Sílvio Roberto Sousa-Pereira

Brazilian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)

OBJECTIVE The purpose of this research was to evaluate the Brazilian-Portuguese version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and to assess its psychometric properties. METHODS This study involved 98 outpatients who underwent psychopathological evaluation with the Mini International Neuropsychiatric Interview-Plus Version, Hamilton Depression Scale (HAM-D), and a Portuguese version of the NDDI-E. RESULTS The NDDI-E was easily understood and quickly administered to most of the patients. At a cutoff score >15, NDDI-E had a sensitivity of 81.5%, a specificity of 83.1%, and a negative predictive value of 92.2% for diagnosis of major depression. Internal consistency reliability of the NDDI-E was 0.79, and there was also a positive correlation between the NDDI-E and the HAM-D (P<0.001). CONCLUSION The Brazilian-Portuguese version of NDDI-E can be used as a practical screening tool to improve recognition of depression in Brazilian people with epilepsy.

Psychiatric disorders in temporal lobe epilepsy: An overview from a tertiary service in Brazil

PURPOSE To evaluate the frequency and intensity of psychiatric disorders in a group of temporal lobe epilepsy (TLE) patients from a tertiary-care center. METHODS Clinical and sociodemographic data of 73 patients were collected and a neuropsychiatric evaluation was performed with the following instruments: Mini-Mental State Examination (MMSE), structured clinical interview (MINI-PLUS), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS). RESULTS Patients with TLE showed a high frequency of lifetime psychiatric disorders (70%), the most frequent being mood disorders (49.3%). At assessment, 27.4% of the patients were depressed and 9.6% met criteria for bipolar disorder. Nevertheless, depression had not been properly diagnosed nor treated. Anxiety disorders were also frequent (42.5%), mainly generalized anxiety disorder (GAD) (21.9%). Obsessive compulsive disorder (OCD) was present in 11.0% and psychotic disorders in 5.5% of the sample. Patients with left mesial temporal sclerosis (LMTS) exhibited more psychopathologic features, mainly anxiety disorders (p=0.006), and scored higher on HAM-A and HAM-D (p<0.05 in both). CONCLUSION TLE is related to a high frequency of psychiatric disorders, such as anxiety and depression, which are usually underdiagnosed and undertreated. Damage to the left mesial temporal lobe, seen in LMTS, seems to be an important pathogenic lesion linked to a broad range of psychopathological features in TLE, mainly anxiety disorders. The present study prompts discussion on the recognition of the common psychiatric disorders in TLE, especially on the Brazilian setting.

Morbidity of schistosomiasis mansoni in the state of Minas Gerais, Brazil

From 2002 to 2005, a program of active search for patients with hepatosplenic schistosomiasis and schistosomal myeloradiculopathy has been implemented in the state of Minas Gerais by the local Health Department. The state was divided in 28 regional health centers and the local representatives have been trained to identify and direct patients with hepatosplenic schistosomiasis and neuroschistosomiasis to a reference center in Belo Horizonte, the capital of the state of Minas Gerais. Seventy five patients with hepatosplenic schistosomiasis and 54 with schistosomal myeloradiculopathy have been referred and examined in the reference center in a period of time of 3 years. Schistosomal myeloradiculopathy should be emphasized because the number of cases reported is increasing rapidly and when timely diagnosed and treated, they respond promptly to treatment. Left untreated, they die or become invalid for life. In our view, the time has come for more active investigation of the different aspects of morbidity caused by schistosomiasis mansoni in Brazil.

Serum and cerebral spinal fluid levels of chemokines and Th2 cytokines in Schistosoma mansoni myeloradiculopathy

Schistosomal myeloradiculopathy (SMR) is the most common neurological form of Schistosoma mansoni infection. In this study we investigated the expression of chemokines and Th2 cytokines in serum and cerebral spinal fluid (CSF) of SMR patients. SMR patients presented increased serum levels of CCL11/eotaxin and CCL24/eotaxin‐2 when compared to controls. SMR patients also had higher levels of IL‐13 in CSF. Thus, SMR patients present enhancement of both IL‐13 and CCR3 acting chemokines, both of which may facilitate the expression of a Th2 response and Th2‐dependent damage to the spinal cord. As this cytokine is responsible for promoting Th2 responses, this finding is in accordance to the view that Th2 cells are important in the immunological process against the S. mansoni.

The role of chemokines in Schistosoma mansoni infection: insights from human disease and murine models

Chemokines are a superfamily of low-molecular-weight cytokines that were initially described for their chemoattractant activity. It is now clear chemokines have several other activities that modulate immune processes. More than 50 chemokines ligands and at least 19 receptors have been described to date. Depending on the number of N-terminal cysteine residues, chemokines are grouped in the subfamilies CXC, CC, C or CX3C. A growing body of evidence suggests a role for chemokines in the pathogenesis of several inflammatory diseases. Our studies involving mice and humans infected with Schistosoma mansoni suggest an important role of the chemokine CCL3 and its receptors (CCR1 and CCR5) in the pathogenesis of severe schistosomiasis. We suggest that the differential activation of CCR1 or CCR5 during the course of schistosomiasis may dictate the outcome of the disease.

