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1.
J Neurol Neurosurg Psychiatry ; 79(7): 808-12, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17991701

RESUMO

BACKGROUND: Earlier studies have shown that aetiology makes a difference in the outcome of epilepsy, but there is a paucity of follow-up studies to evaluate the possibilities of achieving seizure freedom in initially refractory epilepsy. METHODS: We evaluated the cause of epilepsy based on high-resolution brain MRI and patient history in 119 consecutive thoroughly examined adult patients with refractory focal epilepsy followed up in our centre. We also evaluated the influence of aetiology and duration of epilepsy in this patient cohort on the chances of achieving 12-month remission in a 2-year follow-up. RESULTS: The major finding was that a substantial group of patients achieved remission; 30 (25%) initially refractory patients achieved at least 12 months remission during follow-up. A total of 40.0% of the patients with cryptogenic aetiology had achieved 12-month remission compared with the 16.2% patients with symptomatic aetiologies (age-adjusted OR 3.74, 95% CI 1.54 to 9.07, p = 0.004). Aetiologies often considered for surgical treatment (hippocampal sclerosis, cortical dysplasia, vascular malformation, tumour and dual pathology) carried an almost six-fold risk of persistent seizures compared with cryptogenic epilepsy (age-adjusted OR 5.85, 95% CI 2.00 to 17.11, p = 0.001). CONCLUSIONS: Patients with vascular malformation and dual pathology as aetiology were most refractory, none being in remission for 12 months. There were also patients achieving 12-month remission after a long period of active epilepsy. These results encourage physicians to continue with new drug trials, especially on patients with no possibilities of epilepsy surgery, as well as on those still having seizures after epilepsy surgery.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/etiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Intervalo Livre de Doença , Epilepsias Parciais/patologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
2.
Am J Med ; 109(9): 712-7, 2000 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-11137486

RESUMO

PURPOSE: The increased prevalence of autoantibodies in patients with epilepsy has been traditionally regarded to be a consequence of antiepileptic drugs. The purpose of this study was to measure autoantibodies in well-defined groups of patients with seizures to determine the effects of epilepsy and antiepileptic medications on the presence of autoantibodies. PATIENTS AND METHODS: We studied the frequency of antinuclear antibodies, anti-beta2-glycoprotein I antibodies, and anticardiolipin antibodies in 50 patients with therapy-resistant localization-related epilepsy, 50 patients with generalized epilepsy syndromes, 52 patients with a newly diagnosed seizure disorder but no antiepileptic medication, and 83 healthy controls. RESULTS: Compared with controls, newly diagnosed patients had a significantly greater prevalence of immunoglobulin (Ig) G class anticardiolipin antibodies (21% versus 7%); the prevalence was 14% in patients with localization-related epilepsy and 8% in patients with generalized epilepsy. The prevalence of IgM class anticardiolipin antibodies was significantly greater in all seizure groups (60% in localization-related epilepsy, 42% in generalized epilepsies, and 33% in newly diagnosed patients) compared with controls (7%). Antinuclear antibodies were significantly more common in newly diagnosed patients (21%) and localization-related epilepsy (24%) compared with controls (12%). When patients with generalized epilepsy (8%) were used as the reference group, antinuclear antibodies were also significantly more frequent in localization-related epilepsy (relative risk [RR] = 2.9, 95% confidence interval [CI]: 1.1 to 8.2) and newly diagnosed seizures (RR = 3.4, 95% CI: 1.2 to 9.3). There were no consistent associations between autoantibodies and specific antiepileptic medications. CONCLUSIONS: The prevalence of autoantibodies is greater in patients with epilepsy, including newly diagnosed seizure disorder. The increased prevalence of autoantibodies is more strongly associated with epilepsy than with antiepileptic drugs, perhaps indicating that immune dysregulation may be commonly associated with epilepsy.


Assuntos
Anticorpos Antinucleares/sangue , Anticorpos Antifosfolipídeos/sangue , Epilepsia/imunologia , Glicoproteínas/imunologia , Convulsões/imunologia , Adulto , Anticorpos Anticardiolipina/sangue , Anticonvulsivantes/uso terapêutico , Autoanticorpos/sangue , Estudos de Casos e Controles , Epilepsia/tratamento farmacológico , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , beta 2-Glicoproteína I
3.
Life Sci ; 58(6): 519-23, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8569425

RESUMO

Antibodies (IgG and IgM) recognizing a 240 kD antigen of the cat fetal brain were found in sera of healthy people and in sera (IgG) obtained at uncomplicated delivery from the umbilical cord of the newborn infant. The method applied was immunoblotting. Using the same method, the 240 kD antigen could not be detected in the adult brain or other fetal tissues. It seems that the antigen is specific for the fetal brain. The role of the antigen and the origin of generation and significance of function of the antibodies in the circulation are the objects of our further studies.


Assuntos
Autoanticorpos/sangue , Encéfalo/embriologia , Proteínas Fetais/imunologia , Proteínas do Tecido Nervoso/imunologia , Adolescente , Adulto , Animais , Especificidade de Anticorpos , Encéfalo/metabolismo , Química Encefálica , Gatos , Feminino , Humanos , Immunoblotting , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Especificidade de Órgãos
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