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Nava BC, Costa UT, Hamad APA, Garcia CAB, Sakamoto AC, Aragon DC, Machado HR, Santos MV. Long-term seizure outcome and mobility after surgical treatment for Rasmussen encephalitis in children: A single-center experience. Epileptic Disord 2023; 25:749-757. [PMID: 37589547 DOI: 10.1002/epd2.20147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Rasmussen Encephalitis (RE) is a rare inflammatory neurodegenerative disease associated with refractory seizures, hemiparesis, and cognitive deterioration, due to lateralized cortical atrophy. Hemispheric surgery (hemispherotomy) is the mainstay of treatment, but its unavoidable motor deficits and lack of long-term data regarding seizure outcomes can make patients and families apprehensive to undergo this procedure. The present study aimed at analyzing the results of surgical treatment for RE from a motor and epilepsy standpoint, and mitigate such concerns. METHODS Clinical and operative data were retrospectively collected from medical records of pharmacoresistant patients treated with functional hemispherectomy at a tertiary reference center for epilepsy surgery, during a 24-year period (1996-2020). Variables such as age of epilepsy onset, seizure semiology, seizure frequency, immunomodulatory therapy, age at surgery, duration of epilepsy, surgical procedures and complications, number of medications used preoperatively and postoperatively were described and statistically analyzed. RESULTS Forty-three (43) patients were included in this study. Mean age of epilepsy onset was 6.14 years, the average interval between epilepsy onset and hemispherotomy was 2.21 years. and the mean age at surgery was 8.28 years. Thirty patients (69.7%) were Engel I at their last follow-up, of whom 23 (56.4%) were Engel Ia, within a mean follow-up of 11.3 years. Duration of epilepsy, seizure frequency, and age at surgery, among others, did not correlate with seizure outcome, except the use of immunotherapy which led to worse outcomes (p < .05). Also, after surgery, motor functionality was significantly recovered (i.e., most patients returned to their previous status) with time. SIGNIFICANCE This study tackled some issues regarding the surgical treatment of this disease, particularly showing that hemispherotomy is safe and leads to potentially recoverable disability of motor functions while providing high rates of effective and long-lasting seizure control; therefore, early surgical indication should be warranted once medical refractoriness has been established.
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Affiliation(s)
- Brenda Cristina Nava
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ursula Thome Costa
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Andrade Hamad
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Camila Araujo Bernardino Garcia
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Americo Ceiki Sakamoto
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Davi Casale Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Helio Rubens Machado
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Volpon Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Lopes-Santos LE, de Angelis G, Nakano FN, Thome U, Velasco TR, Santos MV, Machado HR, Hamad APA, Sakamoto AC, Wichert-Ana L. Executive functioning in children with posterior cortex epilepsy compared to temporal and frontal lobe epilepsies. Epilepsy Res 2023; 192:107141. [PMID: 37062183 DOI: 10.1016/j.eplepsyres.2023.107141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE People with epilepsy are at an increased risk of experiencing executive dysfunction, particularly those with frontal lobe epilepsy (FLE). The literature has also demonstrated alterations in executive functioning (EF) in patients with temporal lobe epilepsy (TLE). However, few studies have examined the neuropsychological profile of posterior cortex epilepsy (PCE), and little attention has been given to cognitive impairments in the pediatric population with PCE. This study aims to investigate EF performance in children with drug-resistant PCE compared to patients with FLE and TLE. METHODS We analyzed neuropsychological data from 217 patients aged 6-18 years who underwent preoperative evaluation for epilepsy surgery. The EF of patients with PCE was compared to patients with FLE and TLE. RESULTS There was no significant difference in Full-Scale Intelligence Quotient (FSIQ) means between groups. However, we found a significant effect of brain region on the Coding task, in which patients with PCE and FLE performed worse than those with TLE (p = 0.034). We also observed performance differences between groups on the Stroop test (p = 0.005), with patients with PCE and FLE performing worse than the TLE group. SIGNIFICANCE These findings suggest that children with PCE have alterations in their EF that are similar to the deficits found in FLE compared to patients with TLE. This emphasizes the importance of understanding the neuroanatomy of executive functions and the model of neural networks extending beyond the prefrontal cortex.
