Translation to Portuguese and cross-cultural adaptation of the epilepsy transition readiness checklist for use in Brazil.

OBJECTIVES: Planning for the child and adolescent to have a safe handling in the epilepsy transition process is essential. In this work, the authors translated the "Readiness Checklists" and applied them to a group of patients and their respective caregivers in the transition process to assess the possibility of using them as a monitoring and instructional instrument. METHODS: The "Readiness Checklists" were applied to thirty adolescents with epilepsy and their caregivers. The original English version of this instrument underwent a process of translation and cultural adaptation by a translator with knowledge of English and epilepsy. Subsequently, it was carried out the back-translation and the Portuguese version was compared to the original, analyzing discrepancies, thus obtaining the final version for the Brazilian population. RESULTS: Participants were able to answer the questions. In four questions there was an association between the teenagers' educational level and the response pattern to the questionnaires. The authors found a strong positive correlation between the responses of adolescents and caregivers (RhoSpearman = 0.837; p < 0.001). The application of the questionnaire by the health team was feasible for all interviewed patients and their respective caregivers. CONCLUSION: The translation and application of the "Readiness Checklists" is feasible in Portuguese. Patients with lower educational levels felt less prepared for the transition than patients with higher educational levels, independently of age. Adolescents and caregivers showed similar perceptions regarding patients' abilities. The lists can be very useful tools to assess and plan the follow-up of the population of patients with epilepsy in the process of transition.

Predictive factors for successful vagus nerve stimulation in patients with refractory epilepsy: real-life insights from a multicenter study.

Introduction: Vagus nerve stimulation (VNS) therapy is an established treatment for patients with drug-resistant epilepsy that reduces seizure frequency by at least 50% in approximately half of patients; however, the characteristics of the patients with the best response have not yet been identified. Thus, it is important to identify the profile of patients who would have the best response to guide early indications and better patient selection. Methods: This retrospective study evaluated vagus nerve stimulation (VNS) as an adjuvant therapy for patients with drug-resistant epilepsy from six epilepsy centers in Brazil. Data from 192 patients aged 2-66 years were analyzed, and all patients received at least 6 months of therapy to be included. Results: Included patients were aged 2-66 years (25.6 ± 14.3), 105 (54.7%) males and 87 (45.8%) females. Median follow-up interval was 5 years (range, 2005-2018). Overall, the response rate (≥50% seizure reduction) after VNS implantation was 65.6% (126/192 patients). Most patients had 50-90% seizure reduction (60.9%) and nine patients became seizure-free. There were no serious complications associated with VNS implantation. The rate of a ≥ 50% seizure reduction response was significantly higher in patients with no history of neurosurgery. The presence of focal without generalized seizures and focal discharges on interictal EEG was associated with better response. Overall, etiological predictors of a better VNS response profile were tumors while a worse response to VNS was related to the presence of vascular malformations and Lennox-Gastaut Syndrome. Discussion: We observed an association between a better response to VNS therapy no history of neurosurgery, focal interictal epileptiform activity, and focal seizure pattern. Additionally, it is important to highlight that age was not a determinant factor of the response, as children and adults had similar response rates. Thus, VNS therapy should be considered in both adults and children with DRE.

Seizure outcome after hippocampal deep brain stimulation in patients with refractory temporal lobe epilepsy: A prospective, controlled, randomized, double-blind study.

