Made available in DSpace on 2015-04-14T13:35:21Z (GMT). No. of bitstreams: 1 390397.pdf: 1672134 bytes, checksum: 7fcd4787dc65fa3d4398eb2053b95b93 (MD5) Previous issue date: 2005-08-24 / Objective: To compare the neuropsychological effects of anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (AH) on memory tests, and to determine which variables are correlated with post-operative memory deficits.Methodology: It was compared changes in neuropsychological scores in 154 patients who underwent temporal lobe epilepsy due hippocampal sclerosis (ATL n= 63 or AH n=91). We assessed decline in memory as measured by the Weschler Memory Scale-Revised (WMS-R), and Rey Verbal Auditory Learning Test (RAVLT). Deriving logistic regression equation was used to the following measures variables: type of surgery, seizure outcome, age onset, manual dominance, side of resection, timing of postoperative assessment and level of education.Results: No differences were found on memory immediate recall (logical memory and visual reproduction) between patients who underwent ATL or AH (p>0,05). On the other hand, the delayed recall presented a significant decrease after ATL on verbal (p=0,007) and visual memory test (p=0,03). Better verbal memory performance showed higher risk of suffering post surgery decrease, but this association was not observed on visual memory scores. Losses in verbal memory were higher after left side surgery. Visual memory was founded independent of the side of resection. No specific association was detected between memory performance after surgery and age at onset seizure, seizure control, manual dominance and timing of postoperative assessment. These findings evidence that lower level of education was associated with memory and learning impairment after both type of surgery.Conclusion: Losses on delayed recall both verbal and visual memory tests were increased after LTA than AH. Left temporal lobe excisions showed a negative impact on verbal memory, but decrease on visual memory after right temporal lobe resection was not observed. Better performance on verbal memory test on presurgical assessment is at higher risk of suffering post surgery decrease. / Objetivo: Comparar os efeitos das duas t?cnicas cir?rgicas, lobectomia temporal anterior (LTA) e amigdalohipocampectomia seletiva (AH) no desempenho de mem?ria em pacientes com epilepsia refrat?ria ao tratamento medicamentoso, que apresentavam esclerose mesial temporal (EMT). Al?m disso, a pesquisa visa determinar as vari?veis que s?o correlacionadas com os d?ficits de mem?ria no per?odo p?s-operat?rio. Metodologia: Foram comparadas as mudan?as nos resultados dos testes de mem?ria em 154 pacientes submetidos a cirurgia do lobo temporal devido a esclerose hipocampal (LTA n=63 ou AH n=91). O desempenho de mem?ria foi analisado a partir da Escala de Mem?ria Weschler revisada (WMS-R) e do teste de aprendizado verbal de Rey (APVER). A regress?o log?stica foi utilizada para avaliar o impacto na mem?ria das vari?veis: tipo de cirurgia, idade de in?cio das crises, lobo temporal operado, tempo entre as avalia??es, escolaridade e domin?ncia manual. Resultados: N?o foram encontradas diferen?as significativas entre as t?cnicas cir?rgicas no que diz respeito ao desempenho de mem?ria imediata tanto verbal, quanto visual e aprendizado verbal (p>O,O5). No entanto, na t?cnica LTA, observou-se um pior desempenho de mem?ria tardia, tanto em rela??o a mem?ria verbal (p=O,OO7), quanto a mem?ria visual (p=O,O3). Quando o lobo temporal esquerdo foi submetido a interven??o cir?rgica, este foi significativo em rela??o aos testes de mem?ria verbal imediata e tardia. A escolaridade influenciou significativamente em todos os testes. As vari?veis domin?ncia manual, idade de in?cio das crises, melhora da freq??ncia das crises epil?pticas e o tempo entre as avalia??es n?o mostraram impacto significativo sobre nenhum dos testes de mem?ria avaliados. Conclus?o: A LTA foi mais prejudicial que a AH quando foi avaliada a recorda??o tardia (mem?ria tardia) tanto verbal, quanto visual.A ressec??o do LTD n?o se relacionou a preju?zos de mem?ria visual no per?odo p?s-cir?rgico. A ressec??o do LTE induziu perda de mem?ria verbal. O melhor desempenho de mem?ria verbal dos pacientes antes da cirurgia correlacionou se com o pior desempenho ap?s a cirurgia. A baixa escolaridade apresenta um efeito negativo nos escores de todos os testes de mem?ria no per?odo p?s-cir?rgico.

