Historia de la Liga Chilena contra la Epilepsia (LICHE). Conmemorando sus 70 años / History of the Chilean League against Epilepsy. 70 anniversary

La Liga Chilena contra la Epilepsia (LICHE), es una corporación sin fines de lucro, dedicada a apoyar a los pacientes con epilepsia y su entorno, educar en epilepsia, solidarizar con ellos en los aspectos psicosociales y socioeconómicos, procurándoles una mejor calidad de vida. Es parte del capítulo del International Bureau for Epilepsy (IBE). Cumple 70 años de labor y en este artículo se expone su historia y trayectoria, siendo un ejemplo mundial de manejo integral de pacientes con epilepsia y el impacto en la comunidad.

The Chilean League against Epilepsy (LICHE), a non-profit corporation, dedicated to supporting patients with epilepsy and their environment, educating in epilepsy, solidarity with them in psychosocial and socioeconomic aspects, worrying about a better quality of life. It is part of the chapter of the International Bureau for Epilepsy (IBE). It celebrates 70 years of work and this article exposes its history and trajectory, being a world example of integral management of patients with epilepsy and the impact on the community

Burden of epilepsy in China and its provinces, 1990 to 2019: findings from the Global Burden of Disease Study 2019 / 中华医学杂志(英文版)

BACKGROUND@#Epilepsy accounts for a significant portion of the global disease burden. However, little is known about the disease burden of epilepsy in China and its provinces.@*METHODS@#We assessed the burden of epilepsy in China and its provinces, municipalities, and autonomous regions from 1990 to 2019. Burden was measured as incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs), by age, sex, year, and province. We used the Socio-Demographic Index (SDI) to determine the association between the provincial development level and age-standardized DALY rates of epilepsy from 1990 to 2019.@*RESULTS@#In 2019, epilepsy caused 1367.51 thousand (95% uncertainty interval [UI]: 979.92-1837.61 thousand) DALYs, and the age-standardized DALY rate was 99.77 (95% UI: 71.33-133.52)/100,000. The age-standardized incidence and prevalence rates for epilepsy in China were 24.65/100,000 and 219.69/100,000, increased by 45.00% (95% UI: 8.03-98.74%) and 35.72% (95% UI: 0.47-86.19%) compared with that in 1990, respectively. From 1990 to 2019, the proportion of DALY caused by epilepsy in the age group under 25 years steadily decreased. The proportion of DALYs caused by epilepsy in people aged 50 years and over increased from 9.45% and 10.22% in 1990 to 29.01% and 32.72% for male and female individuals in 2019, respectively. The highest age-standardized mortality rates were seen in Tibet (4.26 [95% UI: 1.43-5.66]/100,000), Qinghai (1.80 [95% UI: 1.15-2.36]/100,000), and Yunnan (1.30 [95% UI: 0.88-1.62]/100,000), and the lowest mortality rates were in Guangdong (0.48 [95% UI: 0.39-0.64]/100,000), Zhejiang (0.56 [95% UI: 0.44-0.70]/100,000), and Shanghai (0.57 [95% UI: 0.41-0.73]/100,000). The age-standardized DALY rates across the country and in provinces, municipalities, and autonomous regions generally decreased as their SDI increased.@*CONCLUSIONS@#The disease burden of epilepsy is still heavy in China, especially in the western provinces. The incidence and prevalence of epilepsy increased between 1990 and 2019, and the burden of epilepsy in the elderly increases gradually. This study provides evidence on epilepsy prevention and care of different regions in China.

Características clínicas y sociodemográficas de pacientes con epilepsia en un hospital pediátrico en Honduras / Clinical and sociodemographic characteristics of patients with epilepsy in a pediatric hospital in Honduras

Antecedentes: La epilepsia es una patología frecuente en pediatría; representa el mayor número de referencias al Servicio de Neurología. En Honduras son pocas las publicaciones recientes del tema. Objetivo: Describir las características clínicas y sociodemográficas de pacientes con epilepsia en un centro nacional de referencia pediátrica. Métodos: Estudio descriptivo retrospectivo. Se utilizaron expedientes clínicos de pacientes atendidos en Consulta Externa de Neuropediatría Hospital María, Especialidades Pediátricas (HMEP), Tegucigalpa, Honduras, durante mayo 2015-marzo 2019. Para el análisis de datos se utilizó estadística descriptiva. Resultados: De los 334 pacientes, el sexo masculino fue el más afectado 55.7% (186), procedentes de zona urbana 69.5% (232); la mediana de edad fue 7 años. En 26.3% (88) de los casos, el padre estuvo ausente y el 81.1% (271) de los pacientes eran hijos de madre desempleada. Como etiología se encontró que el 54.4% (182) fue desconocida. El 26.3% (88) tuvo antecedente familiar de epilepsia y el 50.6% (174/344) de los pacientes tuvieron eventualidad perinatal, de estos 24.7% (43/174) presentó asfixia neonatal. El 32.7% (108/330) se encontraban en estado de malnutrición. Las crisis focales fueron más frecuentes y el factor precipitante de crisis más común fue abandono de tratamiento. El 36.6% (126) tenía algún tipo de discapacidad, siendo la cognitiva la más sobresaliente. Discusión: Es necesario reforzar estrategias de salud pública dirigidas a la prevención prenatal, natal y posnatal de la epilepsia, brindar apoyo a las familias monoparentales y asegurar acceso continuo a servicios de salud...(AU)

High prevalence of psychiatric comorbidities in children and adolescents at a tertiary epilepsy center / Alta prevalência de comorbidades psiquiátricas em crianças e adolescentes de um centro terciário de epilepsia

