MARIA LUISA MAIA NOBRE DE PAIVA
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Impact of cognitive rehabilitation in juvenile myoclonic epilepsy: A novel study(2021) PAIVA, Maria Luisa; SERAFIM, Antonio de Padua; ALESSI, Ruda; VINCENTIIS, Silvia; LIMA, Ellen; NADRUZ, Patricia; VALENTE, KetteconferenceObject Polytherapy, frequent seizures, and bilateral tonic-clonic seizures influence on higher depressive and anxiety symptoms in temporal lobe epilepsy(2021) LIMA, Ellen Marise; GOIS, Juliana; PAIVA, Maria Luisa; VINCENTIIS, Silvia; MOSCHETTA, Sylvie; VALENTE, Kette- Higher IQ in juvenile myoclonic epilepsy: Dodging cognitive obstacles and ""masking"" impairments(2018) RZEZAK, Patricia; MOSCHETTA, Sylvie Paes; MENDONCA, Melanie; PAIVA, Maria Luisa Maia Nobre; COAN, Ana Carolina; GUERREIRO, Carlos; VALENTE, Kette Dualibi RamosExecutive deficits and impulsiveness are extensively reported in juvenile myoclonic epilepsy (JME). Previous literature suggests that intelligence may mediate these deficits. In this study, we evaluated and compared the performance of adults with JME with high and low intelligence quotient (IQ) and controls on tasks for executive function (EF) and impulsive trails. We investigated the neuropsychological performance of 53 adults with JME and below average IQ (57% women; 26.9 [+/- 7.88] years; mean IQ: 89.8 [+/- 5.1]), 26 adults with JME and average or above average IQ (53.8% women; 28.2 [+/- 9.33] years; mean IQ: 110.7 [+/- 8.3]), 38 controls with below average IQ (55% women; 28.4 [+/- 8.4] years; mean IQ: 90.1 [+/- 5.8]), and 31 controls with average or above average IQ (61.3% women; 32.20 [+/- 11.3] years; mean IQ: 111.6[+/- 10.5]) with a comprehensive battery of neuropsychological tests that measure executive/attentional function. Impulsive traits were assessed using the Cloninger et al.'s Temperament and Character Inventory (novelty seeking (NS) domain). The group with JME with higher IQ presented worse performance compared with controls with higher IQ on Controlled Oral Word Association (COWA) and Wisconsin Card Sorting Test (WCST) (errors). This group showed worse performance than controls with lower IQ on Stroop Color-Word Test (SCT) 1, Trail Making (TM) A, COWA, and WCST (errors). Patients with lower IQ showed worse performance than controls with higher IQ on Digit Span Forward (DSF), Digit Span Backward (DSB), SCT1, SCT2, SCT3, TM A, COWA, and WCST (errors and failure to maintain set). Patients with lower IQ showed worse performance than controls with lower IQ on DSF, DSB, SCTI, SCT2, SCT3, TM A, TM B, COWA, and WCST (errors and failure to maintain set). Patients from groups with low and high IQ showed higher scores than controls with higher and lower IQ on impulsivity for NS1 and NS2 (except for patients with higher IQ versus controls with lower IQ). Adults with JME and higher IQ show less evidence of EF deficits compared with those with JME and below average IQ suggesting that a higher degree of intellectual efficiency may act as a compensatory mechanism. However, it does not minimize some aspects of impulsive traits. Patients with JME and higher cognitive reserve may create strategies to dodge their cognitive obstacles. In this context, intelligence may protect and, at the same time, ""mask"" impairments that could be detected earlier.
- Factors associated with caregiver burden of adults with epilepsy in a middle-income country(2022) OLIVEIRA, Mariana C.; LIMA, Ellen Marise; PAIVA, Maria Luisa Nobre de; VALENTE, Kette Dualibi RamosPurpose: Despite the relevance of socio-economic background in burden of caregivers of persons with epilepsy (PWE), there is a dearth of knowledge about this topic in low-resource settings. Here we attempt to identify the extent of the burden in caregivers of adults with epilepsy in a middle-income country and the factors associated with it. Methods: In this cross-sectional study, we evaluated the level of burden with the Zarit Caregiver Burden Inventory. A comprehensive questionnaire was developed to assess the demographics of patients and caregivers. Epilepsy-related factors were obtained by interview and file review. Depressive, anxiety symptoms, and sleep quality were evaluated by Beck Depression Inventory, State and Trait Anxiety Inventory, and Pittsburgh Sleep Quality Index. Stigma was evaluated by the Stigma Scale of Epilepsy. Results: The caregiver's burden was mild to moderate in our sample. The factors most strongly associated with the higher caregiver burden were age-onset of epilepsy, PWE years of schooling, needs for assistance in daily life, disabilities, and caregiver's bad-quality of sleep and higher depressive and anxiety symptoms. Conclusion: Caregivers of PWE deserve special attention regarding mental health and other health aspects, such as sleep quality.
