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Objective: We investigated the effects of 5 days of spa therapy on the glycation reaction and oxidative balance defense system. Subjects: The subjects were divided into a glucose spikes group (S group: 5 cases) and non-glucose spike group (non-S group: 6 cases), and a comparative study was conducted. Method: The subjects stayed at the Inubosaki Onsen “Superb View Inubosaki Hotel” for 5 days and took spa baths twice a day for 20 min (balneotherapy). Before and after the baths, the degree of glycation was measured. Erythrocyte deformation by dark field microscope was classified into stages between 0 and 5, and the state of deformation and the levels of advanced glycation end products (AGEs) were measured. In addition, the oxidative stress (reactive oxygen metabolites, d-ROM), antioxidant power (biological antioxidant potential, BAP), and latent antioxidant capacity (BAP/d-ROM ratio) were also measured. Result: The red blood cell images before balneotherapy were worse in the S group, but there was no significant difference in the AGE values. There was also no significant difference between the two groups in terms of the oxidative balance defense system. A comparison before and after balneotherapy showed that the red blood cell images significantly improved from 3 (3-3) (median (IQR)) to 2 (1-2)°in the S group. Oxidative stress also significantly improved in group S from 342 (334-362) to 314 (303-345) CARR U. In the non-S group, the AGE value improved significantly from 0.52 (0.48-0.59) to 0.5 (0.43-053) a.u. There were no significant differences in the other items. Discussion: Changes in red blood cell images are considered to reflect changes in the early reactions of glycation, and AGEs may be evaluated as representing whole early and late reactions of glycation. In the S group, the early reaction improved, and in the non-S group, the entire glycative reaction was effective. Although the each mechanism of blood glucose to different, balneotherapy was shown to be effective in improving glycation.
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@#Prognosis refers to the development of possible “outcome” of disease i.e., survival in patient with cancer. Prognostic factors are characteristics of a particular patient that can be used to predict that patient’s eventual outcome i.e., patients with advanced TNM cancer stage may have lower probability of survival than those with less advance TNM cancer stage. Thus, prognosis is a prediction of the probable outcome of a disease based on a individual’s condition and the usual course of the disease as seen in similar situations. Family physicians are often asked by patients about the probable course of their disease, they need skills on how to inform patients about this.
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PrognosisABSTRACT
Abstract Communicating bad news is one of the most frequent activities in hospitals, for which some recommendations have been adapted to the needs within the coronavirus-2 disease (COVID-19) context. This document presents nine steps to deliver bad news (face to face or remotely) adapted to the COVID-19 context from two international protocols (SPIKES and GRIEV_ING). The importance of promoting physical and emotional self-care skills in health personnel is also described, as well as psychological first aid strategies to address the emotional response of the family member who receives the news. Finally, the limitations and advantages of the proposal should be considered.
Resumen La comunicación de malas noticias es una de las actividades más frecuentes en los hospitales dentro del contexto de la COVID-19. A pesar de su alta frecuencia, existen pocas recomendaciones adaptadas a las necesidades que el contexto de la COVID-19 demanda. Debido a lo anterior, en el presente escrito se presentan nueve pasos para dar malas noticias (cara a cara o por vía remota) de dos protocolos internacionales (SPIKES y GRIEV_ING) adaptados a las necesidades de transmisión de información de la COVID-19. Se describe también la importancia de promover habilidades de autocuidado físico y emocional en el personal de salud, así como estrategias de primeros auxilios psicológicos para el abordaje de la respuesta emocional del familiar que recibe la noticia. Finalmente, se deben considerar las limitaciones y ventajas de la propuesta.
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OBJECTIVES@#To study the difference in cognitive impairment between the children with benign childhood epilepsy with centrotemporal spikes (BECT) and attention deficit hyperactivity disorder (ADHD) and those with BECT or ADHD alone.@*METHODS@#A prospective study was performed on 80 children with BECT and ADHD, 91 children with BECT, and 70 children with ADHD , who were diagnosed with the diseases for the first time. Seventy children of the same age who underwent physical examination were enrolled as the healthy control group. Event-related potential P300, Wechsler Intelligence Scale for Children, and integrated visual and auditory continuous performance test were used to measure and compare each index between groups.@*RESULTS@#Compared with the healthy control group, the BECT+ADHD group, the BECT group, and the ADHD group had a significantly prolonged P300 latency, a significant reduction in the amplitude of P300, and significant reductions in the scores of verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), processing speed index (PSI), full scale intelligence quotient (FSIQ), auditory response control quotient (ARCQ), visual response control quotient, full response control quotient (FRCQ), auditory attention quotient (AAQ), visual attention quotient, and full attention quotient (@*CONCLUSIONS@#Compared with the children with BECT or ADHD alone, the children with both BECT and ADHD have basically the same fields of cognitive impairment but a higher degree of cognitive impairment in some fields.
