Myoclonus-Dystonia (MD) is an inherited, rare, autosomal dominant movement disorder characterized by quick, involuntary muscle jerking or twitching (myoclonus) and involuntary muscle contractions that cause twisting and pulling movements, resulting in abnormal postures (dystonia). The first MD locus was mapped to 7q21-q31 and called DYT11; this locus corresponds to the SGCE gene. Our group previously identified a second MD locus (DYT15) which maps to a 3.18 Mb region on 18p11. Two patients were chosen to undergo next-generation sequencing, which identified 2,292 shared novel variants within the critical region. Analysis of these variants revealed a 3 bp duplication in a transcript referred to as CD108131, which is believed to be a long non-coding RNA. Characterization of this transcript determined that it is 863 bp in size, it is ubiquitously expressed, with high expression in the cerebellum, and it accounts for ~3% of MD cases.

Myoclonus-Dystonia (MD) is an inherited, rare, autosomal dominant movement disorder characterized by quick, involuntary muscle jerking or twitching (myoclonus) and involuntary muscle contractions that cause twisting and pulling movements, resulting in abnormal postures (dystonia). The first MD locus was mapped to 7q21-q31 and called DYT11; this locus corresponds to the SGCE gene. Our group previously identified a second MD locus (DYT15) which maps to a 3.18 Mb region on 18p11. Two patients were chosen to undergo next-generation sequencing, which identified 2,292 shared novel variants within the critical region. Analysis of these variants revealed a 3 bp duplication in a transcript referred to as CD108131, which is believed to be a long non-coding RNA. Characterization of this transcript determined that it is 863 bp in size, it is ubiquitously expressed, with high expression in the cerebellum, and it accounts for ~3% of MD cases.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23104号 / 医博第4731号 / 新制||医||1050(附属図書館) / 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 林 康紀, 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

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21680号 / 医博第4486号 / 新制||医||1036(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊佐 正, 教授 村井 俊哉, 教授 松原 和夫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Indiana University-Purdue University Indianapolis (IUPUI) / Glycogen is a highly branched polymer of glucose that functions to store glucose residues for future metabolic use. Skeletal muscle and liver comprise the largest glycogen reserves and play critical roles in maintaining whole body glucose homeostasis. In addition to glucose, glycogen contains small amounts of covalent phosphate of unknown function, origin and structure. Evidence to support the involvement of glycogen associated phosphate in glycogen metabolism comes from patients with Lafora Disease. Lafora disease is an autosomal recessive, fatal form of progressive myoclonus epilepsy. Approximately 90% of cases of Lafora disease are caused by mutations in either the EPM2A or EPM2B genes that encode, respectively, a dual specificity phosphatase called laforin and an E3 ubiquitin ligase called malin. Lafora patients accumulate intracellular inclusion bodies, known as Lafora bodies that are primarily composed of poorly branched, insoluble glycogen-like polymers. We have shown that laforin is a glycogen phosphatase capable of releasing phosphate from glycogen in vitro and that this activity is dependent on a functional carbohydrate binding domain. In studies of laforin knockout mice, we observed a progressive change in the properties and structure of glycogen that paralleled the formation of Lafora bodies. Glycogen isolated from these mice showed increased glycogen phosphate, up to 6-fold (p< 0.001) compared to WT, providing strong evidence that laforin acts as a glycogen phosphatase in vivo. Furthermore we have demonstrated that glycogen synthase introduces phosphate into glycogen during synthesis by transferring the beta-phosphate of UDP-glucose into the polymer and that laforin is capable of releasing the phosphate incorporated by glycogen synthase. Analysis of mammalian glycogen revealed the presence of covalently linked phosphate at the 2 hydroxyl and the 3 hydroxyl of glucose residues in the polysaccharide, providing the first direct evidence of the chemical nature of the phosphate linkage. We envision a glycogen damage/repair process, analogous to errors during DNA synthesis that are subsequently repaired. We propose that laforin action parallels that of DNA repair enzymes and Lafora disease results from the inability of the phosphatase to repair damaged glycogen, adding another biological polymer to the list of those prone to errors by their respective polymerizing enzymes.

