Quality of life in pregnant women with epilepsy versus women with epilepsy / Qualidade de vida em gestantes com epilepsia versus mulheres com epilepsia

It is assumed that 25 percent of patients with epilepsy are women of fertile age and 0.3 percent to 0.6 percent of all children are born of mothers with epilepsy. The aim of this study was to evaluate the quality of life on pregnant with epilepsy and compare with non-pregnant women with epilepsy. We evaluated two groups (Experimental Group - 29 pregnant women with epilepsy and Control Group - 30 women with epilepsy); they were attended at the HC/UNICAMP. The patients had three meetings to carry out and implement the anamnesis and the application of QQV-65. There were no significant differences in the measurement of quality of life when comparing both groups. However, when we analyzed individually in the pre- and post-partum periods, we observed significant differences in health aspects (p=0.0495), physical (p=0.02868) and emotional (p=0.0253) dimensions in QQV-65. This study shows that pregnancy could be interpreted as a stressor. In late pregnancy when this stressor was removed, women with epilepsy had improvement in their quality of life.

Admite-se que 25 por cento dos pacientes com epilepsia sejam mulheres em idade fértil e que 0,3 por cento a 0,6 por cento de todas as crianças nascidas sejam filhas de mães epilépticas. O objetivo do presente estudo foi avaliar a qualidade de vida em gestantes com epilepsia e compará-la com a de mulheres com epilepsia não grávidas. Foram avaliados dois grupos (Grupo Experimental - 29 gestantes com epilepsia e Grupo Controle - 30 mulheres com epilepsia) atendidos no HC/UNICAMP. As pacientes foram submetidas a três encontros para a realização de anamnese e a aplicação do QQV-65. Não encontramos diferenças significativas na avaliação de qualidade de vida ao comparar ambos os grupos. No entanto quando avaliados individualmente no período pré e pós-natal, observamos diferenças significativas nos aspectos: saúde (p=0,0495), físico (p=0,02868) e emocional (p=0,0253) no QQV-65. Este estudo mostrou que a gravidez pode ser interpretada como um estressor. No final da gravidez, quando este estressor foi removido, mulheres com epilepsia mostraram melhora na qualidade de vida.

MRI reveals structural abnormalities in patients with idiopathic generalized epilepsy.

OBJECTIVE: To evaluate MRI findings in a large group of patients with idiopathic generalized epilepsies. METHODS: Idiopathic generalized epilepsies were diagnosed according to clinical and EEG criteria following International League Against Epilepsy recommendations. MRI was performed in a 2.0 T scanner using a previously established epilepsy protocol. Images were reviewed, and any abnormality was reported. Patients were divided in those with and without MRI abnormalities. Comparisons were made between these groups concerning age, age at seizure onset, subsyndrome, EEG findings, and seizure control. RESULTS: Of the 134 MRIs evaluated, 33 (24%) showed abnormalities, most of which (88%) were nonspecific. There were eight main abnormalities: arachnoid cyst, diffuse cortical atrophy, basal ganglia abnormalities (signal alterations and prominent perivascular spaces), ventricular abnormalities (uni- or bilateral increased volume of the lateral ventricles), white matter abnormalities (increased T2 signal in the frontal lobes), reduced hippocampal volume, focal gyral abnormality, and area of gliosis in the frontal lobe. Comparisons between the groups showed a higher proportion of EEG focalities in patients with abnormal MRI, which were in most part concordant with the location of the MRI abnormalities. CONCLUSIONS: Twenty-four percent of patients with idiopathic generalized epilepsies had MRI abnormalities. However, the majority of these abnormalities were nonspecific.

Patterns of hippocampal abnormalities in malformations of cortical development.

