Perceptions and metaphors of patients about epileptic seizures and postictal state in Medellín-Colombia: A qualitative study.

INTRODUCTION: PWE describe epileptic seizures and the postictal state with the description of experienced symptoms or through metaphorical language. For treating physicians, this metaphoric language may go unnoticed. The purpose of the study is to identify both the real and metaphorical descriptions of epileptic seizures and postictal state referred by PWE from Medellín Colombia. METHODS: It is a qualitative study that uses grounded theory applied in ten semi-structured interviews of PWE from the Metropolitan Area of Medellín, Colombia. Descriptions of epileptic seizures and the postictal state were identified. For their classification into metaphorical and literal characteristics, the texts of "The Living Metaphor" by Paul Riccoeur, "The Illness and its Metaphors - AIDS and its Metaphors" by Susan Sontag, and "Metaphors of Everyday Life" by Lakoff and Johnson were used as references. RESULTS: Ten clinical and fourteen metaphorical descriptions of epileptic seizures were identified. Regarding the postictal state, eight clinical and six metaphorical descriptions were identified. The metaphors were classified into three categories: a. external force b. depreciation and division and c. the absence of continuity (slowness, disconnection). CONCLUSION: Metaphors are frequent in the description of epileptic seizures and can be useful in seizure classification, neuroanatomical localization, and therapeutic approach. Metaphors can be an initial stage in the construction of otherness as a form of identity.

Psychological and social aspects of people with epilepsy expressed through drawing: Pilot study.

INTRODUCTION: Frequently, the psychological and social aspects of PWE go unnoticed in medical consultations. Even in spite of having seizure control, some people can experience a poor quality of life. The objective of the study was to determine if drawing facilitates the expression of the psychological and social difficulties of PWE. METHODS: Hermeneutic, qualitative, situated knowledge study located in the city of Medellín, Colombia. The participants were asked to make one or several drawings under the question "what it is like to live with epilepsy". The drawings were analyzed with criteria of Gestalt psychology, semiotics, image-word relationship and context. RESULTS: Sixteen drawings of ten participants were obtained. The drawings revealed the construction of an identity of otherness and negative emotionality due to epilepsy. The social concepts of restriction, prohibition, dependency, and exclusion appear in the drawings. The authors expose the ways to face adversity. CONCLUSION: Drawing can expose and facilitate the expression of the psychological and social difficulties of PWE, which often go unnoticed in the medical office. Free drawing is an easy-to-use global tool that has been underused in the medical field.

Impact of the educational activities of the Renaser with Love Foundation in Medellín -Colombia.

INTRODUCTION: The Rebirth with Love Foundation from Medellín, Colombia has been active for four years. Several educative actions on epilepsy were carried out to promote a more inclusive society. The objective is to evaluate the impact of the activities carried out by the foundation. METHODS: Review of the minutes of activities. Quantification of the different activities carried out. RESULTS: The foundation shows its strengths in radio programs, training in first aid related to epileptic seizures, support group meetings, and awareness of the rights of people with epilepsy. The weakness is that there is no evaluation of these activities, with the exception of spontaneous feedback from some participants CONCLUSION: The foundation serves as a support group for people with epilepsy, although it must direct its actions with subsequent evaluations to better assess its impact.

Historical review of the cultural concepts around the denominations of epilepsy.

The characteristics of epileptic seizures, especially the fall, the scream, the loss of consciousness, the involuntary movements, and their recovery, confer conceptions of supernatural strangeness. A historical review is carried out on the denominations of epilepsy. Names such as "epilepsy" arise as "being overwhelmed by something"; the relationship with deities and demons; the influence of the stars; the struggle between good and evil in Christianity, or contact with the divine. Other denominations deal with legal aspects as in the case of "morbus comitialis" or "morbus sonticus". The concepts surrounding the denominations can have an impact on the construction of the subjectivity and identity of the affected people. The medical names of epilepsy do not address the social and cultural concepts surrounding the disease, with which the person with epilepsy has lived and still lives.

Saints, demons, and faith - A review of the historical interaction between Christianity and epilepsy.

