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Previous issue date: 2016-12-01 === O c?ncer ? a primeira causa de morte de crian?as no Brasil, com 12.600 casos estimados para
2017. Tumores de sistema nervoso central (SNC) s?o os mais comuns na inf?ncia e 60%
atingem cerebelo e adjac?ncias na fossa posterior. A les?o e o tratamento impactam o SNC e
altera??es em fun??es complexas v?m sendo associadas ? interrup??o de conex?es entre o
cerebelo e ?reas corticais. A radioterapia, respons?vel pelo aumento da sobrevida em casos de
tumores malignos, possui a??o neurot?xica sobre o SNC em desenvolvimento. O objetivo do
presente estudo ? investigar o funcionamento neuropsicol?gico e acad?mico de crian?as e
adolescentes sobreviventes de tumores de fossa posterior. A pesquisa foi subdividida em tr?s
estudos: 1) Caracteriza??o da capacidade intelectual de pacientes pedi?tricos diagnosticados
com tumores de fossa posterior; 2) Investiga??o das fun??es executivas em pacientes
pedi?tricos sobreviventes de tumores de fossa posterior e; 3) Proposi??o de modelo conceitual
para explicar o perfil neuropsicol?gico de crian?as e adolescentes submetidas ? radia??o
craniana. 37 sujeitos com idades entre seis e 16 anos compuseram o grupo cl?nico e 24
sujeitos saud?veis compuseram grupo controle, pareados 1:1 segundo sexo, idade, tipo de
escola e n?vel socioecon?mico dos participantes dos estudos 2 e 3. Os participantes passaram
por avalia??o neuropsicol?gica, com resultados analisados por ferramentas estat?sticas
descritivas e inferenciais e an?lise cl?nico-qualitativa. No estudo 1, crian?as submetidas ?
radioterapia apresentaram desempenho significativamente inferior ao de crian?as submetidas
apenas ? neurocirurgia em todos os dom?nios intelectuais, notadamente os n?o-verbais e
velocidade de processamento. O dom?nio n?o verbal revelou diferen?as significativas em
fun??o do tipo de tratamento, enquanto o dom?nio verbal acarretou diferen?as significativas
em fun??o da escolaridade materna, revelando dissocia??o quanto aos dom?nios cognitivos
mais afetados pelo tumor e pelo tratamento, e aqueles mais impactados por fatores socioculturais. Crian?as diagnosticadas tardiamente apresentaram pior desempenho,
contradizendo estudos anteriores. O estudo 2 revelou altera??es executivas nos dom?nios da
mem?ria de trabalho, inibi??o, flexibilidade e planejamento em ambos os grupos cl?nicos.
Crian?as submetidas ? radioterapia apresentaram mais dom?nios afetados e preju?zos mais
severos. Crian?as tratadas apenas com neurocirurgia apresentaram dificuldades restritas a
tarefas com demandas executivas mais sofisticadas, enquanto crian?as submetidas ?
radioterapia apresentaram dificuldades nestes e em tarefas mais simples. O estudo 3
apresentou importantes resultados em dire??o ? compreens?o do perfil neuropsicol?gico de
crian?as submetidas ? radioterapia. Os dados sugerem que a desmieliniza??o provocada pela
radioterapia acarreta altera??es t?picas de les?es do hemisf?rio direito, em padr?o semelhante
ao perfil do Transtorno N?o-Verbal de Aprendizagem (TNVA). As reflex?es te?ricas
resultantes da interpreta??o dos dados levaram ? proposi??o de modelo conceitual,
compreensivo e sist?mico como hip?tese explicativa para a emerg?ncia do perfil
neuropsicol?gico apresentado por sobreviventes de meduloblastoma. Espera-se que o estudo
estimule o interesse pelo aprofundamento da compreens?o acerca das dificuldades e desafios
enfrentados por essa popula??o, visando contribuir para a proposi??o de pol?ticas p?blicas que
promovam a reinser??o social e acad?mica das crian?as ap?s o tratamento, bem como para a
cria??o de programas de interven??o que garantam a melhoria da qualidade de vida dos
sobreviventes. === Cancer is the leading cause of death among Brazilian children, and 12.600 cases are estimated
for 2017. Central nervous system (CNS) tumors are the most common on childhood, from
which 60% arise in cerebellum or adjacent structures of posterior fossa. The lesion and
treatment affect CNS functioning, and alterations in higher order functions have been related
to the interruption of important connections between the cerebellum and cortical areas.
Radiotherapy is responsible for increasing survivorship in malignant tumor cases, but it also
promotes neurotoxic effects to the developing CNS. This study aimed to investigate
neuropsychological and academic functioning in survivors of posterior fossa tumors. The
research was subdivided into three studies: 1) Description of intellectual performance of
pediatric patients diagnosed with posterior fossa tumors; 2) Investigation of executive
functions in pediatric survivors of posterior fossa tumors and; 3) Proposal of a conceptual
model to explain the neuropsychological profile of children and adolescents submitted to
cranial radiation. 37 subjects aged 6-16 integrated clinical group, and 24 subjects formed a
healthy control group matched 1:1 with the participants of studies 2 and 3 according to sex,
age, type of school and socioeconomic level. Participants were submitted to
neuropsychological evaluation and results were analyzed through descriptive and inferential
statistical tools and clinic-qualitative analysis. In the first study, children who underwent
radiotherapy had significantly lower performances on intellectual domains compared to
children only surgically treated, mainly in nonverbal and processing speed domains.
Nonverbal domain revealed significant differences according to treatment modality, while
verbal domain led to significant differences according to mother educational level, which
reveals a dissociation regarding to the domains more strongly affected by the tumor and the
treatment, and the domains more affected by sociocultural factors. Children diagnosed later showed lower performances, which disagree with previous studies. The second study revealed
executive impairments on both clinical groups in terms of working memory, inhibition,
flexibility and planning. Children submitted to radiotherapy showed a broader range of
affected domains and the most serious impairments compared to children who did not
undergo radiotherapy. These children showed difficulties only in measures with more
sophisticated executive demands, while children submitted to radiotherapy also presented
impairments in more simple executive tasks. The third study presented important results
towards the comprehension of the neuropsychological profile of children submitted to cranial
radiation therapy. Data suggest that demyelination caused by radiotherapy leads to right
hemisphere typical impairments, in a pattern which is similar to the Nonverbal Learning
Disability (NLD) profile. Theoretical reflections resulting from data interpretation led to the
proposition of a conceptual, comprehensive and systemic model as an explanation hypothesis
to the emergency of childhood medulloblastoma neuropsychological profile. It is expected
that this study encourage research interest towards the understanding of difficulties and
challenges faced by this population, in order to contribute to the creation of public policies
which enable children?s social and academic reinsertion after treatment, as well as to the
creation of intervention programs which ensure the improvement of survivors? quality of life.
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