Renato Luiz Marchetti - Academia.edu (original) (raw)

Papers by Renato Luiz Marchetti

Epilepsy & Behavior, 2011

A history of childhood trauma and the presence of dissociative phenomena are considered to be the... more A history of childhood trauma and the presence of dissociative phenomena are considered to be the most important risk factors for psychogenic nonepileptic seizure disorder (PNESD). This case-control study investigated 20 patients with PNESD and 20 with temporal lobe epilepsy (TLE) diagnosed by video/EEG monitoring who were matched for gender and age. Patients with both conditions were not included in the study. Groups were evaluated for age at onset and at diagnosis, worst lifetime weekly seizure frequency, trauma history, and presence of dissociative phenomena. Age at onset (P = 0.007) and age at diagnosis (P b 0.001) were significantly higher in the PNESD group than the control group, as were the scores on the Dissociative Experiences Scale (P b 0.001) and Childhood Trauma Questionnaire (P = 0.014). Only the differences in scores on the Childhood Trauma Questionnaire subscales Emotional Neglect (P = 0.013) and Emotional Abuse (P = 0.014) reached statistical significance. Dissociative phenomena and a reported history of childhood trauma are more common in patients with PNESD than in those with TLE. However, only emotional neglect and abuse were associated with PNESD in this study.

Revista Brasileira De Psiquiatria, 2005

Epilepsy is the most common serious neurological disorder. Worldwide, around 50 million people ha... more Epilepsy is the most common serious neurological disorder. Worldwide, around 50 million people have epilepsy, 40 million of which in developing countries. Though epilepsy is predominantly treatable, most patients in these countries remain without treatment. It is likely that one of the main reasons is the stigma associated with epilepsy. This problem increases when mental disorders are associated with epilepsy, a fairly frequent occurrence. Patients with epilepsy and mental disorders are exposed to a "double stigma", which frequently leads to complete absence of treatment. It is probable that, particularly in developing countries, psychiatrists will be involved with the treatment of people with epilepsy. Our purpose was to review the epidemiology of mental disorders associated with epilepsy, its treatment gap and impact upon quality of life of the patients.

Epilepsy & Behavior, 2004

The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment... more The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment, formal training, attitudes, and knowledge with respect to epilepsy (and associated mental disorders). One hundred fifty-seven Brazilian psychiatrists completed a specially developed questionnaire. Most (95%) had previously treated patients with epilepsy and mental disorders. About one-third (35%) admitted a lack of any formal training in epilepsy, and only 46% confirmed having received some formal training in mental disorders related to epilepsy. Eighty percent were dissatisfied with their knowledge. Three knowledge-based questions were answered correctly by only 10%. Almost half (48%) admitted that among psychiatrists, prejudice exists toward patients with epilepsy. Difficulties with treatment (50%) and lack of knowledge of epilepsy (50%) were considered the main causes of such prejudice. These data indicate an urgent need for improvement in education on epilepsy and associated mental disorders, as well as inclusion of formal epilepsy training in psychiatry residency programs.

Journal of Epilepsy and Clinical Neurophysiology, 2009

PURPOSE: To perform the cross-cultural adaptation of an instrument designed to measure behavioral... more PURPOSE: To perform the cross-cultural adaptation of an instrument designed to measure behavioral changes typically described in temporal lobe epilepsy (TLE), the Neurobehavior Inventory (NBI), for Brazilian population. METHODS: At first the original instrument was translated to Portuguese-Brazilian language. This version was revised and translated back into English. Later, both English versions were compared and the divergences were corrected in the Portuguese text. The second step consisted of the application of the inventory to 15 TLE patients from the Epilepsy Program, Federal University of Minas Gerais. The authors analyzed eventual difficulties and misunderstandings in the application of the questionnaire. RESULTS: In the final Portuguese version, the questions 11, 14, 17, 61 and 75 were considered difficult to understand and were modified. Seven (46.7%) subjects were women, with 26 to 65 years. Most of the patients (93.3%) had a high total score level. Religious convictions, interest in details and sense of personal destiny were the most common altered domains (73.3% of the patients in each one of them). CONCLUSION: The Portuguese-Brazilian version of the NBI may be a useful instrument to evaluate TLE behavioral alterations in the Brazilian clinical context.

Revista De Psiquiatria Clinica, 2005

Epilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mun... more Epilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mundo, 40 milhões delas em países em desenvolvimento. Embora seja um problema predominantemente tratável, nestes países a maioria dos pacientes permanece sem tratamento. Provavelmente uma das principais causas para isto seja o estigma que atinge as pessoas com epilepsia. Tal fato se agrava ainda mais quando à epilepsia se associam transtornos mentais, que ocorrem com prevalência aumentada. Os pacientes com epilepsia e transtornos mentais sofrem o que se chama de "duplo estigma", que freqüentemente os d e i x a s e m t r a t a m e n t o . É p r o v á v e l , p a r t i c u l a r m e n t e e m p a í s e s e m desenvolvimento, que psiquiatras se defrontem com pacientes com epilepsia nos diferentes locais de atendimento. Os autores revisam diferentes aspectos dos principais transtornos mentais associados à epilepsia.

