INTRODUÇÃO: A classificação recente das Crises Hipercinéticas (CH) proposta por Rheims et al. (2008) sugere dois padrões de CH, baseado na semiologia ictal (Tipos I e II): no Tipo I, a zona epileptogênica foi identificada na região ventral pré-frontal, enquanto que no Tipo II, na região mesial pré-motora. Estudos com SPECT ictal em pacientes com CH evidenciaram hiperperfusão nas regiões frontais e extrafrontais, incluindo ínsula e lobo temporal, além de áreas subcorticais, tais como cerebelo, tálamo, gânglios da base e tronco encefálico. OBJETIVO: Avaliar a rede neural ativada nas CH através do SPECT ictal, correlacionando-a aos dois subtipos de CH (Tipos I e II). MATERIAL E MÉTODOS: Uma amostra de 25 pacientes com idade entre 0 e 60 anos com CH que realizaram SPECT ictal foi submetida a análise do VEEG e das imagens do SPECT ictal a fim de determinar o tipo de CH e as áreas de hiperpefusão ativadas, bem como sua correlação. RESULTADOS: Nove pacientes (36%) tiveram CH do Tipo I, dez (40%), do Tipo II e seis (24%), do Tipo Misto. Não houve diferenças significativas entre os tipos de CH e a presença de semiologia ictal não hipercinética durante as crises, bem como o tempo de doença, frequência das crises, história familiar positiva e exame de neuroimagem anormal. A duração média do tempo de injeção do RF foi de 32,2 segundos. O SPECT demonstrou ativação difusa, com predomínio nas regiões subcorticais, temporal lateral, occipital mesial e frontal dorsolateral. Não houve correlação entre os diferentes tipos de CH e as áreas hiperperfundidas, exceto pela região occipital mesial, que foi significativamente maior no Tipo II. CONCLUSÃO: A classificação proposta por Rheims et al. (2008) é útil porém simplista, já que as CH abrangem uma fenomenologia complexa, não sendo possível classificar todos os pacientes em somente dois tipos (I e II). O SPECT ictal nesta amostra demonstrou a presença de hiperperfusão em diferentes áreas cerebrais, reforçando a hipótese de que uma rede neural ampla, que engloba as regiões frontais e possivelmente extrafrontais, incluindo áreas subcorticais, está envolvida na gênese destas crises. / BACKGROUND: The recent classification of hyperkinetic seizures (HS) proposed by Reims et al (2008) suggests two patterns of HS based on ictal symptomatology (Type I and II), whereas in Type I epileptogenic zone was identified in the ventromesial frontal córtex while in Type II, in the mesial premotor córtex. Ictal SPECT studies in patients with HS showed hyperperfusion in frontal and extrafrontal regions, including insula and temporal lobe, and subcortical areas, such as cerebellum, thalamus, basal ganglia and brain stem. OBJECTIVE: To evaluate the neural network activated in HS through the ictal SPECT and to correlate it to the two subtypes of HS (Type I and II). METHODS: We retrospective analyzed ictal signs and ictal SPECT data in 25 patients with HS aged between 0 and 60 years in order to determine the type of HS and the hyperperfused areas, as well as their correlation. RESULTS: Nine patients (36%) were classified as Type I, ten (40%) as Type II and 6 (24%) as a mixed type. There were no significant differences between the types of HS and the presence of non-hyperkinetic ictal semiology, as well as epilepsy duration, frequency of seizures, positive family history and abnormal neuroimage. The average injection duration time was 32.2 seconds. The ictal SPECT showed diffuse activation, predominantly in subcortical regions and the following areas: lateral temporal, mesial occipital and dorsolateral frontal cortex. There was no correlation between the different types of HS and the hyperperfused areas but the mesial occipital region that was significantly higher in Type II. CONCLUSION: The classification proposed by Rheims et al (2008) is useful but simplistic. Since the HS consists of a complex phenomenology, it is not possible to classify all patients in only two types (I and II). The ictal SPECT in this sample showed the presence of hyperperfusion in different brain areas, reinforcing the hypothesis that a broad neural network, which includes the frontal and possibly extrafrontal regions, including subcortical areas, are involved in the genesis of these seizures.

