Psychiatric comorbidities in temporal lobe epilepsy: possible relationships between psychotic disorders and involvement of limbic circuits / Comorbidades psiquiátricas na epilepsia do lobo temporal: possíveis relações entre desordens psicóticas e comprometimento de circuitos límbicos

OBJECTIVE: Mounting evidence suggests that the limbic system is pathologically involved in cases of psychiatric comorbidities in temporal lobe epilepsy (TLE) patients. Our objective was to develop a conceptual framework describing how neuropathological and connectivity changes might contribute to the development of psychosis and to the potential neurobiological mechanisms that cause schizophrenia-like psychosis in TLE patients. METHODS: In this review, clinical and neuropathological findings, especially brain circuitry of the limbic system, were examined together to enhance our understanding of the association between TLE and psychosis. Finally, the importance of animal models in epilepsy and psychiatric disorders was discussed. CONCLUSIONS: TLE and psychiatric symptoms coexist more frequently than chance would predict. Damage and deregulation among critical anatomical regions, such as the hippocampus, amygdala, thalamus, and the temporal, frontal and cingulate cortices, might predispose TLE brains to psychosis. Studies of the effects of kindling and injection of neuroactive substances on behavior and electrophysiological patterns may offer a model of how limbic seizures in humans increase the vulnerability of TLE patients to psychiatric symptoms.

OBJETIVO: Existem cada vez mais evidências de que o sistema límbico está envolvido na patologia das comorbidades psiquiátricas em pacientes com epilepsia do lobo temporal (ELT). Nosso objetivo foi elaborar um desenho conceitual descrevendo como aspectos neuropatológicos e de conectividade podem contribuir para o desenvolvimento de psicose em pacientes com ELT. MÉTODOS: Nesta revisão, achados clínicos e neuropatológicos, e especialmente os aspectos da circuitaria límbica, foram examinados em conjunto para auxiliar nossa compreensão sobre a associação entre ELT e psicose. Achados em modelos animais de epilepsia e esquizofrenia também foram levados em consideração. CONCLUSÕES: ELT e comorbidades psiquiátricas coexistem com maior frequência que o predito pela associação ao acaso. Dano e desregulação entre estruturas anatômicas críticas, como hipocampo, amígdala, tálamo, e córtices temporal, frontal e cingulado podem predispor o cérebro com ELT à psicose. Estudos sobre efeitos comportamentais e eletrofisiológicos do abrasamento elétrico e injeções de substâncias neuroativas em modelos animais podem oferecer pistas sobre como crises límbicas em humanos aumentam a vulnerabilidade de pacientes com ELT a sintomas psiquiátricos.

Neuro – functional and endocrine findings in patients with post-traumatic stress disorder

The authors studied the neuro-functional findings demonstrated by SPECT in a group of 7 patients diagnosed with post traumatic stress disorder (PTSD) and their correlation with endocrinologic and clinical variables. Brain perfusion was assessed using SPECT Tc99m – ECD. The Davidson Trauma Scale (DTS) for post traumatic stress disorder and the abbreviated version of the Beck Depression Inventory (BDI) were used to corroborate clinical impressions. Endocrine measures included: T3, total T4, TSH and cortisol levels. Neuro-functional findings included abnormal radiopharmaceutical uptake in regions involved in the recovery of verbal memories and executive functions (frontal and pre-frontal cortex), and limbic system. No endocrine alterations affecting thyroid or cortisol levels were found. The broad distribution of neuro-functional abnormalities causes us to hypothesize a diffuse etiologic mechanism, possibly involving a dysfunction in the permeability of the blood-brain barrier due to an underlying inflammatory process.

Algunos datos recientes obre la Fisiopatología de los trastornos por ansiedad / Anxiety disorders, some physiopathological recent observations

Los trastornos por ansiedad afectan del 5 al 10 por ciento de la población general y tienden a incrementarse debido a los factores estresantes ambientales y a los problemas socioeconómicos actuales. Sin embargo, la fisiopatología subyacente es sólo parcialmente conocida. Los tratamientos farmacológicos utilizados en el control de la ansiedad son efectivos y del estudio de su acciones es posible obtener indicadores relativos de las alteraciones que originan el proceso ansioso. En el presente trabajo hacemos una breve revisión de las evidencias experimentales y clínicas sobre la fisiopatología de los trastornos por ansiedad y se revisan algunas de la acciones neurofarmacológicas de los compuestos ansiolíticos con énfasis en sus acciones sobre receptores sinápticos de membrana

Schrimer test in Parkinson's disease

We carried out the Schirmer test to measure objectively the amount of lacrimation among 51 clinically diagnosed parkinsonian patients (33 men and 18 women aged 50 to 79 years, mean 64) and 75 age-matched controls (42 men and 33 women aged 50 to 76, mean 62). Whatman No. 2 paper, prepared in precut strips 5mm by 35mm, was placed in the cul-de-sac for five minutes, after which the wetted length of the strip was studied. It was noted that the lacrimation amount decreased in patients with Parkinson's disease compared with controls: the average amount of lacrimation was 3.4 +/- 2.3mm in the former group and 8.1 +/- 6.5mm in the latter group (p < 0.01). We believe that the decrease in the amount of lacrimation is associated with emotional disturbance and autonomic dysfunction, and presume that the lacrimation may be under the control of the basal ganglia which has a connection with the superior salivatory nucleus downward and the limbic system upward.

Síndrome de Klüver-Bucy: importância do reconhecimento clínico no homem / Klüver-Bucy syndrome

Os autores relatam o caso de um paciente com a síndrome de Klüver-Bucy determinada por traumatismo craniencefálico, levando à atrofia do hemisfério cerebral esquerdo. Controle parcial das manifestaçöes foi obtido com o emprego de haloperidol. Na discussäo a seguir, é enfatizada a necessidade do diagnóstico clínico das formas incompletas da apresentaçäo da síndrome no homem. Dada as irredutíveis diferenças entre os aspectos estruturais, simbólicos e comportamentais dos cérebros do Homo sapiens e do Macacus rhesus, procuramos chamar a atençäo para as peculiaridades clínicas do modelo humano

Sistema límbico y epilepsia / Limbic system and epilepsy

Se revisa la clasificación de las epilepsias del lóbulo temporal y las de origen extratemporal, ubicando la epilepsia límbica en sus dos formas: cingular y mesiobasal; con sus respectivas características semioclínicas y bioeléctricas. Se presentan 7 casos, seis de epilepsia mesiolímbica y un caso de epilepsia cingular, con edades entre 2 y 28 años, vistos en un período de 3 años y con seguimiento entre 6 meses y 2 años. Se analiza la sintomatología, los estudios neurofisiológicos y la fisiopatología. Llama la atención la variedad de síntomas con contenido psíquico. Se comparan estos datos con los encontrados en la literatura.