ABSTRACT
RESUMO Objetivo Analisar percepções de pessoas com epilepsia acerca da doença e seu impacto na qualidade de vida. Método Trata-se de um estudo qualitativo e quantitativo de corte transversal realizado em hospital de referência terciária, vinculado ao Sistema Único de Saúde. Participaram do estudo 30 pessoas com o diagnóstico de epilepsia de lobo temporal refratária. Foi aplicado questionário para a coleta dos dados sociodemográficos e clínicos, bem como das percepções acerca da doença. Avaliou-se a qualidade de vida por meio do Subjective Handicap of Epilepsye e o estigma pela Escala Estigma na Epilepsia. Resultados Foi encontrada significância na relação entre estigma e qualidade de vida com os domínios trabalho e social/pessoal, entre estigma e percepções sobre a epilepsia. As respostas fornecidas pelos participantes foram organizadas em quatro categorias: definições e causas; crises e tratamento; impacto familiar e social; impacto na vida das pessoas. Conclusão Evidenciou-se o predomínio do conhecimento restrito dos participantes acerca da epilepsia e o impacto negativo que o estigma relacionado a tal doença acarreta na qualidade de vida. Pode-se verificar que a qualidade de vida e o estigma estão diretamente relacionados ao conhecimento dos participantes sobre a epilepsia. Ressalta-se a necessidade do implemento de programas e ações que objetivem: proporcionar maior conhecimento sobre a epilepsia por parte do paciente e de seus familiares; favorecer a comunicação entre os profissionais de saúde e as PCEs; promover a participação do paciente e de seus familiares na gestão do tratamento.
ABSTRACT Purpose The present study aims to analyze the perceptions of individuals with epilepsy about the disease and its impact in their quality of life (QoL). Methods This is a cross-sectional, qualitative and quantitative study conducted in a tertiary referral hospital associated with the Brazilian National Health System (SUS). Data were collected from 30 individuals with diagnosis of refractory temporal lobe epilepsy (RTLE). The study participants responded to a questionnaire to collect sociodemographic and clinical data, as well as their perceptions about the disease. QoL was assessed by the Subjective Handicap of Epilepsy (SHE) and the Stigma Scale of Epilepsy (SSE). Results Significant correlation was found between stigma and quality of life and the work and activity and social and personal life domains, as well as between stigma and perceptions about epilepsy. The responses provided by the participants were organized into four categories: definitions and causes, seizures and treatment, family and social impacts, and impact on individuals’ lives. Conclusion The results show that participants have limited knowledge about epilepsy and that there is a negative impact caused by the stigma related to this disease on their QoL. It was possible to verify that QoL and stigma are directly related to the understanding of participants about epilepsy. Therefore, it is important to implement programs and actions that aim to provide patients and their families with more comprehensive knowledge about epilepsy; promote communication between health professionals and patients; and encourage the participation of patients and their families during treatment.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Perception , Quality of Life , Seizures/psychology , Epilepsy/psychology , Brazil , Cross-Sectional Studies , Surveys and Questionnaires , Social Stigma , Middle AgedABSTRACT
Background: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes. .
Introdução: estima-se que o número de casos de pacientes com crises não epilépticas psicogênicas (CNEP) seja de 2 a 33 por 100 mil habitantes. O índice de CNEP corresponde ainda a, aproximadamente, 19% dos pacientes tratados como epilépticos. Os pacientes com CNEP são tratados como portadores de epilepsia refratária, chegando ao limite máximo do tratamento medicamentoso e sem a obtenção de resultados satisfatórios. Objetivo: relatar os efeitos do tratamento psicanalítico individual em pacientes com CNEP de forma a avaliar a evolução do quadro clínico de CNEP e verificar sua associação com gênero, tempo de crise, prejuízos sociais, afetivos e profissionais, bem como término do tratamento. Métodos: a casuística foi composta por 37 pacientes com diagnóstico de CNEP feito por meio da monitoração por vídeo-EEG. Foram realizadas sessões de tratamento psicanalítico: atendimento clínico individual com frequência semanal, com duração aproximada de 50 minutos e duração total de 48 sessões em 12 meses. Resultados: este estudo constatou elevado índice de sucesso no tratamento dos pacientes com CNEP: 29,7% (n = 11) de cessação/cura dos sintomas e 51,4% (n = 19) de redução das crises convulsivas. Foi constatada associação entre cessar ou reduzir as crises e gênero (p<0,01), religião (p<0,01) e término do tratamento (p<0,01). Conclusão: este estudo apontou eficácia do tratamento psicanalítico individual realizado com pacientes com CNEP, podendo ser considerada uma forma de assistência essencial para que haja decréscimo ou cessação das crises. .
