RESUMO
Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.
Assuntos
Transtorno Obsessivo-Compulsivo , Radiocirurgia , Humanos , Brasil , Transtorno Obsessivo-Compulsivo/diagnóstico por imagem , Transtorno Obsessivo-Compulsivo/cirurgia , Radiocirurgia/métodos , Resultado do Tratamento , Cápsula Interna/diagnóstico por imagem , Cápsula Interna/cirurgiaRESUMO
We examined the clinical characteristics of six right-handed patients who developed speech motor control disorders after human immunodeficiency virus (HIV) infection. They exhibited an ataxic dysarthria, characterized by irregular articulatory breakdowns in consonant and vowel timing; were slow in timed decision-making tasks; and had impaired procedural learning. Other aspects of the neurologic examination revealed signs of diffuse CNS involvement including action-intention tremors, ataxic gait, and release signs. None developed HIV-associated dementia during 1 year of follow-up. Motor speech control disorder appears to be related to a cerebellar dysfunction.
Assuntos
Infecções por HIV/complicações , Distúrbios da Fala/etiologia , Adulto , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Humanos , Masculino , Atividade Motora , Testes Neuropsicológicos , Distúrbios da Fala/fisiopatologiaRESUMO
This paper examines the relationship between the number of partnerships ever engaged in and fertility, as measured by the average number of live births. It was found that the larger the number of partnerships in which a woman has been engaged the higher is her fertility. This relationship between partnerships and fertility remains even when such variables as present age, age at first partnership, age at first pregnancy, time lost between unions, time spent in partnership, time since entry into first partnership, type of sexual union at first pregnancy, present type of sexual union, and current use or non-use of contraceptives are controlled by cross tabulation. Correlation analysis also bears out the positive relationship between partnership and fertility. The data for this study came from a sample survey of 4,199 women of lower, and lower middle, socio-economic status who were interviewed in 1971 on the island of Barbados. The authors have confidence in the reliability and viability of their data and hence in their findings and conclusions. The authors believe that their findings contradict the previously established positive relationship between patterns of stability of sexual unions and fertility in English-speaking Caribbean societies. They conclude that the relationship was either not rigorously examined in the past or else has undergone changes as these societies modernize economically and socially. (Summary)