A crise não-epilética psicogênica é definida como uma manifestação corporal semelhante àquela das crises epiléticas, porém sem um correlato neurológico que justifique a sua ocorrência. Sua etiologia é atribuída a fatores psicológicos, entretanto as questões subjetivas que estão na origem dos sintomas são pouco estudadas. Esta pesquisa tem por objetivo investigar os traços histéricos da personalidade em dois pacientes encaminhados para psicoterapia de orientação psicanalítica após receberem esse diagnóstico médico, além de analisar os conteúdos afetivos latentes que se relacionam às manifestações sintomáticas nos casos estudados. O material coletado durante o atendimento prestado a esses pacientes se constituiu como registro e fonte de informação, por meio do qual os elementos relativos à personalidade histérica e mecanismos inconscientes que engendram os sintomas são descritos e estudados. Este trabalho tem por referencial a psicanálise e o estudo dos casos foi realizado considerando seus pressupostos conceituais sobre sintoma, conflito, conversão e histeria. O material obtido durante o curso das sessões evidenciou elementos como erotização do espaço analítico, constante reivindicação para ocupar o lugar de objeto de desejo alheio, além da recusa em abandonar a posição de insatisfação e buscar um estado de contentamento. Também foi observado um investimento em fantasias infantis, nas quais há o desejo inconsciente de união exclusiva com as figuras parentais. / A psychogenic nonepileptic seizure is defined as a physical manifestation similar to that of epileptic seizures, but lacking a neurological correlation to justify its occurrence. Its etiology is attributed to psychological factors although subjective questions concerning the origin of symptoms are barely studied. This research aims to investigate hysterical personality traits in two patients forwarded for psychoanalytic psychotherapy after receiving this medical diagnosis, as well as analyze latent affective contents associated with the symptomatic manifestations in these case studies. The material collected during the patient consultation served as a file and source of information through which elements relative to hysterical personality and unconscious mechanisms linked to the symptoms are described and studied. This work has psychoanalysis as a reference and the case studies were carried out considering its conceptual assumptions of symptoms, conflict, conversion and hysteria. The material obtained during the sessions evidenced elements, such as erotization of the analytic space, continuous demands to occupy the place of an object of beauty, as well as refusal to abandon discontentment and search for a contented state. Investment in infantile fantasies with an unconscious desire of exclusive union with parental figures was also observed.