OBJECTIVE: To assess whether different types of malformation of cortical development (MCD) are associated with specific patterns of hippocampal abnormalities. METHODS: A total of 122 consecutive patients with MRI diagnosis of MCD (53 males, age range 1-58 years) were included in the study. Hippocampal measurements were made on 1-3 mm coronal T1-weighted MRIs and compared with MRIs of normal controls. RESULTS: A total of 39 patients had focal cortical dysplasia, 5 had hemimegalencephaly, 5 had lissencephaly-agyria-pachygyria, 11 had SLH, 11 had PNH, 12 had bilateral contiguous PNH, 5 had schizencephaly, and 34 had polymicrogyria. The frequency of hippocampal abnormalities in these patients with MCD was 29.5%. A small hippocampus was present in all types of MCD. Only patients with lissencephaly and SLH had an enlarged hippocampus. Abnormalities in hippocampal rotation and shape were present in all types of MCD; however, these predominated in PNH. None of the patients with lissencephaly-agyria-pachygyria or SLH had hyperintense signal on T2 or FLAIR images or abnormal hippocampal internal architecture. CONCLUSION: A small hippocampus was present in all types of MCD; however, the classic MRI characteristics of hippocampal sclerosis were often lacking. Abnormal enlargement of the hippocampus was associated with only diffuse MCD due to abnormal neuronal migration (lissencephaly-agyria-pachygyria and SLH).

Menstrual cycle worsening of epileptic seizures in women with symptomatic focal epilepsy

INTRODUCTION: Hormonal fluctuation is responsible for worsening of epileptic seizures during the menstrual cycle. OBJECTIVE: To identify irregularities in the menstrual cycles of women with mesial temporal lobe epilepsy (MTLE) and extratemporal focal epilepsy (ETFE) and correlate the frequency of seizures during the menstrual cycles. METHOD: We evaluated prospectively women in the menacme with MTLE and ETFE. Calendars were provided for these patients, and they were asked to mark their seizure frequency according to the menses. Calendars were reviewed in each routine medical appointment. RESULTS: Thirty-nine patients with MTLE and 14 with ETFE were evaluated. We registered 211 cycles in the patients with MTLE and 49 in those with ETFE. Irregular menstrual cycles were found in 28 (28/39, 71.7%) patients with MTLE and 6 (6/14, 42.8%) with ETFE (p=0.052). Premenstrual seizure worsening was observed in 46 (21.8%) patients with MTLE and 9 (18.3%) with ETFE (p=0.596). Menstrual worsening was observed in 47 (22.2%) patients with MTLE and 15 (30.6%) with ETFE (p=0.217). Ovulatory worsening was observed in 36 (17%) patients with MTLE and 13 (26.5%) with ETFE (p=0,126). Catamenial worsening was observed in 58 (27.4%) of the patients with MTLE and in 17 (34.7%) of the patients with ETFE (p=0.315). CONCLUSION: There was no difference between the group of patients with MTLE and ETFE regarding the frequency of irregular cycles and seizure worsening during the premenstrual, menstrual, catamenial or ovulatory periods.

INTRODUÇÃO: Admite-se que a flutuação hormonal seja a responsável para a piora de crises epilépticas no período catamenial. OBJETIVO: Identificar irregularidades nos ciclos menstruais de mulheres com epilepsia de lobo temporal mesial (ELTM) e epilepsia focal extratemporal (EFET); e relacionar a frequencia de crises durante o ciclo menstrual. MÉTODO: Avaliamos mulheres na menacme, que apresentem quadro clínico laboratorial compatível com ELTM e EFET. Foram fornecidos calendários para estas pacientes e instruídas para preenchimento correto da menstruação e das crises epilépticas e serão revistos em cada consulta médica rotineira. RESULTADOS: Foram avaliadas 39 pacientes com ELTM e 14 com EFET. Registramos 211 ciclos nas pacientes com ELTM e 49 nas com EFET. Ciclos menstruais irregulares foram apresentados por 28 (71,7%) pacientes com ELTM e 14 (42,8%) com EFEP (p=0,052). Piora pré-menstrual foi observada em 46 (21,8%) pacientes com ELTM e 9 (18,3%) com EFET (p=0,596). Piora menstrual foi observada em 47 (22,2%) pacientes com ELTM e 15 (30,6%) com EFET (p=0,217). Piora ovulatória foi observada em 36 (17%) pacientes com ELTM e 13 (26,5%) com EFET (p=0,126). Piora catamenial foi observada em 58 (27,4%) das pacientes com ELTM e em 17 (34,7%) das pacientes com EFET (p=0,315). CONCLUSÃO: Não houve diferença entre os grupos de pacientes com ELTM e EFET quanto à freqüência de ciclos irregulares e piora das crises nos períodos pré-menstrual, menstrual, catamenial ou ovulatório.

