Autoinmunidad, convulsiones y epilepsia: breve revisión sistemática / Autoimmunity, seizures and epilepsy: a brief systematic review

INTRODUCCIÓN: La epilepsia es un desorden neurológico crónico caracterizado por crisis convulsivas recurrentes, y constituye uno de los trastornos neurológicos con mayor prevalencia global. Una de las etiologías que ha cobrado mayor relevancia en el último tiempo es la autoinmunidad, la que ha venido a dar explicación a muchos casos de epilepsia idiopática o refractaria a tratamientos convencionales. MÉTODOS: Se realizó una búsqueda avanzada asociada a filtros en la plataforma PubMed con los términos "epilepsy" y "autoimmunity". Se seleccionaron 17 artículos de un total de 98 publicados desde el año 2010 en adelante, y que aportaban mas datos desde la fisiopatología. RESULTADOS: En base a la literatura, se describen los principales mecanismos de autoinmunidad que generan epilepsia entre los destacan generación de auto-anticuerpos, desregulación del perfil de citoquinas y pérdida del control de linfocitos T autorreactivos, fenómenos que redundan en neuroinflamación y que se originan en el contexto de infecciones, síndromes paraneoplásicos, autoinmunidad materna transferida a hijos, encefalitis autoinmune, entre otras. CONCLUSIONES: En los últimos años ha habido grandes avances en la comprensión de la epilepsia autoinmune, sin embargo, aún queda mucho por comprender. Pese a lo prometedor que es el descubrimiento de anticuerpos, existen muchos casos de epilepsia con seronegatividad, o casos con la presencia de anticuerpos, pero no la epilepsia autoinmune. Cabe destacar que se debe precisar mecanismos diagnósticos eficaces y específicos que permitan generar protocolos terapéuticos atingentes y resolutivos.

Epilepsy is a neurological chronic disorder which is characterized by recurrent seizures and constitutes one of the most prevalent neurological disorders worldwide. One of the etiologies that has gained a lot of strength is autoimmunity, which has explained a lot of cases of idiopathic epilepsy or epilepsies refractory to common treatment. METHODS: An advanced search was made in the PubMed platform using filters with the terms "epilepsy" and "autoimmunity", showing 98 publications from 2010 onwards, leaving only 17 selected articles because of their pathophysiological information. RESULTS: Based on the literature, we described the main mechanisms of autoimmunity as a cause of epilepsy, standing out the ones related to auto-antibodies production, cytokines disregulation and autoreactive T lymphocytes control alteration, phenomenons related to neuroinflammation that arise from the context of infections, paraneoplastic syndromes, maternal autoimmunity transmitted to their babies, autoimmune encephalitis, etc. CONCLUSIONS: Great advances has been made on the understanding of autoimmune epilepsy in the last years, but despite this there's a lot that we need to comprehend. Although how promising was the discovery of antibodies there's still a lot of seronegative cases or cases with antibodies but without the epilepsy. It is worth mentioning that it becomes necessary to establish efficient and specific diagnostic mechanisms that allow us to create suitable and resolutive therapeutic protocols.

Encefalitis autoinmune por anticuerpos contra el receptor GABA-A: caso clínico / Autoimmune encephalitis induced by antibodies against GABA-A receptor

Among autoimmune encephalitides, a prevalent group are those associated with antibodies against the N-Methyl-D-aspartate receptor, which present with behavior abnormalities, psychosis, seizures and abnormal movements. A new variant, mediated by antibodies against the GABA-A receptor, was recen­tly described. We report a 66-years-old female with this form of encephalitis whose main manifestation was the presence of severe seizures leading to status epilepticus. The patient had a good response to immunomodulatory therapy with intravenous methylprednisolone, azathioprine and anticonvulsants. The laboratory tests initially detected anti-thyroid peroxidase antibodies which lead to the misdiagnosis of Hashimoto Encephalitis, which was ruled out after the detection of antibodies against GABA-A receptor. No malignancy was detected.

