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Modulation of no signaling pathways in an experimental model of epilepsy: Focus on ictal EEG
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Abstracts / Clinical Neurophysiology 126 (2015) e173–e184
study was to highlight the importance of EEG as non-invasive methods in their diagnosis. The study included 11 children with PD that are clinically, neurophysiological (EEG), neuroradiological (MRI) and molecular genetic examined. Eight children with paroxysmal kinesigenic (DYT10) and three children with nonkinesigenic dystonia (DYT8) have been diagnosed. Provoking factors for dyskinesia were stress, physical activity, hunger, and some drinks. Over 60% of children had dyskinesia attacks preceded by ‘‘sensitive aura.’’ 36% of children had focal onset of attacks with secondary generalized dyskinesia. The frequency of attacks ranged from 30 per day to several a year, and the duration of a single attack from a few seconds to 6 h. Most patients had familial occurrence of the disease (64%) and good therapeutic response to antiepileptic drugs. All children had normal neurologic status, preserved consciousness during the attacks, normal EEG and MRI findings. PD and epilepsy have similar manifestations of the disease and good therapeutic response to antiepileptic drugs. The key method in establishing correct diagnosis of these two entities is the EEG (particularly useful video EEG). doi:10.1016/j.clinph.2015.04.031
Characteristics of the venous drainage of the central nervous ˇ . Krsmanovic´ a, system in patients with multiple sclerosis—Z b a b ˇ M. Zivkovic´ , T. Lepic´ , A. Stankovic´ , D. Veljancˇic´ a, R. Raicˇevic´ a, E. Dincˇic´ a (a Neurology Clinic, Military Medical Academy, Faculty of Medicine, University of Defense, Belgrade, Serbia, b Institute for Nuclear Sciences ‘‘Vincˇa’’, Belgrade, Serbia) In this clinical observational study 157 patients with MS, without disease modifying therapy, and 56 healthy participants were included. The ulstasonographic examination of the neck blood vessels and deep brain veins was performed. Insufficient drainage was defined by presence of: chronic cerebrospinal vein insuficiency; and/or segmental stenosis of internal jugular vein; and/or reflux in internal jugular vein during Valsalva maneuvre. In the patient group we determined: course of the disease, functional disability determined by EDSS (Expanded Disability Status Scale), disease progression determined by MSSS (Multiple Sclerosis Severity Score). Frequency of at least one of the phenotypes was significantly higher in patients with secundary progressive compared to patients with relapsing–remitting course. Mean values of EDSS and MSSS were significantly higher in patients with at least one of investigated phenotypes compared to patients without the presence of these phenotypes. Insufficient venous drainage of central nervous system (CNS) was significantly more frequent in patients with longer duration of disease, higher grade of functional disability and secondary progressive form of MS. doi:10.1016/j.clinph.2015.04.032
From cause to consequence – Presentation of cases of active myoclonus as a result of cerebrovascular damage—D. Jovanovic´ (Neurology Department, Clinical Hospital Center Zemun, Belgrade, Serbia) Three patients who were hospitalized due to cerebrovascular incident with different lesions localization presented with ipsilateral epileptic syndromes with action myoclonus of the hands and in one case associated with active myoclonus of the same half of the face. The aim was to prove the existence of a direct correlation between cerebrovascular incident as the cause and developed action
myoclonus as a result of cerebral lesions by analysing the pathophysiological basis of this entity. The analysed results were obtained through laboratory, serial electroencephalograph monitoring, CD-MAV, computerized tomography or magnetic resonance imaging of the brain and magnetic resonance angiography of blood vessels of the brain. Based on results, the base for the introduction of anticonvulsant therapy, which completely suppressed the clinical picture, was set. This supports the direct relation between cerebrovascular lesions as pathoanatomic substrate and action myoclonus as a pathophysiological substrate. The mechanism of myoclonus as a result of cerebrovascular disease is largely unknown. The essence of the discussion is based on the possible pathophysiological mechanisms of secondary myoclonus. Further analysis should give a deeper insight into the damage mechanisms, but also the survival of neurons that can help and lead to new ways of treating cerebrovascular disease. doi:10.1016/j.clinph.2015.04.033