- Seizure control and anxiety: Which factor plays a major role in social adjustment in patients with Juvenile Myoclonic Epilepsy?(2020) PAIVA, Maria Luisa; LIMA, Ellen Marise; SIQUEIRA, Isabelle Bimbatti; RZEZAK, Patricia; KOIKE, Camila; MOSCHETTA, Sylvie P.; VINCENTIIS, Silvia; ALESSI, Ruda; KHAFIF, Tatiana Cohab; MENDOZA, Melanie; VALENTE, Kette D.Purpose: This study aimed to determine the presence of anxiety disorder and severity of anxiety symptoms in an extensive series of consecutive patients with JME and its association with epilepsy-related factors. In addition, we evaluated the impact of anxiety and clinical variables on social adjustment. Methods: We prospectively evaluated 112 (56.2 % females, mean age 27.2 years) patients with an electroclinical diagnosis of JME and 61 (52.4 % females, mean age 29.3 years) healthy controls. Anxiety symptoms were assessed by the State and Trait Anxiety Inventory (STAI). Social functioning was addressed with Self-Report Social Adjustment Scale (SAS). The patient group was also evaluated with a psychiatric interview. Results: Patients with JME presented more severe anxiety symptoms and worse social adjustment compared with controls. The presence of anxiety disorder and the severity of anxiety symptoms was associated with frequent seizures - generalized tonic-clonic seizures (p= 0.008) and drug-resistant epilepsy (p= 0.021). Regarding social adjustment, the severity of anxiety symptoms was associated with lower economic adjustment (p= 0.039), while the presence of anxiety disorder impacted family relationships (p 0.025). The presence of hard-to-control myoclonic seizure was associated with lower scores on work (p= 0.019), leisure activities (p= 0.008), family relationship (p= 0.022) and overall social adjustment (p= 0.038). Conclusion: Patients with JME have severe anxiety symptoms and worse social adjustment. Anxiety disorder and symptoms were associated with frequent seizures and drug-resistant epilepsy. Epilepsy-related factors and anxiety impaired distinct aspects of social functioning.
- A cognitive rehabilitation program to improve hot and cool executive dysfunction in juvenile myoclonic epilepsy: Preliminary findings(2023) PAIVA, Maria Luisa Maia Nobre; SERAFIM, Antonio; VINCENTIIS, Silvia; ALESSI, Ruda; MARIN, Rachel; MELO, Marcio Braga; VALENTE, Kette D.Objective: Executive and attentional deficits are often described in Juvenile Myoclonic Epilepsy (JME). We aimed to evaluate the short-term impact of rehabilitation developed for the most frequent cognitive deficits of persons with JME. Methods: Thirty-three patients entered this study which consisted of 12 individual sessions once a 60-minute week, divided into planning/organization, attention, and impulsivity. Twenty-seven patients finished the protocol, and all patients had pre-and-post evaluations from neuropsychological tests and self-rating questionnaires. Generalized Estimating Equations (GEE) inferential statistics were used to verify the protocol's effect, and a 95% confidence interval was adopted. Results: We found significant improvement in selective attention (TMT A [p < 0.01] and Stroop test 2 [p = 0.03]), inhibitory control (Stroop test 3 [p = 0.02], FAS [p < 0.01], CPT commissions [p < 0.01]), mental flexibility [WCST categories p < 0.01] and implicit decision making (IGT blocks A [p < 0.01], B [p = 0.02], C [p < 0.01] and D [p < 0.01]). All components of the Behavioral Rating Index of Executive Functions metacognition index and the general quotient had significant improvement (initiative [p & LE; 0.01], working memory [p & LE; 0.01], planning and organization [p & LE; 0.01], task monitor [p = 0.02] and organization of materials [p = 0.02]). Regarding the Behavioral Regulation Index, the ""Emotional Control"" was improved [p = 0.03]. The attentional component and general scores of the Adult Self-Report Scale for Adults also changed significantly [p & LE; 0.01]. Significance: Executive function and attention had an improvement in objective and subjective tests. The context-dependent reactive mechanism of impulsivity improved in instruments based on the ecological evaluation. Our findings, though preliminary due to a lack of controls and practice effect corrections, sup-port that cognitive rehabilitation may be a valuable resource to alleviate cognitive deficits in patients with JME. & COPY; 2023 Elsevier Inc. All rights reserved.