Subject(s)
Child , Humans , Attention Deficit Disorder with Hyperactivity , Cognitive Dysfunction/etiology , Epilepsy , Prospective Studies , Wechsler ScalesABSTRACT
Objective: We investigated the effects of 5 days of spa therapy on the glycation reaction and oxidative balance defense system. Subjects: The subjects were divided into a glucose spikes group (S group: 5 cases) and non-glucose spike group (non-S group: 6 cases), and a comparative study was conducted. Method: The subjects stayed at the Inubosaki Onsen “Superb View Inubosaki Hotel” for 5 days and took spa baths twice a day for 20 min (balneotherapy). Before and after the baths, the degree of glycation was measured. Erythrocyte deformation by dark field microscope was classified into stages between 0 and 5, and the state of deformation and the levels of advanced glycation end products (AGEs) were measured. In addition, the oxidative stress (reactive oxygen metabolites, d-ROM), antioxidant power (biological antioxidant potential, BAP), and latent antioxidant capacity (BAP/d-ROM ratio) were also measured. Result: The red blood cell images before balneotherapy were worse in the S group, but there was no significant difference in the AGE values. There was also no significant difference between the two groups in terms of the oxidative balance defense system. A comparison before and after balneotherapy showed that the red blood cell images significantly improved from 3 (3-3) (median (IQR)) to 2 (1-2)° in the S group. Oxidative stress also significantly improved in group S from 342 (334-362) to 314 (303-345) CARR U. In the non-S group, the AGE value improved significantly from 0.52 (0.48-0.59) to 0.5 (0.43-053) a.u. There were no significant differences in the other items. Discussion: Changes in red blood cell images are considered to reflect changes in the early reactions of glycation, and AGEs may be evaluated as representing whole early and late reactions of glycation. In the S group, the early reaction improved, and in the non-S group, the entire glycative reaction was effective. Although the each mechanism of blood glucose to different, balneotherapy was shown to be effective in improving glycation.
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Benign childhood epilepsy with centrotemporal spikes (BECT) is the most common childhood idiopathic focal epilepsy and used to be considered as one of the childhood epilepsy syndromes with the best prognosis. In recent years, more and more studies have found that patients with BECT have varying degrees of cognitive dysfunction. This article reviews some of research progresses in the clinical features, neuropsychology and neuroimaging of patients with BECT, in order to explore the effects of seizures, age of onset, interictal discharges, changes of brain structure and functional network, as well as antiepileptic drugs on cognitive function in patients with BECT.
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INTRODUÇÃO: A Síndrome da Imunodeficiência Adquirida (AIDS) é a apresentação clínica de deficiência imunológica ocasionada pelo Vírus da Imunodeficiência Humana (HIV). A revelação deste diagnóstico é uma comunicação que afeta profundamente a vida das pessoas envolvidas tanto profissionais quanto pacientes. OBJETIVO: Este estudo tem o objetivo de analisar a revelação do diagnóstico de HIV/Aids, considerando seus impactos psicossociais, afetivos e neurocognitivos. MÉTODOS: Para compreender o processo comunicacional foram utilizados estudos de saúde coletiva e os impactos psicológicos, foram analisados à luz dos conceitos psicanalíticos de Donald Winnicott. A metodologia é de caráter exploratório e descritivo, com abordagem mista e predomínio qualitativo. Os instrumentos de coleta dos dados foram: prontuário do paciente; entrevista semiestruturada, que cotejou etapas do Protocolo SPIKES; o Mini Exame do Estado Mental e a Escala Hospitalar de Ansiedade e Depressão. Foi realizada a análise de conteúdo em dez entrevistas, referenciada em Laurence Bardin. RESULTADOS E CONSIDERAÇÕES FINAIS: Os resultados mostraram que a comunicação do diagnóstico apresentou diversos impactos psicossociais nos sujeitos e o acolhimento balizado pelos princípios do protocolo SPIKES demonstrou ser um excelente alicerce para a comunicação diagnóstica, principalmente, quando associado a arranjos ambientais suficientemente bons, tais como apoio familiar e acesso à informação, promovendo assim, maior adesão ao tratamento.
INTRODUCTION: Acquired Immunodeficiency Syndrome (AIDS) is the clinical presentation of immunological deficiency caused by the Human Immunodeficiency Virus (HIV). The disclosure of this diagnosis is a communication that deeply affects the lives of the people involved, both professionals and patients. OBJECTIVE: This study aims to analyze the disclosure of the HIV / AIDS diagnosis, considering its psychosocial, affective and neurocognitive impacts. METHODS: To understand the communicational process, collective health studies were used and psychological impacts were analyzed in the light of Donald Winnicott's psychoanalytic concepts. The methodology is exploratory and descriptive, with a mixed approach and a qualitative predominance. The instruments for data collection were: patient record; semistructured interview, which compared stages of the SPIKES Protocol; the Mini Mental State Examination and the Hospital Anxiety and Depression Scale. Content analysis was carried out in ten interviews, referenced in Laurence Bardin. RESULTS AND FINAL CONSIDERATIONS: The results showed that the communication of the diagnosis had several psychosocial impacts on the subjects and the reception based on the principles of the SPIKES protocol proved to be an excellent foundation for diagnostic communication, especially when associated with sufficiently good environmental arrangements, such as family support and access to information. thus promoting greater adherence to treatment.
