Sylvia Maria Ciasca

Processamento auditivo e SPECT em crianças com dislexia

Dichotic listening (DL) was evaluated in 36 children with: verbal dichotic listening test, alternating dissilable dichotic test and non-verbal dichotic listening test. Children were separated into two groups: experimental group with 18 dyslexic children and control group with 18 normal children. Both groups were comparable in gender, laterality and social-economic level. All dyslexic children underwent neuroimaging exam (SPECT). Our data showed that there was a statistical difference between both groups in all DL tests. Abnormal SPECT findings were seen in 50% of the dyslexic children, hypoperfusion of the left temporal lobe being the most frequent abnormality. We conclude that dyslexic children present an impairment of central neurologic processing that may be detected by DL tests, and by functional imaging exam, such as SPECT, as well.

Fragile X syndrome: clinical, electroencephalographic and neuroimaging characteristics

We studied 11 patients (9 males) with cytogenetic diagnosis of fragile X syndrome (FXS) with the purpose of investigating the neural circuitry involved in this condition. The ages ranged from 8 to 19. All the individuals presented large ears, elongated faces and autistic features. Ten patients had severe mental retardation. Attention disorder was found in 10 individuals. Electroencephalographic recordings were abnormal in 6 of 10 patients examined, showing focal epileptiform discharges predominantly in frontal and parietal areas. All patients underwent magnetic resonance imaging studies which were abnormal in 8 of them. The most important abnormalities were reduction of the cerebellar vermis and enlargement of the IV ventricle. Single photon emission computerized tomography (SPECT) was performed in 7 patients and was abnormal in all of them, the most frequent finding being a hypoperfusion of the inferior of the frontal lobes. Based on the clinical picture, neuropsychological findings and functional and structural imaging studies we suggest that FXS presents with a dysfunction involving a large area of the central nervous system: cerebellum-basal frontal regions-parietal lobes. The literature points to a disturbance involving the same neural circuitry in patients with autism.

Desempenho de escolares bons leitores, com dislexia e com transtorno do déficit de atenção e hiperatividade em nomeação automática rápida

PURPOSE: To characterize the performance of students with attention deficit hyperactivity disorder and dyslexia in rapid automatized naming and to compare it to the performance of children whose reading ability is considered to be in accordance to age and schooling. METHODS: A number of 30 students aged 8 to 12 years old attending 2nd to 4th grades in a public school participated in this study, divided into three groups, one formed by students with attention deficit and hyperactivity disorder, another one formed by students with dyslexia, and the other formed by students with good academic performance. RESULTS: The results revealed statistically significant differences, evidencing superior performance of the control group when compared to both the group of students with attention deficit and hyperactivity and the group with dyslexia in the subtests of colors, digit span, letters and objects. The results also revealed superior performance of the group of students with attention deficit compared to the group with dyslexia in rapid automatized naming. CONCLUSION: Good readers showed better performance when compared to both students with attention deficit and hyperactivity disorder and dyslexia, showing that this ability can be a prerequisite to reading development.

Análise de erros ortográficos em diferentes problemas de aprendizagem

PURPOSE: to describe the orthographic findings in several types of learning problems, check if the types of produced mistakes are those found in the learning that is considered normal and analyze if orthographic or phonological nature problems prevail in each disorder. METHODS: the writing of 64 subjects was evaluated by the Laboratory of Learning Disabilities of the Neurology Department of UNICAMP and diagnosed as showing some type of learning problem. Deficit of Attention / Hyperactivity disorder (28); School Difficulties (13); Learning Disabilities (7); Dyslexia (3); Associated Disorders (5) and Inconclusive Diagnosis (9). The ages varied between 8;2 and 13;4 years, with a 10;6 year-old average. Only subjects in alphabetical writing level without any type of intellectual deficit were included. The found mistakes were classified in eleven categories and quantified for ends of statistical analysis. RESULTS: the spelling mistakes found in each problem type correspond to those observed in children without learning complaint. The spelling mistakes through Multiple Representations, Omission of letters and Orality, are respectively, the three most frequent types in the cases Deficit of Attention and Hyperactivity disorder, School Difficulties, Associated Disorders and Unknown Diagnosis. In the Disturbance of Learning the sequence is of Multiple Representations, Omission, Other Mistakes and Voiced/Unvoiced mistakes. In the dyslexia we note the sequence of Multiple Representations, Orality, Omission and Other Mistakes. There is a trend, in each problem type, to the prevalence of orthographic nature mistakes, although with no statistically significant difference in relation to the phonological nature mistakes. CONCLUSION: the orthographic nature mistakes are the most frequent, although, there is no significant difference, in each group, in relation to the phonological nature mistakes. With contrary trend, the visual-spatial mistakes have low occurrence in general, which shows that the difficulty concerning all groups has fundamentally a linguistic origin and not a perceptual.

Comparative study of the neuropsychological and neuroimaging evaluations in children with dyslexia

