Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Seizures , Epilepsy/diagnosis , Epilepsy/classificationABSTRACT
Epilepsy is a chronic condition whose building blocks are recurrent seizures. It is this varied presentation that at times poses a challenge to making a diagnosis. The response to treatment is also not uniform, making it necessary to individualise. This article discusses the various seizure types, the latest classification by the International League against Epilepsy (ILAE), treatment and prognosis of the condition
Subject(s)
Epilepsy/classification , Epilepsy/diagnosis , Epilepsy/prevention & control , Epilepsy/therapy , Seizures , South AfricaABSTRACT
Las crisis epilépticas en Pediatría son un importante motivo de consulta. En este artículo se revisará la importancia de la primera crisis epiléptica, cómo enfrentarse a esta situación desde los antecedentes y el examen físico, diagnósticos diferenciales y además se revisará el manejo de la crisis en urgencia y su posterior estudio.
Pediatric seizures are a major complaint. In this article the importance of the first seizure is reviewed, how to deal with this situation from the history and physical examination, and further management and study will be reviewed.
Subject(s)
Humans , Child , Diagnosis, Differential , Epilepsy/diagnosis , Seizures/diagnosis , Epilepsy/classification , Epilepsy/drug therapy , Anticonvulsants/therapeutic useABSTRACT
Objective: The purpose of this study was to determine the nature and extent of depressive symptoms among patients with epilepsy. Methods: Ninety patients were investigated over a three-month period: 42 were suffering from generalized epilepsy, 29 from focal epilepsy and 19 from undetermined epilepsy. All completed the Zung self-rating scale for assessment of the depressive symptoms. Results: Sixty-seven patients felt stigmatized because of epilepsy (67%): 73.6% in the undetermined epilepsy group, 55.1% in the focal epilepsy group and 88% in the generalized epilepsy group. Moreover, among the 90 epileptic patients studied, symptoms of irritability, indecisiveness, personal devaluation and emptiness showed a constant increasing trend for their presence from the undetermined epilepsy group through the generalized epilepsy group to the focal epilepsy group. Conclusions: These findings indicate that although the focal epilepsy patients felt less stigmatized, they did not differ greatly in terms of depressive symptoms, in relation to the undetermined epilepsy and generalized epilepsy patients. .
Objetivo: O objetivo deste estudo foi determinar a natureza e extensão dos sintomas depressivos entre pacientes com epilepsia. Métodos: Noventa pacientes foram avaliados durante o período de três meses: 42 apresentando epilepsia generalizada, 29 com epilepsia focal e 19 com epilepsia indeterminada. Todos completaram a auto-escala de Zung para avaliação de sintomas depressivos. Resultados: Sessenta e sete pacientes se sentiam estigmatizados por causa da epilepsia (67%), sendo 73,6% do grupo epilepsia indeterminada, 55,1% do grupo epilepsia focal e 88% do grupo epilepsia generalizada. Além disto, entre os 90 pacientes epilépticos estudados, os sintomas de irritabilidade, dificuldade para tomar decisões, baixa estima pessoal e sensação de vazio mostraram-se presentes de forma crescente entre os grupos de epilepsia indeterminada, epilepsia generalizada e epilepsia focal. Conclusões: Estes achados indicam que embora os pacientes com epilepsia focal se sintam menos estigmatizados, eles não diferiram de maneira considerável daqueles com epilepsia indeterminada e epilepsia generalizada em termos de sintomas depressivos. .
Subject(s)
Adult , Female , Humans , Male , Depression/psychology , Epilepsy/psychology , Epilepsy/classificationABSTRACT
Las crisis epilépticas son un problema neurológico que afecta entre un 4-10 por ciento de los niños hasta los 16 años. Las crisis deben ser diferenciadas de otros desórdenes neurológicos de los niños y clasificadas según su tipo. El tratamiento de emergencia está focalizado en la estabilización del paciente, terminar con la actividad convulsiva y determinar la causa de ésta. Diferentes modalidades de tratamiento existen a largo plazo, pero el adecuado tratamiento va a depender de un diagnóstico correcto y el conocimiento de los beneficios y efectos adversos de la terapia indicada.