Arquivos De Gastroenterologia, 2010

The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychog... more The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychogenic non-epileptic seizures (PNES). The evaluation was carried out during intensive VEEG monitoring in a diagnostic center for epilepsy in a university hospital. The difficulties involved in reaching this diagnosis are discussed. Ninety-eight patients underwent intensive and prolonged video-electroencephalographic (VEEG) monitoring; out of these, a total of 28 patients presented PNES during monitoring. Epilepsy was defined as present when the patient presented epileptic seizures during VEEG monitoring or when, although not presenting epileptic seizures during monitoring, the patient presented unequivocal interictal epileptiform discharges. The frequency of epilepsy in patients with PNES was 50% (14 patients). Our findings suggest that the frequency of epilepsy in patients with PNES is much higher than that of previous studies, and point out the need, at least in some cases, for prolonging the evaluation of patients with PNES who have clinical histories indicating epilepsy.

Arquivos De Neuro-psiquiatria, 2001

RESUMO -Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do ... more RESUMO -Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do diagnóstico diferencial entre epilepsia e crises pseudo-epilépticas psicogênicas (CPEP) e do seu tratamento. A paciente, uma professora desempregada, com crises desde os 13 anos, foi encaminhada ao PROJEPSI para diagnóstico e tratamento de CPEP. Seu diagnóstico inicial foi de epilepsia parcial sintomática por lesão tumoral cística em região occipto-temporal esquerda, associada a CPEP. Submetida a craniotomia occipital com ressecção de processo expansivo em região de istmo do cíngulo, evoluiu com persistência das CPEP. Submetida a tratamento psicológico integrado envolvendo técnicas de condicionamento operante, manejo de ansiedade, sugestão e orientação familiar, houve remissão completa das CPEP após 4 meses de tratamento. O caso apresentado demonstra a necessidade de múltiplos procedimentos diagnósticos e terapêuticos e a participação de equipe multidisciplinar especializada.

Arquivos De Neuro-psiquiatria, 2002

RESUMO -Motivo do estudo: O desenvolvimento de técnicas confiáveis para a realização de medidas v... more RESUMO -Motivo do estudo: O desenvolvimento de técnicas confiáveis para a realização de medidas volumétricas de estruturas temporais mesiais (amígdala, hipocampo e giro para-hipocampal) em exames de ressonância magnética (RM) pode fornecer dados para o estudo de vários transtornos neuropsiquiátricos, particularmente epilepsia do lobo temporal, doença de Alzheimer e esquizofrenia. Método: Investigamos essas técnicas realizando estudo de confiabilidade intra-observador (IO) e entre-observador (EO), envolvendo controles normais, pacientes com epilepsia e pacientes com doença de Alzheimer, através do coeficiente de correlação intra-classe (CCI). Resultados: A confiabilidade IO para as estruturas analisadas variou de 0,93 a 0,99 (p<0,001). A confiabilidade EO variou de 0,70 a 0,95 (p ≤ 0,001). Conclusão: Os resultados sugerem que a técnica de morfometria por RM de regiões temporais mesiais constitui instrumento confiável, que pode auxiliar na investigação diagnóstica de transtornos neuropsiquiátricos, desde que utilizado por clínicos e pesquisadores adequadamente treinados.

Epilepsy & Behavior, 2003

We describe the postsurgical outcome of six patients with medically intractable temporal lobe epi... more We describe the postsurgical outcome of six patients with medically intractable temporal lobe epilepsy and interictal psychosis who underwent temporal lobe resection. All patients were submitted to a comprehensive presurgical investigation, including prolonged video-EEG monitoring. Despite their psychotic disorders, all patients were able to provide informed consent and we were able to complete the investigation of all cases. Surgical complications occurred in two cases. Seizure outcome was Engel class I (free from incapacitating seizures) in all except one patient. There was no worsening of their psychoses. Until now, there has been relative improvement in the mental conditions of five patients. Although psychosis has been considered by some authors as a contraindication to epilepsy surgery, with appropriate psychiatric intervention, patients with refractory epilepsy and chronic interictal psychosis may be submitted to prolonged presurgical investigation and undergo surgery successfully.

Journal of Neuropsychiatry and Clinical Neurosciences, 2009

The authors evaluate 26 patients with suspected psychogenic non-epileptic seizures (PNES) who wer... more The authors evaluate 26 patients with suspected psychogenic non-epileptic seizures (PNES) who were referred to prolonged intensive video EEG (VEEG) in an epilepsy diagnostic center at the University of São Paulo, Brazil. Following the investigative protocol, 50% of the patients received a diagnosis of PNES, 15.4% of epilepsy, and 34.6% of associated PNES and epilepsy. In all patients in our series, PNES were the pseudoneurological presentations of dissociative or conversion symptoms in patients presenting the following mental disorders: conversion disorder, somatization or undifferentiated somatoform disorder, dissociative disorder not otherwise specified, and posttraumatic stress disorder. Psychiatric comorbidities, mostly depressive disorders, were frequent.