The view that epilepsy is caused by demonic possession prevailed throughout the Middle Ages and re-emerges in rare cases of misguided exorcisms even in modern Western societies. This review reflects on the biblical sources of the demonic understanding of seizures and the subsequent marginalization of people with epilepsy. While the development of science led to a decline in beliefs of supernatural causes of seizures, the link between Christianity and epileptology is sustained through recurrent considerations of epileptic phenomena among religious figures. The influence of epilepsy on the legacy of historical persons of Christianity should be regarded with caution because of limited clinical evidence in historical documents. However, it should be acknowledged that religious experiences, as well as general religiosity, can be important in modern-day epilepsy care as they are shown to have psychological, societal, and even clinical implications. Further studies should expand our knowledge on the contemporary importance of the Christian tradition for people with epilepsy.

SCN1A Variants as the Underlying Cause of Genetic Epilepsy with Febrile Seizures Plus in Two Multi-Generational Colombian Families.

Genetic epilepsy with febrile seizures plus (GEFS+) is an autosomal dominant disorder with febrile or afebrile seizures that exhibits phenotypic variability. Only a few variants in SCN1A have been previously characterized for GEFS+, in Latin American populations where studies on the genetic and phenotypic spectrum of GEFS+ are scarce. We evaluated members in two multi-generational Colombian Paisa families whose affected members present with classic GEFS+. Exome and Sanger sequencing were used to detect the causal variants in these families. In each of these families, we identified variants in SCN1A causing GEFS+ with incomplete penetrance. In Family 047, we identified a heterozygous variant (c.3530C > G; p.(Pro1177Arg)) that segregates with GEFS+ in 15 affected individuals. In Family 167, we identified a previously unreported variant (c.725A > G; p.(Gln242Arg)) that segregates with the disease in a family with four affected members. Both variants are located in a cytoplasmic loop region in SCN1A and based on our findings the variants are classified as pathogenic and likely pathogenic, respectively. Our results expand the genotypic and phenotypic spectrum associated with SCN1A variants and will aid in improving molecular diagnostics and counseling in Latin American and other populations.

Update on first unprovoked seizure in children and adults: A narrative review.

OBJECTIVE: First seizures are always challenging for physicians. Determining etiology, risk of recurrence, need for diagnostic electroencephalogram (EEG) or neuroimaging, balancing starting anti-seizure medication (ASM) versus its potential adverse effects, and addressing patient and family concerns about social or emotional impact in lifestyle issues is always demanding. METHOD: a narrative review providing information from a database search between January 1970 to November 2020 was conducted, with the following search terms: first seizure, epidemiology, treatment, neuroimaging, electroencephalogram, impact, lifestyle. RESULTS: Incidence rates of single unprovoked seizures range from 23 to 64.1 /100000/person-years. The risk of recurrence depends on several clinical, etiological, EEG, and neuroimaging findings that should be approached on an individual basis. Initiating ASM is not generally advised, but shall be considered in individual situations. The emotional and social impact of single seizures must not be underestimated. Some interesting clues are pointing out at risks to present or prevent a first seizure. CONCLUSION: Presentation of first seizure, diagnostic workup, treatment, and impact should be considered individually based on continuously updated knowledge of treating physicians.

Neurology specialists' visual interpretation of psychogenic nonepileptic seizures: Contemplating their etiology and existing challenges.

PURPOSE: The purpose of this study was to explore how neurology specialists with interest in epilepsy depict psychogenic nonepileptic seizures (PNES) and their experience of diagnosing and treating the disorder. METHODS: An art project was organized as part of the curriculum of the 14th Latin American Summer School on Epilepsy (LASSE) in São Paulo (Brazil) from February 27th to March 6th, 2020. Willing neurologists were invited to draw or paint PNES and present their professional perspective of this disorder. Grouped by common themes, the artworks were analyzed in the context of the existing literature on PNES. RESULTS: The participants created 31 paintings and drawings, 13 of which were selected to represent the recurring themes. Throughout the artworks, neurologists often portrayed PNES as masking the underlying psychological issues, but there was little emphasis on the genesis of PNES itself. The manifestation of PNES was more attributed to just emotional suppression rather than to the influence of different situational factors on a pre-established seizure scaffold. Considering the management of PNES, neurology specialists used the symbol of a labyrinth to represent the difficulties of effectively providing diagnosis and multidisciplinary care for the patients. The general outlook on PNES was associated with darkness, possibly due to limited understanding of the disorder's nature and the unavailability of effective treatment options. CONCLUSION: Our study shows that art projects can be useful to better grasp neurology specialists' opinions about a certain disorder. Further research is needed to elucidate the mechanisms of PNES and help establish multidisciplinary care.

