Mauro Muszkat

Exercise impact on sustained attention of ADHD children, methylphenidate effects

Attention deficit hyperactivity disorder (ADHD) is related to a deficiency of central catecholamines (CA) in cognitive, biochemical, and physical tests, and pharmaceutical intervention may have no effect if it is not accompanied by changes in the environment. The objective of our study was to test the hypothesis that central CA are responsible for the increase in speed reaction seen after physical activity (PA) and to measure the impact of high intensity PA on the sustained attention of 25 children diagnosed with ADHD consistent with the Disease Statistical Mental-IV (DSM-IV) criteria. It is possible that practicing sports assists in the management of the disorder. The children were divided between users (US) and non-users (NUS) of methylphenidate (MTP), and the groups were compared to evaluate the effect of the drug on cognition after PA. Post-exercise performance on Conner’s Continuous Performance Test-II (CPT) was not affected by MTP, we observed significant improvements in response time, and we saw normalization in the impulsivity and vigilance measures. These results suggest that the improvements in cognition after physical effort are not CA dependent. Additionally, our results suggest that children’s attention deficits can be minimized through PA irrespective of treatment with MTP. Additional studies are necessary to confirm that exercise mitigates the harmful symptoms of ADHD.

Versão abreviada do WISC-III: correlação entre QI estimado e QI total em crianças brasileiras

In order to calculate the correlation between the Estimated IQ and the Full Scale IQ of children submitted to the WISC III, four different data banks with a total of 207 children were integrated: (1) typically developing children, (2) children diagnosed as having Attention Deficit/ Hyperactivity Disorder, (3) children identified by private clinics as having learning disabilities (4) children with neurological sequelae diagnosed by a public university outpatient treatment program. Results suggest that the Estimated IQ, which is based on the weighted sum of the subtest scores of Cubes and Vocabulary, may be used in the presence of time constraints, when intellectual performance is important for screening in research procedures, and as a reference within a broader neuropsychological evaluation.

Attention Deficit Hyperactivity Disorder in the Light of the Epigenetic Paradigm

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder characterized by a definite behavioral pattern that might lead to performance problems in the social, educational, or work environments. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of ADHD were restricted to those associated with cognitive (attention deficit) and behavioral (hyperactivity/impulsivity) deficits, while deficient emotional self-regulation, a relevant source of morbidity, was left out. The etiology of it is complex, as its exact causes have not yet been fully elucidated. ADHD seems to arise from a combination of various genetic and environmental factors that alter the developing brain, resulting in structural and functional abnormalities. The aim of this paper was to review epigenetics and ADHD focused on how multidimensional mechanisms influence the behavioral phenotype.

Clinical and neuropsychological profile in a sample of children with attention deficit hyperactivity disorders

UNLABELLED The aim of this study was to evaluate clinical and neuropsychological findings in children with suspicion of attention deficity hyperactivity disorder (ADHD). The assessment involved 150 children aged 7 to 14 referred to NANI at UNIFESP. RESULTS 75 children (55 M and 20 F) fulfilled the criteria for ADHD, among which 35 were of the inattentive type, 28 of combined type and 12 were hyperactive/impulsive. There was negative correlation between the digit score and the Corsi test. Children with hyperactivity and impulsivity had a low performance for functional memory. Children with oppositional defiant disorder presented pattern changes in adaptability when there was a change in the rhythm the stimuli were presented and lower adaptation to time variability (Hit RT), in addition to higher rates of omission in the continuous performance test. CONCLUSION This study suggests multiple interrelations between the scores of neuropsychological battery useful for detailed delimitation of the clinical profile of children with ADHD.

Calcificaçäo intracraniana occipital bilateral, epilepsia e doença celíaca: relato de caso

We report a case of a six-year-old girl with frequent diarrhea episodes associated with ferroprive anemia from 6 months of age, normal neuromotor development and partial seizures initiated in her 3rd year which was controlled with carbamazepine. CT scan in her 5th year of age demonstrated gyral calcifications in the occipital and posterior parietal regions bilaterally. MRI has shown low signal areas in the axial T2 sequences corresponding to the gyral calcifications evident on the CT. Blood investigation for coeliac disease with antigliadin, endomysial and transglutaminase antibodies was positive and the intestinal biopsy has showed villous atrophy associated with an increased number of intraepithelial lymphocytes and hypertrophic criptae compatible with coeliac disease.

The response to stress in Brazilian children and adolescents with attention deficit hyperactivity disorder

This study assessed the function of the hypothalamic-pituitary-adrenal (HPA) axis, during response to stress, through the measurement of salivary cortisol in 38 children with attention deficit hyperactivity disorder (ADHD) and its subtypes, who were matched to 38 healthy control subjects. These measures were made at four time intervals: 15 min before exposing the subjects to a stressor - the Continuous Performance Test (CPT) - and 20, 40, and 60 min after such exposure. The baseline cortisol levels were statistically similar in both groups. The mean values of cortisol at the four time intervals were not statistically different between the three subtypes of ADHD (inattentive, hyperactive-impulsive and combined); thus, the ADHD group was treated as a single group. Following the stressor test, the ADHD group had significantly higher levels of salivary cortisol than the control group at time intervals of 20 and 40 min, whereas in this latter group exposure to the CPT did not induce an increase of cortisol. These results suggest that the increased cortisol levels in the ADHD group could be due to the lack of comorbidities. In addition, these patients, when facing a computerized test, might have responded with a motivational pathway with an increase of cortisol.