Made available in DSpace on 2015-04-14T13:35:25Z (GMT). No. of bitstreams: 1 437015.pdf: 2405577 bytes, checksum: 64fe8d7f54de71f570c0f7a29d9c6838 (MD5) Previous issue date: 2012-01-16 / Cellular therapy represent a new frontier for the treatment of several diseases, including diseases related to central nervous system. Human umbilical cord blood is an attractive source of stem cells; however, it has a heterogeneous population with a small amount of mesenchymal stem cells. Currently, cell reprogramming induced by different methodologies can confer pluripotency to differentiated adult cells. The objective of the study was to evaluate the reprogramming potential of fibroblasts and neural differentiation after co-culture with umbilical cord blood mononuclear cells. This study was approved by the Ethics Committee of PUCRS (CEP 11/05504). Cells were obtained from four human umbilical cord blood. Cell suspensions were fractionated at gradient of density 1077. The mononuclear cells of each sample were cultured for 7 days and later, the culture was infected with 105 cells of mouse fibroblast cell line NIH 3T3 and co-cultured for 6 days. To evaluate the pluripotency it was performed RNA extraction and later, amplification using primers specific for pluripotency genes. The differentiation was also confirmed by the adipogenic and osteogenic differentiation. Neural differentiation of the reprogrammed cells was obtained by the method described by Song et. al (2008) and evaluated by immunofluorescence. Population growth was quantified by hemocytometer. All co-cultured cells showed adipogenic and osteogenic differentiation capacity. After co-cultivation cells began transcribing the pluripotency gene KLF4. Statistically significant differences in the parameters area, diameter, optical density and fractal dimension were observed by confocal microscopy in reprogrammed and neural differentiated cells. The population of reprogrammed cells doubled every three days until the addition of the last medium of neural differentiation, when cultures became quiescent until the end of the neural differentiation. The contact in form of co-cultivation of fibroblasts with umbilical cord blood mononuclear fraction for six days promoted the reprogramming of these cells to a indifferentiation stage, allowing the induction of neural differentiation later. / As terapias celulares representam uma nova fronteira para o tratamento de diversas doen?as, inclusive patologias relacionadas ao sistema nervoso central. O sangue de cord?o umbilical humano ? uma atrativa fonte de c?lulas-tronco, por?m, apresenta uma popula??o heterog?nea com pouca quantidade de c?lulas-tronco mesenquimais. Atualmente, a reprograma??o celular induzida atrav?s de metodologias distintas, pode conferir pluripot?ncia ?s c?lulas adultas diferenciadas. O objetivo deste trabalho foi avaliar o potencial de reprograma??o de fibroblastos e a diferencia??o neural ap?s co-cultivo com fra??o mononuclear de sangue de cord?o umbilical. Foram obtidas c?lulas da fra??o mononuclear de quatro cord?es umbilicais humanos de pacientes atendidas no Centro Obst?trico do Hospital S?o Lucas da PUCRS. As suspens?es celulares foram fracionadas em gradiente de densidade 1077. A fra??o mononuclear de cada amostra foi cultivada por sete dias e ap?s, contaminada com 105 c?lulas da linhagem de fibroblasto de camundongos NIH 3T3 e co-cultivadas por 6 dias. Para avalia??o da pluripot?ncia, foi realizada extra??o de RNA e posterior amplifica??o utilizando oligonulceot?deos espec?ficos para os genes de pluripot?ncia Oct3/4, Sox2 e KLF4. O fen?tipo mesenquimal foi confirmado pela diferencia??o adipog?nica e osteog?nica. A neurodiferencia??o das c?lulas reprogramadas seguiu o m?todo descrito por Song et. al (2008) e foi avaliada por imunofluoresc?ncia. O crescimento populacional foi quantificado em hemocit?metro. Todas as c?lulas co-cultivadas mostraram capacidade de diferencia??o adipog?nica e osteog?nica. Ap?s o co-cultivo, as c?lulas passaram a transcrever o gene de pluripot?ncia KLF4. Diferen?as estatisticamente significativas nos par?metros ?rea, di?metro, densidade ?ptica e dimens?o fractal foram observadas por microscopia confocal nas c?lulas reprogramadas e neurodiferenciadas. A popula??o de c?lulas reprogramadas duplicou a cada tr?s dias at? o momento da adi??o do ultimo meio de neurodiferencia??o, quando as culturas tornaram-se quiescentes at? o final do per?odo de neurodiferecia??o. O contato em forma de co-cultivo dos fibroblastos com a fra??o mononuclear de cord?o umbilical por seis dias promoveu a reprograma??o dessas c?lulas a um est?gio com certa plasticidade, permitindo a indu??o posterior de neurodiferencia??o.

