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Depression is the most frequent psychiatric comorbidity seen in mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS). Moreover, the HS is the most frequent pathological hallmark in MTLE-HS. Although there is a well-documented hippocampal volumetric reduction in imaging studies of patients with major depressive disorder, in epilepsy with comorbid depression, the true role of the hippocampus is not entirely understood. This study aimed to verify if patients with unilateral MTLE-HS and the co-occurrence of depression have differences in neuronal density of the hippocampal sectors CA1-CA4. For this purpose, we used a histopathological approach. This was a pioneering study with patients having both clinical disorders. However, we found no difference in hippocampal neuronal density when depression co-occurs in patients with epilepsy. In this series, CA1 had the lowest counting in both groups, and HS ILAE Type 1 was the most prevalent. More studies using histological assessments are needed to clarify the physiopathology of depression in MTLE-HS.
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PURPOSE: The purpose of this study was to explore how people with juvenile myoclonic epilepsy perceive the impact of treatment. METHODS: We conducted 14 interviews of participants with juvenile myoclonic epilepsy recruited with the support of the Brazilian Association of Epilepsy in 2018 in São Paulo. Thematic analysis was carried out by two investigators who independently coded the transcripts and reviewed the coding results to check for agreement. RESULTS: Participants' (n = 14, 8 female) mean age was 31.4 years (SD ± 8.3) and their onset of seizures occurred at mean age 13.4 (SD ± 2.9). The answers to the interview questions revealed the paths of participants through life as they dealt with difficulties and challenges. Three interrelated themes and seven sub-themes emerged from the answers of the participants: seizure control, impact of epilepsy and attitude of others. CONCLUSION: This investigation may be useful in providing insights for the interventions of health providers in caring for people with JME. Themes and sub-themes that emerged from this study are connected to important aspects of treatment that go beyond focusing solely on seizures.
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Epilepsia Mioclônica Juvenil , Adolescente , Adulto , Brasil , Doença Crônica , Feminino , Humanos , Epilepsia Mioclônica Juvenil/terapia , ConvulsõesRESUMO
PURPOSE: To evaluate impulsiveness in adult patients with JME and its relationship with personality traits and executive functioning. METHODS: Patients completed psychiatric evaluation (DSM IV), Barratt Impulsiveness Scale (BIS-11), Neo Revised Personality Inventory (NEO PI-R) and executive functioning evaluation comprising Controlled Oral Word Association (COWA), Digit Span, Trail Making Tests (TMT), Stroop Test (ST) and Wisconsin Card Sorting Test (WSCT). Healthy controls (63 % female, mean age 35.7 yrs. (±8.37)) were examined to allow calculation of z-scores. RESULTS: 50 patients (70 % female; mean age 32.5 yrs. (±9.2)) presented higher scores of Total (z=-0.37; pâ¯=â¯0.005) and Motor Impulsiveness (z=-0.79; pâ¯<â¯0.001) on BIS-11. Motor Impulsiveness was associated with higher rates of mild psychiatric disorders (depression and anxiety) (pâ¯=â¯0.035) and worse myoclonic seizure control (pâ¯=â¯0.007). NEO PI-R showed differences on Neuroticism (z=-0.60; pâ¯<â¯0.001), Openness (zâ¯=â¯0.38; pâ¯=â¯0.043), Agreeableness (z=-0.38; pâ¯=â¯0.033) and Conscientiousness (z=-0.53; pâ¯=â¯0.003). There were positive correlations between BIS-11 and Neuroticism with Total, Motor and Non-Planning Impulsiveness, on the other hand, Conscientiousness was negatively correlated with these as well as with Attentive Impulsiveness. Patients performance was worse than that of controls on COWA (z=-0.43; pâ¯=â¯0.009) and WCST's Total Number of Completed Categories (z=-2.08; pâ¯=â¯0.005), Trials Taken to Complete First Category (z=-1.56; pâ¯=â¯0.013), Percentage of Total Errors (z=-1.56; pâ¯<â¯0.001), Perseverative Errors (z=-0.73; pâ¯=â¯0.002), Non-Perseverative Errors (z=-1.05; pâ¯=â¯0.003) and Conceptual Level Responses (z=-1.52; pâ¯<â¯0.001). Non-Planning Impulsiveness correlated with Performance (ST and TMT). CONCLUSION: Patients with JME present with impulsive behavior, personality features and executive dysfunction which are linked and may lead to lack of commitment in treatment and affect other aspects of life.
