Objective: To compare the executive functions of children and adolescents with idiopathic epilepsy with a control group and to correlate with clinical data, intelligence and academic performance. Method: Cross-sectional, descriptive and analytical study. Thirty-one cases and thirty-five controls were evaluated by the WCST (Wisconsin Card Sorting Test).The results were compared with clinical data (seizure type and frequency, disease duration and number of antiepileptic drugs used), IQ (WISC-III) and academic performance (APT). Results: Patients with epilepsy had poorer executive function scores. There was no positive linear correlation between test scores and epilepsy variables. There was a positive association between academic performance and some executive function results. Conclusion: Children with well controlled idiopathic epilepsy may show deficits in executive functions in spite of clinical variables. Those deficits may influence academic performance.Keywords: epilepsy, executive function, child, adolescent. RESUMOObjetivo: Comparar as funções executivas de crianças e adolescentes com epilepsia idiopática com um grupo controle e correlacioná-las com dados clínicos, nível intelectual, desempenho acadêmico. Método: Estudo transversal, descritivo e analítico. Foram avaliados 31 casos e 35 controles através do WCST (Wisconsin Card SortingTest). Os resultados foram comparados com dados clínicos (tipo e frequência de crises, duração da doença e número de drogas antiepilépticas utilizadas), QI (WISC-III) e desempenho acadêmico (TDE). Resultados: Pacientes com epilepsia tiveram piores resultados de funções executivas. Não houve correlação linear positiva entre a pontuação nos testes e as variáveis da epilepsia. Houve associação positiva entre desempenho acadêmico e alguns resultados de função executiva. Conclusão: Crianças com epilepsia idiopática bem controlada podem apresentar déficit de função executiva não relacionado a aspectos clínicos. Isso pode influenciar o rendimento acadêmico.Palavras-chave: epilepsia, função executiva, criança, adolescente.
Epilepsy is one of the most prevalent chronic disorders of childhood which can threaten child development and mental health. Among cognitive disorders, dyscalculia is one of the most important. In this study, 39 children and adolescents with idiopathic epilepsy underwent clinical and neuropsychological assessment to determine the intellectual level, math skills, reading and writing performance and neuropsychological profile. It was observed that the mathematical ability was below schooling expectations in a higher frequency than expected. There were no significant differences in mathematical performance among groups divided by number of antiepileptic drugs used, duration of disease and types and frequency of seizures. There was a positive correlation with intelligence quotient and attentional and reading level. These results suggest the existence not only of dyscalculia, but the concurrence of attentional and reading problems for the poor mathematical performance in this population.Keywords: mathematical ability, dyscalculia, epilepsy, children, adolescents. RESUMOA epilepsia é uma das doenças crônicas mais comuns da infância que pode ameaçar o desenvolvimento infantil e saúde mental. Dos distúrbios cognitivos, a discalculia é um dos mais importantes. Neste estudo, 39 crianças e adolescentes com epilepsia idiopática, foram submetidos à avaliação clínica e neuropsicológica para determinar o nível intelectual, habilidade em matemática, leitura e escrita e perfil neuropsicológico. Observou-se que a habilidade em matemática ficou abaixo das expectativas de escolarização em uma frequência maior do que a esperada. Não houve diferenças significativas no desempenho matemático em relação ao número de drogas antiepilépticas utilizadas, duração da doença, tipo e frequência das crises. Houve uma correlação positiva com o quociente de inteligência e nível de atenção e leitura. Estes resultados sugerem a existência não só de discalculia, mas também a existência de problemas atencionais e de leitura que fatores causais para a dificuldade matemática apresentada nesta amostra.Palavras-chave: habilidade em matemática, discalculia, epilepsia, crianças, adolescentes.Epilepsy is a chronic neurologic disorder characterized by unprovoked recurrent seizures 1 . Estimation shows that around 5 and 10 million children worldwide have active epilepsy, representing about 25% of the global epilepsy population 2 . Forty percent of the people who develop epilepsy per year are younger than 15 years and more than 80% live in developing countries 2 . Population-based studies on childhood-onset epilepsy suggest an annual incidence of 61-124/ 100,000 in developing countries and 41-50/100,000 in developed countries 2 .Epilepsy is also related to behavioral, cognitive and psychiatric disorders, including autism and intellectual disability in 30% of patients 3,4 . There is a higher incidence of several cognitive disorders, in spite of normal intelligence,
Epilepsy compromises the development of cognitive and social skills and represents a risk of psychiatric comorbidity. Objective: To compare psychopathological symptoms in children with epilepsy and in a healthy group, and to correlate the results with neuropsychological and clinical variables. Method: Forty five children with idiopathic epilepsy and sixty five healthy controls underwent neuropsychological evaluation and their caregivers replied to a psychopathology questionnaire (Child Behavior Checklist -CBCL). Results: : There were significant differences in CBCL, with poorer results showed mainly by patients with epilepsy. There was no significant association between any psychopathological symptom and disease duration or amount of antiepileptic drugs used. There was positive correlation between intelligence quocient and CBCL on items such as sluggish cognitive tempo, aggressive behavior, attention problems and activities and a negative relation