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1.
Z Gerontol Geriatr ; 53(2): 119-122, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32140765

RESUMO

Parasomnias are characterized by abnormal experiences, dreams, movements and behavior during sleep. They may occur in the middle of the sleep during REM (rapid eye movement) or NREM (non-rapid eye movement), during falling asleep or waking up. Characteristically for REM behavior disorder is an increased muscle tone although usually REM is defined by an absence of muscle tone. For these forms aggressive dreams may lead to violating bed partners or self-injury of the sleeping person. Even killing bed partners has been described. Many of the patients develop a kind of Parkinson's disease (synucleinopathies). The rate of phenoconversion is more than 30% in 5 years and nearly 100% after 15 years. There are several recommendations regarding a safe sleeping environment. Medicinal treatment consists of either melatonin or clonazepam.


Assuntos
Parassonias/psicologia , Doença de Parkinson/fisiopatologia , Transtorno do Comportamento do Sono REM/fisiopatologia , Sono REM/fisiologia , Sinucleinopatias/fisiopatologia , Humanos , Movimento , Parassonias/diagnóstico , Doença de Parkinson/complicações , Transtorno do Comportamento do Sono REM/complicações , Sinucleinopatias/complicações
2.
Postgrad Med ; 132(1): 72-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31760836

RESUMO

Parasomnias are abnormal behaviors that occur during sleep and can be associated, in particular during adulthood, with impaired sleep quality, daytime dysfunction, and occasionally with violent and harmful nocturnal behaviors. In these cases, therapies are often considered. Longterm pharmacological treatments are not always well tolerated and often have limited efficacy. Therefore, behavioral approaches remain an important treatment option for several types of parasomnias. However, the evidence-based approaches are limited. In the current review, we highlight results from various nonpharmacological techniques on different types of parasomnias and provide a glimpse into the future of nonpharmacological treatments in this field.


Assuntos
Parassonias/terapia , Terapia Comportamental , Humanos , Terrores Noturnos/terapia , Transtorno do Comportamento do Sono REM/terapia , Transtornos do Despertar do Sono/terapia , Sonambulismo/terapia
3.
Neurologist ; 24(6): 170-175, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31688707

RESUMO

BACKGROUND: Sleep disorders and disturbances are generally underestimated in patients with epilepsy. The aim of this study is to determine the frequency of sleep disturbances and the comorbidity of sleep disorders in people with epilepsy without any complaints about sleep and their relation of sudden unexplained death in epilepsy (SUDEP) risk. METHODS: Sleep complaints and the presence of sleep disorders were assessed with 4 questionnaires in 139 patients with epilepsy. Subjective sleep features were evaluated with Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire for sleep apnea, and restless legs syndrome with International Restless Legs Syndrome Study Group (IRLSSG) severity scale. The presence of rapid eye movement/nonrapid eye movement parasomnia was asked to the patients and their relatives who share the same house. The patients' SUDEP-7 scores were also determined and associations with sleep problems were investigated statistically. RESULTS: Ninety-two patients with focal and 47 patients with generalized epilepsy were evaluated after their consent. The daily sleep quality was poor in 34 (24.5%) patients with PSQI. Daily sleepiness was present in 7 (5%) patients with ESS. Twenty-five patients (18%) had severe sleep apnea risk with the Berlin Questionnaire. Mild or severe RLS was detected in 24 patients (17.2%). There were no significant differences between focal or generalized epilepsy groups' scores. No statistically significant relationship was identified between SUDEP-7 scores and sleep quality or sleep-related disorders. CONCLUSION: Our results emphasized a remarkable magnitude of the comorbidity of sleep disorders in patients with epilepsy, even for those who do not have complaints about sleep. As SUDEP cases are frequently seen during sleep, it is important to evaluate sleep in patients with epilepsy.


