RESUMO
Epilepsy is an increasing global neurological health issue. Recently, epidemiological and mechanistic studies have raised concern about cardiac involvement in individuals with epilepsy. This has resulted in the "epileptic heart" concept. Epidemiological data linking epilepsy to cardiovascular disease indicate an increased risk for ventricular and atrial arrhythmias, myocardial infarction, heart failure, and sudden death among individuals with epilepsy. Pathways of this interaction comprise increased prevalence of traditional cardiac risk factors, genetic abnormalities, altered brain circuitry with autonomic imbalance, and antiseizure medications with enzyme-inducing and ionic channel-blocking proprieties. Pathophysiological findings in the atria and ventricles of patients with epilepsy are discussed. Echocardiographic findings and future applications of this tool are reviewed. A risk stratification model and future studies on cardiac risk assessment in individuals with epilepsy are proposed.
RESUMO
This study aimed to compare heart rate variability (HRV) in patients with drug-resistant mesial temporal lobe epilepsy (MTLE) with healthy controls and to analyze their clinical and sociodemographic variables predictive for HRV. Thirty-nine consecutive patients with drug-resistant MTLE were included in the study. The control group included twenty-seven healthy participants matched by age and gender. Seven HRV indices (HR, RR, rMSSD, SDNN, LF, HF, and LF/HF) were compared between patients and controls. The clinical and sociodemographic variables independently associated with the HRV indices were identified by multiple linear regression. In comparison with controls, the patients with MTLE showed a significant reduction in RR, rMSSD, SDNN, LF, HF, and LF/HF indices (t value 1.97-5.97, pâ¯<â¯0.05). Multiple regression models showed that disease duration predicted 11-22% of the analyzed HRV indices. Time domain indices showed higher association with disease duration than coefficients in frequency domain. Patients with drug-resistant MTLE present cardiac autonomic tone dysfunction, showing a significant reduction in their HRV indices (RR, SDNN, rMSSD, LF, HF, and LF/HF). Disease duration has a negative association with all HRV indices. This study contributes to understanding the relationship between MTLE and the cardiac autonomic tone, with possible implications for sudden unexpected death in epilepsy.
Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia do Lobo Temporal , Epilepsia , Sistema Nervoso Autônomo , Epilepsia do Lobo Temporal/complicações , Frequência Cardíaca/fisiologia , HumanosRESUMO
Introduction: Many neuropsychiatric and neurodegenerative disorders produce Theory of Mind impairment. We aimed to implement a Brazilian Portuguese version of the Faux Pas Recognition Test (FPRT) and evaluate its psychometric properties.Methods: We first completed an English-Brazilian Portuguese translation and adaptation to obtain an FPRT Brazilian Portuguese version. We performed a multicentric study with 153 healthy participants (68.6% women), mean age of 38.8 years (SD = 14.6) and 12.9 years of schooling (SD = 4.5). Linear regression analysis was performed to evaluate the association of social class, age, schooling, and FPRT scores. The psychometric analyses comprised item analysis, exploratory factor analysis, reliability, and validity analysis.Results: Normative data in a Brazilian population is presented. A positive correlation of scores with years of schooling, social class, and an inverse relation with age was found. The exploratory factorial analysis found a two-component structure, one component, consisting of questions 1 through 6 (Eigenvalue 5.325) and another component, consisting of questions 7 and 8 (Eigenvalue 1.09). Cronbach's alpha of the 20 stories was .72. All control stories had a poor discriminative index.Conclusion: The FPRT Brazilian Portuguese version demonstrated good internal consistency and, psychometric properties and is adequate for use even in lower educational contexts in Brazil.
Assuntos
Traduções , Adulto , Brasil , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Autonomic dysfunction in epilepsy is well-described. Heart rate variability (HRV) is a useful method to evaluate autonomic cardiac tone. Cardiac dysfunction may be involved in sudden unexpected death in epilepsy (SUDEP). HRV is a promising biomarker to enlighten the heart-brain axis role in SUDEP, but the required duration for a proper HRV recording in clinical routine remains unknown. This study aimed to verify the reliability of ultra-short HRV indices to evaluate cardiac autonomic tone in patients with epilepsy (PWE). Thirty-nine patients with mesial temporal lobe epilepsy (MTLE) had electrocardiogram recordings during the first day of video-EEG. Pearson's correlations were performed to evaluate the association between ultra-short HRV indices (five 1-min and five 30-s epochs) with standard time recording (5-min) and ANOVA compared the differences between mean HRV indices across epochs. Time domain (TD) indices showed higher mean r values when compared to frequency domain (FD) indices in 1-min (TD: r 0.80-0.99, FD: r 0.61-0.95) and 30-s epochs (TD: r 0.69-0.99, only high frequency: mean r values of 0.96). ANOVA evidenced that standard deviation of RR intervals and very low frequency means had at least 3 epochs significantly different for 1-min and 30-s epochs. Root mean square of the successive differences of RR intervals (rMSSD) presented higher Pearson's coefficient values and lower percentage of variation at 1-min or 30-s epochs in comparison to other HRV indices. In conclusion, rMSSD is the most reliable ultra-short HRV index for cardiac autonomic tone assessment in MTLE. The prognostic value of ultra-short HRV for cardiovascular risk evaluation in epilepsy remains to be determined in future studies.
