Résumé
@#Objective To compare the efficacy of different models of attention rehabilitation on attention deficits after acquired brain injury. Methods According to the training models, 47 patients with attention deficits were randomly assigned to 3 groups: computer-assisted training group(n=16), face-to-face training group(n=21) and control group(n=10). The training groups were given attention training once a day which sustained 30 minutes for 6 weeks. All patients were tested with the Montreal Cognitive Assessment (MoCA) and the Loewenstein Occupational Therapy Cognitive Assessment Battery (LOTCA) before and 6 weeks after the rehabilitation. Results The performance of both the computer-assisted training group and the face-to-face training group significantly improved (P<0.05). The various of the scores was the most in the computer-assisted training group among them (P<0.05). Conclusion The computer-assisted training is a high-effective method for attention deficits.
Résumé
Los problemas atencionales tienen una alta prevalencia en los niños con epilepsia existiendo muchas interrogantes acerca de su fisiopatología. Caracterizar la atención en un grupo de niños epilépticos. Se estudiaron 12 niños con crisis parciales complejas y se les realizó electroencefalograma y una batería neuropsicológica evaluadora de la atención sostenida, dividida y selectiva. Se realizo un ANOVA no paramétrico U Mann Whitney para conocer la existencia de diferencias significativas entre las variables en estudio. No se demostró una asociación estadísticamente significativa entre las variables analizadas. El 90.9 % de los pacientes mostraron alteraciones de la atención selectiva y dividida la mayor parte de ellos tenía descargas epileptiformes interictales sobre regiones temporales izquierdas. El 41.66 % de los niños tenían afectada la atención sostenida. La presencia de descargas epileptiformes interictales en regiones temporales izquierdas parece relacionarse con una mayor afectación de la esfera atencional fundamentalmente la atención dividida y selectiva no pudiendo descartarse alteraciones de otros procesos cognitivos.
Attention disorders are highly prevalent among epileptic children, arising many questions regarding its physiopathology. To characterize attention disorders in children, we chose 12 children with partial complex crisis to perform an EEG and a neuro psychological evaluation of the sustained, divided and selective attention. A U Mann Whitney non parametric ANOVA was performed to recognize the differences between the variables. There was not significance among the studied variables. A 90, 9% of them had divided and selective attention deficits most of them had interictal epileptiform discharges in the left temporal lobe. A 41,66% of children had sustained attention affectation. The presence of interictal epileptiform discharges in left temporal lobe appears to be greatly linked to attention deficits, mostly in divided and selective attention, not probable to rule out other forms of cognitive behaviour disorders.
Résumé
Objective To study the effectiveness of EEG bio-feedback in ameliorating the attention of children with attention deficit/hyperactivity disorder (ADHD) compared to a control group receiving methylphenidate treatment; and to explore the effectiveness of EEG bio-feedback in treating ADHD children refractory to methylphenidate. Methods Forty-four ADHD children were randomly assigned to an EEG bio-feedback group or a methylphenidate group. An additional twenty ADHD children refractory to methylphenidate were referred to as EEG bio-feedback group B. The two EEG bio-feedback groups received training in enhancing their beta activity and suppressing their theta activity. The methylphenidate group were treated with methylphenidate for 3 months. The subjects′ attention stability was measured using a number cancellation test. Their attention allocation and attention shift were tested using a neuropsychological behavioral test instrument, including trail-making test. All groups received re-tests during treatment, post-treatment and during a 6 month follow-up. Results During treatment, the cancellation speed of children in the EEG bio-feedback group A was slower than that of children in the MPH group. At the end of the treatment, there were no significant differences in speed between the two groups. Six months to one year after treatment the cancellation speed of the EEG bio-feedback group A was significantly faster than that of the MPH group. The EEG bio-feedback group B demonstrated significant increases in their cancellation speeds after 20 treatments and during a 1 year follow-up. During treatment and post-treatment, Q scores were significantly lower in EEG bio-feedback group A than in the methylphenidate group. Six months to one year after treatment the Q scores were significantly higher in EEG bio-feedback group A than in the methylphenidate group. There was no significant increase in the Q scores in EEG bio-feedback group B during treatment, but they increased significantly post-treatment. There was no significant difference in the trail-making time between EEG bio-feedback group A and the methylphenidate group during the treatment. Six months to one year after treatment, the trailmaking times in EEG bio-feedback group A were significantly less than in the MPH group. EEG bio-feedback group B showed significant decreases in trailmaking time post-treatment and during follow-up. Conclusions EEG bio-feedback may produce significant and long-term improvements in attention stability, attention allocation and attention shift. EEG bio-feedback may be useful for children with ADHD when methylphenidate is ineffective.
Résumé
Attention appears to be inheritable, stable and influenced by genetic factors. The use of the Continuous Performance Test (CPT), as an endophenotypic measure, is valuable for genetic studies because it may show increased sensitivity to specific dimensions in attention deficit hyperactivity disorder. However, few studies have been designed to examine the influence of the genotype on attention level measured by CPT in ADHD patients. This study examinee the difference between 10/10 and 10/* genotype in the attention deficits measured by the CPT in ADHD patients. Forty-four unrelated ADHD patients were recruited from the psychiatric outpatients' clinic at Kangbuk Samsung Hospital. Two child psychiatrists made the diagnoses of ADHD using the DSM-IV diagnostic criteria. The genomic DNA was extracted from the blood, and analyzed to determine the genotype. A 40-base pair variable number of tandem repeats (VNTR) polymorphism in the 3' untranslated region was amplified. The attention deficits were measured by the test of variables of attention (T.O.V.A.). Between the 10/10 genotype and 10/* genotype, standard scores of the T.O.V.A were compared using a Mann-Whiney test. A comparison with the 10/10 genotype and 10/* genotype showed that those patients with the 10/10 genotype made less omission errors in the first quarter of the test (p < 0.05, by Mann-Whiney test). No significant differences were observed in the errors of commission, response time, variability. This study found that the 10/10 genotype made less omission errors on the T.O.V.A. This suggests that the dopamine transporter genotype influences the attention deficits measured by T.O.V.A.