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É cada vez mais importante para as escolas particulares de educação básica avaliarem em que medida fornecem educação de qualidade para todos, com padrão de qualidade exigido pela Constituição do Brasil, para poderem melhorar o serviço prestado e atenderem aos requisitos dos alunos e de todas as partes interessadas. Além disso, a busca pela rentabilidade é necessária para garantir a própria sobrevivência e continuidade da empresa. A norma ISO 21001, publicada em 2018 e traduzida para o português em 2020, é uma ferramenta de gestão comum para todas as organizações que fornecem produtos e serviços educacionais. O objetivo deste trabalho é apresentar os resultados de uma pesquisa de campo do tipo Survey exploratório-descritivo, conduzido com o propósito de avaliar o nível de compreensão e conhecimento da norma ABNT NBR ISO 21001:2020 ou de sua antecessora ABNT NBR 15419. O instrumento de coleta de dados utilizado foi um questionário estruturado eletrônico, elaborado na plataforma Google Forms. O universo para a coleta de dados foi extraído do cadastro de escolas particulares de educação básica do Estado de São Paulo, fornecido pela instituição para a qual o pesquisador presta serviços profissionais no segmento educacional privado. Os resultados obtidos com o levantamento, possibilitaram compreender que os mantenedores e diretores, não conhecem as normas ISO de gestão específicas para o segmento de educação. No final, o artigo considera perspectivas para trabalhos futuros, relacionados com as dificuldades ou desafios na sua implantação.

Objectives To detect by diffusion tensor imaging (DTI) the extent of microstructural integrity changes of the corpus callosum (CC) in patients with hippocampal sclerosis (HS) and to evaluate possible association with clinical characteristics. Methods Fourty-two patients with temporal lobe epilepsy (TLE) and HS and 30 control subjects were studied with DTI. We grouped patients according to lesion side (left or right) HS. Mean diffusivity (MD), fractional anisotropy (FA), radial (RD) and axial diffusivity (AD) were extracted from five segments in CC midsagittal section obtained by automatic segmentation. CC DTI findings were compared between groups. We also evaluated association of DTI changes and clinical characteristics. Results HS patients displayed decreased FA and increased MD and RD in the anterior, mid-posterior and posterior CC segments, compared to controls. No differences were observed in AD. Patients reporting febrile seizure as the initial precipitating event presented more intense diffusion changes. No differences were seen comparing left and right HS. Age at epilepsy onset, disease duration and seizure frequency were not associated with DTI findings. Conclusions This is one of the largest series of TLE-HS patients evaluating CC white matter fiber integrity by DTI, which allowed us to study how some clinical characteristics, such as seizure frequency, disease duration and lesion side, are related to CC integrity. Occurrence of febrile seizure was the only factor that had significant impact on tract integrity. Diffusion changes were not restricted to the posterior part of the CC; we observed the same changes for the anterior part of the CC. Diffusion changes were characterized by an increase in RD, while the AD remained intact for all regions of the CC.

OBJECTIVE Memory impairment is a recognized complication of mesial temporal sclerosis (MTS). Epileptiform activity may negatively impact on cognition. We evaluated the impact of contralateral EEG involvement on memory in unilateral MTS (uMTS) patients. METHOD Retrospective review of 121 right-handed uMTS patients (69 left) evaluated with prolonged video-EEG and verbal and nonverbal memory tests (Rey Auditory Verbal Learning Test and Rey-Osterrieth Complex figure), with additional very delayed trials. Patients were classified according to ictal/interictal EEG findings and MTS side as left or right concordant or discordant. Thirty-nine normal individuals who underwent the same neuropsychological battery served as controls. RESULTS Demographic, disease, and treatment features did not differ among groups. On the 7-day verbal memory free recall, left discordant performed significantly worse than controls and right concordant, recognized fewer words, and had more recognition errors than all other groups, including left concordant. For nonverbal memory, right discordant performed significantly worse than controls on delayed recall, and attained lower scores than other groups on immediate and 7-day recall, but this difference did not reach statistical significance. Left discordant had higher scores of memory complaints than controls and disclosed a trend toward accentuated memory impairment compared with the other groups over time. CONCLUSIONS Our results suggest that contralateral electrographic involvement in uMTS was associated with more pronounced memory impairment for verbal material in left discordant patients, and to a lesser extent, for nonverbal material in right discordant patients. Left discordant group also had increased memory complaints. (PsycINFO Database Record