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Função Executiva , Epilepsia Mioclônica Juvenil , Personalidade , Adulto , Feminino , Humanos , Masculino , Epilepsia Mioclônica Juvenil/psicologia , Testes Neuropsicológicos , Inventário de PersonalidadeRESUMO
Epilepsy surgery (ES) is a treatment option for patients with refractory temporal lobe epilepsy (TLE). However, psychiatric disorders (PDs) have been a contraindication for presurgical evaluation in many epilepsy centers. The aim of this study was to evaluate the safety of video-EEG (VEEG) and surgical outcome in patients with refractory TLE and mesial temporal sclerosis (TLE-MTS) associated with PDs. We retrospectively analyzed the clinical, sociodemographic, and VEEG data and surgery outcome of patients with refractory TLE-MTS who underwent ES over the period of 2002 to 2011 and compared data between those with and without PDs. Psychiatric evaluation was performed through DSM-IV and ILAE criteria. Safety during presurgical evaluation was analyzed by the rate of adverse events (AEs). Patients' quality of life (QOL) was measured through ESI-55 and the surgical outcome through Engel's classification. Data from 145 patients were included. The mean VEEG length (93h) was not affected by PDs. Among patients with PDs, 4.91% (3/61) had AEs, and 13.11% (8/61) had psychogenic nonepileptic seizures (PNESs). Among patients without PDs, 4.76% (4/84) had AEs, and 5.95% (5/84) had PNESs. In the first two follow-up years, of the 94 patients who underwent ES, 65.85% (27/41) with PDs and 67.92% (36/53) without PDs became free of disabling seizures (Engel I). No significant differences were observed in the patients' QOL between both groups after surgery. The rate of AEs and seizure outcome did not differ significantly between both groups, reinforcing the idea that PDs should not be absolute exclusion criteria for VEEG monitoring and epilepsy surgery among patients with TLE-MTS.
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Lobectomia Temporal Anterior/efeitos adversos , Eletroencefalografia , Epilepsia do Lobo Temporal/cirurgia , Transtornos Mentais/cirurgia , Resultado do Tratamento , Gravação em Vídeo , Adolescente , Adulto , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Estudos Retrospectivos , Esclerose/cirurgia , Índice de Gravidade de Doença , Adulto JovemRESUMO
PURPOSE: Cortico-amygdalohippocampectomy (CAH) has become an important treatment option for patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS); it has resulted in a 60-70% seizure remission rate and significant quality of life (QOL) improvements. Video-electroencephalography (VEEG) monitoring has been widely used in epilepsy centers for pre-surgical evaluation. A major concern in epilepsy surgery is whether to consider CAH treatment in patients with psychosis of epilepsy (POE). This study analyzed the safety and adverse events (AEs) of VEEG monitoring and the post-surgical outcomes of patients with refractory TLE-MTS and POE who underwent CAH. METHOD: Clinical, sociodemographic and VEEG data from 18 patients with TLE-MTS and POE were analyzed. Psychiatric evaluations were performed using DSM-IV and ILAE criteria. The seizure outcome was evaluated using Engel's criteria. RESULTS: Two patients (11.2%) presented AEs that did not result in increased lengths of hospitalization. Of the 10 patients (55.5%) who underwent CAH, 6 (60%) became free of disabling seizures (Engel I). The psychiatric and QOL evaluations revealed improvements of psychotic symptoms (p=0.01) and in Physical Health (p=0.01) following surgery. CONCLUSION: These data reinforce that VEEG monitoring is a safe method to evaluate patients with refractory TLE-MTS and POE in epilepsy centers.
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Lobectomia Temporal Anterior , Eletroencefalografia , Epilepsia do Lobo Temporal/psicologia , Epilepsia do Lobo Temporal/cirurgia , Cuidados Pré-Operatórios/métodos , Transtornos Psicóticos/etiologia , Adulto , Idoso , Lobectomia Temporal Anterior/efeitos adversos , Lobectomia Temporal Anterior/métodos , Epilepsia do Lobo Temporal/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Transtornos Psicóticos/cirurgia , Esclerose , Lobo Temporal/patologia , Lobo Temporal/cirurgia , Resultado do Tratamento , Gravação em VídeoRESUMO
INTRODUÇÃO: Na abordagem de pacientes com epilepsia, particularmente aqueles com crises refratárias ao tratamento clínico, raramente os aspectos relacionados ao suporte familiar desse pacientes são contemplados. Neste artigo nós discutimos conceitos fundamentais como família e suporte familiar e a importância desses conceitos no tratamento multidisciplinar de pessoas com epilepsia. METODOLOGIA: As escalas para mensuração do suporte familiar são discutidas, destacando-se os principais aspectos abordados em cada uma das escalas. CONCLUSÃO: O uso rotineiro dessas escalas permitiria uma análise objetiva do funcionamento e suporte familiar de pacientes com epilepsia, devendo por isso ser objeto de futuros estudos, que enriqueceriam a compreensão do impacto das epilepsias sobre a família, bem como possibilitariam a intervenção precoce nas famílias disfuncionais, com melhora da qualidade de vida.
