Fiocruz in Antarctica - health and environmental surveillance facing the challenges of the 21st century.

FioAntar, FIOCRUZ's research project in Antarctica, is based on the One Health approach. FioAntar aims to generate relevant information that will help reduce the risk of future pandemics and improve the search for chemical compounds and new biological molecules. After four expeditions to Antarctica under the scope of PROANTAR, Fiocruz has identified Influenza H11N2 virus in environmental fecal samples, as well as Histoplasma capsulatum and Bacillus cereus in soil samples. In addition, in a prospective virome analysis from different lakes in the South Shetland Islands, six viral orders were described, supporting future research related to the biodiversity and viral ecology in this extreme ecosystem. Our findings of environmental pathogens of public health importance are a warning about the urgency of establishing a surveillance agenda on zoonoses in Antarctica due to the imminent risks that ongoing environmental and climate changes impose on human health across the planet. FioAntar strives to establish a comprehensive surveillance program across Antarctica, monitoring circulation of pathogens with the potential to transcend continent boundaries, thereby mitigating potential spread. For Fiocruz, Antarctica signifies a new frontier, teeming with opportunities to explore novel techniques, refine established methodologies, and cultivate invaluable knowledge.

Electroencephalogram alterations associated with psychiatric disorders in temporal lobe epilepsy with mesial sclerosis: A systematic review.

Temporal lobe epilepsy (TLE) is the most frequent focal epilepsy in adults and has been associated with psychiatric disorders (PD), especially the TLE with mesial temporal sclerosis (MTS). Electroencephalogram (EEG) could help in locating the epileptogenic zone and supply information regarding cerebral electric activity in these patients. However, there is a scarcity of knowledge about the association between EEG findings and comorbid PD in TLE. The objective of this review was to proceed a systematic review about the association of interictal EEG findings and PD in patients with TLE-MTS. A PRISMA model was used, and MEDLINE, CENTRAL, LILACS, and CAPES databases were searched. Six articles were considered in this review based on the inclusion/exclusion criteria. Results showed few published studies and contradicting conclusions regarding the association of EEG and PD in TLE-MTS. We observed great heterogeneity regarding the populations analyzed, hindering the comparison between the studies found. Studies with greater methodological robustness are needed to better understand the role of EEG as a possible biomarker for PD in TLE-MTS.

Are psychogenic nonepileptic seizures risk factors for a worse outcome in patients with refractory mesial temporal epilepsy submitted to surgery? Results of a retrospective cohort study.

OBJECTIVE: The objective of this study was to verify if the presence of psychogenic nonepileptic seizures (PNES) could be a risk factor precluding corticoamygdalohippocampectomy (CAH) in patients with refractory temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS) (TLE-MTS). METHODS: This retrospective cohort study analyzed medical data of patients with refractory TLE-MTS accompanied in a Brazilian epilepsy surgery center. Presurgical psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Engel's I classification two years after surgery was considered as a favorable outcome. RESULTS: Of the 81 patients initially included (65 females; 56.5%), 49 (60.5%) had TLE-MTS without PNES, 24 (29.7%) with TLE-MTS and PNES, and eight (9.8%) with PNES only, who were excluded from further statistical comparisons. Nine patients with PNES (37.5%) underwent CAH versus 35 (71.4%) without PNES (p = 0.005). Five patients (55.5%) with PNES versus 26 (74.3%) without PNES presented Engel I (p = 0.54). The relative risk (RR) was of 1.90 for patients without PNES to undergo CAH and of 1.33 to be at Engel I. CONCLUSIONS: In this study, PNES were associated with less CAH. There were no differences, however, regarding favorable postsurgical outcomes. These results highlight that the sole presence of PNES should not preclude CAH in patients with TLE-MTS, despite the necessity of careful presurgical psychiatric evaluation.

Gender differences in prevalence of psychiatric disorders, levels of alexithymia, and coping strategies in patients with refractory mesial temporal epilepsy and comorbid psychogenic nonepileptic seizures.

