Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments.

OBJECTIVE: We aimed to evaluate long-term surgical outcomes in patients treated for mesial temporal lobe epilepsy compared with a similar group of patients who underwent a preoperative evaluation. METHODS: Patient interviews were conducted by an independent neuropsychologist and included a sociodemographic questionnaire and validated versions of the Beck Depression Inventory-II, Adverse Events Profile, Quality of Life in Epilepsy-31, and Rey Auditory Verbal Learning Test. RESULTS: Seventy-one patients who underwent surgery and 20 who underwent mesial temporal lobe epilepsy preoperative evaluations were interviewed. After an 81-month mean postoperative follow-up, 44% of the surgical patients achieved complete seizure relief according to the Engel classification and 68% according to the International League Against Epilepsy classification. The surgical group had a significantly lower prevalence of depression (P = 0.002) and drug-related adverse effects (P = 0.002). Improvement on unemployment (P = 0.02) was achieved but not on driving or education. Delayed verbal memory recall was impaired in 76% of the surgical and 65% of the control cases (P = 0.32). Regarding the Quality of Life in Epilepsy-31, the operated patients scored higher in their total score (mean, 75.44 vs. mean, 60.08; P < 0.001) and in all but the cognitive functioning domain irrespective of the follow-up length. Seizure control, Beck Depression Score, and Adverse Events Profile severity explained 73% of the variance in the surgical group quality of life. CONCLUSIONS: Our study found that, although surgical treatment was effective, its impact on social indicators was modest. Moreover, the self-reported quality of life relied not only on seizure control but also on depressive symptoms and antiepileptic drug burden.

The approach to patients with psychogenic nonepileptic seizures in epilepsy surgery centers regarding diagnosis, treatment, and education.

Previous studies, using surveys, provided an understanding about how health-care providers address patients with PNES. To date, there is limited information on the management of patients with PNES by tertiary referral centers for epilepsy. In this study, we surveyed 11 Brazilian epilepsy center directors about diagnosis, treatment, education and research on PNES. Respondents reported that patients with PNES represented 10-20% of all adult patients recorded by video-EEG (VEEG). All respondents recognized VEEG as the method to confirm the diagnosis, and 81.8% used this approach for confirmation. Most centers had a standard protocol for diagnosis. None of the centers had a particular protocol to treat PNES, but 90.9% had a uniform treatment approach including therapy and educational measures. Psychotherapy was not easily obtained in nine centers (81.8%). Seven (63.3%) centers reported ongoing research projects with PNES. Five centers referred to an educational PNES program discussing diagnosis, but only one reported an educational program for treatment. This study showed a commitment to PNES diagnosis; however, some gaps remain regarding treatment and training, namely implementing a psychotherapy approach for patients and providing educational curricula for clinicians.

The influence of Pilates method in quality of life of practitioners.

INTRODUCTION: The priority of Pilates is to obtain physical and mental health, including flexibility, in a secure and balanced way. AIM: To verify the change in the quality of life of practitioners of the Pilates method. METHODOLOGY: Descriptive observational study of 74 Pilates practitioners divided into 3 groups: practitioner for up to three months; practitioner for more than 1 year; and ex-practitioners. The quality of life analysis was performed using the self-administered questionnaire, SF-36. The comparison between groups was made by ANOVA one-way, then an analysis by post-hoc Scheffé, with a significance level of p < 0.05. RESULT: The group of experienced practitioners showed better results in the dimensions of physical function (mean 86.37 points; p < 0.01), general health (mean 29.48 points; p < 0.001) and mental health (mean 43.59 points; p < 0.02) of quality of life. CONCLUSION: Pilates was associated with the improvement of quality of life.

Imitadores da epilepsia: as crises não-epilépticas fisiológicas / Imitators of epilepsy: the physiologic nonepileptic seizures

Crises não-epilépticas (CNE) são eventos que podem lembrar crises epilépticas, porém não acompanhados de suas características clínicas e eletrencefalográficas. Podem ser subdivididas em CNE psicogênicas (CNEP) e fisiológicas (CNEF). As CNEF podem ocorrem em 12-36 por cento dos pacientes com epilepsia. A distinção entre CNEF e epilepsia é importante pacientes erroneamente diagnosticados são freqüentemente investigados de forma excessiva, tratados desnecessariamente e restringidos em sua atuação. A história clinica constitui a ferramenta diagnóstica mais útil no diagnóstico. Lamentavelmente não há um conjunto confiável de sinais e sintomas com adequada sensibilidade e especificidade para formulação do diagnóstico inequívoco. A interpretação errada de padrões eletrencefalográficos benignos pode ser um dos erros cardinais no diagnóstico equivocado. O vídeo-EEG permanece como método de eleição para a apuração do diagnóstico diferencial.