Assuntos
Epilepsia do Lobo Temporal , Sistema Nervoso Autônomo , Eletrocardiografia/métodos , Frequência Cardíaca/fisiologia , Humanos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: In middle-income countries, malnutrition concentrates in marginalized populations with a lack of effective preventive strategies. OBJECTIVE: Identify risk factors for undernutrition in a peri-urban Ecuadorian community of children aged 12 to 59 months. METHODS: Data from a cross-sectional survey in 2011 of children 1 to 5 years were analyzed including demographic data, medical history and examination, food frequency questionnaire (FFQ), anthropometric measurements, and blood for complete blood count, C-reactive protein, vitamin A, iron, and zinc levels. Dietary Diversity Score (DDS) was calculated from FFQ. Bivariate and multivariate analysis assessed effects on primary outcome of undernutrition by DDS, vitamin deficiencies, and demographic and nutritional data. RESULTS: N = 67, 52.2% undernourished: 49.3% stunted, 25.4% underweight, and 3% wasted; 74.6% (n = 50) were anemic and 95.1% (n = 39) had low serum zinc. Dietary Diversity Score was universally low (mean 4.91 ± 1.36, max 12). Undernutrition was associated with lower vitamin A levels (20 306, IQR: 16605.25-23973.75 vs 23665, IQR: 19292-26474 ng/mL, P = .04); underweight was associated with less parental report of illness (43.8%, n = 7 vs 80% n = 40, P = .005) and higher white blood count (13.7, IQR: 11.95-15.8 vs 10.9, IQR: 7.8-14.23 × 109/L, P = .02). In multiple regression, risk of undernutrition decreased by 4% for every $10 monthly income increase (95 CI%: 0.5%-7.4%, P = .02, n = 23); risk of underweight decreased by 0.06 for every increased DDS point (adjusted odds ratio: 0.06; 95 CI%: 0.004-0.91, P = .04, n = 23). CONCLUSIONS: In this peri-urban limited-resource, mostly Indigenous Ecuadorian community, stunting exceeds national prevalence, lower monthly income is the strongest predictor of undernutrition, lower DDS can predict some forms of undernutrition, and vitamin deficiencies are associated with but not predictive of undernutrition.
Assuntos
Desnutrição , Criança , Estudos Transversais , Equador/epidemiologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Desnutrição/epidemiologia , Prevalência , MagrezaRESUMO
OBJECTIVES: To identify variables independently associated with a meaningful improvement in QOL long after surgical treatment of drug-resistant MTLE-HS patients. MATERIAL & METHODS: We prospectively evaluated 72 consecutive MTLE-HS surgically treated patients and analyzed pre and post-surgical variables independently associated with a meaningful improvement in QOL evaluated by the Quality of Life in Epilepsy-31 (QOLIE-31) overall score, and its domain scores determined at follow-up after 36 to 131 months (mean 93 months) after surgery. RESULTS: The mean overall QOLIE-31 score and its subdomain scores improved significantly after surgery (p < 0.01), and 55 patients (76.4%) had a meaningful QOL improvement. Being seizure-free (Engel IA) after surgery showed a non-significant association (OR 2.63, CI 95% 0.53 to 13.05, p = 0.23) and lower depressive symptoms a significant association (OR 4.15, CI 95% 1.19 to 14.53, p = 0.03) with meaningful improvement of QOL. CONCLUSIONS: Patients with MTLE-HS who underwent epilepsy surgery show a sustained, meaningful improvement in their QOL. Pre-surgical variables do not predict long-term QOL improvement after surgery. Lower levels of depressive symptoms at postoperative evaluation are associated with meaningful QOL improvement.
Assuntos
Epilepsia do Lobo Temporal/cirurgia , Qualidade de Vida , Resultado do Tratamento , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , TempoRESUMO
This study aimed to analyse the effect of neuropsychological activation methods on interictal epileptiform discharges, compared to standard activation methods, for both focal and generalized epilepsies. This was a multicentre, prospective study including 429 consecutive EEG recordings of individuals with confirmed or suspected diagnosis of epilepsy. Neuropsychological activation included reading aloud in foreign and native language, praxis and a letter cancelation task (each with a duration of three minutes). After counting interictal discharges in three-minute time windows, activation and inhibition were assessed for each procedure, accounting for spontaneous fluctuations (95% CI) and compared to the baseline condition with eyes closed. Differences between generalized and focal epilepsies were explored. Interictal epileptiform discharges were present in 59.4% of the recordings. Activation was seen during hyperventilation in 31%, in at least one neuropsychological activation method in 15.4%), during intermittent photic simulation in 13.1% and in the resting condition with eyes open in 9.9%. The most frequent single cognitive task eliciting activation was praxis (10.3%). Lasting activation responses were found in 18-25%. Significant inhibition was found in 88/98 patients with baseline interictal epileptiform discharges, and was not task-specific. Adding a brief neuropsychological activation protocol to the standard EEG slightly increased its sensitivity in patients with either focal or generalized epilepsy. However, in unselected epilepsy patients, this effect seems only exceptionally to result in ultimate diagnostic gain, compared to standard procedures. From a diagnostic perspective, cognitive tasks should be reserved for patients with a suspicion of cognitive reflex epilepsy/seizures and probably require longer exposure times. Further research is needed to explore potential therapeutic applications of the observed inhibition of interictal epileptiform discharges by cognitive tasks in some patients.
