Religiosity and spirituality in patients with epilepsy.

OBJECTIVE: Religiosity and spirituality (R/S) are widely regarded as important allies against illness and suffering in general. Findings in temporal lobe epilepsy (TLE) suggest the temporal lobe as the anatomical-functional basis of religious experiences. Both R/S are relevant in patients with epilepsy (PWE) since epilepsy can lead to psychosocial issues for a significant portion of patients and their families. To investigate R/S in PWE, as well as the impact of different epileptic syndromes on patients' R/S. METHODS: One hundred PWE and 50 healthy volunteers matched for age, sex and educational level were submitted to an interview, as well as three previously validated questionnaires: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory (QOLIE-31). RESULTS: PWE's and control's mean ages were 35.9 ± 12.4 vs. 36.3 ± 18.1 years, mean schooling was 8.9 ± 3.7 vs. 10.1 ± 4.2 years. The mean age of epilepsy onset was 14.5 ± 12.1 and monthly frequency of seizures was 5.9 ± 12.6. INSPIRIT-R's scores were not statistically significantly different between patients and controls (3.0 ± 0.8 vs. 3.0 ± 0.8); however, INSPIRIT-R's scores were significantly higher in TLE patients when compared with other epilepsy syndromes (3.2 ± 0.7 vs. 2.8 ± 0.9; p = 0.04). CONCLUSION: Temporal lobe epilepsy patients have higher levels of R/S.

Religiosity and spirituality in patients with epilepsy / Religiosidade e espiritualidade em pacientes com epilepsia

ABSTRACT Religiosity and spirituality (R/S) are widely regarded as important allies against illness and suffering in general. Findings in temporal lobe epilepsy (TLE) suggest the temporal lobe as the anatomical-functional basis of religious experiences. Both R/S are relevant in patients with epilepsy (PWE) since epilepsy can lead to psychosocial issues for a significant portion of patients and their families. Objective: To investigate R/S in PWE, as well as the impact of different epileptic syndromes on patients' R/S. Methods: One hundred PWE and 50 healthy volunteers matched for age, sex and educational level were submitted to an interview, as well as three previously validated questionnaires: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Results: PWE's and control's mean ages were 35.9 ± 12.4 vs. 36.3 ± 18.1 years, mean schooling was 8.9 ± 3.7 vs. 10.1 ± 4.2 years. The mean age of epilepsy onset was 14.5 ± 12.1 and monthly frequency of seizures was 5.9 ± 12.6. INSPIRIT-R's scores were not statistically significantly different between patients and controls (3.0 ± 0.8 vs. 3.0 ± 0.8); however, INSPIRIT-R's scores were significantly higher in TLE patients when compared with other epilepsy syndromes (3.2 ± 0.7 vs. 2.8 ± 0.9; p = 0.04). Conclusion: Temporal lobe epilepsy patients have higher levels of R/S.

Resumo Religiosidade e espiritualidade (R/E) são geralmente consideradas importantes aliadas no enfrentamento de doenças e sofrimento. Estudos na epilepsia do lobo temporal (ELT) sugerem que o lobo temporal é a base anatômico-funcional de experiências religiosas. Além disso, R/E têm impacto na vida de pacientes com epilepsia (PCE), uma vez que a epilepsia frequentemente está associada a distúrbios psicossociais em pacientes e seus familiares. Objetivo: Investigar R/E em PCE, bem como o impacto de diferentes síndromes epilépticas na R/E dos pacientes. Método: Cem PCE e 50 voluntários saudáveis pareados por idade, sexo e nível educacional foram submetidos a uma entrevista, bem como três questionários previamente validados: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), e Quality of Life in Epilepsy Inventory (QOLIE-31). Resultados: As médias de idade de PCE e controles foram de 35,9 ± 12,4 vs. 36,3 ± 18,1 anos, com escolaridade média de 8,9 ± 3,7 vs. 10,1 ± 4,2 anos. A idade média do início da epilepsia foi de 14,5 ± 12,1 e a frequência de crises mensais foi de 5,9 ± 12,6. Os escores do INSPIRIT-R não foram estatisticamente diferentes entre os pacientes e controles (3,0 ± 0,8 vs. 3,0 ± 0,8); entretanto, os escores do INSPIRIT-R foram significativamente maiores em pacientes com ELT quando comparados com outras síndromes epilépticas (3,2 ± 0,7 vs. 2,8 ± 0,9; p = 0,04). Conclusão: Pacientes com epilepsia do lobo temporal possuem níveis mais altos de religiosidade e espiritualidade.

