腦癎症患者在心理和認知能力方面都承受著沉重的壓力。近年，腦癎症與心理狀態的互動關係得到廣泛重視。研究指出，心理治療能夠提升腦癎症患者的心理狀態及生活質素；部份結果更顯示能減少腦癎的發病次數。 / 本研究目的在於了解香港腦癇症患者當中，藥物難治性患者及藥物有效性患者的心理狀態與認知能力。另外，研究以隨機單盲對照的方式，探討靜觀治療小組及社交支援小組對藥物難治性患者在心理健康、生活質素、認知能力及腦癇病發模式的影響。最後，研究為腦外科手術對腦癎症患者心理狀態與認知能力的影響作探索性的研究。 / 研究共邀請186 名腦癇症患者參與。結果發現，在藥物難治性患者當中 (84 例)，39.3%和 29.8%有中度至嚴重的抑鬱症狀和焦慮症狀；相對地，在藥物有效性患者當中 (102 例)，只有15.7%和6.9%有相同程度的抑鬱和焦慮症狀。此外，認知功能損失在患者中十分普遍，尤以語言記憶、視覺專注力、聽覺專注力及工作記憶最為顯著。在藥物難治性患者當中，靜觀治療小組和社交支援小組均有效提升生活質素及減少發病次數(60 例)。比較而言，靜觀治療小組(30 例)比社交支援小組(30 例)更有效減低抑鬱及焦慮症狀，減少發病次數和提升延遲記憶功能。在14 個接受腦外科手術的組群中，於非語言優勢半球進行手術的患者和術後痊癒的患者於整體生活質素方面均有顯著提升。 / 整體結果顯示，在腦癎症患者當中，藥物難治性患者在心理健康、生活質素及認知能力方面，都明顯比藥物有效性患者承受著更大的壓力。另外，短期的心理小組治療有效提升藥物難治性患者的心理健康、生活質素、認知功能以及減低發作次數及減輕發作嚴重性。最後，腦外科手術的探索性研究結果，對術前進行輔導及對術後的預測有輔助的作用。 / 隨著對腦癎症治療的不斷發展，醫療配套方案中需要更具科學實證的心理治療作為輔助療法，以令患者達至身心健康。我們建議加強這範疇的研究工作。另外，研究亦應進一步探討心理治療為患者帶來進步的可持續性，使心理治療能更有效地在臨床上應用。 / Patients with epilepsy (PWEs) experience extensive psychological and cognitive disturbances. Increasing emphasis has been placed on the bidirectional interaction between seizure and psychological states, couples with accumulating evidences suggesting the potential effects of psycho-behavioural therapy on improving well-being and seizure control in PWEs. / This study has three levels of objectives. First, it aims to establish the neurocognitive and psychological profiles of PWEs with different drug-responsiveness in Hong Kong Chinese adults. Second, the effect of a mindfulness-based therapy (MBT) in people with drug-resistant epilepsy is examined against an attention-placebo control, social support (SS) groupusing a prospective assessor-blinded randomized controlled trial. Third, the neuropsychological effects of neurosurgery are explored. / A total of 186 PWEs were recruited. In the 84 patients with drug-resistant epilepsy, 39.3% and 29.8% reported moderate to severe level of anxiety and depression, respectively; versus 15.7% and 6.9% in patients with drug-responsive epilepsy (n = 102). Neurocognitive deficits were prevalent, particularlyin verbal recall memory, visual attention, auditory attention and working memory. The effects of the psycho-behavioural therapy were demonstrated. Specifically, patients received MBT (n = 30) showedsignificantly more improvement at post-intervention compared to the SS group (n=30) in terms of psychological well-being, seizure control and delayed memory function. For patients who underwent neurosurgery (n=14), those who received operation on their non-language dominant hemisphere and those who enjoyed post-operative seizure freedom reported significantly higher quality of life compared to their counterparts whose received operation on their language-dominant hemisphere and those whose seizure persisted. / Our findings established the neuropsychological and cognitive profiles of PWEs and revealed particular vulnerabilities in patients who were resistant to pharmacological treatment. We demonstrated the effects of short-term psycho-behavioural intervention in terms of improving psychological well-being, seizure control and neurocognitive function. Finally, our exploratory study on patients who underwent neurosurgery enhanced our understanding towards post-operative psycho-behavioural conditions on different types of patients, which was clinically important for pre-operative decision making. / Further research in local population focusing on neuro-psycho-behavioural aspects of epilepsy is crucial. The sustainability of the positive effects associated with the psycho-behavioural intervention should be carefully addressed in later study. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Tang, Yu Hing. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 131-158). / Abstracts also in Chinese; appendixes includes Chinese. / Tang, Yu Hing.