ABSTRACT Background: Epilepsy is highly comorbid with psychiatric disorders and a significant amount of the morbidity related to epilepsy is in fact a result of psychiatric comorbidities. Objective: To investigate the frequency of different psychiatric comorbidities in children with refractory epilepsy. Methods: We present preliminary observational data from a series of patients (n=82) examined in the psychiatric branch of a tertiary epilepsy center in Rio de Janeiro, Brazil. Patients were classified as presenting autism spectrum disorders, mood disorders, anxiety disorders, disruptive disorders, attention deficit hyperactivity disorder (ADHD), intellectual development disorder, psychotic episode, dissociative/conversive disorders or others. We determined the frequency of each disorder, along with demographic data, medications prescribed, electroencephalogram findings and additional medical examinations and consultations. Results: The most common comorbidities in our sample were autism spectrum disorders and ADHD. Antipsychotics and selective serotonin uptake inhibitors were the most commonly prescribed psychiatric medications. Conclusions: Knowledge about the prevalence of such comorbidities may provide more targeted interventions in Psychiatry and Psychology services linked to epilepsy centers.

RESUMO Introdução: Epilepsia é altamente comórbida, com transtornos psiquiátricos, e uma parte significativa da morbidade da epilepsia se associa com os transtornos psiquiátricos comórbidos. Objetivo: Investigar a frequência de diferentes comorbidades psiquiátricas em crianças com epilepsia refratária. Métodos: Apresentamos dados observacionais preliminares de uma amostra de pacientes (n=82) avaliados no setor de Psiquiatria de um centro terciário de tratamento de epilepsia no Rio de Janeiro, Brasil. Pacientes foram classificados como apresentando transtorno do espectro autista, transtorno do humor, transtorno de ansiedade, transtornos disruptivos, transtorno do déficit de atenção de hiperatividade (TDAH), transtorno do desenvolvimento intelectual, episódio psicótico, transtornos dissociativos/conversivos e outros. Foram determinados frequência de cada transtorno, bem como dados demográficos, medicações prescritas e achados de eletroencefalograma. Resultados: As comorbidades mais comuns na nossa amostra foram transtornos do espectro autista e TDAH; antipsicóticos e inibidores seletivos da recaptura de serotonina (ISRS) foram as medicações psiquiátricas mais comumente prescritas. Conclusões: Conhecimento acerca da prevalência dessas comorbidades pode facilitar a instituição de intervenções mais precisas em serviços de Psiquiatria e Psicologia vinculados a centros de tratamento de epilepsia.

The impact of COVID-19 on patients with epilepsy / O impacto da COVID-19 em pacientes com epilepsia

ABSTRACT Background: The COVID-19 pandemic and social distancing can have adverse impacts on adult people with epilepsy (PWE). Objective: To investigate the seizure frequency, the perceived well-being, and the presence of anxiety symptoms in PWE during the COVID-19 pandemic period. Methods: Data from a questionnaire on the repercussions of COVID-19 were analyzed in relation to the clinical variables of 114 PWE, with a significance level of p<0.05. Results: There were 26 cases of COVID-19 in PWE and/or family members (22.8%). During the pandemic period, 11 PWE (9.6%) reported an increase in seizures, but unrelated to COVID-19. Also, the number of crises in PWE with previous depressive disorders increased, with differences between epilepsies. Symptoms of depression, impaired well-being, and concern for their lifestyle were significant in PWE with a previous diagnosis of depression. Impaired well-being, increased anxiety, nervousness, and tiredness, and the concern with being infected were mentioned by a high number of PWE in the pandemic. Conclusion: Seizure frequency increased during the pandemic period, a finding associated with clinical variables of epilepsy. PWE with depression had worse perceived well-being. Changes in well-being and increased anxiety and nervousness were frequent in the pandemic.

RESUMO Introdução: A pandemia por COVID-19 e o isolamento social podem ter impactos adversos em pessoas adultas com epilepsia (PCE). Objetivo: Investigar a frequência das crises, a percepção de bem-estar e a presença de sintomas de ansiedade em PCE no período da pandemia da COVID-19. Métodos: Foram relacionados os dados de um questionário de repercussões da COVID-19 com as variáveis clínicas de 114 PCE, com nível de significância p<0,05. Resultados: A COVID-19 ocorreu em 26 (22,8%) PCE e/ou familiares. Durante o período da pandemia, houve aumento das crises epilépticas em 11 (9,6%) PCE, mas sem relação com o diagnóstico de COVID-19. No período da pandemia, houve aumento do número de crises nos PCE com transtorno depressivo prévio e de modo distinto entre as epilepsias. Sintomas de depressão, comprometimento do bem-estar e preocupação com o estilo de vida ocorreram significativamente nos PCE com diagnostico anterior de depressão. O comprometimento do bem-estar, o aumento da ansiedade, do nervosismo e do cansaço, e a preocupação em contrair a doença foram referidos na maior parte do tempo em elevado número de PCE na pandemia. Conclusão: Houve aumento da ocorrência de crises epilépticas durante o período pandêmico e isso foi associado a variáveis clínicas da epilepsia. Pior percepção de bem-estar ocorreu nos PCE com depressão. Alteração do bem-estar e aumento de ansiedade e de nervosismo foram frequentes na pandemia.