Perceptions of adult and child neurologists of transition programs in epilepsy in Latin America: A cross-sectional study.

PURPOSE: The objective of this study was to review the existence and opinion Latin American adult and child neurologists have about the development and function of transition programs in epilepsy. METHODS: This was a cross-sectional study. A questionnaire was constructed with sociodemographic variables, knowledge about transition programs, barriers for building up transition programs, and 21 topics regarding the degree of involvement of healthcare providers and carers should have during the transition process. The online questionnaire was sent to 136 Latin American chapter officers registered in the International League Against Epilepsy (ILAE) webpage and to 36 clinicians assisting to the 13th Latin American Summer School on Epilepsy. RESULTS: The answer rate was 68% (117/172), and all 19 Latin American countries were represented. Adult neurologists represented 60.7%. Only 16.2% knew of transition programs in epilepsy. The main limitations for transition programs were poor education about transition (76.9%), inflexible healthcare systems (75.2%), absence of financial support (61.5%), need of multidisciplinary teams (59%), and scarce communication between child and adult neurologists (53%). Providers and carers are expected to get involved at a high degree in all 21 presented topics for a transition process. The topics with highest percentage of commitment were violence and carrying weapons (93.2%), mental health (92.3%), alcohol and drugs (91.4%), suicide (90.6%), care of own's disease (90.5%), mortality risk (89.7%), and integral healthcare (92.2%). CONCLUSION: Only a few transition programs exist in Latin America. Knowing the benefits of and barriers for transition programs opens the opportunity to move further this strategy in the region considering local specificities. Education, communication skills, team working, and advocacy for adolescents with epilepsy could be initial starting points.

The abbreviation "PWE" may carry a negative connotation compared with the labels "person with epilepsy" and "epileptic".

PURPOSE: Ways of labeling a person with epilepsy (PWE) may have an impact on public position towards affected persons. This study analyzed college students position changes, influenced by three different labels of PWE. METHODS: Observational, descriptive, cross-sectional study. Students of three schools answered one of three questionnaires whose content changed in the labeling form: person with epilepsy, epileptic or PWE. Proportions were compared with Chi square test or Fisher's exact test to explore considering age, gender, religion practicing, socioeconomic status, knowing an affected person and by faculty. RESULTS: A total of 273 questionnaires were included were distributed in medicine 133 (48.7 %), engineering 108 (39.6 %) and law 32 (11.7 %) schools. Labeling type distribution was person with epilepsy 94 (34.4 %), epileptic 93 (34.1 %) and PWE 86 (31.5 %. No statistical differences were found according the labels person with epilepsy and epileptic. The abbreviation PWE had statistical significant connotation in aspects of academic achievement p = 0,007, selecting a PWE in your work team p = 0,009, self control p < 0,000, being dangerous p < 0,000 and having any disturbance in thought or behavior p = 0,05. Religion practicing, socioeconomic status and knowing a person with epilepsy did not impact in attitude related to labeling. Engineering and law students expressed their concern in employability. CONCLUSION: The abbreviation PWE may have negative connotations when used in written questionnaires. No differences were found with the labels person with epilepsy and epileptic in college students. More studies are needed to explore the stigmatizing or destigmatizing effects of labeling a person with epilepsy on different populations.

Painting epilepsy - The essence of disease by participants of the Latin American Summer School on Epilepsy (LASSE XIII).