INTRODUCTION: In the approach of patients with epilepsy, particularly those with clinically refractory seizures, aspects related to the family support of such patients are seldom contemplated. In this article we discuss fundamental concepts such as family and family support, as well as the importance of these concepts in the multidisciplinary treatment of persons with epilepsy. METHODS: The scales that are used for measuring of family support are discussed, with emphasis on the main aspects of each scale. CONCLUSION: Routine use of these scales would allow for an objective analysis of family functioning and support in patients with epilepsy, and thus should be object of future studies, which would enrich the understanding of the impact of epilepsy on families, and would also permit early interventions in dysfunctional families, leading to quality of life improvement.
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Humanos , Apoio Social , Epilepsia , Cirurgia GeralRESUMO
INTRODUÇÃO: O transtorno disfórico interictal (TDI) se constitui em uma síndrome comportamental descrita principalmente em pacientes com epilepsia. A apresentação pleomófica e inespecífica dos seus sintomas, no entanto, dificulta seu diagnóstico. O Interictal Dysphoric Disorder Inventory (IDDI) é um instrumento recentemente criado com a finalidade de facilitar o diagnóstico do TDI entre os pacientes com epilepsia. OBJETIVO: Tradução e adaptação cultural do Interictal Dysphoric Disorder Inventory (IDD) MÉTODOS: Vinte e um pacientes em acompanhamento regular no ambulatório de Epilepsia do Departamento de Neurologia e Neurocirurgia da Universidade Federal de São Paulo - UNIFESP responderam ao questionário. A versão original foi obtida com um dos autores da escala (Marco Mula) que concedeu a versão original em inglês para a tradução. Dois professores de inglês nativos fizeram a retrotradução. As versões em português e a retrotraduzida foram comparadas à original e após consenso foi obtida a versão final. RESULTADOS: Dos pacientes entrevistados, 17 (81 por cento) eram do sexo feminino, com média de idade de 32,3 anos. Sete completaram o ensino fundamental, enquanto quatro completaram o ensino médio e dois, o ensino superior. Após a aplicação dos 21 questionários apenas a questão D do Apêndice não foi compreendida por três pacientes, tendo sido reescrita. CONCLUSÃO: o ITDI demonstrou-se uma escala de fácil aplicação na população brasileira, constituindo-se de grande utilidade para a avaliação do TDI em pacientes com epilepsia.
INTRODUCTION: Interictal dysphoric disorder (IDD) is a behavioral syndrome described mainly in epileptic patients. The pleomorphic and unspecific nature of its symptoms makes difficult its recognition. The Interictal Dysphoric Disorder Inventory (IDDI) is an instrument specifically created to evaluate IDD symptoms and to facilitate its diagnosis. PURPOSE: Translation and cross-cultural adaptation of the Interictal Dysphoric Disorder Inventory (IDDI). METHODS: Twenty-one patients regularly accompanied in the outpatient epilepsy clinic of Universidade Federal de São Paulo - UNIFESP answered the questionnaire. The original version in English for translation was obtained with one of the authors (Marco Mula). Later, two independent native English-speaking teachers fluent in Portuguese translated this consensus version back into English. Comparison of the back-translation with the original English version showed only a few discrepancies and the English and Portuguese versions were considered conceptually equivalents. RESULTS: Seventeen female (81 percent) and four male (19 percent) answered the questionnaire. The mean age was of 32.3 years and seven had primary school, four had completed secondary and two, higher education. After patients had answered the 21 questionnaires, only three of them did not understand question D of the Appendix section, which had to be rewritten. CONCLUSION: Brazilian patients easily understood the questions of IDDI. We believe that after finishing validation of its psychometric properties this instrument will be very helpful to evaluate the IDD in Brazilian people with epilepsy.