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Conversion Disorder/therapy , Psychoanalytic Therapy/methods , Seizures/therapy , Conversion Disorder/diagnosis , Conversion Disorder/psychology , Epilepsy/diagnosis , Interview, Psychological , Longitudinal Studies , Prospective Studies , Religion and Psychology , Sex Factors , Seizures/diagnosis , Seizures/psychology , Time Factors , Treatment OutcomeABSTRACT
The current term psychogenic non-epileptic seizures were coined by contemporary neurologists and epileptologists, since the implementation of Video electroencephalogram, considered today the gold standard diagnostic tool. Patients with psychogenic non-epileptic seizures comprise a heterogeneous group from the psychiatric point of view. The diagnosis that describes the psychogenic non-epileptic seizures is "conversion disorder", often associated with dissociative disorder. These disorders are frequently co-morbid with depression, anxiety and posttraumatic stress disorder. Furthermore, usually coexist with personality disorders, especially borderline personality disorder, although dependence personality disorder has also been described. A history of trauma is very important in the pathogenesis and development of psychogenic non-epileptic seizures. The symptoms "core" of the psychogenic non-epileptic seizures (conversion and dissociation), some co-morbidities and personality disorders are treated with psychotherapy, while psychotropic drugs are used for co-morbidities such as depression and posttraumatic stress disorder.
Subject(s)
Humans , Seizures/diagnosis , Seizures/psychology , Epilepsy/diagnosis , Seizures/therapy , Diagnosis, DifferentialABSTRACT
of the population. A 25
of the patients referred to epilepsy services have paroxysmal clinical events associated with motor activities, sensory or emotional alterations, or consciousness impairment, which are not epileptic seizures. The non-epileptic seizures can be classified as psychogenic, which do not have a medical cause, and are associated with primary or secondary psychological problems, and as of physiological origin. The non-epileptic events are manifested by paroxysmal or repetitive behaviors that might be confused with epileptic seizures. The diagnosis is very important in order to avoid unnecessary tests and iatrogenic therapies. This study will present clinical cases and review of the main non-epileptic physiological events (sleep disorders, movement disorders, hypoxic-ischemic phenomena) and psychogenic events (somatoform disorders, fictitious disorders and anxiety disorder).
Subject(s)
Seizures/diagnosis , Adolescent , Seizures/physiopathology , Seizures/psychology , Child , Diagnosis, Differential , Electroencephalography , Epilepsy/diagnosis , Female , Humans , Infant , Male , Child, PreschoolABSTRACT
Pseudoseizures are a relatively complex problem of unknown aetiology and prognosis. They can at times resemble genuine seizure attacks but they have no abnormal electroencephalograpic (EEG) activity. Understanding the patient's unique psychological background appears to be fundamental in managing seizure frequency. Pseudoseizures can be disruptive to a person's lifestyle, limiting their ability to function and progress in society, particularly when it comes to employment or social interaction. The case discussed involves a 59-year old man who presents with what is believed to be seizure-related activity but through the course of clinical evaluation, this turned out to be pseudoseizures.
Los pseudo-ataques de epilepsia son un problema relativamente complejo de etiologia y prognosis desconocidas. En ciertos momentos pueden parecer genuinos ataques epilépticos, pero no muestran actividad electroencefalográfica (EEG) anormal alguna. Entender el especial trasfondo psicológico del paciente parece ser fundamental a la hora de manejar la frecuencia de los ataques. Los pseudoataques pueden tener un efecto disociador en el estilo de vida de una persona, limitando su habilidad para funcionar y progresar socialmente, en particular cuando se trata de empleos o interacción social. El caso que se analiza corresponde a un hombre de 59 anos de edad que acude con lo que se cree que es una actividad relacionada con un ataque epiléptico, pero en el curso de la evaluación clinica, resultó ser una pseudoepilepsis.
Subject(s)
Humans , Male , Middle Aged , Psychophysiologic Disorders/diagnosis , Seizures/psychology , Electroencephalography , Seizures/diagnosisABSTRACT
Epilepsy causes restrictions in the performance of various daily activities. The aiming of this study was to investigate whether these restrictions affect the perceived quality of life. The assessments Quality of Life in Epilepsy-31 (QOLIE-31) and Canadian Occupational Performance Measure (COPM) were applied in a sample that consisted of a single group of 34 subjects with at least two years of uncontrolled seizures. The results indicated that the most affected domains of QOLIE-31 were seizure worry, 29.77 (±21.72), and effects of drugs, 49.75 (±28.58), and for the COPM, the average of performance and satisfaction were respectively 3.10 (±3.07) and 4.45 (±3.29), and performance limitations most frequently cited were maintain employment (18), left home alone (15) and courses (15). The application of the Spearman correlation coefficient showed that the three main performance limitations posed by the COPM, especially regarding the level of satisfaction, influence the perception of quality of life. Thus, occupational performance proves to be an important area of intervention with subjects with epilepsy.
