PATRICIA RZEZAK TENCER
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
15 resultados
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- Delineating behavioral and cognitive phenotypes in juvenile myoclonic epilepsy: Are we missing the forest for the trees?(2016) VALENTE, Kette D.; RZEZAK, Patricia; MOSCHETTA, Sylvie P.; VINCENTIIS, Silvia de; COAN, Ana C.; GUERREIRO, Carlos A. M.Introduction: Patients with juvenile myoclonic epilepsy (JME) have executive dysfunction and impulsive traits. There are lines of evidence that JME is a heterogeneous epilepsy syndrome considering outcome. In this study, we aimed to analyze this heterogeneity beyond seizure control. The objective was to identify whether the pattern of cognitive dysfunction and impulse control is also heterogeneous, in an attempt to establish possible differences in patients with easy-and hard-to-control epilepsies. Methods: Essentially, 57 patients with JME were compared with 44 controls. Patients and controls were assessed with a neuropsychological battery for executive, attention, and memory functions. The expression of impulsive traits was evaluated with the Temperament and Character Inventory - novelty seeking domain. Then, patients were categorized according to seizure control as having easy-and hard-to-control JME. Results: Patients with hard-to-control JME showed worse performance in 12 out of 25 neuropsychological tests than those with easy-to-control JME. Patients with hard-to-control JME also demonstrated significantly higher scores in novelty seeking -subfactor impulsiveness (p=0.002). Significance: Our study demonstrated the existence of distinct or more severe cognitive and psychiatric profiles in a subset of patients with JME. Patients with treatment-refractory seizures seem to present a broader impairment related to both cognitive deficits and impulsive traits. These findings suggest that patients with JME are not equally compromised by executive and memory deficits or dysfunction, neither by their impulsive traits. Thus, there is a need for a better characterization of patients with JME to include diverse phenotypes since our results suggest a possible existence of distinct groups of patients with JME.
- Distinct domains of impulsivity are impaired in juvenile myoclonic epilepsy but not in temporal lobe epilepsy(2015) RZEZAK, Patricia; MOSCHETTA, Sylvie P.; LIMA, Ellen; CASTRO, Carolina X. L.; VINCENTIIS, Silvia; COAN, Ana Carolina; GUERREIRO, Carlos; BUSATTO FILHO, Geraldo; VALENTE, Kette D.Objective: The Barratt Impulsiveness Scale (BIS-11) is the most widely used questionnaire to study impulsivity in persons with psychiatric disorders, but it has rarely been applied to persons with epilepsy. The present study aimed to evaluate the usefulness of BIS-11 as a tool to explore impulsivity in two distinct epilepsy syndromes. Method: The BIS-11 was applied to 20 patients with juvenile myoclonic epilepsy (JME) (32.5 +/- 8.95 years old), 20 patients with temporal lobe epilepsy (TLE) (37.7 +/- 13.25 years old), and 26 healthy controls (31.86 +/- 11.25 years old). The scores in motor, attentional, and lack of planning impulsivity were compared between groups. Results: Patients with JME showed higher scores than patients with TLE and controls in all domains: motor (JME vs TLE: 28.60 vs 13.25 (mean score), p < 0.001 and JME vs controls: 28.60 vs 14.12, p < 0.001), attentional (JME vs TLE: 21.55 vs 13.45, p < 0.001 and JME vs controls: 21.55 vs 14.88, p < 0.001) and nonplanning (JME vs TLE: 28.05 vs 13.10, p < 0.001 and JME vs controls: 28.05 vs 16.15, p < 0.001). Conclusion: Higher BIS-11 scores in all domains of impulsivity [i.e., motor, attentional, and lack of planning] corroborated previous findings described in patients with JME. On the other hand, BIS-11 could not demonstrate problem solving and inhibitory control deficits related to impulsive behavior, which were described in patients with TLE. Other behavioral measures may be more sensitive to some aspects of impulsivity in TLE. Our results reinforce the concept that distinct epileptic syndromes require different neuropsychological approaches, especially considering a complex construct such as impulsivity.