Control perceptions in epilepsy: A transcultural case-control study with focus on auras.

OBJECTIVE: General Locus of Control (GLoC) is used to measure the extent to which people perceive life events as results of their own actions or external factors. This study analyzes the relationship between GLoC and people with epilepsy's (PWE) clinical characteristics, levels of anxiety, depression, religiosity/spirituality, and quality of life, with particular attention to possible influences of auras. METHODS: A case-control study was carried out with 186 consecutive patients with a definite diagnosis of epilepsy in Brazil and Lithuania. Besides clinical and demographic data, all patients answered to internationally validated scales: Rotter's GLoC, Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy (QOLIE-31), and Index of Core Spiritual Experiences-Revised (INSPIRIT-R). RESULTS: Patient's mean age was 36.15 ±â€¯13.75 years, 61.3% were female, mean age at onset of epilepsy was 17.27 ±â€¯13.59 years, and monthly seizure frequency was 8.22 ±â€¯20.00. People with epilepsy were more depressed than controls, (p = 0.03). Within the group with epilepsy, patients reporting auras and reacting to them had higher levels of depression (p = 0.002) and anxiety (p = 0.004) and lower QOLIE-31 (p = 0.01) score but did not differ in GLoC (p = 0.73) or INSPIRIT-R (p = 0.71). Patients with perceived ability to prevent seizures in response to auras had no increased levels of depression and anxiety. CONCLUSIONS: General Locus of Control externalization in PWE was not confirmed. To perceive and be able to react to auras is associated with increased anxiety and depressive symptoms in PWE but not if it results in preventing seizures. No transcultural differences in these parameters were found.

Cross-cultural adaptation of Rotter's General Locus of Control instrument.

Objective To perform a cross-cultural adaptation of the General Locus of Control (GLoC) questionnaire, which measures where people place causation of events in their lives, i.e., if they interpret events as being the result of their own actions or external factors. Methods After translation and back-translation, a multidisciplinary committee judged and elaborated different versions of the GLoC questionnaire, with a focus on conceptual equivalence, content, comprehensibility and adjustment to the Brazilian socioeconomic context. The final version was tested on 71 healthy subjects, of whom 36 were reinterviewed and answered the GLoC questionnaire twice, after a mean of 73.06±74.15 days (range = 29-359). Results The participants' mean age was 30.82±12.83 years (range = 18-69), 62% were women, and mean years of schooling were 12.54±4.21. Test-retest reliability (Pearson's) was r = 0.828. Internal consistency resulted in a Cronbach's alpha of 0.906. The mean GLoC score obtained was 8.77±3.11 (n = 71). Conclusion The Portuguese version of the GLoC questionnaire is a faithful adaptation of Rotter's original questionnaire.

Cross-cultural adaptation of Rotter's General Locus of Control instrument / Adaptação transcultural do instrumento de Locus of Control Geral de Rotter

Abstract Objective To perform a cross-cultural adaptation of the General Locus of Control (GLoC) questionnaire, which measures where people place causation of events in their lives, i.e., if they interpret events as being the result of their own actions or external factors. Methods After translation and back-translation, a multidisciplinary committee judged and elaborated different versions of the GLoC questionnaire, with a focus on conceptual equivalence, content, comprehensibility and adjustment to the Brazilian socioeconomic context. The final version was tested on 71 healthy subjects, of whom 36 were reinterviewed and answered the GLoC questionnaire twice, after a mean of 73.06±74.15 days (range = 29-359). Results The participants' mean age was 30.82±12.83 years (range = 18-69), 62% were women, and mean years of schooling were 12.54±4.21. Test-retest reliability (Pearson's) was r = 0.828. Internal consistency resulted in a Cronbach's alpha of 0.906. The mean GLoC score obtained was 8.77±3.11 (n = 71). Conclusion The Portuguese version of the GLoC questionnaire is a faithful adaptation of Rotter's original questionnaire.