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Humanos , Epilepsia , Transtornos MentaisRESUMO
INTRODUÇÃO: O evento de Qualidade de Vida (QV) promovido pela ABE teve por objetivo reunir profissionais da área e traçar um breve panorama dos estudos da literatura e da situação dos estudos em nosso país. METODOLOGIA: Temas como instrumentos utilizados mundialmente na avaliação da QV das pessoas com epilepsia (PCE), validações realizadas no Brasil, fatores que afetam a QV nas epilepsias e aspectos da família foram amplamente discutidos. RESULTADOS: Frequência e gravidade das crises, depressão, ansiedade, efeitos adversos das medicações, tratamento cirúrgico, bem como fatores psicossociais (estigma, isolamento social, ausência de suporte) exercem influência marcante sobre a QV. CONCLUSÃO: Ações práticas futuras requerem a realização de estudos brasileiros multicêntricos.
INTRODUCTION: Participants at a workshop sponsored by Associação Brasileira de Epilepsia (ABE) in Brazil, November, 2009 determined the importance of quality of life (QOL) studies. The goal of the symposium was to increase awareness among health care professionals of the importance of QOL reseaches. METHODS: QOL concepts, instruments validation to Brazil, the impact of seizures and influencing factors in QOL were discussed. RESULTS: Seizures severity and frequency, depression, anxiety, adverse drug effects, surgical treatment, and psychosocial factors affecting QOL of people with epilepsy (PWE). The final section looked at the important role of family burden. CONCLUSION: Future multicentric researches in Brazil will allow to understand the implication of seizures in PWE, and to provide tolls to prevent and diminish the negative impact of epilepsy in QOL.
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Humanos , Qualidade de Vida , EpilepsiaRESUMO
PURPOSE: To study the adherence to clinical treatment in patients with Juvenile Myoclonic Epilepsy (JME) and its correlation to Quality of Life (QOL) scores, and antiepileptic drugs (AEDs) adverse effects. METHODS: Forty-three JME (ILAE,1989) outpatients in regular treatment were evaluated by clinical anamnesis and EEG/video-EEG at Hospital São Paulo, UNIFESP, Brazil. They answered a self-report questionnaire assessing adherence to treatment (scores 0 to 100), with higher scores meaning poorer adherence; Quality of Life in Epilepsy-31 (QOLIE-31) Brazilian validated version (scores 0 to 100), and the Adverse Events Profile (AEP), scores 19 to 76, in which scores ≥45 indicate toxicity; values less than 0.05 were considered statistically significant. RESULTS: Sixteen patients (37,2 percent) were on monotherapy, while 26 (60.4 percent) on polytherapy. Twenty-two (48 percent) had experienced a seizure in the preceding three months of the survey. Mean adherence to treatment score was 68.5. AEP scores ≤45 were observed in 38 (88.3 percent), and 29 (67.4 percent) reported spontaneous adverse effects with AEDs. The most common adverse effects were sleepiness in 11(13.8 percent), and restlessness in 7(8.8 percent).QOLIE-31 highest mean score was 79.0 (Social Function), and the lowest 33.0 (Seizure Worry). Adherence to treatment presented good correlation to better QOL scores (Pearson<0.05), while higher AEP scores indicated poorer adherence (Pearson<0.05). CONCLUSIONS: Adherence to treatment showed high correlation to better QOL. The presence of adverse effects was negatively associated with adherence.
OBJETIVOS: Este estudo teve como objetivo avaliar a adesão ao tratamento com drogas antiepilépticas (DAEs) em pacientes com Epilepsia Mioclônica Juvenil (EMJ) e correlacionar com a Qualidade de Vida (QV) e com os efeitos adversos à medicação. METODOLOGIA: A amostra foi composta de 43 pacientes com diagnóstico clínico e eletrográfico (EEG/Vídeo-EEG) de EMJ (ILAE,1989), em tratamento regular no Hospital São Paulo, UNIFESP, Brasil. Todos os pacientes responderam a um questionário de adesão ao tratamento (escores de 0-100), em que escores mais elevados evidenciavam uma pobre adesão ao tratamento. Para avaliar a QV foi utilizada a versão brasileira validada do Quality of Life in Epilepsy Inventory 31 (QOLIE-31); os efeitos adversos das DAEs foram avaliados através do Adverse Events Profile (AEP), escores de 19 a 76, no qual escores ≥45 indicam toxicidade. Foram considerados significantes os valores de p<0,05. RESULTADOS: Dezesseis pacientes (37,2 por cento) estavam em monoterapia e 26 (60,4 por cento), em politerapia; 22 (48 por cento) tiveram uma crise nos últimos três meses antes da entrevista. A média de adesão ao tratamento foi 68.5. Foram observados escores ≤45 em 38 (88.3 por cento) no AEP e 29 (67.4 por cento) apresentaram queixas espontâneas em relação ao uso das DAEs. Os efeitos adversos mais comuns foram sonolência em 11 (13,8 por cento) e inquietação em 7 (8,8 por cento). A maior média do QOLIE-31 foi 79,0 (Funcionamento Social), e a mais baixa 33,0 (Preocupação com as Crises). A adesão ao tratamento apresentou correlação estatística com valores melhores na QV enquanto valores elevados no AEP indicaram pior adesão (Pearson <0,05). CONCLUSÃO: A adesão ao tratamento mostrou alta correlação com uma melhor QV. A presença de efeitos adversos foi negativamente associada com a adesão ao tratamento.
