Ketogenic diet, epilepsy and cognition: what do we know so far? A systematic review.

CONTEXT: Epilepsy is a chronic neurological disorder that has social, cognitive, and psychological consequences to the patient. OBJECTIVE: The effects of the ketogenic diet (KD) in children and adults with pharmacoresistant epilepsy on cognitive function were evaluated in this systematic review. DATA SOURCES: The MEDLINE, Cochrane Library, Scopus, Web of Science, and LILACS databases were searched up to February 2021. STUDY SELECTION AND DATA EXTRACTION: From the 2973 records initially identified, 24 studies were included in the systematic review. These records were screened via PICO criteria, focusing on studies that evaluated the effects of KD on cognitive function of patients with pharmacoresistant epilepsy. RESULTS: Nineteen studies described improvements in cognitive function attributed to KD; improvements were not observed in 2 studies, but neither was aggravation. Contradictory results were reported in 3 studies, depending on the method used to assess cognition. At first glance, cognitive function appears to be associated with the number of seizures, diet effectiveness, amount of carbohydrate ingested, and antiseizure medication used. However, due to the diversity of methods used to assess cognitive function, especially self-perception of cognitive improvement by the patient, it was not possible to confirm this hypothesis. CONCLUSION: It was not possible to confirm if KD itself promotes improvements in cognitive function in patients with pharmacoresistant epilepsy. Certainly, more studies are needed with better methodological quality, larger and more homogeneous samples in relation to epileptic syndrome and clinical aspects of the disease, more rigid monitoring of adherence to the diet, and use of standardized tests for neuropsychological assessment. Systematic Review Registration: PROSPERO registration no. CRD42019129236.

Severity and disability related to epilepsy from the perspective of patients and physicians: A cross-cultural adaptation of the GASE and GAD scales.

PURPOSE: To perform a cross-cultural adaptation of the Global Assessment of Severity of Epilepsy (GASE) and Global Assessment of Disability (GAD) scales to Brazilian Portuguese and compare patients' self-rated scores with their attending physicians' ratings. METHODS: We conducted an observational, multicentre, cross-sectional study. Patients followed up in five epilepsy centres in Brazil responded to GASE and GAD questionnaires and to the Hospital Anxiety and Depression Scale and the Adverse Events Profile, both previously validated in Brazil. GASE and GAD scales were also completed by 20 attending physicians providing care to these patients. RESULTS: A total of 138 patients were interviewed, with a mean age of 39.9 ± 13.81 years and a median of 11 (interquartile range, IQR = 7.5-12) years of education. Eighty-five (61.6%) patients were female. Most patients were diagnosed with focal epilepsy (82.6%). Only 5.8% and 3.6% of respondents reported having difficulty understanding the GASE and GAD, respectively. The patients scored a median of 3 (IQR = 2-5) on the self-perceived GASE and 4 (IQR = 2-6) on the GAD. Physician ratings were moderately to highly correlated with patients' self-perceived scores on the GASE and GAD. Linear regression analysis demonstrated that physicians' GASE and GAD scores predicted 37% and 20% of the patients' self-reported GASE and GAD variation, respectively. CONCLUSION: Brazilian Portuguese cross-cultural adaptation of the GASE and GAD was successful. These scales were found to be easy to use by patients and health professionals, and revealed the burden of epilepsy on patients' lives.

Evolução das manifestações clínicas de pacientes com doença de parkinson / Evolution of clinical manifestations of parkinson's disease patients

Objetivos: Avaliar o perfil clínico e epidemiológico dos pacientes parkinsonianos acompanhados no ambulatório de Distúrbios do Movimento do Hospital Governador Celso Ramos utilizando-se escaladas validadas. Métodos: Estudo longitudinal onde foram incluídos 167 pacientes consecutivos, em diferentes estágios da doença de Parkinson, atendidos no ambulatório de distúrbios do movimento do HGCR e reavaliados 20 pacientes em consulta, 5 anos após a primeira. Aplicou-se questionário e avaliou-se o primeiro sintoma motor cardinal entre as associações independentes e entre os escores de sintomas neurológicos motores avaliados através da escala UPDRS-MDS e Schwab and England Activities of Daily Living Scale. Resultados: Tremor foi o primeiro sintoma motor percebido mais frequentemente pelos pacientes (64,9%), dor foi a primeira queixa de 5,2% dos pacientes. A idade de início do primeiro sintoma foi inversamente proporcional à escolaridade. Quanto maior a pontuação nas escalar UPDRS-MDS ­ III (p=0,004) e Schwab and England Activities of Daily Living Scale (p=0,001) maior a tendência a inatividade. Conclusão: A doença de Parkinson geralmente é percebida por seus sintomas motores clássicos, entretanto, uma série de sintomas não motores iniciam e acompanham a evolução da doença conforme mostra a piora do perfil ao longo de 5 anos.