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HIV , Social Change , DiagnosisABSTRACT
OBJECTIVE: To study the clinical characteristics of epileptic patients with synchronous occipital and frontopolar spikes phenomenon. METHODS: The clinical data,EEG features of patients with synchronous occipital and frontopolar spikes phenomenon were retrospectively reviewed. RESULTS: Totally 34 male and 21 female patients had synchronous occipital and frontopolar spikes. Ages at the time of recording the synchronous occipital and frontopolar spikes phenomenon ranged from 2 years 6 months to 14 years with the median age of 6 years 6 months. In the total 55 patients,12 patients had contralateral synchronous discharges,12 patients had ipsilateral synchronous,17 patients had bilateral synchronous discharges,7 patients had bilateral synchronous discharges tending to contralateral synchronously,and 7 patients had bilateral synchronous discharges tending to ipsilateral synchronously. Occipital preceded frontopolar discharges in 42 patients. Frontopolar preceded occipital discharges in 3 patients. The phase difference between the occipital and frontopolar spikes could not be distinguished in 10 patients. Based on the etiology and diagnoses,there was Panayiotopoulos syndrome in 33 patients,epilepsy with structural abnormality in 13 patients,secondary epilepsy due to immune encephalitis in 1 patient,epilepsy accompanied by inborn error of metabolism in 2 patients and epilepsy with unknown etiology in 6 patients. CONCLUSION: The synchronous occipital and frontopolar spikes phenomenon usually appears during childhood or develops from other discharge patterns in infancy stage. The synchronous occipital and frontopolar spikes phenomenon can be ipsilateral synchronous or contralateral synchronous discharges. The occipital spikes preceded frontopolar spikes in most patients. The synchronous occipital and frontopolar spikes phenomenon is mostly found in Panayiotopoulos syndrome,but it is also found in epilepsy with different etiologies.
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Objective@#To investigate the electroclinical findings in epilepsy children with epileptic negative myoclonus (ENM) restricted to the lower limb as the first seizure type.@*Methods@#Each retrieved electroencephalogram record performed between March 2011 and March 2018 at the Department of Pediatrics of Peking University First Hospital was searched with "midline" . There were 302 records of 175 patients with "benign" or "functional" midline spikes. A retrospective review of each patient′s hospital record was performed. Thirteen patients had ENM restricted to the lower limb as the first seizure type. The clinical and electroencephalogram characteristics of them were analyzed.@*Results@#Thirteen patients manifested ENM restricted to the lower limb as the first seizure type, diagnosed as benign childhood focal epilepsy with vertex spikes (BEVS). Six patients had ENM as the first and only seizure type during the short-time follow-up. Among them, there were 1 male and 5 females. The age at seizure onset was (2.5±0.7) years. One of them had electrical status epilepticus during sleep (ESES) identified on electroencephalogram at theage of 4 years and 8 months. The last follow-up age was (3.8±1.5) years. The remaining 7 patients developed nocturnal focal motor seizures. Among them, there were 4 males and 3 females. The age at seizure onset was (3.5±0.7) years. Two of them were diagnosed as BEVS evolving into benign childhood epilepsy with centrotemporal spikes (BECTS) and 5 were diagnosed as BEVS concurring with BECTS. The age at focal seizures was (4.1±0.6) years. The interval ranged from 1 month to 1 years. Six of 7 patients had electrical ESES with the age of (5.2±1.0) years. All had developmental regression, further diagnosed as atypical benign partial epilepsy (ABPE). The median age at last follow-up was 5.9 years. Five of 13 patients had repeated electroencephalogram records at our apartment, showing that epileptiform discharges in midline regions were significantly reduced either in frequency or amplitude with the improvement of ENM restricted to the lower limb and that independent epileptiform discharges in Rolandic regions from midline regions were noticed with the onset of nocturnal focal seizures.@*Conclusions@#ENM restricted to the lower limb has a close association with vertex (midline) epileptiform discharges. ENM restricted to the lower limb as the first seizure type is a peculiar phenomenon of BEVS. Some patients could evolve into BECTS or overlap with BECTS, and further into ABPE. The age of seizure onset in BEVS with ENM restricted to the lower limb as the first symptom is a little earlier than in BECTS. Ignorance of the close association between midline spikes and ENM restricted to the lower limb may lead to misdiagnosis of these patients.
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Objective To explore features and relevant factors affecting the ecological executive function in benign epilepsy children with centrotemporal spikes(BECT). Methods The behavior rating in-ventory of executive function (BRIEF) parental questionnaires were used to evaluate the executive function of 50 children with BECT (BECT group) and 50 normal children (control group) matched with BECT group (sex,age,education years). The differences of ecological executive function between the two groups were compared. Results (1)In BECT group,the scores of global executive composite (GEC),behavioral regula-tion index (BRI) and metacognition index (MI) ((51. 64±10. 30),(49. 02±8. 98),and (52. 78±10. 92), respectively) were significantly higher than those of the control group ((45. 70± 6. 55),(44. 96± 5. 35), (46. 72±6. 96),respectively,t=3. 440,2. 747,3. 309, all P<0. 05). Meanwhile,in BECT group,inhibit ((49. 90±10. 62),initiate (51. 76±11. 90),and working memory index scores (55. 58±10. 95) were also higher than those of the control group (44. 94± 6. 05,43. 74± 7. 63,47. 54± 7. 15,respectively,t=2. 870, 4. 014,4. 345, all P<0. 05). ( 2) Patients' condition had a negative predictive effect on inhibition ( β= -8. 926,P=0. 002),BRI ( β=-5. 422, P=0. 025), working memory ( β=-4. 980, P=0. 008), MI ( β=-4. 962,P=0. 034)and total score of scale( β=-6. 164,P=0. 004); attack times had a positive predictive effect on BRI(β=2. 555,P=0. 002),task initiation( β=7. 471,P<0. 01),working memory(β=5. 384,P<0. 01),MI (β=4. 726,P<0. 01) and total score of scale(β=4. 221,P<0. 01). Conclusion Children with BECT have ecological executive dysfunction. The number of epileptic seizures and the control of the disease are the main factors affecting the ecological executive function.
