RESUMO
Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are commonly seen in Neurology practice and are categorized in the DSM-5 as functional neurological disorders/conversion disorders. This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. As a group they have puzzled generations of neurologists and psychiatrists and in some ways continue to do so, perhaps embodying and justifying the ultimate and necessary link between these specialties.
Assuntos
Transtorno Conversivo/diagnóstico , Transtornos Psicofisiológicos/diagnóstico , Transtorno Conversivo/terapia , Diagnóstico Diferencial , Eletroencefalografia , Humanos , Prognóstico , Transtornos Psicofisiológicos/terapiaRESUMO
Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are commonly seen in Neurology practice and are categorized in the DSM-5 as functional neurological disorders/conversion disorders. This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. As a group they have puzzled generations of neurologists and psychiatrists and in some ways continue to do so, perhaps embodying and justifying the ultimate and necessary link between these specialties.
Crises não-epilépticas psicogênicas (CNEP) e distúrbios do movimento psicogênicos (DMP) são comuns na prática e na atualidade são melhor categorizados no DSM-V como distúrbios neurológicos funcionais/desordens de conversão. Esta revisão enfatiza os principais dados históricos, epidemiológicos, clínicos, critérios diagnósticos, tratamento e o prognóstico destes pacientes, frequentemente negligenciados e desafiadores, os quais, como um grupo, tem intrigado gerações de neurologistas e psiquiatras, caracterizando, de forma justificada o elo definitivo entre estas especialidades.
Assuntos
Humanos , Transtorno Conversivo/diagnóstico , Transtornos Psicofisiológicos/diagnóstico , Transtorno Conversivo/terapia , Diagnóstico Diferencial , Eletroencefalografia , Prognóstico , Transtornos Psicofisiológicos/terapiaRESUMO
We describe the postsurgical outcome of six patients with medically intractable temporal lobe epilepsy and interictal psychosis who underwent temporal lobe resection. All patients were submitted to a comprehensive presurgical investigation, including prolonged video-EEG monitoring. Despite their psychotic disorders, all patients were able to provide informed consent and we were able to complete the investigation of all cases. Surgical complications occurred in two cases. Seizure outcome was Engel class I (free from incapacitating seizures) in all except one patient. There was no worsening of their psychoses. Until now, there has been relative improvement in the mental conditions of five patients. Although psychosis has been considered by some authors as a contraindication to epilepsy surgery, with appropriate psychiatric intervention, patients with refractory epilepsy and chronic interictal psychosis may be submitted to prolonged presurgical investigation and undergo surgery successfully.
Assuntos
Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/cirurgia , Transtornos Psicóticos/complicações , Adulto , Lobectomia Temporal Anterior , Antipsicóticos/uso terapêutico , Doença Crônica , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológicoRESUMO
BACKGROUND: Volumetric magnetic resonance imaging (MRI) has been extensively studied in the last decade as a method to help with the clinical diagnosis of Alzheimer's disease (AD). In recent years, researchers have also started investigating if that technique would be useful to identify individuals with mild cognitive impairment (MCI), differentiating them from AD patients and from normal elderly controls. This research project was planned to assess the accuracy of volumetric MRI to differentiate those groups of individuals. METHOD: The investigation involved 39 patients with diagnosis of mild to moderate dementia in AD, according to the criteria of the NINCDS-ADRDA, DSM-III-R, and ICD-10; 21 subjects with complaints of cognitive decline without other psychiatric disorders (MCI); and 20 normal elderly controls. All the subjects were submitted to a standard protocol, including volumetric MRI evaluations. RESULTS: The results indicated that all regions of interest measured (amygdala, hippocampus, and parahippocampal gyrus) were significantly different (p < .005) in AD patients compared to MCI subjects and controls. The left volumetric measures (amygdala, hippocampus, and parahippocampal gyrus) were also significantly different between the MCI subjects and controls (p < .05). The discriminant function analysis correctly classified 88.14% of the AD patients and controls, 81.67% of AD patients and MCI subjects, and 80.49% of the MCI subjects and controls. CONCLUSIONS: The results suggest that measures of medial temporal lobe regions are useful to identify mild to moderate AD patients and MCI subjects, separating them from normal elderly individuals.
Assuntos
Envelhecimento/patologia , Doença de Alzheimer/diagnóstico , Transtornos Cognitivos/diagnóstico , Imageamento por Ressonância Magnética/métodos , Idoso , Idoso de 80 Anos ou mais , Tonsila do Cerebelo/patologia , Estudos de Casos e Controles , Transtornos Cognitivos/classificação , Diagnóstico Diferencial , Análise Discriminante , Feminino , Avaliação Geriátrica , Hipocampo/patologia , Humanos , Imageamento por Ressonância Magnética/normas , Masculino , Testes Neuropsicológicos , Giro Para-Hipocampal/patologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Lobo Temporal/patologiaRESUMO
RATIONALE: The development of reliable techniques for volumetric measurement of mesial temporal structures (amygdala, hippocampus and parahippocampal gyrus) on magnetic resonance imaging (MRI) can provide data for the study of neuropsychiatric disorders, mainly temporal lobe epilepsy, Alzheimer's disease and schizophrenia. METHOD: We investigated these techniques performing intraobserver and interobserver reliability study concerning normal controls, epilepsy and Alzheimer's disease patients using the intra-class correlation coefficient. RESULTS: Intra-observer reliability of evaluated structures ranged from 0.93 to 0.99 (p<0.001). Inter-observer reliability ranged from 0.70 to 0.95 (p < or = 0.001). CONCLUSION: The results suggest that the technique of MRI morphometry of mesial temporal regions can be considered a reliable tool which may help in the investigation of neuropsychiatric disorders, since used by adequately trained clinicians and researchers.
Assuntos
Sistema Límbico/anatomia & histologia , Imageamento por Ressonância Magnética/métodos , Doença de Alzheimer/patologia , Tonsila do Cerebelo/anatomia & histologia , Tonsila do Cerebelo/patologia , Epilepsia do Lobo Temporal/patologia , Hipocampo/anatomia & histologia , Hipocampo/patologia , Humanos , Sistema Límbico/patologia , Variações Dependentes do Observador , Giro Para-Hipocampal/anatomia & histologia , Giro Para-Hipocampal/patologia , Transtornos Psicóticos/patologia , Reprodutibilidade dos Testes , Esquizofrenia/patologiaRESUMO
MOTIVO DO ESTUDO: O desenvolvimento de técnicas confiáveis para a realização de medidas volumétricas de estruturas temporais mesiais (amígdala, hipocampo e giro para-hipocampal) em exames de ressonância magnética (RM) pode fornecer dados para o estudo de vários transtornos neuropsiquiátricos, particularmente epilepsia do lobo temporal, doençaáde Alzheimer e esquizofrenia. MÉTODO: Investigamos essas técnicas realizando estudo de confiabilidade intra-observador (IO) e entre-observador (EO), envolvendo controles normais, pacientes com epilepsia e pacientes com doençaáde Alzheimer, atravésádo coeficiente de correlação intra-classe (CCI). RESULTADOS: A confiabilidade IO para as estruturas analisadas variou de 0,93 a 0,99 (p<0,001). A confiabilidade EO variou de 0,70 a 0,95 (p <= 0,001). CONCLUSÄO: Os resultados sugerem que a técnica de morfometria por RM de regiõesátemporais mesiais constitui instrumento confiável, que pode auxiliar na investigação diagnóstica de transtornos neuropsiquiátricos, desde que utilizado por clínicos e pesquisadores adequadamente treinados