Objectives: To evaluate symptoms, establish a profile for the Parkinsonian patient of HGCR's Movement Disorders's Service. Method: Longitudinal study. 167 consecutive patients, in different stages of Parkinson's disease, and treated at HGCR movement disorders service were inclueded. 20 of them were reevaluated after 5 yers. A questionnaire was administered and the first cardinal motor symptoms was evaluated and associated with independent associations and with the scores of neurological symptoms measured by UPDRS-MDS and through the Schwab and England Activities of Daily Living Scale. Results: Tremor was the first motor symptom perceived most frequently by patients (64.9%), pain was the first complaint of 5,2% of patients. The age of onset of the first symptom was inversely proportional to schooling. The higher the scores in the UPDRS-MDS-III scale (p=0,004) and the Schwab and England Activities of the Daily Living Scale (p = 0,001) the greater the tendency to inactivity. Conclusion: Parkinson's disease is usually noticed by its classic motor symptoms, however, a series of non-motor symptoms begin and accompany the disease's progression. This study evaluated the profile of the clinical and epidemiological patients attending our service and showed important clinical worsening in the evolution of 5 years of disease.

Dieta cetogênica para pacientes adultos com epilepsia: um guia prático / Ketogenic diet for adult epilepsy patients: a pratical guide

Introdução: A dieta cetogênica é um tratamento adjuvante para pacientes pediátricos com epilepsia e pode ser vantajoso para adultos. Objetivos: Fazer uma revisão bibliográfica narrativa de estudos envolvendo o tema Dieta Cetogênica (DC) no tratamento de pacientes com epilepsia adultos e disseminar o conhecimento deste tratamento. Métodos: Fez-se uma revisão de artigos publicados, sem limite de tempo, nas bases de dados eletrônicas Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Google Acadêmico e The Scientific Electronic Library Online (SciELO). O primeiro passo foi a busca pelos descritores "ketogenic diet", "ketogenic diet for adults", "modified Atkins diet", "modified Atkins diet for adults", "medium chain tryglyceride diet", "low glycemic index treatment", "dieta cetogênica", "dieta cetogênica em adultos", "dieta de Atkins modificada" e "dieta de Atkins modificada em adultos". Resultados: Encontrou-se um total de 230 artigos por meio de busca nas bases de dados Medline/PubMed, SciELO e Google Acadêmico. De todos esses 231 artigos apenas 41 deles realmente abordavam o tema "dieta cetogênica em pacientes adultos com epilepsia" e estes foram lidos integralmente. Excluiu-se 189 artigos pois estes não abordavam o tema DC em adultos, abordavam a DC em outras doenças e não somente em epilepsia, utilizavam outra faixa etária que não somente adultos, estavam em outro idioma que não inglês ou português. Dos 41 artigos lidos na íntegra, 17 foram escolhidos para de fato compor o estudo. Conclusão: A dieta cetogênica é um tratamento eficaz e bem tolerado para pacientes adultos com epilepsia.

Introduction: The ketogenic diet is an adjunctive treatment for pediatric patients with epilepsy and may be of benefit to adults. Objectives: To perform a bibliographic review of studies involving the topic Ketogenic Diet in the treatment of patients with adult epilepsy and disseminate the knowledge of this treatment. Methods: A review of published articles was published, without time limit, in the electronic databases Medical Literature Analysis and Retrieval System Online (Medline / PubMed), Google Scholar and The Scientific Electronic Library Online (SciELO). The first step was to search for the descriptors "ketogenic diet", "ketogenic diet for adults", "modified Atkins diet", "modified Atkins diet for adults", "medium chain tryglyceride diet", "low glycemic index treatment" ketogenic diet in adults, modified Atkins diet, and modified Atkins diet in adults. Results: A total of 230 articles were found by searching the databases Medline / PubMed, SciELO and Google academic. Of all 231 articles only 41 of them actually addressed the topic "ketogenic diet in adult patients with epilepsy" and these were read in full. We excluded 189 articles because they did not address the topic DC in adults, they approached CD in other diseases and not only in epilepsy, used another age group that not only adults, were in a language other than English or Portuguese. Of the 41 articles read in their entirety, 17 were chosen to actually compose the study. Conclusion: The ketogenic diet is an effective and well tolerated treatment for adult patients with epilepsy.