The recent explosion of DNA sequence information has provided compelling evidence for the following facts. (1) Simple repetitive sequences-microsatellites and minisatellites occur commonly in the human genome and (2) these repetitive DNA sequences could play an important role in the regulation of various genetic processes including modulation of gene expression. These sequences exhibit extensive polymorphism in both length and the composition between species and between organisms of the same species and even cells of the same organism. The repetitive DNA sequences also exhibit structural polymorphism depending on the sequence composition. The functional significance of repetitive DNA is a well-established fact. The work done in many laboratories including ours has conclusively documented the functional role played by repetitive sequences in various cellular processes. Structural studies have established the sequence requirement for various non-B DNA structures and the functional significance of these unusual DNA structures is becoming increasingly clear. The structures that were characterised earlier purely from conformation point of view have aroused interest after the recent realisation that these structures could be formed in vivo when cloned in a supercoiled plasmid. The discovery of novel type of dynamic mutations where intragenic amplifications of trinucleotide repeats is associated with phenotypic changes causing many neurodegenerative disorders has provided the most compelling evidence for the importance of simple repeats in the etiology of these disorders. Secondary structures adopted by these simple repeats is a common causative factor in the mechanism of expansion of these repeats. This realisation prompted many investigations into the relationship between the DNA sequence, structure and molecular basis of dynamic mutation. Many experimental evidences have implicated paranemic DNA structures in various biological processes, especially in the regulation of gene expression. Earlier work done in our laboratory on the structure function relationship of repetitive DNA sequences provided experimental evidence for the role of paranemic DNA structure in the regulation of gene expression. It was demonstrated that intramolecular triplex potential sequences within a gene downregulate its expression in vivo (Sarkar and Brahmachari (1992) Nucleic Acids Res., 20, 5713-5718). Similarly the effect of cruciform structure forming sequences on gene expression was also documented. Sequence specific alterations in DNA structures were studied in our laboratory using a variety of biophysical and biochemical techniques. An intramolecular, antiparallel tetraplex structure was proposed for human telomeric repeat sequences (Balagurumoorthy, et al., (1994) J. Biol. Chem., 269, 21858-21869). The telomeric repeats are not only present at the end of chromosomes but they are also present at many interstitial sites in the human genome. Database search reveals that the human telomeric sequences as well as similar sequences with minor variations are present at many locations in the human genome. Telomeric repeats are GC rich sequences with the G rich strand protruding as a 3' end overhang at the end of chromosomes. When human telomeric repeats are cloned in a supercoiled plasmid, the C rich strand adopts a hairpin like conformation where as the G-rich strand extrudes into a quadruplex structure. However, the biological significance of these structures in vivo still remains to be elucidated completely. The role of a putative tetraplex DNA structure in the insulin gene linked polymorphic region of the human insulin gene in vivo in the regulation of expression of the insulin gene has been suggested. In this context, we have addressed the question whether the telomeric repeats when present within a gene affect its expression in vivol If so, what would be the possible mechanism? An attempt has been made to understand the effect of presence of telomeric repeats within a gene on its expression. The details of these studies have been presented in Chapter 2 of this thesis. Contrary to telomeric repeats which provide stability to the chromosomes, recently expansion of a GC rich dodecamer repeat upstream of cystatin B gene (chromosome 21q) has been shown to be the most common mutation associated with Progressive Myoclonus Epilepsy (EPM1) of Unverricht-Lundberg type. Two to three copies of the repeat (CCCCGCCCCGCG)n are present in normal individuals whereas the affected individuals have 30-75 copies of this repeat. The expression of cystatin B gene is reduced in patients in a cell specific manner. The repeat also shows intergenerational variability. The exact mechanism of expansion of this repeat is not known. In the case of trinucleotide repeat expansion, it is shown that the structure adopted by the repeat plays an important role in the mechanism of expansion and that some of the secondary structures adopted by trinucleotide repeats could be inherently