Resumo Objetivo Realizar a adaptação transcultural do questionário General Locus of Control (GLoC), que avalia a que as pessoas atribuem a causa dos seus eventos de vida, isto é, se interpretam os eventos como sendo resultado de suas próprias ações ou de fatores externos. Métodos Após as fases de tradução e retrotradução do instrumento, uma equipe multidisciplinar julgou as versões obtidas quanto à manutenção do conceito original, compreensibilidade e clareza para o contexto socioeconômico da população brasileira. A versão final foi testada em 71 indivíduos saudáveis, dos quais 36 responderam duas vezes ao questionário, com um intervalo de 73,06±74,15 (29-359) dias. Resultados A média de idade dos participantes foi de 30,82±12,83 anos (com variação de 18-69), 62% eram mulheres, e o número médio de anos de escolaridade foi 12,54±4,21. A análise de confiabilidade teste-reteste (coeficiente de correlação de Pearson) foi r = 0,828. A análise de consistência interna resultou em um valor de Crohnbach de 0,906. O escore médio entre aplicações do teste foi de 8,77±3,11 (n = 71). Conclusão A versão em português do questionário GLoC é uma adaptação fiel ao instrumento original de Rotter.

Postsurgical infection after myelomeningocele repair: a multivariate analysis of 60 consecutive cases.

OBJECTIVE: We investigate the demographic, clinical and surgical variables associated with wound and ventriculoperitoneal (VP) shunt infections in a well-defined group of patients submitted to neurosurgical myelomeningocele repair. METHODS: We analyzed the data of sixty consecutive patients with a myelomeningocele diagnosis submitted to neurosurgical repair between January 2002 and December 2005. Multiple logistic regression analysis identified clinical, demographic and neurosurgical variables that were independently associated with the occurrence of wound and VP shunt infections. RESULTS: Seven patients (11.7%) developed wound infections after myelomeningocele repair and two (3.3%) presented with sepsis unrelated to the neurosurgical procedures. Forty-six patients (76.7%) received a VP shunt and nine of them (19.6%) had VP shunt infection. There was a non-significant trend (p=0.09) for a higher association between thoracic than lumbar or sacral topography and the occurrence of any type of infection. Among patients who underwent VP shunt placement, there was a non-significant trend for a higher association between VP shunt infection and thoracic topography compared to lumbar or sacral regions (adjusted OR 4.3; CI 95% 0.7-24.7; p=0.10). Evans' index scores higher than 70 were ten times more associated with VP shunt infection (adjusted OR 10.5; CI 95% 1.6-67.4; p=0.01) than lower scores. CONCLUSION: The thoracic topography of myelomeningocele has a trend for a higher association with infection in general and VP shunt infection. Evans' index scores higher than 70 were independently associated with VP shunt infection.

Mid-term clinical and angiographic results of cerebral aneurisms treated with matrix2(®) coils.

OBJECTIVE: To evaluate 1 year results of endovascular treatment (EVT) of intracranial aneurisms using Matrix second generation detachable coils (MSG(®)). PATIENTS AND METHODS: Between January and December 2006, 32 patients with 32 intracranial aneurisms were treated by coiling using MSG(®), with a minimum follow-up of 1 year. Data were acquired prospectively. Exclusion criteria were: permanent adjunctive device, less than 50% MSG(®) length, and additional bioactive or coated coils. All procedures were carried out in a single institution. Six months and 1 year follow-up were performed with magnetic resonance angiography and digital subtraction angiography, respectively. We assessed radiological and clinical results using the modified Raymond classification, a 3-level longitudinal grading scale (LGS), Glasgow outcome and Rankin scales. RESULTS: Thirteen (40.6%) male and 19 (59.4%) female underwent EVT using MSG(®) with a mean follow-up of 16.6 months. Ruptured aneurisms (75%) outnumbered unruptured. Immediate radiological results showed 15 complete occlusions (46.9%), 12 (37.5%) neck remnant, and five (15.6%) residual sac. In the mean time, six patients (18.7%) needed to be retreated due to insufficient initial packing or early recanalization. Using the LGS, a stable occlusion was observed in 40.7%, a progressive thrombosis in 25%, and 34.3% of the cases evolved unfavorably. Thirty-one patients had stable or improved clinical status, while one patient died from a thromboembolic event 1 month after retreatment (3.1% overall mortality). CONCLUSION: At 1 year follow-up, MSG(®) demonstrated similar angiographic results compared to Matrix first generation coils and didn't suggest advantage over platinum coils.