Assuntos
Transtornos do Sono-Vigília/epidemiologia , Morte Súbita Inesperada na Epilepsia/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parassonias/complicações , Parassonias/epidemiologia , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/complicações
4.
Zhonghua Nei Ke Za Zhi ; 58(10): 786-787, 2019 10 01.
Artigo em Chinês | MEDLINE | ID: mdl-31594179
5.
Sleep Med Clin ; 14(3): 363-370, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31375204

RESUMO

Our understanding of non-REM parasomnias is just beginning to unfold the potential biomarkers and underlying pathophysiologic processes that lead to these events. Biomarkers need further investigation and will help us to understand better ways to develop risk models and possible mechanisms. Similarly, as we develop more accurate pathophysiologic-based diagnostic testing for non-REM parasomnias, we will begin the evolution toward a physiologic-based classification scheme that aids the application of precision medicine. This article explores currently known characteristics and exploratory features that may aid in this transition to better understanding our individual patients with non-REM parasomnias and tailoring their treatments.


Assuntos
Parassonias/diagnóstico , Antidepressivos/uso terapêutico , Benzodiazepinas/uso terapêutico , Terapia Cognitivo-Comportamental , Antígenos HLA/genética , Humanos , Hipnóticos e Sedativos/uso terapêutico , Parassonias/genética , Parassonias/fisiopatologia , Parassonias/terapia , Farmacogenética , Medicina de Precisão
6.
Ann Clin Transl Neurol ; 6(9): 1900-1904, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31392847

RESUMO

We report sleep phenotypes and polysomnographic findings in two siblings with a novel homozygous variant of the GLRA1 gene causing hereditary hyperekplexia (HH). Both sisters had startles during wakefulness and sleep, sleep terrors, and one had symptoms of REM sleep behavior disorder (RBD). Frequent startles were found in NREM sleep associated with NREM parasomnias in deep sleep. In REM sleep, both had motor behaviors and increased phasic/tonic muscle activities confirming RBD. Clonazepam improved startles, motor behaviors, and muscle activities in REM sleep. Impaired glycinergic transmission in human HH could be involved in the pathophysiology of RBD and NREM parasomnias.


Assuntos
Hiperecplexia/fisiopatologia , Parassonias/fisiopatologia , Transtorno do Comportamento do Sono REM/fisiopatologia , Receptores da Glicina/genética , Sono/genética , Adolescente , Adulto , Feminino , Humanos , Hiperecplexia/complicações , Hiperecplexia/genética , Parassonias/complicações , Parassonias/genética , Polissonografia , Transtorno do Comportamento do Sono REM/complicações , Transtorno do Comportamento do Sono REM/genética , Reflexo de Sobressalto/genética , Irmãos
7.
Curr Psychiatry Rep ; 21(9): 80, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31410580

RESUMO

PURPOSE OF REVIEW: We review recent and growing evidence that provides support for a novel parasomnia, trauma associated sleep disorder (TASD). Based on these findings, we further develop the clinical and polysomnographic (PSG) characteristics of TASD. We also address factors that precipitate TASD, develop a differential diagnosis, discuss therapy, and propose future directions for research. RECENT FINDINGS: Nightmares, classically a REM phenomenon, are prevalent and underreported, even in individuals with trauma exposure. When specifically queried, trauma-related nightmares (TRN) are frequently associated with disruptive nocturnal behaviors (DNB), consistent with TASD. Capture of DNB in the lab is rare but ambulatory monitoring reveals dynamic autonomic concomitants associated with disturbed dreaming. TRN may be reported in NREM as well as REM sleep, though associated respiratory events may confound this finding. Further, dream content is more distressing in REM. Therapy for this complex disorder likely requires addressing not only the specific TASD components of TRN and DNB but comorbid sleep disorders. TASD is a unique parasomnia developing after trauma. Trauma-exposed individuals should be specifically asked about their sleep and if they have nightmares with or without DNB. Patients who report TRN warrant in-lab PSG as part of their evaluation.


