VALMIR DE OLIVEIRA PASSARELLI
Índice h a partir de 2011
5
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- Contralateral ictal electrographic involvement is associated with decreased memory performance in unilateral mesial temporal sclerosis(2015) PASSARELLI, Valmir; CASTRO-LIMA FILHO, Humberto; ADDA, Carla C.; PRETURLON-SANTOS, Ana P.; VALERIO, Rosa M.; JORGE, Carmen L.; PUGLIA- JR., Paulo; LYRA, Katarina; OTADUY, Maria G.; WEN, Hung-Tzu; CASTRO, Luiz H.Purpose: To evaluate the effect of contralateral electrographic involvement on memory performance (measured by neuropsychological and Wada memory testing) in patients with epilepsy associated with unilateral mesial temporal sclerosis (MTS). Methods: We studied 51 patients with medically-refractory epilepsy associated with unilateral MTS (27 women, 30/51, left MTS) submitted to prolonged non-invasive video-EEG monitoring and bilateral Wada testing. According to ictal electrographic involvement, patients were classified as: Contralateral ictal involvement, when one or more seizures evolved with rhythmic activity in the temporal region contralateral to the MTS or exclusive ipsilateral ictal involvement if all seizures showed ictal EEG activity exclusively on the MTS side. Wada testing involved a twelve-item memory paradigm. Wada memory asymmetry score was calculated for each patient subtracting the number of recalled items after injection on the lesion side from the number of recalled items after contralateral injection. Expected asymmetry (EA) was considered if Wade memory asymmetry > 0, and Symmetrical or Reversed memory asymmetry (S-RA) when <= 0. Neuropsychological testing was applied in the 51 patients and in 40 healthy controls. Verbal Memory was evaluated with the Rey Auditory Verbal Learning Test (RAVLT), considering the number of recalled items on immediate recall after the initial five consecutive encoding trials (RAVLT 6), a post-interference delayed (30 min) recall (RAVLT 7), and recall after 7 days. Nonverbal memory was tested with Wechsler Memory Scale-III (WMS-III) Faces subtests 1 e 2. Results: Groups did not differ in demographic, clinical and video-EEG monitoring variables. S-RA was observed more frequently in the group with contralateral ictal involvement (57.2% vs. 27.0%; p: 0.03). Logistic regression analysis considering demographic, clinical, hippocampal volume and video-EEG monitoring variables showed contralateral ictal involvement as the only independent variable associated with S-RA (coefficient = 1.32, p = 0.029, odds ratio 3.77; 95% CI 1.1-12.47). Additionally, the patient group with contralateral ictal EEG involvement displayed worse verbal and nonverbal memory scores compared to healthy controls. Conclusion: In this cohort of unilateral MTS patients, contralateral ictal involvement was associated with decreased memory performance on Wada and on neuropsychological testing.
- Contralateral Interictal and Ictal EEG Epileptiform Activity Accentuate Memory Impairment in Unilateral Mesial Temporal Sclerosis Patients(2017) PINTO, Lecio F.; ADDA, Carla C.; SILVA, Liliane C. A.; BANASKIWITZ, Natalie H. C.; PASSARELLI, Valmir; JORGE, Carmen L.; VALERIO, Rosa M.; CASTRO, Luiz H.Objective: Memory impairment is a recognized complication of mesial temporal sclerosis (MTS). Epileptiform activity may negatively impact on cognition. We evaluated the impact of contralateral EEG involvement on memory in unilateral MTS (uMTS) patients. Method: Retrospective review of 121 right-handed uMTS patients (69 left) evaluated with prolonged video-EEG and verbal and nonverbal memory tests (Rey Auditory Verbal Learning Test and Rey-Osterrieth Complex figure), with additional very delayed trials. Patients were classified according to ictal/interictal EEG findings and MTS side as left or right concordant or discordant. Thirty-nine normal individuals who underwent the same neuropsychological battery served as controls. Results: Demographic, disease, and treatment features did not differ among groups. On the 7-day verbal memory free recall, left discordant performed significantly worse than controls and right concordant, recognized fewer words, and had more recognition errors than all other groups, including left concordant. For nonverbal memory, right discordant performed significantly worse than controls on delayed recall, and attained lower scores than other groups on immediate and 7-day recall, but this difference did not reach statistical significance. Left discordant had higher scores of memory complaints than controls and disclosed a trend toward accentuated memory impairment compared with the other groups over time. Conclusions: Our results suggest that contralateral electrographic involvement in uMTS was associated with more pronounced memory impairment for verbal material in left discordant patients, and to a lesser extent, for nonverbal material in right discordant patients. Left discordant group also had increased memory complaints.