Journal of Epilepsy and Clinical Neurophysiology, 2007

In spite of the growing interest in psychogenic nonepileptic seizures (PNES), this diagnosis clea... more In spite of the growing interest in psychogenic nonepileptic seizures (PNES), this diagnosis clearly lacks both standard protocols and efficient treatment. We analyzed seizure frequency, as well as, academic and working performances in a group of PNES patients, both prior and following a specific eight-week program developed at PROJEPSI (Epilepsy and Psychiatry Project) – Institute of Psychiatry, Hospital de Clinicas, School of Medicine, University of Sao Paulo. The program targeted seizure reduction and decrease in losses associated to PNES. Fifteen patients (62.5%) entered prolonged remission and 19 (79.2%) improved academic and professional performances. Our study shows evidence supporting the efficacy of the NES protocol proposed by PROJEPSI. The number of patients presenting with either remission or significant decrease on their seizures following the diagnosis presentation, psychiatric comorbidity treatment and specific therapy aiming to damage and crisis suggests that the knowledge of this condition by patients, family members and friends is key to successful treatment.

Epilepsy & Behavior, 2003

We investigated a series of patients with epileptic psychosis in Brazil and compared our findings... more We investigated a series of patients with epileptic psychosis in Brazil and compared our findings with those of other authors. We evaluated 38 outpatients with epileptic psychosis with a semistructured clinical interview, Annett inventory for hand dominance, international classifications for seizures and syndromes, and DSM-IV for psychosis diagnoses. We studied course and outcome for epilepsy and psychosis. Gender distribution was approximately even. Epilepsy and psychiatric disorders among relatives and early CNS insults in personal histories were frequent findings. Mean age of epilepsy onset was 9.3 years. Epilepsy started before psychosis in all cases, and evolved to clinical refractoriness. There was a predominance of temporal lobe epilepsy. Mean age of psychosis onset was 27.4 years, after a mean duration of epilepsy of 18.1 years, with predominance of schizophrenic presentations with interictal onset, frequent psychiatric admissions, suicide attempts, and postpsychosis functional decline. Tumors or lesions of an embryologic nature were uncommon, but mesial temporal sclerosis was frequent.

Seizure-european Journal of Epilepsy, 2008

Objective: Our purpose was to present and discuss the psychiatric diagnoses of patients who prese... more Objective: Our purpose was to present and discuss the psychiatric diagnoses of patients who presented psychogenic non-epileptic seizures (PNES) during videoelectroencephalographic monitoring (VEEG). Methods: Out of 98 patients, a total of 28 patients presented PNES during the diagnostic procedure. In those cases in which the PNES that occurred during VEEG were validated by clinical history (clinical validation), and by showing the recorded event on video to an observer close to the patient (observer validation), was defined psychogenic non-epileptic seizure disorder (PNESD). Psychiatric diagnoses were made according to DSM-IV. Results: In 27, psychogenic non-epileptic seizures disorder was diagnosed. Fourteen patients presented only with psychogenic non-epileptic seizure disorder, 13 with both psychogenic non-epileptic seizures disorder and epilepsy, and one patient with epilepsy only. Psychiatric diagnoses were: 17 (63%) patients with conversion disorder, five (19%) with somatization disorder, two (7%) with dissociative disorder NOS, two (7%) with post-traumatic stress disorder and one (4%) with undifferentiated somatoform disorder. Conclusions: Dissociative-conversion non-epileptic seizures are the most frequent finding, representing the pseudoneurological manifestation of mental disorders that have these symptoms as a common feature. Provisionally, they may be defined as dissociative-conversion non-epileptic seizure disorders.

International Psychogeriatrics, 2002

Background: Volumetric magnetic resonance imaging (MRI) has been extensively studied in the last ... more Background: Volumetric magnetic resonance imaging (MRI) has been extensively studied in the last decade as a method to help with the clinical diagnosis of Alzheimer's disease (AD). In recent years, researchers have also started investigating if that technique would be useful to identify individuals with mild cognitive impairment (MCI), differentiating them from AD patients and from normal elderly controls. This research project was planned t o assess the accuracy of volumetric MRI t o differentiate those groups of individuals. Method: The investigation involved 39 patients with diagnosis of mild to moderate dementia in AD, according to the criteria of the NINCDS-ADRDA, DSM-111-R, and ICD-10; 21 subjects with complaints of cognitive decline without other psychiatric disorders (MCI); and 20 normal elderly controls. All the subjects were submitted to a standard protocol, including volumetric MRI evaluations. Results: The results indicated that all regions of interest measured (amygdala, hippocampus, and parahippocampal gyrus) were significantly different (p 5.005) in AD patients compared to MCI subjects and controls. The left volumetric measures (aniygdala, hippocampus, and parahippocampal gyrus) were also significantly different between the MCl subjects and controls @ < .05). The discriminant function analysis correctly classified 88.14% of the AD patients and controls, 81.67% of AD patients and MCI subjects, and 80.49% of the MCI subjects and controls. Conclusions: The results suggest that measures of medial temporal lobe regions are useful to identify mild to moderate AD patients and MCI subjects, separating them from normal elderly individuals.