Differential diagnosis and therapeutic approach of treatment of patient with acute Miller Fisher syndrome—D. Jovanovic´ (Neurology Department, Clinical Hospital Center Zemun, Belgrade, Serbia) The case of Miller Fisher syndrome in a young girl with a typical clinical picture and good therapeutic response to standard therapeutic protocol was presented. The aim was to emphasize the importance of this rare pathological entity by comprehensive clinical and diagnostic methods for confirming the Miller Fisher syndrome. Analysis of the results was obtained by means of anamnesis, clinical findings of disease development (prodromal infectious syndrome, progressive ophthalmoparesis, ataxia, areflexia), diagnostic tests – brain MRI, evoked potentials, lumbar puncture, EMG as well as the response to therapeutic treatment protocol implemented – corticosteroids pulse therapy with plasmapheresis. Albumincytological dissociation was found in the second report of CSF, while the first was negative. Despite the typical clinical presentation and CSF findings, there are a number of diseases that may imitate this condition. Often the clinical findings of Guillain–Barre syndrome, respectively Miller Fisher syndrome, may only be a part of a wider clinical spectrum and of a different pathological entity. doi:10.1016/j.clinph.2015.04.034
Modulation of no signaling pathways in an experimental model of epilepsy: Focus on ictal EEG—D. Hrncˇic´ a, A. Rašic´ – Markovic´ a, ˇ . Grubacˇ a, M. Vorkapic´ a, Ð. Macut a, V. Šušic´ b, N. Šutulovic´ a, Z a D. Ðuric´ , O. Stanojlovic´ a (a Physiology Institute, Faculty of Medicine, University of Belgrade, Belgrade, Serbia, b Serbian Academy of Sciences and Arts, Belgrade, Serbia) One of the EEG hallmarks of homocysteine thiolactone (HcT)-induced epilepsy is spike-and-wave discharges (SWD). Nitric oxide (NO) is gasotransmitter produced by neuronal, endothelial and inducible NO synthesis (NOS). Contribution of NO-mediated signaling in epileptogenesis is unclear. The aim of our experiments were to compare the effects of non-selective (L-NAME) and selective (7-nitroindazole for neuronal and aminoguanidine for inducible) NOS inhibitors on ictal EEG phenomena in a model of HcT-induced epilepsy in rats. Male Wistar rats with implanted EEG-recording electrodes were intraperitoneally treated with HcT (subconvulsive dose of
Abstracts / Clinical Neurophysiology 126 (2015) e173–e184
5.5 mmol/kg) and EEG activity was recorded during next 90 min. LNAME (700 mg/kg), 7-nitroindazole (75 mg/kg), aminoguanidine (100 mg/kg) or saline were injected 30 min prior to HcT administration. Visual inspection of digital EEG signals and analysis of number and duration of SWDs was performed offline. L-NAME significantly increased the number of SWDs per rat induced by HcT, but did not affect its duration. 7-nitroindazole increased duration, but not the number of SWDs in this model. Aminoguanidine increased both parameters significantly. These results indicated that modulation of NO-singaling pathways could affect EEG manifestations of HcT epilepsy showing contribution of this gasotransmitter in epileptogenesis and prominent effects of iNOS inhibition. doi:10.1016/j.clinph.2015.04.035
Hereditary motor and sensory neuropathy lom type in 6-year-old boy: Case report—S. Ostojic´ a, D. Zamurovic´ a, G. Kovacˇevic´ a, D. Savic´ Pavic´evic´ b (a Mother and Child Health Care Institute of Serbia ‘‘Dr Vukan Cupic’’, Belgrade, Serbia, b Faculty of Biology, University of Belgrade, Belgrade, Serbia) Six year old boy had slow psychomotor development from an early age. Sitting independently at the age of 11 months and walking at the age of 17 months. He was always clumsy, often stumbling and falling. Neurological examination on admission to the Institute at the age of 6.6 years: wasting of leg muscles, moderate weakness of proximal and distal muscles of legs, absent deep tendon reflexes; eqinovarus. Upper limbs, cranial nerves and sensory exam including hearing were found normal. Magnetic resonance of the brain was normal, and developmental quotient was 78. Electromyoneurographic examination (EMG) showed signs of sensitive and motor demyelinating neuropathy of a severe degree. Data on ethnicity of Bulgarian Gypsy directed us to the molecular – genetic testing, which was conducted at the Faculty of Biology in Belgrade. It was found that the boy has a homozygous mutation c.442>T in the NDRG1 gene. EMG examination is of great importance in the diagnosis of hereditary neuropathy, and in accordance with clinical signs directing us to the molecular genetic studies, which are important for establishing the diagnosis and providing appropriate genetic advice to the patients and their families.