- Memory in children with temporal lobe epilepsy is at least partially explained by executive dysfunction(2012) RZEZAK, Patricia; GUIMARAES, Catarina A.; FUENTES, Daniel; GUERREIRO, Marilisa M.; VALENTE, Kette D.An association between memory and executive dysfunction (ED) has been demonstrated in patients with mixed neurological disorders. We aimed to investigate the impact of ED in memory tasks of children with temporal lobe epilepsy (TLE). We evaluated 36 children with TLE and 28 controls with tests for memory, learning, attention, mental flexibility, and mental tracking. Data analysis was composed of comparison between patients and controls in memory and executive function; correlation between memory and executive function tests; and comparison between patients with mild and severe ED in memory tests. Children with TLE had worse performance in focused attention, immediate and delayed recall, phonological memory, mental tracking, planning, and abstraction. Planning, abstraction, and mental tracking were correlated with visual and verbal memory. Children with severe ED had worse performance in verbal and visual memory and learning tests. This study showed that ED was related to memory performance in children with TLE.
- Genetic polymorphisms of the 5HT receptors are not related with depression in temporal lobe epilepsy caused by hippocampal sclerosis(2018) VINCENTIIS, Silvia; ALCANTARA, Juliana; RZEZAK, Patricia; KERR, Daniel S.; GATTAZ, Wagner F.; LINDEN JR., Helio van der; SANTOS, Bernardo dos; MELO-SOUZA, Sebastiao E.; ARRUDA, Francisco; RAGAZZO, Paulo; CHAIM-AVANCINI, Tiffany; SERPA, Mauricio H.; FERNANDES, Fernando; MORENO, Ricardo A.; BUSATTO, Geraldo; ALESSI, Ruda; DEMARQUE, Renata; VALENTE, Kette D.Background: Temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) is the most frequent form of drug-resistant epilepsy in adults. Mood disorders are the most frequent psychiatric comorbidities observed in these patients. Common pathophysiological mechanisms of epilepsy and psychiatric comorbidities include abnormalities in the serotonin pathway. The primary goal of this study was to determine the possible association between polymorphisms of genes encoding the serotonin receptors 5HT1A (rs6295), 5HT1B (rs6296), and 5HT2C (rs6318) and the presence of mood disorders in patients with TLE-HS. Our secondary goal was to evaluate the possible association between these variants and susceptibility to develop seizures in TLE-HS. Methods: We assessed 119 patients with TLE-HS, with and without psychiatric comorbidities; 146 patients with major depressive disorder; and 113 healthy volunteers. Individuals were genotyped for the rs6295, rs6296, and rs6318 polymorphisms. Results: No difference was observed between the group with TLE-HS, healthy controls, and the group with major depressive disorder without epilepsy regarding the polymorphisms that were evaluated. There was no correlation between rs6318, rs6295, rs6296, and epilepsy-related factors and history of psychiatric comorbidities. Conclusions: Our work suggests that the studied polymorphisms were not related to the presence of TLE, psychiatric comorbidities in TLE, and epilepsy-related factors.
- Episodic and semantic memory in children with mesial temporal sclerosis(2011) RZEZAK, Patricia; GUIMARAES, Catarina; FUENTES, Daniel; GUERREIRO, Marilisa M.; VALENTE, Kette Dualibi RamosThe aim of this study was to analyze semantic and episodic memory deficits in children with mesial temporal sclerosis (MTS) and their correlation with clinical epilepsy variables. For this purpose, 19 consecutive children and adolescents with MTS (8 to 16 years old) were evaluated and their performance on five episodic memory tests (short- and long-term memory and learning) and four semantic memory tests was compared with that of 28 healthy volunteers. Patients performed worse on tests of immediate and delayed verbal episodic memory, visual episodic memory, verbal and visual learning, mental scanning for semantic clues, object naming, word definition, and repetition of sentences. Clinical variables such as early age at seizure onset, severity of epilepsy, and polytherapy impaired distinct types of memory. These data confirm that children with MTS have episodic memory deficits and add new information on semantic memory. The data also demonstrate that clinical variables contribute differently to episodic and semantic memory performance.
