Fun??es de mem?ria em pacientes com epilepsia refrat?ria do lobo temporal antes e ap?s transplante aut?logo de c?lulas-tronco da medula ?ssea

• Main Author: Costa, Danielle Irigoyen da
• Other Authors: Portuguez, Mirna Wetters
• Format: Others
• Language: Portuguese
• Published: Pontif?cia Universidade Cat?lica do Rio Grande do Sul 2015
• Subjects: MEDICINA; NEUROCI?NCIA; EPILEPSIA; C?LULAS-TRONCO; MEM?RIA; CNPQ::CIENCIAS DA SAUDE::MEDICINA
• Online Access: http://tede2.pucrs.br/tede2/handle/tede/1701

Made available in DSpace on 2015-04-14T13:35:34Z (GMT). No. of bitstreams: 1 440859.pdf: 1769440 bytes, checksum: 1b3b990746636f5c1f4b9a971b320293 (MD5) Previous issue date: 2012-03-26 === Introduction: As a chronic disease which is highly prevalent, epilepsy has an important impact on the affected person's psychic/cognitive functioning and their family and social relationships. Among refractory epilepsies, epilepsy of the temporal lobe (ETL) is the most frequent in adults. Studies about lesions on the hippocampus and their effects found that patients with ETL presented verbal and visual memory deficits, depending on the affected hemisphere. Refractoriness to clinical treatment leads to the recommendation of surgery when it is seen that up to that point there have not been any other therapeutic alternatives available. In this context, there is a glimpse of a new treatment possibility for refractory epilepsies, using stem cells. These present a large capacity for proliferation and auto-renovation and the capacity to respond to external stimuli and give rise to different, more specialized cell lines. Objectives: To evaluate the effect of autologous stem cell transplants of bone marrow on the memory functions of patients with refractory epilepsy of the mesial temporal lobe. Patients and Methods: The selection of patients was done at the Outpatient Center for Clinical Epilepsy Research at PUCRS S?o Lucas Hospital [Ambulat?rio de Pesquisa Cl?nica em Epilepsia do Hospital S?o Lucas da PUCRS]. The 13 patients submitted themselves to therapy, and they were evaluated before and after the stem cell treatment (3 and 6 months after). The tests utilized for neuropsychological evaluation (pre and post-therapy) include the Wechsler Memory Scale revised (WMS-R), the Rey Auditory Verbal Learning Test (RAVLT) and the Taylor Complex Figure. Results and Conclusions: The results indicate a significant increase in the neuropsychological scores over time. In six out of seven utilized tests, the increase of average score obtained was significant. In only one test (visual reproduction I WMS R), the increase showed limitrofe statistical significance (between 5% and 10%). Given the favorable evolution of those patients analyzed, the stem cell transplant showed itself to be feasible, safe and with important perspectives for rehabilitation as well as psychosocial and professional reinsertion. === Introdu??o: A epilepsia, enquanto condi??o cr?nica de alta preval?ncia tem impacto importante no funcionamento ps?quico/cognitivo e nas rela??es familiares e sociais da pessoa acometida. Entre as epilepsias refrat?rias, a epilepsia do lobo temporal (ELT) ? a mais freq?ente em adultos. Estudos sobre les?es no hipocampo e seus efeitos, constataram que pacientes com ELT apresentam d?ficits de mem?ria verbal e visual, dependendo do hemisf?rio acometido. A refratariedade ao tratamento cl?nico, leva ? indica??o cir?rgica, visto que at? o momento, n?o est?o dispon?veis outras alternativas terap?uticas. Neste contexto, se vislumbra uma nova possibilidade de tratamento para as epilepsias refrat?rias, utilizando-se c?lulas-tronco (CT). Estas apresentam grande capacidade de prolifera??o e auto-renova??o e capacidade de responder a est?mulos externos dando origem a diferentes linhagens celulares mais especializadas. Objetivos: Avaliar o efeito do transplante aut?logo de c?lulas-tronco da medula ?ssea (CTMO) nas fun??es de mem?ria de pacientes com epilepsia refrat?ria do lobo temporal mesial. Pacientes e M?todos: A sele??o dos pacientes foi realizada no Ambulat?rio de Pesquisa Cl?nica em Epilepsia do Hospital S?o Lucas da PUCRS. Os 13 pacientes que se submeteram ? terapia, foram avaliados antes e ap?s o tratamento com c?lulas-tronco (3 meses e 6 meses depois). Os testes utilizados para avalia??o neuropsicol?gica: Escala de Mem?ria Wechsler-revisada (WMS-R), Teste de Aprendizado de Mem?ria Verbal de Rey (RAVLT) e Figura Complexa de Taylor. Resultados e Conclus?es: Os resultados indicam um aumento significativo nos escores neuropsicol?gicos ao longo do tempo. Em seis dos sete testes utilizados, o acr?scimo no escore m?dio obtido foi significativo e, em apenas um teste (WMS R visual imediato), o acr?scimo apresentou signific?ncia estat?stica lim?trofe (entre 5% e 10%). Dada a evolu??o favor?vel dos pacientes analisados, o transplante de CTMO mostrou-se fact?vel, seguro e com perspectivas importantes para a reabilita??o e reinser??o psicossocial e profissional.