e181
Deficit of cognitive and affective empathy in adolescents with conduct disorder may be due to various causes: the negative sentiment, cognitive distortions, anxiety or poor emotional regulation. Adolescents with conduct disorder may exhibit lower empathy because of the presence overresponsiveness (not responsiveness) to negative stimuli. Abnormalities in the frontal brain regions involved in emotional and cognitive control may be associated with empathy deficits in adolescents with conduct disorder. doi:10.1016/j.clinph.2015.04.037
Inter-hemispheric interaction of complex positive and negative emotional stimuli in psychopathy—M. Stankovic´ a, M. Nešic´ b, V. Miloševic´ c (a Faculty of Philosophy, University of Niš, Niš, Serbia, b Medical Faculty, University of Niš, Niš, Serbia, c Center for Cognitive Science, University of Niš, Niš, Serbia) From a neurobiological perspective psychopathy can be associated with altered and unbalanced interhemispheric dynamics. The main objective of this study is to determine whether emotional processing, such as decision making of complex emotional meanings, is more successfully accomplished with both hemispheres or separately with the left hemisphere (LH) or left hemisphere (RH) in psychopathic participants. Non-psychopathic participants were recruited from the Admission Unit of the hospital (n = 19) and psychopathic participants were recruited from the Forensic Unit of the hospital in Gornja Toponica (n = 22). The different positive or negative social situations with emotional meaning (96 photographs) were chosen from the IAPS, as well as a set of primary facial expressions of emotions of happiness, surprise, sadness, anger, disgust and fear. Psychopathy is not associated with an unbalanced interhemispheric dynamics in decision making in emotional processing. Complex negative emotions are more successfully processed with both hemispheres and complex positive emotions processed with equal success with both or just one hemisphere. When we exclude the emotional valence factor we get the result that suggests an advantage of interhemispheric cooperation in processing. Globally, in complex emotional tasks interhemispheric cooperation is inviolable, despite the undeniable hemisphere specialization for different functions. doi:10.1016/j.clinph.2015.04.038
doi:10.1016/j.clinph.2015.04.036
Deficit of cognitive and affective empathy in adolescents with behavior disorders—J. Kostic´ a, M. Nešic´ b (a Clinic for Mental Health Protection, Clinical Center Niš, Niš, Serbia, b Medical Faculty, University of Niš, Niš, Serbia) Empathy is viewed as a complex cognitive-affective reaction to perceptions of other people. Deficit of cognitive and affective empathy is described in some psychiatric disorders. The aim of this study was to examine the level of cognitive and affective empathy in adolescents with conduct disorder. The study included 87 adolescents with conduct disorders and 85 control group of adolescents aged 15–18 years. Empathy was assessed using a questionnaire Interpersonal Reactivity Index (IRI). The results suggest that the level of cognitive and affective empathy is lowered in adolescents with conduct disorders compared to the healthy population of adolescents, in the prosocial-oriented dimension – Perspective Taking and Empathic Concern, while the differences in Personal Distress is very close to statistically significant values.
Correlation between the number of antiepileptic drugs and the scores on measurements of executive functions in patients with epilepsy—N. Miloševic´ a, M. Nenadovic´ a, D. Lecˇic´-Toševski b,c,d, M. ˇ ovicˇkovic´ Šternic´ b,f Milovanovic´ d, J. Vrbaški d, G. Trajkovic´ b,e, N. C (a School of Medicine, University of Pristina-Kosovska Mitrovica, Serbia, b School of Medicine, University of Belgrade, Serbia, c Serbian Academy of Sciences and Arts, d Institute of Mental Health, Belgrade, Serbia, e Institute for Medical Statistics and Informatics, Belgrade, Serbia, f Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia) The aim of this work was to evaluate the significance of the number of applied antiepileptic drugs (AEDs) in the disorder of executive function in patients with temporal lobe epilepsy (TLE). We included patients with TLE over 18 years. For the assessment of executive functions were used Wiskonsin card sorting test (WCST) with an estimate of the number of categories achieved, the number of perseverative response and the impossibility of maintaining a set and the Trail Making Test-Part B (TMT-B).
