LIA ARNO FIORE

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4
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Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina

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Autor: GALLUCCI-NETO, Jose ×

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  • article 8 Citação(ões) na Scopus
    Ictal SPECT in Psychogenic Nonepileptic and Epileptic Seizures
    (2021) GALLUCCI-NETO, Jose; BRUNONI, Andre Russowsky; ONO, Carla Rachel; FIORE, Lia Arno; CASTRO, Luiz Henrique Martins; MARCHETTI, Renato Luiz
    Background: Psychogenic nonepileptic seizures (PNES) are a common and debilitating problem in patients with epilepsy. They can be virtually indistinguishable from epileptic seizures, demanding video-electroencaphalogram monitoring, which is costly and not widely available, for differential diagnosis. Specific functional brain correlates of PNES have not been demonstrated so far. We hypothesized that PNES and epileptic seizures have distinct brain activation patterns, assessed by functional neuroimaging during ictal events of both conditions. Objective: Compare ictal brain activation patterns of PNES and epileptic seizures using single-photon emission computerized tomography. Methods: We prospectively assessed brain functional activation using single-photon emission computerized tomography 99mTc-ethyl cysteinate dimer in 26 patients with PNES, confirmed by trained psychiatrists in epileptology, who had their seizures induced by provocative tests compared with 22 age- and sex-matched subjects with temporal lobe epilepsy who underwent prolonged intensive video-electroencaphalogram monitoring. Results: In PNES patients compared with temporal lobe epilepsy group, we found a consistent increase in regional cerebral blood flow in the right precuneus (Brodmann area 7; P = 0.003) and right posterior cingulate cortex (Brodmann area 31; P = 0.001), as well as a decrease in regional cerebral blood flow in the right amygdala (P = 0.027). Conclusions: Activation of default mode network brain areas and temporoparietal junction may be a distinct feature of ictal PNES and could be explained by a disruption between movement prediction input and sensory outcome. Such information mismatch might be the neurobiological underpinning of dissociative episodes.
  • article 18 Citação(ões) na Scopus
    Immunization stress-related responses presenting as psychogenic non-epileptic seizures following HPV vaccination in Rio Branco, Brazil
    (2020) MARCHETTI, Renato Luiz; GALLUCCI-NETO, Jose; KURCGANT, Daniela; PROENCA, Inah Carolina Galatro Faria; VALIENGO, Leandro da Costa Lane; FIORE, Lia Arno; PINTO, Lecio Figueira; MARANHAO, Ana Goretti Kalume; OLIVEIRA, Maria Tereza da Costa; OLIVEIRA, Lucia Helena de
    Importance: The absence of a positive diagnosis of psychogenic non-epileptic seizures (PNES) in immunization stress-related response (ISRR) clusters may have not only a direct impact on affected patients' health but may also reduce compliance to national vaccination programs. It is therefore crucial to develop efficient diagnostic tools and a feasible proposal for proper communication and treatment of ISRR. Purpose: To explore the psychogenic nature of patients' convulsive seizures in a suspected outbreak of an ISRR cluster following human papillomavirus vaccination in Rio Branco, Brazil. Methods: Twelve patients with convulsive seizures were submitted to prolonged intensive videoelectroencephalography monitoring, brain magnetic resonance imaging, cerebrospinal fluid diagnostic testing, laboratory subsidiary examinations, and complete neurological and psychiatric evaluations. Results: Ten patients received the positive diagnosis of PNES, and two patients received the diagnosis of idiopathic generalized epilepsy. No biological association was found between the HPV vaccine and the clinical problems presented by the patients. Conclusions: Prolonged VEEG monitoring can contribute significantly to the positive diagnosis of PNES in ISRR clusters and to avoid hesitancy to vaccinate.