Assuntos
Sonhos , Parassonias/etiologia , Parassonias/psicologia , Trauma Psicológico/complicações , Humanos , Parassonias/diagnóstico , Polissonografia , Sono REM
8.
Asian J Psychiatr ; 44: 68-69, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31325762

RESUMO

Sleep-related eating disorder (SRED) is characterized by recurrent episodes of eating during the night, accompanied by partial consciousness and followed by limited recall. Zolpidem is a sedative-hypnotic drug commonly used to treat sleep disorders. Zolpidem reduces sleep latency and increases the total time of sleep. Here, we described a case of a patient with attention-deficit/hyperactivity disorder (ADHD) who suffered from zolpidem-induced SRED. The symptoms disappeared when the use of zolpidem as discontinuation. To the best of our knowledge, this is the first documented case of SRED induced by the use of zolpidem in a patient with ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtornos da Alimentação e da Ingestão de Alimentos/induzido quimicamente , Parassonias/induzido quimicamente , Medicamentos Indutores do Sono/efeitos adversos , Zolpidem/efeitos adversos , Adulto , Feminino , Humanos , Adulto Jovem
9.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(4. Vyp. 2): 50-55, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317915

RESUMO

The article covers the current state of the problem of disorders of arousal (DOAs). The clinical features and diagnostics of the disease are described in detail. Separately, emphasis is placed on the mechanisms of the occurrence of DOAs and the characteristic changes in the central nervous system. The question of neurophysiological changes preceding the clinical manifestation of DOAs and the concept of local sleep as a physiological basis for the occurrence of DOAs are considered. Current therapeutic approaches in the treatment of these forms of parasomnias are reviewed.


Assuntos
Nível de Alerta , Parassonias , Fases do Sono , Humanos , Neurofisiologia , Sono
12.
Sleep ; 42(7)2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-30946468

RESUMO

OBJECTIVE: The main objective of this study was to study rapid eye movement (REM) sleep behavior disorder (RBD) and other sleep disorders in dementia with Lewy bodies (DLB). METHODS: Consecutive patients with DLB and mild dementia severity were recruited irrespective of sleep complaints. Patients underwent clinical interview, assessment of sleep scales, and video-polysomnography (V-PSG). RBD was diagnosed with V-PSG based on electromyographic and audiovisual analysis. RESULTS: Thirty-five patients (65.7% men; mean age 77.7 ± 6.1 years) were evaluated. Poor sleep quality (54.3%), hypersomnia (37.1%), snoring (60%), and abnormal nocturnal behaviors (77.1%) were reported. Sleep-wake architecture abnormalities occurred in 75% patients and consisted of occipital slowing on awake electroencephalography (EEG; 34.4%), the absence of sleep spindles and K complexes (12.9%), slow frequency sleep spindles (12.9%), delta activity in REM sleep (19.2%), and REM sleep without atonia (44%). Three patients showed hallucinatory-like behaviors and 10 patients showed abnormal behaviors during arousals mimicking RBD. RBD was diagnosed in 50% of those patients in whom sufficient REM sleep was attained. Of these, 72.7% were not aware of displaying dream-enacting behaviors and in 63.7% RBD preceded the onset of cognitive impairment. For RBD diagnosis, the sensitivity of Mayo Sleep Questionnaire was 50%, specificity was 66.7%, positive predictive value was 83.3%, and negative predictive value was 28%. False-positive RBD cases according to clinical history had hallucinatory-like behaviors, severe obstructive sleep apnea, and prominent periodic limb movements in sleep. Occipital EEG frequency while awake and rate of electromyographic activity in REM sleep were negatively correlated, suggesting a common subcortical origin. CONCLUSION: In DLB, RBD and sleep-wake disorders are common, heterogeneous, and complex, challenging their identification without performing V-PSG.