mutagenic conformations. In order to understand the mechanism of expansion EPM1 dodecamer repeat, the work reported in this thesis was carried out with the following objectives. • To understand the structure of G rich and C-rich strands of EPM1 repeat. • To understand the variations in the structure with the increase in the length and its possible implications in the mechanism of expansion of EPM 1 repeat. Studies aimed with these objectives are presented in chapters 3, 4 and 5 of the thesis. Chapter 1 provides a general introduction to repetitive DNA, the various structures adopted by repetitive DNA sequences in the genome, the functional significance of the various simple repetitive DNA sequences in the genome has been presented. An account of trinucleotide repeat expansion and associated disorders, non-trinucleotide repeat expansions and associated disorders has been presented. The various non B-DNA structures adopted these repeats and their implications in the mechanism of expansion have been discussed. Chapter 2 describes in frame cloning of human telomeric repeats d(G3T2A)3G3 in the N-terminal region of β-galactosidase gene. The effect of such repeat Sequences on transcription elongation in vivo has been studied using E.coli as a model system. The 3.5 copies of human telomeric repeat sequences were cloned in the sense strand of plasmid pBluescriptllSK+ so as to create plasmid clone pSBQ8 and in the template strand of plasmid pBluescriptHKS+ so as to create clone pSBRQ8. One dimensional chloroquine gel shift assay indicated presence of an unwound structure in pSBQ8 and pSBRQ8. β-galactosidase activity assay suggested downregulation of the gene in vivo. In the case of plasmid pSBQ8 the difference in β-galactosidase activity was approximately 6 fold as compared to the parent plasmid pBluescriptIISK+ whereas in the case of pSBRQ8 the difference in β-galactosidase activity was approximately 8 fold as compared to the control pBluescriptIIKS+. The analysis of β-galactosidase transcript showed that full length transcript was formed in the case of pSBQ8. Full length transcript was not formed in the case of pSBRQ8. We propose that in the case of pSBQ8 the gene expression is inhibited in steps subsequent to transcription elongation. In the case of pSBRQ8, we propose that quadruplex structure may be formed by the template strand at the DNA level thereby blocking transcription elongation step. Chapter 3 describes studies aimed at understanding the structure of G-rich strand (referred to as G strand) of Progressive Myoclonus Epilepsy (EPM1) repeat. The sequence of the G strand of dodecamer EPM1 repeat is d(GGGGCGGGGCGC)n. Oligoucleotides containing one (12mer), two (24mer) and three(36mer) were synthesised. These oligonucleotides are referred to as dG12, dG24 and dG36 respectively. Structural studies were carried out using CD spectroscopy, UV melting, non-denaturing gel electrophoresis and chemical and enzymatic probing. The G strand oligonucleotides showed enhanced gel elecrophoretic mobility in the presence of monovalent cations KCl and NaCl. Oligonucleotide dG12 also showed retarded species on non-denaturing gel in the presence of 70mM KCl indicating intermolecular associations. Oligonucleotides dG24 and dG36 predominantly formed intramolecular structures which migrated anomalously faster than the expected size. The CD spectrum for dG12 showed an intense positive band at 260nm and a negative band at 240nm in the presence of KCl indicative of an intermolecular, parallel G quartet structure. The CD spectra of dG24 and dG36 showed 260nm positive peak, 240nm negative peak along with a positive band around 290nm. This is indicative of folded back structure. These findings support the results of non-denaturing gel electrophoresis of G strand oligonucleotides. The UV melting profiles suggested increase in the stability with the increase in the length. These structures were further characterised by PI nuclease and chemical probing using DMS and DEPC. The structural studies with G-rich strand of EPM1 dodecamer repeat showed that this repeat motif adopts intramolecularly folded structures with increase in the length of the repeat thereby favouring slippage during replication. Chapter 4 deals with the studies aimed at understanding the structure at acidic pH of C-rich strand (referred to as C strand) of Progressive Myoclonus Epilepsy (EPM1) repeat. The sequence of the C strand of dodecamer EPM1 repeat is d(CCCCGCCCCGCG)n. The C rich oligonucleotides are known to form a four stranded structure called i-motif at acidic pH involving intercalated base pairs. The i-motif consists of two parallel stranded, base paired duplexes are arranged in an antiparallel orientation. Since, the base pairs of one base paired duplex intercalate into those of the other duplex, the structure is called as i-motif. We have investigated structure of C strand of EPM1 repeat by circular dichroism (CD), native polyacrylamide gel electrophoresis and UV