ABSTRACT Trabecular bone score (TBS) is an indirect and noninvasive measure of bone quality. A low TBS indicates degraded bone microarchitecture, predicts osteoporotic fracture, and is partially independent of clinical risk factors and bone mineral density (BMD). There is substantial evidence supporting the use of TBS to assess vertebral, hip, and major osteoporotic fracture risk in postmenopausal women, as well as to assess hip and major osteoporotic fracture risk in men aged > 50 years. TBS complements BMD information and can be used to adjust the FRAX (Fracture Risk Assessment) score to improve risk stratification. While TBS should not be used to monitor antiresorptive therapy, it may be potentially useful for monitoring anabolic therapy. There is also a growing body of evidence indicating that TBS is particularly useful as an adjunct to BMD for fracture risk assessment in conditions associated with increased fracture risk, such as type-2 diabetes, chronic corticosteroid excess, and other conditions wherein BMD readings are often misleading. The interference of abdominal soft tissue thickness (STT) on TBS should also be considered when interpreting these findings because image noise can impact TBS evaluation. A new TBS software version based on an algorithm that accounts for STT rather than BMI seems to correct this technical limitation and is under development. In this paper, we review the current state of TBS, its technical aspects, and its evolving role in the assessment and management of several clinical conditions.

This study aimed to explore attentional patterns among children with inattentive attention-deficit/hyperactivity disorder (ADHD-I) and children with typical development (TD), using a latent class analysis (LCA). Patterns of brain connectivity were also explored. The sample comprised 29 ADHD-I and 29 TD matched children. An LCA was conducted to reclassify subjects according to their attentional performance, considering cognitive measures of attention and behavioral symptoms, regardless of group of origin. The new clusters were then compared in respect to brain white matter measurements (extracted from diffusion tensor imaging). Participants were rearranged in 2 new latent classes, according to their performance in an attention task and the results of behavioral scales, resulting in groups with more homogeneous attentional profiles. A comparison of the 2 new classes using the white matter measurements revealed increased fractional anisotropy in the left inferior fronto-occipital fasciculus and left inferior longitudinal fasciculus for the class composed by participants with a higher risk of attentional problems. The findings indicated that it was possible to observe variability regarding neuropsychological profile, accompanied by underpinning neurobiological differences, even among individuals with the same disorder subtype - inattentive ADHD. This specific data-driven clustering analysis may help to enhance understanding of the pathophysiology of the disorder's phenotypes.

Com o objetivo de correlacionar o QI Estimado com o QI Total, quatro bancos de dados do WISC III de 207 crianças foram associados: 1) crianças com desenvolvimento típico; 2) crianças com diagnóstico do transtorno do déficit de atenção e hiperatividade; 3) crianças referenciadas por dificuldades de aprendizagem em consultório particular; e 4) crianças com sequela neurológica avaliadas em ambulatório universitário. Os dados do QI total foram correlacionados aos do QI estimado, correspondentes à soma dos pontos ponderados dos subtestes Vocabulário e Cubos. Os resultados sugerem que o QI Estimado pode ser adotado quando há restrição de tempo e quando o desempenho intelectual está sendo usado como triagem em pesquisa, ou como ponto de referência dentro de uma avaliação neuropsicológica.

In order to calculate the correlation between the Estimated IQ and the Full Scale IQ of children submitted to the WISC III, four different data banks with a total of 207 children were integrated: (1) typically developing children, (2) children diagnosed as having Attention Deficit/ Hyperactivity Disorder, (3) children identified by private clinics as having learning disabilities (4) children with neurological sequelae diagnosed by a public university outpatient treatment program. Results suggest that the Estimated IQ, which is based on the weighted sum of the subtest scores of Cubes and Vocabulary, may be used in the presence of time constraints, when intellectual performance is important for screening in research procedures, and as a reference within a broader neuropsychological evaluation.

O objetivo deste trabalho foi delimitar indicadores clínicos e neuropsicológicos em crianças com suspeita de transtorno do déficit de atenção e hiperatividade (TDA/H). Foram avaliadas 150 crianças (idade de 7 a 14 anos) encaminhados ao NANI da UNIFESP. RESULTADOS: 75 crianças (55 M e 20 F) preenchiam os critérios para o TDA/H, dentre os quais 35 (46,6%) pacientes eram desatentos, 28 do tipo combinado e 12 do tipo hiperatividade/impulsivo. Observou-se correlação negativa com o escore de dígitos e no escore do teste de Corsi. Crianças com hiperatividade e impulsividade apresentaram baixo desempenho nas funções relacionadas à memória operacional. Crianças com transtorno opositor desafiante apresentaram alterações nos padrões de adaptação às mudanças do ritmo com menor adaptação às variações do tempo de exposição aos estímulos (Hit RT), além de maiores taxas de omissão no teste contínuo de performance. CONCLUSÃO: Este estudo sugere múltiplas interrelacões entre os escores em provas neuropsicológicas que são úteis para uma delimitação do perfil clínico de crianças com TDAH.