Made available in DSpace on 2015-04-14T13:35:31Z (GMT). No. of bitstreams: 1 438275.pdf: 12783566 bytes, checksum: d6ff8fd347a19bd2c64de39963e3e8f0 (MD5) Previous issue date: 2012-03-27 / Background: Anticipation of epileptic seizures may allow acute interventions to reduce physical and psychosocial harm associated with unexpected attacks. Recent data suggest that electrical abnormalities evolve during many hours before a seizure and these may potentially be clinically identified as seizure prodromes. Objectives: We aimed to determine, in an objective and verifiable fashion, the types, prevalence, sensitivity, specificity and predictive value of seizure prodromes in patients with refractory partial epilepsies, as well to study the clinical and psychiatric correlates of these premonitory symptoms. Methods: We studied 55 adult patients who had at least one focal seizure recorded during of video-EEG monitoring. Patients noted any symptoms they associated with impending seizures and that information was complemented daily by entering actual seizure occurrence according to video- EEG. Detailed clinical and psychiatric data were then correlated with the occurrence of prodromes. Results: Thirty-six patients (65%) reported prodromal symptoms, a median of 12 hours before seizures. Half were related to mood changes. Female sex, higher baseline seizure frequency and a history of more severe depressive disorders independently correlated with the occurrence of prodromes. Mean specificity and PPV slightly above 80% contrasted with sensitivity and NPV slightly below 60%. Conclusion: Seizure prodromes in the context of presurgical evaluation are common in adult patients with medically refractory seizures and should be discussed with patients as a means to anticipate seizures and thus minimize harm. Development of acute interventions to prevent seizures at the time of prodromes is an attractive possibility. / Introdu??o: A antecipa??o de crises epil?ticas pode permitir interven??es agudas para reduzir danos f?sicos e psicol?gicos associados ? ocorr?ncia de crises inesperadas. Dados recentes sugerem que anormalidades el?tricas desenvolvem-se durante muitas horas antes de uma crise, podendo ser clinicamente identificadas como pr?dromos de crises epil?pticas. Objetivos: Nosso estudo se prop?s a determinar, de forma objetiva e verific?vel, os tipos, a preval?ncia, a sensibilidade, a especificidade e o valor preditivo dos pr?dromos em pacientes com epilepsia parciais refrat?rias, assim como estudar os correlatos cl?nicos e psiqui?tricos destes sintomas premonit?rios. M?todos: Foram estudados 55 pacientes adultos, com pelo menos uma crise parcial gravada por monitora??o por v?deo-EEG. Os pacientes observaram diversos sintomas que foram associados ?s crises iminentes, e estas informa??es foram registradas diariamente e complementadas pelos dados do registro da ocorr?ncia real de crise epil?ptica, de acordo com o v?deo-EEG. Dados cl?nicos e psiqui?tricos detalhados foram correlacionados com as ocorr?ncias de pr?dromos. Resultados: Trinta e seis pacientes (65%) relataram sintomas de pr?dromos, ocorrendo em uma mediana de 12 horas antes das crises epil?pticas. Metade destes sintomas foram relacionados ? altera??o de humor. Sexo feminino, frequ?ncia de crises alta e hist?ria de transtorno depressivo grave, foram correlacionados, de modo independente, com a ocorr?ncia dos pr?dromos. A especificidade m?dia e o VPP ficaram um pouco acima de 80%, contrastando com a sensibilidade, e o VPN, um pouco abaixo de 60%. Conclus?o: Pr?dromos, em um contexto de avalia??o pr?-cir?rgica, s?o comuns em pacientes com crises refrat?rias ? medica??o, devendo os mesmos ser discutidos com os pacientes, como um meio de antecipar as crises epil?pticas e, assim, minimizar os danos ocasionados por estas. O desenvolvimento de interven??es agudas, para prevenir as crises no momento em que os pr?dromos ocorrem, torna-se uma possibilidade interessante.

Made available in DSpace on 2015-04-14T13:35:32Z (GMT). No. of bitstreams: 1 438285.pdf: 5375731 bytes, checksum: 4cabd22bcc7565970e16fa7e9057a2bb (MD5) Previous issue date: 2012-03-28 / Introduction: Patients with Frontal Lobe Epilepsy (FLE), although they generally show a good performance in traditional memory tests, they are very forgetful in daily life, which affects their academic, professional and social life. Such forgetfulness is related to Prospective Memory (PM), which consists in recalling, at the appropriate time, an intention to be performed in the future. Objective: This study investigated PM in patients with frontal epilepsy, analyzing the interference of the lesion, laterality and location of the epileptogenic focus in PM performance, as well as its correlation with other memory and executive function tests. Methodology: We conducted a case-control study to evaluate the PM, being comprised of 27 adult patients with frontal lobe epilepsy, confirmed by EEG (electroencephalography), VEEG (video electroencephalography), or MRI (cerebral magnetic resonance imaging). Out of this group, 16 showed lesion on the frontal region and 11 did not show any lesion. A group of 16 adults with no epilepsy formed the control group. All subjects underwent a neuropsychological evaluation, consisting of manual dominance tests, IQ (intelligence quotient) estimated test, verbal memory tests, (immediate and delayed) visual test, PM test, attention, verbal fluency and other executive function tests. They also answered a questionnaire for memory selfevaluation and a scale to identify psychiatric comorbidities. PM was assessed by a test that simulates daily life tasks. Results: The case group (10.3?4.2) showed a significantly lower mean than the control group (15.7?2.1) in the PM test. When comparing the group with lesion to the group with no lesion, they were not