melting. Oligonucleotide dC12 showed two bands of which the major band was retarded on the native gel (pH 5.0) at low temperature suggesting that dC12 predominantly formed intermolecular structure, Oligonucleotides dC24 and dC36 migrated anomalously faster than the expected size indicating formation of compact, intramolecularly folded structures. Circular dichroism studies indicate that, all the oligonucleotides displayed an intense positive band near 285nm, a negative band around 260nm with a cross over at 270nm, This is a characteristic CD signature for an i-motif structure and reflects the presence of secondary structure due to formation of hydrogen bonded pairs between protonated cytosines. All the C strand oligonucleotides showed hyperchromism at 265nm, which is an isobestic wavelength for C protonation. Studies described in this chapter suggest an intramolecular i-motif structure for dC24 and dC36 and an intermolecular i-motif for oligonucleotide dC12. In addition, it was interesting to note that inspite of the presence of G residues, the stretch of C residues could adopt i-motif structure. Although these structures are formed at an acidic pH, it is indicative of formation of possible intramolecularly folded structure. Many reports have suggested the possibility of cytosine rich sequences adopting i-motif structure even at neutral pH. In order to test this possibility, structural studies were carried out on the C strand EPM1 oligonucleotides at pH 7.2 in the presence of 70mM NaCl. These studies have been described in Chapter 5. The investigations were done using CD spectroscopy, UV melting, native polyacrylamide gel electrophoresis, and chemical probing using hydroxylamine and PI nuclease. These studies indicate that all the C strand oligonucleotides form intramolecular, hairpin structure at physiological pH. All the three C strand oligonucleotides migrated anomalously faster on the native gel indicating the presence of a compact structure. The CD spectra at pH 7.2 showed a blue shift as compared to those at pH 5.0. This indicated absence of base pairs. The hydroxylamine chemical probing suggested presence of G-C Watson-Crick base pairs. The loop residues of the folded back hairpin structures were probed with PI nuclease. The C strand oligonucleotides showed possibility of formation of multiple hairpin structures with the increase in the length of the repeat. The propensity to form hairpin structures suggests a possibility of formation of slip loop structures during the replication process thereby promoting expansion of this repeat. Formation of folded back hairpin like structures is significant in terms of mechanism of expansion of this repeat. Chapter 6 is devoted to concluding remarks highlighting the significance of the experimental results presented in this thesis and their possible biological implications in the light of contemporary research.

Glycine receptor antibodies have been identified in a few patients with progressive encephalomyelitis with rigidity and myoclonus (PERM), a highly disabling disorder characterised by rigidity, spasm and brainstem symptomatology. The clinical characteristics of patients with glycine receptor antibodies have not yet been fully described and it is not clear whether GlyR-Abs are pathogenic or just an epiphenomenon. This study examined the clinical features and immunotherapy responses of 45 patients; characterised the GlyR-Ab pathogenicity, subunit specificity and binding to different brain region in vitro, and examined mice injected with GlyR-Abs to model the disease in vivo. Most of the patients were classified as PERM but some patients had symptomatology beyond the classical motor manifestations and there were four patients with tumours (thymomas and lymphomas). GlyR-Ab titres were varied in serum and CSF, but there was intrathecal synthesis in the six patients with suitable samples. Most patients were very disabled but almost all showed excellent responses to immunotherapies. The antibodies were mainly IgG1 and IgG3 subclasses, activated complement on glycine receptor-transfected HEK cells at room temperature, and caused internalisation and lysosomal degradation of the glycine receptors at 37°C. GlyR-Abs bound to rodent spinal cord and brainstem co-localising with monoclonal antibodies to GlyRα1 on the surface of neurons. GlyR-IgG injected intra-peritoneally led to impairment in forced walking ability, sensorimotor function and coordination. Analysis of the brain showed that animals injected with patients' IgG, but not control IgG, had antibodies bound to the brainstem, spinal cord, cerebellum and caudate, co-localising with GlyRα1 monoclonal antibody. Intra-cerebroventricular injection of GlyR-IgG caused an anxiety-like behaviour in mice but no evident motor disturbances. These results provide the first evidence of in vitro and in vivo pathogenicity of the GlyR-Abs, supporting the use of long term immunosuppression in these patients to provide them with a good prognosis.

