RESUMO
INTRODUCTION: In July 2013, the US Food and Drug Administration approved the use of NEBA as the first device for the complementary evaluation of attention deficit hyperactivity disorder (ADHD). It is based on quantitative electroencephalogram (qEEG) and includes the standardised theta/beta ratio, the results of which were consistent with both the medical and psychological clinical evaluation. Likewise, it has proved to be a useful tool for determining whether the ADHD is primary, secondary or comorbid to another pathology. Yet, to date no publications have specified whether it is a total theta/beta ratio or theta/beta-1 and theta/beta-2. Additionally, no data are provided to be able to discriminate between diagnostic subtypes of ADHD. AIMS: To quantify the theta/beta ratios, by means of qEEG, in a sample of patients from the Rio de la Plata area with a main confirmed diagnosis of ADHD, in order to compare the neurophysiological patterns according to the diagnostic subtypes. PATIENTS AND METHODS: We used a randomised stratified sample of 62 subjects of both sexes, with ages between 8 and 17 years, distributed into two groups, depending on the diagnostic subtype: attention deficit subtype of ADHD (n = 31) and the combined subtype of ADHD (n = 31). RESULTS: High theta/beta-1 and theta/beta-2 ratios were confirmed in the Cz region, being higher than the ratios in the C3 and C4 areas. Moderate and statistically significant differences were found between the two subtypes only in the beta-1 band in the occipital regions. The analysis of the interhemispheric coherence suggests an association of the power peak crossed with the diagnostic subtype, which is the fastest peak (10 Hz) for the combined subtype. No important differences are found on analysing the phase spectra or the theta/beta ratios. CONCLUSIONS: Although the scientific literature, especially the NEBA system, highlights the importance of the theta/beta ratio in the differential diagnosis of ADHD in control samples and other neurodevelopmental disorders, a distinction must be made between beta-1 and beta-2.
TITLE: Cociente theta/beta (NEBA) en el diagnostico del trastorno por deficit de atencion/hiperactividad.Introduccion. En julio del año 2013, la Food and Drug Administration estadounidense aprobo el NEBA como el primer dispositivo para la evaluacion complementaria del trastorno por deficit de atencion/hiperactividad (TDAH), basado en el electroencefalograma cuantificado (EEGq) e incluyendo la relacion theta/beta estandarizada, cuyos resultados fueron consistentes con la evaluacion clinica, tanto medica como psicologica, y es una herramienta util para determinar si el TDAH es primario, secundario o comorbido a otro trastorno. Sin embargo, ninguna de las publicaciones, hasta la fecha, especifica si se trata de un cociente theta/beta total, o theta/beta-1 y theta/beta-2, como tampoco se aportan datos para discriminar entre subtipos diagnosticos del TDAH. Objetivo. Cuantificar los cocientes theta/beta, a traves del EEGq, en una muestra de pacientes rioplatenses con diagnostico principal confirmado de TDAH, para comparar el patron neurofisiologico segun el subtipo diagnostico. Pacientes y metodos. Muestra aleatoria estratificada de 62 sujetos de ambos sexos, de 8 a 17 años, distribuidos en dos grupos segun subtipo diagnostico, TDAH subtipo deficit de atencion (n = 31) y TDAH subtipo combinado (n = 31). Resultados. Se confirman cocientes altos theta/beta-1 y theta/beta-2 en la region Cz, mayores a los cocientes en las areas C3 y C4. Se encontraron diferencias moderadas y estadisticamente significativas entre los dos subtipos solo en la banda beta-1 en las regiones occipitales. El analisis de la coherencia interhemisferica sugiere una asociacion del pico de potencia cruzada con el subtipo diagnostico, que para el subtipo combinado es el pico mas rapido (10 Hz). No se encuentran diferencias importantes al analizar los espectros de fase, ni los cocientes theta/alfa. Conclusiones. Si bien la bibliografia cientifica, especificamente el sistema NEBA, plantea la importancia del cociente theta/beta en el diagnostico diferencial del TDAH de muestras controles y otros trastornos del neurodesarrollo, es necesario discriminar entre beta-1 y beta-2.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Ritmo beta , Ritmo Teta , Adolescente , Algoritmos , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Criança , Dominância Cerebral , Feminino , Humanos , Masculino , Distribuição Aleatória , Estudos de AmostragemRESUMO
INTRODUCTION: Different contributions to the scientific literature made over the last few decades have confirmed the prefrontal cortex as the neurobiological basis of the executive functions. Today, both the evaluation protocols for carrying out diagnoses and the structuring of the treatment and neurocognitive stimulation plans must interpret each of the prefrontal syndromes (dorsolateral, medial or of the anterior cingulate, and orbitofrontal) involved in the aetiopathogenesis of the different neurodevelopmental and adult disorders in which the executive functions are affected. AIMS: To report on the latest advances in diagnosis and treatment of the executive functions and to stress the importance of identifying and understanding the three syndromes of prefrontal dysfunction in the phase of diagnosis and in neurocognitive rehabilitation. DEVELOPMENT: The authors carry out a review of the literature on the latest advances in neuroscience as regards the neurobiological and neuropsychological foundations of the executive functions and their diagnosis and treatment. CONCLUSIONS: Every day, the scientific community confirms the importance of identifying and understanding the brain circuits in the diagnostic stage, especially the prefrontal dysfunction syndromes involved in the neuropsychological deficits of the different neurodevelopmental and adult disorders, so as to be able to establish effective neurocognitive stimulation protocols.