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Affiliation(s)
- Lucas Emmanuel Lopes-Santos
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Geisa de Angelis
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Frederico Nakane Nakano
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ursula Thome
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Tonicarlo Rodrigues Velasco
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcelo Volpon Santos
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Hélio Rubens Machado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Paula Andrade Hamad
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Américo Ceiki Sakamoto
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lauro Wichert-Ana
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Santos MV, Garcia CAB, Hamad APA, Costa UT, Sakamoto AC, Dos Santos AC, Machado HR. Clinical and Surgical Approach for Cerebral Cortical Dysplasia. Adv Tech Stand Neurosurg 2023; 48:327-354. [PMID: 37770690 DOI: 10.1007/978-3-031-36785-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The present article describes pathophysiological and clinical aspects of congenital malformations of the cerebral tissue (cortex and white matter) that cause epilepsy and very frequently require surgical treatment. A particular emphasis is given to focal cortical dysplasias, the most common pathology among these epilepsy-related malformations. Specific radiological and surgical features are also highlighted, so a thorough overview of cortical dysplasias is provided.
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Affiliation(s)
- Marcelo Volpon Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil.
- Department of Surgery and Anantomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil.
| | - Camila Araujo Bernardino Garcia
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Paula Andrade Hamad
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Ursula Thome Costa
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Americo Ceiki Sakamoto
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Antonio Carlos Dos Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Helio Rubens Machado
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
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de Matos MMF, Batista LA, Thomé U, Sakamoto AC, Santos MV, Machado HR, Wichert-Ana L, Hamad APA. Reduction in anti-seizure medications use in pediatric patients with pharmacoresistant epilepsy submitted to surgical treatment. Childs Nerv Syst 2022; 39:1193-1200. [PMID: 36580119 PMCID: PMC9798357 DOI: 10.1007/s00381-022-05812-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE We aimed to analyze the potential for postoperative (PO) medication suspension and reduction, emphasizing passive withdrawal. METHODS Retrospective study of patients under 18 years old submitted to surgical treatment for pharmacoresistant epilepsy and classified as Engel I during the first year of PO follow-up. Therapeutic management was evaluated through discontinuation or reduction of medications, both in terms of the number of ASM prescribed and in daily maintenance dosages in mg/kg. RESULTS ASM withdrawal started in the first year PO and occurred in 1.2% of cases, with a significant yearly reduction in the number of ASM during follow-up (p < 0.001). A comparison of the most commonly used ASM in daily mg/kg between the preoperative period (preop) and PO showed a reduction of ASM maintenance dosages during PO. Even though recurrence of seizures was observed 5 years after surgery, 125 patients (85%) were still classified as Engel I, albeit a higher number of ASM per patient was observed. Most patients showed no changes in cognitive and adaptive behavior evaluation between preop and PO, even in those who were able to reduce ASM. CONCLUSION Significant reduction observed both in the number and daily maintenance dosages of ASM following each year of PO may be an indirect measure of the effectiveness of epilepsy surgery.
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Affiliation(s)
| | - Larissa Aparecida Batista
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
| | - Ursula Thomé
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
| | - Américo Ceiki Sakamoto
- Department of Neurosciences and Behavioural Sciences, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
| | - Marcelo Volpon Santos
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
- Division of Pediatric Neurosurgery, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Hélio Rubens Machado
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
- Division of Pediatric Neurosurgery, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lauro Wichert-Ana
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
- Division of Nuclear Medicine, Internal Medicine Department, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Paula Andrade Hamad
- Department of Neurosciences and Behavioural Sciences, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil.
