Self-reported adherence among people with epilepsy in Brazil.

BACKGROUND: Nonadherence rates among people with epilepsy (PWE) are widely variable, ranging from 26% to 95.4%. We aimed to identify nonadherence in Brazil, its determinant factors, its impact on patients' management, and to compare it with other chronic nonparoxysmal diseases. METHODS: A multicenter observational case-control study was conducted between March 2015 and October 2016, and 153 subjects were included. Subjects' clinical-epidemiological data were surveyed with the Morisky-Green test (MGT), Brief Medication Questionnaire (BMQ), and the Liverpool adverse events profile (LAEP). RESULTS: One hundred three PWE and 50 controls with other, nonparoxysmal chronic conditions were interviewed; both groups were matched according to age and socioeducational level. People with epilepsy were aged 36.4 ±â€¯13.9 (range 18-67), 55% were women, mean age at epilepsy onset was 18.1 ±â€¯15.5 years, 51.5% had pharmacoresistant epilepsy, and 48.5% were on monotherapy. 74.8% of patients and 70.0% controls were nonadherent to treatment according to MGT (p = 0.58); and barrier of recall (BMQ) was associated with nonadherence in 78% of PWE and 76% of controls (p = 0.84). Binary logistic regression analysis revealed LAEP (OR 1.05; 95%CI = 1.01-1.09; p = 0.03) and self-reported frequency of forgetfulness on the last three months (OR 19.13; 95%CI = 2.40-152.28; p < 0.01) as the main factors associated with nonadherence. Nonadherent subjects did not have more seizures and did not need emergency treatment more often than adherent ones. CONCLUSION: Three of four PWE were not fully adherent to their treatment. Adherence assessment should be routine in all outpatient visits as well as interventions aimed to improving it. Adverse events are important predictors of adherence, and they should be considered when choosing the initial treatment of epilepsy.

Prevalência de Doenças Neurológicas em Uma Região Rural do Brasil / Frequency of Neurological Diseases in a Rural Region of Brazil

The World Health Organization recommends identifying the most prevalent diseases in each developing country or region to promote the optimal use of health services. Few studies have analysed the prevalence of neurological diseases in developing countries, especially in tropical regions. This study aims to describe neurological syndromes and tropical neurological diseases encountered in the mid-northern Mato Grosso region of Brazil. This study represents a retrospective, descriptive evaluation of the demographic and clinical data of patients 15 years old above living in the region and analyzing information regarding neurological diagnoses identified in the sample. In 2008, 1,402 patients were referred to neurological consultations. The mean age of the adults was 38 years; the study included slightly more women (52.2%) than men. The most common syndromes were headaches (32.2%) and epilepsy (16.3%). No tropical disease was found in our sample, and according to sanitary authorities, the number of related notifications was lower than the expected for a tropical region. The present study is the only study conducted to date in a rural region of Brazil using outpatient evaluations to define the frequency of neurological diseases. The prevalence of tropical diseases in this region is lower than the expected.

A Organização Mundial de Saúde - OMS recomenda a identificação das doenças mais prevalentes nos países ou regiões em desenvolvimento, a fim de promover melhorias direcionadas nos serviços de saúde locais. Poucos estudos analisam prevalência de doenças neurológicas em países em desenvolvimento, especialmente em regiões tropicais. Este artigo descreve síndromes neurológicas e doenças neurológicas tropicais identificadas na região do Médio Norte de Mato Grosso, Brasil. Trata-se de estudo retrospectivo descritivo, analisando dados clínicos e demográficos de pacientes com mais de 15 anos de idade que moram na região, assim como os diagnósticos neurológicos identificadas na amostra. Em 2008,1,402 pacientes foram encaminhados a consulta neurológica, sendo a média de idade de 38 anos com leve predomínio do sexo feminino (52.2%). Síndromes neurológicas mais frequentes foram cefaleia (32.2%) e epilepsia (16.3%). Nenhuma doença neurológica tropical foi identificada na amostra e, de acordo com dados oficiais da vigilância sanitária local, a notificação destas foi abaixo do esperado para uma área de clima tropical. O presente estudo é a única publicação brasileira com dados coletados em área rural no Brasil, utilizando pacientes acompanhados em ambulatório de neurologia, para definir a frequência de doenças neurológicas, que estão abaixo das taxas esperadas para a região.