RAQUEL REIS DE PAIVA
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
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- Lateral hypothalamic activity indicates hunger and satiety states in humans(2017) TALAKOUB, Omid; PAIVA, Raquel R.; MILOSEVIC, Matija; HOEXTER, Marcelo Q.; FRANCO, Ruth; ALHO, Eduardo; NAVARRO, Jessie; PEREIRA JR., Jose F.; POPOVIC, Milos R.; SAVAGE, Cary; LOPES, Antonio C.; ALVARENGA, Pedro; DAMIANI, Durval; TEIXEIRA, Manoel J.; MIGUEL, Euripides C.; FONOFF, Erich T.; BATISTUZZO, Marcelo C.; HAMANI, ClementLateral hypothalamic area (LHA) local field potentials (LFPs) were recorded in a Prader-Willi patient undergoing deep brain stimulation (DBS) for obesity. During hunger, exposure to food-related cues induced an increase in beta/low-gamma activity. In contrast, recordings during satiety were marked by prominent alpha rhythms. Based on these findings, we have delivered alpha-frequency DBS prior to and during food intake. Despite reporting an early sensation of fullness, the patient continued to crave food. This suggests that the pattern of activity in LHA may indicate hunger/satiety states in humans but attest to the complexity of conducting neuromodulation studies in obesity.
conferenceObject Personality Changes in Refractory Patients With Obsessive-Compulsive Disorder Submitted to Gamma Ventral Capsulotomy(2016) PAIVA, Raquel; LOPES, Antonio C.; BATISTUZZO, Marcelo; MATHIS, Maria Eugenia de; CANTERAS, Miguel; GREENBERG, Benjamin; SHAVITT, Roseli; MIGUEL, Euripedes; HOEXTER, Marcelo- Personality measures after gamma ventral capsulotomy in intractable OCD(2018) PAIVA, Raquel R.; BATISTUZZO, Marcelo C.; MCLAUGHLIN, Nicole C.; CANTERAS, Miguel M.; MATHIS, Maria E. de; REQUENA, Guaraci; SHAVITT, Roseli G.; GREENBERG, Benjamin D.; NOREN, Georg; RASMUSSEN, Steven A.; TAVARES, Hermano; MIGUEL, Euripedes C.; LOPES, Antonio C.; HOEXTER, Marcelo Q.Background: Neurosurgeries such as gamma ventral capsulotomy (GVC) are an option for otherwise intractable obsessive-compulsive disorder (OCD) patients. In general, clinical and neuropsychological status both improve after GVC. However, its consequences on personality traits are not well-studied. The objective of this study was to investigate personality changes after one year of GVC in intractable OCD patients. Methods: The personality assessment was conducted using the Revised NEO Personality Inventory (NEO PI-R) and Cloninger's Temperament and Character Inventory (TCI) in 14 intractable OCD patients before and one year after GVC. Comparisons of personality features between treatment responders (n = 5) and non-responders (n = 9) were performed. Multiple linear regression was also used for predicting changes in clinical and global functioning variables. Results: Overall, no deleterious effect was found in personality after GVC. Responders had a reduction in neuroticism (p = 0.043) and an increase in extraversion (p = 0.043). No significant changes were observed in nonresponders. Increases in novelty seeking and self-directedness, and decreases in persistence and cooperativiness predicted OCD symptom improvement. Similary, improvement in functioning was also predicted by hgher novelty seeking and self-directedness after GVC, whereas better functioning was also associated with lower reward dependence and cooperativeness after surgery. Conclusions: The pattern of changes in personality traits after GVC was generally towards that observed in nonclinical population, and does not raise safety concerns.
- Assessment of Safety and Outcome of Lateral Hypothalamic Deep Brain Stimulation for Obesity in a Small Series of Patients With Prader-Willi Syndrome(2018) FRANCO, Ruth R.; FONOFF, Erich T.; ALVARENGA, Pedro G.; ALHO, Eduardo J. L.; LOPES, Antonio Carlos; HOEXTER, Marcelo Q.; BATISTUZZO, Marcelo C.; PAIVA, Raquel R.; TAUB, Anita; SHAVITT, Roseli G.; MIGUEL, Euripides C.; TEIXEIRA, Manoel J.; DAMIANI, Durval; HAMANI, ClementIMPORTANCE Deep brain stimulation (DBS) has been investigated for treatment of morbid obesity with variable results. Patients with Prader-Willi syndrome (PWS) present with obesity that is often difficult to treat. OBJECTIVE To test the safety and study the outcome of DBS in patients with PWS. DESIGN, SETTING, AND PARTICIPANTS This case series was conducted in the Hospital das Clinicas, University of Sao Paulo, Brazil. Four patients with genetically confirmed PWS presenting with severe obesity were included. EXPOSURE Deep brain stimulation electrodes were bilaterally implanted in the lateral hypothalamic area. After DBS implantation, the treatment included the following phases: titration (1-2 months), stimulation off (2 months), low-frequency DBS (40 Hz; 1 month), washout (15 days), high-frequency DBS (130 Hz; 1 month), and long-term follow-up (6 months). MAIN OUTCOMES AND MEASURES Primary outcome measures were adverse events recorded during stimulation and long-term DBS treatment. Secondary outcomes consisted of changes in anthropometric measures (weight, body mass index [calculated as weight in kilograms divided by height in meters squared], and abdominal and neck circumference), bioimpedanciometry, and calorimetry after 6 months of treatment compared with baseline. The following evaluations and measurements were conducted before and after DBS: clinical, neurological, psychiatric, neuropsychological, anthropometry, calorimetry, blood workup, hormonal levels, and sleep studies. Adverse effects were monitored during all follow-up visits. RESULTS Four patients with PWS were included (2 male and 2 female; ages 18-28 years). Baseline mean (SD) body mass index was 39.6 (11.1). Two patients had previous bariatric surgery, and all presented with psychiatric comorbidity, which was well controlled with the use of medications. At 6 months after long-term DBS, patients had a mean 9.6% increase in weight, 5.8% increase in body mass index, 8.4% increase in abdominal circumference, 4.2% increase in neck circumference, 5.3% increase in the percentage of body fat, and 0% change in calorimetry compared with baseline. Also unchanged were hormonal levels and results of blood workup, sleep studies, and neuropsychological evaluations. Two patients developed stimulation-induced manic symptoms. Discontinuation of DBS controlled this symptom in 1 patient. The other required adjustments in medication dosage. Two infections were documented, 1 associated with skin picking. CONCLUSIONS AND RELEVANCE Safety of lateral hypothalamic area stimulation was in the range of that demonstrated in patients with similar psychiatric conditions receiving DBS. In the small cohort of patients with PWS treated in our study, DBS was largely ineffective.