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Nunes MEN, Zuanetti PA, Hamad APA. Attitudes and practices in the management of attention deficit hyperactivity disorder among Brazilian pediatric neurologists who responded to a national survey: a cross-sectional study. SAO PAULO MED J 2022; 141:e2021966. [PMID: 36541950 PMCID: PMC10065098 DOI: 10.1590/1516-3180.2021.0966.r1.20092022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 09/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) has a prevalence of 5.3% among children and adolescents. It is characterized by attention deficit, hyperactivity, and impulsivity. OBJECTIVE We aimed to conduct a survey involving pediatric neurologists in the management of ADHD and compare the results with the current literature and guidelines. DESIGN AND SETTING Descriptive analytical study of a virtual environment, was used Test of equality of proportions for comparison between two groups of pediatric neurologists (working as specialists for > 6 versus ≤ 6 years), with a significance level of P = 0.05. METHODS This cross-sectional study used a virtual questionnaire covering the steps in the diagnosis and treatment of children with ADHD. The inclusion criteria were professionals who had completed their residency/specialization in pediatric neurology and clinical neurologists working in pediatric neurology. RESULTS Among the 548 electronic invitations sent, 128 were considered valid. For all participants, the diagnosis was clinically based on the disease classification manuals. Combination treatment promotes improvement of symptoms (96.9%). Among psychostimulants, short-acting methylphenidate was the most commonly prescribed medication (85.2%). Headache was the most common side effect (77.3%). Altogether, 73.4% of the participants requested laboratory tests, 71.1% requested an electrocardiogram, and 42.2% requested an electroencephalogram. Pediatric neurologists working as specialists for ≤ 6 years had more frequent referrals to psycho-pedagogists for diagnosis (P = 0.03). CONCLUSIONS The participants complied with clinical guidelines, emphasizing the relevance of diagnostic manuals and treatment guidelines for an eminently clinical situation and enabling uniformity in quality treatment.
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Affiliation(s)
- Marina Estima Neiva Nunes
- MD. Child Neurologist, Department of Neurosciences and Behavioral Sciences, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - Patricia Aparecida Zuanetti
- PhD. Speech and Hearing Therapist, Department Health Sciences, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - Ana Paula Andrade Hamad
- MD, PhD. Child Neurologist, Department of Neurosciences and Behavioral Sciences, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
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Lopes E Santos LE, de Angelis G, Velasco TR, Thome U, Santos MV, Machado HR, Hamad APA, Sakamoto AC, Wichert-Ana L. The intellectual profile of pediatric patients with posterior cortex epilepsy. Epilepsy Behav 2021; 125:108447. [PMID: 34839240 DOI: 10.1016/j.yebeh.2021.108447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/27/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cognitive functioning in epileptic syndromes has been widely explored in patients with temporal lobe epilepsy (TLE), but few studies have investigated the neuropsychological profile in posterior cortex epilepsy (PCE). In this study, we investigated the presurgical intellectual profile of children and adolescents with drug-resistant PCE. METHODS Children and adolescents diagnosed with PCE (n = 25) participated in this study. The data were obtained from medical records, with assessments carried out between the years 2003 and 2019. To compare the intellectual profile, we also included patients diagnosed with frontal (n = 26) and temporal lobe epilepsy (n = 40). The Wechsler Intelligence Scales were used for the assessment of general intelligence. RESULTS There was an effect of the brain region on the Working Memory Index (p < 0.01), in which patients with TLE had significantly higher scores than groups with FLE (p < 0.01) and PCE (p < 0.05). We also demonstrated that patients with PCE tended to perform worse in the Processing Speed Index than patients with TLE (p = 0.055). The Full-Scale Intelligence Quotient, Verbal Comprehension, and Perceptual Reasoning indexes did not differ among the brain regions. CONCLUSIONS Children and adolescents with PCE demonstrated significant impairment in working memory and processing speed. The pattern of cognitive dysfunction in PCE was similar to that observed in FLE, which expands the evidence of the involvement of frontoparietal networks on cognitive proficiency.