Assuntos
Doença por Corpos de Lewy/fisiopatologia , Parassonias/fisiopatologia , Transtorno do Comportamento do Sono REM/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Sono REM/fisiologia , Idoso , Idoso de 80 Anos ou mais , Nível de Alerta/fisiologia , Disfunção Cognitiva/fisiopatologia , Feminino , Humanos , Doença por Corpos de Lewy/diagnóstico , Masculino , Pessoa de Meia-Idade , Movimento , Polissonografia , Sensibilidade e Especificidade , Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários , Vigília/fisiologia
13.
Sleep Med ; 56: 57-65, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30952579

RESUMO

OBJECTIVE: Childhood adversity figures prominently in the clinical histories of children and adolescents suffering from a panoply of physical, mental or sleep disorders, including posttraumatic stress disorder. But the nature and prevalence of early adversity in the case of idiopathic nightmare-prone individuals have received little study. We characterize the types and frequencies of self-reported childhood adversity for nightmare-prone individuals using the developmentally sensitive Traumatic Antecedents Questionnaire (TAQ) and assess relationships between separation adversity and sleep spindles. METHOD: The TAQ was administered to 73 non-treatment-seeking volunteers with frequent idiopathic nightmares and 67 healthy controls. Nightmare severity, anxiety, depression, alexithymia and past and present sleep disorders were also assessed. Sleep was recorded with polysomnography (PSG) for 90 participants and sleep spindles were assessed for 63. RESULTS: Nightmare-prone participants scored higher on most TAQ measures, including adversity at 0-6 years of age. TAQ-derived scales assessing traumatic and nontraumatic forms of adversity were both elevated for nightmare-prone participants; for 0-6 year estimates, nontraumatic adversity was associated with nightmares independent of trauma adversity. Group differences were only partially mediated by current psychopathology symptoms and were largely independent of nightmare frequency but not of nightmare distress. Adversity/nightmare relationships were graded differentially for the two study groups. Separation adversity at 0-6 years of age correlated with current sleep spindle anomalies-in particular, lower slow spindle density-an anomaly known to index both psychopathology and early nightmare-onset. CONCLUSIONS: Self-reported adversity occurring as young as 0-6 years of age is associated with nightmare severity and sleep spindle anomalies. Adversity-linked nightmares may reflect pathophysiological mechanisms common also to the nightmares of pre-clinical and full-blown post-traumatic stress disorder.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Ondas Encefálicas/fisiologia , Sonhos/fisiologia , Parassonias/epidemiologia , Trauma Psicológico/epidemiologia , Fases do Sono/fisiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
15.
Clin Neuropharmacol ; 42(2): 52-54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30724788

RESUMO

BACKGROUND: Non-rapid-eye-movement (NREM) parasomnias are disorders of sleep ranging from confusional arousals to sleepwalking and sleep-related eating disorders. Historically, antidepressants and benzodiazepines were recommended in treatment of NREM parasomnias. In this case report, we are reporting the use of buspirone in a patient with NREM parasomnias, which produced substantial resolution of symptoms. CASE PRESENTATION: A 38-year-old man presented with confusional arousals and somnambulism. In addition, the patient had significant anxiety with work-related stress. Given the patient's concerns of side effect profile of other medications indicated in NREM parasomnias and the patient's history of anxiety, we started the patient on buspirone. The patient had significant improvement in his symptoms immediately after starting the medication with sustained relief from symptoms. CONCLUSION: Buspirone can be considered an effective alternate treatment option for NREM parasomnias when other medications are not preferred or cannot be prescribed.