OBJECTIVE: The objective of this study was to investigate the psychological aspects and psychiatric disorders (PDs) in patients dually diagnosed with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) with psychogenic nonepileptic seizures (PNES) treated in a tertiary center in order to find any gender differences in psychiatric, clinical, and sociodemographic characteristics. METHOD: Psychiatric assessment was performed through the Diagnostic and Statistical Manual for Psychiatric Disorders - 5th edition (DSM-5). The Brazilian versions of the Medical Outcomes Study 36 (SF-36), Toronto Alexithymia Scale (TAS-20), Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), and Ways of Coping Checklist (WCC) were applied. RESULTS: Of the 47 patients enrolled (25 females; 53.2%), females were significantly more likely to have a history of previous psychiatric treatment (P=0.02), family history of epilepsy (P=0.01), and family history of PD (P=0.03). They also presented earlier onset of PNES (P=0.01) and higher PNES duration (P=0.02) compared with males. Major depressive disorder (MDD) was the most frequent PD (24; 51.0%). Females presented more psychiatric diagnoses (P<0.001), more diagnoses of MDD (P<0.001), and posttraumatic stress disorder (PTSD) (P<0.001). Several differences regarding quality of life, levels of alexithymia, anxiety/depressive symptoms, and coping strategies were observed between groups. CONCLUSIONS: There are significant gender differences in psychiatric, clinical, and sociodemographic aspects in a group of patients with TLE-MTS and PNES, as well as in quality of life, levels of alexithymia, anxiety/depressive symptoms, and coping strategies. These gender differences suggest that specific approaches might be adopted depending on the patient's gender and, consequently, their distinct psychological/psychiatric profile.

Oxidative stress in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis: Possible association with major depressive disorder?

OBJECTIVE: The objective was to evaluate the genetic and biochemical profiles associated with oxidative stress (OS) in patients with temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS) and a healthy control group, and also to verify the possible existence of association between OS markers and psychiatric disorders (PD) in group with TLE-MTS. METHODS: Forty-six patients with refractory TLE-MTS and 112 healthy controls were included. Psychiatric evaluation occurred through Diagnostical and Statistical Manual of Mental Disorders (DSM-5) criteria. A peripheral blood sample was collected for analysis of glutathione S-transferase (GST) T1/M1 polymorphisms and serum levels of malondialdehyde (MDA) and antioxidant capacity equivalent to the trolox (TEAC), serum markers of OS. Student's t-test, Fisher's exact test, Chi-square test, and Analysis of Variance (ANOVA) were used, with a significance level of P<0.05. RESULTS: The PD were observed in 27 patients of the group with TLE-MTS (58.6%); major depressive disorder (MDD) was the most frequent. Serum levels of MDA (P<0.0001) and TEAC (P<0.0001) were higher in group with TLE-MTS. When patients with MDD were compared with patients without PD, significant differences were observed between MDA (P=0.002) and TEAC (P=0.003) serum levels. Patients with TLE-MTS and MDD presented higher levels when compared with patients with TLE-MTS without PD and with another PD except MDD. CONCLUSIONS: The present study observed significantly higher serum levels of MDA and of TEAC in patients with refractory TLE-MTS in comparison with the control group. The MDD was observed as an important issue associated with higher OS levels in refractory TLE-MTS. Further studies are needed to investigate the association of OS, TLE-MTS, and PD.

Clinical and sociodemographic variables associated with interictal dysphoric disorder and interictal personality in patients with drug-resistant temporal lobe epilepsy: A controlled study.

