Evaluation of deep gray matter volume, cortical thickness and white matter integrity in patients with typical absence epilepsy: a study using voxelwise-based techniques.

INTRODUCTION: The objective of this study was to evaluate the cortical thickness and the volume of deep gray matter structures, measured from 3D T1-weighted gradient echo imaging, and white matter integrity, by diffusion tensor imaging (DTI) in patients with typical absence epilepsy (AE). METHODS: Patients (n = 19) with typical childhood AE and juvenile AE, currently taking antiepileptic medication, were compared with control subjects (n = 19), matched for gender and age. 3D T1 magnetization-prepared rapid gradient echo-weighted imaging and DTI along 30 noncolinear directions were performed using a 1.5-T MR scanner. FreeSurfer was used to perform cortical volumetric reconstruction and segmentation of deep gray matter structures. For tract-based spatial statistics analysis of DTI, a white matter skeleton was created, along with a permutation-based inference with 5000 permutations. A threshold of p < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The mean, radial, and axial diffusivities were also projected onto the mean FA skeleton. RESULTS: Patients with AE presented decreased FA and increased mean diffusivity and radial diffusivity values in the genu and the body of the corpus callosum and right anterior corona radiata, as well as decreased axial diffusivity in the left posterior thalamic radiation, inferior cerebellar peduncle, right cerebral peduncle, and right corticospinal tract. However, there were no significant differences in cortical thickness or deep gray matter structure volumes between patients with AE and controls. CONCLUSION: Abnormalities found in white matter integrity may help to better understand the pathophysiology of AE and optimize diagnosis and treatment strategies.

The Brazilian database on pregnancy in multiple sclerosis.

OBJECTIVES: To report the results from the Brazilian database on multiple sclerosis (MS) and pregnancy. METHODS: Retrospective data from MS patients who became pregnant at any time of their disease were sent to a Brazilian database, using a specific file for this purpose. RESULTS: Data on 128 women (142 pregnancies) from 30 neurologists working in 21 cities in Brazil were collected. Patients' average age at pregnancy was 29.8 years (range 16-42). EDSS at start of pregnancy was 1.5±1.4; and the relapse rate in the year preceding pregnancy was 1.2±1.5. Exposure to medication at any time during pregnancy was high (69.7%): 48.6% to interferon beta; 14.1% to glatiramer acetate; and 7% to other immunomodulatory and immunosuppressive drugs. There was a significant decrease in relapse rate during pregnancy. The prevalence of complications was relatively low, with 4.9% of obstetric and 1.4% neonatal unfavorable outcomes. CONCLUSIONS: Our patients had low degrees of disability, short histories of disease, high drug exposure, and relatively high relapse rate in the year previous to pregnancy. Obstetric and neonatal outcomes were successful in over 90% of our patients.

Ethnicity-dependent association of HLA DRB1-DQA1-DQB1 alleles in Brazilian multiple sclerosis patients.

OBJECTIVE: The present study focused on human leukocyte antigen (HLA) DQB1, DQA1 and DRB1 allelic variation according to ethnicity and analyzed whether susceptibility to multiple sclerosis (MS) depends on population characteristics. METHODS: Eighty-eight healthy African-Brazilians and 92 healthy white Brazilians living in Rio de Janeiro City were selected and the HLA phenotype between the two ethnic groups was compared with 44 MS patients of African descent and 40 patients of European descent. HLA class II genes were performed using polymerase chain reaction (PCR) and PCR-sequence-specific primer amplification. RESULTS: DQA1*0201-0301 alleles were associated with the white Brazilian population (P < 0.001). The DRB*1501 allele was present in White Brazilians (P=0.003), and DRB1*03-1503 in African-Brazilians. The DRB1*1501 allele confers an ethnicity-dependent MS susceptibility in White patients and the DQB1*0602 allele confers genetic susceptibility regardless of ethnicity. CONCLUSION: Heterogeneous phenotypes occur in both Brazilian ethnic groups. Taking into account that the response to immunomodulator drugs for MS treatment changes according to the DRB1*1501 allele and African-American MS patients presented poor response to the interferons, phenotype heterogeneity of HLA loci found in this study could influence therapeutic decisions in the Brazilian MS population.

Monitorización prolongada por videoelectroencefalografía de pacientes con diagnóstico ambulatorio de epilepsia del lóbulo temporal de difícil control: aplicación del modelo de lógica fuzzy / Video-electroencephalography prolonged monitoring in patients with ambulatory diagnosis of medically refractory temporal lobe epilepsy: application of fuzzy logic’s model

Introducción. La monitorización prolongada por videoelectroencefalografía(vídeo-EEG) constituye un instrumento importantede auxilio al diagnóstico de epilepsia; facilita informacionesvaliosas con relación a la clasificación de los tipos de crisis ysíndromes epilépticos y la localización de la zona epileptógena. Lalógica fuzzy provee un método de análisis eficaz e inteligente,capaz de realizar inferencias sobre sistemas ambiguos y cada vezse utiliza más en diferentes áreas. Objetivos. Correlacionar datosclínicos y electroencefalográficos obtenidos por la monitorizaciónprolongada por vídeo-EEG de pacientes con diagnóstico en elambulatorio de epilepsia del lobo temporal (ELT) de difícil controle inferir los grados de precisión del diagnóstico por la aplicacióndel modelo COPPE/Cosenza de jerarquía fuzzy; investigar conqué frecuencia la monitorización puede corroborar o modificar eldiagnóstico clínico, sindrómico y topográfico de los pacientes estudiados;evaluar la utilidad y aplicabilidad de la lógica fuzzy en elanálisis de ese tipo de estudio. Pacientes y métodos. Estudio prospectivo,transversal, que incluye a 22 pacientes adultos con diagnósticoen el ambulatorio de ELT de difícil control, sometidos amonitorización por vídeo-EEG. Resultados. El diagnóstico clínicose modificó en dos pacientes (9%), el sindrómico en seis (27,2%), yel topográfico en 16 (72,7%). Los indicadores fuzzy de precisióndel diagnóstico en el ambulatorio fueron: 0,91 para diagnósticoclínico, 0,74 para diagnóstico sindrómico y 0,36 para diagnósticotopográfico; se considera 1 el valor de máxima precisión dediagnóstico (se atribuye a los resultados de la monitorización porvídeo-EEG). Conclusiones. La monitorización prolongada por vídeo-EEG estableció el diagnóstico clínico, sindrómico y topográficoen esos pacientes; la lógica fuzzy mostró definir mejor un valormatemático de la correspondencia entre el diagnóstico en el ambulatoriode ELT y la monitorización prolongada por vídeo-EEG