Epidemiological study of infantile epilepsy incidence density among infants under 36 months of age in Ningbo City from 2015 to 2019 / 北京大学学报(医学版)

OBJECTIVE@#To describe the distribution and trend of infantile epilepsy among infants under 36 months in Ningbo, Zhejiang Province.@*METHODS@#Using the birth cohort design, we retrospectively collected the local born infants in Ningbo national health information platform from 2015 to 2019, and took the first visit of epilepsy in the electronic medical record of the platform as the new case. The incidence density and 95% confidence interval (CI) of epilepsy were estimated by Poisson distribution.@*RESULTS@#From 2015 to 2019, a total of 294 900 children were born in Ningbo, with male accounting for 51.92%. The total person-years of observation were 595 300, while the median follow-up person-years was 2.31 [interquartile range (IQR): 1.90]. There were 575 new onset epilepsy patients during the whole observation period. The total number of visits was 2 599, with an average of 4.52. The total incidence density was 96.59/100 000 person-years (95%CI: 88.85-104.82). The median age of onset was 13 months (IQR: 15), 0-12 months old infants had the highest incidence density (102.18/100 000 person-years), 25-36 months old infants had the lowest incidence density (89.68/100 000 person-years), and the difference was not statistically significant (P>0.05). The incidence density of male was 97.58/100 000 person-years, female was 95.53/100 000 person-years, and the difference was not statistically significant (P>0.05). Fenghua was the highest (130.54/100 000 person-years, 95%CI: 94.47-175.83) and Ninghai was the lowest (66.44/100 000 person-years, 95%CI: 47.02-91. 19), with significant difference (P < 0.05). There was no significant difference in the incidence density in different birth years (P>0.05). There was significant difference in the incidence density between 0-12 months old infants in different calendar years (Ptrend < 0.05). In this age group, the incidence density was the lowest in 2015 (69.41/100 000 person-years, 95%CI: 41.79-108.39), and the highest in 2019 (225.61/100 000 person-years, 95%CI: 186.10-271.03). There was no significant difference in the incidence density between 13-24 and 25-36 months old infants in different calendar years (P>0.05).@*CONCLUSION@#The incidence density of epilepsy in 0-36 months old infants in Ningbo City from 2015 to 2019 was low as a whole, and there was no difference in age group, gender, and year of birth. The incidence density of 0-12 months old infants increased with the year.

Trastorno paroxístico no epiléptico en paciente referido por sospecha de epilepsia / Paroxysmal non-epileptic events in patients referred for suspicion of epilepsy

Los Trastornos Paroxísticos No Epilépticos (TPNE), son diagnóstico diferencial de crisis epilépticas. En Chile no existen reportes de frecuencia. OBJETIVO: Determinar frecuencia de TPNE en pacientes derivados por sospecha de epilepsia a Unidad de Electroencefalografía, Hospital Roberto del Río. METODOLOGÍA: Estudio observacional, transversal. Se revisó registros clínicos de pacientes derivados por sospecha de epilepsia(2012- 2014). Inclusión: paciente con TPNE, >1 mes, sin epilepsia previa. Caracterización: sexo, edad, tipo/subtipo TPNE, comorbilidades, electroencefalograma (EEG), uso fármaco antiepiléptico (FAE). Aprobado por comité de ética. RESULTADOS: Derivados 913 pacientes por sospecha de epilepsia. 36% TPNE (2,3% con epilepsia concomitante), 22% epilepsia aislada. TPNE más frecuente: escolares (31%), adolescentes (29%), femenino (52%). 30,1% hipoxia cerebral (síncope, Espasmo Sollozo); 22,4% trastornos del comportamiento (Descontrol Episódico, Crisis Psicógena no Epiléptica). 32,8% con comorbilidades no epilépticas (Trastornos psiquiátricos/neurodesarrollo). 4,3 % recibieron FAE. CONCLUSIONES: La frecuencia de TPNE en niños/adolescentes supera a la de epilepsia. Es fundamental evaluación multidisciplinaria.

Paroxysmal non-epileptic events (PNE) are differential diagnosis of epileptic seizures. In Chile, there are no reports on its frequency. OBJECTIVE: To determine the frequency of PNE in patients referred for suspicion of epilepsy to the Electroencephalography Unit of Roberto del Río Hospital. METHODOLOGY: Observational, cross-sectional study. Clinical records of patients referred for suspicion of epilepsy (2012-2014) were reviewed. Inclusion: Patient with PNE, >1 month, without previous epilepsy. Characterization: gender, age, PNE type/subtype, comorbidities, electroencephalogram, use of antiepileptic drug (AED). Approved by the ethics committee. RESULTS: 913 patients were referred for suspected epilepsy: 36% PNE (2,3% with concomitant epilepsy), 22% isolated epilepsy. PNE were more frequent in children (31%) adolescents (29%), and in females (52%). 30.1% Cerebral hypoxia (syncope, breathholding-spells); 22,4% Behavioral disorders (Episodic loss of control, Non-Epileptic Psychogenic Seizures). 32.8% non-epileptic comorbidities (Psychiatric/ neurodevelopmental disorders). 4.3% received AEDs. CONCLUSIONS: The frequency of PNE in children and adolescents exceeds that of epilepsy. A multidisciplinary medical evaluation is of the outmost importance. Keywords: Paroxysmal Non-Epileptic Disorder, Non-epileptic episodes, Epilepsy.