Psychiatric disorders (PD) have an elevated prevalence and an important negative impact on patients with epilepsy (PWE) since they are associated with lower quality of life and clinical refractoriness. However, it is also necessary to identify behavioral conditions possibly associated with epilepsy that are not part of the standard psychiatric classifications, such as Interictal Dysphoric Disorder (IDD) and Interictal Personality (IP). The frequency of IDD and IP in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) was assessed. The Brazilian versions of the Neurobehavioral Inventory (NBI) and Interictal Dysphoric Disorder Inventory (IDDI) were applied to patients and to a control group. Psychiatric standard assessment was conducted through the Diagnostic and Statistical Manual for Psychiatric Disorders - 5th edition (DSM-5). The value of p considered significant was <0.05. Ninety-five patients (51 women; 53.6%) and 50 controls (29 women; 58.0%) were assessed. Axis I PD were observed in 41 patients (43.1%). Interictal Dysphoric Disorder was observed in 18 patients (18.4%) and IP in 36 (37.9%). Interictal Dysphoric Disorder was associated with left-sided MTS (OR=3.22; p=0.008), previous psychiatric treatment (OR=4.29; p=0.007), and more than one AED used (OR=2.73; p=0.02) while presence of bilateral MTS (OR=3.27; p=0.008), longer disease duration (OR=3.39; p=0.006), and presence of Major Depressive Disorder (OR=4.73; p=0.004) were associated with IP. In the present study, there was a high prevalence of IDD and IP in patients with drug-resistant TLE-MTS; studies should be conducted to identify the presence of behavioral conditions that are not present in the conventional psychiatric classifications.

Anti-Inflammatory Effects of a Pomegranate Leaf Extract in LPS-Induced Peritonitis.

Folk medicine suggests that pomegranate (peels, seeds and leaves) has anti-inflammatory properties; however, the precise mechanisms by which this plant affects the inflammatory process remain unclear. Herein, we analyzed the anti-inflammatory properties of a hydroalcoholic extract prepared from pomegranate leaves using a rat model of lipopolysaccharide-induced acute peritonitis. Male Wistar rats were treated with either the hydroalcoholic extract, sodium diclofenac, or saline, and 1 h later received an intraperitoneal injection of lipopolysaccharides. Saline-injected animals (i. p.) were used as controls. Animals were culled 4 h after peritonitis induction, and peritoneal lavage and peripheral blood samples were collected. Serum and peritoneal lavage levels of TNF-α as well as TNF-α mRNA expression in peritoneal lavage leukocytes were quantified. Total and differential leukocyte populations were analyzed in peritoneal lavage samples. Lipopolysaccharide-induced increases of both TNF-α mRNA and protein levels were diminished by treatment with either pomegranate leaf hydroalcoholic extract (57 % and 48 % mean reduction, respectively) or sodium diclofenac (41 % and 33 % reduction, respectively). Additionally, the numbers of peritoneal leukocytes, especially neutrophils, were markedly reduced in hydroalcoholic extract-treated rats with acute peritonitis. These results demonstrate that pomegranate leaf extract may be used as an anti-inflammatory drug which suppresses the levels of TNF-α in acute inflammation.

Factors predicting the outcome following surgical treatment of mesial temporal epilepsy due to mesial temporal sclerosis.

BACKGROUND: Mesial temporal sclerosis (MTS) is the most common disease found in an epilepsy surgery series. Early age of onset, a history of febrile convulsions, epileptiform discharges on EEG, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with MTS. OBJECTIVE: The aim of this study is to review the clinical, semiotic, psychological, electrophysiological and neuroradiological researches and relate their findings to the prognosis of patients with MTS who underwent anteromedial temporal lobectomy (ATL). METHODS: Of 1,214 patients evaluated for surgery in the epilepsy Center of Faculdade de Medicina de São Jose do Rio Preto (FAMERP), a tertiary Brazilian epilepsy center, 400 underwent ATL for MTS. Examinations and clinical data were analyzed and compared with the Engel Outcome Classification. RESULTS: Of all the items analyzed, the MRI showed the greatest influence on patient outcome. As for the clinical evaluation and pathological antecedents, age at surgery, epilepsy duration, perinatal insults, family history of epilepsy, febrile seizures, neuropsychological abnormalities and presence of generalized tonic-clonic seizure all had statistical significance. CONCLUSION: In order to identify the most appropriate candidates for ATL, it is very important to consider the prognostic factors associated with a favorable outcome for counseling patients in daily practice.