Seizures are a neurological problem that affects between 4 to 10 per cent of children up to age 16. The crisis must be differentiated from other neurological disorders of children and classified by type. Emergency treatment is focused on stabilizing the patient, ending the seizure activity and determine the cause of this. There are different treatment modalities in the long term, but proper treatment will depend on a correct diagnosis and awareness of the benefits and adverse effects of prescribed therapy.
Subject(s)
Humans , Child , Seizures/complications , Diagnosis, Differential , Epilepsy/classification , Electroencephalography , Laboratory Test , NeuroimagingABSTRACT
JUSTIFICATIVA E OBJETIVOS: A epilepsia é uma doença neurológica crônica das mais frequentes. Embora a anestesia para portadores de epilepsia seja mais frequente em neurocirurgia, esse grupo de pacientes necessita, da mesma maneira que a população geral, de anestesia para dife rentes procedimentos diagnósticos e terapêuticos. Este artigo visou abordar os aspectos de maior interesse para o anestesiologista na conduta perioperatória do paciente epiléptico submetido à anestesia para procedimentos não neurocirúrgicos. CONTEÚDO: Abordam-se aspectos relevantes de fisiopatologia, classificação e diagnóstico da epilepsia; terapêutica anticonvulsivante e interações com drogas anestésicas; tratamento cirúrgico e dieta cetogênica; efeitos pró- e anticonvulsivante das drogas utilizadas em anestesia; avaliação pré-operatória, conduta intra- e pós-operatória no paciente epiléptico, bem como o diagnóstico e a terapêutica das convulsões perioperatórias. CONCLUSÕES: No manuseio perioperatório do paciente epiléptico é importante para o anestesiologista identificar o tipo de epilepsia; a frequência, a gravidade e os fatores desencadeantes das crises epileptogênicas; o uso de drogas anticonvulsivantes e as eventuais interações com as drogas utilizadas em anestesia; a presença de dieta cetogênica e de estimulador do nervo vago e suas implicações na técnica anestésica. É essencial o conhecimento das propriedades pró- e anticonvulsivantes dos fármacos utilizados na anestesia, minimizando o risco de atividade convulsiva no intra- e no pós-operatório. Por fim, é importante traçar o diagnóstico e realizar o tratamento das crises convulsivas perioperatórias, o que possibilita menor morbimortalidade.
BACKGROUND AND OBJECTIVES: Epilepsy is one of the most frequent chronic neurological diseases. Although anesthesia for epilepsy patients is more common in neurosurgery, this group of patients needs, just as the general population, anesthesia for different diagnostic and therapeutic procedures. This article aims to address the issues of greatest interest to the anesthesiologist in the perioperative management of epileptic patients undergoing anesthesia for non-neurosurgical procedures. CONTENT: We discuss relevant aspects of pathophysiology, classification and diagnosis of epilepsy; anticonvulsant therapy and interactions with anesthetic drugs; surgery and the ketogenic diet; pro-and anticonvulsant effects of drugs used in anesthesia; preoperative evaluation, intra- and postoperative conduct in epileptic patients, as well as the diagnosis and treatment of perioperative seizures. CONCLUSIONS: In the perioperative management of epileptic patients is important for anesthesiologists to identify the type of epilepsy, the frequency, severity and the factors triggering the epileptogenic crises; the use of anticonvulsant drugs and possible interactions with drugs used in anesthesia; the presence of ketogenic diet and stimulatory of the vagus nerve, and its implications in anesthetic techniques. It is essential the understanding of pro- and anticonvulsant properties of drugs used in anesthesia, minimizing the risk of seizure activity in the intra- and postoperative. Finally, it is important to outline the diagnosis and initiate treatment of seizures, perioperative, which offers lower both morbidity and mortality.