Inflammatory signs and epileptic crisis in patients admitted in an emergency unit / Signos inflamatorios y crisis epiléptica en pacientes admitidos en una unidad de emergencia / Sinais inflamatórios e crise epiléptica em pacientes admitidos em unidade de emergência

ABSTRACT Objective: To evaluate inflammatory signs presented in medical records of patients with a main diagnosis of epileptic seizures, admitted in an emergency unit. Method: Cross-sectional and retrospective study. The sample was composed of 191 medical records, from children, adolescents, adults, and elders, with a clinical diagnosis of epileptic seizures, admitted between June 2016 and June 2017 at the emergency unit of a hospital in Porto Alegre/RS. Results: The prevalent inflammatory signs were tachypnea (33.5%) and/or fever (27.2%) associated with leukocytosis (P=0.030). Children/adolescents had seizures less frequently (P=0.010) and these were due to fever (P=0.000). Adults presented seizures more frequently (P=0.006), which were related to medication/intoxication (P=0.000). In elders, seizures occurred due to metabolic or circulatory abnormalities (P=0.000), less often due to fever (P=0.005). Conclusion: Seizures are related to fever and tachypnea, being caused by different etiologies according to age, being more frequent in adults. Fever is related to leukocytosis, regardless of age.

RESUMEN Objetivo: Evaluar signos inflamatorios registrados en prontuarios de pacientes con diagnóstico principal de crisis epilépticas, admitidos en unidad de emergencia. Método: Estudio transversal, retrospectivo. Muestra compuesta por 191 prontuarios de pacientes pediátricos, adolescentes, adultos y ancianos, diagnosticados con crisis epilépticas, admitidos entre junio de 2016 a junio de 2017 en unidad de emergencia de un hospital de Porto Alegre/RS. Resultados: Prevalencia del taquipnea (33,5%) y/o fiebre (27,2%) como signos inflamatorios, fiebre relacionada a leucocitosis (P=0,030). Niños/adolescentes tienen crisis menos frecuentes (P=0,010) de origen febril (P=0,000). Los adultos presentaron mayor número de eventos (P=0,006), provocados por medicamentos/intoxicaciones (P=0,000). En ancianos, crisis ocurrieron debido a disturbios metabólicos/circulatorios (P=0,000),menor ocurrencia de fiebre (P=0,005). Conclusión: Crisis epilépticas están relacionadas a fiebre y taquipnea, presentando diferentes etiologías según grupo de edad, con mayor ocurrencia entre adultos. Fiebre relacionada con el leucocitosis, independientemente de la edad.

RESUMO Objetivo: Avaliar os sinais inflamatórios registrados em prontuários de pacientes com diagnóstico principal de crise epiléptica, admitidos em unidade de emergência. Método: Estudo transversal, retrospectivo. Amostra composta por 191 prontuários de pacientes pediátricos, adolescentes, adultos e idosos, com diagnóstico clínico de crise epiléptica, admitidos entre junho de 2016 a junho de 2017, na unidade de emergência de um hospital de Porto Alegre/RS. Resultados: Prevalência do relato de taquipneia (33,5%) e/ou febre (27,2%) como sinais inflamatórios, estando febre relacionada à leucocitose (P=0,030). Crianças/adolescentes tiverem crises menos frequentes (P=0,010) ede origem febril (P=0,000). Adultos apresentaram maior número de eventos (P=0,006), provocados por medicações/intoxicações (P=0,000). Nos idosos, crises ocorreram por distúrbios metabólicos/circulatórios (P=0,000), com menor ocorrência de febre (P=0,005). Conclusão: Crises epilépticas estão relacionadas à presença de febre e taquipneia, apresentando diferentes etiologias conforme faixa etária, com maior frequência de ocorrência entre adultos. Febre está relacionada à leucocitose, independentemente da idade.

Clinical aspects of congenital microcephaly syndrome by Zika virus in a rehabilitation center for patients with microcephaly

SUMMARY OBJECTIVE In this study, we intend to identify the prevalence of clinical variables in children with microcephaly. METHODS This is a cross-sectional and observational study with data collected from medical records of patients admitted to the microcephaly outpatient clinic of a referral center in Teresina-PI. Demographic (gender and age) and clinical data (presence of epilepsy, dysphagia, irritability, and associated comorbidities) were collected. The frequency of Zika virus as a probable etiology was determined from computed tomography patterns and the exclusion of other etiologies by serological tests. RESULTS A total of 67 patient records were evaluated, of which 31 were male and 36 were female, with a mean age of 1 year and 10 months. The most prevalent clinical variables were epilepsy, present in 47 children (70.2%), and irritability in 37 (55.2%). Also with a high frequency, 22 had dysphagia (32.8%), and 13 had musculoskeletal comorbidities (19.4%). Only three patients in the sample had cardiac abnormalities (4.5%), and no endocrine comorbidity was found. A total of 38 children in the sample (56.7%) presented ZIKV as a probable etiology and, in these cases, there was a higher frequency of epilepsy and dysphagia compared to other etiologies, although not statistically significant. CONCLUSION Epilepsy, irritability, dysphagia, and musculoskeletal comorbidities were the most frequent clinical variables in children with microcephaly. There was a high prevalence of congenital ZIKV microcephaly syndrome in this sample.

