Cognitive outcome of pediatric epilepsy surgery across ages and different types of surgeries: A monocentric 1-year follow-up study in 306 patients of school age.

OBJECTIVE: The neuropsychological outcome of pediatric epilepsy surgery has been reported before, but only few studies compared different major types of surgery in differentially located epilepsies. METHODS: Neuropsychological performance of 306 children and adolescents (ages 6-17 years) were assessed before and one year after epilepsy surgery. Individual impairments, changes into and out of impairment, as well as intraindividually meaningful positive or negative changes were examined. Regression analyses addressed the effects of site, side, pathology, type of surgery, seizure outcome, and drug change on the cognitive and behavioral domains. RESULTS: Preoperatively 85% of the patients had cognitive impairments in at least one domain, 71% had behavioral problems. Postoperatively the number of impaired patients dropped considerably: 21-50% of the patients changed from impaired to unimpaired, individually significant gains were registered in 16-42%. Seizure freedom was achieved in 81% of all patients. The number of antiepileptic drugs decreased significantly. Seizure freedom, a younger age at evaluation, a later age at onset, a lower antiepileptic drug load, and less baseline damage predict better cognitive and behavioral outcomes. Gender, pathology, localization, and lateralization had little or no impact. CONCLUSION: Differentially located and lateralized epilepsies hardly differed in cognition and behavior indicating nonspecific developmental rather than domain specific impairments. Childhood epilepsy surgery is very successful and the functional improvements one year after surgery confirm the general relevance of baseline damage, mental reserve capacities, functional plasticity, the preservation of functional tissues and the functional release due to seizure freedom and drug load reduction.

Implantation of undifferentiated and pre-differentiated human neural stem cells in the R6/2 transgenic mouse model of Huntington's disease.

BACKGROUND: Cell therapy is a potential therapeutic approach for several neurodegenetative disease, including Huntington Disease (HD). To evaluate the putative efficacy of cell therapy in HD, most studies have used excitotoxic animal models with only a few studies having been conducted in genetic animal models. Genetically modified animals should provide a more accurate representation of human HD, as they emulate the genetic basis of its etiology. RESULTS: In this study, we aimed to assess the therapeutic potential of a human striatal neural stem cell line (STROC05) implanted in the R6/2 transgenic mouse model of HD. As DARPP-32 GABAergic output neurons are predominately lost in HD, STROC05 cells were also pre-differentiated using purmorphamine, a hedgehog agonist, to yield a greater number of DARPP-32 cells. A bilateral injection of 4.5x105 cells of either undifferentiated or pre-differentiated DARPP-32 cells, however, did not affect outcome compared to a vehicle control injection. Both survival and neuronal differentiation remained poor with a mean of only 161 and 81 cells surviving in the undifferentiated and differentiated conditions respectively. Only a few cells expressed the neuronal marker Fox3. CONCLUSIONS: Although the rapid brain atrophy and short life-span of the R6/2 model constitute adverse conditions to detect potentially delayed treatment effects, significant technical hurdles, such as poor cell survival and differentiation, were also sub-optimal. Further consideration of these aspects is therefore needed in more enduring transgenic HD models to provide a definite assessment of this cell line's therapeutic relevance. However, a combination of treatments is likely needed to affect outcome in transgenic models of HD.

Avaliação do estresse psíquico em pacientes submetidos a operações de grande porte sob anestesia geral / Assessment of psychic stress in patients submitted to big surgical procedures under general anaesthesia