Purpose To evaluate the effect of contralateral electrographic involvement on memory performance (measured by neuropsychological and Wada memory testing) in patients with epilepsy associated with unilateral mesial temporal sclerosis (MTS). Methods We studied 51 patients with medically-refractory epilepsy associated with unilateral MTS (27 women, 30/51, left MTS) submitted to prolonged non-invasive video-EEG monitoring and bilateral Wada testing. According to ictal electrographic involvement, patients were classified as: Contralateral ictal involvement, when one or more seizures evolved with rhythmic activity in the temporal region contralateral to the MTS or exclusive ipsilateral ictal involvement if all seizures showed ictal EEG activity exclusively on the MTS side. Wada testing involved a twelve-item memory paradigm. Wada memory asymmetry score was calculated for each patient subtracting the number of recalled items after injection on the lesion side from the number of recalled items after contralateral injection. Expected asymmetry (EA) was considered if Wada memory asymmetry > 0, and Symmetrical or Reversed memory asymmetry (S-RA) when ≤ 0. Neuropsychological testing was applied in the 51 patients and in 40 healthy controls. Verbal Memory was evaluated with the Rey Auditory Verbal Learning Test (RAVLT), considering the number of recalled items on immediate recall after the initial five consecutive encoding trials (RAVLT 6), a post-interference delayed (30 min) recall (RAVLT 7), and recall after 7 days. Nonverbal memory was tested with Wechsler Memory Scale-III (WMS-III) Faces subtests 1 e 2. Results Groups did not differ in demographic, clinical and video-EEG monitoring variables. S-RA was observed more frequently in the group with contralateral ictal involvement (57.2% vs. 27.0%; p: 0.03). Logistic regression analysis considering demographic, clinical, hippocampal volume and video-EEG monitoring variables showed contralateral ictal involvement as the only independent variable associated with S-RA (coefficient = 1.32, p = 0.029, odds ratio 3.77; 95% CI 1.1–12.47). Additionally, the patient group with contralateral ictal EEG involvement displayed worse verbal and nonverbal memory scores compared to healthy controls. Conclusion In this cohort of unilateral MTS patients, contralateral ictal involvement was associated with decreased memory performance on Wada and on neuropsychological testing.

Autoimmune limbic encephalitis (ALE) associated with systemic lupus erythematosus (SLE) is a rare entity with few reports in the literature to date. In general, ALE associated with SLE has a satisfactory response to immunosuppressive treatment (RIT), but the pathogenesis of this association is poorly understood and may include an autoimmunity component. We report a case study describing the diagnosis and management of limbic encephalitis in a patient with active Systemic Lupus Erythematosus disease (SLE) and past medical history of cancer (endometrial adenocarcinoma in 2004 and papillary urothelial carcinoma in 2011 with curative treatment), followed over a one-year period. We discuss the possible association between limbic encephalitis and all past neoplastic and immune-mediated conditions of this patient. In this particularly case, autoimmunity was the most relevant factor associated with limbic encephalitis given negative neoplastic screening. Moreover, a good response was observed to immunotherapy, not seen with paraneoplastic limbic encephalitis, which is associated with poor response. In this case, the association of ALE with SLE is possible, since laboratory testing disclosed lupic activity and the patient had involvement of other systems (such as hematologic) during the period. However, the presence of other surface membrane antibodies are possible in the search for alternative etiologies.

Hemispheric language dominance and isolated hemispheric memory function evaluation can be undertaken with the intracarotid injection of a general anesthetic agent (Wada test). Amobarbital has been traditionally used as the anesthetic agent, but legal and commercial constraints limit its use. We evaluated the use of etomidate as an alternative agent for the Wada test in a series of 54 consecutive adult patients with mesial temporal sclerosis undergoing presurgical evaluation for epilepsy surgery. Language lateralization and hemispheric memory function evaluation were successfully achieved in all cases. Side effects (somnolence, tremor, and dystonia) were infrequent, minor, and transient and did not require interruption of the procedure. Etomidate appears to be a safe and effective alternative agent to amobarbital in the Wada test. Similarly to the amobarbital Wada test, the ability of the etomidate Wada test to predict postoperative memory decline remains unclear.

Introduction Rasmussen encephalitis is a rare hemispheric inflammatory disease with progressive course leading to intractable focal seizures and neurological deficits, which can evolve to epilepsia partialis continua, hemiplegia, aphasia and other symptoms. Neuroimaging classically reveals progressive hemispheric atrophy, based on sequential computed tomography (CT) and magnetic resonance imaging (MRI). Contralateral injury to the cerebellum is expected, represented either by atrophy in anatomical images or by hypometabolism in functional studies as positron emission tomography-computed tomography (PET-CT) or single-photon emission computed tomography (SPECT). The postulated mechanism is interruption to the cerebropontine-cerebellar pathway, with resultant involvement of cerebellum ipsilateral to motor deficits. Methods We describe a case of Rasmussen encephalitis with unexpected cerebellar involvement, evidenced in MRI and ictal SPECT performed during preoperative evaluation. Results A 4-year-old boy had onset of focal clonic motor seizures involving right face and tongue seizures, which evolved to epilepsia partialis continua, progressive right hemiparesis and aphasia. Neuroimaging studies showed progressive left cerebral hemisphere and left cerebellum atrophy. Ictal spect disclosed right cerebellar diaschisis. The patient underwent left functional hemispherectomy. Pathology findings were compatible with Rasmussen’s encephalitis. Clinical follow-up reveals a patient that remains with no more seizures. Conclusion Considering cerebral hemisphere and cerebellum fiber connections, one would expect cerebellar atrophy contralateral to the involved cerebral hemisphere, as previously demonstrated. In our case, functional assessment with ictal SPECT showed contralateral diaschisis, but MRI demonstrated ipsilateral atrophy of cerebellum. These findings did not compromise clinical and surgical prognosis and anatomopathological studies confirmed the diagnosis of Rasmussen encephalitis. The reason for ipsilateral cerebellar involvement in our patient is unclear, but it appears to be more an anatomical variation of neuronal circuits between cerebral cortex and cerebellum than a marker of different clinical course.