PURPOSE: The purpose of this study was to present and analyze the way epilepsy researchers and specialists present epilepsy through visual art forms. METHODS: Students and epilepsy specialists, including clinicians and scientists, participating in the Latin American Summer School on Epilepsy (LASSE XIII) 2019 were asked to voluntarily portray epilepsy artistically by painting or drawing what they perceive that represents the feeling or challenges of persons with epilepsy. Resulting artwork was categorized according to several themes. The latter was analyzed in the clinical and social context of the disease. RESULTS: Twenty-six paintings available for analysis have been reviewed. The three main interpretations of epilepsy were outlined as follows: epilepsy as an identity schism, epilepsy as a loss of control, and epilepsy as a complex condition. Five artworks best suited the first category as they presented people with faces split into healthy and diseased sides, representing the emotional and social burden of seizures. Three drawings defined epilepsy as a loss of control, visualizing that all the phases of seizure activity (ictal, postictal, and interictal) are able to imprison the patient by disrupting mental processes. The last theme included four artworks that defined epilepsy as being a multicomponent enigma: the intertwining of unresolved pathophysiologic processes and psychosocial burden accompanying the disease was emphasized. In addition, the challenges to care for the patients in order to improve not only seizures but also their quality of life were noticed as an idea complementing the visual definition of epilepsy. CONCLUSION: Participants of LASSE XIII demonstrated an ability to empathize with their patients in retrospect by portraying the inner feelings of division and imprisonment of those having seizures. Epilepsy specialists visualize the disease as a composite phenomenon both in terms of its neural origin and of multidisciplinary requirements to implement its care.

Estado epiléptico en niños: experiencia de un hospital de alta complejidad en Medellín, Colombia / Status epilepticus in children: experience of a high complexity hospital in Medellín, Colombia

RESUMEN OBJETIVO: Describir las características clínicas, electroencefalográficas, imagenológicas y etiológicas de niños y adolescentes mayores de un mes de vida y menores de 14 años, con diagnóstico de estado epiléptico (EE), atendidos entre enero del 2005 y diciembre del 2015 en el Hospital Universitario San Vicente Fundación (HUSVF) en Medellín, Colombia. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo. Se describieron los datos clínicos, demográficos, imagenológicos y etiológicos de las historias clínicas recolectadas en el periodo mencionado. Se incluyeron pacientes con edad ≤14 años, excepto los neonatos. Para el análisis de los datos se utilizó el programa estadístico IBM SPSS Statistics 21,0. RESULTADOS: Se obtuvieron 234 registros, correspondientes a 348 episodios de EE. La edad promedio de presentación fue de 3,2 años (± 2,7 DE). La presentación clínica más frecuente fue la convulsión tónico-clónica generalizada, seguida por la convulsión focal motora. Existió el antecedente personal de epilepsia en el 50,9 %. Las principales etiologías fueron fiebre (60,6 %), malformaciones del sistema nervioso central (32,6 %) y suspensión de anticonvulsivantes (13 °/o). Los hallazgos imagenológicos más frecuentes fueron la hidrocefalia y las malformaciones del desarrollo cortical. El tratamiento de primera línea fue con benzodiacepinas, seguido por fenitoína y fenobarbital. El 9 °% requirieron medicamentos de tercera línea. La mortalidad fue de 1,2 °%. CONCLUSIÓN: Los resultados encontrados fueron similares a los descritos en otras poblaciones. La etiología del EE es heterogénea. Adicionalmente, se encontró que la suspensión de medicamentos constituye una causa importante de EE en nuestra población.

SUMMARY OBJECTIVE: To describe the clinical, electroencephalographic, imaging and etiological characteristics of children and adolescents older than one month of life and under 14 years of age with a diagnosis of status epilepticus (SE) attended from January 2005 to December 2015 at San Vicente University Hospital in Medellin, Colombia. MATERIALS AND METHODS: Retrospective descriptive study. It included clinical, demographic, imaging and etiology data recorded in the clinical charts from January 2005 to December 2015. Patients under 14 years of age were included except neonates. The IBM SPSS Statistics 2.0 program was used to analyze the data. RESULTS: 234 patients with 348 episodes of SE were included. The average age at presentation was 3.2 years (± 2.7 SD). The most common clinical presentation was generalized tonic clonic seizure followed by focal motor seizure. The antecedent of epilepsy was found in 50.9 °% of the patients. The main etiologies were fever (60.6 °%), brain malformations (32.6 °%) and the withdrawal of antiepileptic drugs (13 °%). The most frequent imaging findings were hydrocephalus and cortical developmental disorders. The first-line treatments were benzodiazepines followed by phenytoin and phenobarbital. Nine percent required third-line medications. Mortality was 1.2 °%. CONCLUSION: The results of our study were similar to those described in other populations. SE was characterized by heterogeneous etiology. It was found that the withdrawal of medications was an important cause of SE in our study.