conferenceObject Online survey revealing patients' journey throughout the Brazilian healthcare system(2021) SOUZA, M. N.; KUBOTA, G.; SIMIONI, C.; CALDERARO, M.; MATTOS, B.; CHAVES, L.; COSTA, B.; SANTOS, F. R.; PASSARELLI, V.; FORTINI, I.conferenceObject Intracarotid Ethomidate - WADA Test: A 75 Patient Series(2013) BASTOS, Carla; HOBI, Camila; LIMA FILHO, Humberto; PASSARELLI, Valmir; PINTO, Lecio; JORGE, Carmen; VALERIO, Rosa; CASTRO, LuizbookPart Crise epiléptica na emergência e estado de mal epiléptico(2021) VALERIANO, Rafael Pires de Sá; PASSARELLI, Valmir de Oliveira; PINTO, Lécio Figueira- Metabolic differences in the contralateral hippocampus of concordant and discordant mesial temporal sclerosis (MTS) patients: evaluation with proton magnetic resonance spectroscopy (1H-MRS)(2012) NASCIMENTO, SC; PARK, EJ; LYRA, KP; VALÉRIO, RM; JORGE, CL; PASSARELLI, V; CASTRO-LIMA, H; LEITE, CC; CASTRO, LHM; OTADUY, MCGPURPOSE: Patients with mesial temporal sclerosis (MTS) are clinically classified as concordant or discordant according to the extent of epileptogenic activity. The aim of this study is to determine whether the metabolic changes in the hippocampus are different in the two groups. MATERIALS AND METHODS: 33 patients diagnosed with MTS, 23 concordant (33±9 years old) and 10 discordant (33±10 years old) and 28 controls (33±10 years old) were evaluated. We obtained magnetic resonance spectroscopy of both hippocampi (ipsilateral and contralateral) on a 3T scanner with single voxel PRESS sequence with TE/TR=135/1500ms. The main metabolites were quantified with LC Model. For comparison between groups statistical tests were performed with a significance level of 0.05. RESULTS: In all patients a reduction of NAAipsi and Cr ipsi was observed, when compared to the contralateral side, but this difference was only significant for the group of concordant patients. In comparison with controls a significant reduction of Cr ipsi and NAAipsi was observed for both groups and for Naa/Cr ipsi in the group of concordant patients while NAA/Cr contra was reduced only in the group of discordant patients. CONCLUSION: Our findings suggest a stronger decline of NAA/Cr ipsi in the group of concordant patients and of NAA/Cr contra in discordant patients, suggesting a slightly different metabolic pattern for both groups. However, we need to increase the sample size to confirm these findings.
- Gender and age influence in daytime and nighttime seizure occurrence in epilepsy associated with mesial temporal sclerosis(2015) PASSARELLI, Valmir; CASTRO, Luiz Henrique MartinsObjectives: The aim of this study was to analyze the daytime and nighttime seizure distribution during video-EEG monitoring in patients with epilepsy associated with unilateral mesial temporal sclerosis (MTS) and the role of gender, age, and lesion side on 24-hour seizure distribution. Methods: We studied 167 consecutive adult (age >= 16 years) patients with epilepsy associated with unilateral mesial temporal sclerosis that had three or more recorded seizures during continuous video-EEG monitoring with a minimum recording time period of 24 h. Seizure onset time was classified according to occurrence in six 4-hour periods. Results: Seven hundred thirty-five seizures were evaluated. We observed two higher seizure occurrence periods: 08: 01-12: 00 (p = 0.001) and 16: 01-20: 00 (p = 0.03). Significantly fewer seizures were observed between 0: 01 and 4: 00 (p = 0.01). Nonuniform seizure distribution was noted in women (p < 0.0001), in young patients (less than 45 years of age) (p < 0.0001), and in both patients with left (p = 0.03) and patients with right mesial temporal sclerosis (p = 0.008). Men presented uniform seizure occurrence distribution (p = 0.15). Women had fewer seizures than expected and fewer seizures than men between 0: 01-04: 00 (p < 0.0001 and p = 0.0015, respectively) and 04: 01-08: 00 (p = 0.01 and p = 0.03, respectively). Young patients (age b 45 years) had two seizure occurrence peaks, 08: 01-12: 00 (p = 0.016) and 16: 01-20: 00 (p = 0.004). Middle-aged/old patients (>= 45 years) had only one seizure occurrence peak, 08: 01-12: 00 (p = 0.012). Young patients had more seizures than middle-aged/old patients between 16: 01-20: 00 (p = 0.04). No differences were noted between left and right MTS. Significance: We observed two seizure occurrence peaks: morning and late afternoon/evening. We encountered variations in daytime and nighttime seizure distribution according to gender and age, but not according to side of MTS. Future studies are needed to confirm these findings and to unravel the neurobiological substrate underlying daytime and nighttime variations of seizure occurrence in different age groups and between genders.