Assuntos
Ansiolíticos/uso terapêutico , Buspirona/uso terapêutico , Parassonias/diagnóstico , Parassonias/tratamento farmacológico , Fases do Sono/efeitos dos fármacos , Adulto , Doença Crônica , Humanos , Masculino , Fases do Sono/fisiologia , Resultado do Tratamento
16.
Epileptic Disord ; 21(1): 55-64, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30767900

RESUMO

Electrical status epilepticus in sleep (ESES) is an age-related, self-limited epileptic encephalopathy. The syndrome is characterized by cognitive and behavioral abnormalities and a specific EEG pattern of continuous spikes and waves during slow-wave sleep. While spikes and sharp waves are known to result in transient cognitive impairment during learning and memory tasks performed during the waking state, the effect of epileptiform discharges during sleep on cognition and behavior is unclear. There is increasing evidence that abnormalities of coherence, a measure of the consistency of the phase difference between two EEG signals when compared over time, is an important feature of brain oscillations and plays a role in cognition and behavior. The objective of this study was to determine whether coherence of EEG activity is altered during slow-wave sleep in children with ESES when compared to typically developing children. We examined coherence during epochs of ESES versus epochs when ESES was not present. In addition, we compared coherence during slow-wave sleep between typically developing children and children with ESES. ESES was associated with remarkably high coherences at all bandwidths and most electrode pairs. While the high coherence was largely attributed to the spikes and spike-and-wave discharge, activity between spikes and spike-and-wave discharge also demonstrated high coherence. This study indicates that EEG coherence during ESES is relatively high. Whether these increases in coherence correlate with the cognitive and behavioral abnormalities seen in children with this EEG pattern remains to be determined.


Assuntos
Sincronização de Fases em Eletroencefalografia/fisiologia , Parassonias/fisiopatologia , Sono de Ondas Lentas/fisiologia , Estado Epiléptico/fisiopatologia , Criança , Pré-Escolar , Humanos , Síndrome
17.
J Clin Sleep Med ; 15(1): 157-158, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30621834

RESUMO

ABSTRACT: Sleep-related rhythmic movement disorder (RMD) is common in very young children but rarely persists beyond childhood. Despite its high frequency, the underlying pathophysiology remains unclear. Familial occurrence is rare. Here we present monozygotic female triplets, all of them being affected by body rolling in terms of RMD. Furthermore, they all present with an additional genetic disease, cystic fibrosis, with the same documented mutation of the cystic fibrosis transmembrane conductance regulator gene (F508del-CFTR). Because all three monozygotic siblings are concordant for RMD, genetic factors may contribute to the time course of the disorder.


Assuntos
Fibrose Cística/complicações , Predisposição Genética para Doença , Parassonias/complicações , Parassonias/diagnóstico , Trigêmeos , Adulto , Feminino , Humanos , Polissonografia/métodos , Adulto Jovem
18.
Int J Law Psychiatry ; 62: 135-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30616848

RESUMO

The governance of sleep sex (or sexsomnia) in the criminal law is a nightmare. Press reports of sleeping, often drunk, men acquitted as automatons of raping adults and children suggest cases are rising. The use of automatism, rather than insanity, in these cases is strong evidence of the immemorial struggle faced by legal psychiatry in appropriately construing unconscious defendants. This paper responds by drawing on well-established psychoanalytic conceptions of unconsciousness to present sexsomnia as dispositional to the defendant. Taking the Freudian concepts of eros and death instinct, it asserts that sexsomniacs are acting on repressed sadistic desires. Accordingly, those on notice of their sexsomnia, who fail to mitigate the risk of further attacks, should be guilty of rape. Reliance on (a reformed) insanity defence - being a denial of responsibility at the time of the offence - undermines the scope of the criminal law to self-responsibilise sexsomniacs against perpetrating unwanted sex.