Non-epileptic seizures (NES) are events resembling epileptic attacks, but lacking their characteristic clinical and electrographic features. They can be subdivided in psychogenic NES and physiologic non-epileptic seizures. Physiologic NES reportedly occur in 12-36 percent of patients with presumed epilepsy. The distinction between physiologic NES and epilepsy is important because patients misdiagnosed are often excessively investigated, inappropriately treated and have unnecessary restrictions. Additionally, once a diagnosis of epilepsy is given it is not easily removed. In differentiating between epilepsy and physiologic NES, the history is the most useful tool. Unfortunately, there is no particular constellation of clinical signs and symptoms with a good sensitivity and specificity for the diagnosis. Improper interpretation of an EEG, mainly because of the overinterpretation of benign EEG patterns, is one of the cardinal errors inducing a misdiagnosis. EEG video-telemetry has as yet no reliable equivalent for the differential diagnosis.

A inserção da epilepsia no ensino médico (graduação) / Epilepsy education in medical school (medical undergraduate)

A epilepsia como um distúrbio crônico do SNC é freqüentemente atendida numa primeira etapa por um medico não neurologista. É crescente este atendimento principalmente pelo médico generalista na assistência básica de saúde. Do ponto de vista epidemiológico dos distúrbios neurológicos a epilepsia destaca-se como um dos mais prevalente. Este fato mostra importância da inserção da epilepsia na graduação médica. A Comissão de Ensino da Liga Brasileira de Epilepsia propõe um programa mínimo no currículo médico, sob a orientação da Disciplina de Neurologia, abrangendo os seguintes tópicos: definições, epidemiologia, classificação, semiologia, etiologia, fisiopatologia, métodos complementares, tratamento e os aspectos médico­sociais. Pretende-se que este programa mínimo proporcione, ao futuro médico, uma abordagem adequada e competente para o atendimento do paciente com epilepsia e ou crises epilépticas.

Epilepsy as a chronic CNS disorder is often treated in its first stage by a non-neurologist. Interest in epilepsy in general practice is growing at the community-based health care services. From the neuroepidemiological point of view the epilepsy stands out as one of the most prevalent neurological disorders. This fact shows the importance of integrating epilepsy into the medical graduation curriculum. The Brazilian Epilepsy League Committee on Epilepsy Education has proposed a minimum program in the medical curriculum, as part of the Neurology Course with the basic clinical aspects such as the definitions, epidemiology, classification, semiology, etiology, physiopathology, complementary methods, treatment and medical-social aspects. This minimum program is intended to provide the future doctor with a proper and competent approach for attending the patient with epilepsy and/or epileptic seizures.

Epilepsia e aspectos legais / Epilepsy and legal aspects

Durante a XXX Reunião da Liga Brasileira de Epilepsia, ocorrida durante o XX Congresso Brasileiro de Neurofisiologia Clínica em Gramado, a Comissão de Aspectos Legais optou-se por colocar em pauta a discussão da Portaria nº 391 de 07 de julho de 2005 do Ministério da Saúde (http://dtr2001.saude.gov.br/sas/portarias/ port2005/pt-391). Tendo por objetivo regulamentar a assistência de alta complexidade ao paciente com doença neurológica, a portaria 391 define que a rede de assistência a este paciente será composta por Unidades de Assistência de Alta Complexidade em Neurocirurgia (UAAC em NC) e Centros de Referência de Alta Complexidade em Neurocirurgia (CRAC em NC). A Cirurgia de Epilepsia passa então a ser um dos procedimentos oferecidos por um CRAC em NC. As implicações práticas desta regulamentação serão discutidas.(AU)

In the XXX Brazilian Epilepsy Meeting, taking place during the XX Brazilian Clinical Neurophysiology Meeting in Gramado, the Commission for Legal Aspects decided to discuss the Health Ministry Decision number 391 of July 07 2005 (http://dir2001.saude.gov.br/sas/portarias/port2005/pt-391). This decision defined that the high complexity neurological assistance, in the public health system, will be offered in two hierarchic different centers: Higt Complexity Neurosurgical Units and High Complexity Neurosurgical Reference Centers. Epilepsy Surgery can only take place in a High Complexity Neurosurgical Reference Center. The possible consequences of this decision will be discussed.(AU)

Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment.