JUSTIFICATIVA Y OBJETIVOS: La epilepsia es una enfermedad neurológica crónica de las más frecuentes. Aunque la anestesia para portadores de epilepsia sea más frecuente en neurocirugía, ese grupo de pacientes necesita la anestesia de la misma forma que la población en general, para diferentes procedimientos diagnósticos y terapéuticos. Este artículo pretendió abordar los aspectos de más interés para el anestesiólogo sobre la conducta perioperatoria a ser seguida con el paciente epiléptico sometido a la anestesia para procedimientos no neuroquirúrgicos. CONTENIDO: Abordamos aspectos relevantes de fisiopatología, clasificación y diagnóstico de la epilepsia; terapéutica anticonvulsiva e interacciones con fármacos anestésicos; tratamiento quirúrgico y dieta cetogénica; efectos pro y anticonvulsivos de los fármacos utilizados en anestesia; evaluación preoperatoria, conducta intra y postoperatoria en el paciente epiléptico, como también el diagnóstico y la terapéutica de las convulsiones perioperatorias. CONCLUSIONES: En el manejo perioperatorio del paciente epiléptico, es importante para el anestesiólogo identificar el tipo de epilepsia; la frecuencia, la gravedad y los factores desencadenantes de las crisis epilépticas; el uso de fármacos anticonvulsivos y las eventuales interacciones con los fármacos utilizados en anestesia; la presencia de una dieta cetogénica y estimuladora del nervio vago y sus implicaciones en la técnica anestésica. Es esencial también, el conocimiento de las propiedades pro y anticonvulsivas de los fármacos utilizados en la anestesia, minimizando así el riesgo de la actividad convulsiva en el intra y en el postoperatorio. En resumen, es importante trazar el diagnóstico y realizar el tratamiento de las crisis convulsivas perioperatorias, minimizando el nivel de morbimortalidad.
Subject(s)
Humans , Anesthesia , Anesthesia/methods , Epilepsy , Epilepsy/classification , Epilepsy/diagnosis , Epilepsy/physiopathology , Perioperative Care , Anticonvulsants/therapeutic use , Epilepsy/classification , Epilepsy/drug therapyABSTRACT
Telemetry is defined as simultaneous video and EEG monitoring of presumably epileptic patients while they are hospitalized in telemetry ward so that one or more of the habitual seizures or funs are captured and recorded; these events would be visualized and analyzed later by expert epileptologists for the sake of proper diagnosis, classification, presurgical evaluation or else. To define and evaluate simultaneous Video-EEG monitoring in epilepsy management. Two hundreds consecutive telemetries at King's College Hospital in London over the period of nine months starting from Jan 2007 back to May 2006 were reviewed and the conclusive yields were evaluated. It showed that the three main indications for referral were to be the diagnosis' in a proportion of 56.5% presurgical evaluation in 19.8% and ' classification' in 15.2% whereas other application like assessment for vagal nerve stimulation [VNS] candidacy, sleep studies, follow up and frequency estimation constitute the remaining 8.5% . It was conclusive in 63% for 'classification', 60% for 'diagnosis', and only 34%for presurgical evaluation, whereas categorically was conclusive in 56.55 of all referrals. The study shows that telemetry is a crucial and probably an indispensable tool if the proper understanding of the problem, and consequently proper handling and management are to be considered
Subject(s)
Humans , Male , Female , Epilepsy/diagnosis , Epilepsy/classification , Electroencephalography , Diagnosis, DifferentialABSTRACT
La Liga Internacional Contra la Epilepsia propuso una nueva clasificación de la epilepsia en el año 2001, soportada en cinco ejes que reflejan los hallazgos hasta ahora conocidos. Se informan los resultados de su aplicación en los pacientes que acuden a consulta de neurología del Hospital de San José de Bogotá D.C. Se trata de un estudio observacional descriptivo prospectivo. Fueron incluidos 95 casos, observando la mayor frecuencia de presentación de la primera crisis en el rango de 10 a 20 años, de los cuales 98,9% se presentaron con epilepsia activa. La coincidencia entre la semiología ictal (eje 1) y el tipo de crisis (eje 2) fue del 87,4%. El síndrome epiléptico (eje 3) fue parcial en 31,6% y generalizado en 64,2% de los casos. La etiología (eje 4) más identificada correspondió a anomalías cromosómicas en 29,5% y no se reconoció en 41,1%. Al evaluar el grado de afectación del sujeto (eje 5) con el cuestionario QOLIE-31, su aplicación permitió cuantificar la calidad de vida y consideramos que su uso permitiría optimizar el manejo de los enfermos. En general la mayoría pudieron ser categorizados con esta propuesta de clasificación en forma similar a cuando se aplicaron las dos clasificaciones previas ILAE 1981 y 1989.