Assuntos
Parassonias/psicologia , Psicanálise , Estupro/psicologia , Sono , Feminino , Humanos , Masculino , Parassonias/terapia , Psicanálise/métodos , Teoria Psicanalítica , Estupro/legislação & jurisprudência
19.
Sleep Med ; 53: 181-188, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29753639

RESUMO

BACKGROUND: Non-REM parasomnias are not uncommon conditions in the general population. Current treatment options are based on small case series and reports. In this study, we aimed to present the clinical experience from a large cohort of patients. PATIENTS: Five hundred and twelve patients with Non-REM parasomnia or parasomnia overlap disorder (POD), who had undergone a video polysomnography and were exposed to treatment, were retrospectively identified. Treatment outcome was assessed based on patients' reports, and treatment approach on a locally accepted hierarchy of interventions. RESULTS: Forty percent of patients were diagnosed with sleepwalking, 23.8% with mixed-phenotype and 10% with POD. Ultimately, 97.2% reported adequate control of their symptoms. Moreover, 60.1% were treated with pharmacotherapy and 32.0% without, consistent across all phenotypes (p = 0.09). Benzodiazepines were the most common drugs prescribed (47.1%, p < 0.05). In the end, 37.7% of our patients were receiving a benzodiazepine as part of their successful treatment, 11.7% an antidepressant, 9.2% a z-drug, and 10.7% melatonin. Finally, 13.2%, 12.1%, and 5.8% of our patients reported good control of their symptoms with sleep hygiene, management of sleep-disordered breathing, and psychological interventions (cognitive behavioral therapy [CBT] or mindfulness-based stress reduction [MBSR]), as monotherapy, respectively. CONCLUSION: The treatment approach to effective treatment of the patients with Non-REM parasomnias or POD offering first sleep hygiene advice, next treatment of concurrent sleep disorders and management of other priming factors like stress and anxiety, and lastly pharmacotherapy for Non-REM parasomnia is supported by our results. Non pharmacological interventions were effective in one third of our patients, and CBT/MBSR and melatonin appeared promising new treatments.


Assuntos
Antioxidantes/uso terapêutico , Benzodiazepinas/uso terapêutico , Melatonina/uso terapêutico , Parassonias/tratamento farmacológico , Adulto , Terapia Cognitivo-Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos , Síndromes da Apneia do Sono/terapia
20.
Sleep ; 42(3)2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30476248

RESUMO

STUDY OBJECTIVES: Complex sexual behavior during sleep (CSBS) is a well described clinical entity in nonrapid eye movement (NREM) sleep parasomnias (i.e. sexsomnia). We report a retrospective case series of CSBS as clinical manifestation of epileptic seizures and compare them with the semiology of sexsomnia. METHODS: Video-electroencephalopraphy (EEG)-monitoring data of patients with epileptic and nonepileptic paroxysmal events from one tertiary epilepsy center between 2013 and 2016 were retrospectively reviewed. Clinical features and presurgical, electroclinical, and follow-up data are presented and then discussed in the context of other published cases. RESULTS: From 4,629 patients, 6 patients had CSBS. EEG, single photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), and histopathology confirmed an epileptic origin in four female patients, with temporal or frontal seizures. Two male patients had sexsomnia. None of the epilepsy patients had parasomnias. Clinical criteria to differentiate epileptic from parasomnic CSBS were: events also occurred out of wakefulness; current presence of additional nonsexual manifestations of epilepsy; sexual behavior only as part of a broad spectrum of emotional and motor automatisms; stereotyped behavior pattern without modulability by bystanders; unarousability during the event; no completion of sexual intercourse. The accuracy of the clinical diagnosis was improved by the development of an algorithm comparing patients' fulfillment of the criteria of epilepsy versus parasomnia. CONCLUSIONS: In our cohort, CSBS was a rare ictal phenomenon in temporal or frontal seizures. Symptomatological similiarities with sexsomnia might be explained by the same phylogenetically primitive "central pattern generator" manifesting in ictal CSBS by activation and in sexsomnia by disinhibition. Ictal CSBS should be considered in the differential diagnosis of sexsomnia.


Assuntos
Epilepsia/fisiopatologia , Parassonias/fisiopatologia , Comportamento Sexual/fisiologia , Sono/fisiologia , Adulto , Diagnóstico Diferencial , Eletroencefalografia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Estudos Retrospectivos , Convulsões/fisiopatologia
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