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No. of bitstreams: 2 Cesar Augusto Hafele.pdf: 1965497 bytes, checksum: 254bf7fb24bb95ad4973810cd095067d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-07-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Objetivo: Descrever variáveis sociodemográficas, clinicas, comportamentais, nutricional e de saúde de indivíduos com epilepsia. Metodologia: Foi realizado um estudo observacional descritivo em Pelotas, RS. Foram coletadas variáveis sociodemográficas (sexo, idade, cor da pele, estado civil, escolaridade, renda, número de filhos, profissão e benefício social), clínicas (descrição, etiologia e classificação das crises, uso de drogas antiepilépticas (DAE), tempo de utilização das DAE, idade da primeira crise, data da última crise, idade de diagnóstico da epilepsia, histórico familiar, frequência de crises, número de crises, controle das crises, epilepsia ativa, frequência de crises nos últimos dois anos, outra doença, qual doença, outra medicação e qual medicação), comportamentais (atividade física, tabagismo e ingestão de bebidas alcoólicas), nutricional (índice de massa corporal) e de saúde (qualidade de vida, efeitos colaterais das DAE, depressão, ansiedade, estresse, qualidade do sono e autopercepção de saúde). Foi utilizada a análise univariada, com cálculo de medidas de tendência central para variáveis contínuas e de proporções para variáveis categóricas. Resultados: A amostra foi composta por 101 sujeitos de 12 a 75 anos, sendo a maioria do sexo masculino (50,5%) e de cor da pele branca (59,4%). Apenas 37,2% estavam empregados e a mediana de renda foi de R$ 788,00 Reais. A maioria estava em monoterapia (65,6%), teve mais de 15 crises durante a vida (62,9%), tinha epilepsia ativa (67,3%), era inativa fisicamente (64,6%) e apresentava índice de massa corporal normal (52,5%). O principal precipitante das crises epilépticas foi o estresse (13,0%) e a droga antiepiléptica mais utilizada foi a carbamazepina (40%). Pouco mais de um terço (34,6%) estavam deprimidos e 25,6% e 30,3% estavam nos tercis mais altos de estado e traço de ansiedade, respectivamente. A média de qualidade de vida foi de 63,2 (DP 18,2) pontos, sendo que 67% estavam nos tercis baixo e médio. Do total, 38,5% alcançaram níveis elevados de efeitos colaterais da medicação, 29,3% estavam no tercil mais alto de estresse e apenas 16% apresentaram boa qualidade do sono. Conclusão: Concluiu-se que os indivíduos da amostra possuíam níveis elevados de depressão e ansiedade, baixos níveis de atividade física e baixas condições gerais de saúde. / Purpose: The aim of this study was to describe variables sociodemographic, clinical, behavior, nutrition, and related to health from individuals with epilepsy. Methods: It was performed a descriptive bservational study in the city Pelotas, southern Brazil. It were collected sociodemographic (gender, age, skin color, marital status, education, income, number of children, occupation and social benefit), clinic (seizure type, etiology, classification, use of antiepileptic drugs - AED, time use of AED, age of first seizure, date of the last seizure, age of diagnosis of epilepsy, family history, seizure frequency, number of seizures, seizure control, status of epilepsy, seizure frequency over the last two years, other disease, and other medication), behavioral (physical activity, smoking and alcohol use), nutritional (body mass index) and health (quality of life, adverse effects of AED, depression, anxiety, stress, sleep quality and self-rated health) variables. It was performed the univariate analysis, with the calculation of measures of central tendency for continuous variables and proportions for categorical variables. Results: The sample consisted of 101 people, with age between 12 and 75 years, most being male (50.5%) and white skin color (59.4%). Only 37,2% were employed and the median for income was $ 245.86 dólares. Of all subjects, 65.6% were in treatment with monotherapy, 62.9% of sample had more than 15 seizures during the life, 67.3% had active epilepsy, 64.6% were physically inactive, and 52.5% presented normal body mass index. The main precipitant factor of epileptic seizures was the stress and the most used antiepileptic drug were the carbamazepine. One-third (34.6%) had depression, 25.6% and 30.3% were in highest tertile of state and trait of anxiety, respectively. The mean of quality of life was 63.2 (SD 18.2) points, being that 67% were in low and middle tertiles, and only 16% had good quality in sleep. Conclusion: It was concluded that people with epilepsy had higher levels of depression and anxiety, low levels of physical activity and poor general healthy conditions.

Les ganglions de la base (GB) sont principalement connus pour leurs fonctions motrices, mais présentent également des fonctions non motrices. Sans surprise, il a été montré qu’ils sont impliqués dans des troubles moteurs tels que la maladie de Parkinson ou les dystonies. Des études récentes suggèrent que les GB jouent également un rôle prépondérant dans des maladies “non-motrices” telles que l’épilepsie d’absence , qui est une épilepsie généralisée non convulsive. Dans l’ensemble de ces dysfonctions des GB, les symptômes sont accompagnés de différents patrons oscillants d’activité neuronale souvent synchronisés entre les différents noyaux des GB, le cortex et d’autres aires cérébrales. Comment les GB peuvent-ils favoriser ou soutenir ces différentes activitées oscillantes?Des expériences récentes ont montré le rôle clé joué par les GB dans l’épilepsie d’absence et remettent en question le point de vue traditionnel selon lequel les circuits thalamo-corticaux sont responsables des crises d’absence. Nous proposons une nouvelle théorie selon laquelle les rétroactions opérées par les GB sur l’activité corticale rend le réseau bistable et entraîne les patrons d’activité oscillante qui apparaîssent pendant les crises. Notre théorie est compatible avec l’ensemble des résultats expérimentaux connus et elle prédit qu’un input excitateur transitoire sur le cortex peut terminer prématurément les crises d’absence. Nous présentons ici des résultats préliminaires en accord avec cette prédiction.De multiples fréquences des oscillations d’activité sont observées dans la maladie de Parkinson au sein des GB, telles que les fréquences correspondant aux tremblement des membres ou encore les oscillations béta. Nous montrons que notre model peut générer des oscillations à différentes échelles temporelles qui coïncident avec les fréquences des oscillations dans la maladie de Parkinson. Notre théorie peut rendre compte des oscillations observées dans la maladie de Parkinson et dans l’epilépsie d’absence dans un cadre théorique unifié et suggère deux scénarios pour expliquer les multiples fréquences des oscillations d’activité, à la fois pathologiques et fonctionnelles. / The Basal Ganglia (BG) are thought to be involved primarily in motor but also in non-motor functions. Unsurprisingly, the BG are shown to be involved in motor dysfunctions such as Parkinson's disease or dystonia. More recent studies suggest the key role of the BG in "non-motor" diseases such as absence epilepsy which is a generalized non-convulsive epilepsy. In these diseases, symptoms accompany various oscillatory patterns of neural activity often synchronized across the BG, cortex and other brain areas. How can the BG support these different kinds of oscillatory patterns?Recent experiments have highlighted the key role of the BG in absence seizures and question the traditional view in which thalamocortical circuits underlie absence seizures. We propose a novel theory according to which the feedbacks of cortical activity through BG make this network bistable and drive the oscillatory patterns of activity occurring during the seizures. Our theory is compatible with virtually all known experimental results and it predicts that well-timed transient excitatory inputs to the cortex advance the termination of absence seizures. We report preliminary experimental results consistent with this prediction.Multiple oscillatory frequencies are observed in Parkinsonian BG such as the frequencies of the limb tremor and the beta oscillations. We show that our model can generate oscillations with multiple timescales which resemble Parkinsonian oscillations. Our theory can model the oscillations in Parkinson's disease and absence epilepsy in a unified framework and points to two scenarios to explain multiple frequencies of pathological and functional oscillations.