Does public attitude change by labeling a person as epileptic, person with epilepsy or the acronym PWE? A systematic review.

PURPOSE: It is still unknown if attitudinal differences by diverse labeling of persons with epilepsy could be universally accepted with the actual literature evidence. The manner in which questions are constructed could also have an impact in final results. The purpose of this systematic review was to examine the published articles regarding changes in public´s attitude towards epilepsy by labeling a person as epileptic, person with epilepsy or with the acronym PWE. METHODS: We undertook a systematic review of the literature using common databases with specific keywords and combinations searching for original articles, meta-analysis and systematic reviews. Sociodemographic variables, attitude results and questions style were analyzed in included articles. RESULTS: Four original articles were found. Significant attitudinal changes were described in three studies with the label person with epilepsy. One study failed to demonstrate an attitudinal change by distinct labeling of a person with epilepsy. All questions were formulated in a personal way. Few neutral and mostly induced questions were found in the studies. CONCLUSION: By the use of the label "person with epilepsy" there is a trend towards positive changes in public's attitudes, although evidence is scarce to consider this tendency as universally applicable. More studies are needed considering widespread social and cultural backgrounds and patient opinion. Language power by wording type could be a key consideration for future studies.

Sleepwalking and Sleep Paralysis: Prevalence in Colombian Families With Genetic Generalized Epilepsy.

BACKGROUND: Sleep deprivation commonly increases seizure frequency in patients with genetic generalized epilepsy, though it is unknown whether there is an increased prevalence of sleepwalking or sleep paralysis in genetic generalized epilepsy patients. Establishing this could provide insights into the bio-mechanisms or genetic architecture of both disorders. The aim of this study was to determine the prevalence of sleepwalking and sleep paralysis in a cohort of patients with genetic generalized epilepsy and their relatives in extended families. METHODS: A structured interview based on International League Against Epilepsy (ILAE) and International Classification of Sleep Disorders (ICSD-3) criteria was applied to 67 index cases and their relatives to determine genetic generalized epilepsy subtypes and assess the occurrence of sleepwalking or sleep paralysis. Bivariate analysis was performed using chi-square and Fisher exact tests. RESULTS: The prevalence of sleepwalking and sleep paralysis was 15.3% (95% confidence interval 12.1-18.9) and 11.7% (95% confidence interval 8.7-15.3), respectively. Unusually, no sleepwalkers were found among individuals displaying epilepsy with generalized tonic-clonic seizures. Approximately a quarter of the patients had either parasomnia or genetic generalized epilepsy. Over half the genetic generalized epilepsy families had at least 1 individual with sleepwalking, and more than 40% of the families had one individual with sleep paralysis. CONCLUSION: The prevalence of sleepwalking or sleep paralysis is reported for individuals with genetic generalized epilepsy and their relatives. The co-existence of either parasomnia in the genetic generalized epilepsy patients and the co-aggregation within their families let suggest that shared heritability and pathophysiological mechanisms exist between these disorders. We hypothesize that sleepwalking/sleep paralysis and genetic generalized epilepsy could be variable expression of genes in shared pathways.

How can transition to adult care be best orchestrated for adolescents with epilepsy?

Objective evidence is limited for the value of transition programs for youth with chronic illness moving from pediatric to adult care; however, such programs intuitively "make sense". We describe the strengths and weaknesses of a variety of transition programs from around the world for adolescents with epilepsy. Consequences of poorly organized transition beyond suboptimal seizure control may include an increased risk of sudden unexpected death in epilepsy (SUDEP), poor psychological and social outcome, and inadequate management of comorbidities. The content of transition programs for those with normal intelligence differs from those with intellectual disability, but both groups may benefit from an emphasis on sporting activities. Concerns that may interfere with optimal transition include lack of nursing or social work services, limited numbers of adult neurologists/epileptologists confident in the treatment of complex pediatric epilepsy problems, institutional financial support, and time constraints for pediatric and adult physicians who treat epilepsy and the provision of multidisciplinary care. Successful programs eventually need to rely on a several adult physicians, nurses, and other key healthcare providers and use novel approaches to complex care. More research is needed to document the value and effectiveness of transition programs for youth with epilepsy to persuade institutions and healthcare professionals to support these ventures.