The new classification of epilepsies proposed by the International League Against Epilepsy [ILAE] in 2001 is supported on five axis which reflect the findings known to date. This paper reports the results obtained when applied at the Neurology Clinic at the San José Hospital in Bogotá D.C. Ninety-five patients were enrolled in this descriptive observational prospectivestudy. The first seizure was most commonly observed in the age range 10 to 20 years of which 98.9% presented with active epilepsy. An inter-axial accordance of 87.4% between ictal phenomenology (axis 1) and seizure type (axis 2) was identified. The epileptic syndrome (axis 3) was partial in 31.6% and generalized in 64.2%. The most common etiology (axis 4) corresponds to chromosomal abnormalities in 29.5% and was nonspecific in 41.1%. When assessing the degree of impairment caused by the epileptic condition (axis 5), health-related quality of life could be surveyed by applying the QOLIE-31 questionnaire, and we considered this would favor an optimized management of the patients. Overall, most patients could be categorized with this type of classification similarly to when the two previous classifications (ILAE 1981and 1989) were applied.
Subject(s)
Humans , Male , Female , Epilepsy/classificationABSTRACT
La epilepsia se define como una alteración que afecta al Sistema Nervioso Central, específicamente la corteza cerebral y que se manifiesta clínicamente como eventos discontinuos denominados "crisis epilépticas". Es una afección neurológica crónica, de alta frecuencia, de manifestación episódica y de diversa etiología. Se estima que afecta a 50 millones de personas en el mundo. En Chile los datos de prevalencia son de 17 a 10.8 por mil habitantes y la incidencia de 114 por 100.000 habitantes por año (2, 3). En relación a la incidencia acumulativa, que es el riesgo individual de desarrollar epilepsia en un tiempo determinado, en nuestro país, así como en el resto de Latinoamérica, esta información es desconocida. En países europeos es del 2 por ciento al 4 por ciento. La epilepsia tiene una distribución bimodal, siendo mayor en las dos primeras décadas de la vida y luego a partir de la sexta década. La mortalidad es 2 a 3 veces mayor que la población general. La epilepsia en el adulto tiene implicancias intelectuales, psicosociales y económicas, por lo que su diagnóstico, tratamiento precoz y correcto, impacta en los indicadores de salud como los años de vida saludables. El diagnóstico de esta enfermedad es principalmente clínico y se ha demostrado que una significativa proporción de ellos, realizados por médico no especialistas es incorrecto. Si se trata adecuadamente, el 70 por ciento a 80 por ciento de las personas afectadas podrían tener una vida normal. La meta del tratamiento es reducción del número y severidad de la crisis, provocando la menor cantidad de efectos colaterales posibles. La epilepsia no es una condición uniforme y comprende diferentes tipos de crisis y síndromes epilépticos. La severidad de esta condición y su pronóstico, es variable en relación al tipo de epilepsia diagnosticado. El impacto que produce también depende de las características individuales de cada persona, asociándose a un aumento del riesgo de muerte prematura principalmente en las personas con crisis intratables.
