KETTE DUALIBI RAMOS VALENTE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Severity of depressive symptomatology and functional impairment in children and adolescents with temporal lobe epilepsy(2013) PEREIRA, Adriana; VALENTE, Kette D.Objective: Depression is a frequent psychiatric disorder in children with temporal lobe epilepsy (TLE). However, severity of depressive symptoms (DS) is frequently neglected in these patients. This study aimed to determine severity of DS and global functioning by using quantitative measures and to establish their correlation with patients' demographics and clinical variables. Methods: 31 children (mean age of 11.8 +/- 2.3 years) with TLE were assessed with K-SADS-PL for axis I DSM-IV diagnosis. Severity of DS was measured by Children Depression Rating Scale-Revised - CDRS-R. Global functional impairment was evaluated with Child Global Assessment Scale-CGAS. Results: 25 patients (56% boys; 12 +/- 2.3 years) had current DS, moderate or severe in 84% according to CDRS-R T-Score. Severity of DS was not correlated with age (p = 0.377), gender (p = 0.132), seizure control (p = 0.936), age of onset (p = 0.731), duration of epilepsy (p = 0.602) and the presence of hippocampal sclerosis (p = 0.614). Patients had moderate to major functional impairment measured by CGAS (48.7 +/- 8.8), being adolescents more impaired than children (p = 0.03). Impairment of global functioning was not associated with epilepsy variables (p > 0.05). Conclusion: Children with TLE had moderate to severe DS early in the course of their disease with a relevant impact on their global functional activities, especially considering adolescents. Epilepsy severity seems not to be correlated to the severity of DS, contradicting the idea of a cause-consequence relationship. More systematic research is needed to better understand the association of depressive disorders in children and adolescents with TLE.
- Correlation between platelet and brain PLA(2) activity(2013) TALIB, Leda L.; VALENTE, Kette D.; VINCENTIIS, Silvia; GATTAZ, Wagner F.The phospholipase A(2) (PLA(2)) enzymes have been implicated in several neuropsychiatry disorders and activity alterations have been described in brain and platelet. Since brain tissue is not readily available for the measurement of PLA(2) activity, it would be of interest to test directly whether PLA(2) activities in both tissues are correlated. We performed this task assessing PLA(2) activity in platelets and hippocampus collected simultaneously from 19 patients undergoing temporal lobectomy for treatment of refractory epilepsy. Our findings suggest that total PLA(2) activity in platelets may reflect the total activity of the enzyme in the brain (r(s)=0.59, p=0.008). However in our sample no correlations were found between the subgroups of the enzyme in brain and in platelets. This lack of correlations may be due to different effects of drug treatment on the PLA(2) subtypes. In face of the difficulty to obtain brain tissues from living patients, further studies with larger drug-free samples are warranted to clarify whether the use of platelets is a reliable strategy to reflect the subtypes of PLA(2) activity in the brain.
- Impulsivity and seizure frequency, but not cognitive deficits, impact social adjustment in patients with juvenile myoclonic epilepsy(2013) MOSCHETTA, Sylvie; VALENTE, Kette D.Purpose Despite growing evidence on the occurrence of poor psychosocial adjustment, to the moment there is no formal assessment of social adjustment (SA) using a validated instrument developed and standardized for this purpose in patients with juvenile myoclonic epilepsy (JME). We aimed to: (1) verify social adjustment in patients with JME with an objective scale and; (2) identify whether clinical variables, impulsiveness, and neuropsychological profile are associated with worse social adjustment. Methods We prospectively evaluated 42 patients with an unequivocal diagnosis of JME and 42 controls. The inclusion criteria for patients and controls included age range from 16 to 40years and an estimated intelligence quotient (IQ) ranging from 85 to 110. One trained neuropsychologist administered the scales and tests in a standard sequence. Social Adjustment was evaluated by The Self-Report Social Adjustment Scale (Weissman & Bothwell, ), a 42-item scale, measuring performance in seven major areas: work; social and leisure activities; relationship with extended family; marital role as a spouse; parental role; membership in the family unit; and economic adequacy. Impulsivity was assessed by using the Temperament and Character Inventory (Cloninger, ). Patients with JME and control subjects were evaluated with a comprehensive battery of neuropsychological tests evaluating executive and memory functions. We evaluated the age at onset; time from onset to seizure control with antiepileptic drugs (duration of epilepsy); seizure control; frequency of myoclonic seizures; frequency of generalized tonicclonic GTC seizures; frequency of absence seizures; family history of epilepsy; family history of psychiatric disorders; and personal history of psychiatric disorders. Key Findings The score on Global Social Adjustment was worse than controls (p=0.001), especially on the factors: Work (p=0.032); Extended Family (p=0.005). Higher Novelty Seeking (NS) scores were significantly correlated with worse on Global (p=0.002); Work (p=0.001) and Leisure (p=0.003). There was no correlation between cognitive performance and Social Adjustment Scale (SAS) factors. Higher seizure frequencymyoclonic (p=0.005) and GTC (p=0.035)were correlated with higher scores on factor Work of SAS. Significance Our findings suggest that patients with JME have worse social adjustment in two relevant aspects of their liveswork and familiar relationship. In this series of patients with JME, higher seizure frequency and impulsive traits, but not cognitive performance, were correlated with worse social adjustment.
