Disturbios cognitivos na epilepsia

Autor Principal: Florindo Stella
Tipo: Teses/dissertações
Idioma: Português
Publicado em: 1998
Assuntos:
Link Texto Completo: http://libdigi.unicamp.br/document/?code=000131889
Saved in:
The present research refers to the the relationship between epileptic syndrome - Complex Partial Seizures - and cognitive performance.

In order to study this subject we defined the following aims: 1) Characterization of neuroclinic condition of epileptic patients; 2) We studied the correlations between Epilepsy and Neuropsychological disorders; and 3) Contribuitions presentation to discuss the cognitive quality in Epilepsy.

Fifty outpatients clinic consultation of both, males and females, (range 19-49 years), with Epilepsy, who had attended regularly at Neuroepilepsy Division of State University of Campinas, SP, were the Patients Group studied.

These seizures were like Complex Partial, with bioelectric alteration and consciousness disturb.

Theses seizures should or not be preceded by Sample Partial Seizures, and with or without secondary generalization.

Comparing the results among patients and non-epileptic subjetcs, we studied 20 people without neuropsychiatric disturbs.

These people were the Contrasting Group, whose social, economic, cultural conditions, professional work, and scholar level were similar to the patients.

The methods were: 1) Clinic diagnosis of Epilepsy whit Complex Partial Seizures.

2) Neuropsychological examination by the means: Concentrated Attention Test (Tolulouse- Pieron), Memory Test (Wechsler), and Intelligence Test for Adults (Wechsler-Bellevue) - Logical Functions, with 13 subtests.

Correlation between neuroimage technics and neuropsychological performance - Brain Interictal CBF SPECT HMPAO Tc 99m, CT and IRM.

3) Contributions to the Health Professionals in order to aid cognitive quality preservation.

The patients scores were compared to 20 normal contrasting group no neuropsychiatric disorders.

The results showed the next data.

In Concentrated Attention Test (Toulouse-Pieron), in Correct section, the Contrasting Group had 207,7 scores average, and the Patients Group had 189,9 scores average (p <0,05).

In Wrongs + Absences section the Contrasting Group obtained 13,4 scores average, and the Patients Group had 40,4 scores average (p <0,05).

And in Time section, the Contrasting Group spent 683 seconds average for making the Test, and the Patients Group spent 727 seconds average (p >0,05).

The finds from Concentrated Attention Test showed p <0,05, and this index become evident the significative statistically difference between both, the Contrasting Group and the Patients Group.

Only at Time section it was p >0,05.

In Storage and Retrieval (Wechsler) the Contrasting Group had 11,0 points average, and the Patients Group, 5,5 points average (p <0,05).

In Recent Memory (Wechsler) the Contrasting Group obtained 15,4 points average, while the Patients Group, 14,5 points average (p <0,05).

In Immediated Memory (Wechsler) the Contrasting Group obtained 38,0 points average, while the Patients Group, 27,0 points average (p <0,05).

The Intelligence Test for Adults (Wechsler-Bellevue) - Logical Functions - showed these results at next respective Subtests.

In Stories the Contrasting Group had 18,7 points average, and the Patients Group, 13,7 points average (p <0,05).

In Comprehension the points average from Contrasting Group was about 5,7, and from Patients Group was 3,1 (p <0,05).

In Pictures Completion the Contrasting Group had 5,7 points average, while the Patients Group had 4,2 points average (p <0,05).

In Arithmetic Reasoning the Contrasting Group obtained 5,2 points average, and the Patients Group 3,3 points average (p <0,05).

In Similarities the Contrasting Group presented 5,0 points average, and the Patients Group 2,8 points average (p <0,05).

In Mosaic the Contrasting Group obtained 29,7 points average, while the Patients Group 21,3 points average (p <0,05).

In Coding the Contrasting Group had 29,2 points average, and the Patients Group obtained 20,0 points average (p <0,05).

All theses Subtests showed significative statistically difference (p <0,05) among both the Contrasting Group and the Patients Group, at a loss to the patients.

By the present Tests, the Neuropsychological Evaluation showed lower cognitive performance from the patients when they are compared to the normal subjects.

Statistically, the finds had p <0,05 on all the Tests, excepting the Time section of Concentrated Attention Test.

It was correlated cognitive activity and specific finds from epileptic condition, like date of last seizure, chronicity of epileptic condition, seizures frequency, brain lesion disease, electroencephalography, and neuroimaging.

We included too few considerations about Complex Partial Seizures and about neropsychiatric disorders.

The main conclusions from this work were: a) The patients with Complex Parcial Seizures had lower cognitive performance in the three sections of Neuropsychological Evaluation: Concentrated Attention, Memory, and Logical Functions, b) The Neuropsychological Evaluation made immediatly after the seizure suffers interference from it; when brief the interictal intervals tend to be more deleterious than long intervals; chronicity above 10 years and precocious beginning of the seizures are important risk factor of cognitive impairment, d) Patients with hypoperfusion in Left Temporal Lobe showed by Cerebral SPECT and patients with abnormality showed by EEG in Right Temporal Lobe showed lower cognitive performance.

The difference from the cognitive performance associated with these investigation mean s requests others studies.

Finally, we recommend to the Health Professionals working with epileptic patients in order to comprehend interdisciplinary way, and to preserve the cognitive quality of these patients