- Sleep quality and circadian rhythm profile of persons with juvenile myoclonic epilepsy in a tertiary epilepsy center: A case-control study(2023) KOIKE, Camila; LIMA, Ellen M.; PAIVA, Maria L.; PENTAGNA, Alvaro; BIMBATTI, Isabelle; VALENTE, Kette D.Purpose: This study evaluated sleep quality, chronotype, and excessive diurnal somnolence in persons with Ju-venile Myoclonic Epilepsy (JME) and their possible association with clinical variables. Methods: This cross-sectional controlled study evaluated 49 consecutive patients (65% females, mean age 27.53 years) with an electroclinical diagnosis of JME and 49 healthy controls (55% females, mean age 28.55 years). The Pittsburgh Sleep Quality Inventory (PSQI) was used to assess sleep quality and the Epworth Sleepiness Scale (ESS) to evaluate excessive daytime sleepiness. The patients' chronotype was evaluated by the Morningness-Eveningness Questionnaire (MEQ). Epilepsy-related factors gathered from the medical chart and personal interview were epilepsy duration, age at onset, frequency of myoclonic (Mcl), generalized tonic-clonic (GTC) and absence (ABS) seizures, pharmacoresponse, and current antiseizure medication (ASM).Results: Persons with JME did not differ from the control group regarding daytime sleepiness (p=0.840); how-ever, the JME group had worse sleep quality (p=0.01) than the controls. Persons with JME presented a more evening chronotype than controls (p = 0.003). The age at onset, epilepsy duration, frequency of Mcl seizure, frequency of GTC seizure, frequency of ABS seizure, and drug response did not predict ESS and MEQ scales. Pharmacoresponsive patients had lower PSQI scores compared with pharmacoresistant patients (p=0.036). Conclusion: Persons with JME have worse sleep quality and a more evening chronotype. Notably, pharmacor-esistant patients present a worse sleep quality that deserves attention and special care due to the relationship between sleep deprivation and seizure worsening.
- Anxiety symptoms are the strongest predictor of quality of life in temporal lobe epilepsy(2021) LIMA, Ellen Marise; GOIS, Juliana; PAIVA, Maria Luisa; VINCENTIIS, Silvia; MOSCHETTA, Sylvie; VALENTE, Kette Dualibi RamosPurpose: It is established that the severity of depressive and anxiety symptoms is associated with poorer quality of life (QOL) in persons with drug-resistant epilepsy. We aimed to verify the presence of subsyndromic depressive episodes (SDEs) and subsyndromic anxiety episodes (SAEs) in persons with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) compared to healthy controls and to determine the impact of depressive and anxiety symptoms on patients & rsquo; QOL. Methods: We prospectively evaluated 35 persons with TLE-HS and 90 healthy controls. QOL was assessed by the Epilepsy Surgery Inventory (ESI) and QOL in Epilepsy Inventory-31 (QOLIE-31). The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI-X) were used to assess symptoms, and SDEs and SAEs diagnosis were made considering the total scores of BDI (<9) and STAI-Trait (<49), respectively. Results: Persons with TLE-HS had higher symptoms on BDI, STAI-S, and STAI-T. They have 3.011 greater odds of presenting SDEs and 7.056 times odds, SAEs. The depressive and anxiety symptoms, added in the model with epilepsy-related factors, accounted for a significant increase in the variance in several aspects of QOL. Anxiety trait symptoms are the most critical individual determinant of the QOL. Conclusion: Our results demonstrated that persons with TLE-HS had greater odds of presenting SDE and SAE than healthy controls. Besides, there was a relationship between anxiety and depressive symptoms and worse QOL in TLE-HS. It is essential to be aware of psychiatric symptoms, even though these symptoms do not meet the criteria to be considered a ""disorder.""
- Dissociation between decision making under ambiguity and risk in patients with juvenile myoclonic epilepsy(2019) PAIVA, Maria L.; RZEZAK, Patricia; SANTOS, Bernardo; LIMA, Ellen M.; MOSCHETTA, Sylvie P.; VINCENTIIS, Silvia; ALESSI, Ruda; MENDOZA, Melanie; VALENTE, Kette D.Introduction: Decision making (DM) is one aspect of impulsivity that can be defined by the ability to decide between two or more options in a given situation. To date, there are at least two types of DM that differ in the level of uncertainty, and how much information about consequences is provided. In this study, we aimed to evaluate the two domains of DM - under risk and ambiguous - with a comprehensive evaluation in a group of patients with juvenile myoclonic epilepsy (JME), and correlate with patients' characteristics, clinical variables, and neuropsychological evaluation for executive functions. Methods: We evaluated 35 patients with JME and 39 healthy controls using the Iowa Gambling Task for DM under ambiguity and the Game Dice Task for DM under risk. We assessed the performance in Iowa Gambling Task and Game Dice Task through net scores, safe and risky choices, besides the type of decisions across time. Results: Patients with JME had a higher number of risky choices compared to controls in the Game Dice Task. There was no significant difference between patients and controls in the Iowa Gambling Task. However, patients with higher seizure frequency had worse scores on decks C and D (safe choices) from the Iowa Gambling Task. Conclusion: Patients with JME have worse performance on DM under risk. The same was not observed for DM under ambiguity. Epilepsy-related factors and the presence of psychiatric disorders, but not executive dysfunction, were associated with a lower tendency for safe choices. These findings showed a dissociation between DM processes in patients with JME and a tendency to make disadvantageous decisions with measurable risks.
conferenceObject The impact of anxiety and depressive symptoms on quality of life in patients with temporal lobe epilepsy caused by hippocampal sclerosis(2021) LIMA, Ellen Marise; GOIS, Juliana; PAIVA, Maria Luisa; VINCENTIIS, Silvia; MOSCHETTA, Sylvie; VALENTE, Kette