Abstracts / Clinical Neurophysiology 126 (2015) e173–e184
study was to highlight the importance of EEG as non-invasive methods in their diagnosis. The study included 11 children with PD that are clinically, neurophysiological (EEG), neuroradiological (MRI) and molecular genetic examined. Eight children with paroxysmal kinesigenic (DYT10) and three children with nonkinesigenic dystonia (DYT8) have been diagnosed. Provoking factors for dyskinesia were stress, physical activity, hunger, and some drinks. Over 60% of children had dyskinesia attacks preceded by ‘‘sensitive aura.’’ 36% of children had focal onset of attacks with secondary generalized dyskinesia. The frequency of attacks ranged from 30 per day to several a year, and the duration of a single attack from a few seconds to 6 h. Most patients had familial occurrence of the disease (64%) and good therapeutic response to antiepileptic drugs. All children had normal neurologic status, preserved consciousness during the attacks, normal EEG and MRI findings. PD and epilepsy have similar manifestations of the disease and good therapeutic response to antiepileptic drugs. The key method in establishing correct diagnosis of these two entities is the EEG (particularly useful video EEG). doi:10.1016/j.clinph.2015.04.031
Characteristics of the venous drainage of the central nervous ˇ . Krsmanovic´ a, system in patients with multiple sclerosis—Z b a b ˇ M. Zivkovic´ , T. Lepic´ , A. Stankovic´ , D. Veljancˇic´ a, R. Raicˇevic´ a, E. Dincˇic´ a (a Neurology Clinic, Military Medical Academy, Faculty of Medicine, University of Defense, Belgrade, Serbia, b Institute for Nuclear Sciences ‘‘Vincˇa’’, Belgrade, Serbia) In this clinical observational study 157 patients with MS, without disease modifying therapy, and 56 healthy participants were included. The ulstasonographic examination of the neck blood vessels and deep brain veins was performed. Insufficient drainage was defined by presence of: chronic cerebrospinal vein insuficiency; and/or segmental stenosis of internal jugular vein; and/or reflux in internal jugular vein during Valsalva maneuvre. In the patient group we determined: course of the disease, functional disability determined by EDSS (Expanded Disability Status Scale), disease progression determined by MSSS (Multiple Sclerosis Severity Score). Frequency of at least one of the phenotypes was significantly higher in patients with secundary progressive compared to patients with relapsing–remitting course. Mean values of EDSS and MSSS were significantly higher in patients with at least one of investigated phenotypes compared to patients without the presence of these phenotypes. Insufficient venous drainage of central nervous system (CNS) was significantly more frequent in patients with longer duration of disease, higher grade of functional disability and secondary progressive form of MS. doi:10.1016/j.clinph.2015.04.032
From cause to consequence – Presentation of cases of active myoclonus as a result of cerebrovascular damage—D. Jovanovic´ (Neurology Department, Clinical Hospital Center Zemun, Belgrade, Serbia) Three patients who were hospitalized due to cerebrovascular incident with different lesions localization presented with ipsilateral epileptic syndromes with action myoclonus of the hands and in one case associated with active myoclonus of the same half of the face. The aim was to prove the existence of a direct correlation between cerebrovascular incident as the cause and developed action
myoclonus as a result of cerebral lesions by analysing the pathophysiological basis of this entity. The analysed results were obtained through laboratory, serial electroencephalograph monitoring, CD-MAV, computerized tomography or magnetic resonance imaging of the brain and magnetic resonance angiography of blood vessels of the brain. Based on results, the base for the introduction of anticonvulsant therapy, which completely suppressed the clinical picture, was set. This supports the direct relation between cerebrovascular lesions as pathoanatomic substrate and action myoclonus as a pathophysiological substrate. The mechanism of myoclonus as a result of cerebrovascular disease is largely unknown. The essence of the discussion is based on the possible pathophysiological mechanisms of secondary myoclonus. Further analysis should give a deeper insight into the damage mechanisms, but also the survival of neurons that can help and lead to new ways of treating cerebrovascular disease. doi:10.1016/j.clinph.2015.04.033