TITLE: Trastornos de las funciones ejecutivas. Diagnostico y tratamiento.Introduccion. Los diferentes aportes de la literatura cientifica ratifican, desde hace un par de decadas, a la corteza prefrontal como base neurobiologica de las funciones ejecutivas. En la actualidad, tanto los protocolos de evaluacion para la realizacion del diagnostico como la estructuracion de los planes de tratamiento y estimulacion neurocognitiva deben hacer la lectura de cada uno de los sindromes prefrontales (dorsolateral, medial o del cingulo anterior, y orbitofrontal) implicados en la etiopatogenia de los diferentes trastornos del neurodesarrollo y del adulto en los que se ven afectadas las funciones ejecutivas. Objetivos. Exponer los ultimos avances sobre diagnostico y tratamiento de las funciones ejecutivas y resaltar la importancia de identificar y comprender en la fase diagnostica y en la rehabilitacion neurocognitiva los tres sindromes de disfuncion prefrontal. Desarrollo. Se realiza una revision bibliografica sobre los ultimos avances neurocientificos alrededor de las bases neurobiologicas, neuropsicologicas, diagnostico y tratamiento de las funciones ejecutivas. Conclusion. Cada dia la comunidad neurocientifica ratifica la importancia de identificar y comprender en la etapa diagnostica los circuitos cerebrales, especificamente los sindromes de disfuncion prefrontal implicados en los deficits neuropsicologicos de los diferentes trastornos del neurodesarrollo y del adulto para poder establecer protocolos eficaces de estimulacion neurocognitiva.
Assuntos
Transtornos Cognitivos/diagnóstico , Função Executiva , Adolescente , Adulto , Algoritmos , Terapia Comportamental , Dano Encefálico Crônico/complicações , Dano Encefálico Crônico/psicologia , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/etiologia , Transtornos do Comportamento Infantil/fisiopatologia , Pré-Escolar , Transtornos Cognitivos/classificação , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/reabilitação , Transtornos Cognitivos/terapia , Função Executiva/fisiologia , Lobo Frontal/fisiopatologia , Giro do Cíngulo/fisiopatologia , Humanos , Lactente , Testes Neuropsicológicos , Córtex Pré-Frontal/fisiopatologia , Distúrbios da Fala/diagnóstico , Distúrbios da Fala/etiologia , Distúrbios da Fala/fisiopatologia , Adulto JovemRESUMO
In the last decades there have been those in favor of recognizing the attention deficit disorder (ADD) as a neurodevelopment entity with a strong neurobiological basis responding to a specific interdisciplinary treatment versus those who think, sustain and defend that the accumulated scientific evidence is not sufficient to justify the disorder as a development anomaly in need of a specific therapeutic outline. The attention model versus the autoregulation model are described. The neurological basis of the disorder is discussed analyzing the use of functional neuroimages such as PET (positron emission tomography), SPECT (single photon emission tomography) and FMR (functional magnetic resonance) neuroanatomy, neurophysiology, neurochemistry of neurotransmitters up to genetics. The importance of an adequate diagnosis is emphasized, analyzing the cognitive areas involved and trying to differentiate the ADD types, and to determine in some cases the phenotype or phenocopy of the disorder. The different treatments advocated are discussed taking into account the interdisciplinary approaches. Finally, a complete analysis of the information available is presented and conclusions are drawn to facilitate the understanding of this disorder.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Humanos , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
En las últimas décadas hemos visto como se han ido distanciando quienes están a favor de reconocer al TDAH como un trastorno del neurodesarrollo con fuerte base neurobiológica, que responde a un tratamiento específico de modalidad interdisciplinar y por otro lado, quienes piensan, sostienen y defienden que la evidencia científica acumulada no es suficiente para justificar la presencia de este cuadro como una anormalidad del desarrollo que merecería un abordaje terapéutico propio. Se describen las hipótesis del modelo atencional versus modelo de autorregulación, Se exponen las bases neurobiológicas del trastorno, haciendo un análisis desde las neuroimágenes funcionales, como por ejemplo el PET (tomografía por emisión de positrones), SPECT (tomografía de emisión de fotón único) y la RMF (resonancia magnética funcional), neuroanatomía, neurofisiología, neuroquímica de neurotransmisores hasta la genética. Luego se hace hincapié en las características del abordaje diagnóstico adecuado, analizando las áreas cognitivas involucradas en el trastorno, que nos posibilitará diferenciar los tipos de TDAH y en algunos casos el origen del trastorno, ya sea fenotipo o fenocopia. También se enumera una recopilación sobre la evidencia preexistente con respecto al tratamiento del TDAH y cuales tienen que ser las características de un abordaje completo e interdisciplinar. Por ultimo se hace un análisis de toda la información y se dan conclusiones útiles para la comprensión del trastorno.
In the last decades there have been those in favor of recognizing the attention deficit disorder (ADD) as a neurodevelopment entity with a strong neurobiological basis responding to a specific interdisciplinary treatment versus those who think, sustain and defend that the accumulated scientific evidence is not sufficient to justify the disorder as a development anomaly in need of a specific therapeutic outline. The attention model versus the autoregulation model are described. The neurological basis of the disorder is discussed analyzing the use of functional neuroimages such as PET (positron emission tomography), SPECT (single photon emission tomography) and FMR (functional magnetic resonance) neuroanatomy, neurophysiology, neurochemistry of neurotransmitters up to genetics. The importance of an adequate diagnosis is emphasized, analyzing the cognitive areas involved and trying to differentiate the ADD types, and to determine in some cases the phenotype or phenocopy of the disorder. The different treatments advocated are discussed taking into account the interdisciplinary approaches. Finally, a complete analysis of the information available is presented and conclusions are drawn to facilitate the understanding of this disorder.