Epilepsy & Behavior, 2003

We investigated anatomic alterations and lateralization effect in the mesial temporal lobe struct... more We investigated anatomic alterations and lateralization effect in the mesial temporal lobe structures (amygdala and hippocampus) in epileptic psychosis MRI volumetric measurements. Patients with epileptic psychosis and normal controls were studied. Left hippocampus values were significantly smaller for patients (P < 0:001). Hippocampal ratio was significantly greater for patients (P < 0:01). Group (patients  normal) was the only factor explaining the statistically significant variation of left hippocampus and hippocampal ratio (P < 0:001 and P < 0:05). Twenty patients had hippocampal atrophy (4 on the right side, 15 on the left side, and 1 bilateral) associated with mesial temporal sclerosis. These results confirm the existence of anatomic alterations and a left laterality effect in the mesial temporal lobe structures of patients with epileptic psychosis.

Journal of Ect, 2003

The authors report on the use of electroconvulsive therapy (ECT) in the treatment of three patien... more The authors report on the use of electroconvulsive therapy (ECT) in the treatment of three patients with mental disorders associated with epilepsy. They discuss several aspects related to safety, efficacy, and indications of ECT in these patients. The observed results, as well as published data, provide evidence that ECT is a safe and effective therapeutic option for some patients with mental disorders associated with epilepsy. The indications are the same as in patients without epilepsy. There might be another possible indication for patients with alternative mental disorders (forced normalization), although improvement after spontaneous seizures may not always predict response to ECT.

Revista De Psiquiatria Clinica, 2005

Epilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mun... more Epilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mundo, 40 milhões delas em países em desenvolvimento. Embora seja um problema predominantemente tratável, nestes países a maioria dos pacientes permanece sem tratamento. Provavelmente uma das principais causas para isto seja o estigma que atinge as pessoas com epilepsia. Tal fato se agrava ainda mais quando à epilepsia se associam transtornos mentais, que ocorrem com prevalência aumentada. Os pacientes com epilepsia e transtornos mentais sofrem o que se chama de "duplo estigma", que freqüentemente os d e i x a s e m t r a t a m e n t o . É p r o v á v e l , p a r t i c u l a r m e n t e e m p a í s e s e m desenvolvimento, que psiquiatras se defrontem com pacientes com epilepsia nos diferentes locais de atendimento. Os autores revisam diferentes aspectos dos principais transtornos mentais associados à epilepsia.

Arquivos De Gastroenterologia, 2010

The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychog... more The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychogenic non-epileptic seizures (PNES). The evaluation was carried out during intensive VEEG monitoring in a diagnostic center for epilepsy in a university hospital. The difficulties involved in reaching this diagnosis are discussed. Ninety-eight patients underwent intensive and prolonged video-electroencephalographic (VEEG) monitoring; out of these, a total of 28 patients presented PNES during monitoring. Epilepsy was defined as present when the patient presented epileptic seizures during VEEG monitoring or when, although not presenting epileptic seizures during monitoring, the patient presented unequivocal interictal epileptiform discharges. The frequency of epilepsy in patients with PNES was 50% (14 patients). Our findings suggest that the frequency of epilepsy in patients with PNES is much higher than that of previous studies, and point out the need, at least in some cases, for prolonging the evaluation of patients with PNES who have clinical histories indicating epilepsy.

Arquivos De Neuro-psiquiatria, 2001

We report a case of a female patient with refractory complex partial seizures since 15 years of a... more We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

Arquivos De Neuro-psiquiatria, 2001

ABSTRACT Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do... more ABSTRACT Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do diagnóstico diferencial entre epilepsia e crises pseudo-epilépticas psicogênicas (CPEP) e do seu tratamento. A paciente, uma professora desempregada, com crises desde os 13 anos, foi encaminhada ao PROJEPSI para diagnóstico e tratamento de CPEP. Seu diagnóstico inicial foi de epilepsia parcial sintomática por lesão tumoral cística em região occipto-temporal esquerda, associada a CPEP. Submetida a craniotomia occipital com ressecção de processo expansivo em região de istmo do cíngulo, evoluiu com persistência das CPEP. Submetida a tratamento psicológico integrado envolvendo técnicas de condicionamento operante, manejo de ansiedade, sugestão e orientação familiar, houve remissão completa das CPEP após 4 meses de tratamento. O caso apresentado demonstra a necessidade de múltiplos procedimentos diagnósticos e terapêuticos e a participação de equipe multidisciplinar especializada.