Epilepsy, Physical Activity and Sports: A Narrative Review.

People with epilepsy (PWE) are less physically active compared with the general population. Explanations include prejudice, overprotection, unawareness, stigma, fear of seizure induction and lack of knowledge of health professionals. At present, there is no consensus on the role of exercise in epilepsy. This paper reviews the current evidence surrounding the risks and benefits associated with physical activity (PA) in this group of patients. In the last decade, several publications indicate significant benefits in physiological and psychological health parameters, including mood and cognition, physical conditioning, social interaction, quality of life, as well as potential prevention of seizure presentation. Moreover, experimental studies suggest that PA provides mechanisms of neuronal protection, related to biochemical and structural changes including release of ß-endorphins and steroids, which may exert an inhibitory effect on the occurrence of abnormal electrical activity. Epileptic discharges can decrease or disappear during exercise, which may translate into reduced seizure recurrence. In some patients, exercise may precipitate seizures. Available evidence suggests that PA should be encouraged in PWE in order to promote wellbeing and quality of life. There is a need for prospective randomized controlled studies that provide stronger clinical evidence before definitive recommendations can be made.

Epilepsia y actividad física: conceptos desde la perspectiva de las ciencias básicas / Epilepsy and physical activity: concepts from the perspective of basic sciences / Epilepsia e atividade física: conceitos desde a perspectiva das ciências básicas

RESUMEN La Organización Mundial de la Salud considera que la epilepsia es una prioridad de salud pública. A las personas afectadas se les restringe con frecuencia su participación en actividades físicas y deportivas, pero los estudios clínicos han demostrado un efecto benéfico de la actividad física sobre el control de las crisis epilépticas. Se describen los hallazgos desde la perspectiva de las ciencias básicas que demuestran los mecanismos reguladores del efecto del ejercicio sobre la epileptogénesis, el control de la enfermedad y de su comorbilidad psiquiátrica. Tanto las investigaciones clínicas como las básicas indican que se debería considerar la actividad física como una estrategia terapéutica complementaria en las personas con epilepsia, la cual está disponible en todas partes del mundo y a un muy bajo costo.

SUMMARY According to the World Health Organization, epilepsy is a public health priority. Persons with this disease are frequently restricted from participating in physical activities and sports. Clinical studies have shown the beneficial effects of exercise on seizure control. Results from basic research demonstrating the mechanisms of physical activity on epileptogenesis, seizure control and psychiatric comorbidity are described. Basic and clinical research indicates that physical activity should be considered a complementary therapeutic approach for persons with epilepsy, a beneficial strategy that is available worldwide at a low cost.

RESUMO A Organização Mundial da Saúde considera que a epilepsia é uma prioridade de saúde pública. Às pessoas afetadas se lhes restringe com frequência sua participação em atividades físicas e esportivas, mas os estudos clínicos há demostrado um efeito benéfico da atividade física sobre o controle das crises epilépticas. Se descrevem as descobertas desde a perspectiva das ciências básicas que demostram os mecanismos reguladores do efeito do exercício sobre a epileptogênese, o controle da doença e de sua co-morbilidade psiquiátrica. Tanto as investigações clínicas como as básicas indicam que se deveria considerar a atividade física como uma estratégia terapêutica complementária nas pessoas com epilepsia, a qual está disponível em todas partes do mundo e a um muito baixo custo.

Epilepsia, actividad física y deporte / Epilepsy, physical activity and sports / Epilepsia, atividade física e esporte

Las personas con epilepsia tienden a ser más sedentarias que la población general. Las causas para ello son ignorancia, prejuicio, sobreprotección, temor o vergüenza. No existe sustentación científica que oriente a una limitación del ejercicio en dichas personas. Los estudios indican que son enormes los beneficios del deporte en los individuos afectados de epilepsia. Los aspectos positivos del ejercicio son acondicionamiento físico, protección para la aparición de crisis, alivio emocional, mejores destrezas sociales, mayor adherencia al tratamiento farmacológico, prevención de la osteoporosis y mejora en la calidad de vida de los pacientes y sus familias. De manera sensata y acorde con las particularidades de cada paciente, se debe prescribir u orientar el tipo de actividad física que se va a realizar. La evidencia disponible sitúa a la actividad física y el deporte en la categoría de terapia complementaria para las personas con epilepsia, que a un bajo costo, logra grandes beneficios. El llamado es a promover estas herramientas como una indicación habitual en los pacientes con epilepsia.