Differential diagnosis and therapeutic approach of treatment of patient with acute Miller Fisher syndrome—D. Jovanovic´ (Neurology Department, Clinical Hospital Center Zemun, Belgrade, Serbia) The case of Miller Fisher syndrome in a young girl with a typical clinical picture and good therapeutic response to standard therapeutic protocol was presented. The aim was to emphasize the importance of this rare pathological entity by comprehensive clinical and diagnostic methods for confirming the Miller Fisher syndrome. Analysis of the results was obtained by means of anamnesis, clinical findings of disease development (prodromal infectious syndrome, progressive ophthalmoparesis, ataxia, areflexia), diagnostic tests – brain MRI, evoked potentials, lumbar puncture, EMG as well as the response to therapeutic treatment protocol implemented – corticosteroids pulse therapy with plasmapheresis. Albumincytological dissociation was found in the second report of CSF, while the first was negative. Despite the typical clinical presentation and CSF findings, there are a number of diseases that may imitate this condition. Often the clinical findings of Guillain–Barre syndrome, respectively Miller Fisher syndrome, may only be a part of a wider clinical spectrum and of a different pathological entity. doi:10.1016/j.clinph.2015.04.034
Modulation of no signaling pathways in an experimental model of epilepsy: Focus on ictal EEG—D. Hrncˇic´ a, A. Rašic´ – Markovic´ a, ˇ . Grubacˇ a, M. Vorkapic´ a, Ð. Macut a, V. Šušic´ b, N. Šutulovic´ a, Z a D. Ðuric´ , O. Stanojlovic´ a (a Physiology Institute, Faculty of Medicine, University of Belgrade, Belgrade, Serbia, b Serbian Academy of Sciences and Arts, Belgrade, Serbia) One of the EEG hallmarks of homocysteine thiolactone (HcT)-induced epilepsy is spike-and-wave discharges (SWD). Nitric oxide (NO) is gasotransmitter produced by neuronal, endothelial and inducible NO synthesis (NOS). Contribution of NO-mediated signaling in epileptogenesis is unclear. The aim of our experiments were to compare the effects of non-selective (L-NAME) and selective (7-nitroindazole for neuronal and aminoguanidine for inducible) NOS inhibitors on ictal EEG phenomena in a model of HcT-induced epilepsy in rats. Male Wistar rats with implanted EEG-recording electrodes were intraperitoneally treated with HcT (subconvulsive dose of
Abstracts / Clinical Neurophysiology 126 (2015) e173–e184
5.5 mmol/kg) and EEG activity was recorded during next 90 min. LNAME (700 mg/kg), 7-nitroindazole (75 mg/kg), aminoguanidine (100 mg/kg) or saline were injected 30 min prior to HcT administration. Visual inspection of digital EEG signals and analysis of number and duration of SWDs was performed offline. L-NAME significantly increased the number of SWDs per rat induced by HcT, but did not affect its duration. 7-nitroindazole increased duration, but not the number of SWDs in this model. Aminoguanidine increased both parameters significantly. These results indicated that modulation of NO-singaling pathways could affect EEG manifestations of HcT epilepsy showing contribution of this gasotransmitter in epileptogenesis and prominent effects of iNOS inhibition. doi:10.1016/j.clinph.2015.04.035
Hereditary motor and sensory neuropathy lom type in 6-year-old boy: Case report—S. Ostojic´ a, D. Zamurovic´ a, G. Kovacˇevic´ a, D. Savic´ Pavic´evic´ b (a Mother and Child Health Care Institute of Serbia ‘‘Dr Vukan Cupic’’, Belgrade, Serbia, b Faculty of Biology, University of Belgrade, Belgrade, Serbia) Six year old boy had slow psychomotor development from an early age. Sitting independently at the age of 11 months and walking at the age of 17 months. He was always clumsy, often stumbling and falling. Neurological examination on admission to the Institute at the age of 6.6 years: wasting of leg muscles, moderate weakness of proximal and distal muscles of legs, absent deep tendon reflexes; eqinovarus. Upper limbs, cranial nerves and sensory exam including hearing were found normal. Magnetic resonance of the brain was normal, and developmental quotient was 78. Electromyoneurographic examination (EMG) showed signs of sensitive and motor demyelinating neuropathy of a severe degree. Data on ethnicity of Bulgarian Gypsy directed us to the molecular – genetic testing, which was conducted at the Faculty of Biology in Belgrade. It was found that the boy has a homozygous mutation c.442>T in the NDRG1 gene. EMG examination is of great importance in the diagnosis of hereditary neuropathy, and in accordance with clinical signs directing us to the molecular genetic studies, which are important for establishing the diagnosis and providing appropriate genetic advice to the patients and their families.