Introduction. The video-electroencephalography (video-EEG) prolonged monitoring is an important auxiliarydiagnostic instrument in epilepsy, and provides valuable information to classify the type of crisis and epileptic syndromes andto localize the epileptogenic zone. The fuzzy logic gives an efficient and intelligent analysis method, able to make inferencesover ambiguous systems, and has been increasing used in several areas. Aims. To correlate clinical and electroencephalographicdata obtained with video-EEG of patients with clinical and interictal electroencephalography criteria ofmedically refractory temporal lobe epilepsy (TLE) and to make inferences of diagnosis precision with the application of theFuzzy Hierarchy COPPE/Cosenza Model; to investigate the frequency in which the clinical, syndromic and topographicdiagnosis can be modified in these patients; to evaluate the usefulness and applicability of fuzzy logic on the analysis of thistype of study. Patients and methods. Transversal, prospective study, that included 22 adult outpatients with ambulatorydiagnosis of medically refractory TLE, submitted to video-EEG monitoring that varied from 48 hours to 10 days. The grade ofdiagnosis precision was infered by fuzzy logic. Results. The clinical diagnosis of epilepsy was modified in two (9%) patients,the syndromic in six (27.2%) and the topographic in 16 (72.7%). The fuzzy indicators of ambulatory diagnostic precisionwere: 0.91 to clinical diagnosis; 0.74 to syndromic diagnosis and 0.36 to topographic diagnosis, considering 1 the maximalprecision diagnostic value (attributed to the video-EEG results). Conclusions. The video-EEG prolonged monitoring establishedthe clinical, syndromic and topographic correct diagnosis in these patients; the fuzzy logic best defined a mathematical valueof the correspondence between ambulatorial diagnosis of TLE and the video-EEG prolonged monitoring

[Video-electroencephalography prolonged monitoring in patients with ambulatory diagnosis of medically refractory temporal lobe epilepsy: application of fuzzy logic's model]. / Monitorización prolongada por videoelectroencefalografía de pacientes con diagnóstico ambulatorio de epilepsia del lóbulo temporal de difícil control: aplicación del modelo de lógica fuzzy

INTRODUCTION: The video-electroencephalography (video-EEG) prolonged monitoring is an important auxiliary diagnostic instrument in epilepsy, and provides valuable information to classify the type of crisis and epileptic syndromes and to localize the epileptogenic zone. The fuzzy logic gives an efficient and intelligent analysis method, able to make inferences over ambiguous systems, and has been increasing used in several areas. AIMS: To correlate clinical and electroencephalographic data obtained with video-EEG of patients with clinical and interictal electroencephalography criteria of medically refractory temporal lobe epilepsy (TLE) and to make inferences of diagnosis precision with the application of the Fuzzy Hierarchy COPPE/Cosenza Model; to investigate the frequency in which the clinical, syndromic and topographic diagnosis can be modified in these patients; to evaluate the usefulness and applicability of fuzzy logic on the analysis of this type of study. PATIENTS AND METHODS: Transversal, prospective study, that included 22 adult outpatients with ambulatory diagnosis of medically refractory TLE, submitted to video-EEG monitoring that varied from 48 hours to 10 days. The grade of diagnosis precision was infered by fuzzy logic. RESULTS: The clinical diagnosis of epilepsy was modified in two (9%) patients, the syndromic in six (27.2%) and the topographic in 16 (72.7%). The fuzzy indicators of ambulatory diagnostic precision were: 0.91 to clinical diagnosis; 0.74 to syndromic diagnosis and 0.36 to topographic diagnosis, considering 1 the maximal precision diagnostic value (attributed to the video-EEG results). CONCLUSIONS: The video-EEG prolonged monitoring established the clinical, syndromic and topographic correct diagnosis in these patients; the fuzzy logic best defined a mathematical value of the correspondence between ambulatorial diagnosis of TLE and the video-EEG prolonged monitoring.

Determination of soluble ICAM-1 and TNFalphaR in the cerebrospinal fluid and serum levels in a population of Brazilian patients with relapsing-remitting multiple sclerosis.

Cytokines and adhesion molecules have been implicated in the pathogenesis of multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system. In this study we analyzed intrathecal (CSF) and serum levels of soluble intercellular adhesion molecule (ICAM-1) and TNFalphaR (60kD) from 20 patients with clinically definite MS during acute relapse or stable disease. Comparing to control groups of healthy individuals and patients with intervertebral herniated disc, MS patients showed increased levels (p< 0.001) of sICAM-1 and TNFalphaR in both serum and CSF samples. Regardless stage of disease there was no significant difference in the levels of sICAM-1 during acute relapse (657+/-124.9 ng/ml) or remission (627+/-36.2 ng/ml). A steady increase of TNFalphaR (60kD) in both serum and CSF, indicate the existence of a continuous inflammatory process within the brain tissue of MS patients despite absence of clinical signs of disease activity.