUSION: Based on the results of our study, we can conclude that a crossed leg sign in the acute phase of stroke is associated with USN severity, specifically the misinterpretation of the midline.

13.
Arq Neuropsiquiatr ; 76(10): 654-662, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30427504

RESUMO

OBJECTIVE: Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. METHODS: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. RESULTS: Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. CONCLUSION: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.


Assuntos
Neuroimagem/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Terapia de Exposição à Realidade Virtual/métodos , Atividades Cotidianas , Adulto , Idoso , Feminino , Substância Cinzenta/lesões , Humanos , Cápsula Interna/lesões , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento , Extremidade Superior , Substância Branca/lesões
14.
Neuroimage Clin ; 19: 302-310, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30013913

RESUMO

Branched-chain amino acids increase the brain perfusion of patients with hepatic encephalopathy (HE), but the amino acid and the mechanisms involved are still unknown. This study compared brain perfusion and clinical improvement during leucine or isoleucine supplementation. After randomization, 27 subjects with cirrhosis and HE received leucine or isoleucine supplements for one year. Brain single Photon Emission Computed Tomography (SPECT) and dynamic brain scintigraphy (DBS) were performed pretreatment and at 1, 8 and 12 months of supplementation. Brain perfusion was increased only in the isoleucine group at 8 months of treatment by both SPECT and DBS (p < 0.001 and p = 0.05, respectively) and by SPECT at the 12th month (p < 0.05). This was associated with hepatic encephalopathy improvement at 8 and 12 months (p = 0.008 and 0.004, respectively), which was not observed in the leucine group (p = 0.313 and 0.055, respectively). Isoleucine supplementation achieved a better impact on brain perfusion restoration in HE.


Assuntos
Encéfalo/efeitos dos fármacos , Circulação Cerebrovascular/efeitos dos fármacos , Encefalopatia Hepática/diagnóstico por imagem , Isoleucina/farmacologia , Leucina/farmacologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Circulação Cerebrovascular/fisiologia , Método Duplo-Cego , Feminino , Encefalopatia Hepática/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada de Emissão , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
16.
Epilepsy Res ; 132: 100-108, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28376388

RESUMO

PURPOSE: Quantitative techniques of diffusion analysis allow for an in-vivo investigation of the physiopathology of epilepsies. The objective of this study was to evaluate the variation of the main diffusion parameters and explore differences between two methodologies of voxel-wise analysis comparing a group of patients with mesial temporal lobe epilepsy (MTLE) with controls. METHODS: 24 patients with a diagnosis of MTLE were selected. All patients and a control group of 36 individuals were submitted to 3T magnetic resonance imaging. Diffusion parameters were obtained from the raw images. Based on the tensors, a customized template was created, and images were registered into standard space. Voxel-based comparisons between patients and controls was performed by whole brain voxel-wise analysis and tract-based spatial statistics (TBSS). Tract-specific analysis (TSA) was performed in the mostly damaged fasciculi. RESULTS: 10 patients presented with right hippocampal sclerosis (HS), 11 with left HS and 3 with bilateral HS with left predominance. Whole brain voxel-wise analysis showed abnormalities mainly localized in the temporal lobes (total volume of 3859mm3). TBSS showed more widespread abnormalities (21931mm3). TSA pointed to abnormalities situated essentially in the temporal stem topography. Fractional anisotropy (FA) and radial diffusivity (RD) were the parameters that showed more abnormalities. CONCLUSION: Whole brain voxel-wise analysis was more restricted than TBSS. The methods were complementary stressing the significance of the findings. The abnormalities were more frequently observed in FA and RD indicating the need for using several diffusion parameters for the investigation of patients with MTLE.


Assuntos
Imagem de Tensor de Difusão , Epilepsia do Lobo Temporal/diagnóstico por imagem , Adulto , Idoso , Anisotropia , Imagem de Tensor de Difusão/métodos , Feminino , Hipocampo/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Esclerose/patologia , Lobo Temporal/diagnóstico por imagem , Substância Branca/patologia , Adulto Jovem
17.
Front Neurol ; 8: 24, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28220103

RESUMO

A 59-year-old man was admitted with respiratory tract infection, compromised conscience and generalized tonic-clonic seizures. His medical history included schizophrenia diagnosis, for which he had been being treated since he was 27 years old. EEG disclosed non-convulsive status epilepticus. A magnetic resonance image (MRI) acquired 3 days later showed increased left hippocampal volume with hyperintensity on T2-weighted and FLAIR sequences. After being treated with antibiotics and antiepileptic medications, the patient's condition improved. A follow-up MRI showed reduction of the left hippocampus. The relationship between epilepsy and schizophrenia is not yet clear. This case illustrates this interaction. Hippocampal atrophy may have been caused by environmental aggression in the present patient with schizophrenia, perhaps in association with a predisposing genotype.

