Arq Neuropsiquiat r 2002;60(4):1048-1052
THESES
DEVELOPM ENT OF TARGET CENTERED ARC APPARATUS FOR NEUROSURGICAL STEREOTACTIC PROCE-DURES (ABSTRACT)* . THESIS. RIO DE JANEIRO, 2002.
CESAR FANTEZIA ANDRAUS* *
URBAN PREVALENCE OF EPILEPSY: A STUDY OF THE POPULATION OF SÃO JOSÉ DO RIO PRETO - BRAZIL (ABSTRACT)* . THESIS. SÃO JOSÉDO RIOPRETO, 2002.
M OACIR ALVES BORGES * *
Int roduct ion. The purpose of t his st udy w as t o sur-vey t he prevalence of epilepsy in t he urban populat ion of São José do Rio Pret o, a m edium -sized cit y, 360,000 inhabit ant s, at nort hw est of São Paulo st at e, Brazil.
Method: This population cross-sectional epidemiolo-gical st udy w as carried out int o t w o st ages. The first w as t o access validat ion of t he screening quest ionnaire on a neighborhood of the city; the second w as the study of t he prevalence in a random ly, st rat ified large-scale survey on t he populat ion of t he cit y. A gold st andard prot ocol, clinical hist ory and neurological examinat ion, w as used t o diagnose all t he posit ive cases. The false negat ive cases w ere obt ained aft er t he validat ion of result s by a m at hem at ical m odel. For assessing preva-lence Chi-square t est and Confidence Int erval (CI 95%) w ere used t o analyze t he result s (p-value ≤ 0.05).
Result s: The Validat ion of t he screening quest ion-naire show ed a sensit ivit y of 95.83% and a specificit y of 97.8%. There w ere 17,293 individuals in t he st udied sam ple; t he dist ribut ion according t o sex, age group and race w as sim ilar t o t he general populat ion. Lifet i-m e crude prevalence of epilepsy w as 18.6/1000 inh. (CI 95%;16.6-20.6); 8.2(CI 95%;6.8-9.5) for act ive and
10.4(CI 95%;8.9-11.9) of inact ive ( considering at least one seizure in t he last t w o years). The prevalence w as 4.9(CI 95%;3.9-6.0) in t he age group of 0 t o 4 years old; 11.7 (CI 9%;10.0-13.3), 5 t o 14 years old; 20.3 (CI 95%;18.2-24.4), 15 t o 64 years old ; and 32.8 (CI 95%;30.1-35.4), over 65 years old. The prevalence on t he A economic class w as 3.6(CI 95%;2.2-4.5), B, 9.0(CI 95%;7.6-10.5), C, 21.6(CI 95%;19.4-23.8), D, 26.3(CI 95%;24,0-28.7) and on E, 10.6(CI 95%;9.0-12.9) . The prevalence of part ial seizures w as 14.0(CI 95%;12,2-15,7). The prevalence of cryptogenic seizure w as 10.4(CI 95%;8.9-11.9).
Conclusion: The prevalence lifet im e and act ive epi-lepsy w as high; sim ilar t o som e developing count ries, such as t he ones of Lat in Am erica. The prevalence of epilepsy in childhood w as low ; w hile in t he elderly w as high, similar t o developed count ries. The lifet ime preva-lence w as great ly associat ed w it h t he econom ic st at us classes. These result s show ed t hat t he prevalence of epilepsy in São José do Rio Pret o has charact erist ics of developed and developing count ries.
KEY W ORDS: epilepsy, epidem iology, prevalence, Lat in America.
* Prevalência urbana da epilepsia: est udo populacional na cidade de São José Do Rio Pret o - Brasil (Resumo). Tese de Dout orado, Faculdade de M edicina de São José do Rio Pret o (FAM ERP) (Área: Ciências da Saúde, Epidemiologia).Orient adora: Dirce M aria Trevisão Zanet t a.
* * Ad d ress: Ru a Nair d o s San t o s Lim a 110, 15090-290 São Jo sé d o Rio Pret o SP, Brasil E-m ail: m o acirab @h o t m ail.co m ; moacirb@w est net .com.br
The neurosurgical st ereot act ic procedures present s prom inence in m odern neurosurgey, f or it s accuracy and m inim ally invasive charact er. St ereot act ic localiza-t ion is essenlocaliza-t ial localiza-t o perf orm w ilocaliza-t h precision inlocaliza-t racranial biopsies, guided craniot omies, nervous t issues ablat ion for movement disorders and pain t reat ment , cat het he-res and endoscope placem ent , and like a guide for ra-diosurgery. The t arget cent ered arc apparat us (isocen-tric) for neurosurgical stereotactic procedures have been
t he m ost used f or t he t w o last decades in t he w hole w orld.
ne-Arq Neuropsiquiat r 2002;60(4) 1049
cessit y of special soft w are t o calculat e t he cart esian coordinat es. Are described it s developm ent and t ech-nic of use, and report ed t he aut hor’s experience w it h it s use, specially in t he t reat m ent of m ovem ent disor-ders and t o m ake int racranial biopsies, perform ed at Inst it ut o de Neurologia Deolindo Cout o, Universidade Federal do Rio de Janeiro, since 1997.