- Valproate and Lamotrigine in Pediatric Patients With Refractory Epilepsy: After the First Year(2013) THOME-SOUZA, Sigride; VALENTE, Kette D.The combination of lamotrigine and valproate/divalproex sodium has been shown to be effective in the treatment of refractory epilepsy. This study aims to evaluate the pharmacologic properties of using this combination in a pediatric population refractory to antiepileptic drugs, with an extended follow-up. We studied a group of 51 patients, ranging from 4 to 16 years of age. Sixteen patients (31.4%) had generalized epilepsy and 35 (69.6%) had focal epilepsy. The combination was effective in 39 patients (76.5%) in the first year of follow-up and in 36 patients (70.6%) in the second year, with a reduction in drop attacks observed in 22 (88.5%). Adverse effects included rash, leading to discontinuation in four patients (7.8%). Slower introduction of lamotrigine minimizes adverse effects, thereby improving quality of life and adherence to treatment. In addition, therapeutic efficacy is maintained with lower doses of lamotrigine, even after the first year of treatment.
- Semiology of psychogenic nonepileptic seizures: Age-related differences(2013) ALESSI, Ruda; VINCENTIIS, Silvia; RZEZAK, Patricia; VALENTE, Kette D.The few studies addressing semiology of psychogenic nonepileptic seizures (PNES) in children showed that this group differs from adults, considering the classical signs described. Our study with systematic assessment provides a direct comparison of the classical signs of psychogenic nonepileptic seizures (PNESs) in children and adults in order to establish the usefulness of the most important signs described for adults in children. Video-EEG recordings of patients with PNESs from 2006 to 2011 were analyzed. Twenty-five signs were selected as the most prevalent in literature, and their presence was evaluated. Events were categorized as either of the following: catatonic, major motor, minor motor, and subjective (Griffith et al., 2007 [11]). One hundred and fifteen patients were included; 63.5% were adults, 73.2% were females, and 14.4% had epilepsy. Adults presented more ictal eye closure (p=0.006), convulsions lasting >2 min (p<0.001), postictal speech change (p=0.021), vocalization during the ""tonic-clonic"" phase (p=0.005), and pelvic thrust movement (p=0.035). Biting the tip or side of the tongue and opisthotonos were rare and only present in adults. As for the semiological categories, major motor activity was the main feature in adults, and minor motor activity was more prevalent among children (52.9% and 38.1%, respectively; p=0.01). Our data showed that research about the distinct ictal features of PNESs, such as minor motor events that are more typical in children, is likely to be useful in promoting earlier recognition of PNESs in this population.
- Angelman syndrome caused by deletion: A genotype-phenotype correlation determined by breakpoint(2013) VALENTE, Kette D.; VARELA, Monica Castro; KOIFFMANN, Celia Priszkulnik; ANDRADE, Joaquina Queiroz; GROSSMANN, Rosi; KOK, Fernando; MARQUES-DIAS, Maria JoaquinaObjectives: Deletion of the chromosome 15q11-q13, the most common genetic mechanism associated with Angelman syndrome (AS), is highly associated with a severe phenotype. However, deletion is not a genetically homogeneous group as it is composed by two main groups: Class I with breakpoints at BP1 (proximal) and BP3 (distal) and Class II present breakpoints at BP2 (proximal) and BP3 (distal). In this study, we aimed to evaluate the impact of the breakpoint on the electroclinical profile. Methods: We evaluated 16 patients with AS caused by 15q11-13 deletion (6 were Class I; 10 were Class II). We characterized epilepsy features by clinical history obtained from parents and caretakers with a pre-standard questionnaire. These data were corroborated by medical records, contact with previous physicians, and video-EEG monitoring. Suggestive EEG patterns for AS were classified according to the classical description of Boyd et al. (1988). Results: AS patients with BP1 BP3 deletion had significantly more daily and disabling seizures than AS patients with BP1 BP2 deletion. They also presented a significant higher frequency of status epilepticus and epilepsy aggravated by fever. Need for polytherapy was significantly more frequent in BP1 BP3 patients. EEG features were similar in both groups. Conclusion: This study shows a significant correlation between the two deletion classes and AS clinical, but not the electrographic phenotype. Epilepsy is more severe and refractory to treatment in patients with larger deletions. Deletion is not a homogeneous group and knowledge on the breakpoint may have a clinical implication and represent an important factor in parental counseling.