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Humanos , Qualidade de Vida , Epilepsia Mioclônica Juvenil , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Adesão à Medicação , AnticonvulsivantesRESUMO
PURPOSE: The aim of this study was to evaluate in patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS): (1) employment patterns before and three years after epilepsy surgery and their impact in Quality of Life (QOL); (2) demographic and clinical variables associated with employment. METHODS: Data from 58 patients with diagnosis of refractory MTLE with HS who had corticoamygdalo-hippocampectomy were analyzed. The subjects answered to Brazilian validated version of the Epilepsy Surgery Inventory (ESI-55) before, and three years after surgery. In a semi-structured interview, sociodemographic and clinical characteristics were obtained. Changes in employment after surgery were classified in one of the three categories: (i) improvement status: those who were unemployed, no-formal employed, students, housewives and subjects who have never worked to employed category; (ii) unchanged status: no change in occupation; this category included subjects who were employed before and after the surgery, housewives, students, and the group who remained unemployed, receiving ill-health benefits or retired after the surgical treatment; and (iii) worsened status: loss of employment. RESULTS: Employment status did not show any significant change after surgery: in 51(87.9 percent) it remained unchanged, in six (10.3 percent) it improved, and one patient (1.7 percent), who was employed before the surgery, retired after that. In a subgroup of 22 patients employed after surgery, ten (45.5 percent) were seizure-free, seven (31.8 percent) had only rare auras, and five (22.7 percent) had seizures. In the group of improvement, 12 patients (70.5 percent) had no-formal employment and five (29.5 percent) had a formal job before surgery. After three years, 14 (63.6 percent) of 22 subjects were formally employed. Our data suggested that the employability was strongly correlated (p<0.05) with a positive perception of health-related quality of ...
OBJETIVO: Avaliar o estado empregatício e a qualidade de vida (QV) de indivíduos com epilepsia do lobo temporal mesial (ELTM) com esclerose do hipocampo (EH) antes e três anos após a realização de corticoamigdalohipocampectomia e verificar as variáveis demográficas e clínicas associadas ao emprego. METODOLOGIA: 58 pacientes com ELTM com EH submetidos a corticoamigdalohipocampectomia foram avaliados antes e três anos após a cirurgia. Todos responderam ao Epilepsy Surgery Inventory (ES-I55) - versão brasileira como medida da QV, bem como a um breve questionário contendo dados sociodemográficos e clínicos. Alterações na situação de emprego após a cirurgia foram classificadas do seguinte modo: (i) melhora: indivíduos desempregados, com emprego não-formal, estudantes, donas-de-casa e aqueles que nunca haviam trabalhado e que estavam empregados três anos após a cirurgia; (ii) nenhuma mudança: aqueles que não obtiveram modificações em sua situação ocupacional. Esta categoria compreendeu indivíduos que permaneceram empregados, continuaram com atividades domésticas, estudantes, em auxílio doença, aposentados e os que nunca trabalharam; e (iii) piora: perda do emprego. RESULTADOS: A situação de emprego não mudou significativamente após a cirurgia: 51(87.9 por cento) permaneceram com o mesmo estado empregatício anterior à cirurgia, seis (10.3 por cento) tiveram melhora, e um paciente (1.7 por cento), que estava empregado antes da cirurgia, aposentou-se. No subgrupo dos 22 pacientes empregados após três anos, dez (45.5 por cento) estavam livres de crises, sete (31.8 por cento) tinham apenas auras esporádicas e cinco (22.7 por cento) permaneceram com crises. No grupo que obteve melhora, 12 pacientes (70.5 por cento) eram autônomos antes da cirurgia e cinco (29.5 por cento), tinham emprego formal. Na avaliação do terceiro ano após cirurgia, 14 (63.6 por cento) dos 22 indivíduos conseguiram um emprego formal. Nosso estudo verificou que a QV manteve ...