RESUMO OBJETIVO Pretende-se, neste estudo, identificar a prevalência de variáveis clínicas em crianças com microcefalia. MÉTODOS Trata-se de um estudo transversal e observacional com dados coletados de prontuários de pacientes admitidos no ambulatório de microcefalia de um centro de referência em Teresina (PI). Foram coletados dados demográficos (gênero Ve idade) e clínicos (presença de epilepsia, disfagia, irritabilidade e comorbidades associadas). A frequência de Zika vírus como provável etiologia foi determinada a partir de padrões da tomografia computadorizada e da exclusão de outras etiologias por exames sorológicos. RESULTADOS Foram avaliados 67 prontuários de pacientes, sendo 31 do sexo masculino e 36 do sexo feminino, com idade média de 1 ano e 10 meses. As variáveis clínicas mais prevalentes foram epilepsia, presente em 47 das crianças (70,2%), e irritabilidade, em 37 (55,2%). Também com elevada frequência, 22 possuíam quadro de disfagia (32,8%) e 13 apresentavam comorbidades osteomusculares (19,4%). Apenas três pacientes da amostra tinham quadro de alterações cardiológicas (4,5%) e nenhuma comorbidade endocrinológica foi encontrada. Trinta e oito crianças da amostra (56,7%) apresentaram ZIKV como provável etiologia e, nesses casos, houve maior frequência de epilepsia e disfagia em comparação com outras etiologias, embora não de forma significativa estatisticamente. CONCLUSÕES Epilepsia, irritabilidade, disfagia e comorbidades osteomusculares foram as variáveis clínicas mais frequentes em crianças com microcefalia. Houve uma prevalência alta de síndrome de microcefalia congênita por ZIKV nessa amostra.

Salud mental infantil: una prioridad a considerar / Children's mental health: a priority to consider

Resumen: Objetivo: Identificar posibles cambios en la frecuencia de manifestaciones sindromáticas sugerentes de problemas de salud mental en población infantil mexicana empleando el Cuestionario Breve de Tamizaje y Diagnóstico (CBTD), a lo largo de 15 años. Material y métodos: Se analiza información de diferentes estudios en población general, escuelas y práctica médica. La estimación obtenida en la Ciudad de México fue utilizada como población de referencia para comparación. Resultados: Se apreciaron incrementos notables respecto a la prevalencia de síndromes como el déficit de atención e hiperactividad, y conducta oposicionista y explosiva, así como manifestaciones de ansiedad y depresivas. Estas últimas resultaron más frecuentes en la edad escolar tardía. Las alteraciones en el lenguaje y la epilepsia también mostraron incremento en diferentes grupos de edad. Conclusiones: Se discuten los hallazgos a la luz de estudios longitudinales en la literatura, así como de reportes de población adolescente en nuestro país.

Abstract: Objective: To identify possible changes in the frequency of psychopathological syndromes in Mexican children population over a 15-year period using the Brief Screening and Diagnostic Questionnaire (CBTD in Spanish). Materials and methods: Information gathered from different studies on the general population, schools and medical general practice are analyzed. Results from the Mexico City study were used as base rates for comparisons. Results: Higher prevalence of externalizing syndromes such as attention deficit and hyperactivity, oppositional and explosive conduct were very evident. Also, anxiety and depressive syndromes showed a notable increase. Prevalence of abnormal language and probable epilepsy were also increased on different age-groups. Conclusions: Findings are discussed in light of longitudinal reports in the literature as well as on reports in adolescent population in Mexico.

Perfil de pacientes em idade reprodutiva tratadas por epilepsia / Profile of patients in reproductive age treated by epilepsy

Objetivo: Descrever o perfil de pacientes em idade reprodutiva internadas por epilepsia nas regiões brasileiras em 5 anos, elucidando os riscos promovidos por ela durante a gravidez e abordando o gerenciamento do quadro. Métodos: Pesquisa e análise de dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), acerca das internações em mulheres em idade reprodutiva (10 a 49 anos) por epilepsia, avaliando a ocorrência, de acordo com faixa etária, etnia e região do Brasil, no período de janeiro de 2012 a dezembro de 2016. Resultados: No total, foram notificadas 42.204 internações de mulheres em idade reprodutiva associadas à epilepsia, estando a maior parte delas (22,66%) na faixa de 20 a 29 anos e na de 40 a 49 anos (22,59%). O Sudeste correspondeu a 43,01% do total de casos (18.152), seguido pela Região Sul, com 9.456 registros (22,4%), e pelo Nordeste (8.245; 19,53%). A etnia mais atingida foi a de brancas (15.804; 37,44% dos atendimentos) e pardas (12.200; 28,9%). Conclusão: O planejamento da gravidez em mulheres epilépticas contribui para redução dos riscos tanto maternos quanto fetais, pois permite ao prescritor e à gestante pesar quais os benefícios e os malefícios de cada terapia anticonvulsivante disponível. Vale lembrar que uma abordagem individualizada da paciente epiléptica grávida por equipe multidisciplinar se faz necessária para melhorar os desfechos e prevenir internações por crises convulsivas. (AU)

Objective: To describe the profile of female patients in childbearing age hospitalized due to epilepsy in the Brazilian regions in 5 years, elucidating the risks it causes during pregnancy, and addressing the management of the condition. Methods: Research and analysis of data provided by the Informatics Department of the Unified Health System (DATASUS), concerning hospitalizations of women of childbearing age (10-49 years) due to epilepsy, evaluating the occurrence according to age, ethnicity and the region in Brazil, from January 2012 to December 2016. Results: A total of 42,204 admissions of women of childbearing age due to epilepsy were reported, with most of them in the age group from 20 to 29 years old (22,66%), and in the 40-49 age group (22.59%). The Southeast Region accounted for 43.01% of the total number of cases (18,152), followed by the South Region, with 9,456 records (22.4%), and the Northeast (8,245 - 19.53%). The most affected ethnic group was the white one (15,804; 37,44% of the admissions) and brown one (12,200; 28,9%). Conclusion: Pregnancy planning in epileptic women contributes to both maternal and fetal risk reduction, since it allows the prescriber and the pregnant woman to weigh the benefits and harms of each available anticonvulsant therapy. It is worth remembering that an individualized, multidisciplinary approach of the epileptic pregnant patient is necessary to improve the outcomes, and to prevent hospitalizations due to seizures. (AU)