Is hospitalization really necessary during the introduction of the ketogenic diet

The ketogenic diet is traditionally introduced with an initial period of fasting. This study compares the efficacy and tolerability of the introduction of a prediet (2:1 ratio of fat:protein + carbohydrates) before hospitalization with the aim at reducing the time of same and the period of fasting necessary to reach ketosis. For a minimum period of 1 year, adverse effects, metabolic profile, and linear growth were prospectively evaluated in 46 children. Twenty-three children received a prediet for a period of 10 days, and in the other 23 children, the ketogenic diet was introduced by hospitalization regimen after a fasting period. The use of the prediet led to a shorter fasting period of a mean 18.3 hours compared with the group without prediet, in which the fasting period was 41.3 hours (P = .001). At the end, there was no difference in the adverse effects between the groups. In those submitted to the prediet, a better adaptation to the diet and acceptance to the proposal of introducing the ketogenic diet were observed.

LATERALIZACAO DAS FUNCOES MUSICAIS NA EPILEPSIA PARCIAL

Fourteen right handed patients with partial epilepsy (Epileptic Group) and with a median age of 31 years were divided into two groups (Right and Left), according the laterality of paroxystic activity in the eletroencaphalogram. Of the 14 patients, 42.8% (6/14) presented a focus at the right side while the others 57.2% (8/14) presented a focus at the left. The Control Group consisted of 31 right handed individuals with a median age of 30 years and with no previous history of neurological disease or epileptic seizures. All the individuals had no musical skills. They carried out Music Abilities Tests including Spontaneous Rhythm, Elemental Music Functions Perception (tone color, duration, pitch, intensity and rhythm) and Complex Strutures Tests (recognition and reproduction of corporal rhythmic movements). We concluded that the focus at the right and the left cerebral hemisphere affect the development of the melodic recognition functions while in cases with focus at the left cerebral hemisphere, rhythmic reproduction and organization are more impaired when compared to the Control Group.Fourteen right handed patients with partial epilepsy (Epileptic Group) and with a median age of 31 years were divided into two groups (Right and Left), according the laterality of paroxystic activity in the electroencaphalogram. Of the 14 patients, 42.8% (6/14) presented a focus at the right side while the others 57.2% (8/14) presented a focus at the left. The Control Group consisted of 31 right handed individuals with a median age of 30 years and with no previous history of neurological disease or epileptic seizures. All the individuals had no musical skills. They carried out Music Abilities Tests including Spontaneous Rhythm, Elemental Music Functions Perception (tone color, duration, pitch, intensity and rhythm) and Complex Strutures Tests (recognition and reproduction of corporal rhythmic movements). We concluded that the focus at the right and the left cerebral hemisphere affect the development of the melodic recognition functions while in cases with focus at the left cerebral hemisphere, rhythmic reproduction and organization are more impaired when compared to the Control Group.

Attentional Profiles and White Matter Correlates in Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type

Attention-deficit/hyperactivity disorder (ADHD) is a widely studied neurodevelopmental disorder. It is a highly heterogeneous condition, encompassing different types of expression. The predominantly inattentive type is the most prevalent and the most stable over the lifetime, yet it is the least-studied presentation. To increase understanding of its cognitive profile, 29 children with attention-deficit/hyperactivity disorder of predominantly inattentive type (ADHD-I) and 29 matched controls, aged 7–15 years, had their attentional abilities assessed through the Conners’ continuous performance test. Diffusion tensor imaging data were collected for all of the participants using a 3.0-T MRI system. Fractional anisotropy (FA) values were obtained for 20 fiber tracts, and brain-behavior correlations were calculated for 42 of the children. The ADHD-I children differed significantly from the typically developing (TD) children with respect to attentional measures, such as the ability to maintain response-time consistency throughout the task (Hit RT SE and Variability), vigilance (Hit RT ISI and Hit RT ISI SE), processing speed (Hit RT), selective attention (Omissions), sustained attention (Hit RT Block Change), error profile (Response Style), and inhibitory control (Perseverations). Evidence of significant differences between the ADHD-I and the TD participants was not found with respect to the mean FA values in the fiber tracts analyzed. Moderate and strong correlations between performance on the attention indicators and the tract-average FA values were found for the ADHD-I group. Our results contribute to a better characterization of the attentional profile of ADHD-I individuals and suggest that in children and adolescents with ADHD-I, attentional performance is mainly associated with the white matter structure of the long associative fibers that connect anterior–posterior brain areas.

Kleine-Levin syndrome: interface between neurology and psychiatry

We report the first episode of Kleine-Levin (KLS) syndrome in a 17-year-old male. The illness onset, clinical features, neuropsychological evaluation and polysomnographic recording are described. Typical symptoms hypersomnia, hyperphagia and sexual disinhibition were observed besides behavioral disturbances, polysomnographic and neuropsychological alterations. Behavioral disturbances similar to a manic episode including psychotic symptoms were relevant. The pharmacologic treatment included lithium, methylphenidate and risperidone. The introduction of risperidone aimed the control of psychotic symptoms and the persistent manifestations of hypersexuality after sleepiness control and to the best of our knowledge there are no other reports regarding risperidone use for KLS in the literature.