The aut hor developed a simple and pract ical appa-rat us, achieving a syst em t hat perm it s t he direct m ea-surement of X, Y and Z cartesian coordinates on the pro-per m onit or of com put ed t om ography. The st ereot ac-t ic apparaac-t us is com posed by a head ring, ac-t haac-t is fixed to skull w ith three or four stainless steel screw s, a rulers system that permits movements of the arc to front or back, to up or dow n, to inside or outside, and moreover t w o t ypes of f ree angulat ion: of t he cilinder and of t he needle in t he arc. The pat ient perf orm s t he brain com -put ed t om ographic scan w it h t he head ring fixed w it h t he screw s, w hich ext rem it ies t ouch t he ext ernal bone skull board and do not permit any movement. At the side of the ring, are placed localizing plaques, in the right
and left , t hat permit t he direct correlat ion bet w een t he t om ographic scan t arget t o t he t ridim ensional coordi-nates, related to the ring. So, the zero point (X0, Y0, Z0) is t he cent er of t he ring circumference, at it s superior surface. The movement s are performed w it h t he linear sliding, m ilim et red in t he t hree cart esian axis (X, Y, Z), and there is no neccessity to the calculation of any angle. With the coordinates calculated and in the operation room, the apparatus is set, fixed to the ring. The rulers movements are performed in the three axis, perm it ing t hat t he needle point t ouch t he t arget point pre-f ixed. The f ree angulat ions perm it m ovem ent s t o choice t he best w ay t o t ouch t he t arget . The developed appa-rat us present s precison com parable t o t he t arget cen-t ered arcs apparacen-t us in use now adays (2 mm). Icen-t pre-sent s t echnology ent irely nat ional, easy handling, and it s development has been diffusing in t echnical-cient ific enviroinment , specially t hrough t he report s of aut hor’s experience w it h it s use.
KEY WORDS: st ereot act ic neurosurgery, int racranial biopsy, f unct ional neurosurgery.
* Desenvolviment o de aparelho arco alvo-cent rado para procediment os est ereot áct icos neurocirúrgicos (Resumo). Tese de Dout orado, Universidade Federal do Rio de Janeiro, (Área: Engenharia de Produção). Orient adores: Carlos Albert o Nunes Cosenza e Ricardo Wagner.
* * Address: Rua Djalma Ulrich 201 / 1201, 22071-020 Rio de Janeiro RJ, Brasil. E-mail andrauscm@aol.com
DEPRESSION IN PARKINSON’S DISEASE: STUDY OF 60 CASES (ABSTRACT)* . THESIS. SÃO PAULO2001.
ROBERTO CÉSAR PEREIRA DO PRADO* *
Neuropsychiat ric disorders, specially depression, are f requent in Parkinson’s disease (PD), how ever t hese sym p t om s are of t en und errecognized b y neurolo-gist s.The object ives of t his st udy w ere: 1) t o emphasize the need of a better approach to neuropsychiatric symp-t om s in PD by symp-t he neurologissymp-t s, in order symp-t o ensure an early diagnosis and proper t reat m ent of depression. 2) t o evaluat e t he clinical charact erist ics and t he frequency of depression in PD. 3) t o st udy t he correlat ions of de-pression in PD w it h ot her variables, discussing t he neu-rophysiological m echanism s of depression in PD.
Sixty patients w ho fulfilled the clinical criteria for PD (primary), 56.6% male, non dement ed, ages ranging from 44 to 85 years old, in different stages of the disease (Hoehn & Yahr modified), w ere submitted to the UPDRS-III, V and VI, Clinical Interview Schedule – revised edit ion (CIS-R), a sem i-st ruct ured int erview in order t o det ect neuropsychiat ric sym pt om s and t he Ham ilt on
depres-sion scale (HAM -D), applied by t he exam iner/aut hor. The most prevalent psychiat ric sympt oms w ere sleep disorder (40%), depression + depressive ideas (38.33%), w orry (30%), anxiet y (25%), obsessions (23.33%), con-centration (18.33%), irritability (11.66%), panic (8.33%), com pulsions (5%), phobias (5%). There w as not sig-nificant correlat ion bet w een depression and: sex, age of onset , current age and cognit ive funct ion. A signifi-cant correlat ion w as found bet w een depression and UPDRS-III, V and VI. A significant correlat ion w as also found bet w een depression, anxiet y and irrit abilit y.
The frequency of depression in PD in t his st udy w as arround 40% and had it s ow n charact erist ics. The ut ili-zat ion of st ruct ured int erview s and evaluat ion scales is essent ial for an accurat e diagnosis and proper t reat -m ent of depression in PD.
KEY W ORDS: Parkinson’s disease, depression.
* Depressão na doença de Parkinson: est udo de 60 casos (Resumo). Tese de Dout orado, Universidade de São Paulo (Área: Neurologia). Orient ador: Egbert o Reis Barbosa.