Subject(s)
Humans , Male , Female , Adult , Epilepsy/classification , Epilepsy/epidemiology , Chile , Epilepsy/surgery , Epilepsy/diagnosis , Epilepsy/therapyABSTRACT
El Síndrome de ovario poliquístico (SOP) es un tema muy controvertido y lo seguirá siendo por los grandes avances en biología molecular que nos ayudan a entender mejor su etiología. Hoy, para definir SOP, nos regimos por lo consensuado en el encuentro de expertos de Rotterdam de 2003, donde se definió este síndrome con dos de los siguientes tres criterios: oligomenorrea/amenorrea, hiperandrogenismo clínico y/o de laboratorio y poliquistosis ovárica por ecografía, excluyendo la hiperplasia suprarrenal congénita (HSC), el hipotiroidismo, prolactinemias y uso de drogas (ácido valproico). La aplicación de la definición y el diagnóstico de SOP son aún más difíciles cuando se da en adolescentes con menos de tres años de edad ginecológica. Con todo este bagaje de conocimientos y dudas, nos enfrentamos además a otra cuestión sobre ciertas patologías o drogas que parecerían asociarse al SOP y que se pueden dar en cualquier momento de la vida, como es la epilepsia en todas sus formas y las drogas anticonvulsivantes que se utilizan par su tratamiento. Hasta el momento, se discutía si el ácido valproico y la carbamazepina estaban relacionados con el SOP, pero con los recientes hallazgos, parecería que la epilepsia tiene una gran importancia en relación con este síndrome. En esta revisión tratamos de aunar los conocimientos en los tres temas: SOP, epilepsia y anticonvulsivantes para intentar esclarecer el abordaje desde lo médico en el manejo de un adolescente que enfrenta esta problemática.
Subject(s)
Humans , Adolescent , Female , Epilepsy/classification , Epilepsy/etiology , Epilepsy/physiopathology , Epilepsy/drug therapy , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/diagnosis , Polycystic Ovary Syndrome/chemically induced , Valproic Acid/adverse effects , Carbamazepine/adverse effects , Fertility/radiation effectsABSTRACT
PURPOSE: To test the usefulness of a simplified and clinically oriented, the Epidemiological Classification (EC), in determination of seizure types and appropriate drug selection in epileptic patients at the primary care level. METHODS: The EC was applied to all epileptic patients over 5 years then compared with the currently recommended international classifications of seizures and epilepsy (ICES/ICEES). RESULTS: A total of 1176 patients were enrolled with 2:1 male preponderance and 88% had onset of disease below 30 years of age. Based on EC, 682 (58%) had partial, 333 (28.3%) had generalized and 161 (13.7%) had undetermined seizures semiology. When ICES was applied, seizure typing was same in 86.2%, 68.5% and 26.7% patients of partial, generalized and unclassified seizures respectively. About 87% patients in generalized and partial seizure semiology had no change in selected antiepileptic drug even after the ICES, but 53.6% patients in undetermined group had change in selected AED. Only, 146 patients (12.5%) found to have symptomatic cause for seizure(s) on applying the EC system. After utilizing the ICEES on 1030 patients (87.5%) of "unknown etiology" cases after the EC system, almost 86.5% patients could be classified to a definite etiological class. CONCLUSION: The EC was found useful for determination of seizure type and appropriate AEDs selection at the primary care level. The ICES/ICEES works better at the tertiary care level. This "two-tier" system can be more effective for overall epilepsy management in developing countries with limited facilities.
Subject(s)
Adolescent , Adult , Anticonvulsants/adverse effects , Child , Child, Preschool , Developing Countries , Epilepsy/classification , Female , Humans , Infant, Newborn , Male , Patient Care Planning , Primary Health Care , Risk Factors , Severity of Illness Index , Terminology as Topic , Young AdultABSTRACT
La primera descripción de las crisis de ausencias data de 1705. Sin embargo, aún persiste el desconocimiento y la confusión en relación con algunos aspectos conceptuales, de clasificación, terminológicos, diagnósticos, pronósticos y de tratamiento de las diferentes formas de epilepsias con ausencias. El objetivo fundamental de esta publicación es tomar en consideración las denominadas epilepsias generalizadas idiopáticas con ausencias, en los aspectos clínicos y electroencefalográficos. Se realizó una revisión y actualización del tema.