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Affiliation(s)
- Lucas Emmanuel Lopes E Santos
- Department of Radiology, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Geisa de Angelis
- Department of Radiology, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Tonicarlo Rodrigues Velasco
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ursula Thome
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcelo Volpon Santos
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Hélio Rubens Machado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Paula Andrade Hamad
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Américo Ceiki Sakamoto
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lauro Wichert-Ana
- Department of Radiology, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Zuanetti PA, Avezum MDMDM, Ferretti MI, Pontes-Fernandes AC, Nunes MEN, Liporaci NM, Fukuda MTH, Hamad APA. Development of language and arithmetic skills: risk and protective factors. Comparative cross-sectional study. SAO PAULO MED J 2021; 139:210-217. [PMID: 33729418 PMCID: PMC9625007 DOI: 10.1590/1516-3180.2020.0280.r1.10122020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/10/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In a literate society, linguistic/arithmetic performance is highly valued. Based on defined risk factors, strategies for promotion of better performance can be developed. OBJECTIVE To ascertain the risk and protective factors relating to development of language and arithmetic. DESIGN AND SETTING Observational comparative cross-sectional study at a public elementary school in Ribeirão Preto (SP), Brazil. METHODS A total of 66 children (41% females) attending first to fifth grades participated in this study. They were divided into two groups: G1, children classified as presenting language or arithmetic deficits; G2, average performance. Language (oral and written) and arithmetic skills were assessed through standardized tests. Variables relating to social skills, home environment resources and behavioral problems were assessed through standardized scales. Data on other variables (pre, peri and postnatal complications, maternal variables and others) were collected through interviews. The logistic regression technique with LASSO was used (α = 0.05). RESULTS Teenage pregnancy and consumption of psychoactive substances during pregnancy or complications during pregnancy were risk factors for performance regarding arithmetic and language. Higher schooling level for the mother was a protective factor in the development of arithmetic and language. Being female and having a history of otitis were risk factors for language. Altered social skills (responsibility and civility) and complaints of inattention were risk factor for arithmetic. Adequate linguistic development was a protective factor for the development of arithmetic. CONCLUSION The risk/protective factors included variables relating to the gestational period, mother's age when pregnant, mother's schooling, social skills, behavior and development issues.
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Affiliation(s)
- Patrícia Aparecida Zuanetti
- PhD. Speech Therapist, Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP), Brazil.
| | - Marina Dias Macedo de Melo Avezum
- BSc. Psychologist, Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP), Brazil.
| | - Marita Iannazzo Ferretti
- BSc. Psychologist, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP), Brazil.
| | - Angela Cristina Pontes-Fernandes
- PhD. Psychologist, Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP), Brazil.
| | - Marina Estima Neiva Nunes
- MD. Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP), Brazil.
| | - Nelson Macedo Liporaci
- MD. Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP), Brazil.
| | - Marisa Tomoe Hebihara Fukuda
- PhD. Speech Therapist, Associate Professor, Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP), Brazil.
| | - Ana Paula Andrade Hamad
- MD, PhD. Assistant Professor, Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP), Brazil.
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Paterlini LSM, Zuanetti PA, Pontes-Fernandes AC, Fukuda MTH, Hamad APA. Screening and diagnosis of learning disabilities/disorders - outcomes of interdisciplinary assessments. Rev CEFAC 2019. [DOI: 10.1590/1982-0216/201921513319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to determine the occurrence of children with poor school performance and to investigate which intrinsic influences are most prevalent among them. Methods: a total of 104 children from the 1st grade to the 5th of elementary school participated in phase 1 (selection of children with poor school performance by a standardized test and based on average grade) and 56 of them (54%) were classified as having poor school performance. In phase 2 (differential diagnosis), 35 of these 56 children underwent multidisciplinary assessments and the results were submitted to a descriptive analysis. Results: out of the 35 children who completed phase 2, 18 (51%) were diagnosed with mood disorder (2 - 6% depression; 16 - 45% anxiety disorder/signs), 14 (40%) showed attention deficit disorder and hyperactivity, 1 (3%) showed specific language disorder and 1 (3%) showed specific learning disorder. Among the most prevalent changes in reading/writing/arithmetic dysortography (19 children - 54%) and the presence of non-literate children (10 - 29%) were observed. Conclusions: more than a half of the school-age children studied had learning deficits in written language and/or arithmetic, and the most prevalent intrinsic variables were internalizing disorders and the attention deficit/hyperactivity one.