Psychiatric disorders as "hidden" contraindications for presurgical VEEG in patients with refractory epilepsy: A retrospective cohort study in a tertiary center.

Given the high frequency of psychiatric disorders (PDs) observed among patients with epilepsy, studies have highlighted the necessity of psychiatric evaluation for these patients, especially for those with refractory temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS) who are surgical candidates. Current evidence highlights the safety of video-electroencephalography (VEEG) as a means of investigation in patients with TLE-MTS and PDs. However, the presence of such disorders has still been seen as a contraindication for presurgical evaluation with VEEG in some epilepsy centers mainly because of the risk of negative behavioral events. The present retrospective cohort study performed in a Brazilian tertiary epilepsy center aimed to identify whether the presence of a PD remains a contraindication for presurgical VEEG. Clinical, sociodemographic, and psychiatric data from 41 patients who underwent VEEG as part of their presurgical evaluation were compared to data from 32 patients with refractory TLE-MTS who had not undergone VEEG. Psychiatric diagnoses were determined using the DSM-IV and ILAE criteria. Psychiatric disorders were diagnosed in 34 patients (46.6%). Major depressive disorder was the most frequent PD and was observed in 22 patients (30.1%). Anxiety disorders were observed in 14 patients (19.2%). Of the 41 patients (56.2%) who underwent presurgical VEEG, only 12 (29.2%) were found to have a PD during the presurgical psychiatric evaluation compared to 22 of the 32 (68.7%) who did not undergo VEEG (p=0.001; RR=2.35). The present findings suggest that the presence of a PD alone should not be a contraindication for VEEG monitoring and epilepsy surgery.

Effects of a psychotherapeutic group intervention in patients with refractory mesial temporal lobe epilepsy and comorbid psychogenic nonepileptic seizures: A nonrandomized controlled study.

PURPOSE: Psychogenic nonepileptic seizures (PNES) are paroxysmal episodes superficially resembling epileptic seizures but are not associated with any electrical abnormalities. Despite the existence of recent evidence addressing psychological interventions on PNES, there is a scarcity of studies investigating such interventions on patients with dual diagnoses, such as in temporal lobe epilepsy/mesial temporal sclerosis (TLE-MTS) with comorbid PNES; TLE-MTS is a very frequent epilepsy syndrome found in tertiary centers. We aimed to investigate the effects of a group psychotherapeutic intervention program based on cognitive-behavioral therapy (CBT) on patients dually diagnosed with TLE-MTS and PNES treated in a tertiary center. METHOD: Patients with TLE-MTS and PNES who were followed-up in a tertiary center were invited. The intervention consisted of eight weekly, semi-structured group meetings. The Brazilian versions of the Quality of Life Scale (SF-36), the Toronto Alexithymia Scale (TAS), the Hamilton Depression Scale (HAM-D), the Hamilton Anxiety Scale (HAM-A), and the Ways of Coping Checklist (WCC) were applied before and after the intervention. RESULTS: Forty-seven patients were enrolled (25 females; 53.2%). Psychiatric disorders (PD) were observed in all 47 patients (100%); Major Depressive Disorder (MDD) was the most frequent PD (24; 51.0%). There were improvements on quality of life (P = 0.003), decreased depression (P<0.0001) and anxiety symptoms (P = 0.02), decreased levels of alexithymia (P = 0.02) and a reduction in seizure frequency (P = 0.02) after the intervention. CONCLUSIONS: Present data suggest a positive impact of a group psychological intervention based on CBT in patients with TLE-MTS and PNES, highlighting this therapeutic possibility for this specific subgroup.

Demonstration Project on Epilepsy in Brazil: situation assessment.