The first description of absence seizures dates back to 1705. However, the lack of knowledge and confusion still persist as regards some aspects of concept, classification, terminology, diagnosis, prognosis and treatment of the different forms of epilepsies with absences. The fundamental purpose of this publication was to take into consideration the so-called idiopathic generalized epilepsies with absences in the clinical and electroencephalographic aspects. The topic was reviewed and updated.
Subject(s)
Humans , Adolescent , Child , Electroencephalography/methods , Epilepsy/classification , Epilepsy/diagnosis , Epilepsy/pathologyABSTRACT
Se revisó la utilización del electroencefalograma (EEG) en el manejo de las epilepsias y síndromes epilépticos, como una herramienta para el diagnóstico y pronóstico del paciente con crisis epilépticas en el área de la neuropediatría, correlacionando las manifestaciones clínicas, edad de inicio, frecuencia, pronóstico y características electroencefalográficas de los trazados de cada una de ellas. El electroencefalograma goza de una extraordinaria vigencia en las neurociencias, dado que es un instrumento del que disponemos para aproximarnos realmente al funcionamiento cerebral en tiempo reales decir, a escala de milisegundos. A pesar de que en el último decenio se ha producido un desarrollo espectacular de las técnicas de neuroimágenes y funcionales, como la tomografía axial computarizada (TAC), resonancia magnética cerebral (RM) con sus variantes funcionales, la tomografía de emisión de positrones (PET), la tomografía computarizada de emisión de fotones (SPECT) y la magnetoencefalografía (MEG), la llegada de esas técnicas no ha conseguido relegar al EEG a un papel secundario. La calidad del EEG va a depender de los datos obtenidos, de una evaluación adecuada para llegar a conclusiones valederas que se obtengan como producto de la habilidad, entrenamiento y experiencia de la persona a cargo de realizarlo. El EEG aporta el diagnóstico definitivo en muchas de las epilepsias y síndromes epilépticos de la infancia.
The utility of the electroencephalogram (EEG) in handling childhood epilepsies and epileptic syndromes was reviewed as a diagnosis and prognosis tool in the patient with epileptic crisis. Correlations were stablished between clinical manifestations, age of onset, frequency, prognosis and electroencephalographic characteristics of the layouts of each one of the different types. EEG is extremely useful in neurosciences; since it is the only instrument that we have to assess the brain´s function in real time, that is to say, at the scale of milliseconds. Although in the last decade a spectacular development of neuroimages and functional techniques has taken place, as with computerized axial tomography (CAT), cerebral magnetic resonance (MR) with its fuctional variants, positron emission tomography (PET), photon emission computerized tomography (SPECT) and magnetoencephalography (MEG), the arrival of those techniques has not been able to relegate EEG to a secondary place. The utility of the EEG depends on an adequate evaluation that will lead to valid conclusions. The accuracy of this evaluation is related to the ability, training and experience of the operator. The EEG contributes to the definite diagnosis in many of childhood epilepsies and epileptic syndromes.