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Bernardino MRA, Funayama C, Hamad APA, Machado H, Sakamoto A, Thome U, Terra VC, Santos ACD. Refractory epilepsy in children with brain tumors. The urgency of neurosurgery. Arq Neuropsiquiatr 2016; 74:1008-1013. [PMID: 27992000 DOI: 10.1590/0004-282x20160157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/16/2016] [Indexed: 11/21/2022]
Abstract
In order to verify indications for surgery, 27 patients with refractory epileptic seizures and brain tumor, aged up to 19 years at the time of surgery, were studied between 1996 and 2013 and followed up for at least one year. The mean interval between the onset of seizures and the diagnosis of the tumor was 3.6 years, and from diagnosis to the surgery, 18 months. The location of the tumor was in the temporal lobe in 16, with ganglioglioma and dysembryoplastic neuroepithelial tumors being the most frequent. Among the patients, 92.5% and 90.4% were seizure-free in the first and fifth year after surgery, respectively. Twelve of 16 children were successful in becoming drug-free, with complete withdrawal by 3.2 years. Surgery proved to be potentially curative and safe in these cases, suggesting that the tumor diagnosis and surgery cannot be postponed.
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Affiliation(s)
- Marília Rosa Abtibol Bernardino
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
| | - Carolina Funayama
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
| | - Ana Paula Andrade Hamad
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
| | - Hélio Machado
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
| | - Américo Sakamoto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
| | - Ursula Thome
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
| | - Vera Cristina Terra
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
| | - Antonio Carlos Dos Santos
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neuroradiologia, Seção de Ressonância Magnética, Ribeirão Preto SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Centro de Ciências das Imagens e Física Médica, Ribeirão Preto SP, Brasil
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Caboclo LOSF, Neves RS, Jardim AP, Hamad APA, Centeno RS, Lancellotti CLP, Scorza CA, Cavalheiro EA, Yacubian EMT, Sakamoto AC. Surgical and postmortem pathology studies: contribution for the investigation of temporal lobe epilepsy. Arq Neuropsiquiatr 2013; 70:945-52. [PMID: 23295424 DOI: 10.1590/s0004-282x2012001200009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 04/17/2012] [Indexed: 11/21/2022]
Abstract
Pathology studies in epilepsy patients bring useful information for comprehending the physiopathology of various forms of epilepsy, as well as aspects related to response to treatment and long-term prognosis. These studies are usually restricted to surgical specimens obtained from patients with refractory focal epilepsies. Therefore, most of them pertain to temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and malformations of cortical development (MCD), thus providing information of a selected group of patients and restricted regions of the brain. Postmortem whole brain studies are rarely performed in epilepsy patients, however they may provide extensive information on brain pathology, allowing the analysis of areas beyond the putative epileptogenic zone. In this article, we reviewed pathology studies performed in epilepsy patients with emphasis on neuropathological findings in TLE with MTS and MCD. Furthermore, we reviewed data from postmortem studies and discussed the importance of performing these studies in epilepsy populations.