Efficacy of clobazam as add-on therapy in patients with refractory partial epilepsy.

PURPOSE: Clobazam (CLB) has an important antiepileptic effect and is less expensive than the new antiepileptic drugs (AEDs), but still has not been considered as first-line drug in the treatment of epilepsy. We evaluated the efficacy of CLB as add-on therapy in patients with refractory partial epilepsy. METHODS: This was an open, retrospective study, conducted at the epilepsy clinic of our university hospital. All patients had chronic epilepsy and were being evaluated for epilepsy surgery. CLB was introduced as add-on therapy (starting with 10 mg/ day) in patients with previous failure of at least two AEDs. Information was obtained from clinical notes and follow-up visits. RESULTS: We evaluated 97 patients, 37 men and 60 women. Ages ranged from 15 to 70 years (mean, 35.8 years). Etiology of epilepsy was hippocampal atrophy in 67 (69%), cortical dysgenesis in nine (9.3%), and other etiologies in nine (9.3%). In 12 (12.3%) patients, the etiology of epilepsy was not identified despite clinical and neurologic investigation. Patients used CLB for a period ranging from 1 month to 7 years and 9 months (mean, 16.7 months) with doses ranging from 10 to 60 mg/day (mean, 29.7 mg/day). Seven (7.2%) patients were seizure free, 48 (49.4%) had > or =50% of improvement in seizure control, 39 (40.2%) had <50% of improvement in seizure control, and in three (3.1%), no data were available. CONCLUSIONS: We conclude that CLB may have efficacy equivalent to that of the new AEDs when used as add-on therapy in patients with refractory epilepsy. CLB should be considered an economic alternative in the treatment of patients with refractory epilepsy.

Late onset temporal lobe epilepsy with MRI evidence of mesial temporal sclerosis following acute neurocysticercosis: case report.

UNLABELLED: The objective of this case report is to describe magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS) in a patient with new onset temporal lobe epilepsy (TLE) and acute neurocysticercosis with multiple cysts. A 56 years old man with new onset headache, Simple Partial Seizures and Complex Partial Seizures underwent CT scan and lumbar puncture as diagnose proceeding. Multiple cysts and meningitis were identified, with a positive immunology for cysticercosis. Seizures were recorded over the left temporal region in a routine EEG. Treatment with albendazole was performed for 21 days, with clinical improvement and seizure remission after 4 months. An MRI scan 11 months after treatment, showed complete resolution of those cystic lesions and a left hippocampal atrophy (HA) with hyperintense T2 signal. The presence of HA and hyperintense T2 signal in this patient has not, to date, been associated with a poor seizure control. CONCLUSIONS: This patient presented with MRI evidence of left MTS after new onset partial seizures of left temporal lobe origin. Although we did not have a previous MRI scan, it is likely that this hippocampal abnormality was due to the acute inflammatory response to cysticercosis associated to repeated partial seizures. This suggests that acute neurocysticercosis associated with repeated seizures may cause MTS and late onset TLE.

Interictal hyposexuality in male patients with epilepsy.

The purpose of this study was to compare the serum levels of androgens between hyposexual and non-hyposexual patients with epilepsy. Adult male patients with epilepsy were investigated. Serum levels of testosterone (T) and free-T, estradiol, and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. While there were no differences between hyposexual and non-hyposexual patients in the serum levels of T, free-T, and estradiol, or to the FAI, the serum levels of SHBG were significantly higher in hyposexual patients than in non-hyposexual patients. Thus, the effects of increased SHBG upon serum levels of testosterone biologically active in patients with epilepsy and hyposexuality were not detected by the methods used in this study. Four (44%) of nine hyposexual patients who were re-evaluated after two years follow-up improved sexual performance. Thus, clinical treatment that results in good seizure control may improve sexual performance in some patients with epilepsy.

Congenital destructive hemispheric lesions and epilepsy: clinical features and relevance of associated hippocampal atrophy.