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La epilepsia benigna con puntas centrotemporales o rolándicas se caracteriza por crisis parciales motoras en la infancia y un electroencefalograma en que observan descargas de puntas en las regiones centrotemporales medias. Ha sido reconocida como benigna, debido a la ausencia de déficits neurológicos evidentes; sin embargo, en los últimos años en la literatura médica internacional han aparecido varias publicaciones que cuestionan su evolución favorable. El objetivo de este trabajo es actualizar algunos criterios que no concuerdan con el buen pronóstico referido inicialmente. Representa una etapa fundamental en la historia de la epilepsia, debido a que es la primera vez que se describió una epilepsia focal o parcial en la que se presumía que no existía una lesión cortical subyacente. La evolución de esta forma de epilepsia puede mostrar elementos que niegan su benignidad. Se recomienda en un futuro efectuar en nuestro servicio un estudio que confirme los criterios expuestos en la literatura médica internacional(AU)
Benign epilepsy with centrotemporal spikes, aka benign rolandic epilepsy, is characterized by partial motor crisis in childhood and electroencephalography showing point discharges in medial centrotemporal regions. The condition has been recognized as benign due to the absence of evident neurological deficits. However, in recent years several publications have appeared in international medical literature in which its favorable evolution is questioned. The objective of the present study is to update some criteria differing from the good prognosis initially stated. It constitutes a fundamental stage in the history of epilepsy, since for the first time a case of focal or partial epilepsy was being described in which presumably there did not exist an underlying cortical lesion. The evolution of this form of epilepsy may display features denying its benignity. It is recommended that in the future a study be conducted in our service confirming the criteria expounded in international medical literature(AU)
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Humans , Child, Preschool , Child , Adolescent , Cognition Disorders/diagnostic imaging , Epilepsy, Rolandic/complications , Brain Diseases/complications , Multicenter Studies as Topic , Prospective StudiesABSTRACT
Objective To evaluate the risk factors for benign childhood epilepsy with centrotemporal spikes (BECT) complicated by electrical status epilepticus in sleep(ESES).Methods From January 2013 to January 2017,a total of 80 children diagnosed as BECT in pediatric neurology outpatient department of Provincial Clinical Medical College Affiliated to Fujian Medical University were enrolled.According to whether there was an attack of ESES or not,patients were divided into ESES group(38 cases) and non-ESES group(42 cases).In order to elucidate risk factors for BECT complicated by ESES,clinical data including age,gender,first seizure age,seizure frequency before treatment,types of seizure,therapeutic drug,recurrence of seizure after treatment,febrile seizure,status at birth,family history,brain MRI,discharge quantity,discharge location,and intelligence score were investigated by multivariate Logistic regression analysis.Results Compared with non-ESES patients,ESES patients were more likely to have recurrence of epilepsy after treatment (68.4％ vs 26.2％,P ＜ 0.001),and had worse intellectual development (＜ 90 scores;73.7％ vs 38.1％,P =0.001);while electroencephalogram showed more discharge in anterior location (47.4％ vs 21.4％,P =0.014) and bilateral distribution of brain (52.6％ vs 26.2％,P =0.015).However,the multivariate Logistic regression analysis showed that only recurrence of seizure after treatment was the risk factor for ESES in BECT patients(P=0.008,OR=4.039,95％CI:1.429-11.418).Conclusion Recurrence of seizure after treatment of BECT was a high risk factor for ESES.Controlling seizure and reducing ESES phenomenon could be beneficial to alleviate the intellectual impairment of patients with BECT.
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@#Objective: Dipole fit source (DFS) localisation is a non-invasive imaging process used to identify the epileptogenic zone (EZ) in the brain. The purpose of the present study was to verify the use of DFS localisation for identifying the EZ in patients with and without lesions using magnetic resonance imaging (MRI). Methods: In this study, DFS localisation was used in 16 patients, of whom 7 had no lesions and 9 had lesions on MRI post-surgery, with at least 3 years of follow-up data. For DFS localisation, different scalp electroencephalogram (EEG) ictal activity was assessed (ictal spikes, rhythmic, paroxysmal fast, and obscured activity). DFSs were superimposed with postoperative MRIs to confirm the accuracy of the determined EZs. Results: The DFS correctly identified EZ localization within the resection area in 14 of the 16 patients. These 14 patients were all seizure free after surgery. The two remaining patients, in whom the DFS was adjacent to the resected area, had a decreased seizure frequency following surgery.Conclusions: DFSs determined during preoperative evaluations can provide information on EZ lateralisation and localisation and contribute to the presurgical decision process. Thus, the accurate identification of EZ boundaries is important and can be achieved more reliably with the use of multiple quantitative EEG analysis methods.