People with epilepsy are prone to be sedentary compared with the general population. The causes of inactivity are ignorance, prejudice, overprotection, fear and shame. There is no scientific evidence supporting a limitation of physical exercise in persons with epilepsy. The benefits of exercise in these patients are huge. Positive aspects are: physical conditioning, prevention of seizures, emotional wellbeing, social interaction, drug treatment adherence, osteoporosis prevention and better quality of life for patients and their families. Having in mind the individual characteristics, physical exercise should be prescribed and guided. Available evidence underlies the complementary therapeutic effects of physical activity with large positive results at a low cost. Sports or regular physical activity should be a standard indication for persons with epilepsy.

As pessoas com epilepsia tendem ser mais sedentárias do que a população em geral. As causas para isto são ignorância, preconceito, sobre proteção, temor ou vergonha. Não existe sustentação científica que oriente a uma limitação do exercício em ditas pessoas. Os estudos indicam que são enormes os benefícios do esporte nos indivíduos afetados de epilepsia. Os aspectos positivos do exercício são acondicionamento físico, proteção para a aparição de crise, alívio emocional, melhores destrezas sociais, maior aderência ao tratamento farmacológico, prevenção da osteoporose e melhora na qualidade de vida dos pacientes e suas famílias. De maneira sensata e acorde com as particularidades de cada paciente, se deve prescrever ou orientar o tipo de atividade física que irá realizar A evidência disponível situa à atividade física e o esporte na categoria de terapia complementária para as pessoas com epilepsia, que a um baixo custo, consegue grandes benefícios. O chamado é a promover estas ferramentas como uma indicação habitual nos pacientes com epilepsia.

Epilepsy in the tropics: Emerging etiologies.

Epilepsy is considered by the World Health Organization a public health priority with more than 50 million human beings affected by the disease. More than 80% of persons with epilepsy live in low and middle income countries and most of them in tropical areas. Several emerging, re-emerging and neglected diseases are symptomatic etiologies that jointly contribute to the enormous global burden of epilepsy. Besides the clinical strengths to reduce diagnostic and treatment gaps, other strategies in social, economic, cultural, educational and health policies are needed to prevent and treat appropriately vulnerable and affected persons with epilepsy. From the public health point of view, several of those strategies could be more effective in reducing the incidence and burden of the disease than the clinical approach of diagnosis and treatment. Special attention has to be given to stigma reduction and promotion of human rights. Several aspects mentioned in this abstract slip away the scope of the article, but it is a remainder to approach epilepsy in an inter- and transdisciplinary manner, an integral and pertinent approach needed and requested in tropical counties. The article focuses only on emergent and re-emergent etiologies of epilepsy in the tropics like malaria, HIV, neurocysticercosis, viral encephalitis and traumatic brain injury.

Eugenesia y discriminación en Colombia: el papel de la medicina y la psiquiatría en la política inmigratoria a principios del siglo XX / Eugenics and Discrimination in Colombia: the Role of Medicine and Psychiatry in Immigration Policy at the Beginning of the 20th Century

A finales del siglo XIX la eugenesia tuvo su inicio con la teoría de la evolución. Los académicos disertaron con los avances obtenidos de sus estudios e influyeron progresivamente en la implementación de normas y leyes de higienización para mejorar la raza. Dichos principios sirvieron de base para ir decretando leyes eugenésicas y luego discriminatorias. Colombia no estuvo al margen de dicha corriente y propició leyes inmigratorias congruentes con ese pensamiento en la primera mitad del siglo XX.

With the Theory of Evolution, eugenics had its beginnings during the last decades of the 19th century. Academics discussed the results obtained from their observations, and progressively had influence on the promulgation of laws and norms related to ethnic hygiene and improvement of race. Such principles were the fundamentals to order eugenic and discriminatory laws. Colombia was not outside that discussion and developed immigration laws congruent to that thinking during the first half of the 20th century.