We studied the clinical, EEG and MRI findings in 19 patients with epilepsy secondary to congenital destructive hemispheric insults. Patients were divided in two groups: 10 with cystic lesions (group 1), and 9 with atrophic lesions (group 2). Seizure and EEG features, as well as developmental sequelae were similar between the two groups, except for the finding that patients of group 2 more commonly presented seizures with more than one semiological type. MRI showed hyperintense T2 signal extending beyond the lesion in almost all patients of both groups, and it was more diffuse in group 2. Associated hippocampal atrophy (HA) was observed in 70% of group 1 patients and 77.7% of group 2, and it was not correlated with duration of epilepsy or seizure frequency. There was a good concordance between HA and electroclinical localization. The high prevalence of associated HA in both groups suggests a common pathogenesis with the more obvious lesion. Our findings indicate that in some of these patients with extensive destructive lesions, there may be a more circumscribed epileptogenic area, particularly in those with cystic lesions and HA, leading to a potential rationale for effective surgical treatment.

Cysticidal therapy: impact on seizure control in epilepsy associated with neurocysticercosis.

OBJECTIVE: To evaluate the clinical features and seizure control of epilepsy related to neurocysticercosis. METHOD: 18 patients with partial epilepsy and neurocysticercosis were treated with albendazol or praziquantel and followed from 3 months to 12 years. We analyzed results from the CSF exam, interictal electroencephalogram (EEG), head computerized tomography and/or magnetic resonance imaging. RESULTS: The patients' mean age was 36.4 years. The mean duration of epilepsy was 16 years. 83% patients had simple partial seizures; 17% had complex partial seizures. All patients underwent routine EEGs: 62% had abnormalities and 38% were normal. A relationship was observed between focal EEG abnormality and the location of cyst in 28% of the patients. The CSF exams showed pleocytosis in 33% of the patients, and 28% had elevated protein levels. Only 22% of patients had positive titer for cysticercosis in the CSF. In all patients who had somatosensory and special sensory seizures there was a relationship between location of the cysts and seizure semiology (n=11). After cysticidal therapy, 83% patients had a significant improvement in controlling seizures. CONCLUSION: In this group, we found a predominance of simple partial seizures and a relationship between somatosensory and special sensory seizures and the location of the cysts. Cysticidal therapy was effective in controlling seizures in these patients and should be considered for patients with partial seizures and semiology related to cyst location.

Predisposition to metabolic acidosis induced by topiramate.

RATIONALE: Metabolic acidosis induced by topiramate is a well documented but infrequent adverse event. The objective was to demonstrate the lowering of carbon dioxide serum levels, which is usually asymptomatic but may facilitate the occurrence of metabolic acidosis in patients using topiramate. METHODS: We evaluated, prospectively, the carbon dioxide serum levels of 18 patients seen at the epilepsy clinic of our university hospital, before and 3 months after introducing topiramate. RESULTS: Five patients were female and 13 were male, age ranging from 2 to 16 years old (mean=9. 3). Carbon dioxide mean serum levels were 25 and 21.2 mmol/L (normal = 22 to 30), before and 3 months after introducing topiramate, respectively. Dose ranged from 2.08 to 11.76 mg/kg/day (mean=6. 7mg/kg/day). Adverse events were anorexia, nausea and somnolence. CONCLUSION: We conclude that the lowering of carbon dioxide serum levels induced by topiramate is mostly asymptomatic, but may facilitate the occurrence of metabolic acidosis. Since patients in use of topiramate have refractory epilepsy, they may need epilepsy surgery, and must be carefully monitored for the risk of metabolic acidosis during surgery.

De novo psychogenic seizures after epilepsy surgery: case report.

The occurrence of de novo psychogenic seizures after epilepsy surgery is rare, and is estimated in 1.8% to 3.6%. Seizures after epilepsy surgery should be carefully evaluated, and de novo psychogenic seizures should be considered especially when there is a change in the ictal semiology. We report a patient with de novo psychogenic seizures after anterior temporal lobe removal for refractory temporal lobe epilepsy. Once psychogenic seizures were diagnosed and psychiatric treatment was started, seizures stopped.