A epilepsia causa limitações quanto ao desempenho de várias atividades diárias. Este estudo procurou investigar se essas limitações afetam a percepção da qualidade de vida (QV) do sujeito com epilepsia. Foram estudados 34 sujeitos com crises epiléticas não controladas há pelo menos dois anos, para os quais foram aplicadas, dentre outras, as avaliações QOLIE-31 para QV e Medida Canadense de Desempenho Ocupacional (COPM) para análise das limitações no desempenho ocupacional. Os resultados indicaram que os domínios da QOLIE-31 mais afetados foram preocupação com as crises (29,8±21,7) e efeitos dos medicamentos (49,7±28,6). Em relação à COPM, as médias de desempenho e satisfação foram, respectivamente, 3,10±3,07 e 4,45±3,29, sendo as limitações no desempenho mais frequentes a manutenção do emprego (18), ser capaz de sair de casa sozinho (15) e poder frequentar cursos (15). A aplicação do coeficiente de correlação de Spearman evidenciou que as três principais limitações no desempenho levantadas pela COPM, principalmente em relação ao nível de satisfação, influenciam na percepção da qualidade de vida do sujeito com epilepsia. Dessa forma, o desempenho ocupacional provou ser uma importante área de intervenção com sujeitos epiléticos.
Subject(s)
Adult , Female , Humans , Male , Activities of Daily Living/psychology , Epilepsy/psychology , Quality of Life/psychology , Work/psychology , Social Behavior , Socioeconomic Factors , Seizures/psychology , Task Performance and AnalysisABSTRACT
Psychogenic nonepileptic seizures (PNES) may be defined as paroxysmal changes in behavior that are similar to epileptic seizures but are not associated with quantifiable alterations in the electrical activity of the brain. At the Epilepsy Surgery Program (ESP) of the São Lucas Hospital at PUCRS (HSL-PUCRS), we studied 52 individuals (37 females and 15 males) with a diagnosis of PNES, associated (57 percent) or not (23 percent) with refractory epileptic seizures. We found emotional abuse (100 percent), physical abuse (80 percent), emotional neglect (80 percent), physical negligence (70 percent) and sexual abuse (30 percent), mood (40 percent) and anxiety disorders (50 percent), as the main psychological components in such population. Although the medical and psychosocial impact of PNES can be estimated as significant, the absence of specialized services for its treatment is striking. Multiple diagnostic and therapeutic procedures and the participation of a specialized multidisciplinary team â where neuropsychology functions as a link between the mental processes/psychopathologies and the brain â are required to ensure proper management of such cases.
Crises não-epilépticas psicogênicas podem ser definidas como episódios de alterações paroxísticas no comportamento, similares a crises epilépticas, porém não associadas a alterações quantificáveis da atividade elétrica cerebral. No Programa de Cirurgia de Epilepsia do Hospital São Lucas da PUCRS estudamos 52 indivíduos (37 mulheres e 15 homens) com o diagnóstico de CNEP, associadas (57 por cento) ou não (23 por cento) a epilepsia refratária. Aspectos psicológicos nesta população incluíram abuso emocional (100 por cento), abuso físico (80 por cento), negligência física (70 por cento), abuso sexual (30 por cento), desordens de humor (40 por cento) e ansiedade (50 por cento). O impacto médico e psicossocial deste diagnóstico é elevado, fazendo contraponto a carência de serviços especializados em seu tratamento. Múltiplos procedimentos diagnósticos e terapêuticos e a participação de um time multiprofissional â onde a neuropsicologia representa o elo natural entre a psicopatologia e o cérebro â são necessários para o melhor atendimento a estes pacientes.