Epilepsie-absences de l'enfant et de l'adolescent au Sénégal aspects épidémiologiques, diagnostiques, thérapeutiques et pronostiques

Description: L'épilepsie-absence est un syndrome épileptique généralisé, fréquent, de cause présumée génétique, caractérisé par la survenue d'épisodes fréquents de rupture brutale et complète du contact sans perte de tonus. Objectif: L'objectif était de décrire l'épidémiologie et les caractéristiques cliniques de l'épilepsie-absence chez l'enfant et l'adolescent. Méthode: Nous avons mené une étude transversale longitudinale, portant sur 53 patients, de décembre 2003 à mars 2014 en colligeant les données épidémiologiques, diagnostiques, thérapeutiques et évolutives. L'analyse des données s'est faite avec le logiciel statistique CSPro 5.0 avec calcul de fréquences et moyennes. Résultats: Cinquante trois patients dont 42 enfants et 11 adolescents ont été colligé avec un âge moyen de 10 ans. L'âge moyen de début des crises était de 6,8 ans chez les enfants et 12,4 ans chez les adolescents. On notait une prédominance féminine à 52,4 % chez les enfants et masculine à 63,6 % chez les adolescents. Une consanguinité parentale était retrouvée dans 55,5 % chez l'enfant et 37,5 % chez l'adolescent. Quarante pourcent des enfants présentaient des antécédents familiaux d'épilepsie. Les crises survenaient spontanément dans 86,8 % des cas avec une durée moyenne de 10 secondes environ. Le Valproate de sodium a été utilisé chez tous nos patients avec une maitrise dans 81,6 % à trois mois. L'évolution de l'épilepsie-absence était globalement satisfaisante avec des difficultés d'apprentissage observées chez 22,6 % des patients. Conclusion: L'épilepsie-absence est fréquente, de causes multifactorielles et peut retentir sur le devenir psychosocial

Valoración del niño con una primera crisis no provocada / Evaluation of a child with a first unprovoked seizure

Los episodios paroxísticos son uno de los trastornos neurológicos más frecuentes en niños. Es importante diferenciar entre los trastornos paroxísticos no epilépticos, las crisis sintomáticas agudas, las crisis febriles y las crisis no provocadas. La historia clínica permite, en la gran mayoría de los casos, poder llegar al diagnóstico. Las crisis no provocadas únicas son frecuentes en el niño. La tasa de recurrencia tras una primera crisis no provocada varía entre un 23-96% en los dos años siguientes a la primera crisis. El objetivo de este trabajo es describir cómo evaluar al paciente con una primera crisis no provocada y revisar el valor predictivo de los distintos factores de riesgo de recurrencia. Entre dichos factores de riesgo, se evalúan datos como la presencia de antecedentes familiares de epilepsia, historia previa de crisis febriles, edad de debut, tipo de crisis, presencia de crisis prolongadas o crisis agrupadas, crisis de presentación en sueño, anomalías neurológicas, evidencia de una etiología definida, y presencia de anomalías epileptiformes en el electroencefalograma. Los factores de riesgo de recurrencia más importantes son la etiología de las crisis y la presencia de anomalías epileptiformes en el electroencefalograma.

Paroxysmal episodes are one of the most common neurological disorders in children. It is important to distinguish between paroxysmal non-epileptic events, symptomatic seizures, febrile seizures, and unprovoked seizures. Patient's history is the key to proper diagnosis in most of the cases. A single unprovoked seizure is a frequent phenomenon in the pediatric population. Studies of recurrence after a first unprovoked seizure show percentages between 23% and 96% over a median follow-up of two years. The aim of this study is to define how to evaluate the first unprovoked epileptic seizure in a child and to review the weight of the different recurrence risk factors. Several factors enable us to predict the recurrence risk after a first unprovoked seizure including family history of epilepsy, prior history of febrile seizures, age at onset, type of seizure, prolonged seizures at onset, multiple seizures in a single day, sleep state, neurological abnormalities, etiology, and abnormalities in the electroencephalogram. The most important of these risk factors are the etiology of the seizures and the evidence of epileptiform abnormalities in the electroencephalogram.

Seizures and Epilepsy following Subarachnoid Hemorrhage: A Review on Incidence, Risk Factors, Outcome and Treatment

The mortality rates of subarachnoid hemorrhage (SAH) average 51%, and survivors frequently experience acute and long-term neurological conditions, including seizures and epilepsy. The incidence of post SAH-related seizures and epilepsy, its risk factors, outcomes and management are controversial. The present paper aims to discuss these aspects, to provide the pros and cons of different management options of this condition. A review on PubMed was performed encompassing the incidence of seizures and epilepsy following SAH, the risk factors for its occurrence, its related outcomes, and treatment. The incidence of seizures and epilepsy following SAH varies widely in the literature (from 6 to 26%). Some possible risk factors were identified, such as middle cerebral artery (MCA) aneurysm, Hunt and Hess grade III, aneurysm clipping, thick subarachnoid clot, intracerebral hemorrhage, rebleeding, ischemic brain infarction, Fisher grade III or IV, acute hydrocephalus, hypertension history and poorWorld Federation of Neurosurgical Societies (WFNS) grade. Nevertheless, these relations are frequently uncertain. Also, it appears that the outcome of patients who suffered SAH is worsened by seizures. Given these uncertainties, the need for antiepileptic drug (AED) prophylaxis, the choice of the best drug and dose, as well as the duration of the treatment are controversial topics. However, some recommendations based on low quality evidence are reasonable to be adopted. These include considering AED prophylaxis when a seizure occur after SAH, considering routine long-term AED prophylaxis in specific populations, considering electroencephalogram (EEG) monitoring, and avoiding phenytoin prescription. That is, an individualized approach appears to be the best option, since there is no high-quality evidence.

