Samanta Fabrício Blattes da Rocha

Instituto de Neurologia de Curitiba, Curityba, Paraná, Brazil

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Publications (8)44.48 Total impact

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    ABSTRACT: The aim of this study was to investigate not only the effectiveness of epilepsy surgery in improving seizure control but also patient satisfaction with the result of the procedure in a sample of patients operated on at a specialized epilepsy unit. Patients with temporal lobe epilepsy who had undergone epilepsy surgery (temporal lobectomy/amygdalohippocampectomy) were interviewed in a standardized telephone survey about their satisfaction with the results of the surgery. The morbidity of the surgery was also analyzed retrospectively. The initial study population consisted of 6 amygdalohippocampectomy and 102 temporal lobectomy patients and was reduced to a final sample consisting of 4 amygdalohippocampectomy and 67 lobectomy patients, as the other patients were not available for interview. Surgical results were based on the Engel classification, and satisfaction with the surgery was assessed by asking patients to rate their result and state whether they would make the same decision (to be operated on) again. A significant number of patients classified as Engel I or II, who considered the surgical outcome good or excellent, said they would have the surgery again (p<0.001). Left temporal lobectomy patients whose results fell in the Engel III/IV bracket were less satisfied (p=0.001) than right temporal lobectomy patients with the same Engel classifications (0.048). Left temporal lobectomy patients who were classified as Engel class III and IV were less likely to have the surgery again if they had the choice (p=0.016). Patient satisfaction with the results of epilepsy surgery may depend not only on achieving seizure control but also on the temporal lobe resected. Since worse results were associated with lower satisfaction rates only for left temporal resection patients, it is possible that the cognitive consequences of this procedure compound the worse surgical result, leading to decreased satisfaction.
    Epilepsy & Behavior 11/2013; · 1.84 Impact Factor
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    Arquivos de neuro-psiquiatria 04/2013; 71(4):267-8. · 0.55 Impact Factor
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    ABSTRACT: Refractory epilepsy accounts for 20 to 30% of epilepsy cases and remains a challenge for neurologists. Vagus nerve stimulation (VNS) is an option for palliative treatment. It was to study the efficacy and tolerability of VNS in patients implanted with a stimulator at the Curitiba Institute of Neurology (INC). A case study of six patients with refractory epilepsy submitted to a VNS procedure at the INC in the last four years was described and discussed. Mean age at time of implantation was 29 years. Mean follow-up was 26.6 months. Seizure frequency decreased in all patients (40-50% (n=2) and >80% (n=4)). Three patients no longer required frequent hospitalizations. Two patients previously restricted to wheelchairs started to walk, probably because of improved mood. In this population, VNS proved to be a sound therapeutic option for treating refractory epilepsy.
    Arquivos de neuro-psiquiatria 01/2013; 71(1):25-30. · 0.55 Impact Factor
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    ABSTRACT: In March, 2010, a 75-year-old woman was referred to us because of a 6-month history of progressive dementia. Her illness started with gait apraxia and progressed to cognitive decline with variable degrees of sphincter incontinence. She was an otherwise healthy woman with no history of previous medical conditions, and a widow of 15 years since her husband had died from a myocardial infarction. She had had three uneventful pregnancies, had never undergone surgery or blood transfusions, and did not come from a region with high HIV prevalence. She had loss of initiative and spontaneous speech, apathy, inattention, and short-term memory decline, and was unable to perform daily life activities without help. Neurological examination revealed an apraxic gait with small steps and a shift to the right, as well as a festinating gait. Her score on the mini-mental examination (MMSE) scale was 18. Neuropsychological examination showed impaired short-term memory, attention, and visuospatial abilities, and decreased mental processing speed. An electroencephalogram showed general slowing of background activity. Axial FLAIR MRI showed ventricular enlargement out of proportion to sulcal atrophy, and rounding of the frontal horns associated with periventricular hyperintensities, which suggested transependymal fl ow of cerebrospinal fl uid (CSF) (fi gure). To exclude secondary dementia due to normal-pressure hydrocephalus, 1 we did a tap test, 2 which revealed normal opening pressure (17 mm Hg), with no Lancet 2011; 378: 1676 Neurology Unit improvement in gait or cognition. CSF examination showed leucocytosis (33 cells per μL, 91% lymphocytes and 9% neutrophils), high protein concentration (0·76 g/L), and normal glucose (2·27 mmol/L). Laboratory tests showed only an increased ESR (85 mm/h). CT of the chest was unremarkable. CSF PCR for tuberculosis, VDRL, and cultures and staining with China ink to detect fungi were negative. Serological tests for toxo-plasma, cytomegalovirus, Epstein-Barr virus, herpes virus, and varicella zoster virus were negative. Treponemal antibody test (FTA-ABS) was also negative, but ELISA for HIV-1 and HIV-2 was positive and confi rmed by western-blot analysis. CD4-cell count was 113 per μL. A diagnosis of HIV-associated dementia 3 was made. After 2 months on HAART, our patient's dementia reversed to mild cognitive impairment (MMSE score 28), and her urinary incontinence and gait apraxia improved. At fi nal follow-up on Nov 8, 2010, she was in a stable clinical condition. Our patient presented with clinical fi ndings resembling classic and treatable Hakim-Adams syndrome (gait apraxia, dementia, and sphincter incontinence) 1 with compatible neuroimaging fi ndings. 