Epilepsy perception amongst education professionals / Percepção de epilepsia entre profissionais da educação

INTRODUCTION: Epilepsy is a prevalent neurological disorder that may cause school failure due to several factors such as seizure severity, lack of information about the condition and stigma. This study aimed to evaluate the degree of perceived stigma and knowledge towards epilepsy among education professionals, and additionally, provide them correct information about epilepsy to reduce stigma through a training course. METHODS: Social and demographic data, as well as the degree of stigma were obtained through the Stigma Scale of Epilepsy. To estimate the level of educational professionals' knowledge about epilepsy we used the Questionnaire about Epilepsy. Statistical analysis consisted of Pearson's or Spearman's correlation tests for numerical parametric or non-parametric variables were used to determine potential significant associations. A p <0.05 was considered significant. RESULTS: Two hundred and twenty-five education professionals were interviewed in three different cities in Southern Brazil. Approximately 65% of subjects would attempt to open the mouth of a student during a seizure and the stigma measured by Stigma Scale of Epilepsy before the course was 45.4±16.61. CONCLUSION: The data indicate that education professionals have partial knowledge about epilepsy and a short duration course would be able to improve it and reduce its stigma in this population.

INTRODUÇÃO: A epilepsia é uma doença neurológica prevalente que pode causar fracasso escolar devido a fatores como severidade das crises, pouca informação sobre a doença e estigma. Este estudo teve como objetivo avaliar a percepção do estigma e conhecimento em epilepsia pelos profissionais de educação, fornecer informações corretas sobre epilepsia e reduzir o estigma através de um curso de curta duração. METODOLOGIA: Os dados sociodemográficos e o grau de estigma foram obtidos através da Escala de Estigma em Epilepsia. O grau de conhecimento em epilepsia foi obtido através da adaptação do Questionário Sobre Epilepsia. O teste de correlação de Pearson ou Spearman foi utilizado para análise das variáveis numéricas contínuas paramétricas ou não-paramétricas. O valor de p<0,05 foi considerado significante. RESULTADOS: Duzentos e vinte e cinco sujeitos foram entrevistados em três cidades do Sul do Brasil. Aproximadamente 65% deles abriria a boca do estudante durante uma crise e o grau do estigma avaliado com a Escala de Estigma em Epilepsia pré-curso foi de 45.4±16.61. CONCLUSÃO: Os dados indicam que os profissionais da educação têm um conhecimento pacial sobre epilepsia e que um curso de curta duração foi capaz de aumentar o conhecimento e reduzir o estigma na população estudada.

Seizure precipitants and inhibiting factors in mesial temporal lobe epilepsy.

Epileptic seizures may be triggered by both nonspecific facilitating factors and specific reflex epileptic mechanisms. These consist of sensory or cognitive inputs activating neural networks that, due to some functional instability, may respond with an epileptic discharge. The aim of this study was to determine the prevalence and nature of self-perceived seizure-inducing and -inhibiting factors in patients with mesial temporal lobe epilepsy (MTLE) followed from March 3rd to December 8th, 2009 at the Centro de Epilepsia de Santa Catarina Outpatient Clinic of the Hospital Governador Celso Ramos in Florianópolis, Brazil and their relation to demographics, epilepsy-related variables and anxiety level. Of the 71 patients, 60 (84.5%) patients identified at least one seizure trigger, and 36 (50.7%) patients identified inhibiting factors. In order of frequency, the most freely recalled precipitants were nervousness (58.8%), worrying (21.6%) and menstruation (19.6%), while the precipitants that were most frequently identified from a list were worrying (73.2%), anxiety (66.2%) and anger (53.5%). Knowledge of precipitant factors may have implications on the treatment and seizure control of patients.

Epilepsy and occupational accidents in Brazil: a national statistics study.

Epilepsy may restrict the patient's daily life. It causes lower quality of life and increased risk for work-related accidents (WRA). The aim of this study is to analyze the implantation of the Epidemiologic and Technical Security System Nexus (ETSSN) and WRA patterns among patients with epilepsy. Data regarding WRA, between 1999 and 2008, on the historical database of WRA Infolog Statistical Yearbook from Brazilian Ministry of Social Security were reviewed. There was a significant increase of reported cases during the ten year period, mainly after the establishment of the ETSSN. The increased granted benefits evidenced the epidemiologic association between epilepsy and WRA. ETSSN possibly raised the registration of occupational accidents and granted benefits. However, the real number of WRA may remain underestimated due to informal economy and house workers' accidents which are usually not included in the official statistics in Brazil.