Vestibular-Evoked Myogenic Potential (VEMP) in the Evaluation of Schistosomal Myeloradiculopathy

Schistosomal myeloradiculopathy (SMR) is the most severe and disabling form of schistosomiasis. The diagnosis is based on clinical, laboratory, and image data. Vestibular-evoked myogenic potential (VEMP) is a neurophysiologic test that assesses the vestibulospinal pathway through acoustic or galvanic stimuli. The aim of this study was to evaluate cervical spinal abnormalities in patients with SMR. Fifty-two subjects were evaluated, of whom 29 had SMR and 30 did not (normal control). Normal VEMP was observed in all volunteers without SMR. Abnormal VEMP was recorded in 34% of the group with SMR. After treatment, abnormal VEMP was found in 80% of those with persistent neurologic abnormalities. VEMP is a functional test, and the alteration may precede image abnormalities. This procedure may be useful for early diagnosis of schistosomal cervical spinal cord involvement.

Inventário de Depressão em Transtornos Neurológicos para a Epilepsia (IDTN-E): versão brasileira de um instrumento de rastreamento

INTRODUCTION: Depression is the most common psychiatric comorbidity in epilepsy, being its identification frequently neglected in most epilepsy centers. OBJECTIVE: To evaluate the performance of the Brazilian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) in a group of patients from a specialized center. METHODS: The recently validated Brazilian version of the NDDI-E was applied to a group of 142 outpatients with epilepsy. We used the MINI-Plus as a gold standard to diagnosis major depressive episode. Results: Forty patients (28.2%) were depressed at the time of evaluation. The ROC curve analysis indicated that the cutoff at 15 (>15) represented the greatest dichotomy between depressed and nondepressed (sensitivity 70.0%, specificity of 87.3%, positive predictive value of 68.3% and negative predictive value of 88.1%). The use of lower cutoff points may eventually be adopted to provide greater sensitivity to the instrument. CONCLUSION: The Brazilian version of NDDI-E is a sensitive and practical tool that can help in tracking depression in epilepsy in order to reduce its underdiagnosis.

Inventário de Depressão de Beck (BDI) e Escala de Avaliação de Depressão de Hamilton (HAM-D) em pacientes com epilepsia

OBJECTIVE: To determine cutoff points of highest sensitivity and specificity on the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D) for depression diagnosis in epilepsy. METHODS: Seventy-three patients from a referral center for the treatment of epilepsy underwent neuropsychiatric evaluation. We collected clinical and socio-demographic data, and applied the following instruments: Structured Clinical Interview (MINI-PLUS) for psychiatric diagnosis according to DSM-IV, HAM-D and BDI. RESULTS: At assessment, 27.4% of the patients were depressed and 37% met diagnostic criteria for lifetime major depression. The ROC curve analysis indicated that a score > 16 on the BDI (94.4% sensitivity, 90.6% specificity) and > 16 on the HAM-D (95% sensitivity, 75.5% specificity) revealed great dichotomy between depressed and nondepressed patients. Both instruments showed a negative predictive value exceeding 95%. CONCLUSION: The frequency of major depression is elevated in patients with epilepsy. BDI and HAM-D can help physicians in the identification of depression in epilepsy, reducing its underdiagnosis.

Schistosoma mansoni Encephalomyelitis

A 27-YEAR-OLD BRAZILian woman had a history of lumbar and lower-limb pain associated with a progressive decrease in muscle strength and paresthesias. Neurological examination findings revealed flaccid paraparesis, lack of patellar and Achilles-tendon bilateral reflexes, and urinary retention. Thoracic and lumbar spinal cord magnetic resonance imaging showed a hyperintense signal extending from T3 to T6. She was diagnosed as having an inflammatory myeloradiculopathy, and corticosteroid therapy was started with partial improvement in her condition. Five months after being discharged from hospital, she was readmitted owing to tonicoclonic seizures and visual impairment. Brain magnetic resonance imaging revealed a right parieto-occipital mass (Figure 1) and a lesion in the left cerebellar hemisphere (Figure 2). Microscopy showed multiple granulomas within which Schistosoma mansoni ova were observed (Figure 3). The patient received a combination of praziquantel (60 mg/kg, body weight, single dose) and prednisone (1 mg/kg, body weight, daily for 6 months), and her condition improved quickly. Three months later, she was seen again, and she reported no seizures. Less intense lower extremity sensory and motor deficits persisted. Her visual impairment was resolved. Ten months after treatment, new magnetic resonance imaging showed almost complete resolution of the brain lesions (Figure 4). COMMENT

Adaptação transcultural do inventário neurocomportamental (NBI) para o Brasil

OBJETIVO: Realizar a adaptacao transcultural de instrumento para avaliacao das alteracoes comportamentais tipicamente descritas em portadores de epilepsia do lobo temporal (ELT), o Inventario Neuro-Comportamental (NBI) para a populacao brasileira. METODOS: Inicialmente, foi feita a traducao do instrumento original para o portugues. Esta versao foi revisada e retrotraduzida para o ingles. A seguir, a versao retrotraduzida foi comparada a versao original em ingles, sendo corrigidas as divergencias no texto em portugues. Em um segundo momento, 15 pacientes do Ambulatorio de Epilepsia do Hospital das Clinicas da UFMG portadores de ELT responderam ao inventario. A aplicacao do questionario, eventuais dificuldades e os itens mal compreendidos foram analisados pelos autores. RESULTADOS: Na versao final para o portugues, os itens 11, 14, 17, 61 e 75 foram modificados. Sete pacientes (46,7%) eram do sexo feminino, com idade entre 26 e 65 anos. A maioria dos pacientes (93,3%) apresentou uma pontuacao total elevada. Os dominios mais comumente alterados foram hiperreligiosidade, detalhismo e crenca na predestinacao pessoal (73,3% dos pacientes em cada um deles). CONCLUSAO: A versao em portugues do NBI pode ser um instrumento util para avaliar alteracoes comportamentais na ELT aplicada ao contexto clinico dos pacientes brasileiros.