ABSTRACT
Objetivos: O tratamento inicial de pacientes com epilepsia do lobo temporal é feito com drogas antiepilépticas, porém grande parte destes apresenta epilepsia refratária aos medicamentos e, portanto, devem ser avaliados para cirurgia de ressecção. Para tanto, este artigo fornece informações para avaliação cirúrgica e uma análise do tratamento cirúrgico nestes casos refratários da doença. Métodos: As buscas foram realizadas na base de dados MEDLINE. A estratégia de busca foi desenvolvida utilizando-se os seguintes termos de pesquisa: "temporal lobe epilepsy" AND "epilepsy surgery". Cada termo foi revisado individualmente e sinônimos de cada termo foram combinados. Os critérios de elegibilidade foram estudos realizados em humanos e com texto disponível, publicados em português ou inglês, atualizado. Resultados: De um total de 1330 artigos que foram encontrados na base de dados, 6 artigos foram incluídos nessa revisão, além das referências de livros-texto do tema. Conclusões: Surgical evaluation requires the identification of the early focus of seizures, and if that focus is in an area of the brain that can be removed with a low risk of new neurological deficits. The surgical treatment has been shown to be beneficial, allowing potentially curative ducts in patients who previously would be resistant to pharmacological treatment.
Aims: The initial treatment of patients with temporal lobe epilepsy is made with antiepileptic drugs, but a large part of these presents refractory to drugs and therefore should be evaluated for resection surgery. For both, this article provides information for surgical evaluation and an analysis of surgical treatment in these cases of refractory disease. Methods: The searches were conducted on MEDLINE database. The search strategy was developed using the following search terms: "temporal lobe epilepsy" AND "epilepsy surgery". Each term has been reviewed individually and each term synonyms were combined. The eligibility criteria were studies in humans and with text available, published in Portuguese or English, updated. Results: From 1330 articles found in the database, 6 articles were included in this review, in addition to the references to textbooks. Conclusions: Surgical evaluation requires the identification of the early focus of seizures, and if that focus is in an area of the brain that can be removed with a low risk of new neurological deficits. The surgical treatment has been shown to be beneficial, allowing potentially curative ducts in patients who previously would have been by the failure of chronic drug therapy.
Subject(s)
Epilepsy, Temporal Lobe/surgery , Epilepsy, Temporal Lobe/drug therapyABSTRACT
Objetivos: Pretende-se contextualizar o surgimento e implementação dos Sistemas de Resposta Rápida (SRR) em hospitais terciários, trazendo aspectos históricos e organizacionais, com uma visão geral da composição e funcionamento dos SRRs, explicando a estrutura em braços de atuação (o braço aferente que identifica pacientes em risco e o braço eferente (conhecido como time de resposta rápida) que atua para melhorar o desfecho deste paciente). Aborda-se ainda o contexto regional, com uma apresentação da experiência de centros nacionais e as dificuldades de implementação. Métodos: as buscas basearam-se em duas plataformas, PubMed (NCBI) e Google Scholar. Focou-se em artigos publicados nos últimos 5 anos e utilizou-se tanto palavras chave em inglês quanto em português. As buscas foram realizadas em maio de 2018. Resultados: a busca revelou que ainda existe muita discordância na literatura sobre o SRR, existindo poucos estudos randomizados controlados, o que dificulta a elaboração de metanálises sobre o tema, apesar de os estudos mais recentes identificarem impactos positivos dos SRRs tanto em mortalidade quanto em organização hospitalar. Conclusões: apesar de ainda não existir uma unanimidade na literatura sobre todos os aspectos do SRR, existem dados de redução de desfechos negativos e de melhoria da assistência ao paciente crítico. Discutimos ainda a implementação do SRR no Brasil e boa evidência de sucesso.
Objective: This article intends to bring to light the context of the onset and implementation of the Rapid Response System (RRS) in tertiary hospitals around the globe, presenting historic and organizational aspects. We also present the arms structure of the SRR actuation (the afferent arm that is responsible for identifying at risk patients and the efferent or effector arm (best known as the rapid response team (RRT)) that acts to improve the patient outcome). This text was based on the most recent studies in the literature and in classics texts of the area. Our objective is to present a general vision of the composition and the operation of the RRS, besides the impact on the routine in the hospital. We also discuss the national context by presenting the experience in regional centers and the difficulties of RRS implementation. Methods: searches were conducted using two platforms, PubMed (NCBI) and Google Scholar. We focused on articles published in the last 5 years and both English (total of 984 articles) and Portuguese (total of 82 articles) keywords were used. Searches were conducted on May 2018. Results: our research revealed that there is still much disagreement in the literature regarding RRT, with few randomized case control studies, which dificults the elaboration of meta-analysis upon the subject, although some recent studies show positive impact of RRS both on mortality rates and hospital organization. Conclusions: although there is no unanimity in the literature about all of the aspects of RRS, recent data reveals benefits regarding reduction of negative outcomes and assistance for the critical patients . We found discrepancies between RRT's formats and discussed its implications in the assistential context. We also present articles that support the implementation of this system in Brazilian hospitals with a good success expectancy.