2 A possible mech-anism for the pathophysiology of hydrocephalus is an infl ammatory and toxic process in the CSF (an increase in the number of cells and the protein concentration) caused by HIV. HIV-related dementia generally occurs late in the course of AIDS in younger patients, 3 but it is not common as a presenting symptom in elderly patients. 4 However, the life expectancy and sexual activity of this population have increased, 5 and HIV infection has become treatable. Our patient improved with HAART and without shunting. HIV infection should therefore be considered as a possible diagnosis and HIV testing done even in older individuals presenting with any dementia syndrome. Figure: Axial FLAIR MRI of head showing enlarged and rounded ventricles associated with periventricular hyperintensities (arrows). Esta mensagem, incluindo os seus anexos, contém informações confidenciais destinadas a indivíduo e propósito específicos, e é protegida por lei. É proibida a utilização, acesso, cópia ou divulgação não autorizada das informações presentes nesta mensagem. The information contained in this communication is confidential, is law protected, and is intended only for business use of the addressee. It's forbidden the unauthorized use, access, copy or disclose of the information contained in this communication.
    The Lancet 11/2011; 378(9803):1676. · 39.06 Impact Factor
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    ABSTRACT: Catastrophic epileptic encephalopathies in children comprise devastating conditions that features cerebral dysfunction in association with refractory epileptic seizures. The diagnosis is based on the clinical findings, on magnetic resonance imaging (MRI) of the brain and on electroencephalographic findings. For these conditions, surgery remains essential for attaining seizure control. We report two cases of 5-year-old girls. The first one had a diagnosis of Rasmussen’s syndrome. The second one had a large porencephalic cyst secondary to perinatal cerebral ischemia. Despite trials of anticonvulsants, both patients deteriorated, and a functional hemispherectomy guided by neuronavigation was indicated and performed, with low morbidity and excellent seizure control. The neuronavigation proved to be a valuable guidance tool in performing the functional hemispherectomy, making the disconnections more accurate, and thus decreasing the surgical time and blood loss.
    Journal of Epilepsy and Clinical Neurophysiology 12/2010; 17(3):93-99.
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    ABSTRACT: Syncope is a condition often misdiagnosed as epileptic seizures. However, the differential diagnosis between both conditions can be quite difficult, even for well-trained physicians. Four cases of epilepsy and/or syncope are reported, to exemplify this situation. Each case is discussed individually, and the confounding factors are analyzed.
    Arquivos de Neuro-Psiquiatria 10/2005; 63(3A):597-600. · 0.83 Impact Factor
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    ABSTRACT: Forty-three patients with epilepsy resistant to drug therapy were submitted to temporal lobe epilepsy surgery at the Instituto de Neurologia de Curitiba, from 1998 to 2003. Thirty-nine patients (90.6%) had mesial temporal sclerosis, and four had brain tumors. According to Engel's rating, 83.7% from 37 patients with complete postoperative evaluation were classified as Class I (free of disabling seizure). Postoperative complications (18.6%) were evaluated, with one case of surgical wound infection, one case of hydrocephalus, one case of cerebrospinal fluid fistula, two cases of transient palsy of the trochlear nerve and one case of transient hemiparesis. No death related to epilepsy surgery was found in our study.
    Arquivos de Neuro-Psiquiatria 10/2005; 63(3A):618-24. · 0.83 Impact Factor
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    ABSTRACT: Functional magnetic resonance imaging (fMRI) is a technique for detecting minimal changes in brain perfusion and oxygenation secondary to neuronal activation. Its application in the pre-surgical evaluation of epileptic patients with temporal mesial sclerosis is currently being under investigation in several centers. This study aims to describe an activation paradigm for the evaluation of language and memory functions, as an alternative to the worldwide used Wada test, which is an invasive procedure. In order to propose a paradigm adapted to the Portuguese language, we report our experience in determining the dominant cerebral area for language through fMRI with a verbal fluency task. The results of the fMRI from 19 patients studied in Curitiba in a period of approximately two years were studied. Sixteen of them presented with left hemispheric cerebral language dominance. In five patients, results from fMRI and Wada test could be compared and agreed in localization. Our results reinforce the view that fMRI may become an essential tool for medical practice, perhaps for the determination of eloquent areas in the evaluation of candidates for epilepsy surgery.
    Arquivos de Neuro-Psiquiatria 04/2004; 62(1):61-7. · 0.83 Impact Factor