DISFUNÇÃO DOS CIRCUITOS CÓRTICO-ESTRIATO-TÁLAMO-CORTICAIS EM TRANSTORNOS NEUROPSIQUIÁTRICOS: TOC, TDAH E SÍNDROME DE TOURETTE
Palavras-chave:
Transtornos do Neurodesenvolvimento, Neurofisiologia, Doenças do Sistema NervosoResumo
Objetivo: Analisar as evidências sobre a participação dos circuitos córtico-estriato-tálamo-corticais no Transtorno Obsessivo-Compulsivo (TOC), Transtorno do Déficit de Atenção e Hiperatividade (TDAH) e síndrome de Tourette. Métodos: Realizou-se uma revisão integrativa da literatura nas bases PubMed e Scopus, incluindo estudos publicados em língua inglesa que utilizaram neuroimagem para investigar alterações estruturais, funcionais, microestruturais, neuroquímicas ou de conectividade relacionadas a esses circuitos nos transtornos selecionados. Os estudos foram organizados segundo transtorno, regiões cerebrais, modalidade de investigação e associações clínicas. Devido à heterogeneidade das amostras, técnicas e desfechos, realizou-se síntese narrativa. Resultados e Discussão: Foram incluídos 18 estudos, com predomínio de investigações sobre TOC. O estriado foi a estrutura mais recorrente, associado a alterações no córtex pré-frontal, cíngulo, tálamo, amígdala e ínsula. No TOC, destacaram-se alterações córtico-estriatais e límbicas associadas à gravidade dos sintomas e, em alguns estudos, à resposta ao tratamento. Na síndrome de Tourette, predominaram alterações em conexões motoras, pré-frontais, estriatais, pálidas e talâmicas relacionadas à gravidade dos tiques e a manifestações psiquiátricas. No TDAH, os achados envolveram núcleo accumbens, sistema de recompensa e redes de modo padrão, saliência e controle frontoparietal. Conclusão: Os transtornos apresentaram alterações em componentes dos circuitos córtico-estriato-tálamo-corticais, mas a sobreposição identificada foi descritiva e não permite inferir mecanismo comum. Estudos longitudinais, multimodais e com amostras maiores, especialmente em quadros comórbidos, são necessários.
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