between academic achievement, conduct and rule-breaking behavior. Conclusion: Children with epilepsy had the worse results in the psychopathology evaluation. Certain psychopathological variables are related to the cognitive profile, with no relation to clinical variables.Keywords: epilepsy, children, adolescent, neuropsychology, psychopathology, mental health. RESUMOA epilepsia compromete o desenvolvimento de habilidades cognitivas e sociais e representa um risco para comorbidade psiquiátrica. Objetivo: Comparar sintomas psicopatológicos em crianças com epilepsia e um grupo saudável, e correlacionar os resultados com variáveis neuropsicológicas e clínicas. Método: Quarenta e cinco crianças com epilepsia idiopática e sessenta e cinco controles saudáveis foram submetidos à avaliação neuropsicológica e seus cuidadores responderam a um questionário de psicopatologia (Child Behavior Checklist -CBCL). Resultados: Houve diferenças significativas no CBCL, com piores resultados principalmente para pacientes com epilepsia. Não houve associação significativa entre os resultados e duração da doença ou número de drogas antiepilépticas. Houve relação positiva entre quociente de inteligência e CBCL em itens como tempo cognitivo lento, comportamento agressivo, problemas de atenção e atividades e uma relação negativa entre o desempenho acadêmico e conduta e comportamento de quebras de regra. Conclusão: Crianças com epilepsia apresentaram piores resultados em psicopatologia, com certas variáveis psicopatológicas relacionadas ao perfil cognitivo, mas sem relação com variáveis clínicas.Palavras-chave: epilepsia, crianças, adolescentes, neuropsicologia, psicopatologia, saúde mental.Although the most specific characteristic of epilepsy is the epileptic seizure, the condition involves mental problems, including learning disorders, compromised quality of life and psychopathology. Such problems arise from a complex sum of factors related to ethiology, therapy, seizure per se, as well as individual and social-familiar aspects.Rates of mental disorder in children and adolescents with epi...
IntroductionCognitive dysfunction is present in the prodromal phase of Huntington Disease (HD) before motor diagnosis is given. In order to obtain an evaluation of the patients' global cognitive function, complex batteries of exams are needed. For this purpose, the Mini Mental State Exam (MMSE) is the screening test most frequently used. On the other hand, the Montreal Cognitive Assessment (MoCA) is a recent screening test with higher sensitivity for mild cognitive impairment. It has bean applied for the detection of the earliest cognitive impairments in patients with HD.ObjectiveTo compare the MMSE with the MoCA in identifying cognitive deficits in prodromal and early stages of HD.MethodsThe MMSE and the MoCA were performed in 37 patients with genetic diagnosis of HD regularly evaluated in the Neurogenetic Consultation of the Coimbra's University Hospital; as well as in 40 control subjects with no neurodegenerative pathology, using age, gender and education as comparison factors in the selection criteria.ResultsBoth groups (subjects with HD and control subjects) showed no differences in the distribution of the demographic characteristics. The MMSE and MoCA's total scores showed lower values in the HD group (p=0.002 and p=0.003 respectively). Samples' description according to educational level showed differences between the two groups in the MMSE scores only, for an education lower or equal to 11 years. With the cut-offs determined to the Portuguese population, the MoCA presented a superior sensitivity to detect cognitive decline among HD patients in comparison to the MMSE (64, 9% vs 21, 6%; p<0.001). Receiver Operating Characteristics curves analysis registered significant statistic results only in the MoCA, concerning Visual-Spacial, Language and Executive Function/Attention areas (p=0.01, p=0.039 and p=0.018, respectively).ConclusionsAccording to the cut-offs established for the Portuguese population, the MoCA is a brief screening test with higher sensitivity in the detection of cognitive impairments related to Huntington's Disease, when in comparison to the MMSE, requiring tasks inherent to cerebral areas characteristically affected in this disease. Due to the fact that it evaluates certain cerebral domains, such as the Executive/Attention Function, it reveals itself more appropriate for the detection of the mild cognitive impairment in Huntington's disease patients, and should therefore be used instead of the MMSE.
Resumo:O presente artigo apresenta algumas reflexões resultantes de uma pesquisa que buscou analisar a organização do Trabalho em Rede voltado à garantia da integralidade dos direitos da criança e do adolescente, a partir da Política de Saúde, tendo como lócus o município de Curitiba-PR. A pesquisa, de natureza qualitativa, compreendeu uma revisão bibliográfica, uma pesquisa documental e, sequencialmente, uma pesquisa de campo, onde foram entrevistados treze trabalhadores do território e da gestão inseridos em serviços, órgãos e espaços que compõem o Sistema de Garantia de Direitos da Criança e do Adolescente (SGDCA) no Distrito Sanitário Bairro Novo. Como principais resultados, destaca-se que o trabalho desenvolvido pela Rede de Proteção é um avanço inegável, ainda que a falta de transversalidade, de visão de totalidade, a dificuldade de comunicação e de corresponsabilização de todos os atores envolvidos no SGDCA, assim como a falta de um ator que assuma e exerça o papel de articulador dos demais atores, faz com que esse trabalho não constitua de fato uma Rede Intersetorial. Palavras-chave:Direitos da criança e do adolescente. Rede intersetorial.Integralidade. Saúde. Abstract:The current study brings a reflection on the service network directed to the guarantee of the integrity of child and teenager's rights through health policy, having as locus Curitiba, capital of Paraná. In
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