Submitted by MARINA LOPES MECHLER null (mlopesvet@gmail.com) on 2018-02-19T14:08:06Z No. of bitstreams: 1 Dissertação_Marina Lopes Mechler.pdf: 2026984 bytes, checksum: ffc0d70577dd42d4b80d5ee121754dbd (MD5) / Approved for entry into archive by Alexandra Maria Donadon Lusser Segali null (alexmar@fcav.unesp.br) on 2018-02-20T12:49:32Z (GMT) No. of bitstreams: 1 mechler_ml_me_jabo.pdf: 2026984 bytes, checksum: ffc0d70577dd42d4b80d5ee121754dbd (MD5) / Made available in DSpace on 2018-02-20T12:49:32Z (GMT). No. of bitstreams: 1 mechler_ml_me_jabo.pdf: 2026984 bytes, checksum: ffc0d70577dd42d4b80d5ee121754dbd (MD5) Previous issue date: 2018-02-02 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O tremor congênito em suínos possui diversas etiologias, inclusive os pestivirus. O objetivo deste trabalho foi avaliar se o vírus da diarreia viral bovina (BVDV) é um dos agentes etiológicos da enfermidade. Para tal, foi realizada inoculação de dez fêmeas suínas gestantes com BVDV-2 em dois diferentes modelos experimentais, sendo o primeiro a inoculação oronasal das fêmeas (Grupo 1; n=4), e o segundo a inoculação fetal intrauterina (Grupo 2; n=4). O terceiro grupo (Grupo 3; n=2) foi o controle. As marrãs e os fetos foram desafiados aos 45 dias de gestação com BVDV-2. Foram colhidas amostras sangue de todos os leitões nascidos para obtenção de sangue total e soro, para determinação dos títulos de anticorpos pela virusneutralização (VN) e detecção de RNA viral pela técnica de RTPCR. Um terço dos neonatos foram eutanasiados ao terceiro dia de idade, e deles coletaram-se fragmentos de encéfalo, tronco encefálico e medula espinhal para avaliação anatomohistopatológica e RT-PCR. Os leitões que permaneceram vivos foram avaliados clinicamente todos os dias, e foi realizada colheita de sangue periodicamente durante 35 dias, as quais foram submetidas à sorologia (VN) e RTPCR. Os leitões de ambos os grupos não apresentaram sinais clínicos neurológicos e nasceram com ausência de vírus no sangue e nos órgãos. Os leitões do Grupo 1 não apresentaram anticorpos contra o BVDV-2 ao nascimento, que posteriormente foram adquiridos por transferência passiva materna. Ao contrário, os leitões do Grupo 2 nasceram com altos títulos de anticorpos contra o agente, que permaneceram altos até o término do período experimental. Microscopicamente, não foram observadas alterações dignas de nota. Macroscopicamente, observou-se que 29,5% do total de leitões abatidos dos grupos infectados nasceram com baixa relação entre cérebro e cerebelo, o que pode ser indicativo de hipoplasia cerebelar. Desta forma, concluiu-se que o BVDV não parece ser um agente etiológico para o tremor congênito suíno. / Congenital tremor in pigs has several etiologies, including pestiviruses. The objective of this study was to evaluate whether bovine viral diarrhea virus (BVDV) is one of the etiological agents of this disease. Ten pregnant gilts were inoculated with BVDV-2 in two different experimental models, the first being the oronasal inoculation of the females (group 1; n=4), and the second was the intrauterine fetal inoculation (group 2; n=4). The third group (group 3; n=2) constituted the control group. Gilts and fetuses were challenged at 45 days of gestation with strain BVDV-2 SV 280. Blood samples were collected from all piglets born to obtain whole blood and serum for determination of antibody titers by virus neutralization (VN) and detection of viral RNA by the RT-PCR technique. One third of the neonates were euthanized at the third day of age, and fragments of brain, cerebellum, brain stem and spinal cord were collected for anatomopathological and RT-PCR evaluation. The piglets that remained alive were clinically evaluated every day, and blood samples were collected periodically for 35 days, which were submitted to serology (VN) and RT-PCR. The piglets of both groups showed no clinical neurological signs and were born without virus in the blood and organs. Group 1 piglets did not present antibodies against BVDV-2 at birth, which were acquired by passive maternal transfer. In contrast, Group 2 piglets were born with high antibody titers against the agent, which remained high until the end of the experimental period. Microscopically, no noticeable changes were observed. Macroscopically, it was observed that 29.5% of the total piglets slaughtered from the infected groups were born with a low ratio between brain and cerebellum, which may be indicative of cerebellar hypoplasia. Thus, it was concluded that BVDV does not appear to be an etiological agent for congenital pig tremor. / 409435/2016-3 / 2016/02982-3,

