Comparação da acurácia diagnóstica do questionário de rastreamento neurológico para epilepsia aplicado na população geral e numa coorte de crianças / Comparison of the diagnostic accuracy of the questionnaire of neurological screening for epilepsy administered to the general population and to a cohort of children

Introdução: O rastreamento das crises convulsivas na infância necessita de instrumentos acurados. O Objetivo deste trabalho foi comparar o desempenho dos Questionários de Rastreamento Neurológico para Epilepsia (QRNE) aplicados à população geral e a uma coorte de crianças menores de cinco anos de idade, nascidas na zona urbana de Passo Fundo/RS em 2003, incluindo-se 1.687 localizadas em 2007-2008. Metodologia: Aplicou-se o QRNE nos domicílios, com expansão das questões 12 a 14 para familiares em primeiro grau. As crianças com resultado positivo realizaram Entrevista Diagnóstica Neurológica para Epilepsia (EDNE) e exame eletroencefalográfico, revisados por avaliador cego e foram considerados padrão ouro.Compararam-se os desempenhos do questionário aplicado à coorte com os resultados obtidos pelo QRNE Porto Alegre e dois dos sub-questionários que o compõem. Resultados: A sensibilidade do QRNE aplicado à coorte foi semelhante à obtida na população de Porto Alegre (z=0,557~p=0,558), com diferença significativa em relação aos sub-questionários OMS (z=6,23~ p<0,0001) e ICBERG (z=4,82~ p<0,0001). A especificidade se mostrou significativamente inferior: POA (z=10,694~p<0, 0001),OMS (z=17,422~p<0,0001) e ICBERG (z=16,447~p<0,0001). O valor preditivo positivo diferiu significativamente em relação ao QRNE Porto Alegre (z=2,129~p=0,03). O valor preditivo negativo foi semelhante aos demais. Conclusão: Houve semelhança entre o QRNE aplicado à coorte de crianças menores de cinco anos de idade e à população geral na sensibilidade e valor preditivo negativo. Em relação à especificidade e ao valor preditivo positivo, os resultados mostraram-se inferiores, sugerindo que a expansão das questões para os familiares tornou o instrumento mais sensível, porém menos específico

Introduction: Screening for convulsive crises in childhood requires accurate instruments. The aim of this work was to compare the performance of Questionnaires for Neurological Screening for Epilepsy (QNTE) administered to the general population and to a cohort of children under 5 years of age, born in the urban area of Passo Fundo/RS in 2003, including 1687 located in 2007-2008. Methods: The QNTE was administered in the households, extending questions 12 and 14 to first degree relatives. Children with positive results were submitted to the Neurological Diagnostic Interview for Epilepsy (NDIE) and the electroencephalographic exam (EEG), reviewed by blind evaluator, and were considered as the gold standard. The performance of the questionnaires administered to the cohort were compared with the results obtained with the QNTE Porto Alegre and 2 sub-questionnaires that compose it. Results: The sensitivity of the QNTE administered to the cohort was similar to the one obtained in the population of Porto Alegre (z=0.557~p=0.558), with significant difference as compared to sub-questionnaires OMS (z=6.23~ p<0.0001) and ICBERG (z=4.82~ p<0.0001). Specificity was significantly lower: POA (z=10,694~p<0, 0001), OMS (z=17.422~p<0.0001) and ICBERG (z=16.447~p<0.0001). The positive predictive value was significantly different from the QNTE Porto Alegre (z=2.129~p=0.03). The negative predictive value was similar to the others. Conclusion: There was a similarity between the QNTE administered to the cohort of children under 5 and to the general population in sensitivity and negative predictive value. It was inferior in specificity and positive predictive value, suggesting that extending the questions to relatives made the instrument more sensitive but less specific

Factores pronósticos de recurrencia de la epilepsia focal en el niño / Prognostic factors of recurrence of focal epilepsy in children

INTRODUCCIÓN. El objetivo de este trabajo fue determinar los factores pronósticos de recurrencia de las crisis epilépticas focales a los 2 años del diagnóstico y del inicio del tratamiento. MÉTODOS. Este estudio observacional, analítico y prospectivo incluyó a 207 niños que presentaron dos o más crisis epilépticas focales no provocadas, hospitalizados en el Departamento de Neuropediatría del Hospital William Soler, entre diciembre de 2001 y diciembre de 2003. Al final de los 2 años de seguimiento, 185 pacientes concluyeron el estudio. RESULTADOS. El 33,5 por ciento de los pacientes presentó recurrencias de las crisis epilépticas focales al finalizar el estudio. Constituyeron factores de riesgo de recurrencia de las crisis epilépticas focales los siguientes: edad menor de un año, etiología sintomática, presencia de antecedentes personales de crisis neonatales sintomáticas y discapacidades neurológicas y la persistencia de descargas en el electroencefalograma (EEG) evolutivo. El análisis de regresión logística demostró como variables pronósticas de recurrencia la etiología sintomática (p = 0,000; OR = 3,107), el antecedente personal de crisis neonatales sintomáticas (p = 0,037; OR = 4,623) y la persistencia de descargas en el EEG evolutivo (p = 0,000; OR = 2,109). CONCLUSIONES. El antecedente personal de crisis neonatales sintomáticas constituyó el factor independiente con mayor influencia en las recurrencias de las crisis epilépticas focales

INTRODUCTION: The objective of present paper was to determine the recurrent prognostic factors of focal epileptic crises at 2 years of diagnosis and of treatment onset. METHODS: This prospective, analytical and observational study included 207 children presenting two or more non-provoked epileptic crises, admitted in Neuropediatrics Department of William Soler Hospital between December, 2001 and December, 2003. At a two years follow-up, 185 patients concluded the study. RESULTS: The 33,5 percent of patients had recurrences of focal epileptic crises at the end of the year. Recurrent risk factors of crises above mentioned included: aged under 1 year, symptomatic etiology, presence of personal backgrounds of symptomatic neonatal crises and neurologic disabilities and persistence of the evolutionary electroenphalogram discharges. The logistic regression analysis showed as prognostic variables of symptomatic etiology recurrence (p = 0,000; OR = 3, 107), the persona background of symptomatic neonatal crises (p = 0,037; OR = 4,623) and the discharges persistence in the evolutionary electroencephalogram (p = 0,000; OR = 2,109). CONCLUSIONS: The personal background of symptomatic neonatal crises was the independent factor with a higher influence on recurrent focal epileptic crises