OBJECTIVE: To investigate the effect of three months of low-frequency repetitive transcranial magnetic stimulation (rTMS) treatment in intractable epilepsy. METHODS: Five patients (four males, one female; ages 6 to 50 years), were enrolled in the study; their epilepsy could not be controlled by medical treatment and surgery was not indicated. rTMS was performed twice a week for three months; patients kept records of seizure frequency for an equal period of time before, during, and after rTMS sessions. rTMS was delivered to the vertex with a round coil, at an intensity 5% below motor threshold. During rTMS sessions, 100 stimuli (five series of 20 stimuli, with one-minute intervals between series) were delivered at a frequency of 0.3 Hz. RESULTS: Mean daily number of seizures (MDNS) decreased in three patients and increased in two during rTMS--one of these was treated for only one month; the best result was achieved in a patient with focal cortical dysplasia (reduction of 43.09% in MDNS). In the whole patient group, there was a significant (p<0.01) decrease in MDNS of 22.8%. CONCLUSION: Although prolonged rTMS treatment is safe and moderately decreases MDNS in a group of patients with intractable epilepsy, individual patient responses were mostly subtle and clinical relevance of this method is probably low. Our data suggest, however, that patients with focal cortical lesions may indeed benefit from this novel treatment. Further studies should concentrate on that patient subgroup.

Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment

OBJETIVO: investigar o efeito de três meses de estimulação magnética transcraniana repetitiva (EMTr) de baixa freqüência, na epilepsia de difícil controle. MÉTODO: Cinco pacientes (quatro homens, uma mulher, idades entre 6 e 50 anos), participaram do estudo; suas crises epilépticas não puderam ser controlados por tratamento medicamentoso e não tinham indicação cirúrgica; a EMTr foi realizada duas vezes por semana durante três meses, sendo que os pacientes anotaram o número diário de crises neste período, assim como nos três meses anteriores e posteriores ao tratamento. A aplicação da EMTr foi feita no vértex com bobina circular, com intensidade 5 por cento abaixo do limiar motor. Durante as sessões de EMTr, 100 estímulos (5 séries de 20 estímulos, com um minuto de intervalo entre as séries) foram realizadas na freqüência de 0,3 Hz. RESULTADOS: A média diária de crises (MDC) decresceu em três pacientes e aumentou em dois durante o uso da EMTr; um destes casos foi tratado somente por um mês; o melhor resultado foi encontrado em um paciente com displasia cortical focal (redução de 43,09 por cento na MDC). Em todo o grupo de pacientes, houve decréscimo significativo na MDC de 22,8 por cento (p<0,01). CONCLUSAO: Embora o tratamento prolongado com a EMTr seja seguro e tenha sido registrado decréscimo moderado da MDC em um grupo de pacientes com epilepsia de difícil controle, respostas individuais de pacientes foram imprevisíveis e a relevância clínica deste método é provavelmente baixa. Nossos dados sugerem, contudo, que pacientes com lesões corticais focais podem ser beneficiar deste novo tipo de tratamento. Estudos futuros devem se concentrar neste grupo de pacientes.

Is the prevalence of celiac disease increased among epileptic patients?

OBJECTIVE: To assess the prevalence of celiac disease (CD) among a group of epileptic patients attending the Epilepsy Clinics of two general hospitals in the city of Brasilia (DF), Brazil. METHOD: Serum samples were collected from 255 epileptic patients (119 children, 136 adults) originating from Epilepsy Clinics, and from a control group composed by 4405 individuals (2034 children, 2371 adults) attending the Laboratory of Clinical Analysis, for routine blood testing. The diagnosis of CD was determined by the antiendomysium antibody (IgA-EMA) test and by small intestine biopsy. RESULTS: two of the 255 epileptic patients (1:127) and fifteen subjects from the control group (1:293) tested positive for the IgA-EMA assay. CONCLUSION: the prevalence of CD was 2.3 times higher in epileptic patients than in controls (7.84 per 1000 versus 3.41 per 1000). Although still not statistically significant, this result is highly suggestive of an increased prevalence of CD among epileptic patients.

Is the prevalence of celiac disease increased among epileptic patients?

OBJECTIVE: To assess the prevalence of celiac disease (CD) among a group of epileptic patients attending the Epilepsy Clinics of two general hospitals in the city of Brasilia (DF), Brazil. METHOD: Serum samples were collected from 255 epileptic patients (119 children, 136 adults) originating from Epilepsy Clinics, and from a control group composed by 4405 individuals (2034 children, 2371 adults) attending the Laboratory of Clinical Analysis, for routine blood testing. The diagnosis of CD was determined by the antiendomysium antibody (IgA-EMA) test and by small intestine biopsy. RESULTS: two of the 255 epileptic patients (1:127) and fifteen subjects from the control group (1:293) tested positive for the IgA-EMA assay. CONCLUSION: the prevalence of CD was 2.3 times higher in epileptic patients than in controls (7.84 per 1000 versus 3.41 per 1000). Although still not statistically significant, this result is highly suggestive of an increased prevalence of CD among epileptic patients