Subject(s)
Humans , Male , Female , Electroencephalography/methods , Epilepsy/classification , Spasms, Infantile/pathology , Landau-Kleffner Syndrome/physiopathology , Seizures/etiology , Seizures/pathology , Neurology , PediatricsABSTRACT
Diagnosis epilepsy depends heavily on a detailed, and accurate description of the abnormal transient neurological manifestations. Observing the seizures yields important semiologic features that characterize epilepsy. Video-EEG monitoring allows the identification of important lateralizing [left versus right], and localizing [involved brain region] semiologic features. This information is vital for identifying the seizure origin for possible surgical interventions. The aim of this review is to present a summary of important semiologic characteristics of various seizures that are important for accurate seizure lateralization and localization. This would most likely help during reviewing video-EEG recorded seizures of intractable patients for possible epilepsy surgery. Semiologic features of partial and secondarily generalized seizures can be grouped into one of 4 categories including; automatism, speech, motor, and autonomic features. These features will be discussed in detail in this review. However, seizure semiology should be correlated with EEG and MRI findings. Accurate identification of the seizure origin is more likely if focal EEG onset and MRI findings were concordant with the clinical semiology
Subject(s)
Humans , Epilepsy/classification , Epilepsy, Absence , Epilepsy, Complex Partial , Epilepsy, Frontal Lobe , Epilepsy, Temporal Lobe , Electroencephalography , SeizuresABSTRACT
O objetivo deste texto é rever a terminologia sobre epilepsia utilizada no Brasil, a fim de unificar termos de uso comum tanto para leigos como para profissionais da área de saúde, uma vez que não há consenso. Em teses e artigos leigos sobre epilepsia são comuns termos como epiléptico e portador sendo a epilepsia referida como uma doença ou uma síndrome. Por outro lado, em reuniões de pessoas com epilepsia o termo paciente com epilepsia é comumente utilizado e os indivíduos ali presentes não são pacientes. A partir da heterogeneidade da epilepsia, o termo distúrbio parece ser o mais abrangente nos âmbitos cientifico e social. A Associação Brasileira de Epilepsia (ABE) propõe a definição de epilepsia baseada na última da Liga Internacional contra a Epilepsia (ILAE) (2005): distúrbio cerebral causado por predisposição persistente a gerar crises epilépticas e pelas conseqüências neurobiológicas, cognitivas, psicossociais e sociais da condição, devendo ter ocorrido pelo menos uma crise epiléptica. A ABE considera que os termos doença, portador, epiléptico devam ser proscritos e a epilepsia deva ser considerada um distúrbio, e os indivíduos que a apresentem, pessoas com epilepsia.
The objective of this paper is to review the terminology about epilepsy used in Brazil, in order to unify terms for lay people and health professionals, hence there is no consensus. Because of the heterogeneity of epilepsy, the term disorder seems to be the more complete regarding scientific and social aspects. The Associação Brasileira de Epilepsia proposes the following definition based on ILAE definition (2005): "Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure". The ABE considers that the terms disease, carrier, epileptic must be outlawed and epilepsy should be considered a disorder, and the individuals that present it, people with epilepsy.
Subject(s)
Seizures/classification , Epilepsy/classification , Terminology as Topic , BrazilABSTRACT
OBJETIVOS: Evaluar la utilidad de un cuestionario para establecer el diagnóstico de epilepsia en niños de 1 a 10 años de edad y clasificar las crisis epilépticas en los servicios de atención primaria. MÉTODOS: Estudio observacional transversal; participaron 204 niños de 1 a 10 años de edad (102 con diagnóstico de epilepsia y 102 sin epilepsia) escogidos al azar en el Centro Regional de Epilepsias y en el Hospital Vicente Corral Moscoso, ambos de la ciudad de Cuenca, Ecuador. Los niños fueron pareados por grupos de edad (de 1 a 5 y de 6 a 10 años). Cuatro estudiantes del último año de la Escuela de Medicina de esa ciudad que desconocían el diagnóstico del niño aplicaron el cuestionario a un familiar del niño o a su representante. Se evaluó el grado de discriminación diagnóstica (validez) del cuestionario, la sensibilidad, la especificidad y el valor diagnóstico de un resultado positivo o negativo, con un intervalo de confianza de 95 por ciento (IC95 por ciento). Como criterio de referencia se utilizó el diagnóstico clínico emitido por especialistas. RESULTADOS: La evaluación realizada demostró que el cuestionario de diagnóstico estudiado tiene buena sensibilidad (95,10 por ciento; IC95 por ciento: 94,58 a 95,61) y especificidad (97,06 por ciento; IC95 por ciento: 96,58 a 97,59). El índice de validez fue de 96,08 (IC95 por ciento: 95,84 a 96,36), con un valor pronóstico de un resultado positivo de 97,00 por ciento (IC95 por ciento: 96,48 a 97,52) y un valor pronóstico de un resultado negativo de 95,19 por ciento (IC95 por ciento: 94,74 a 95,74). El grado de concordancia de la clasificación de las crisis epilépticas realizadas por los neurólogos y los estudiantes de medicina que utilizaron el cuestionario fue satisfactorio para las crisis generalizadas (índice k: 0,67). Según la prueba de reproducibilidad de resultados entre observadores, el índice k para el diagnóstico de los neurólogos fue de 0,80 y para el diagnóstico de los pediatras de 0,89. CONCLUSIONES: El cuestionario de diagnóstico evaluado posee una buena sensibilidad y una adecuada especificidad y puede ayudar a los médicos generales, después de un breve entrenamiento, a diagnosticar las crisis epilépticas en los servicios de atención primaria.