Epilepsy & Behavior, 2011

A history of childhood trauma and the presence of dissociative phenomena are considered to be the... more A history of childhood trauma and the presence of dissociative phenomena are considered to be the most important risk factors for psychogenic nonepileptic seizure disorder (PNESD). This case-control study investigated 20 patients with PNESD and 20 with temporal lobe epilepsy (TLE) diagnosed by video/EEG monitoring who were matched for gender and age. Patients with both conditions were not included in the study. Groups were evaluated for age at onset and at diagnosis, worst lifetime weekly seizure frequency, trauma history, and presence of dissociative phenomena. Age at onset (P = 0.007) and age at diagnosis (P b 0.001) were significantly higher in the PNESD group than the control group, as were the scores on the Dissociative Experiences Scale (P b 0.001) and Childhood Trauma Questionnaire (P = 0.014). Only the differences in scores on the Childhood Trauma Questionnaire subscales Emotional Neglect (P = 0.013) and Emotional Abuse (P = 0.014) reached statistical significance. Dissociative phenomena and a reported history of childhood trauma are more common in patients with PNESD than in those with TLE. However, only emotional neglect and abuse were associated with PNESD in this study.

Revista Brasileira De Psiquiatria, 2005

Epilepsy is the most common serious neurological disorder. Worldwide, around 50 million people ha... more Epilepsy is the most common serious neurological disorder. Worldwide, around 50 million people have epilepsy, 40 million of which in developing countries. Though epilepsy is predominantly treatable, most patients in these countries remain without treatment. It is likely that one of the main reasons is the stigma associated with epilepsy. This problem increases when mental disorders are associated with epilepsy, a fairly frequent occurrence. Patients with epilepsy and mental disorders are exposed to a "double stigma", which frequently leads to complete absence of treatment. It is probable that, particularly in developing countries, psychiatrists will be involved with the treatment of people with epilepsy. Our purpose was to review the epidemiology of mental disorders associated with epilepsy, its treatment gap and impact upon quality of life of the patients.

Epilepsy & Behavior, 2004

The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment... more The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment, formal training, attitudes, and knowledge with respect to epilepsy (and associated mental disorders). One hundred fifty-seven Brazilian psychiatrists completed a specially developed questionnaire. Most (95%) had previously treated patients with epilepsy and mental disorders. About one-third (35%) admitted a lack of any formal training in epilepsy, and only 46% confirmed having received some formal training in mental disorders related to epilepsy. Eighty percent were dissatisfied with their knowledge. Three knowledge-based questions were answered correctly by only 10%. Almost half (48%) admitted that among psychiatrists, prejudice exists toward patients with epilepsy. Difficulties with treatment (50%) and lack of knowledge of epilepsy (50%) were considered the main causes of such prejudice. These data indicate an urgent need for improvement in education on epilepsy and associated mental disorders, as well as inclusion of formal epilepsy training in psychiatry residency programs.

Journal of Epilepsy and Clinical Neurophysiology, 2009

PURPOSE: To perform the cross-cultural adaptation of an instrument designed to measure behavioral... more PURPOSE: To perform the cross-cultural adaptation of an instrument designed to measure behavioral changes typically described in temporal lobe epilepsy (TLE), the Neurobehavior Inventory (NBI), for Brazilian population. METHODS: At first the original instrument was translated to Portuguese-Brazilian language. This version was revised and translated back into English. Later, both English versions were compared and the divergences were corrected in the Portuguese text. The second step consisted of the application of the inventory to 15 TLE patients from the Epilepsy Program, Federal University of Minas Gerais. The authors analyzed eventual difficulties and misunderstandings in the application of the questionnaire. RESULTS: In the final Portuguese version, the questions 11, 14, 17, 61 and 75 were considered difficult to understand and were modified. Seven (46.7%) subjects were women, with 26 to 65 years. Most of the patients (93.3%) had a high total score level. Religious convictions, interest in details and sense of personal destiny were the most common altered domains (73.3% of the patients in each one of them). CONCLUSION: The Portuguese-Brazilian version of the NBI may be a useful instrument to evaluate TLE behavioral alterations in the Brazilian clinical context.

Revista De Psiquiatria Clinica, 2005

Epilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mun... more Epilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mundo, 40 milhões delas em países em desenvolvimento. Embora seja um problema predominantemente tratável, nestes países a maioria dos pacientes permanece sem tratamento. Provavelmente uma das principais causas para isto seja o estigma que atinge as pessoas com epilepsia. Tal fato se agrava ainda mais quando à epilepsia se associam transtornos mentais, que ocorrem com prevalência aumentada. Os pacientes com epilepsia e transtornos mentais sofrem o que se chama de "duplo estigma", que freqüentemente os d e i x a s e m t r a t a m e n t o . É p r o v á v e l , p a r t i c u l a r m e n t e e m p a í s e s e m desenvolvimento, que psiquiatras se defrontem com pacientes com epilepsia nos diferentes locais de atendimento. Os autores revisam diferentes aspectos dos principais transtornos mentais associados à epilepsia.