Subject(s)
Humans , Seizures/psychology , Health Programs and Plans , Neuropsychological Tests , Anxiety Disorders , Sex Offenses , Mood Disorders , Physical AbuseABSTRACT
O diagnóstico de epilepsia acarreta um rompimento na maneira como o indivíduo se percebe, na sua vida social e econômica e nos seus planos de futuro. Este estudo buscou avaliar variáveis psicológicas (percepçäo de controle de crises) e características da doença na determinaçäo da qualidade de vida (QV) de pacientes adultos com diagnóstico de epilepsia há mais de dois anos. Foram avaliados 60 participantes, aleatoriamente selecionados no ambulatório de epilepsia do HC/Unicamp, com idade entre 18 e 70 anos (M = 37,05; DP = 11,25), através do Questionário de Qualidade de Vida 65 (QQV-65). As variáveis da doença näo foram significativas, com exceçäo da freqüência de crises, que apareceu associada à piora na QV, entre crises controladas e crises com freqüência acima de 10 por mês (p = 0,021). A percepçäo do controle de crises apareceu significativamente associada à QV (p = 0,005). A interpretaçäo subjetiva de crises controla a resposta de ajustamento à doença e do senso de bem-estar geral e explicam porque a QV é melhor nos participantes livres de crises.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Quality of Life/psychology , Seizures/psychology , Epilepsy/psychology , Brazil , Surveys and Questionnaires , Qualitative ResearchABSTRACT
Relatamos o caso de uma paciente de 26 anos em que é evidenciada a importância médica do diagnóstico diferencial entre epilepsia e crises pseudo-epilépticas psicogênicas (CPEP) e do seu tratamento. A paciente, uma professora desempregada, com crises desde os 13 anos, foi encaminhada ao PROJEPSI para diagnóstico e tratamento de CPEP. Seu diagnóstico inicial foi de epilepsia parcial sintomática por lesäo tumoral cística em regiäo occipto-temporal esquerda, associada a CPEP. Submetida a craniotomia occipital com ressecçäo de processo expansivo em regiäo de istmo do cíngulo, evoluiu com persistência das CPEP. Submetida a tratamento psicológico integrado envolvendo técnicas de condicionamento operante, manejo de ansiedade, sugestäo e orientaçäo familiar, houve remissäo completa das CPEP após 4 meses de tratamento. O caso apresentado demonstra a necessidade de múltiplos procedimentos diagnósticos e terapêuticos e a participaçäo de equipe multidisciplinar especializada.
Subject(s)
Humans , Female , Adult , Epilepsy/diagnosis , Epilepsy/therapy , Mental Disorders/diagnosis , Mental Disorders/therapy , Seizures/diagnosis , Seizures/therapy , Diagnosis, Differential , Mental Disorders/psychology , Seizures/psychologyABSTRACT
The occurrence of de novo psychogenic seizures after epilepsy surgery is rare, and is estimated in 1.8 per cent to 3.6 per cent. Seizures after epilepsy surgery should be carefully evaluated, and de novo psychogenic seizures should be considered especially when there is a change in the ictal semiology. We report a patient with de novo psychogenic seizures after anterior temporal lobe removal for refractory temporal lobe epilepsy. Once psychogenic seizures were diagnosed and psychiatric treatment was started, seizures stopped.
Subject(s)
Humans , Female , Adolescent , Epilepsy, Temporal Lobe/surgery , Seizures/diagnosis , Somatoform Disorders/diagnosis , Depression/diagnosis , Depression/therapy , Postoperative Period , Risk Factors , Seizures/psychology , Seizures/therapy , Somatoform Disorders/psychology , Somatoform Disorders/therapyABSTRACT
Después de una breve revisión del concepto de Sistema Límbico (SL), se describen una serie de experimentos de nuestro laboratorio, utilizando el análisis de potenciales evocados sensoriales y repuestas paroxísticas en diversos modelos de epilepsia experimental: metrazol, electrochoque, focos corticales con cobalto, aplicación tópica repetida de penicilina y estimulación eléctrica breve y periódica de la amígdala del lóbulo temporal (kindling). Estos dos últimos modelos, por su cronicidad y permanencia, nos han permitido establecer medidas de cambios plásticos cerebrales con localizaciones precisas. En estos experimentos se implementaron programas para el análisis computacional (RFM) de la posdescarga paroxística y de las respuestas eléctricas sensoriales. Se describen las modificaciones en la organización del sueño, así como el efecto inhibidor del sueño paradójico o MOR sobre los paroxismos del Kindling químico o eléctrico
Subject(s)
Psychology, Experimental , Seizures/psychology , Cerebral Cortex/drug effects , Modalities, Sensorial , Epilepsy/psychology , Evoked Potentials/physiology , Neuropsychology , Limbic System/physiologyABSTRACT
The anticonvulsant effect of clobazam in refractory epileptics of all types in different age groups was studied. Subjects were kept on their basic monotherapy antiepileptic regimens with phenytoin, valproic acid or carbamazepine [to which the response was unsatisfactory], in addition to 0.5-1 mg clobazam/kg/day for 6 months. Clinical, EGG and psychological assessments were carried out at the start, 3 months and at the end of the study. An improvement [50% reduction of seizure frequency or more] was noticed in 24 patients, but with no statistical significance. None of the subjects in this study developed tolerance. There was no correlation between the degree of the effect and serum levels of phenytoin and carbamazepine; while valproic acid was positively correlated, but without statistical significance. Normal EEG patterns were obtained in two patients. Although the present study was populated by negative sample of problem patients, the results were encouraging to recommend inclusion of clobazam in unproblematic cases with expected greater success rates than have been observed so far