Objective. To evaluate the usefulness of a questionnaire in primary health care services for establishing the diagnosis of epilepsy in children from 1 to 10 years old and for classifying their epileptic seizures. Methods. This cross-sectional observational study was conducted in 2004. There were 204 children in the study (102 diagnosed with epilepsy and 102 without epilepsy). The children were randomly selected at the Regional Center of Epilepsies and the Vincent Corral Moscoso Hospital, which are both in the city of Cuenca, Ecuador. For the study, each child with epilepsy was matched with a child without epilepsy, in two age groups: 1 to 5 years old and 6 to 10 years old. Four students who were in their last academic year in the School of Medicine of Cuenca and who did not know the child's diagnosis utilized the questionnaire with a family member or other guardian of the child. The validity, sensitivity, specificity, positive predictive value, and negative predictive value of the questionnaire were calculated, with 95% confidence intervals (95% CIs). The clinical diagnosis carried out by specialists was used as the gold standard. Results. The assessment showed that the questionnaire had good sensitivity (95.10%; 95% CI: 94.58%95.61%) and good specificity (97.06%; 95% CI: 96.58%97.59%). Validity was 96.08% (95% CI: 95.84%96.36%), with a positive predictive value of 97.00% (95% CI: 96.48%97.52%) and a negative predictive value of 95.19% (95% CI: 94.74% 95.74%). The level of agreement in the classification of the epileptic seizures carried out by the neurologists and by the medical students who used the questionnaire was satisfactory for the generalized seizures (kappa = 0.67). Upon testing for interobserver agreement among the specialists, the kappa value for the diagnoses was 0.80 among the neurologists and 0.89 among the pediatricians. Conclusions. The diagnostic questionnaire that was assessed has good sensitivity and adequate specificity, and, after brief training, primary health care general practitioners can use it to help them diagnose epileptic seizures.
Subject(s)
Humans , Infant , Child, Preschool , Child , Epilepsy/classification , Epilepsy/diagnosis , Surveys and Questionnaires , Confidence Intervals , Cross-Sectional Studies , Ecuador , Family Practice , Observer Variation , Primary Health Care , Reproducibility of Results , Sensitivity and Specificity , Time FactorsABSTRACT
The aim of this paper is to study the clinical, electroencephalographic features, response to treatment and the outcome of juvenile myoclonic epilepsy in Libyan patients. A total of 12 patients with prevalence of 1.7% among 704 patients with epilepsies, 3 males [25%], 9 females [75%], age of onset is between [9-17 years] with a mean of 13.8 years, myoclonic jerks were the presenting symptoms in 7[58.4%] patients, 4[33.3%] of them their myoclonic jerks[MJ] were severe enough to make them fall down to the ground, generalized tonic clonic seizures [GTCS] in 5[41.6%] patients, one [8.3%] patient had symptoms of typical absence [TA] in association with the [MJ], no family history of epilepsy was found in all patients. Waking interictal electroencephalographic features showed normal background in all the 12[100%] patients, 3 [25%] patients were photosensitive with characteristic 4 HZ/sec spike and wave. All 12 [100%] patients responded well to small dose of sodium valproate 600mg/day and were seizure free for 3years. The out come in all the 12 [100%] patients showed relapse of the myoclonic jerks after the withdrawing of the treatment