Orientadores: Marilisa Mantovani Guerreiro, Catarina Abrão Guimarães / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T22:11:29Z (GMT). No. of bitstreams: 1 Neri_MarinaLiberalesso_D.pdf: 1266603 bytes, checksum: 21ed75ba94dfafe79f7d15127e020891 (MD5) Previous issue date: 2012 / Resumo: A epilepsia benigna da infância com pontas centrotemporais (EBIPCT) ou rolândica (ER) é a forma mais freqüente de epilepsia na infância e é classificada como sendo focal, genética e de evolução benigna. Apesar de não haver déficit intelectual, essas crianças podem apresentar alterações cognitivas específicas. O presente estudo teve como objetivos: identificar e descrever alterações de funções executivas em crianças com ER e verificar a influência de variáveis clínicas da epilepsia nas funções executivas. Os participantes foram submetidos à aplicação de testes de funções executivas. Foram incluídas crianças com diagnóstico clínico e eletroencefalográfico de ER. A maioria dos pacientes estava controlada e muitos deles encontravam-se sem medicação. Os resultados obtidos foram comparados com os de um grupo de crianças de um grupo-controle (GC) constituído de indivíduos normais, com idade e nível sócio-educacional semelhantes ao das crianças com epilepsia. Os dados coletados nos dois grupos foram analisados e comparados através dos testes estatísticos: Mann-Whitney, teste Qui-quadrado e teste Exato de Fisher. Os resultados mostraram que quanto aos dados numéricos crianças com ER obtiveram pior desempenho em cinco das seis categorias consideradas do Wisconsin Card Sorting Test (WCST): nº de erros, nº de erros perseverativos, nº de respostas perseverativas, nº de categorias completadas e nº de fracassos em manter o set. Considerando-se resultados categóricos crianças com ER obtiveram pior desempenho no Trail Making Test (TMT) parte B, no Teste de fluência verbal FAS e em três categorias do WCST: nº de erros, nº de erros perseverativos e nº de respostas perseverativas. Em relação à variável idade de início da epilepsia, crianças com início mais precoce apresentaram pior desempenho em um dos instrumentos utilizados quando comparadas com crianças com início mais tardio da epilepsia; em relação às demais variáveis da epilepsia, não foi possível qualquer tipo de análise; quanto às variáveis das crises, não houve diferença nos resultados obtidos pelos pacientes divididos em grupos. Diante desses resultados concluímos que: as crianças com ER apresentaram déficit em funções executivas quando comparadas com o grupo-controle; a bateria utilizada mostrou-se adequada para detecção das disfunções apresentadas pelas crianças com ER; em relação à variável da epilepsia idade de início, crianças com início mais precoce apresentaram pior desempenho do que crianças com início mais tardio da epilepsia; em relação às demais variáveis da epilepsia e às variáveis das crises, não houve diferença entre os dois grupos. Assim, nosso estudo segue a linha de raciocínio de que o termo benigno deve ser usado com cautela uma vez que nossos pacientes apresentaram déficits neuropsicológicos em funções executivas, independentemente da fase ativa da epilepsia e do uso de medicações / Abstract: The benign childhood epilepsy with centrotemporal spikes (EBIPCT) or rolandic epilepsy (RE) is the most common type of childhood epilepsy and is considered to be a focal, genetic and benign epilepsy. Although there is no intellectual deficit, these children may have specific cognitive impairments. This study aimed: to identify and describe changes in executive functions in children with RE and to verify the influence of clinical variables of epilepsy in executive functions. Participants were evaluated with tests to assess executive functions. We included children with clinical and EEG features of RE. Most patients were controlled and several were without medication. The results were compared with those of a control group (CG) comprised of normal subjects with age and socioeconomic level similar to that of the RE group. The data collected from both groups were analyzed and compared using statistical tests: Mann-Whitney, Chi-square and Fisher exact tests. The results showed that concerning the numerical data, children with RE had the worst performance in five of the six categories of the WCST: number of errors, number of perseverative errors, number of perseverative answers, number of completed categories and number of failures to maintain the set. Considering categorical results, children with RE had worse performance in Trail Making Test part B, Verbal fluency test FAS and three categories of the WCST: number of errors, number of perseverative errors and number of perseverative answers. Concerning the variable age of onset of epilepsy, children with earlier onset of epilepsy had a worse performance in one of the tools when compared with children with later onset of epilepsy; the other variables of epilepsy did not allow any analysis; considering seizure variables, there was no difference between the two groups. We conclude that: children with RE showed deficits in executive functions when compared with the control group; the set of tests was adequate to detect the dysfunctions presented by children with RE; in relation to the variable age of onset of epilepsy, children with earlier onset had a worse performance than children with later onset of epilepsy; concerning other epilepsy and seizure variables, there was no difference between the two groups. Thus, our study is in keeping with the idea that the term benign should be cautiously used since our patients had neuropsychological deficits in executive functions regardless of the active phase of epilepsy and the use of medications / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas