Thesis (doctoral)--Westfälischen Wilhelms-Universität zu Münster, 1995. / Includes bibliographical references.

Thesis (M.S.) -- University of Texas Southwestern Medical Center at Dallas, 2006. / Not embargoed. Vita. Bibliography: 62-72.

M.A. (Clinical Psychology) / Attention deficit hyperactivity disorder (ADHD) is a form of psychopathology characterised by difficulties with hyperactivity, attention and behavioural inhibition. Although ADHD has been historically considered a disorder specific to children, the contemporary consensus among researchers is that, in some cases, ADHD may persist into adulthood. Neurologically, ADHD is associated with deficits in the executive functions, located in the frontal lobe. Cortical arousal, which refers to the level of neuronal activity in the cerebral cortex and is measurable using electroencephalograph machinery (EEGs), is usually lower in the frontal lobes in those with ADHD when compared to individuals without the disorder. With regards to anxiety disorders, which are dysfunctional variations in the normal fear response, the aetiology of the pathologies in this category are multifaceted and complex. At the neurological level, however, there is a clear link between anxiety disorders and hypervigilance, which is characterised by high cortical arousal in the frontal lobes. Despite the fact that, at face value, it seems impossible for an increase and decrease in cortical arousal to occur simultaneously, ADHD is often diagnosed alongside anxiety disorders, and it is this anomaly which is the focus of this study. Electroencephalograph machinery (EEGs) are able to measure levels of cortical arousal using electrodes placed on the scalp. This research employs this equipment in order to elucidate on how cortical arousal manifests during a task that demands significant involvement from the frontal areas of the brain. A quasi-xperimental research design using non-parametric statistics (Mann-Whitney U Test) was used in order to compare the levels of cortical arousal between 4 groups of 5 research participants with either ADHD, an anxiety disorder, comorbid ADHD and anxiety and no discernible psychopathology. The significant results found in this study point to the fact that, in cases where ADHD and anxiety disorders occur comorbidly, there is a possibility that the anxiety component enables an individual to achieve more pronounced levels of attention, concentration and focus than normal participants and those with ADHD alone...

Pacientes com epilepsias farmacorresistentes estão cada vez mais se beneficiando do tratamento cirúrgico, dado o avanço nas técnicas de diagnóstico. Com a cirurgia, busca-se tornar o paciente livre de crises sem que para isso sejam provocados déficits neurológicos secundários. Para que isso seja alcançado é fundamental que a região cerebral epileptogênica seja delimitada com precisão. Os principais meios que o neurofisiologista dispõe para localizar a zona epileptogênica (ZE) na avaliação pré-cirurgica são a eletroencefalografia escapelar e a ressonância magnética (RM). Nos casos em que a RM não apresenta lesões ou os dados obtidos são conflitantes as técnicas de imagem funcional tais como a tomografia por emissão de fóton único (SPECT) e a tomografia por emissão de pósitron passam a ter um papel decisivo. O SPECT crítico apresenta uma imagem da perfusão sanguínea cerebral no momento da crise evidenciando, assim, as áreas cerebrais que estavam mais ativas. A técnica de subtração do SPECT intercrítico do crítico e o corregistro deste resultado coma RM do paciente (SISCOM) tem sido estudada como uma maneira de aumentar a sensibilidade e especificidade do SPECT crítico. Este trabalho buscou estudar e validar o papel dos SPECT crítico, intercrítico e SISCOM na localização da ZE. Todos os pacientes com suspeita de epilepsias refratária do lobo frontal baseada nos outros exames, operados no período de 2007 a 2011 e que realizaram um SPECT crítico e um intercrítico foram considerados nesse estudo. Para cada SPECT crítico foi realizado o SISCOM e o resultado comparado com o local da ressecção e o resultado cirúrgico sendo calculadas as métricas de desempenho diagnóstico de cada um dos métodos de neuroimagem funcional. No total foram operados 14 pacientes e 5 tiveram um bom resultado cirúrgico. O SPECT crítico apresentou 40% de sensibilidade e 88,9% de especificidade enquanto que o SPECT intercrítico apresentou 40% de sensibilidade e 66,7% de especificidade. O SISCOM foi o método com melhores parâmetros de desempenho apresentando uma sensibilidade de 60% e uma especificidade de 88,9%. Esses resultados coadunam com os dados encontrados na literatura em que o SISCOM é o estado da arte na interpretação do SPECT crítico e sugerem que o SISCOM tem potencial para ser utilizado na avaliação pré-cirurgica de pacientes com suspeita de epilepsias do lobo frontal. / The surgical treatment for patients with intractable epilepsies has become more efficient with the evolution of diagnosis techniques. The surgery aims at rendering the patient free of seizures, without postoperative neurological deficits. In order to accomplish this, it is of major importance to precisely delineate the epileptogenic zone (EZ). The main exams the neurologists use in order to find the EZ in the pre-surgical evaluation are the scalp electroencephalography and the magnetic resonance imaging (MRI). However, in cases where the MRI doesn\'t show any lesion or there are conflicting data, functional imaging such as Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography techniques play a crucial role. Ictal SPECT shows a snapshot of cerebral blood perfusion during the seizure, highlighting the most active areas during the ictus state and it has been shown this technique is useful in localizing the EZ in frontal lobe epilepsy cases. Sensitivity and specificity of ictal SPECT might be improved by a developed Computer Aided Diagnosis tool that subtracts the interictal SPECT image from the ictal one and coregisters the result with the MRI (SISCOM). In the present study, we aimed to evaluate the contribution of SISCOM to the pre-surgical evaluation in frontal lobe epilepsies. We considered for this study patients submitted to frontal lobe epilepsy surgery at our institution between 2007 and 2011 and with at least one ictal and one interictal SPECT. 14 patients were included and only 5 had a good outcome after the surgery. The ictal SPECT had a sensibility of 40% and specificity of 88,9% while the interictal SPECT showed a sensibility of 40% and a specificity of 66,7%. The sensitivity of the SISCOM tool was 60% and the specificity 88,9%.These results agree with the literature showing that SISCOM is the state-of-the-art in interpreting the ictal SPECT and has the potential to be used during presurgical evaluation of patients being considered for surgical treatment of frontal lobe epilepsy.

Pacientes com epilepsias farmacorresistentes estão cada vez mais se beneficiando do tratamento cirúrgico, dado o avanço nas técnicas de diagnóstico. Com a cirurgia, busca-se tornar o paciente livre de crises sem que para isso sejam provocados déficits neurológicos secundários. Para que isso seja alcançado é fundamental que a região cerebral epileptogênica seja delimitada com precisão. Os principais meios que o neurofisiologista dispõe para localizar a zona epileptogênica (ZE) na avaliação pré-cirurgica são a eletroencefalografia escapelar e a ressonância magnética (RM). Nos casos em que a RM não apresenta lesões ou os dados obtidos são conflitantes as técnicas de imagem funcional tais como a tomografia por emissão de fóton único (SPECT) e a tomografia por emissão de pósitron passam a ter um papel decisivo. O SPECT crítico apresenta uma imagem da perfusão sanguínea cerebral no momento da crise evidenciando, assim, as áreas cerebrais que estavam mais ativas. A técnica de subtração do SPECT intercrítico do crítico e o corregistro deste resultado coma RM do paciente (SISCOM) tem sido estudada como uma maneira de aumentar a sensibilidade e especificidade do SPECT crítico. Este trabalho buscou estudar e validar o papel dos SPECT crítico, intercrítico e SISCOM na localização da ZE. Todos os pacientes com suspeita de epilepsias refratária do lobo frontal baseada nos outros exames, operados no período de 2007 a 2011 e que realizaram um SPECT crítico e um intercrítico foram considerados nesse estudo. Para cada SPECT crítico foi realizado o SISCOM e o resultado comparado com o local da ressecção e o resultado cirúrgico sendo calculadas as métricas de desempenho diagnóstico de cada um dos métodos de neuroimagem funcional. No total foram operados 14 pacientes e 5 tiveram um bom resultado cirúrgico. O SPECT crítico apresentou 40% de sensibilidade e 88,9% de especificidade enquanto que o SPECT intercrítico apresentou 40% de sensibilidade e 66,7% de especificidade. O SISCOM foi o método com melhores parâmetros de desempenho apresentando uma sensibilidade de 60% e uma especificidade de 88,9%. Esses resultados coadunam com os dados encontrados na literatura em que o SISCOM é o estado da arte na interpretação do SPECT crítico e sugerem que o SISCOM tem potencial para ser utilizado na avaliação pré-cirurgica de pacientes com suspeita de epilepsias do lobo frontal. / The surgical treatment for patients with intractable epilepsies has become more efficient with the evolution of diagnosis techniques. The surgery aims at rendering the patient free of seizures, without postoperative neurological deficits. In order to accomplish this, it is of major importance to precisely delineate the epileptogenic zone (EZ). The main exams the neurologists use in order to find the EZ in the pre-surgical evaluation are the scalp electroencephalography and the magnetic resonance imaging (MRI). However, in cases where the MRI doesn\'t show any lesion or there are conflicting data, functional imaging such as Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography techniques play a crucial role. Ictal SPECT shows a snapshot of cerebral blood perfusion during the seizure, highlighting the most active areas during the ictus state and it has been shown this technique is useful in localizing the EZ in frontal lobe epilepsy cases. Sensitivity and specificity of ictal SPECT might be improved by a developed Computer Aided Diagnosis tool that subtracts the interictal SPECT image from the ictal one and coregisters the result with the MRI (SISCOM). In the present study, we aimed to evaluate the contribution of SISCOM to the pre-surgical evaluation in frontal lobe epilepsies. We considered for this study patients submitted to frontal lobe epilepsy surgery at our institution between 2007 and 2011 and with at least one ictal and one interictal SPECT. 14 patients were included and only 5 had a good outcome after the surgery. The ictal SPECT had a sensibility of 40% and specificity of 88,9% while the interictal SPECT showed a sensibility of 40% and a specificity of 66,7%. The sensitivity of the SISCOM tool was 60% and the specificity 88,9%.These results agree with the literature showing that SISCOM is the state-of-the-art in interpreting the ictal SPECT and has the potential to be used during presurgical evaluation of patients being considered for surgical treatment of frontal lobe epilepsy.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19366号 / 医博第4043号 / 新制||医||1011(附属図書館) / 32380 / 新制||医||1011 / 京都大学大学院医学研究科医学専攻 / (主査)教授 渡邉 大, 教授 福田 和彦, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

The Whole thesis is in Afrikaans: Epilepsy is a phenomenon that can manifest in a variety of ways, which differ mainly in severity, appearance, aetiology, effect and control thereof. In this study a lack of knowledge and education about epilepsy is pointed out as a factor that was neglected over the years. It is of utmost importance to distinguish between three main categories of epilepsy as all three types have a restraining effect that may leave any learner vulnerable. The popular belief about the concept epilepsy until recently did not recognize the type of epilepsy where a disturbance in consciousness or relapse in consciousness only occurred as in the case with elementary partial attacks (temporal and frontal lobe epilepsy). Ignorance about temporal and frontal lobe epilepsy, as well as the fact that the physical symptoms of this type of epilepsy are very subtle in nature, may be the cause why acceptance of this condition has been slow or undervalued. In reality learners with lobe epilepsy are not regarded as disabled and should such a learner not be diagnosed and not receive the correct treatment, he/she will not be able to function optimally. The researcher has made a study of epilepsy as well as the physical, cognitive, emotional, social, self image impact on the learner in family and school context. The impact of epilepsy on the primary school learner was studied from a gestalt point of view. In this study the researcher employed both a quantitative and qualitative research approach. It was therefore fitting to formulate a research question and a hypothesis. The research question formulated for this study is as follows: What is the knowledge basis of teachers regarding learners with lobe epilepsy? The empirical study indicated that the researcher could provide an answer to the research question by way of semi-structured interviews that indicated that the knowledge basis of the teachers was not sufficient to identify learners with this phenomena. The researcher determined through these interviews that teachers experienced a need to extend their knowledge about temporal and frontal lobe epilepsy. The hypothesis formulated for this study is as follows: Should information and clear guidelines regarding the identification of a learner with lobe epilepsy be offered to teachers, the learner with lobe epilepsy would be identified timeously in the school system. The researcher did a pre-test on the knowledge levels on lobe epilepsy among teachers by way of questionnaires. The pre-test was followed by a structured information session after which an after-test was done by way of questionnaires to determine the change in the teachers’ knowledge basis. The empirical study showed that the teachers’ knowledge basis increased due to the information session offered to them. After this study the teachers could identify learners and refer them for diagnosis and treatment as a result of an increased knowledge basis about this phenomena. The study was followed up by guidelines offered to the teachers on identifying the primary school learner with temporal and frontal lobe epilepsy. / Thesis (DPhil (Social Work))--University of Pretoria, 2005. / Social Work and Criminology / unrestricted