Factores asociados a epilepsia en niños en México: un estudio caso-control / Factors associated with epilepsy in children in Mexico: A case-control study

Resumen: Introducción: La epilepsia es la enfermedad neurológica crónica más común en el mundo. En México es considerada dentro de las principales enfermedades vinculadas a la mortalidad por enfermedades no infecciosas de la población infantil. El objetivo del estudio fue identificar los factores asociados a epilepsia en niños derechohabientes del Instituto Mexicano del Seguro Social (IMSS), en Acapulco, México. Métodos: Estudio de casos y controles realizado entre abril de 2010 y abril de 2011. Fueron seleccionados 118 casos de la consulta externa de neurología pediátrica, con criterios diagnósticos de epilepsia de acuerdo a la Liga Internacional Contra la Epilepsia, con máximo dos años de evolución. Los controles fueron seleccionados de las Unidades de Medicina Familiar de donde procedieron los casos. En una encuesta a las madres, se obtuvo información sobre antecedentes heredofamiliares, prenatales, perinatales y posnatales. El análisis bivariado y multivariado se realizó mediante el procedimiento de Mantel-Haenszel. Resultados: Tres factores estuvieron asociados con la epilepsia: el antecedente familiar de epilepsia en familiares de primer grado (Razón de Momios ajustada (RMa) 2.44, IC95% 1.18 - 5.03), la asfixia al nacimiento (RMa 2.20, IC95% 1.16-34.18) y la infección de la vía urinaria en la etapa prenatal (RMa, 1.80 IC95% 1.0 - 3.24). Conclusiones: La asfixia al nacimiento y el reporte de infecciones de vías urinarias durante la gestación fueron factores asociados a epilepsia independientemente del antecedente de epilepsia en familiares de primer grado.

Abstract: Background: Epilepsy is the most common chronic neurological disease in the world. In Mexico, epilepsy is among the diseases more related to mortality due to non-infectious diseases in children. The objective of the study was to identify the factors associated with epilepsy in children entitled to the Mexican Social Security Institute (IMSS), in Acapulco, Mexico. Methods: We carried out a case-control study from April 2010 to April 2011. We selected 118 cases from the database of outpatient pediatric neurology with epilepsy diagnostic with two year of evolution according to the International League Against Epilepsy criteria. We selected 118 controls from the same Medical Units where cases were detected. Data collected throughout an interview with the mothers included information on history of epilepsy among relatives, prenatal, perinatal and postnatal history. Bivariate and multivariate analysis was performed using Mantel-Haenszel process. Results: Multivariate analysis identified three factors associated with epilepsy: family history of epilepsy in first-degree relatives (adjusted Odds ratio (ORa) 2.44, 95%CI 1.18 -5.03), birth asphyxia (ORa 2.20, 95%CI 1.16-34.18), and urinary tract infection in the prenatal stage (ORa, 1.80, 95%CI 1.0 - 3.24). Conclusions: Preventing birth asphyxia and urinary tract infections during pregnancy reduces the risk of epilepsy regardless of the history of epilepsy in first-degree relatives.

Air pollution and risk of hospitalization for epilepsy: the role of farm use of nitrogen fertilizers and emissions of the agricultural air pollutant, nitrous oxide / Poluição do ar e risco de hospitalização por epilepsia: o papel do uso agrícola de fertilizantes nitrogenados e as emissões de poluente atmosférico agrícola, óxido nitroso

ABSTRACT The link between various air pollutants and hospitalization for epilepsy has come under scrutiny. We have proposed that exposure to air pollution and specifically the pervasive agricultural air pollutant and greenhouse gas, nitrous oxide (N2O), may provoke susceptibility to neurodevelopmental disorders. Evidence supports a role of N2O exposure in reducing epileptiform seizure activity, while withdrawal from the drug has been shown to induce seizure-like activity. Therefore, we show here that the statewide use of anthropogenic nitrogen fertilizers (the most recognized causal contributor to environmental N2O burden) is significantly negatively associated with hospitalization for epilepsy in all three pre-specified hospitalization categories, even after multiple pollutant comparison correction (p<.007), while the other identified pollutants were not consistently statistically significantly associated with hospitalization for epilepsy. We discuss potential neurological mechanisms underpinning this association between air pollutants associated with farm use of anthropogenic nitrogen fertilizers and hospitalization for epilepsy.

RESUMO A ligação entre vários poluentes do ar e a hospitalização por epilepsia tem sido examinada. Propusemos que a exposição à poluição do ar, especificamente ao poluente atmosférico generalizado e ao gás de efeito estufa, o óxido nitroso (N2O), poderiam fomentar a susceptibilidade a distúrbios do desenvolvimento neurológico. A evidência apoia o papel da exposição ao N2O na redução da atividade convulsiva epileptiforme, enquanto mostra que a retirada do fármaco induz atividade pseudo-convulsiva. Portanto, mostramos aqui que o uso a nível estatal de fertilizantes nitrogenados antropogênicos (o agente causal mais reconhecido para a carga ambiental de N2O) está significativa e negativamente associado à hospitalização por epilepsia nas três categorias de hospitalização pré-especificadas, mesmo após a correção de comparação de poluentes múltiplos (p <0,007 ), enquanto os outros poluentes identificados não foram consistentemente associados de forma estatística com a hospitalização por epilepsia. Discutimos possíveis mecanismos neurológicos subjacentes a esta associação entre poluentes atmosféricos associados ao uso agrícola de fertilizantes nitrogenados antropogênicos, e hospitalização por epilepsia.