INTRODUÇÃO: Estudo realizado em clínicas cirúrgicas de dois hospitais de Belo Horizonte com 100 pacientes adultos de ambos os sexos, distribuídos em dois grupos: Grupo 1 - 22 pacientes sem experiência com cirurgia; Grupo 2 - 78 pacientes submetidos previamente a outras operações de médio e grande porte. OBJETIVO: Avaliar o impacto do estresse psíquico em pacientes submetidos a operações de grande porte sob anestesia geral, relacionando suas reações físicas e psíquicas com as diferentes fases do estresse. MÉTODO: Para investigação do estresse, utilizou-se o Inventário de Sintomas de Stress para Adultos, desenvolvido por Lipp, um dia antes e dois dias e sete dias após a operação. A comparação dos grupos quanto às variáveis "sexo", "dor" e "percentual de estresse" foi realizada pelo teste do qui ao quadrado e para a variável idade foi utilizado o teste t de Student. As diferenças foram consideradas significativas para p < 0,05. RESULTADOS: Os grupos não foram homogêneos quanto ao percentual geral de estresse nas três mensurações. O Grupo 1 diminuiu e o Grupo 2 aumentou o estresse no pós-operatório. Prevaleceram sintomas psíquicos do estresse em ambos os grupos. CONCLUSÃO: O fato de ter sido operado previamente reduziu a tensão pré-operatória, porém não interferiu nos distúrbios emocionais pós-operatórios.

INTRODUCTION: One hundred adult patients hospitalized in the surgical wards of two hospitals of Belo Horizonte city, Brazil, were separated into two groups: group 1, 22 patients who had no previous experience with surgeries; and group 2, 78 patients who had been previously submitted to major surgical procedures. OBJECTIVE: To evaluate the impact of psychical stress on patients submitted to major operations under general anesthesia and to correlate physical and psychological reactions to different stages of stress. METHOD: The Stress Symptoms Inventory for Adults was used one day before and two and seven days after the operation. The groups were compared with regard to sex, level of pain and stress percentage with the chi-square test and for age with the Student t test. The level of significance was set at p < 0.05. RESULTS: The groups were not homogeneous regarding the general percentage of stress on the occasion of the three measurements. The level of stress was decreased in Group 1 and increased in Group 2. Psychic stress symptoms prevailed in both groups. CONCLUSION: Previous experience with surgery under general anesthesia reduces preoperative stress, but does not affect postoperative stress.

Chronic high frequency stimulation of the posteromedial hypothalamus in facial pain syndromes and behaviour disorders.

Chronic high frequency stimulation (HFS) of the posteromedial hypothalamus (PMH) has been the first direct therapeutic application of functional neuroimaging data in a restorative reversible procedure for the treatment of an otherwise refractory neurological condition; in fact, the target coordinates for the stereotactic implantation of the electrodes have been provided by positron emission tomography (PET) studies, which were performed during cluster headache attacks. HFS of PMH produced a significant and marked reduction of pain attacks in patients with chronic cluster headache (CCH) and in one patient with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). The episodes of violent behaviour and psychomotor agitation during the attacks of CCH supported the idea that the posteromedial hypothalamus could be also involved in the control of aggressiveness; this has been previously suggested, in the seventies, by the results obtained in Sano's hypothalamotomies for the treatment of abnormal aggression and disruptive behaviour. On the basis of these considerations, we have performed HFS of the PMH and controlled successfully violent and disruptive behaviour in patients refractory to the conventional sedative drugs. Finally, we also tested the same procedure in three patients with refractory atypical facial pain, but unfortunately, they did not respond to this treatment.

Egas Moniz and the origins of psychosurgery: a review commemorating the 50th anniversary of Moniz's Nobel Prize.

Modern psychosurgery began in 1936 with the work of the Portuguese neurologist, Egas Moniz, who attempted to treat the symptoms of mental illness by severing neural tracts in the frontal lobes. This procedure eventually became widespread and applied to thousands of institutionalized, psychotic patients in the United States and other countries. Despite serious side effects associated with psychosurgery, the apparent importance and validity of the treatment was recognized in 1949 when Moniz received the Nobel Prize for his innovation. Psychosurgery was largely replaced by anti-psychotic drugs in the mid-1950s, and the procedure and its practitioners rapidly fell into disrepute. This article reviews Moniz's career, the factors that led up to his first clinical trials of frontal lobe surgery, and the circumstances that allowed psychosurgery to flourish in the 1940s, eventually leading to Moniz's Nobel Prize.