e181
Deficit of cognitive and affective empathy in adolescents with conduct disorder may be due to various causes: the negative sentiment, cognitive distortions, anxiety or poor emotional regulation. Adolescents with conduct disorder may exhibit lower empathy because of the presence overresponsiveness (not responsiveness) to negative stimuli. Abnormalities in the frontal brain regions involved in emotional and cognitive control may be associated with empathy deficits in adolescents with conduct disorder. doi:10.1016/j.clinph.2015.04.037
Inter-hemispheric interaction of complex positive and negative emotional stimuli in psychopathy—M. Stankovic´ a, M. Nešic´ b, V. Miloševic´ c (a Faculty of Philosophy, University of Niš, Niš, Serbia, b Medical Faculty, University of Niš, Niš, Serbia, c Center for Cognitive Science, University of Niš, Niš, Serbia) From a neurobiological perspective psychopathy can be associated with altered and unbalanced interhemispheric dynamics. The main objective of this study is to determine whether emotional processing, such as decision making of complex emotional meanings, is more successfully accomplished with both hemispheres or separately with the left hemisphere (LH) or left hemisphere (RH) in psychopathic participants. Non-psychopathic participants were recruited from the Admission Unit of the hospital (n = 19) and psychopathic participants were recruited from the Forensic Unit of the hospital in Gornja Toponica (n = 22). The different positive or negative social situations with emotional meaning (96 photographs) were chosen from the IAPS, as well as a set of primary facial expressions of emotions of happiness, surprise, sadness, anger, disgust and fear. Psychopathy is not associated with an unbalanced interhemispheric dynamics in decision making in emotional processing. Complex negative emotions are more successfully processed with both hemispheres and complex positive emotions processed with equal success with both or just one hemisphere. When we exclude the emotional valence factor we get the result that suggests an advantage of interhemispheric cooperation in processing. Globally, in complex emotional tasks interhemispheric cooperation is inviolable, despite the undeniable hemisphere specialization for different functions. doi:10.1016/j.clinph.2015.04.038
doi:10.1016/j.clinph.2015.04.036
Deficit of cognitive and affective empathy in adolescents with behavior disorders—J. Kostic´ a, M. Nešic´ b (a Clinic for Mental Health Protection, Clinical Center Niš, Niš, Serbia, b Medical Faculty, University of Niš, Niš, Serbia) Empathy is viewed as a complex cognitive-affective reaction to perceptions of other people. Deficit of cognitive and affective empathy is described in some psychiatric disorders. The aim of this study was to examine the level of cognitive and affective empathy in adolescents with conduct disorder. The study included 87 adolescents with conduct disorders and 85 control group of adolescents aged 15–18 years. Empathy was assessed using a questionnaire Interpersonal Reactivity Index (IRI). The results suggest that the level of cognitive and affective empathy is lowered in adolescents with conduct disorders compared to the healthy population of adolescents, in the prosocial-oriented dimension – Perspective Taking and Empathic Concern, while the differences in Personal Distress is very close to statistically significant values.
Correlation between the number of antiepileptic drugs and the scores on measurements of executive functions in patients with epilepsy—N. Miloševic´ a, M. Nenadovic´ a, D. Lecˇic´-Toševski b,c,d, M. ˇ ovicˇkovic´ Šternic´ b,f Milovanovic´ d, J. Vrbaški d, G. Trajkovic´ b,e, N. C (a School of Medicine, University of Pristina-Kosovska Mitrovica, Serbia, b School of Medicine, University of Belgrade, Serbia, c Serbian Academy of Sciences and Arts, d Institute of Mental Health, Belgrade, Serbia, e Institute for Medical Statistics and Informatics, Belgrade, Serbia, f Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia) The aim of this work was to evaluate the significance of the number of applied antiepileptic drugs (AEDs) in the disorder of executive function in patients with temporal lobe epilepsy (TLE). We included patients with TLE over 18 years. For the assessment of executive functions were used Wiskonsin card sorting test (WCST) with an estimate of the number of categories achieved, the number of perseverative response and the impossibility of maintaining a set and the Trail Making Test-Part B (TMT-B).