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BACKGROUND AND PURPOSE: This study is to assess the responsiveness of electroencephalography (EEG) abnormalities and their effects on language ability after initiating different types of antiepileptic therapy in children with newly diagnosed benign epilepsy of childhood with centrotemporal spikes (BECTS). METHODS: The records of patients newly diagnosed with BECTS (n=120; 69 males) were reviewed retrospectively. The patients were randomly treated with lamotrigine, oxcarbazepine, or topiramate monotherapy, and underwent at least two EEG and standardized language tests. Effects were compared using Pearson’s chi-square tests and paired t-tests. RESULTS: The recurrence rates for seizures in the lamotrigine, topiramate, and oxcarbazepine groups were 19.4%, 21.7%, and 11.4%, respectively, while complete or partial recovery (as indicated by EEG) occurred in 32%, 39%, and 16% of the patients. Patients in the lamotrigine group showed significant improvements in all parameters assessed by the Test of Language Problem Solving Abilities, except for ‘determining cause.’ Patients in the oxcarbazepine group also showed improvements, except for ‘making inferences’ (p < 0.05). Most linguistic index scores were worse in the topiramate group except for Mean Length of Utterance in Words. Patients in the lamotrigine and oxcarbazepine groups showed significant improvements in the receptive language test (p < 0.05). EEG improvements were not related to language ability. CONCLUSIONS: The improvements in language and problem-solving performance in children with BECTS were greater for lamotrigine and oxcarbazepine than for topiramate. However, EEG remission did not imply that language function would be improved after the treatments.
Subject(s)
Child , Humans , Anticonvulsants , Electroencephalography , Epilepsy , Epilepsy, Rolandic , Language Tests , Language , Linguistics , Problem Solving , Recurrence , Retrospective Studies , SeizuresABSTRACT
Objective To investigate the theory of mind ( TOM) and eye basic emotion recognition in benign epilepsy children with centrotemporal spikes( BECT) . Methods Totally 51 BECT patients( BECT group) and 51 healthy controls( control group) were studied by Yoni task and Eye Basic Emotion Discrimi-nation Task (EBEDT). Results ①Compared with healthy controls,BECT got significantly lower score ((54. 02±6. 03) vs (58. 04±5. 41),F(1,100)=10. 34,P<0. 05))in Yoni task,especially in affective(hot) TOM .②There was no significant difference between the BECT group(M(P25,P75):103(96,108)) and the control group(M(P25,P75):105(96,110))in the total score of Eye Basic Emotion Discrimination Task(Z=-1. 37,P>0. 05),but got significantly lower score in recognizing sadness(M(P25,P75):16(14,17) vs 18 (15,19),Z=-3. 05,P<0. 05)and fear(M(P25,P75):15(14,17) vs 16(16,18),Z=-2. 21,P<0. 05).③Pearson or Spearman correlation analysis showed that there was no significant correlation between the total score of TOM and the age,age of onset, education,seizure total number,MMSE,the Digital Span test, the verbal fluency test and eye basic emotion recognition ( r=-0. 257-0. 908,all P>0. 05) . Conclusion BECT children have impairments in sadness and fear emotion recognition and TOM aspects.
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La Epilepsia Rolándica (ER) o Epilepsia con espigas centrotemporales, es la epilepsia idiopática más frecuente, focal autolimitada, de buena evolución. Debuta entre los 3 a 13 años, con crisis estereotipadas durante el sueño, al inicio o al despertar, focales motoras y somatosensoriales. El electroencefalograma (EEG) muestra una base normal con actividad epileptiforme interictal centrotemporal, con espigas con escaso desarrollo de onda lenta, uni o bilaterales. Se describe en los últimos años una forma atípica de ER (ERA), asociando otros tipos de crisis, que responden peor a tratamiento, manteniendo crisis, con complicaciones neuropsicológicas asociadas y deterioro del EEG, observándose en algunos casos, actividad, continua o casi continua en sueño. El objetivo de este trabajo es caracterizar a los pacientes con ER que se controlan en Red Salud UC-Christus y describir la presencia de posibles factores de riesgo asociados a la evolución atípica de la ER. 16 pacientes con ER típica y otros 6 con ERA, ambos grupos edad promedio 6 años al debut presentación, de predominio sexo masculino, la mayoría con buen rendimiento escolar y examen neurológico normal. En ER, crisis de predominio focales y base de EEG 62% normal. EEG entre ocasional y muy frecuentes descargas epileptiformes. En ERA, solo un 33% base normal, y predominio crisis generalizadas. Mayoría evoluciona con descargas EEG contínuas o casi continuas en sueño No-REM. Hubo peor respuesta a FAEs en ERA. Concluimos que este estudio es concordante con lo descrito en la literatura actual para pacientes con ER y ERA, por lo que recomendamos considerar la presencia de posibles factores indicadores, iniciales o durante la evolución, de formas atípicas de ER. Palabras Clave: Epilepsia Rolándica, Epilepsia Rolándica atípica, Factores de riesgo de evolución atípica, Espigas centrotemporales, Crisis epilépticas focales.
Abstract: Rolandic Epilepsy (ER) or epilepsy with centrotemporal spikes, is a focal and selflimited epilepsy and it is the most frequent and well-recognized idiopathic epilepsy. It is characterized by an age of presentation between 3 and 13 years, with stereotyped seizures during sleep, at the beginning or on awakening, which can be focal, motor and sensory. The electroencephalogram shows a normal base with interictal epileptiform activity, centrotemporal spikes with poor slow wave development, which can be unilateral o bilateral. In recent years, an atypical presentation of Rolandic Epilepsy (ERA) has been described, with presence of other types of seizures, with poor response to treatment, continued seizures and asso- ciated neuropsychological complications and deterioration of the electroencephalogram, in some cases with continuous or almost continuous activity during sleep. Our work aims to characterize the patients that are controlled in the Red Salud UC-Christus and to describe the presence of possible risk factors associated with the atypical evolution of Rolandic Epilepsy. We studied 16 patients with typical ER and other 6 with ERA, both groups with an age average of 6 years at time of debut presentation, more frequent in males, most with good school performance and normal neurological examination. In ER there were focal prevalence seizures and 62% had an EEG with a normal base. The EEG showed occasional to very frequent epileptiform discharges. In ERA, only 33% of the EEG had a normal base, and it most frequently showed generalized seizure. Most of the patients followed up with continuous or nearly continuous discharges in the EEG during REM sleep. There was worse response to FAEs in ERA. We conclude that this study is consistent with that described in the current literature for patients with ER and ERA, we recommend physicians to consider the presence of possible initial of belated indicators of atypical forms of ER.Key words: Rolandic Epilepsy, atypical Rolandic Epilepsy, risk factors of atypical evolution, centrotemporal spikes, focal seizures.