As epilepsias generalizadas idiopáticas (EGIs) associam-se a controle satisfatório de crises e a exames de neuroimagem convencionais normais. Métodos de neuroimagem avançada, como DTI (diffusion tensor imaging) e VBM (voxel based morphometry), permitiram melhor compreensão dos mecanismos envolvidos no comportamento clínico das EGIs. O objetivo do estudo foi avaliar diferenças clínicas entre pacientes com EGI não refratária e refratária, assim como avaliar as diferenças entre pacientes com EGI não refratária, refratária e indivíduos saudáveis através de ressonância por DTI e VBM. Avaliamos 40 pacientes com características clínicas e eletrencefalográficas de EGI, sendo 22 pacientes com EGI não refratária (GNR) e 18 pacientes com EGI refratária (GR). Participaram do estudo 20 indivíduos saudáveis, os quais compuseram o grupo controle (GC). O grupo GR apresentava maior número de pacientes usuários de fármacos benzodiazepínicos (p=0,01) e de fármacos antiepilépticos não-valproato (p=0,02). Pacientes do grupo GR também utilizavam doses maiores de VPA que os pacientes do grupo GNR (p=0,03) e recebiam maior carga total média de fármacos antiepilépticos (p=0,04). Observou-se, em relação aos 16 feixes e tratos avaliados nos índices de DTI (AF, DM, DR, DA) que houve diferença estatística do grupo GNR em relação ao GC em duas áreas do índice AF (anisotropia fracional), seis áreas do índice DM (difusividade média), seis áreas do índice DR (difusividade radial) e seis áreas do índice DA (difusividade axial), assim como houve diferença estatística do grupo GR em relação ao GC em duas áreas do índice AF, sete áreas do índice DM, seis áreas do índice DR e três áreas do índice DA. Entre as 94 regiões estudadas por VBM, observou-se redução volumétrica estatística em nove áreas de interesse no GNR quando em comparação ao GC e em sete áreas de interesse no GR quando em comparação ao GC. Não se observaram diferenças entre os grupos GNR e GR nos parâmetros avaliados por DTI ou por VBM. Como esperado, observamos que pacientes com EGI refratária mais frequentemente utilizam fármacos antiepilépticos de segunda linha ou não habituais a este tipo de epilepsia. O estudo permitiu concluir que o comprometimento encefálico nas EGIs analisadas é difuso e envolve áreas habitualmente não associadas a estas epilepsias, como o hipocampo e outras áreas temporais, e que os achados imagenológicos não se associam à refratariedade clínica dos pacientes / Generalized idiopathic epilepsies (IGEs) are usually associated with good seizure control and normal conventional neuroimaging exams. Advanced neuroimaging methods, such as DTI (diffusion tensor imaging) and VBM (voxel based morphometry) have provided a better understanding of the IGEs. This study´s primary objective was to evaluate clinical diferences between refractory and non-refractory IGEs, and to compare advanced MRI methods (DTI and VBM) findings in refractory and non-refractory IGE patients. Forty IGE patients were divided in two groups: 22 non-refratory (NRG) patients and 18 refractory (RG) patients. Twenty healthy subjects were enrolled as a control group (CG). RG patients received benzodiazepines (p=0,01) and non-valproate antiepileptic drugs (p=0,02) more often than NRG patients. RG group also received a higher mean total of antiepileptic drug load (p=0,04) than NRG group. Regarding neuroimaging methods, DTI index analysis (FA, MD, RD, AD) statiscally demonstrated that NRG group had two compromised areas on FA (fractional anisotropy) index, six areas on MD (mean diffusivity) index, six areas on RD (radial diffusivity) index and six areas on AD (axial diffusivity) index, when compared to CG. On RG group, DTI index analysis statiscally demonstrated that this group had two compromised areas on FA index, seven areas on MD index, six areas on RD index and three areas on AD index, when compared to CG, of 16 analyzed areas of interest. VBM analysis of 94 regions of interest showed reduced volumes in nine areas in the NRG group when compared to CG and in seven areas of interest in the RG group when compared to CG. We found no differences on DTI and VBM parameters comparing NRG and RG groups. As expected, refractory IGE patients received second line or non-usual antiepileptic drugs for this epilepsy type more often than non-refractory patients. We concluded that brain involvement´s in IGEs is diffuse and affects areas usually not related to this epilepsy type, such as the hipocampus and other temporal areas. Advanced neuroimaging findings in IGEs were not associated with clinical refractoriness