18.
Arch Neurol ; 62(6): 1008-10, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15956175

RESUMO

BACKGROUND: Schistosoma mansoni is a parasitic trematoid worm that infects humans. Schistosomiasis is endemic in parts of South America, sub-Saharan Africa, the Middle East, and some Caribbean islands. Disorders of the liver and gastrointestinal tract are the most common clinical manifestations. The central nervous system is not usually affected. The most common neurologic manifestation is transverse myelitis. In some circumstances, the eggs of S. mansoni are found in the brain, causing inflammatory reaction. OBJECTIVE: To describe a young Brazilian patient with partial epileptic seizures caused by a granulomatous lesion due to S. mansoni. CONCLUSION: In endemic areas or in patients with a positive epidemiological history, schistosomiasis must be considered as a possible diagnosis of seizures, particularly when they are associated with granulomatous lesions on magnetic resonance imaging.


Assuntos
Córtex Cerebral/fisiopatologia , Córtex Cerebral/parasitologia , Neuroesquistossomose/diagnóstico , Neuroesquistossomose/fisiopatologia , Convulsões/diagnóstico , Convulsões/parasitologia , Adulto , Humanos , Masculino
19.
Arq Neuropsiquiatr ; 73(12): 1005-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26465286

RESUMO

OBJECTIVE: The objective of this study was to prospectively evaluate the International Classification of Headache Disorders I (ICHD-I) diagnostic criteria for migraine in children and adolescents. METHODS: 150 pain diaries were analyzed during an initial consultation. The duration of migraine headache attacks were divided into 2 groups: Group I, for attacks lasting > 2 hours, and Group II, for attacks lasting < 2 hours.The two groups were statistically compared using Fisher's exact test (p < 0.05). RESULTS: In this study, 51(34%) subjects were male and 99 (66%) were female, aged 7-15 years. Fisher's exact test demonstrated that the ICHD-3 beta had a 58% sensitivity for Group I diagnoses and a 94% sensitivity for Group II diagnoses (p < 0.001). CONCLUSION: The current ICHD-3 beta classification improves and advances migraine diagnosis in children and adolescents; however, more research is needed to identify additional characteristics of headache in this age group.


Assuntos
Classificação Internacional de Doenças , Transtornos de Enxaqueca/diagnóstico , Adolescente , Criança , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/classificação , Transtornos de Enxaqueca/complicações , Medição da Dor , Estudos Prospectivos , Sensibilidade e Especificidade
20.
Arq Neuropsiquiatr ; 61(4): 1045-70, 2003 Dec.
Artigo em Português | MEDLINE | ID: mdl-14762617

RESUMO

Epilepsy is a frequent condition in the world. Recently a study in Brazil showed prevalence of 18/1000 inhabitants in São José do Rio Preto, São Paulo State. In the last decade, new therapeutic options were discovered or developed. The main therapeutic decision method is based on randomized clinical trials. This method represents the higher level of evidence. However, even these studies have limitations and in some cases the treatment of choice remains controversial. In these instances, the epilepsy experts' opinions become helpful. In 2001 a similar study had been conducted in USA. The aim of this study is to create guidelines for epilepsy treatment based on the opinion of the Brazilian experts. These guidelines can be used to create manuals and strategies for the treatment of some epileptic syndromes according to Brazilian experts. As compared to the North-American guidelines our study better reflects the resources available in our country.


Assuntos
Anticonvulsivantes/uso terapêutico , Consenso , Epilepsia/tratamento farmacológico , Anticonvulsivantes/economia , Brasil , Intervalos de Confiança , Interpretação Estatística de Dados , Quimioterapia Combinada , Epilepsias Parciais/tratamento farmacológico , Epilepsia Generalizada/tratamento farmacológico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários
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