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Estudo quase experimental, com grupo de intervenção avaliado antes e após o procedimento, com o objetivo de capacitar os profissionais da saúde para as situações de comunicação de más notícias aos pacientes e aos seus familiares, por meio de um curso de difusão gratuito, com duração de cinco horas. Participaram 79 profissionais da saúde, entre enfermeiros, estudantes de enfermagem, biólogos, farmacêuticos, estudantes de medicina, psicólogos, assistentes sociais e terapeutas ocupacionais. Foram utilizados como instrumentos de pesquisas: 1) o questionário Breaking Bad News sobre o protocolo SPIKES, que possui 13 questões objetivas. Este questionário foi analisado pela distribuição da porcentagem de respostas para cada questão; 2) o questionário de avaliação do curso de más notícias composto por 43 questões objetivas. Para a análise das variáveis quantitativas foram utilizadas as médias e as medianas para resumir as informações, e os desvios-padrão, mínimo e máximo, para indicar a variabilidade dos dados, além da porcentagem. A comparação entre as pontuações dos participantes na primeira e na segunda avaliação de habilidades de comunicação foi realizada pelo teste estatístico de McNemar. O teste estatístico não paramétrico Mann-Whitney foi utilizado para comparar a relação entre a idade dos participantes e as respostas do questionário de avaliação do curso de más notícias. A comparação entre a idade e a pontuação total dos participantes na avaliação de conteúdo do curso foi feita pelo coeficiente de correlação de Spearman. Para todos os testes assumiu-se o nível de significância em 5%. A idade dos participantes variou entre 18 e 55 anos, sendo a maioria do sexo feminino (83,5%) e da área da enfermagem (53,2% profissionais e 24,1% estudantes). Ademais, 57% dos participantes nunca tiveram qualquer formação sobre transmissão de más notícias, porém mesmo após este curso, oito pessoas continuaram afirmando que não tiveram formação alguma. A autoavaliação da capacidade de informar uma má notícia no pré-teste foi considerada boa por 18,2%; 20,8% consideraram-se ruins e 6,5%, péssimos, enquanto que o pós-teste 42,8% consideraram-se bons, 11,7%, ruins e 2,6%, péssimos. O conforto do profissional neste momento variou de 21,8% para 7,7% no item absolutamente desconfortável, e de 6,4% para 14,1% no item confortável. Após o conhecimento sobre o protocolo SPIKES, 92,3% acreditam em sua aplicabilidade na prática clínica.Quanto à estratégia utilizada pelos entrevistados em sua prática clínica, o item mostrou que "um plano ou estratégia consistente" apresentou frequências de 21,9% no pré-teste e 51,56% no pós-teste. Os elementos do protocolo SPIKES apontados como de maiores facilidades entre os participantes no pré-teste foi o local da notícia e a verificação da compreensão de tudo o que foi dito, 30,6% e 28,6%, ao passo que no pós-teste o item mais escolhido foi a escolha do ambiente (53,06%). A relação entre idade e conhecimento do protocolo SPIKES teve apenas um item que apresentou significância. Concluiu-se, portanto, que o treinamento de habilidades de comunicação de más notícias atingiu seus objetivos melhorando o conhecimento e a aptidão dos profissionais da saúde. Evidenciou-se também que a educação em comunicação na área da saúde mantém-se falha, bem como é escassa a difusão de protocolos que abarquem esta difícil tarefa destinada aos profissionais da saúde. O pós-teste mostrar-se-ia mais eficaz caso fosse aplicado após o retorno dos profissionais aos seus pacientes e o uso das técnicas apreendidas. Sugerimos a adoção de educação permanente aos atuantes na área da saúde
A quasi-experimental study with an intervention group evaluated before and after the procedure, in order to enable health professionals to communicate bad news to patients and their families through a free course of five hours duration. We evaluated 79 health professionals, including nurses, nursing students, biologists, pharmacists, medical students, psychologists, social workers and occupational therapists. The following research tools were used: 1) the Breaking Bad News questionnaire about the SPIKES protocol, which has 13 objective questions. This questionnaire was analyzed by the distribution of the percentage of answers for each question; 2) the evaluation questionnaire of the course of bad news composed by 43 objective questions. For the quantitative analysis we used the means and the medians to summarize the information, and the standard deviations, minimum and maximum to indicate the variability of the data, besides the percentage. The comparison between the scores of participants in the first and second evaluation of communication skills was performed by the McNemar statistical test. The Mann-Whitney non-parametric statistical test was used to compare the relationship between the age of the participants and the responses of the evaluation questionnaire of the course of bad news. The comparison between the age and the total score of the participants in the evaluation of course content was made by the Spearman correlation coefficient. For all tests, the level of significance was set at 5%. The participants' ages ranged from 18 to 55 years old, with most females (83.5%) and nursing (53.2% professionals and 24.1% students). In addition, 57% of the participants never had any training on the transmission of bad news, but even after this course, eight people continued to claim that they had no training. The self-reported ability to report bad news in the pre-test was considered good by 18.2%; 20.8% were considered bad and 6.5% were poor, while the post-test 42.8% were considered good, 11.7%, bad and 2.6% Lousy. The comfort of the professional at the time ranged from 21.8% to 7.7% on the uncomfortable item and from 6.4% to 14.1% on the comfortable item. After knowing about the SPIKES protocol, 