significantly different in PM performance. Regarding the lateralization of the epileptogenic focus, the group with bilateral focus had a worse performance in the PM than the group with the focus on the right, though it did not differ significantly from the group with the focus on the left. Conclusion: Patients with frontal lobe epilepsy had a worse prospective memory performance than the control group. The presence or absence of injury did not affect PM performance. Patients with bilateral focus had the worst PM performance. Regarding focus laterality (right or left), there was no difference in PM. PM performance was connected to attention and delayed visual memory. / Introdu??o: Pacientes com Epilepsia do Lobo Frontal (ELF), embora geralmente demonstrem um bom desempenho nos testes tradicionais de mem?ria, apresentam muitos esquecimentos na vida di?ria, comprometendo sua vida acad?mica, profissional e social. Tais esquecimentos referem-se ? Mem?ria Prospectiva (MP), que consiste em recordar, no momento adequado uma inten??o a desempenhar no futuro. Objetivo: Este estudo buscou investigar a MP nos pacientes com epilepsia frontal, analisando a interfer?ncia da presen?a de les?o, da lateralidade e da localiza??o do foco epileptog?nico no desempenho da MP, assim como sua correla??o com outros testes de mem?ria e de fun??es executivas. Metodologia: Foi realizado um estudo de caso-controle para avalia??o da MP, sendo constitu?do de 27 pacientes adultos com epilepsia de lobo frontal, confirmada por EEG (eletroencefalografia), VEEG (v?deo-eletroencefalografia) ou RM (resson?ncia magn?tica cerebral). Desse grupo, 16 apresentavam les?o em regi?o frontal e 11 n?o apresentavam nenhuma les?o. Um grupo de 16 adultos sem epilepsia constituiu o grupo controle. Todos os sujeitos realizaram avalia??o neuropsicol?gica, constitu?da de testes de domin?ncia manual, teste estimado de QI (Coeficiente de Intelig?ncia), testes de mem?ria verbal, visual (imediata e tardia), teste de MP, aten??o, flu?ncia verbal e demais testes de fun??o executiva. Tamb?m responderam a um Question?rio de auto-avalia??o da mem?ria e uma escala para identificar comorbidades psiqui?tricas. A MP foi avaliada atrav?s de um teste que simula tarefas da vida di?ria. Resultados: O grupo de casos (10,3?4,2) apresentou m?dia significativamente menor que o grupo controle (15,7?2,1) no teste de MP. Ao comparar o grupo com les?o e sem les?o, estes n?o se mostraram significativamente diferentes quanto ao desempenho na MP. Em rela??o ? lateraliza??o do foco epileptog?nico, o grupo com foco bilateral obteve pior desempenho na MP que o grupo ? direita, embora n?o tenha diferido de forma significativa do grupo ? esquerda. Conclus?o: Os pacientes com epilepsia frontal tiveram pior desempenho da mem?ria prospectiva do que o grupo controle; a presen?a ou n?o de les?o n?o interferiu no desempenho da MP; os pacientes com foco bilateral tiveram pior desempenho da MP. Em rela??o ? lateralidade do foco (direita ou esquerda) n?o houve diferen?a na MP. O desempenho da MP correlacionou-se com a aten??o e com a mem?ria visual tardia.

Made available in DSpace on 2015-04-14T13:35:33Z (GMT). No. of bitstreams: 1 439242.pdf: 1575567 bytes, checksum: 619d0569503f83efdbc96d24f37eb2fb (MD5) Previous issue date: 2012-05-26 / Memories are not stored in its final form immediately after the acquisition. They undergo a long stabilization process known as consolidation. Consolidated memories can become labile again after the retrieval and susceptible to the action of amnesic agents. Thus, to persist must go through the re-stabilization process called reconsolidation. Several evidences indicate that the hippocampus plays an important role in both consolidation and reconsolidation process of different memories. In this way, we decided investigate the participation of NMDA and GABA receptors of dorsal hippocampus CA1 region on the retrieval and reconsolidation of spatial memory. We used the Morris water maze task (MWM) to demonstrate that infusion of AP5 (5 μg/μl), the selective antagonist of the NMDA receptor, into the dorsal hippocampus CA1 region of rats is able to block temporarily the retrieval of spatial memory. However, when we administered different doses and different times after the reactivation session in the absence of reinforcement is not observed any effect on spatial memory reconsolidation. While agonists of the glycine site of NMDA receptors, D-SER (10 μg/μl), improves the consolidation and the reconsolidation of spatial memory. Furthermore, we found that infusion of the agonist of GABA, muscimol (0.1 μg/μl), temporarily prevents the memory retrieval of MWM. However, when the animals received infusion of muscimol before the reactivation session and the protein synthesis inhibitor, anisomycin (160 μg/μl), immediately after this session, spatial memory remains inhibited. Thus, we have demonstrated that inhibition of NMDA receptors prevents the retrieval but not the reconsolidation of the spatial memory and the NMDA agonist is capable of improving consolidation and reconsolidation of memory, while the GABA activation temporarily prevents retrieval and the impairment of memory is maintained through inhibition of protein synthesis. / As mem?rias n?o s?o armazenadas em sua forma definitiva. Logo ap?s a aquisi??o, elas passam por um longo processo de estabiliza??o conhecido como consolida??o. Mem?rias j? consolidadas podem se tornar novamente l?beis logo ap?s a evoca??o e suscet?veis a a??o de agentes amn?sicos. Dessa forma, para persistirem devem passar pelo processo de reestabiliza??o denominado, reconsolida??o. In?meras evid?ncias indicam que o hipocampo tem um papel importante tanto na consolida??o quanto na reconsolida??o de diferentes mem?rias. Assim, decidimos investigar a participa??o dos receptores NMDA e GABA da