Caracteriza??o do perfil neuropsicol?gico, acad?mico e comportamental de crian?as e adolescentes sobreviventes de tumores de fossa posterior

• Main Author: Campelo, Danielle Ferreira Garcia Mafra
• Other Authors: 71223010449
• Language: Portuguese
• Published: PROGRAMA DE P?S-GRADUA??O EM PSICOLOGIA 2017
• Subjects: CNPQ::CIENCIAS HUMANAS::PSICOLOGIA; Tumores de fossa posterior; Meduloblastoma; Neuropsicologia; Oncologia pedi?trica; Transtorno n?o-verbal de aprendizagem
• Online Access: https://repositorio.ufrn.br/jspui/handle/123456789/22673

Submitted by Automa??o e Estat?stica ([e-mail]) on 2017-04-17T20:58:04Z No. of bitstreams: 1 DanielleFerreiraGarciaMafraCampelo_TESE.pdf: 12451781 bytes, checksum: 2d36de05d3f436e95789402636f289ad (MD5) === Approved for entry into archive by Arlan Eloi Leite Silva ([e-mail]) on 2017-04-18T18:19:09Z (GMT) No. of bitstreams: 1 DanielleFerreiraGarciaMafraCampelo_TESE.pdf: 12451781 bytes, checksum: 2d36de05d3f436e95789402636f289ad (MD5) === Made available in DSpace on 2017-04-18T18:19:09Z (GMT). No. of bitstreams: 1 DanielleFerreiraGarciaMafraCampelo_TESE.pdf: 12451781 bytes, checksum: 2d36de05d3f436e95789402636f289ad (MD5) 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.