Interpretação da diretriz da Associação Nacional de Medicina do Trabalho (ANAMT) Epilepsia e Trabalho: rastreamento utilizando a razão de verossimilhança / Interpretation of National Association of Occupational Medicine (ANAMT) guideline Epilepsy and Work: screening using likelihood ratio

Contexto: O conhecimento e a utilização de metodologias de epidemiologia clínica no cenário atual da prática da medicina do trabalho pode ser um diferencial importante para o profissional que atua no setor. Frequentemente, o médico solicita testes ou encontra-se diante de resultados de exames, devendo decidir sobre a validade ou não de um diagnóstico realizado por colegas, muitas vezes, de outras especialidades. O eletroencefalograma (EEG) é um desses exemplos. A Associação Nacional de Medicina do Trabalho/Associação Médica Brasileira (ANAMT/AMB) publicou, em 2016, a diretriz "Epilepsia e Trabalho", visando orientar seus associados. Nessa diretriz não recomenda a utilização do eletroencefalograma no rastreamento da epilepsia. Objetivos: O presente artigo pretende discutir a utilização da razão de verossimilhança (RV) na avaliação clínica de exames médicos, notadamente no EEG, objetivando comparar os resultados obtidos com essa metodologia da medicina baseada em evidências. Métodos: Inicialmente, realizou-se uma busca bibliográfica em relação à RV na literatura clássica da medicina baseada em evidência. Posteriormente, fez-se a leitura da diretriz e das referências bibliográficas nela citadas, retirando os elementos importantes para o cálculo da RV. Após calcular a RV, realizou-se a comparação dos resultados. Resultados: Foram obtidas RV entre 2,36 e 43,5% dependendo da metodologia de realização do EEG (inicial ou sequencial). Conclusões: O EEG não mostrou ser importante no rastreamento da epilepsia, sempre tendo valor menor do que a percentagem de falso-positivos, mesmo nos casos em que se considera a especificidade de 98,0%, corroborando as recomendações da diretriz.

Background: Knowledge of and use of clinical epidemiology methods within the current scenario of occupational medicine practice might make a difference for the professionals who work in this field. Doctors frequently request or receive the results of tests and must decide on the validity or not of diagnoses made by colleagues, often from other specialties. Electroencephalography (EEG) is one example of this situation. In 2016 the National Association of Occupational Medicine/Brazilian Medical Association (ANAMT/ AMB) published the "Epilepsy and Work" guideline to orient its members, which does not recommend EEG for screening. Objectives: The present article discusses the use of likelihood ratio (LR) for clinical evaluation of medical tests, especially EEG, aiming at comparing the results obtained by means of this evidence-based medicine method. Methods: First a literature search on LR was conducted in the classical literature of evidence-based medicine. Next, the ANAMT/AMB guideline and its bibliographic references were analyzed, and relevant elements for the calculation of LR were extracted. LRs were calculated and the results were compared. Results: The LR values varied from 2.36 to 43.5% according to the EEG method used (initial or sequential). Conclusions: EEG proved not to be relevant for screening for epilepsy, with values systematically lower than the percentage of false-positive results, even in cases when 98.0% of specificity was considered, thus corroborating the recommendation made in ANAMT/AMB guideline.

Convulsão febril: estudo de base populacional / Febrile seizures: a population-based study

Resumo Objetivos Estabelecer a prevalência das crises febris e descrever o perfil clínico e epidemiológico dessa população. Métodos Estudo transversal de base populacional feito em Barra do Bugres (MT), de agosto de 2012 a agosto de 2013. Os dados foram coletados em duas etapas. Na primeira etapa usamos um questionário validado previamente em outro estudo brasileiro, para identificação de casos suspeitos de crises epilépticas. Na segunda etapa fizemos a avaliação neuroclínica para confirmação diagnóstica. Resultados A prevalência de crise febril foi de 6,4/1.000 habitantes (IC95% 3,8; 10,1). Não houve diferença entre os sexos. As crises febris simples foram encontradas em 88,8% dos casos. A história familiar de crise febril e epilepsia em parentes de primeiro grau esteve presente em 33,3% e 11,1% dos pacientes, respectivamente. Conclusões A prevalência da crise febril na Região Centro-Oeste foi menor do que a encontrada em outras regiões brasileiras, provavelmente relacionado à inclusão apenas das crises febris com manifestações motoras e as diferenças de fatores socioeconômicos entre as regiões pesquisadas.

Abstract Objectives To determine the prevalence of benign febrile seizures of childhood and describe the clinical and epidemiological profile of this population. Methods This was a population-based, cross-sectional study, carried out in the city of Barra do Bugres, MT, Brazil, from August 2012 to August 2013. Data were collected in two phases. In the first phase, a questionnaire that was previously validated in another Brazilian study was used to identify suspected cases of seizures. In the second phase, a neurological evaluation was performed to confirm diagnosis. Results The prevalence was 6.4/1000 inhabitants (95% CI: 3.8-10.1). There was no difference between genders. Simple febrile seizures were found in 88.8% of cases. A family history of febrile seizures in first-degree relatives and history of epilepsy was present in 33.3% and 11.1% of patients, respectively. Conclusions The prevalence of febrile seizures in Midwestern Brazil was lower than that found in other Brazilian regions, probably due to the inclusion only of febrile seizures with motor manifestations and differences in socioeconomic factors among the evaluated areas.