Epilepsias recém-diagnosticadas: aderência, tolerância e prognóstico com a primeira droga / Recently diagnosed epilepsy: adherence, tolerance, and prognostic with the first drug

Há poucos dados no nosso meio sobre epilepsias recém-diagnosticadas (ERD). Com o objetivo de avaliar a aderência, a tolerância e a eficácia da primeira droga antiepiléptica receitada, seguimos 78 pacientes de 6 a 61 anos de idade (média: 17.96 anos) com ERD por um tempo médio de 12.68 meses (1 a 29 meses). Estes pacientes apresentavam crises parciais, com ou sem generalizaçäo secundária, e crises generalizadas tônico-clônicas com um tempo médio de epilepsia de 7.68 meses (4 dias a 7 anos). Encontramos 11 pacientes (14.10 por cento ) näo aderentes ao tratamento e 14 (17,94 por cento ) com efeitos colaterais que justificaram a troca da medicaçäo. Os efeitos colaterais mais prevalentes foram alteraçöes dismórficas como hirsutismo e hiperplasia gengival, síndrome dispéptica, reaçöes idiossincrásicas e sedaçäo. Sessenta e seis por cento dos pacientes mantiveram-se completamente controlados por um período de 8 semanas e 63.88 por cento por 56 semanas. Estes dados säo consistentes com os achados da literatura internacional. A taxa de näo aderência ao tratamento foi relativamente alta (14,10 por cento ), possivelmente devido aos aspectos sócio-econômicos e culturais da populaçäo estudada. Ressaltamos que 17,94 por cento dos pacientes näo toleraram a primeira droga, necessitando de substituiçäo. Aproximadamente 2/3 dos pacientes com ERD obtém controle satisfatório com a primeira medicaçäo

Presença de ansiedade no período pré-menstrual em mulheres epilépticas / Presence of anxiety state in premenstrual period in women with epilepsy

O objetivo deste trabalho foi investigar se as mulheres com epilepsia parciais secudariamente generalizadas exibem mais ansiedade com estado e traço, durante o período pré-mentrual do que em outros períodos do mês, em comparaçäo com outras mulheres näo epilépticas, através do uso do inventário de ansiedade traço e estado de Spielperger, Gorsuch e Luschene (1970). A presença de ansiedade-estado medida nas condiçöes pré e pós-mentrual näo diferenciou os dois grupos estudados, epilépticas e näo epilépticas. A presença de ansiedade apareceu independente das fases do ciclo menstrual. No entanto, verificou-se a presença da ansiedade-traço em algumas mulheres epilépticas, sugerindo talvez, a ansiedade como característica de personalidade

Lupus eritematoso sistêmico (LES) induzido por carbamazepina (CBZ): relato de caso / Systemic lupus erythematosus (LES) induced by carbamazepine (CBZ): repor a case

C. M. M. A., 32 a., fem, bca, severo atraso no desenvolvimento neuropsicomotor desde o nascimento. Iniciou, aos 13 anos, crises parciais complexas com ou sem generalizaçäo secundária. Foi submetida a vários esquemas medicamentosos sem controle completo das crises. Com a introduçäo de CBZ em 05/88, houve evidente reduçäo da frequência das crises. Em 11/89 passou a apresentar apatia, febre, emagrecimento (13 kg em 4 meses), náuseas, vômitos, rash malar e artrite de tornozelos. Laboratorialmente, o hemograma mostrou anemia miocrítica, Hb=9.8, Ht=31, VHS=100mm, células LE: 40 por cento , fator antinúcleo (FAN) = 10240 padräo periférico e homogêneo, anti SM-RNP-PO-LA-DNA negtivos; RX tórax mostrou finas áreas de atelectasia na base pulmonar direita. Com estes elementos, foi feito o diagnóstico de LES induzido por CBZ e introduzido 20mg de predinisona, com retirada lenta e gradual em 7 meses. Substituído a CBZ por valproato de sódio (VA), houve piora das crises, porém com desaparecimento da sintomatologia e normalizaçäo das provas laboratoriais, exceto a manutençäo da positividade do FAN, com títulos baixos (1:2560 - 05/91). Ressaltamos a importância de investigaçäo laboratorial para LES, em pacientes em uso de drogas antiepilépticas com manifestaçöes sistêmicas, particularmente em pacientes com retardo mental severo, cujos dados clínicos podem näo ser confiáveis. A evoluçäo favorável, na ausência de tratamento específico, e diminuiçäo significativa do FAN, após a suspensäo da CBZ, sugerem tratar-se de LES induzido por droga

[Ovulatory period and epileptic crisis]. / Período ovulatório e crises epilépticas.