92.3% believe in its applicability in clinical practice. Regarding the strategy used by the interviewees in their clinical practice, the item showed that "a consistent plan or strategy" presented frequencies of 21.9% in the pre-test and 51.56% in the post-test. The elements of the SPIKES protocol identified as greatest facilities among participants in the pre-test were the news site and the verification of the understanding of all that was said 30.6% and 28.6%, while in the post-test the most chosen item was the choice of the environment (53.06%). The relationship between age and knowledge of the SPIKES protocol had only one item that presented significance. It was concluded, therefore, that communication education in the health area remains flawed, as well as the dissemination of protocols that cover this difficult task for health professionals. The post-test would be more effective if it were applied after the return of the professionals to their patients and the use of the seized techniques. We suggest the adoption of permanent education to those in the health area
Subject(s)
Humans , Health Personnel/education , Interdisciplinary Communication , Education, Continuing , Health CommunicationABSTRACT
Estudo quase experimental, com grupo de intervenção avaliado antes e após o procedimento, com o objetivo de capacitar os profissionais da saúde para as situações de comunicação de más notícias aos pacientes e aos seus familiares, por meio de um curso de difusão gratuito, com duração de cinco horas. Participaram 79 profissionais da saúde, entre enfermeiros, estudantes de enfermagem, biólogos, farmacêuticos, estudantes de medicina, psicólogos, assistentes sociais e terapeutas ocupacionais. Foram utilizados como instrumentos de pesquisas: 1) o questionário Breaking Bad News sobre o protocolo SPIKES, que possui 13 questões objetivas. Este questionário foi analisado pela distribuição da porcentagem de respostas para cada questão; 2) o questionário de avaliação do curso de más notícias composto por 43 questões objetivas. Para a análise das variáveis quantitativas foram utilizadas as médias e as medianas para resumir as informações, e os desvios-padrão, mínimo e máximo, para indicar a variabilidade dos dados, além da porcentagem. A comparação entre as pontuações dos participantes na primeira e na segunda avaliação de habilidades de comunicação foi realizada pelo teste estatístico de McNemar. O teste estatístico não paramétrico Mann-Whitney foi utilizado para comparar a relação entre a idade dos participantes e as respostas do questionário de avaliação do curso de más notícias. A comparação entre a idade e a pontuação total dos participantes na avaliação de conteúdo do curso foi feita pelo coeficiente de correlação de Spearman. Para todos os testes assumiu-se o nível de significância em 5%. A idade dos participantes variou entre 18 e 55 anos, sendo a maioria do sexo feminino (83,5%) e da área da enfermagem (53,2% profissionais e 24,1% estudantes). Ademais, 57% dos participantes nunca tiveram qualquer formação sobre transmissão de más notícias, porém mesmo após este curso, oito pessoas continuaram afirmando que não tiveram formação alguma. A autoavaliação da capacidade de informar uma má notícia no pré-teste foi considerada boa por 18,2%; 20,8% consideraram-se ruins e 6,5%, péssimos, enquanto que o pós-teste 42,8% consideraram-se bons, 11,7%, ruins e 2,6%, péssimos. O conforto do profissional neste momento variou de 21,8% para 7,7% no item absolutamente desconfortável, e de 6,4% para 14,1% no item confortável. Após o conhecimento sobre o protocolo SPIKES, 92,3% acreditam em sua aplicabilidade na prática clínica.Quanto à estratégia utilizada pelos entrevistados em sua prática clínica, o item mostrou que "um plano ou estratégia consistente" apresentou frequências de 21,9% no pré-teste e 51,56% no pós-teste. Os elementos do protocolo SPIKES apontados como de maiores facilidades entre os participantes no pré-teste foi o local da notícia e a verificação da compreensão de tudo o que foi dito, 30,6% e 28,6%, ao passo que no pós-teste o item mais escolhido foi a escolha do ambiente (53,06%). A relação entre idade e conhecimento do protocolo SPIKES teve apenas um item que apresentou significância. Concluiu-se, portanto, que o treinamento de habilidades de comunicação de más notícias atingiu seus objetivos melhorando o conhecimento e a aptidão dos profissionais da saúde. Evidenciou-se também que a educação em comunicação na área da saúde mantém-se falha, bem como é escassa a difusão de protocolos que abarquem esta difícil tarefa destinada aos profissionais da saúde. O pós-teste mostrar-se-ia mais eficaz caso fosse aplicado após o retorno dos profissionais aos seus pacientes e o uso das técnicas apreendidas. Sugerimos a adoção de educação permanente aos atuantes na área da saúde
A quasi-experimental study with an intervention group evaluated before and after the procedure, in order to enable health professionals to communicate bad news to patients and their families through a free course of five hours duration. We evaluated 79 health professionals, including nurses, nursing students, biologists, pharmacists, medical students, psychologists, social workers and occupational therapists. The following research tools were used: 1) the Breaking Bad News questionnaire about the SPIKES protocol, which has 13 objective questions. This questionnaire was analyzed by the distribution of the percentage of answers for each question; 2) the evaluation questionnaire of the course of bad news composed by 43 objective questions. For the quantitative analysis we used the means and the medians to summarize the information, and the standard deviations, minimum and maximum to indicate the variability of the data, besides the percentage. The comparison between the scores of participants in the first and second evaluation of communication skills