The following Creative Nonfiction Thesis delves into the suppressed past of a girl who experienced brief episodes of adolescent epilepsy. She was diagnosed with Rolandic seizures when she was eight years old and eventually “grew out” of them when she hit puberty. Since that time, the author had not spoken of these events with her family. The topic of her epilepsy remained, somewhat, the elephant in the room until the epilepsy discontinued. She interviewed her mother and her sister to see the perspectives of those people who were closest to her throughout this era. Through these interviews, the author learns of what her family truly experienced and their opinions of these events. These events largely affected the past and future relationship between her mother, her sister, and the relationship the author has with herself.

The researcher examined the relationships between tuberous sclerosis, a multi-system genetic disorder, and school functioning through the use of a parent questionnaire and behavior rating scale. Information was gathered on the typical school experiences of children with tuberous sclerosis, including educational placement and services, behavioral functioning, parent involvement, and parent satisfaction. The results indicated that the majority of students with tuberous sclerosis are in special education and receiving related services. Three-quarters received one or more related services through the public school, and 30% received private related services paid for by their parents. Parent involvement was positively correlated with parent satisfaction, and negatively correlated with t-scores on the Withdrawn/Depressed subscale of the CBCL. Parents of children receiving Autism services were generally less satisfied with their children's school experiences than other parents. Parent satisfaction was negatively correlated with the Attention Problems scale of the CBCL. Student age was negatively correlated with time in inclusion and with related services. This information forms the basis for a discussion of school psychologists' roles in the educational success of students with tuberous sclerosis and the critical areas towards which interventions should be directed.

Genetic epilepsy with febrile seizures plus (GEFS+) is associated with a wide range of neurological dysfunction caused in part by limited function in voltage-gated sodium channels (Escayg & Goldin, 2010; Gambardella & Marini, 2009; Mulley et al., 2005). The seizure and behavioral phenotypes, as well as use of non-pharmacologic agents as neuroprotectants in GEFS+, are not well-understood. An experimental design used an animal model of GEFS+ to 1. explore the effects of stress on seizure phenotype, 2. examine behavioral phenotypes, and 3. study the effects of an omega 3 fatty acid on abnormal behaviors noted in the various paradigms. This study used C57BL/6J mice with the R1648H missense mutation on the Scn1a gene (engineered in the Escayg lab) (Martin, M. S. et al., 2010). The three specific aims used separate groups of animals for experimentation, and all paradigms were performed under strict laboratory conditions. Data were analyzed using either an independent t-tests, two-way ANOVA or repeated measures two-way ANOVA. Results showed that stress worsens seizure phenotype in both the Scn1aR1648H (RH) mutants and wild-type (WT) group with the RH mutants more severely impacted. In addition, there was clear and consistent evidence for hyperactive locomotor behavior. Lastly, no evidence was found for use of docosahexaenoic acid (DHA, an omega 3 fatty acid) as a neuroprotectant for hyperactivity (DHA was given subcutaneously for two weeks starting at weaning). Outcomes from this study implicate that stress worsens the seizure phenotype in animals with Scn1aR1648H. This study is also the first to report hyperactive locomotor behavior in animals with Scn1aR1648H. Results from this study may broaden beyond GEFS+ in that we may also be able to apply the findings to other disorders with SCN1A dysfunction. In addition, it may be that genetic variants affecting SCN1A, but not necessarily in epilepsy, may contribute to hyperactivity. This could mean that SCN1A is a candidate gene for hyperactivity. The main goal of nursing care is to reduce and prevent disease morbidity, and knowledge gained from the current study will guide clinical nursing practice, such as targeted behavioral assessment and education, as well as nursing research focusing on children with this genetic disorder.