The aim of this study was to analyze the daytime and nighttime seizure distribution during video-EEG monitoring in patients with epilepsy associated with unilateral mesial temporal sclerosis (MTS) and the role of gender, age, and lesion side on 24-hour seizure distribution.We studied 167 consecutive adult (age≥16years) patients with epilepsy associated with unilateral mesial temporal sclerosis that had three or more recorded seizures during continuous video-EEG monitoring with a minimum recording time period of 24h. Seizure onset time was classified according to occurrence in six 4-hour periods.Seven hundred thirty-five seizures were evaluated. We observed two higher seizure occurrence periods: 08:01-12:00 (p=0.001) and 16:01-20:00 (p=0.03). Significantly fewer seizures were observed between 0:01 and 4:00 (p=0.01). Nonuniform seizure distribution was noted in women (p0.0001), in young patients (less than 45years of age) (p0.0001), and in both patients with left (p=0.03) and patients with right mesial temporal sclerosis (p=0.008). Men presented uniform seizure occurrence distribution (p=0.15). Women had fewer seizures than expected and fewer seizures than men between 0:01-04:00 (p0.0001 and p=0.0015, respectively) and 04:01-08:00 (p=0.01 and p=0.03, respectively). Young patients (age45years) had two seizure occurrence peaks, 08:01-12:00 (p=0.016) and 16:01-20:00 (p=0.004). Middle-aged/old patients (≥45years) had only one seizure occurrence peak, 08:01-12:00 (p=0.012). Young patients had more seizures than middle-aged/old patients between 16:01-20:00 (p=0.04). No differences were noted between left and right MTS.We observed two seizure occurrence peaks: morning and late afternoon/evening. We encountered variations in daytime and nighttime seizure distribution according to gender and age, but not according to side of MTS. Future studies are needed to confirm these findings and to unravel the neurobiological substrate underlying daytime and nighttime variations of seizure occurrence in different age groups and between genders.

Purpose of the study The aims of this study were to determine the percentage of women with epilepsy (WWE) taking folic acid (FA) in an outpatient epilepsy tertiary hospital at Sao Paulo, Brazil, and to identify the possible predictors of adherence. Method Five hundred seventy-six medical records of patients followed in our service were reviewed. Sixty-six WWE using antiepileptic drugs with age between 16 and 52, sexually active but not in menopausal period, not pregnant, and not sterilized or with vasectomized partners underwent direct interviews with a prestructured questionnaire. Logistic regression with clinical and demographic variables using a stepwise method was performed to identify predictable variables of folate use. Results We found 42.40% of FA intake. Hormonal contraceptive method use was an independent variable negatively associated with adherence to folate. Additionally, educational level was an independent variable positively associated with adherence to folate in WWE above 35 years of age. Conclusion We found low folate adherence. Improved planning pre-conception for WWE should improve rates of effective folate supplementation.

Periventricular nodular heterotopias (PNH) is a neuronal migration disorder characterized by nodules of gray matter located along the lateral ventricles, which can range from isolated single nodules to bilateral confluent nodules. This malformation of cortical development can be related genetic or extrinsic factors. Reading dysfluency, epilepsy and normal intelligence are main hallmark. PNH and overlying cortex integrate a (dis)functional network. In this review, we discuss the recent progress about pathogenes and epileptogenesis on PNH, and their participation in the processing of higher cortical functions.

Neurologist at Santa Marcelina Hospital, Sao Paulo SP, Brazil.Correspondence: Valmir Passarelli; Rua Oscar Freire 1.380 / apto. 51; 05409-010 Sao Paulo SP - Brasil; E-mail: valmirpas@ig.com.brConflict of interest: There is no conflict of interest to declare.Received 15 January 2012; Received in final form 27 April 2012; Accepted 07 May 2012

Hypoglycemia is a well recognized cause of acute symptomatic seizures. The fact that hypoglycemia can cause peripheral neuropathy is less appreciated. We describe a case of insulinoma associated peripheral neuropathy. A 17 year-old previously healthy man was referred for investigation of refractory epilepsy. A history of recurrent seizures, slowly progressive weakness of his feet and hands, and weight gain was obtained. Physical examination showed signs of a chronic sensory-motor polyneuropathy. He was diagnosed with insulinoma and primary hyperparathyroidism, characterizing multiple endocrine neoplasia, type 1 syndrome. Cases of insulinoma associated peripheral neuropathy are very rare. The more characteristic clinical picture appears to be distal weakness, worse in the intrinsic hand and feet muscles, and no or mild sensory signs. Peripheral nervous system symptoms may not completely resolve, despite removal of the cause of hyperinsulinism/hypoglycemia and full reversion of central nervous system symptoms. Mechanisms underlying hypoglycemic neuropathy are still poorly understood.