was performed by the McNemar statistical test. The Mann-Whitney non-parametric statistical test was used to compare the relationship between the age of the participants and the responses of the evaluation questionnaire of the course of bad news. The comparison between the age and the total score of the participants in the evaluation of course content was made by the Spearman correlation coefficient. For all tests, the level of significance was set at 5%. The participants' ages ranged from 18 to 55 years old, with most females (83.5%) and nursing (53.2% professionals and 24.1% students). In addition, 57% of the participants never had any training on the transmission of bad news, but even after this course, eight people continued to claim that they had no training. The self-reported ability to report bad news in the pre-test was considered good by 18.2%; 20.8% were considered bad and 6.5% were poor, while the post-test 42.8% were considered good, 11.7%, bad and 2.6% Lousy. The comfort of the professional at the time ranged from 21.8% to 7.7% on the uncomfortable item and from 6.4% to 14.1% on the comfortable item. After knowing about the SPIKES protocol, 92.3% believe in its applicability in clinical practice. Regarding the strategy used by the interviewees in their clinical practice, the item showed that "a consistent plan or strategy" presented frequencies of 21.9% in the pre-test and 51.56% in the post-test. The elements of the SPIKES protocol identified as greatest facilities among participants in the pre-test were the news site and the verification of the understanding of all that was said 30.6% and 28.6%, while in the post-test the most chosen item was the choice of the environment (53.06%). The relationship between age and knowledge of the SPIKES protocol had only one item that presented significance. It was concluded, therefore, that communication education in the health area remains flawed, as well as the dissemination of protocols that cover this difficult task for health professionals. The post-test would be more effective if it were applied after the return of the professionals to their patients and the use of the seized techniques. We suggest the adoption of permanent education to those in the health area
Subject(s)
Health Personnel , Physician-Nurse Relations , Interdisciplinary CommunicationABSTRACT
Objective To investigate the ability of decision-making under risk condition in benign epilepsy children with centrotemporal spikes (BECT).Method Seventy-eight BECT patients and seventyfive healthycontrols were studied by Iowa Gambling Task (IGT) with inexplicit probability and Game of Dice Test (GDT) with explicit probability.Results (1) There was a significant difference in IGT task scores between the two group (t=-2.56,P＜0.05).The total number of advantageous choices in IGT were lower in BECT group (49.35±5.38) than that in healthy control group (52.24±6.23).BECT group (-1.41 ± 10.60) performed worse on task than healthy control group (4.43±11.88),and the difference was statistically significant (t=-3.21,P＜0.05).The control group scored higher on Blockl,Block4 and Block5 than that of BECT group (P＜0.05).(2) There was no significant difference between the BECT group (4.42±7.74) and the control group(5.49±6.81) in the GDT test scores (t=-0.91,P=0.37).(3) Pearson correlation analysis showed that there was no significant correlation between the age,age of onset,education,seizure frequency and onset duration and the score of IGT and GDT (r =-0.091-0.274,all P ＞ 0.05).Conclusion There is no significant decision-making disability in children with BECT under the condition of certain risk probability,while there is significant impairment under the condition of uncertain risk probability.The decision-making disability may be associated with impaired frontal lobe function.
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Data from magnetoencephalography (MEG) and electroencephalography (EEG) suffer from a rather limited signal-to-noise-ratio (SNR) due to cortical background activities and other artifacts. In order to study the effect of the SNR on the size and distribution of dipole clusters reconstructed from interictal epileptic spikes, we performed simulations using realistically shaped volume conductor models and extended cortical sources with different sensor configurations. Head models and cortical surfaces were derived from an averaged magnetic resonance image dataset (Montreal Neurological Institute). Extended sources were simulated by spherical patches with Gaussian current distributions on the folded cortical surface. Different patch sizes were used to investigate cancellation effects from opposing walls of sulcal foldings and to estimate corresponding changes in MEG and EEG sensitivity distributions. Finally, white noise was added to the simulated fields and equivalent current dipole reconstructions were performed to determine size and shape of the resulting dipole clusters. Neuronal currents are oriented perpendicular to the local cortical surface and show cancellation effects of source components on opposing sulcal walls. Since these mostly tangential aspects from large cortical patches cancel out, large extended sources exhibit more radial components in the head geometry. This effect has a larger impact on MEG data as compared to EEG, because in a spherical head model radial currents do not yield any magnetic field. Confidence volumes of single reconstructed dipoles from simulated data at different SNRs show a good correlation with the extension of clusters from repeated dipole reconstructions. Size and shape of dipole clusters reconstructed from extended cortical sources do not only depend on spike and timepoint selection, but also strongly on the SNR of the measured interictal MEG or EEG data. In a linear approximation the size of the clusters is proportional to the inverse SNR.