PURPOSE: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. METHODS: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. RESULTS: The lifetime prevalence of epilepsy was 9.2/1,000 people [95% CI 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19% who were taking no medication. The survey of health workers showed that they estimated that 60% of patients under their care were seizure-free. They estimated that 55% of patients were on monotherapy and that 59% had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56%. Most of the physicians (73%) did not feel confident in managing people with epilepsy. DISCUSSION: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de Informação da Atenção Básica - SIAB) and iv) continuous education of health professionals. The educational program should be broad spectrum and include not only medical management, but also psycho-social aspects of epilepsy.

Demonstration project on epilepsy in Brazil: outcome assessment.

PURPOSE: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. METHOD: We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patients and the physicians point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. RESULTS: A total of 181 patients (93 women - 51%) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (>10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients and relatives opinions were that in the majority (59%) the health status had improved a lot, some (19%) had improved a little, 20% experienced no change and in 2% the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. DISCUSSION: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward in accordance with local health providers and managers.

Prognostic factors for temporal lobe epilepsy surgery in a tertiary center.

BACKGROUND: Temporal lobe epilepsy (TLE) represents the most common type of partial epilepsy. Early age of onset, a history of febrile convulsions, epileptiform discharges on electroencephalography, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with mesial temporal sclerosis. The aim of this study is to review the findings of clinical research, semiotic, psychological, electrophysiological and neuroradiological, and to relate these findings with the prognosis of patients with TLE who underwent anteromedial temporal lobectomy (ATL). METHODS: Of 1214 patients evaluated for surgery in the epilepsy Center of the São Jose do Rio Preto Faculty of Medicine (Faculdade de Medicina de São José do Rio Preto - FAMERP), a tertiary Brazilian epilepsy center, 459 underwent ATL for TLE. Exams and clinical data were analyzed and compared with Engel classification for outcome. RESULTS: Of all the items analyzed, the MRI showed a greater influence on the outcome of patients and for clinical evaluation and pathological antecedents, age at surgery, the epilepsy duration, seizure frequency, mesial temporal sclerosis, dysplasia, perinatal insults, vascular insults, a family history of epilepsy, febrile seizures, neuropsychological abnormalities and presence of generalized tonic-clonic seizure has a statistical significance. CONCLUSIONS: In order to identify the most appropriate candidates for ATL, it is very important to consider the prognostic factors associated with favorable for counseling patients in daily practice.

Shorter epilepsy duration is associated with better seizure outcome in temporal lobe epilepsy surgery.

OBJECTIVE: To investigate the influence of patient's age and seizure onset on surgical outcome of temporal lobe epilepsy (TLE). METHOD: A retrospective observational investigation performed from a cohort of patients from 2000 to 2012. RESULTS: A total of 229 patients were included. One-hundred and eleven of 179 patients (62%) were classified as Engel I in the group with < 50 years old, whereas 33 of 50 (66%) in the group with ≥ 50 years old group (p = 0.82). From those Engel I, 88 (61%) reported epilepsy duration inferior to 10 years and 56 (39%) superior to 10 years (p < 0.01). From the total of patients not seizure free, 36 (42%) reported epilepsy duration inferior to 10 years and 49 (58%) superior to 10 years (p < 0.01). CONCLUSION: Patients with shorter duration of epilepsy before surgery had better postoperative seizure control than patients with longer duration of seizures.

Longer epilepsy duration and multiple lobe involvement predict worse seizure outcomes for patients with refractory temporal lobe epilepsy associated with neurocysticercosis.

OBJECTIVE: To investigate the surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) and neurocysticercosis (NCC). METHODS: A retrospective investigation of patients with TLE-HS was conducted in a tertiary center. RESULTS: Seventy-nine (62.2%), 37 (29.1%), 6 (4.7%), and 5 (3.9%) patients were Engel class I, II, III, and IV, respectively. Fifty-two (71.2%) patients with epilepsy durations ≤ 10 years prior to surgery were seizure-free 1 year after the operation compared to 27 (50.0%) patients with epilepsy durations > 10 years (p = 0.0121). Forty-three (72.9%) patients with three or fewer lobes affected by NCC were seizure-free one year after the operation, and 36 (52.9%) patients with more than three involved lobes were seizure-free after surgery (p = 0.0163). CONCLUSIONS: Longer epilepsy durations and multiple lobe involvement predicted worse seizure outcomes in TLE-HS plus NCC patients.