As epilepsias generalizadas idiopáticas (EGIs) associam-se a controle satisfatório de crises e a exames de neuroimagem convencionais normais. Métodos de neuroimagem avançada, como DTI (diffusion tensor imaging) e VBM (voxel based morphometry), permitiram melhor compreensão dos mecanismos envolvidos no comportamento clínico das EGIs. O objetivo do estudo foi avaliar diferenças clínicas entre pacientes com EGI não refratária e refratária, assim como avaliar as diferenças entre pacientes com EGI não refratária, refratária e indivíduos saudáveis através de ressonância por DTI e VBM. Avaliamos 40 pacientes com características clínicas e eletrencefalográficas de EGI, sendo 22 pacientes com EGI não refratária (GNR) e 18 pacientes com EGI refratária (GR). Participaram do estudo 20 indivíduos saudáveis, os quais compuseram o grupo controle (GC). O grupo GR apresentava maior número de pacientes usuários de fármacos benzodiazepínicos (p=0,01) e de fármacos antiepilépticos não-valproato (p=0,02). Pacientes do grupo GR também utilizavam doses maiores de VPA que os pacientes do grupo GNR (p=0,03) e recebiam maior carga total média de fármacos antiepilépticos (p=0,04). Observou-se, em relação aos 16 feixes e tratos avaliados nos índices de DTI (AF, DM, DR, DA) que houve diferença estatística do grupo GNR em relação ao GC em duas áreas do índice AF (anisotropia fracional), seis áreas do índice DM (difusividade média), seis áreas do índice DR (difusividade radial) e seis áreas do índice DA (difusividade axial), assim como houve diferença estatística do grupo GR em relação ao GC em duas áreas do índice AF, sete áreas do índice DM, seis áreas do índice DR e três áreas do índice DA. Entre as 94 regiões estudadas por VBM, observou-se redução volumétrica estatística em nove áreas de interesse no GNR quando em comparação ao GC e em sete áreas de interesse no GR quando em comparação ao GC. Não se observaram diferenças entre os grupos GNR e GR nos parâmetros avaliados por DTI ou por VBM. Como esperado, observamos que pacientes com EGI refratária mais frequentemente utilizam fármacos antiepilépticos de segunda linha ou não habituais a este tipo de epilepsia. O estudo permitiu concluir que o comprometimento encefálico nas EGIs analisadas é difuso e envolve áreas habitualmente não associadas a estas epilepsias, como o hipocampo e outras áreas temporais, e que os achados imagenológicos não se associam à refratariedade clínica dos pacientes / Generalized idiopathic epilepsies (IGEs) are usually associated with good seizure control and normal conventional neuroimaging exams. Advanced neuroimaging methods, such as DTI (diffusion tensor imaging) and VBM (voxel based morphometry) have provided a better understanding of the IGEs. This study´s primary objective was to evaluate clinical diferences between refractory and non-refractory IGEs, and to compare advanced MRI methods (DTI and VBM) findings in refractory and non-refractory IGE patients. Forty IGE patients were divided in two groups: 22 non-refratory (NRG) patients and 18 refractory (RG) patients. Twenty healthy subjects were enrolled as a control group (CG). RG patients received benzodiazepines (p=0,01) and non-valproate antiepileptic drugs (p=0,02) more often than NRG patients. RG group also received a higher mean total of antiepileptic drug load (p=0,04) than NRG group. Regarding neuroimaging methods, DTI index analysis (FA, MD, RD, AD) statiscally demonstrated that NRG group had two compromised areas on FA (fractional anisotropy) index, six areas on MD (mean diffusivity) index, six areas on RD (radial diffusivity) index and six areas on AD (axial diffusivity) index, when compared to CG. On RG group, DTI index analysis statiscally demonstrated that this group had two compromised areas on FA index, seven areas on MD index, six areas on RD index and three areas on AD index, when compared to CG, of 16 analyzed areas of interest. VBM analysis of 94 regions of interest showed reduced volumes in nine areas in the NRG group when compared to CG and in seven areas of interest in the RG group when compared to CG. We found no differences on DTI and VBM parameters comparing NRG and RG groups. As expected, refractory IGE patients received second line or non-usual antiepileptic drugs for this epilepsy type more often than non-refractory patients. We concluded that brain involvement´s in IGEs is diffuse and affects areas usually not related to this epilepsy type, such as the hipocampus and other temporal areas. Advanced neuroimaging findings in IGEs were not associated with clinical refractoriness