Arquivos De Gastroenterologia, 2010

The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychog... more The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychogenic non-epileptic seizures (PNES). The evaluation was carried out during intensive VEEG monitoring in a diagnostic center for epilepsy in a university hospital. The difficulties involved in reaching this diagnosis are discussed. Ninety-eight patients underwent intensive and prolonged video-electroencephalographic (VEEG) monitoring; out of these, a total of 28 patients presented PNES during monitoring. Epilepsy was defined as present when the patient presented epileptic seizures during VEEG monitoring or when, although not presenting epileptic seizures during monitoring, the patient presented unequivocal interictal epileptiform discharges. The frequency of epilepsy in patients with PNES was 50% (14 patients). Our findings suggest that the frequency of epilepsy in patients with PNES is much higher than that of previous studies, and point out the need, at least in some cases, for prolonging the evaluation of patients with PNES who have clinical histories indicating epilepsy.

Arquivos De Neuro-psiquiatria, 2001

RESUMO -Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do ... more RESUMO -Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do diagnóstico diferencial entre epilepsia e crises pseudo-epilépticas psicogênicas (CPEP) e do seu tratamento. A paciente, uma professora desempregada, com crises desde os 13 anos, foi encaminhada ao PROJEPSI para diagnóstico e tratamento de CPEP. Seu diagnóstico inicial foi de epilepsia parcial sintomática por lesão tumoral cística em região occipto-temporal esquerda, associada a CPEP. Submetida a craniotomia occipital com ressecção de processo expansivo em região de istmo do cíngulo, evoluiu com persistência das CPEP. Submetida a tratamento psicológico integrado envolvendo técnicas de condicionamento operante, manejo de ansiedade, sugestão e orientação familiar, houve remissão completa das CPEP após 4 meses de tratamento. O caso apresentado demonstra a necessidade de múltiplos procedimentos diagnósticos e terapêuticos e a participação de equipe multidisciplinar especializada.

Arquivos De Neuro-psiquiatria, 2002

RESUMO -Motivo do estudo: O desenvolvimento de técnicas confiáveis para a realização de medidas v... more RESUMO -Motivo do estudo: O desenvolvimento de técnicas confiáveis para a realização de medidas volumétricas de estruturas temporais mesiais (amígdala, hipocampo e giro para-hipocampal) em exames de ressonância magnética (RM) pode fornecer dados para o estudo de vários transtornos neuropsiquiátricos, particularmente epilepsia do lobo temporal, doença de Alzheimer e esquizofrenia. Método: Investigamos essas técnicas realizando estudo de confiabilidade intra-observador (IO) e entre-observador (EO), envolvendo controles normais, pacientes com epilepsia e pacientes com doença de Alzheimer, através do coeficiente de correlação intra-classe (CCI). Resultados: A confiabilidade IO para as estruturas analisadas variou de 0,93 a 0,99 (p<0,001). A confiabilidade EO variou de 0,70 a 0,95 (p ≤ 0,001). Conclusão: Os resultados sugerem que a técnica de morfometria por RM de regiões temporais mesiais constitui instrumento confiável, que pode auxiliar na investigação diagnóstica de transtornos neuropsiquiátricos, desde que utilizado por clínicos e pesquisadores adequadamente treinados.

Epilepsy & Behavior, 2003

We describe the postsurgical outcome of six patients with medically intractable temporal lobe epi... more We describe the postsurgical outcome of six patients with medically intractable temporal lobe epilepsy and interictal psychosis who underwent temporal lobe resection. All patients were submitted to a comprehensive presurgical investigation, including prolonged video-EEG monitoring. Despite their psychotic disorders, all patients were able to provide informed consent and we were able to complete the investigation of all cases. Surgical complications occurred in two cases. Seizure outcome was Engel class I (free from incapacitating seizures) in all except one patient. There was no worsening of their psychoses. Until now, there has been relative improvement in the mental conditions of five patients. Although psychosis has been considered by some authors as a contraindication to epilepsy surgery, with appropriate psychiatric intervention, patients with refractory epilepsy and chronic interictal psychosis may be submitted to prolonged presurgical investigation and undergo surgery successfully.

Journal of Neuropsychiatry and Clinical Neurosciences, 2009

The authors evaluate 26 patients with suspected psychogenic non-epileptic seizures (PNES) who wer... more The authors evaluate 26 patients with suspected psychogenic non-epileptic seizures (PNES) who were referred to prolonged intensive video EEG (VEEG) in an epilepsy diagnostic center at the University of São Paulo, Brazil. Following the investigative protocol, 50% of the patients received a diagnosis of PNES, 15.4% of epilepsy, and 34.6% of associated PNES and epilepsy. In all patients in our series, PNES were the pseudoneurological presentations of dissociative or conversion symptoms in patients presenting the following mental disorders: conversion disorder, somatization or undifferentiated somatoform disorder, dissociative disorder not otherwise specified, and posttraumatic stress disorder. Psychiatric comorbidities, mostly depressive disorders, were frequent.