Microsurgical treatment of patients with refractory epilepsy and mesial temporal cavernous malformations: Clinical experience of a tertiary epilepsy center.

BACKGROUND: Mesiotemporal cavernous malformation can occur in 10-20% of patients with cerebral cavernomas and are frequently associated with refractory. METHODS: A retrospective investigation was performed in the epilepsy clinic of a Brazilian tertiary referral epilepsy center, from January 2000 to March 2012. RESULTS: A total of 21 patients were included in the study. Thirteen patients (62%) evolved to Engel I; 5 (24%) to Engel II, 2 (10%) to Engel III, and 1 (5%) to Engel IV. We observed that 10 (48%) patients with 12 years or less of epilepsy duration evolved to Engel I and 1 (5%) to Engel II; whereas from a total of 10 patients with epilepsy duration of more than 12 years, 3 (30%) evolved to Engel I and 7 (70%) to Engel II, III, or IV (P < 0.001 [bilateral]; P1 ≠ P2). CONCLUSION: Postsurgical seizure outcome for temporal lobe epilepsy associated with mesiotemporal cavernomas is very satisfactory.

Gross-total resection of temporal low grade gliomas is a critically important factor in achieving seizure-freedom.

OBJECTIVE: To present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome. METHOD: A retrospective study was conducted with patients with temporal low-grade gliomas (LGG). RESULTS: Sixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years). The mean age at seizure onset was 25.7 ± 9.2 (11-66 years). Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6%) were Engel I; seventeen (26.2%) Engel II; four (6.2%) Engel III and two (3.1%) Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6%) with total resection and in only 3 (33.3%) patients with partial resection. CONCLUSION: Gross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.

[Prolonged vídeo-EEG monitoring in nonepileptic seizures: clinical semiology]. / Monitorização vídeo-EEG prolongada em crises não epilépticas: semiologia clínica.

The purpose of this study was to point out the effectiveness of prolonged video EEG monitoring (PVEM) in the diagnosis of nonepileptic seizures (NES) as well as to estimate its prevalence in a reference center of epilepsy (EP). A sample of 47 patients with the diagnosis of NES with spontaneous or provoked seizures was observed. A protocol with the clinical history and semiology of seizures was analyzed; Fisher's exact test and cluster analysis were used for statistical observation. The results showed a prevalence of 10% of NES; more prevalence in females (63.8%); the crises were spontaneous in 57% of the patients. The mean age was 32.5 +/- 11 years and the most frequent semiological sign was apparent sleep (82.2%). Either EP or NES was observed in 9% of the patients. There were three groups according to the cluster analysis: hypermotor NES of the extremities with tonus alteration; NES with automatism; and axial NES with eye movements. In conclusion, the study of clinical semiology of NES during the PVEM provides both this nosological entity and the differential EP diagnoses while the provocative test helps to obtain the seizures.

Assessment of the epilepsy treatment gap in two cities of south-east of Brazil.

OBJECTIVE: To assess the epilepsy treatment gap in Campinas and São Josédo Rio Preto, two cities in the State of São Paulo, Brazil. METHOD: The treatment gap was estimated using the formula n1-n2/n1x100, where n1 was calculated using 1.86% prevalence and represented the number of individuals with epilepsy, while n2 represented the number of people who could be treated with an adult standard dose for a year utilizing the antiepileptic drugs supplied by the public health system. RESULTS: Our estimates revealed that in 2001, approximately 50% of the population with epilepsy was treated with the recommended antiepileptic medication. CONCLUSION: These results suggest that a relevant percentage of patients with epilepsy are not untreated. Further epidemiological studies are needed to investigate the reasons for this treatment gap so that interventions can reduce this gap and improve the quality of life of patients with epilepsy.