- Lower doses of sublingual Zolpidem are more effective than oral Zolpidem to anticipate sleep onset in healthy volunteers(2013) VALENTE, Kette D.; HASAN, Rosa; TAVARES, Stella M.; GATTAZ, Wagner F.Objective: To compare the efficacy of sublingual Zolpidem (5 and 10 mg) to conventional oral Zolpidem (10 mg). Methods: This was an open, randomized, double-blind, double-dummy, controlled, and single center study. The study took place at the Laboratory of Clinical Neurophysiology and total number of participants was 58 volunteers completed the study whose demographics of age, gender, body mass index (BMI) were similar among everyone. Scores in Epworth, Pittsburgh, Beck and Hamilton Scales did not differ among groups. A model of transient insomnia was determined by the sleep anticipation in 120 minute. Subjects were randomly divided in three groups for drug administration (5 m SL; 10 mg SL and 10 mg oral), given in a single dose prior to polysomnography (PSG). Sleep parameters were assessed by PSG and post-sleep questionnaires. Results: A significant main treatment effect was evident considering the sleep onset latency (SOL) and persistent sleep latency (PSL). An earlier sleep onset was induced by SL Zolpidem 10 mg (SOL = p < 0.004; PSL = p < 0.006) and SL Zolpidem 5 mg (SOL = p < 0.025; PSL = p < 0.046) compared to oral Zolpidem 10 mg. Subjects that received SL Zolpidem 10 mg reported an earlier sleep onset (latency to sleep and latency until persistent sleep) when compared to subjects from other groups (p < 0.005). Conclusions: Sublingual Zolpidem, both 5 and 10 mg, induced faster sleep initiation than 10 mg oral Zolpidem. A subjective perception of earlier sleep onset was reported by subjects using SL 10 mg.
- Psychogenic non-epileptic seizures at a tertiary care center in Brazil(2013) ALESSI, Ruda; VALENTE, Kette D.Although psychogenic non-epileptic seizures (PNES) are a worldwide phenomenon, most of our knowledge addressing clinical characteristics is based on studies conducted in the USA, Europe, and Australia. There are scarce data about PNES in South American countries. This study provided a detailed analysis of the demographic, clinical, and psychosocial characteristics of 102 Brazilian patients with PNES. Seventy-eight patients (76.4%) were female with mean age of 35.27 years. Mean age at onset was 27.85 years; mean time to diagnosis was 7.89 years; 87.25% lived with their families; 56.89% were single; and only 33 (39.75%) worked on a regular basis. Depression was diagnosed in 48.03%. Thirty-three patients misdiagnosed as having epilepsy were using antiepileptic drugs. Stress factors were identified in 57.84%. This is the first Brazilian study that involves a large sample of patients with video-EEG-documented PNES and corroborates the idea that PNES are a worldwide phenomenon sharing several similarities, despite cultural and socioeconomic differences.
- Depression and temporal lobe epilepsy represent an epiphenomenon sharing similar neural networks: clinical and brain structural evidences(2013) VALENTE, Kette D. R.; BUSATTO FILHO, GeraldoThe relationship between depression and epilepsy has been known since ancient times, however, to date, it is not fully understood. The prevalence of psychiatric disorders in persons with epilepsy is high compared to general population. It is assumed that the rate of depression ranges from 20 to 55% in patients with refractory epilepsy, especially considering those with temporal lobe epilepsy caused by mesial temporal sclerosis. Temporal lobe epilepsy is a good biological model to understand the common structural basis between depression and epilepsy. Interestingly, mesial temporal lobe epilepsy and depression share a similar neurocircuitry involving: temporal lobes with hippocampus, amygdala and entorhinal and neocortical cortex; the frontal lobes with cingulate gyrus; subcortical structures, such as basal ganglia and thalamus; and the connecting pathways. We provide clinical and brain structural evidences that depression and epilepsy represent an epiphenomenon sharing similar neural networks.