Journal of Epilepsy and Clinical Neurophysiology, 2007

In spite of the growing interest in psychogenic nonepileptic seizures (PNES), this diagnosis clea... more In spite of the growing interest in psychogenic nonepileptic seizures (PNES), this diagnosis clearly lacks both standard protocols and efficient treatment. We analyzed seizure frequency, as well as, academic and working performances in a group of PNES patients, both prior and following a specific eight-week program developed at PROJEPSI (Epilepsy and Psychiatry Project) – Institute of Psychiatry, Hospital de Clinicas, School of Medicine, University of Sao Paulo. The program targeted seizure reduction and decrease in losses associated to PNES. Fifteen patients (62.5%) entered prolonged remission and 19 (79.2%) improved academic and professional performances. Our study shows evidence supporting the efficacy of the NES protocol proposed by PROJEPSI. The number of patients presenting with either remission or significant decrease on their seizures following the diagnosis presentation, psychiatric comorbidity treatment and specific therapy aiming to damage and crisis suggests that the knowledge of this condition by patients, family members and friends is key to successful treatment.

Epilepsy & Behavior, 2003

We investigated a series of patients with epileptic psychosis in Brazil and compared our findings... more We investigated a series of patients with epileptic psychosis in Brazil and compared our findings with those of other authors. We evaluated 38 outpatients with epileptic psychosis with a semistructured clinical interview, Annett inventory for hand dominance, international classifications for seizures and syndromes, and DSM-IV for psychosis diagnoses. We studied course and outcome for epilepsy and psychosis. Gender distribution was approximately even. Epilepsy and psychiatric disorders among relatives and early CNS insults in personal histories were frequent findings. Mean age of epilepsy onset was 9.3 years. Epilepsy started before psychosis in all cases, and evolved to clinical refractoriness. There was a predominance of temporal lobe epilepsy. Mean age of psychosis onset was 27.4 years, after a mean duration of epilepsy of 18.1 years, with predominance of schizophrenic presentations with interictal onset, frequent psychiatric admissions, suicide attempts, and postpsychosis functional decline. Tumors or lesions of an embryologic nature were uncommon, but mesial temporal sclerosis was frequent.

Seizure-european Journal of Epilepsy, 2008

Objective: Our purpose was to present and discuss the psychiatric diagnoses of patients who prese... more Objective: Our purpose was to present and discuss the psychiatric diagnoses of patients who presented psychogenic non-epileptic seizures (PNES) during videoelectroencephalographic monitoring (VEEG). Methods: Out of 98 patients, a total of 28 patients presented PNES during the diagnostic procedure. In those cases in which the PNES that occurred during VEEG were validated by clinical history (clinical validation), and by showing the recorded event on video to an observer close to the patient (observer validation), was defined psychogenic non-epileptic seizure disorder (PNESD). Psychiatric diagnoses were made according to DSM-IV. Results: In 27, psychogenic non-epileptic seizures disorder was diagnosed. Fourteen patients presented only with psychogenic non-epileptic seizure disorder, 13 with both psychogenic non-epileptic seizures disorder and epilepsy, and one patient with epilepsy only. Psychiatric diagnoses were: 17 (63%) patients with conversion disorder, five (19%) with somatization disorder, two (7%) with dissociative disorder NOS, two (7%) with post-traumatic stress disorder and one (4%) with undifferentiated somatoform disorder. Conclusions: Dissociative-conversion non-epileptic seizures are the most frequent finding, representing the pseudoneurological manifestation of mental disorders that have these symptoms as a common feature. Provisionally, they may be defined as dissociative-conversion non-epileptic seizure disorders.

International Psychogeriatrics, 2002

Background: Volumetric magnetic resonance imaging (MRI) has been extensively studied in the last ... more Background: Volumetric magnetic resonance imaging (MRI) has been extensively studied in the last decade as a method to help with the clinical diagnosis of Alzheimer's disease (AD). In recent years, researchers have also started investigating if that technique would be useful to identify individuals with mild cognitive impairment (MCI), differentiating them from AD patients and from normal elderly controls. This research project was planned t o assess the accuracy of volumetric MRI t o differentiate those groups of individuals. Method: The investigation involved 39 patients with diagnosis of mild to moderate dementia in AD, according to the criteria of the NINCDS-ADRDA, DSM-111-R, and ICD-10; 21 subjects with complaints of cognitive decline without other psychiatric disorders (MCI); and 20 normal elderly controls. All the subjects were submitted to a standard protocol, including volumetric MRI evaluations. Results: The results indicated that all regions of interest measured (amygdala, hippocampus, and parahippocampal gyrus) were significantly different (p 5.005) in AD patients compared to MCI subjects and controls. The left volumetric measures (aniygdala, hippocampus, and parahippocampal gyrus) were also significantly different between the MCl subjects and controls @ < .05). The discriminant function analysis correctly classified 88.14% of the AD patients and controls, 81.67% of AD patients and MCI subjects, and 80.49% of the MCI subjects and controls. Conclusions: The results suggest that measures of medial temporal lobe regions are useful to identify mild to moderate AD patients and MCI subjects, separating them from normal elderly individuals.