Endovascular treatment of 174 middle cerebral artery aneurysms: clinical outcome and radiologic results at long-term follow-up.

PURPOSE: To retrospectively evaluate the immediate safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS: This is a retrospective review of patients in whom coiling of MCA aneurysms was attempted over a 7-year period. Institutional review board approval and informed written consent were obtained. This study included 153 patients (90 women, 63 men; mean age, 49.5 years +/- 11.7 [standard deviation]) with 174 MCA aneurysms (71 unruptured, 103 ruptured). Complications of EVT, clinical outcome, and the results of either cerebral digital subtraction angiography (DSA) or magnetic resonance (MR) angiography were analyzed at initial, intermediate (6-18 months), and late (2-7 years) follow-up. RESULTS: Coiling was performed in 160 (92%) aneurysms in 141 patients. Periprocedural complications were observed in 31 (19.4%) procedures, including aneurysm perforations (n = 7, 4.4%) and thromboembolic events (n = 24, 15.0%). EVT induced permanent morbidity in eight (5.7%) patients, with severe neurologic impairment in three (2.1%) and two deaths (1.4%). Of 114 MCA aneurysms controlled by using DSA (n = 50) or MR angiography (n = 64) at 50 months +/- 14, 73 (64%) remained completely occluded, 31 (27.2%) recurred, and 12 (10.5%) major recurrences were retreated. A balloon remodeling technique allowed treatment of complex aneurysms (n = 63) but was associated with more recurrences in the long term (42.6%) than aneurysms treated without balloon assistance (16.4%; P = .016). CONCLUSION: EVT of MCA aneurysms was safe and long-term monitoring of patients showed a low rate of recurrence requiring retreatment. However, complex anatomy and long-term recurrences have to be addressed when considering EVT for MCA aneurysms.

Clinical epidemiology for childhood primary central nervous system tumors.

This work was conducted by the French Brain Tumor Data Bank (FBTDB) and aims to prospectively record all primary central nervous system tumors (PCNST), in France, for which histological diagnosis is available. Results concerning children are presented. This study analyzes the childhood cases (0-19 years) of newly diagnosed and histologically confirmed PCNST (during the years 2004-2006) which have been recorded by the FBTDB. All French neuropathology and neurosurgery departments participated in this program. Neurosurgeons and neuropathologists completed a data file containing socio-demographic, clinical, radiologic and anatomopathologic information. The Tumor Registry from Herault was authorized to compile the data files with personal identifiers. About 1,017 cases (533 boys and 484 girls) of newly diagnosed childhood PCNST have been recorded (gliomas: 52%, all other neuroepithelial tumors: 31%, craniopharyngioma: 5%, germ cell tumors, meningioma and neurinoma: approximately 3% each, all histological subtypes have been detailed). Tumor resections were performed in 83.3%, and biopsies in 16.7%. The distributions by histology, cryopreservation of the samples, age, sex, tumor site and surgery have been detailed. To our knowledge, this work is the first databank in Europe dedicated to PCNST that includes the collection of clinical, radiological and histological data (including cryopreservation of the specimen). The long term goals of the FBTDB are to create a national registry and a network to perform epidemiological studies, to implement clinical and basic research protocols, and to evaluate and harmonize the healthcare of children and adult patients affected by PCNST.