Alteraciones cognoscitivas después de un trauma craneoencefálico / Cognitive impairment after traumatic brain injury / Alterações cognitivas após um traumatismo crânio-encefálico

Colombia carece de estudios sobre las características neuropsicológicas de personas que sufren un Trauma Craneoencefálico (TCE), a pesar de ser un problema de salud pública y la primera causa de incapacidad y muerte. Estudios previos han demostrado que el TCE genera alteraciones cognoscitivas en mayor medida en la atención y en la memoria, las cuales, a su vez, afectan la vida diaria de los pacientes. El objetivo de este estudio fue describir las funciones cognitivas que pueden verse afectadas como consecuencia de un TCE. Se evaluó un total de 30 pacientes, con edad promedio de 34 años y antecedentes de TCE de por lo menos seis meses de evolución; nueve de ellos presentaban un TCE leve; diez, una condición moderada, y once, una lesión cerebral severa; la escolaridad promedio era de nueve años, y no presentaban antecedentes neurológicos y/o psiquiátricos. Se aplicó la evaluación neuropsicológica breve en español (NEUROPSI), el Trail Making Test A y B (TMTA-TMTB), el Test de Clasificación de Tarjetas de Wisconsin (WCST), la Figura Compleja de Rey, el Test de Aprendizaje Audioverbal de Rey y el Stroop Test. Los resultados mostraron puntuaciones inferiores a la media en todas las pruebas y en los tres grupos de TCE, evidenciándose una disminución en los procesos de evocación de memoria verbal y visual, atención, lenguaje y funciones ejecutivas. En conclusión, el TCE afecta la mayoría de las funciones cognitivas, alterándolas de manera diferencial, y en algunos casos sin que ello esté relacionado con la severidad del TCE. Estos hallazgos son de gran importancia debido a las implicaciones que se presentan en el proceso de rehabilitación ofrecido a estos pacientes, el cual no sólo debe limitarse a la condición física.

Colombia lacks studies on the neuropsychological characteristics of people who suffer a traumatic brain injury (TBI), despite this being a public health problem and the leading cause of disability and death. Previous studies have shown that TBI generates further cognitive impairment in attention and memory, which, in turn, affect the daily lives of patients. The aim of this study was to describe the cognitive functions that may be affected as a result of TBI. A total of 30 patients, mean age 34 years and a history of TBI of at least 6 months duration participated in the study; 9 of them had mild head injury; 10 had a moderate condition and 11 had severe TBI; their average schooling was 9 years and they had no history of previous neurological and / or psychiatric problems. The brief neuropsychological assessment in Spanish (NEUROPSI) was carried out, along with the application of the Trail Making Test A and B (TMTA-TMTB), the Wisconsin Card Sorting Test (WCST), the Figura Compleja de Rey, the Test de Aprendizaje Audioverbal de Rey and the Stroop Test. Results showed below average scores in all tests and in the three groups of TBI, detecting a decrease in the processes of evocation of verbal and visual memory, attention, language and executive functions. In conclusion, TBI affects most cognitive functions, differentially altering them and in some cases without this being related to the severity of TBI. These findings are important due to their implications for the rehabilitation process offered to these patients which should not be limited to the physical condition.

Colômbia não tem realizado estudos sobre as características neuropsicológicas de pessoas que sofrem um traumatismo crânio-encefálico (TCE), apesar de ser um problema de saúde pública e principal causa de incapacidade e morte. Estudos anteriores demonstraram que o TCE gera mais comprometimento cognitivo de atenção e memória que, por sua vez, afeta a vida diária dos pacientes. O objetivo deste estudo foi descrever as funções cognitivas que podem ser afetados como resultado de TCE. Foram avaliados 30 pacientes de idade média 34 anos e uma história de TCE, pelo menos, de seis meses de evolução. Nove pacientes tinham um leve traumatismo craniano; dez apresentavam condição moderada; e onze sofriam lesão cerebral grave. A escolaridade média foi 9 anos, e não tinham história neurológica ou psiquiátrica. Aplicou-se avaliação neuropsicológica breve em espanhol (NEUROPSI), o Trail Making Test A e B (TMTA-TMTB), o Teste de Wisconsin Card Sorting (WCST), a Figura Complexa de Rey, o Teste de Aprendizagem Audioverbal de Rey e o Stroop Test. Os resultados mostraram pontuações abaixo da média em todos os testes e nos três grupos de TCE, mostrando uma diminuição nos processos de evocação de memória verbal e visual, atenção, linguagem e funções executivas. Em conclusão, o TCE afeta a maioria das funções cognitivas e as altera diferencialmente. Em alguns casos, sem relacionar-se com a gravidade do TCE. Essas descobertas são importantes porque influenciam no processo de reabilitação oferecido a esses pacientes, o que não deve ser limitado à condição física.