- Extratemporal abnormalities in phosphorus magnetic resonance spectroscopy of patients with mesial temporal sclerosis(2016) PARK, Eun Joo; OTADUY, Maria Concepcion Garcia; LYRA, Katarina Paz de; ANDRADE, Celi Santos; CASTRO, Luiz Henrique Martins; PASSARELLI, Valmir; VALERIO, Rosa Maria Figueiredo; JORGE, Carmen Lisa; TSUNEMI, Miriam Harumi; LEITE, Claudia da CostaObjective: We evaluated extratemporal metabolic changes with phosphorus magnetic resonance spectroscopy (P-31-MRS) in patients with unilateral mesial temporal sclerosis (MTS). Method: P-31-MRS of 33 patients with unilateral MTS was compared with 31 controls. The voxels were selected in the anterior, posterior insula-basal ganglia (AIBG, PIBG) and frontal lobes (FL). Relative values of phosphodiesters-PDE, phosphomonoesters-PME, inorganic phosphate - Pi, phosphocreatine-PCr, total adenosine triphosphate [ATP(t=) gamma- + a- + b-ATP] and the ratios PCr/ATP(t), PCr/gamma-ATP, PCr/Pi and PME/PDE were obtained. Results: We found energetic abnormalities in the MTS patients compared to the controls with Pi reduction bilaterally in the AIBG and ipsilaterally in the PIBG and the contralateral FL; there was also decreased PCr/gamma-ATP in the ipsilateral AIBG and PIBG. Increased ATP(T) in the contralateral AIBG and increased gamma-ATP in the ipsilateral PIBG were detected. Conclusion: Widespread energy dysfunction was detected in patients with unilateral MTS.
- Multiple endocrine neoplasia type 1 presenting as refractory epilepsy and polyneuropathy - A case report(2012) PAIVA, Anderson Rodrigues Brandao de; CASTRO, Luiz Henrique Martins; RODRIGUES JR., Waldyr; PASSARELLI, Valmir; JORGE, Carmen Lisa; BROTTO, Mario Wilson I.; HIRATA, Maria Teresa Alves; MARCHIORI, Paulo EuripedesHypoglycemia is a well recognized cause of acute symptomatic seizures. The fact that hypoglycemia can cause peripheral neuropathy is less appreciated. We describe a case of insulinoma associated peripheral neuropathy. A 17 year-old previously healthy man was referred for investigation of refractory epilepsy. A history of recurrent seizures, slowly progressive weakness of his feet and hands, and weight gain was obtained. Physical examination showed signs of a chronic sensory-motor polyneuropathy. He was diagnosed with insulinoma and primary hyperparathyroidism, characterizing multiple endocrine neoplasia, type 1 syndrome. Cases of insulinoma associated peripheral neuropathy are very rare. The more characteristic clinical picture appears to be distal weakness, worse in the intrinsic hand and feet muscles, and no or mild sensory signs. Peripheral nervous system symptoms may not completely resolve, despite removal of the cause of hyperinsulinism/hypoglycemia and full reversion of central nervous system symptoms. Mechanisms underlying hypoglycemic neuropathy are still poorly understood.
- Bilateral ictal EEG is associated with better memory outcome after hippocampal sclerosis surgery(2023) CASTRO-LIMA, Humberto; PASSARELLI, Valmir; RIBEIRO, Elyse S.; ADDA, Carla C.; PRETURLON-SANTOS, Ana Paula P.; JORGE, Carmen L.; VALERIO, Rosa; TZU, Wen Hung; BOA-SORTE, Ney; PIPEK, Leonardo Zumerkorn; CASTRO, Luiz Henrique M.ObjectiveTo compare memory outcomes after surgery for unilateral hippocampal sclerosis (HS)-associated epilepsy in patients with unilateral and bilateral ictal electrographic involvement.MethodsWe prospectively evaluated HS patients, aged 18-55 years and IQ >= 70. Left (L) and right (R) surgical groups underwent noninvasive video-EEG monitoring and Wada test. We classified patients as Ipsilateral if ictal EEG was restricted to the HS side, or Bilateral, if at least one seizure onset occurred contralaterally to the HS, or if ictal discharge evolved to the opposite temporal region. Patients who declined surgery served as controls. Memory was evaluated on two occasions with Rey Auditory-Verbal Learning Test and Rey Visual-Design Learning Test. Baseline neuropsychological test scores were compared between groups. Pre- and postoperative scores were compared within each group. Reliable change index Z-scores (RCI) were obtained using controls as references, and compared between surgical groups.ResultsWe evaluated 64 patients. Patients were classified as: L-Ipsilateral (9), L-Bilateral (15), L-Control (9), R-Ipsilateral (10), R-Bilateral (9), and R-Control (12). On preoperative evaluation, memory performance did not differ among surgical groups. Right HS patients did not present postoperative memory decline. L-Ipsilateral group presented postoperative decline on immediate (P = 0.036) and delayed verbal recall (P = 0.011), while L-Bilateral did not decline. L-Ipsilateral had lower RCI Z-scores, indicating delayed verbal memory decline compared to L-Bilateral (P = 0.012).SignificanceDominant HS patients with bilateral ictal involvement presented less pronounced postoperative verbal memory decline compared to patients with exclusive ipsilateral ictal activity. Surgery was indicated in these patients regardless of memory impairment on neuropsychological testing, since resection of the left sclerotic hippocampus could result in cessation of contralateral epileptiform activity, and, therefore, improved memory function.