regi?o CA1 do hipocampo dorsal na evoca??o e reconsolida??o da mem?ria espacial. Utilizando a tarefa de labirinto aqu?tico de Morris (LAM) em ratos, demonstramos que a infus?o na regi?o CA1 do hipocampo do antagonista seletivo do receptor NMDA, AP5 (5 μg/μl) ? capaz de bloquear temporariamente a evoca??o da mem?ria espacial. Por?m quando administrado diferentes doses e diferentes tempos, ap?s a sess?o de reativa??o na aus?ncia de refor?o n?o se observa efeito algum sobre a reconsolida??o da mem?ria espacial. Enquanto que o agonista do s?tio da glicina no receptor NMDA, D-SER (10 μg/μl), melhora n?o s? a consolida??o, mas tamb?m a reconsolida??o da mem?ria espacial. Al?m disso, a infus?o do agonista do receptor GABA, muscimol (0,1 μg/μl), impede temporariamente a evoca??o da mem?ria do LAM. Por?m, quando os animais recebem a infus?o de muscimol antes da sess?o de reativa??o e do inibidor da s?ntese de prote?nas, anisomicina (160 μg/μl), imediatamente ap?s esta sess?o, a mem?ria espacial permanece inibida. Assim, demonstramos que a inibi??o dos receptores NMDA impede a evoca??o mas n?o a reconsolida??o da mem?ria espacial e seu agonista ? capaz de melhorar a consolida??o e a reconsolida??o dessa mem?ria, enquanto a ativa??o do receptor GABA impede temporariamente a evoca??o e o preju?zo na mem?ria ? mantido com a inibi??o da s?ntese de prote?nas.

Made available in DSpace on 2015-04-14T13:35:34Z (GMT). No. of bitstreams: 1 440859.pdf: 1769440 bytes, checksum: 1b3b990746636f5c1f4b9a971b320293 (MD5) Previous issue date: 2012-03-26 / Introduction: As a chronic disease which is highly prevalent, epilepsy has an important impact on the affected person's psychic/cognitive functioning and their family and social relationships. Among refractory epilepsies, epilepsy of the temporal lobe (ETL) is the most frequent in adults. Studies about lesions on the hippocampus and their effects found that patients with ETL presented verbal and visual memory deficits, depending on the affected hemisphere. Refractoriness to clinical treatment leads to the recommendation of surgery when it is seen that up to that point there have not been any other therapeutic alternatives available. In this context, there is a glimpse of a new treatment possibility for refractory epilepsies, using stem cells. These present a large capacity for proliferation and auto-renovation and the capacity to respond to external stimuli and give rise to different, more specialized cell lines. Objectives: To evaluate the effect of autologous stem cell transplants of bone marrow on the memory functions of patients with refractory epilepsy of the mesial temporal lobe. Patients and Methods: The selection of patients was done at the Outpatient Center for Clinical Epilepsy Research at PUCRS S?o Lucas Hospital [Ambulat?rio de Pesquisa Cl?nica em Epilepsia do Hospital S?o Lucas da PUCRS]. The 13 patients submitted themselves to therapy, and they were evaluated before and after the stem cell treatment (3 and 6 months after). The tests utilized for neuropsychological evaluation (pre and post-therapy) include the Wechsler Memory Scale revised (WMS-R), the Rey Auditory Verbal Learning Test (RAVLT) and the Taylor Complex Figure. Results and Conclusions: The results indicate a significant increase in the neuropsychological scores over time. In six out of seven utilized tests, the increase of average score obtained was significant. In only one test (visual reproduction I WMS R), the increase showed limitrofe statistical significance (between 5% and 10%). Given the favorable evolution of those patients analyzed, the stem cell transplant showed itself to be feasible, safe and with important perspectives for rehabilitation as well as psychosocial and professional reinsertion. / Introdu??o: A epilepsia, enquanto condi??o cr?nica de alta preval?ncia tem impacto importante no funcionamento ps?quico/cognitivo e nas rela??es familiares e sociais da pessoa acometida. Entre as epilepsias refrat?rias, a epilepsia do lobo temporal (ELT) ? a mais freq?ente em adultos. Estudos sobre les?es no hipocampo e seus efeitos, constataram que pacientes com ELT apresentam d?ficits de mem?ria verbal e visual, dependendo do hemisf?rio acometido. A refratariedade ao tratamento cl?nico, leva ? indica??o cir?rgica, visto que at? o momento, n?o est?o dispon?veis outras alternativas terap?uticas. Neste contexto, se vislumbra uma nova possibilidade de tratamento para as epilepsias refrat?rias, utilizando-se c?lulas-tronco (CT). Estas apresentam grande capacidade de prolifera??o e auto-renova??o e capacidade de responder a est?mulos externos dando origem a diferentes linhagens celulares mais especializadas. Objetivos: Avaliar o efeito do transplante aut?logo de c?lulas-tronco da medula ?ssea (CTMO) nas fun??es de mem?ria de pacientes com epilepsia refrat?ria do lobo temporal mesial. Pacientes e M?todos: A sele??o dos pacientes foi realizada no Ambulat?rio de Pesquisa Cl?nica em Epilepsia do Hospital S?o Lucas da PUCRS. Os 13 pacientes que se submeteram ? terapia, foram avaliados antes e ap?s o tratamento com c?lulas-tronco (3 meses e 6 meses depois). Os testes utilizados para avalia??o neuropsicol?gica: Escala de Mem?ria Wechsler-revisada (WMS-R), Teste de Aprendizado de Mem?ria Verbal de Rey (RAVLT) e Figura Complexa de Taylor. Resultados e Conclus?es: Os resultados indicam um aumento significativo nos escores neuropsicol?gicos ao longo do tempo. Em seis dos sete testes utilizados, o acr?scimo no escore m?dio obtido foi significativo e, em apenas um teste (WMS R visual imediato), o acr?scimo apresentou signific?ncia estat?stica lim?trofe (entre 5% e 10%). Dada a evolu??o favor?vel dos pacientes analisados, o transplante de CTMO mostrou-se fact?vel, seguro e com perspectivas importantes para a reabilita??o e reinser??o psicossocial e profissional.