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Hamad APA, Carrete H, Bianchin MM, Ferrari-Marinho T, Lin K, Yacubian EMT, Vilanova LCP, Garzon E, Caboclo LO, Sakamoto AC. Morphological variations of hippocampal formation in epilepsy: image, clinical and electrophysiological data. Epilepsy Behav 2013; 26:67-70. [PMID: 23220462 DOI: 10.1016/j.yebeh.2012.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 10/12/2012] [Accepted: 10/15/2012] [Indexed: 11/15/2022]
Abstract
Morphological variations of hippocampal formation (MVHF) are observed in patients with epilepsy but also in asymptomatic individuals. The precise role of these findings in epilepsy is not yet fully understood. This study analyzes the hippocampal formation (HF) morphology of asymptomatic individuals (n = 30) and of patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) (n = 68), patients with malformations of cortical development (MCD) (n = 34), or patients with pure morphological variations of hippocampal formation (pure MVHF) (n = 12). Main clinical and electrophysiological data of patients with MVHF were also analyzed. Morphological variations of hippocampal formation are more frequently observed in patients with MCD than in patients with MTLE-HS or in asymptomatic individuals. Patients with pure morphological variations of hippocampal formation showed higher incidence of extratemporal seizure onset. Refractoriness seems to be more associated with other abnormalities, like HS or MCD, than with the HF variation itself. Thus, although morphological HF abnormalities might play a role in epileptogenicity, they seem to contribute less to refractoriness.
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Affiliation(s)
- Ana Paula Andrade Hamad
- Departamento de Neurologia e Neurocirurgia, Hospital São Paulo, Universidade Federal de São Paulo, Rua Napoleão de Barros, 865, Vila Clementino, São Paulo/SP, Brazil.
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Garófalo Gómez N, Hamad APA, Centeno RS, Ferrari Marinho TP, Carrete Jr. H, Caboclo LO, Targas Yacubian EM. Evolución posquirúrgica en pacientes con encefalitis de Rasmussen operados por hemisferotomía. Rev Neurol 2013. [DOI: 10.33588/rn.5604.2012419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Caboclo LOSF, Miyashira FS, Hamad APA, Lin K, Carrete H, Sakamoto AC, Yacubian EMT. Ictal spitting in left temporal lobe epilepsy: report of three cases. Seizure 2006; 15:462-7. [PMID: 16893661 DOI: 10.1016/j.seizure.2006.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 04/10/2006] [Accepted: 05/23/2006] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Ictal spitting is rarely reported in patients with epilepsy. More often it is observed in patients with temporal lobe epilepsy (TLE) and is presumed to be a lateralizing sign to language nondominant hemisphere. We report three patients with left TLE who had ictal spitting registered during prolonged video-EEG monitoring. METHODS Medical charts of all patients with medically refractory partial epilepsy submitted to prolonged video-EEG monitoring in the Epilepsy Unit at UNIFESP during a 3-year period were reviewed, in search of reports of ictal spitting. The clinical, neurophysiological and neuroimaging data of the identified patients were reviewed. RESULTS Among 136 patients evaluated with prolonged video-EEG monitoring, three (2.2%) presented spitting automatisms during complex partial seizures. All of them were right-handed, and had clear signs of left hippocampal sclerosis on MRI. In two patients, in all seizures in which ictal spitting was observed, EEG seizure onset was seen in the left temporal lobe. In the third patient, ictal onset with scalp electrodes was observed in the right temporal lobe, but semi-invasive monitoring with foramen ovale electrodes revealed ictal onset in the left temporal lobe, confirming false lateralization in surface records. The three patients became seizure-free following left anterior temporal lobectomy. CONCLUSIONS Ictal spitting is a rare finding in patients with epilepsy, and may be considered a localizing sign of seizure onset in the temporal lobe. It may be observed in seizures originating from the left temporal lobe, and thus should not be considered a lateralizing sign of nondominant TLE.
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Affiliation(s)
- Luís Otávio Sales Ferreira Caboclo
- Unidade de Pesquisa e Tratamento das Epilepsias, Department of Neurology and Neurosurgery, Division of Neurology, Federal University of São Paulo, R. Napoleão de Barros, 737/13 degrees andar, São Paulo 04024-002, SP, Brazil.
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