Epilepsy accounts for 0.5% of the global burden of disease, and primary prevention of epilepsy represents one of the three 2007 NINDS Epilepsy Research Benchmarks. Efforts to understand and intervene in the process of epileptogenesis have yielded fruitful preventative strategies in animal models. This article reviews the current understanding of epileptogenesis, introduces the concept of a "critical period" for epileptogenesis, and examines strategies for epilepsy prevention in animal models of both acquired and genetic epilepsies. As proof of principle, we investigated whether early preventative treatment during epileptogenesis in the WAG/Rij rat model of primary generalized epilepsy would persistently suppress the epilepsy phenotype in adulthood. Oral ethosuximide was given from age p21 to 5 months, covering the established period for epileptogenesis in this model. We then assessed the epilepsy phenotype by performing electroencephpalogram (EEG) recordings at serial time points after treatment cessation and by immunocytochemically measuring the cortical expression of ion channels Nav1.1, Nav1.6, and HCN1, which are dysregulated in epileptic WAG/Rij rats. Treatment both persistently suppressed seizures, even up to 3 months after treatment cessation, and blocked ion channel dysregulation. These findings indicated that treatment during epileptogenesis prevented the development of the epileptic phenotype. Subsequently, we investigated the C3H/HeJ mouse model of genetic epilepsy as a candidate for future studies in preventative treatment during epileptogenesis. Serial EEG recordings were performed from p5 to 3 months of age. We found that C3H/HeJ mice underwent three distinct, stereotyped phases of seizure development, which suggests that this model would be an appropriate candidate for future research on prevention of epileptogenesis.

Thesis (Ph. D.)--Medical College of Ohio, 2003. / "In partial fulfillment of the requirements for the degree of Doctor of Philosophy in Medical Sciences." Major advisor: Howard Rosenberg. Document formatted into pages: iv, 144 p. Title from title page of PDF document. Includes bibliographical references (p. 104-132).

Seizing Civilization uses the Shanghai Museum as a case study to examine an extraordinary process of art appropriation that persisted from 1949 to 1996 in the People's Republic of China (PRC). At the heart of this story is the museum's destruction of the preexisting art market, its wholesale seizure of privately-owned antiquities, and its sale of these objects on the international market. My findings show that museum employees used these events to create public art collections in the PRC. The Shanghai Museum pioneered the techniques that Chinese museums use to transform craft objects, as well as select ancient paintings, ceramics, and bronzes, into canonized cultural relics. I argue that the application of these techniques explains the erasure of provenance at Chinese Museums, and demonstrate how state cultural institutions render acquisition ledgers, private collecting records, and connoisseurship disputes invisible. I examine cultural relics' transformation into Chinese cultural heritage in five chapters. I first demonstrate how museum employees appropriated private collections during nation-building campaigns such as the nationalization of industries (1956). Second, I investigate changes to the Chinese art historical canon, placing them in the context of art market takeovers, the wholesale acquisition of ethnic minority artifacts, as well as municipal programs in salvage archaeology. Then, in two chapters, I reveal the Shanghai Museum's active participation in antiquities confiscation and divestment during the Cultural Revolution (1966 – 1976), which enriched public art collections on a previously unprecedented scale. I conclude with an examination of the mass restitution of expropriated property in the 1980s and 90s, which underpinned the museum’s dual function as both a preservationist institution, as well as a political and commercial enterprise. The antiquities and events I analyze not only explain the ascendency of a dominant narrative about Chinese civilization, but also reveal the limits, contradictions, and challenges of PRC national patrimony. / History