Made available in DSpace on 2015-04-14T13:35:35Z (GMT). No. of bitstreams: 1 443569.pdf: 1818330 bytes, checksum: 440d1a0ec56c8d386d2ce13eb489f265 (MD5) Previous issue date: 2012-08-28 / Introduction: Although temporal lobe epilepsy is associated with high rates of psychiatric comorbidities, investigations about the temperament of these patients have been neglected. Previous studies have suggested that epileptiform and clinical variables may have a role in this context. Objectives: The present study characterized, through a reliable instrument, the temperament of patients with mesial temporal lobe epilepsy, compared them to controls and established relationships with disease-related variables. Methods: Temperament was assessed in 42 (forty-two) adult patients with unilateral mesial temporal lobe epilepsy and 84 (eighty-four) control, through the questionnaire AFECTS (Affective and Emotional Composite Temperament Scale). Among patients, variables related to epilepsy were collected prospectively as well as the scales of the BDI and BAI. Results: Statistically significant correlations were observed between disease duration and higher BDI against temperaments "Depressive" and "Anxious" and the emotional dimension of temperament "Fear." The number of antiepileptic drugs correlated inversely with the temperament "Obsessive." Regarding laterality, patients with lesion in the left lobe had lower average in the emotional dimension "Sensitivity". Discussion: Even though some findings, such as higher BDI scores in patients with temperament "Depressive" and "Anxious" could be justified by the bigger prevalence of psychiatric disorders in patients with mesial temporal lobe epilepsy, statistically significant correlations were found between affective dimensions and variables, independently. Lower means of "Sensitivity" in patients with left itcal focus were consistent with recent data about neurobiological basis of temperament. Conclusion: While they should be interpreted with caution, the results suggest a possible role of mesial temporal lobe epilepsy, directly and through lesion, as one of the determinants of temperament in these patients. / Introdu??o: Embora a epilepsia do lobo temporal esteja associada a altas taxas de comorbidades psiqui?tricas, investiga??es acerca do temperamento destes pacientes t?m sido negligenciadas. Estudos pr?vios t?m sugerido que vari?veis cl?nicas e epileptiformes possam exercer um papel fundamental neste contexto. Objetivos: O presente estudo caracterizou, atrav?s de instrumento confi?vel, o temperamento de pacientes com epilepsia temporal mesial, comparando-os a controles e estabelecendo rela??es com vari?veis associadas ? doen?a. M?todos: O temperamento foi analisado em 42 adultos, portadores de epilepsia mesial temporal unilateral e 84 controles, atrav?s do question?rio AFECTS (Affective and Emotional Composite Temperament Scale). Entre os pacientes, as vari?veis relacionadas ? epilepsia foram coletadas prospectivamente, assim como as escalas de BDI e BAI. Resultados: Correla??es estatisticamente significativa foram observadas entre dura??o da doen?a e altos ?ndices no BDI aos temperamentos Depressivo e Ansioso e ? dimens?o emocional do temperamento Medo. O n?mero de drogas antiepil?pticas correlacionou-se inversamente ao temperamento Obsessivo. Quanto ? lateralidade, pacientes com les?o ? esquerda apresentaram m?dias menores na dimens?o emocional Sensibilidade. Discuss?o: Mesmo que alguns achados, como os elevados ?ndices no BDI em pacientes com temperamento Depressivo e Ansioso possam ser justificados pela maior preval?ncia de dist?rbios psiqui?tricos em indiv?duos com epilepsia temporal mesial, correla??es estatisticamente significativas encontradas entre dimens?es afetivas e vari?veis epileptiformes foram independentes. Menores m?dias de Sensibilidade em pacientes com foco itcal ? esquerda foram condizentes com dados recentes sobre as bases neurobiol?gicas do temperamento. Conclus?o: Embora devam ser interpretados com cautela, os resultados sugerem um poss?vel papel da epilepsia mesial temporal, de maneira direta e lesional, como um dos determinantes do temperamento nestes pacientes.