We prospectively follow up 80 mentally healthy women at menacme age, with chronic epilepsy and had had least one seizure in the month preceding the study. We selected 59 patients from whom we were able to observe at least three regular menstrual cycles with seizures. We defined regular, irregular cycle, perimenstrual and ovulation period. According to our concepts we have got 19, 30 and 6 patients with respectively severe, moderate and mild exacerbation of perimenstrual seizures. Using our definitions 6, 20 and 17 patients showed severe, moderate and mild accentuation of seizures during ovulation, while 15 patients showed no ovulatory accentuation. Our attention was drawn to the great number of perimenstrual and ovulatory exacerbation of seizures, according to our criteria. From 55 patients with perimenstrual accentuation of seizures 44 (74.54%) showed exacerbation during the ovulatory period. In our opinion, these data speak out in favor of the hormonal theory to explain these occurrences. We discuss these data based on the available literature. We think the estrogen peak is probably the main cause of the increased frequency of epileptic seizures during the ovulation period. New studies, documenting objectively the ovulation and seizures are mandatory to clarify the relationship of these aspects of the female endocrine reproductive physiology in epileptics.

[Cranial computed tomography aspects in neurocysticercosis in childhood]. / Aspectos da tomografia computadorizada craniana na neurocisticercose na infância.

The authors present the analysis of 27 computed tomography scans (CT) of 18 children which were divided in three groups according to clinical and tomographic criteria. Group 1 was characterized mainly by epilepsy and calcifications. Group 2 was characterized by intracranial hypertension and several tomographic aspects: edema, cysts and nodules were seen in three patients; hydrocephaly and calcifications were seen in two patients and CT was normal in one patient. Group 3 had patients with epilepsy or headache and variable tomographic patterns. The results are discussed based on the available literature.

A new treatment for large cerebral paracoccidioidomycosis.

A patient with a large paracoccidioidal granuloma in the right fronto-parietal region was treated with sulfamethoxazole-trimethoprim alone, without the use of amphotericin B or any surgical measures. The authors stress the excellent therapeutic results through a twenty-six month follow-up, documented by repeated CT scans.

Hemorragia cerebral apos corrida no "looping" da montanha russa:relato de caso. / Cerebral hemorrhage following \"looping\" roller coaster: a case report

O caso descrito refere-se a um paciente que apresentou hemorragia na regiao parietal posterior esquerda, originada em malformacao arteriovenosa e que ocorreu imediatamente apos uma corrida no "looping" da montanha russa. A literatura consultada sugere que nao ha relacao entre atividade fisica e sangramento de malformacao arteriovenosa. O aspecto interessante e o inusitado fator desencadeante de hemorragia

Herpes zoster oftalmico e posterior acidente vascular cerebral: relato de caso / Ocular herpes zoster and delayed cerebrovascular disorder: report of a case

Um caso de acidente vascular cerebral (AVC) 14 semanas apos a instalacao de herpes zoster oftalmico (HZO) e apresentado.A tomografia computadorizada craniana documentou comprometimento em territorio de arteria cerebral media ipsilateral ao HZO.O diagnostico de probabilidade e o de arterite por herpes zoster com posterior trombose. Os autores reviram a literatura e enfatizam o longo intervalo entre o HZO e a instalacao da hemiplegia. Citam as novas drogas antivirais que tornam esta causa de AVC potencialmente passivel de ser prevenida

Cisto cerebral gigante na neurocisticercose. / Giant cerebral cyst in cysticercosis

Sao apresentados 4 casos da forma tumoral de neurocisticercose com cistos cerebrais gigantes, de localizacao supratentorial em 3 e infratentorial em um. Em 2 pacientes a sindrome predominante era de hipertensao intracraniana, ocorrendo nos outros 2 sinais focais deficitarios, num deles con instalacao aguda.A tomografia computadorizada cerebral revelou, em um dos pacientes lesao cistica unica supratentorial, levando a diagnostico diferencial com varias outras patologias. O resultado cirurgico obtido foi bom, sugerindo-se a indicacao desse procedimento para diagnostico e tratamento das lesoes cisticas extensas