Analisamos retrospectivamente exames de neuroimagem de criancas com diagnostico de dislexia e correlacionamos os achados com avaliacao das funcoes corticais superiores. Estudamos 34 prontuarios de pacientes atendidos no Ambulatorio de Neuro-Dificuldades de Aprendizado, FCM/UNICAMP, no periodo de 1994 a 2002. Todas foram encaminhadas com queixa primaria ou secundaria de dificuldade escolar e submetidas a avaliacao neuropsicologica e exame de imagem (SPECT). Das criancas avaliadas, 58,8% apresentaram exames alterados. Dentre as alteracoes, 16 possuiam hipoperfusao no lobo temporal. Nas funcoes corticais superiores, as habilidades mais prejudicadas foram leitura, escrita e memoria. Houve significância entre as areas hipoperfundidas com a variavel escolaridade, leitura, escrita, memoria e raciocinio matematico. Os SPECTs mostraram hipoperfusao em areas envolvidas nos processos de leitura/escrita. Ambos se equivalem em termos de areas funcionais e sao semelhantes nas criancas com e sem alteracoes especificas a neuroimagem.We analyzed retrospectively the neuroimaging exams of children with a confirmed diagnosis of dyslexia and correlated our findings with the evaluation of higher cortical functions. We studied 34 medical files of patients of the Ambulatory of Neuro-difficulties in Learning, FCM/UNICAMP. All of them had been sent to the ambulatory with primary or secondary complaints of difficulties at school and were submitted to neuropsychological evaluation and imaging exam (SPECT). From the children evaluated 58.8% had exams presenting dysfunction with 47% presenting hypoperfusion in the temporal lobe. As for the higher cortical functions, the most affected abilities were reading, writing and memory. There was significance between the hypoperfused areas and the variables schooling, reading, writing, memory and mathematic reasoning. The SPECTs showed hypoperfusion in areas involved in the reading and writing processes. Both are equivalent in terms of involved functional areas and are similar in children with or without specific dysfunctions in neuroimaging.

A importância da equipe interdisciplinar no diagnóstico de dislexia do desenvolvimento: relato de caso

We describe the work of the interdisciplinary staff of FCM/UNICAMP for the diagnosis of developmental dyslexia, evaluating a 9 years old boy from the second year of a first grade public school. The procedure consisted of four stages: 1) Interview with the mother (anamnesis); 2) neuropsychological evaluation; 3) specific evaluation for reading and writing skills; 4) complementary exams. The results revealed that the child presented normal intelligence, normal auditory and visual function but difficulties in reading specific test, in auditory short-term memory (specially in auditory sequences), and in phonological conscience, as well as slowness, lack of concentration, slight neurological signs and hypoperfusion of the mesial portion of the temporal lobe. These data suggest that the child has developmental dyslexia of mixed type, requiring psychopedagogic follow-up.

Attentional performance and executive functions in children with learning difficulties

Estudos tem descrito alteracoes na atencao visual e nas funcoes executivas em criancas com Dislexia do Desenvolvimento. O presente trabalho pretendeu comparar o desempenho de criancas com e sem dificuldades de aprendizagem em tarefas de atencao visual e funcoes executivas. Participaram 23 estudantes, com idade entre 9 e 14 anos e idade media de 10,8 anos, divididos em tres grupos: com dificuldades escolares, com dislexia e controle sem dificuldades. Para a avaliacao foram usados os Testes de Cancelamento, Trail Making Test, Stroop Color Word Test e Tower of London. Os resultados indicaram que as criancas com dislexia apresentaram piores desempenhos em diferentes medidas atencionais e das funcoes executivas, indicando que tais alteracoes podem ser caracteristicas do quadro e acompanhar o deficit no componente fonologico da linguagem.Studies have described changes in visual attention and executive function in children with developmental dyslexia. This study intended to compare the performance of children with and without learning difficulties on tasks of visual attention and executive functions. The participants were 23 students, aged between 9 and 14 years old, with a mean age of 10.8 years. They were divided into three groups: (a) with learning difficulties; (b) with dyslexia; and (c) control (without any difficulty). For the evaluation, Tests of Cancellation, Trail Making Test, Stroop Color-Word Test and Tower of London Test were used. The results indicated that children with dyslexia had the worst performance on different measures of attention and executive functions, indicating that such changes may be characteristic of the disorder and keep the deficit in the phonological component of language.

Processamento auditivo em criança com doença cerebrovascular

BACKGROUND: cerebrovascular disease (CVD) during childhood is a rare condition; its short, medium and long-term characteristics deserve further investigation. The application of behavioral techniques may improve clinical characterization, thus rendering more efficient therapeutic planning and control. AIM: to describe the audiological manifestations in a child with CVD in two distinct moments of clinical follow-up. METHOD: the child, with a confirmed diagnosis of a single and unilateral episode of CVD, presenting satisfactory cognition and language skills, was submitted to a battery of conventional and auditory processing tests, which included a simplified evaluation as well as monotic, dichotic, and temporal processing tests. The obtained data was paired with those of a normal right-handed child, of the same gender, age and socio-cultural level. RESULTS: results indicate impairments in auditory memory as well as in selective attention during binaural separation and integration tasks for verbal and non-verbal stimuli. CONCLUSION: clinical development, although favorable, was below the average expected for the same age when compared to the control. The prospective evaluation of a child with DCV permitted the characterization of the auditory behavior, the definition of its parameters as well as the development of the audiological characteristics.

Neuropsychological evaluation of children after ischemic cerebrovascular disease

The purpose of this study is to associate neuropsychological evaluation with neuroimaging results in children with cerebral tomography indicating ischemic cerebrovascular disease (ICVD). Neuroimaging, neurological exams and neuropsychological instruments were used to evaluate five children. The study revealed that the cognitive and perceptive skills in two children were normal and motor sequele in four cases. The rhythm, visual and speech receptive skills remained unchanged. In four cases the SPECT exam showed regions with hypoperfusion and in four cases the EEG was normal. Neuropsychological, neurological and image indication some degree of sequele demonstrating the importance of follow up of children who had suffered cerebrovascular disease.

Visual control in children with developmental dyslexia

PURPOSE To assess binocular control in children with dyslexia. METHODS Cross-sectional study with 26 children who were submitted to a set of ophthalmologic and visual tests. RESULTS In the dyslexic children less eye movement control in voluntary convergence and unstable binocular fixation was observed. CONCLUSION The results support the hypothesis that developmental dyslexia might present deficits which involve the magnocellular pathway and a part of the posterior cortical attentional network.