Made available in DSpace on 2015-04-14T13:35:36Z (GMT). No. of bitstreams: 1 444379.pdf: 796253 bytes, checksum: 4373f9d99666d84dec56318b0fe505a4 (MD5) Previous issue date: 2012-09-14 / Introduction: Lesions hypoxic-ischemic pathologies can cause a higher or lesser degree, depending on when they occur. In postnatal insults, is the common occurrence of scarring, characterizing ulegyria and/or cysts porencephalic (U/PC).Objectives: To associate the location, extent and severity of brain injury in the spectrum U/PC, with characteristics of epilepsy, motor abnormalities and their impact on activities of daily living (ADLs).Methods: We evaluated 21 patients (15 men and 6 women, aged between 15 and 39 years, mean 25.66 SD 7.12) with epilepsy and brain injury by U/PC attending the epilepsy clinic of the Neurology Service S?o Lucas Hospital of the Catholic University of RS. All patients underwent MRI, EEG, motor and functional assessment.Results: Fifteen patients (71%) presented U, 2 (9.8%) PC and 4 (19.2%) U + PC. All EEGs were abnormal, with a predominance of slowing multilobar (66.6%) and multilobar discharges (71%). The vast number of patients (47.6%) had a combination of simple partial seizures (SPS), complex (CPS), evolving to secondarily generalized (GTS). Decreased balance and difficulty in performing activities of daily living were common to 21 patients.Conclusion: motor abnormalities resulting from brain damage, coupled with the occurrence of seizures impact the functional capacity of patients with U/PC / Introdu??o: Les?es hip?xico-isqu?micos (HI) podem causar patologias em maior ou menor grau, dependendo do momento em que estes ocorrem. Em insultos p?s-natais, ? comum a ocorr?ncia de les?es cicatriciais, caracterizando ulegiria e/ou cistos porencef?licos (U/CP).Objetivos: associar a localiza??o, extens?o e gravidade da les?o cerebral no espectro U/CP, com caracter?sticas da epilepsia, das altera??es motoras e do impacto destas em atividades de vida di?ria (AVD).M?todos: Foram avaliados 21 pacientes (15 homens e 6 mulheres, com idades entre 15 e 39 anos, m?dia de 25,66; DP = 7,12) com epilepsia e les?o cerebral por U/CP que frequentavam o ambulat?rio de epilepsia do Servi?o de Neurologia do Hospital S?o Lucas da Pontif?cia Universidade Cat?lica do RS (PUCRS). Todos realizaram RNM, EEG, avalia??o motora e funcional.Resultados: Quinze pacientes (71%) apresentaram U, dois (9,8%) CP e quatro (19,2%) U + CP. Todos os EEGs estavam alterados, com predom?nio de lentifica??o multilobar (66,6%) e descargas multilobares (71%). A maioria dos pacientes (47,6%) apresentou combina??o de crise parcial simples (CPS) e complexa (CPC), evoluindo para secundariamente generalizada (CSG). Equil?brio diminu?do e dificuldades na realiza??o de atividades de vida di?ria foram comuns aos 21 pacientes.Conclus?o: altera??es motoras, advindas de les?es cerebrais, somadas a ocorr?ncia de crises epil?pticas impactam na capacidade funcional de pacientes com U/CP

Made available in DSpace on 2015-04-14T13:35:47Z (GMT). No. of bitstreams: 1 450585.PDF: 3679647 bytes, checksum: 449520a022e29d4951604d60809e331f (MD5) Previous issue date: 2013-08-09 / Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders among children. Although the clinical presentation and treatment of ADHD are well established, its etiology is not yet known. Recent functional neuroimaging techniques may help increase knowledge about the pathophysiology of the disorder, allowing for the empirical testing of theoretical hypotheses on brain networks in ADHD. In this study, we analyzed a group of 23 treatment na?ve boys with ADHD, aged between 8 and 10 years old, who underwent a protocol of resting-state functional magnetic imaging before and after six months of treatment with methylphenidate. Analyses of functional connectivity were performed between regions of interest (seeds) placed within the default mode network (DMN). Subsequently, changes in the DMN connectivity before and after treatment were investigated with an independent component analysis (ICA). Results of the seeds analysis showed no significant changes in connectivity between regions of the DMN following treatment, with a relatively small increase in the anterior-posterior connectivity of the network. The ICA revealed a significant increase in the connectivity between the left putamen and the DMN (p <0.01, corrected). There was also a positive correlation between the decrease of symptoms and the connectivity between the putamen and the DMN after treatment (rho = 0.65, p = 0.17). These findings indicate that treatment with methylphenidate modifies the connectivity between the DMN and subcortical nuclei. Dysfunctions in corticalsubcortical circuits have often been associated with the pathophysiology of ADHD. The effect of treatment with methylphenidate may in part be associated with elevated dopamine levels in subcortical nuclei, modulating its connectivity with the DMN. / O transtorno de d?ficit de aten??o/hiperatividade (TDAH) ? um dos transtornos neuropsiqui?tricos mais prevalentes entre crian?as. Embora a apresenta??o cl?nica e o tratamento do TDAH estejam bem estabelecidos, suas causas ainda n?o s?o conhecidas. T?cnicas recentes de