- The relevance of attention deficit hyperactivity disorder in self-limited childhood epilepsy with centrotemporal spikes(2018) LIMA, Ellen Marise; RZEZAK, Patricia; SANTOS, Bernardo dos; GENTIL, Leticia; MONTENEGRO, Maria A.; GUERREIRO, Marilisa M.; VALENTE, Kette D.In this study, we aimed to evaluate the attentional and executive functions in patients with benign childhood epilepsy with centrotemporal spikes (BCECTS) with and without attention-deficit hyperactivity disorder (ADHD) compared with controls and compared with patients with ADHD without epilepsy. We evaluated 12 patients with BCECTS and ADHD (66.7% boys; mean age of 9.67 years); 11 children with non-ADHD BCECTS (63.6% boys; mean age of 11.91 years); 20 healthy children (75% boys; mean age of 10.15 years); and 20 subjects with ADHD without epilepsy (60% boys; mean age of 10.9 years). We used a comprehensive battery of neuropsychological tests to evaluate attentional and executive functions in their broad domains. Patients with BCECTS and ADHD had worse performance in Conners Continuous Performance Test II ( reaction time standard error [p = 0.008], variability [p = 0.033], perseverations [p = 0.044] and in reaction time interstimuli interval [p = 0.016]). Patients with ADHD showed worse performance in Trail Making Test B errors [p = 0.012]. In conclusion, patients with BCECTS and ADHD had worse executive and attentional performance compared with controls than non-ADHD patients with BCECTS. Regardless of the presence of epilepsy, ADHD also negatively impacted executive and attentional functions but in different executive subdomains compared with patients with epilepsy.
- 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.
- Everyday memory impairment in patients with temporal lobe epilepsy caused by hippocampal sclerosis(2017) RZEZAK, Patricia; LIMA, Ellen Marise; GARGARO, Ana Carolina; COIMBRA, Erica; VINCENTIIS, Silvia de; VELASCO, Tonicarlo Rodrigues; LEITE, Joao Pereira; BUSATTO, Geraldo F.; VALENTE, Kette D.Objective: Patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) have episodic memory impairment. Memory has rarely been evaluated using an ecologic measure, even though performance on these tests is more related to patients' memory complaints. We aimed to measure everyday memory of patients with TLE-HS to age-and gender-matched controls. Methods: We evaluated 31 patients with TLE-HS and 34 healthy controls, without epilepsy and psychiatric disorders, using the Rivermead Behavioral Memory Test (RBMT), Visual Reproduction (WMS-III) and Logical Memory (WMS-III). We evaluated the impact of clinical variables such as the age of onset, epilepsy duration, AED use, history of status epilepticus, and seizure frequency on everyday memory. Statistical analyses were performed using MANCOVA with years of education as a confounding factor. Results: Patients showed worse performance than controls on traditional memory tests and in the overall score of RBMT. Patients had more difficulties to recall names, a hidden belonging, to deliver a message, object recognition, to remember a story full of details, a previously presented short route, and in time and space orientation. Clinical epilepsy variables were not associated with RBMT performance. Memory span and working memory were correlated with worse performance on RBMT. Significance: Patients with TLE-HS demonstrated deficits in everyday memory functions. A standard neuropsychological battery, designed to assess episodic memory, would not evaluate these impairments. Impairment in recalling names, routes, stories, messages, and space/time disorientation can adversely impact social adaptation, and we must consider these ecologic measures with greater attention in the neuropsychological evaluation of patients with memory complaints.
- 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.
- Temporal lobe epilepsy in children: Executive and mnestic impairments(2014) RZEZAK, Patricia; VALENTE, Kette D.; DUCHOWNY, Michael S.The current definition of epilepsy emphasizes the importance of cognitive impairment for a complete understanding of the disorder. Cognitive deficits have distinct functional manifestations that differentially impact the daily life experiences of children and adolescents with epilepsy and are a particular concern as they frequently impair academic performance. In particular, memory impairment and executive dysfunction are common disabilities in adults with temporal lobe epilepsy but are less easily recognized and studied in the pediatric population. This review focuses on the consequences of early-onset temporal lobe epilepsy for the development of memory and executive function and discusses current theories to explain these deficits.