Epilepsy & Behavior, 2003

We investigated anatomic alterations and lateralization effect in the mesial temporal lobe struct... more We investigated anatomic alterations and lateralization effect in the mesial temporal lobe structures (amygdala and hippocampus) in epileptic psychosis MRI volumetric measurements. Patients with epileptic psychosis and normal controls were studied. Left hippocampus values were significantly smaller for patients (P < 0:001). Hippocampal ratio was significantly greater for patients (P < 0:01). Group (patients  normal) was the only factor explaining the statistically significant variation of left hippocampus and hippocampal ratio (P < 0:001 and P < 0:05). Twenty patients had hippocampal atrophy (4 on the right side, 15 on the left side, and 1 bilateral) associated with mesial temporal sclerosis. These results confirm the existence of anatomic alterations and a left laterality effect in the mesial temporal lobe structures of patients with epileptic psychosis.

Journal of Ect, 2003

The authors report on the use of electroconvulsive therapy (ECT) in the treatment of three patien... more The authors report on the use of electroconvulsive therapy (ECT) in the treatment of three patients with mental disorders associated with epilepsy. They discuss several aspects related to safety, efficacy, and indications of ECT in these patients. The observed results, as well as published data, provide evidence that ECT is a safe and effective therapeutic option for some patients with mental disorders associated with epilepsy. The indications are the same as in patients without epilepsy. There might be another possible indication for patients with alternative mental disorders (forced normalization), although improvement after spontaneous seizures may not always predict response to ECT.

Revista De Psiquiatria Clinica, 2005

Epilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mun... more Epilepsia é o mais freqüente transtorno neurológico sério, atingindo 50 milhões de pessoas no mundo, 40 milhões delas em países em desenvolvimento. Embora seja um problema predominantemente tratável, nestes países a maioria dos pacientes permanece sem tratamento. Provavelmente uma das principais causas para isto seja o estigma que atinge as pessoas com epilepsia. Tal fato se agrava ainda mais quando à epilepsia se associam transtornos mentais, que ocorrem com prevalência aumentada. Os pacientes com epilepsia e transtornos mentais sofrem o que se chama de "duplo estigma", que freqüentemente os d e i x a s e m t r a t a m e n t o . É p r o v á v e l , p a r t i c u l a r m e n t e e m p a í s e s e m desenvolvimento, que psiquiatras se defrontem com pacientes com epilepsia nos diferentes locais de atendimento. Os autores revisam diferentes aspectos dos principais transtornos mentais associados à epilepsia.

Arquivos De Gastroenterologia, 2010

The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychog... more The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychogenic non-epileptic seizures (PNES). The evaluation was carried out during intensive VEEG monitoring in a diagnostic center for epilepsy in a university hospital. The difficulties involved in reaching this diagnosis are discussed. Ninety-eight patients underwent intensive and prolonged video-electroencephalographic (VEEG) monitoring; out of these, a total of 28 patients presented PNES during monitoring. Epilepsy was defined as present when the patient presented epileptic seizures during VEEG monitoring or when, although not presenting epileptic seizures during monitoring, the patient presented unequivocal interictal epileptiform discharges. The frequency of epilepsy in patients with PNES was 50% (14 patients). Our findings suggest that the frequency of epilepsy in patients with PNES is much higher than that of previous studies, and point out the need, at least in some cases, for prolonging the evaluation of patients with PNES who have clinical histories indicating epilepsy.

Arquivos De Neuro-psiquiatria, 2001

We report a case of a female patient with refractory complex partial seizures since 15 years of a... more We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

Arquivos De Neuro-psiquiatria, 2001

ABSTRACT Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do... more ABSTRACT Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do diagnóstico diferencial entre epilepsia e crises pseudo-epilépticas psicogênicas (CPEP) e do seu tratamento. A paciente, uma professora desempregada, com crises desde os 13 anos, foi encaminhada ao PROJEPSI para diagnóstico e tratamento de CPEP. Seu diagnóstico inicial foi de epilepsia parcial sintomática por lesão tumoral cística em região occipto-temporal esquerda, associada a CPEP. Submetida a craniotomia occipital com ressecção de processo expansivo em região de istmo do cíngulo, evoluiu com persistência das CPEP. Submetida a tratamento psicológico integrado envolvendo técnicas de condicionamento operante, manejo de ansiedade, sugestão e orientação familiar, houve remissão completa das CPEP após 4 meses de tratamento. O caso apresentado demonstra a necessidade de múltiplos procedimentos diagnósticos e terapêuticos e a participação de equipe multidisciplinar especializada.