The aim of this study was to evaluate clinical and neuropsychological findings in children with suspicion of attention deficity hyperactivity disorder (ADHD). The assessment involved 150 children aged 7 to 14 referred to NANI at UNIFESP. RESULTS: 75 children (55 M and 20 F) fulfilled the criteria for ADHD, among which 35 were of the inattentive type, 28 of combined type and 12 were hyperactive/impulsive. There was negative correlation between the digit score and the Corsi test. Children with hyperactivity and impulsivity had a low performance for functional memory. Children with oppositional defiant disorder presented pattern changes in adaptability when there was a change in the rhythm the stimuli were presented and lower adaptation to time variability (Hit RT), in addition to higher rates of omission in the continuous performance test. CONCLUSION: This study suggests multiple interrelations between the scores of neuropsychological battery useful for detailed delimitation of the clinical profile of children with ADHD.

O objetivo deste texto é rever a terminologia sobre epilepsia utilizada no Brasil, a fim de unificar termos de uso comum tanto para leigos como para profissionais da área de saúde, uma vez que não há consenso. Em teses e artigos leigos sobre epilepsia são comuns termos como epiléptico e portador sendo a epilepsia referida como uma doença ou uma síndrome. Por outro lado, em reuniões de pessoas com epilepsia o termo paciente com epilepsia é comumente utilizado e os indivíduos ali presentes não são pacientes. A partir da heterogeneidade da epilepsia, o termo distúrbio parece ser o mais abrangente nos âmbitos cientifico e social. A Associação Brasileira de Epilepsia (ABE) propõe a definição de epilepsia baseada na última da Liga Internacional contra a Epilepsia (ILAE) (2005): distúrbio cerebral causado por predisposição persistente a gerar crises epilépticas e pelas conseqüências neurobiológicas, cognitivas, psicossociais e sociais da condição, devendo ter ocorrido pelo menos uma crise epiléptica. A ABE considera que os termos doença, portador, epiléptico devam ser proscritos e a epilepsia deva ser considerada um distúrbio, e os indivíduos que a apresentem, pessoas com epilepsia.

The objective of this paper is to review the terminology about epilepsy used in Brazil, in order to unify terms for lay people and health professionals, hence there is no consensus. Because of the heterogeneity of epilepsy, the term disorder seems to be the more complete regarding scientific and social aspects. The Associação Brasileira de Epilepsia proposes the following definition based on ILAE definition (2005): "Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure". The ABE considers that the terms disease, carrier, epileptic must be outlawed and epilepsy should be considered a disorder, and the individuals that present it, people with epilepsy.

São descritos dois casos de pacientes com anemia falciforme (AF) que desenvolveram complicações neurológicas. Os estudos angiográficos mostraram alterações semelhantes àquelas encontradas na doença moyamoya. Estes achados ocorrem também em outras patologias e são resultado de mecanismo de compensação a oclusão das artérias da base do cérebro. São comentados os riscos e as precauções para a realização da angiografia cerebral.

Two cases of sickle cell disease with neurological complications are described. Cerebral angiograms were performed and a characteristic moyamoya-like angiographic pattern was demonstrated. This pattern results from a compensatory vascularization which may follow occlusion of the arteries at the base of the brain in several diseases. The risks of angiography and appropriate precautions are emphasized.

Foram estudados 65 pacientes de ambulatório que apresentaram resposta fotoparoxística (RF) no EEG intercrítico. Houve predomínio da RF no sexo feminino (75,4%) e 61,1% dos casos tinham história de crises epilépticas. Dos 8 padrões de RF observados, o padrão poliponta-onda lenta foi o mais freqüente (53%). Em relação às faixas de fotostimulação, o grupo epiléptico apresentou distribuição bimodal (8 e 20-24 Hz). Os autores discutem seus achados em relação aos descritos na literatura.

Sixty-five outpatients with photoparoxysmal response (PPR) during routine EEG were studied. The PPR showed prevalence in women (75.4%). Seizures were found in 66.1% of cases. The rest recordings were abnormal in 41.8% with prevalence of generalized paroxysm. Eight patterns of PPR were observed, being polyspike mixed to slow wave the most frequent (53%). The epileptic group showed a bimodal distribution in the several bands of photic stimulation, near 8 and 20-24 Hz. A sustained paroxysmal abnormality persisting after the photic stimulation was present in 6 epileptic patients.

Foram analisados 77 casos de cefaléia na infância. A faixa etária situou-se em 9 anos ± 2 sem diferença entre os sexos. A localização frontal foi encontrada em aproximadamente 49% dos casos com relato de hemicrania em apenas 9%. Os fatores associados mais freqüentes foram náuseas, vômitos e tontura, sendo o fator desencadeante mais comum o stress emocional. Antecedente familiar de cefaléia ocorreu em 76,5%. Dos 36 pacientes considerados como tendo enxaqueca, 31 foram submetidos a tratamento profilático com pizotifeno ou propranolol. Houve resposta clínica satisfatória em aproximadamente 90% dos casos.

Seventy seven cases of migraine in children were studied. Age average was 9 years ± 2; there were any sex differences. The frontal localization was found in roughly 49% of cases, whereas hemicrania was just found in 9% of cases. The most frequent factors associated were nausea, vomiting and dizziness. The most common triggering factor was the stress. Family history of migraine occurred in 76.5%. Out of 36 patients suffering migraine, 31 underwent a prophylactic treatment with pizotifen or propranolol. There was satisfactory clinical responses in roughly 90% of cases.