Caracterización neuropsicológica de pacientes con glioma tratados en el instituto de cancerología de Medellín / Neuropsychological characteristics of patients with glioma treated in the Institute of cancer of Medellín Colombia

INTRODUCCIÓN: el 50 al 80 por ciento de los pacientes con gliomas presentan perturbaciones cognitivas, lo cual empeora la calidad de vida del enfermo. OBJETIVOS: analizar las características neuropsicológicas en pacientes con gliomas del instituto de cancerología de Medellín. MATERIAL Y MÉTODOS: se seleccionaron 50 pacientes con glioma, a quienes se les aplicó una batería neuropsicológica para evaluar atención, memoria, habilidades visuales y constructivas, lenguaje y función ejecutiva. Se compararon los promedios de los pacientes con los de la población general colombiana, también entre grupos de acuerdo con la localización, el tamaño, el grado de malignidad; lo mismo que entre grupos según edad, escolaridad y género. RESULTADOS: la proporción entre hombres (52 por ciento) y mujeres (48 por ciento) fue similar. La localización más frecuente fue del lóbulo frontal (32 por ciento) con predominio del lado derecho (20 por ciento). El tamaño del tumor en el 48 por ciento de la muestra fue de 3cm o más y en 50 por ciento se encuentra en un grado de malignidad avanzado. Hubo alteración en todas las funciones neuropsicológicas en comparación con la población general. Los lesionados del lado izquierdo tuvieron alteraciones significativas en la fluidez verbal y en la capacidad de categorización. Aquellos con lesiones posteriores tuvieron ejecuciones más bajas que los pacientes con lesiones frontales en la capacidad intelectual, las habilidades constructivas y en memoria. Como dato inesperado no se encontraron diferencias significativas en las variables de función ejecutiva. CONCLUSIONES: los pacientes con glioma tuvieron lentitud en las ejecuciones, fallas en el almacenamiento y evocación de la información y características de afasia sensorial transcortical.

INTRODUCTION: 50 to 80 per cent of the patients with brain gliomas have cognitive impairment, which produces worsening of the quality of life. OBJECTIVE: to analyze the neuropsychological characteristics in patients with gliomas from the Instituto de Cancerología (Cancer Institute) of Medellín. MATERIALS AND METHODS: 50 patients with malignant brain tumors (gliomas) were selected. A neuropsychological battery to assess attention, memory, visual and motor skills, language and executive function was administered. Patient’s performance was compared to Colombian general population; also groups of patients according to tumor localization, size and grade of severity were analyzed; similar comparisons were done between age, gender and school achievement groups. RESULTS: gender distribution was similar (males 52 per cent and females 48 per cent). Frontal localizations (32 per cent) were the most frequent, and predominate in the right hemisphere (20 per cent). Tumor size was over 3 cm in 48 por ciento of the sample, and 50 per cent had a severe malignity grade. There was alteration in all of the assessed neuropsychological functions, compared to general population. Patients with left tumors had significant impairment in verbal fluency and categorization ability. Those with posterior lesions had low performance in intellectual level, motor skills and memory. As an unexpected data significant differences were not found in executive function related to frontal lobe localization. CONCLUSIONS: patients with gliomas had slowing to store and to retrieve information, and had features of sensory transcortical aphasia.

Clinical and Electroencephalogram Characteristics of Children with Electrical Status Epilepticus during Sleep / 实用儿科临床杂志

Objective To investigate the clinical and electroencephalogram (EEG) characteristics of children with electrical status cpilepticus during sleep (ESES), and the response to medication therapy. Methods AEEG and VEEG including an entire sleeping c-ycle were performed on 26 patients with ESES. The clinical and EEG changes, neuropsychological impairment and the response to medication therapy were followed up. Results Twenty five patients had seizures,21 cases had normal psychomotor development before ESES. After the onset of the disease,Fifteen cases developed language disorder, 16 cases developed psychological and behavior abnormalities, 13 cases had both of the problems Seventeen patients belonged to epileptic syndrome. Patients in this cohort had good response to clonazepam and valproate treatment. Cortical steroid could dispel the electrical discharge. Eighteen patients had been followed up. Seizures stopped in 15 cases after treatment ESES disappeared in 16 cases, 4 of them still had neuropsychological impairment ESES sustained in 2 cases Conclusions ESES is a specific EEG phenomenon. Continue epileptic form discharge during non - rapid cye movement sleep is the major cause of neuropsychological impairment in patients with ESES. To control the seizures and electrical state are very important for the prevention and treatment of neuropsychological impairment.