Assuntos
Epilepsias Parciais/diagnóstico , Epilepsias Parciais/fisiopatologia , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/fisiopatologia , Testes Neuropsicológicos , Desempenho Psicomotor/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atenção/fisiologia , Criança , Protocolos Clínicos , Eletroencefalografia , Feminino , Neuroimagem Funcional , Humanos , Hiperventilação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa , Estudos Prospectivos , Leitura , Adulto JovemRESUMO
The central autonomic network, which is connected to the limbic system structures including the amygdala (AMY) and anterior hippocampus (aHIP), regulates the sympathetic and parasympathetic modulation of visceromotor, neuroendocrine, pain, and behavior manifestations during stress responses. Heart rate variability (HRV) is useful to estimate the cardiac autonomic tone. The levels of phosphorylation on the Ser831 and Ser845 sites of the GluA1 subunit of the AMPAr (P-GluA1-Ser845 and P-GluA1-Ser831) are useful markers of synaptic plasticity. The relation between synaptic plasticity in the human limbic system structures and autonomic regulation in humans is unknown. This study investigated the association between HRV and neurochemistry biomarkers of synaptic plasticity in AMY and aHIP. HRV indices were obtained from the resting state electrocardiogram of patients with drug-resistant mesial temporal lobe epilepsy (MTLE, n = 18) and the levels of P-GluA1-Ser845 and P-GluA1-Ser831 in the AMY and aHIP resected during the epilepsy surgery. A backward stepwise multiple linear regression models were used to analyze the association between HRV and synaptic plasticity biomarkers controlling for imbalances in the distribution of sociodemographic, clinical, neuroimaging, and neurosurgical variables. P-GluA1-Ser845 levels in AMY show a negative association (p < 0.05) with the 3 investigated parasympathetic autonomic HRV indices (SDNN, rMSSD, and HF) predicting 24 to 40% of their variation. The final multiple linear regression models include disease duration and levels of P-GluA1-Ser845 and predict 24 to 56% of cardiac autonomic tone variation (p < 0.01). P-GluA1-Ser845 levels in AMY and aHIP are negatively associated with the resting HRV in MTLE-HS indicating that increased synaptic efficiency in amygdala is associated with a parasympathetic cardiac autonomic tone impairment. The results suggest that specific changes in synaptic plasticity may be involved in the brain-heart axis regulation by the limbic system.
Assuntos
Sistema Nervoso Autônomo/metabolismo , Coração/inervação , Sistema Límbico/metabolismo , Fosfosserina/metabolismo , Receptores de AMPA/metabolismo , Tonsila do Cerebelo/metabolismo , Biomarcadores/metabolismo , Feminino , Frequência Cardíaca , Hipocampo/metabolismo , Humanos , Masculino , Plasticidade Neuronal , FosforilaçãoRESUMO
OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is a tragic event. Cardiac models of sudden death state that, paradoxically, healthy individuals compose most of the victims of this event. Exploration of cardiac physiological variables related to outcome could help unveil risk markers for sudden death in epilepsy. We investigated left ventricle end-systolic elastance, arterial-effective elastance and ventricle-arterial coupling (VAC) in PWE compared with controls. MATERIAL & METHODS: Adult patients with temporal lobe epilepsy without known cardiovascular diseases were submitted to treadmill test and transthoracic echocardiogram. Individuals without epilepsy matched by sex, age, and body mass index composed the control group. Cardiac risk factors, exercise performance, autonomic data from treadmill test, systolic and diastolic function, morphological cardiac data, and left ventricle pressure-volume loop were recorded. RESULTS: Sixty subjects were consecutively enrolled (30 PWE and 30 controls). Epilepsy duration was 22.5 ± 10.7 years (age of onset 15.2 ± 10.1 years). Treadmill variables were significantly worse in TLE patients compared with controls. End-systolic elastance, arterial-effective elastance, and ventricle-arterial coupling were similar between groups. Female sex, percentage of maximal predicted heart rate achieved in exercise, exercise time, and epilepsy duration explained 28,4% of VAC in PWE in multiple stepwise linear regression (P = .018). CONCLUSIONS: Some aspects of the cardiac pressure-volume curves, mainly linked to left ventricle systolic performance, contractile function and their interaction with afterload appears normal in young PWE and cannot explain their increase risk to adverse outcomes or lower physical fitness.