OBJECTIVE: We designed a prospective, randomized, controlled, double-blind study to evaluate the efficacy of hippocampal deep brain stimulation (Hip-DBS) in patients with refractory temporary lobe epilepsy (TLE). METHODS: Sixteen adult patients with refractory TLE were studied. Patient's workup included medical history, interictal and ictal electroencephalography (EEG), and high-resolution 1.5T magnetic resonance imaging (MRI). Patients were randomized on a 1:1 proportion to an active (stimulation on) or to a control (no stimulation) arm. After implantation, patients were allowed to recover for 1 month, which was followed by a 1-month titration (or sham) period. The 6-month blinded phase started immediately afterward. A postoperative MRI confirmed the electrode's position in all patients. All patients received bipolar continuous stimulation. Stimulus duration was 300 µs and frequency was 130 Hz; final intensity was 2 V. Patients were considered responders when they had at least 50% seizure frequency reduction. RESULTS: All patients had focal impaired awareness seizures (FIAS, complex partial seizures), and 87% had focal aware seizures (FAS, simple partial seizures). Mean preoperative seizure frequency was 12.5 ± 9.4 (mean ± standard deviation) per month. MRI findings were normal in two patients, disclosed bilateral mesial temporal sclerosis (MTS) in three, left MTS in five, and right MTS in six patients. An insertional effect could be noted in both control and active patients. In the active group (n = 8), four patients became seizure-free; seven of eight were considered responders and one was a nonresponder. There was a significant difference regarding FIAS frequency between the two groups from the first month of full stimulation (p < 0.001) until the end of the blinded phase (p < 0.001). This was also true for FAS, except for the third month of the blinded phase. SIGNIFICANCE: Hip-DBS was effective in significantly reducing seizure frequency in patients with refractory TLE in the active group, as compared to the control group. Fifty-percent of the patients in the active group became seizure-free. The present study is the larger prospective, controlled, double-blind study to evaluate the effects of Hip-DBS published to date.

A dor e a delícia do internato de atenção primária em saúde: desafios e tensões / The pain and the delight of primary health care internship: challenges and tensions

INTRODUÇÃO: As Diretrizes Curriculares Nacionais para o curso de Medicina sinalizaram a necessidade de formar um médico capaz de atuar conforme as necessidades de saúde da população visando o fortalecimento do Sistema Único de Saúde. A implantação de um estágio, na área de Atenção Primaria à saúde, na Faculdade de Medicina ABC, resultou em uma reforma mais ampliada do internato médico. OBJETIVO: Identificar a percepção dos estudantes quanto a inserção do ciclo de Atenção Primária à Saúde (CAPS) no internato médico. MÉTODOS: Estudo transversal que utilizou um questionário fechado, aplicados aos estudantes do 5º e 6º anos, totalizando 157 participantes, em 2011 abordando os aspectos teóricos e práticos do CAPS. RESULTADOS: Chamou a atenção na comparação entre o 5º e 6º anos do Ciclo de Atenção Primaria à Saúde: o CAPS no 5º ano teve o maior número de quesitos respondidos com regular e fraco, enquanto que o 6º ano teve um grande número respondido com ótimo e bom. Observaram-se diferenças marcantes quanto à percepção dos estudantes entre os aspectos abordados do CAPS entre os estudantes do 5º e 6º, com destaque para maior grau de satisfação com o 6º ano (UBS tradicional) do que com o 5º ano Estratégia de saúde da família (ESF). CONCLUSÃO: Há indícios de que os respondentes validaram a implementação do CAPS, mas ainda restam desafios e tensões quanto à estruturação e integração ensino e serviço.

INTRODUCTION: The National Curriculum Guidelines for the medical school showed that a doctor to graduate is necessary to be able to act upon the health needs of the population aimed at strengthening the Unified Health System. The implementation of a stage in Primary Care area of health, ABC School of Medicine, has resulted in a broader reform of the medical internship. OBJECTIVE: To identify the perception of students and the insertion of the Primary Health Care Cycle (CAPS) in medical internship. METHODS: Cross-sectional study that used a closed questionnaire applied to students of 5th and 6th year, totaling 157 participants in 2011 addressing the theoretical and practical aspects of CAPS. RESULTS: They draw attention in the comparison between the 5th and 6th year of Primary Care Cycle Health: CAPS at 5 years had the highest number of answered questions with regular and weak, while the 6th grade had a large number responded with great and good. There were marked differences in the perception of students among the topics of CAPS aspects among students of 5th and 6th, highlighting greater degree of satisfaction with the 6th grade (Traditional UBS) than with the 5 year Family Health Strategy (FHS). CONCLUSION: There are indications that respondents validated the implementation of CAPS, but there are still challenges and tensions on the structuring and integrating teaching and service.