neuroimagem funcional podem ampliar o conhecimento acerca da fisiopatologia do transtorno, permitindo a testagem emp?rica de hip?teses conceituais sobre o funcionamento de redes cerebrais no TDAH. Neste trabalho, analisamos um grupo de 23 meninos com diagn?stico de TDAH, com idades entre 8 e 10 anos, virgens de tratamento, que foram submetidos a um protocolo de resson?ncia funcional de repouso antes e ap?s seis meses de tratamento com metilfenidato. Foram realizadas an?lises de conectividade funcional entre regi?es de interesse (seeds) demarcadas sobre ?reas da rede default mode network (DMN). Posteriormente, a conectividade da DMN antes e ap?s o tratamento foi mapeada atrav?s de uma an?lise de componentes independentes (ICA, independent component analysis). Os resultados da an?lise de seeds n?o demonstraram modifica??es significativas na conectividade entre regi?es da DMN com o tratamento, havendo apenas um pequeno aumento da conectividade ?ntero-posterior da rede. A an?lise por ICA revelou um aumento significativo de conectividade da DMN com o put?men esquerdo (p<0,01 corrigido). Observou-se ainda uma correla??o positiva entre a redu??o dos sintomas e a conectividade entre o put?men e a DMN ap?s o tratamento (rho=0,65, p=0,17). Esses achados indicam que o tratamento com metilfenidato modifica a conectividade entre a DMN e n?cleos subcorticais. Disfun??es em circuitos corticosubcorticais foram frequentemente associados ? fisiopatologia do TDAH. O efeito do tratamento com metilfenidato pode, em parte, estar associado ? eleva??o dos n?veis dopamin?rgicos em n?cleos subcorticais, modulando a sua conectividade com a DMN.

Made available in DSpace on 2015-04-14T13:36:01Z (GMT). No. of bitstreams: 1 462235.pdf: 2683765 bytes, checksum: dc15bd33e02ceefcb7c6427763878df3 (MD5) Previous issue date: 2014-08-11 / It is unclear how temperament is related to alcohol-related behavior in large population studies. We have used the Affective and Emotional Composite Temperament Scale (AFECTS) model to evaluate how emotional traits and affective temperaments are associated with alcohol use, abuse, and dependence in the general population. Data from 10,603 subjects (mean age=28.0?7.8yrs, 70.3% females) was collected anonymously by the Internet in Brazil using the AFECTS model and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Alcohol use was stratified into control, low use, abuse, and dependence groups. The analysis of dimensional traits showed that Volition and Coping were lower, and Sensitivity was higher, in the abuse and dependence groups, with no differences between the Control and the Low Use groups. Alcohol consumption was also associated with lower Control, Stability, and Caution, and higher with Anger, Anxiety, and Desire, with significant differences between all groups. Regarding affective temperament types, alcohol abuse and dependence were associated with euphoric and cyclothymic temperaments in both genders, which was mirrored by a lower frequency of both euthymic and hyperthymictypes. Only hyperthymics were overrepresented in the Control group for both genders. A global dysfunction of emotional traits and a predominance of cyclothymic and euphoric temperaments were associated with alcohol-related behavior. Prevention and treatment strategies may be developed more effectively if these traits are taken into account. / N?o est? claro na literatura como otemperamento associa-se a comportamentos relacionados ao consumo de ?lcool em grandes estudos populacionais. Utilizamos o modelo Affective and Emotional Composite Temperament Scale (AFECTS) para avaliar como tra?os emocionais e temperamentos afetivos relacionam-se ao uso, abuso e depend?ncia de ?lcool na popula??o geral. Dados de 10.603 participantes (m?dia de idade = 28.0 ? 7.8 anos, 70,3% mulheres) foram coletados anonimamente pela Internet no Brasil utilizando o modelo AFECTS e o Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Estratificamos os sujeitos de acordo com o consumo da subst?ncia, sendo os grupos respectivamente nomeados: controle (baix?ssimo uso), baixo uso, abuso e depend?ncia. As an?lises para tra?os emocionais mostraram que nos grupos de abuso e depend?ncia os n?veis de Vontade e Maturidade (Coping) foram mais baixos, enquanto que os escores de Sensibilidade estavam mais altos, sem diferen?as entre os grupos controle e baixo uso. O consumo de ?lcool foi tamb?m associado com baixo Controle, Estabilidade e Cautela, alta Raiva, Ansiedade e Desejo, apresentando diferen?as significativas entre todos os grupos. Com rela??o aos tipos de temperamento afetivo, abuso e depend?ncia de ?lcool foram associados com temperamentos euf?rico e ciclot?mico em ambos os sexos, acompanhados de uma menor freq??ncia dos tipos eut?mico e hipert?mico. Apenas os hipert?micos tiveram alta representatividade no grupo controle, tanto para homens quanto para mulheres. A exist?ncia de uma disfun??o global de tra?os emocionais e a predomin?ncia de temperamentos ciclot?mico e euf?rico foram associados a comportamentos relacionados ao consumo de ?lcool. Ressalta-se que estrat?gias de preven??o e tratamento podem ser desenvolvidas de forma mais eficaz,sendo estas caracter?sticas identificadas e consideradas.