Absenteísmo-doença no serviço público municipal de Goiânia / Sickness absence in a municipal public service of Goiânia, Brazil

INTRODUÇÃO: O absenteísmo-doença, enquanto falta ao trabalho justificada por licença médica, é um importante indicador das condições de saúde dos trabalhadores. Em geral, características sociodemográficas e ocupacionais situam-se entre os principais fatores associados ao absenteísmo-doença. A administração pública é responsável por 21,8% dos empregos formais no Brasil. Esta população permite o estudo de uma grande variedade de categorias profissionais. OBJETIVO: Analisar o perfil e os indicadores de absenteísmo-doença entre servidores municipais de Goiânia, no Estado de Goiás, Brasil. Métodos: Estudo transversal das licenças certificadas para tratamento de saúde superiores a três dias, de todos os servidores, desde janeiro de 2005 a dezembro de 2010. Foram calculadas as prevalências, utilizando como critérios o número de indivíduos, os episódios e os dias de afastamento. RESULTADOS: Foram concedidas 40.578 licenças certificadas para tratamento de saúde a 13.408 servidores numa população média anual de 17.270 pessoas, o que resultou em 944.722 dias de absenteísmo. A prevalência acumulada de licença no período foi de 143,7%, com média anual de 39,2% e duração de 23 dias por episódio. A prevalência acumulada de absenteísmo-doença foi maior entre mulheres (52,0%) com idade superior a 40 anos (55,9%), com companheiro (49,9%), de baixa escolaridade (54,4%), profissionais de educação (54,7%), > 10 anos de serviço (61,9%) e múltiplos vínculos profissionais (53,7%). Os grupos de diagnósticos (CID-10) com as maiores prevalências acumuladas de licenças foram os do capítulo de transtornos mentais (26,5%), doenças osteomusculares (25,1%) e lesões (23,6%). CONCLUSÕES: Os indicadores de absenteísmo-doença expressam a magnitude desse fenômeno no serviço público e podem auxiliar no planejamento das ações de saúde do trabalhador, priorizando os grupos ocupacionais mais vulneráveis. .

BACKGROUND: Sickness absence, as work absenteeism justified by medical certificate, is an important health status indicator of the employees and, overall, sociodemographic and occupational characteristics are among the main factors associated with sickness absence. Public administration accounts for 21.8% of the formal job positions in Brazil. This population allows the study of a wide range of professional categories. OBJECTIVE: To assess the profile and indicators of sickness absence among public workers from the municipality of Goiania, in the State of Goiás, Brazil. METHODS: A cross-sectional study on certified sick leaves, lasting longer than three days, of all civil servants from January 2005 to December 2010. Prevalence rates were calculated using as main criteria the number of individuals, episodes and sick days. RESULTS: 40,578 certified sick leaves were granted for health treatment among 13,408 public workers, in an annual average population of 17,270 people, which resulted in 944,722 days of absenteeism. The cumulative prevalence of sick leave for the period was of 143.7%, with annual average of 39.2% and duration of 23 days per episode. The cumulative prevalence of sickness absence was higher among women (52.0%), older than 40 years old (55.9%), with a partner (49.9%), low schooling (54.4%), education professionals (54.7%), > 10 years of service (61.9%), and with multiple work contracts (53.7%). Diagnoses groups (ICD-10) with higher cumulative prevalence of sick leaves were those with mental disorders (26.5%), musculoskeletal diseases (25.1%), and injuries (23.6%). CONCLUSIONS: Indicators of sickness absence express the magnitude of this phenomenon in the public sector and can assist in planning health actions for the worker, prioritizing the most vulnerable occupational groups. .

Convulsion and its relation to anti-DNA antibody levels in systemic lupus erthematosus

The neuropsychiatric manifestations of systemic lupus erythematosus are frequent. One of the most serious presentations is convulsion. This study was carried out to evaluate the relation between convulsion and anti-DNA antibody levels. An analytic, retrospective case-controlled study was carried out, with reference to 1001 recorded cases of systemic SLE lupus erythematosus in Lupus Unit, Rheumatology Center, Shariati Hospital, Tehran University of Medical Sciences. The frequency of convulsion was 13.3%. there was no significant difference in the frequency of convulsoin in patients with different levels of anti-DNA antibodies. Anti-DNA antibody is not an important diagnostic and activity criterion for neuropsychiatric manifestations of SLE