Trastornos del sueño en niños con epilepsia / Sleep disorders in children with epilepsy

Introducción: Los niños con epilepsia tienen más trastornos del sueño (TS) que la población sana. Es fundamental su diagnóstico, ya que la epilepsia y los TS tienen una relación bidireccional. Objetivo: Determinar la incidencia de TS y malos hábitos de sueño en niños con epilepsia. Método: Estudio transversal de pacientes menores de 18 años con epilepsia sobre TS, mediante la versión española de Sleep Disturbance Scale for Children (SDSC), y sobre hábitos de sueño, mediante cuestionario de elaboración propia. Resultados: La muestra incluyó 153 pacientes. El 84% de la población estudiada presentaba alterado algún aspecto del sueño. Lo más frecuente fueron las alteraciones en la transición sueño-vigilia (53%), en el inicio-mantenimiento del sueño (47,7%) y la somnolencia diurna (44,4%). Un 70% de los padres de los pacientes referían que su hijo «dormía bien», pero en este grupo se detectaron TS hasta en el 75,7%. Muchos de los pacientes tenían hábitos de sueño poco saludables, como dormirse con dispositivos electrónicos (16,3%), precisar presencia familiar para dormirse (39%) o dormir en colecho o cohabitación (23,5 y 30,5%, respectivamente). Aquellos con epilepsias generalizadas, refractarias, crisis nocturnas y discapacidad intelectual presentaron mayor probabilidad de presentar TS. En cambio, los malos hábitos de sueño fueron frecuentes independientemente de las características de la epilepsia. Conclusiones: Los TS y los malos hábitos de sueño son frecuentes en niños con epilepsia. Su tratamiento puede conllevar una mejoría en la calidad de vida del paciente y su familia, así como una mejoría en el pronóstico de la epilepsia.(AU)

Introduction: Children with epilepsy present greater prevalence of sleep disorders than the general population. Their diagnosis is essential, since epilepsy and sleep disorders have a bidirectional relationship. Objective: Determine the incidence of sleep disorders and poor sleep habits in children with epilepsy. Methods: We conducted a cross-sectional study of patients under 18 years of age with epilepsy, assessing sleep disorders using the Spanish-language version of the Sleep Disturbance Scale for Children (SDSC), and sleep habits using an original questionnaire. Results: The sample included 153 patients. Eighty-four percent of our sample presented some type of sleep alteration. The most frequent alterations were sleep-wake transition disorders (53%), sleep initiation and maintenance disorders (47.7%), and daytime sleepiness (44.4%). In 70% of cases, the patients’ parents reported that their child “slept well,” although sleep disorders were detected in up to 75.7% of these patients. Many patients had poor sleep habits, such as using electronic devices in bed (16.3%), requiring the presence of a family member to fall asleep (39%), or co-sleeping or sharing a room (23.5% and 30.5%, respectively). Those with generalised epilepsy, refractory epilepsy, nocturnal seizures, and intellectual disability were more likely to present sleep disorders. In contrast, poor sleep habits were frequent regardless of seizure characteristics. Conclusions: Sleep disorders and poor sleep habits are common in children with epilepsy. Their treatment can lead to an improvement in the quality of life of the patient and his/her family, as well as an improvement in the prognosis of epilepsy.(AU)

Decimocuarta lección Jesús Culebras. Dieta cetogénica, un tratamiento a medio descubrir / Fourteenth Jesús Culebras Lecture. Ketogenic diet, a half-discovered treatment

La dieta cetogénica constituyó desde su inicio un planteamiento sorprendente para el tratamiento de la epilepsia. Someter al organismo a un cambio en la obtención de energía, pasando de depender de los carbohidratos a hacerlo de las grasas, pone en marcha toda una serie de rutas bioquímicas que, de forma independiente pero también complementaria, dan lugar a un conjunto de efectos que benefician al paciente. Esta búsqueda de su mecanismo de acción, de idear cómo mejorar el cumplimiento y de aprovecharla para otras enfermedades ha marcado su trayectoria. En este artículo se revisan someramente estos aspectos, haciendo hincapié en la importancia de seguir realizando investigación básica y clínica para que este tratamiento pueda aplicarse con bases científicas sólidas.(AU)

The ketogenic diet was an amazing approach to treating epilepsy from its beginning. The body undergoes a change in obtaining energy, going from depending on carbohydrates to depending on fats, and then a whole series of biochemical routes are launched that, independently but also complementary, give rise to a set of effects that benefit the patient. This search for its mechanism of action, of devising how to improve compliance and take advantage of it for other diseases has marked its trajectory. This article briefl y reviews these aspects, emphasizing the importance of continuing to carry out basic and clinical research so that this treatment can be applied with solid scientific bases.(AU)

Crisis en urgencias: una vista a las características clínicas y terapéuticas a través de 122 pacientes / Seizures in the emergency service: the clinical and therapeutic characteristics of 122 patients

Introducción Las crisis epilépticas son un motivo frecuente de consulta en los servicios de urgencias hospitalarias. Llegar al diagnóstico correcto puede ser complejo, y es fundamental decidir cuándo y qué medicamento anticrisis (MAC) pautar. Nuestro objetivo es detallar las características de los pacientes que consultaron por este motivo en un hospital mediano. Pacientes y métodos Estudio observacional retrospectivo de todos los pacientes mayores de edad que consultaron en el servicio de urgencias del Hospital Universitario Lucus Augusti entre enero de 2022 y enero de 2023 con diagnóstico al alta de crisis epiléptica. Se registraron variables demográficas, los antecedentes, si era una primera crisis, el número de éstas, si se inició un MAC y cuál, el diagnóstico, qué pruebas se realizaron y si se interconsultó con la guardia de neurología. Resultados Se diagnosticó a 122 pacientes de crisis epilépticas en urgencias. El 50,8% eran mujeres. La media de edad fue de 69,8 años. Se solicitó valoración por neurología en un 47,6%. El 50,8% presentó una primera crisis. No se llegó al diagnóstico en un 46% de los casos, de los cuales sólo 10 fueron valorados por neurología. La etiología más frecuente fue la vascular. Se realizó un electroencefalograma en un 41,8%. El levetiracetam fue prácticamente el único fármaco utilizado cuando no se consultó con neurología. Conclusiones La valoración precoz de los pacientes con una primera crisis en urgencias por un especialista en neurología es determinante para el diagnóstico de epilepsia. Cuando no se interconsulta, casi siempre se pauta el mismo MAC. (AU)

INTRODUCTION Epileptic seizures are a common cause of admission in emergency services at hospitals. Performing the correct diagnosis can be difficult, and deciding when and which anti-seizure medication (ASM) to prescribe is critical. Our objective is to detail the characteristics of patients treated in a medium-sized hospital for this reason. PATIENTS AND METHODS A retrospective observational study was performed, including all the adult patients treated by the emergency service of the Lucus Augusti University Hospital between January 2022 and January 2023 with a diagnosis of epileptic seizure on discharge. The study recorded their demographic variables, history, whether it was their first seizure, the number of seizures, whether an anti-seizure medication was administered and which one, the diagnosis, the tests performed, and whether the patient was referred to the neurology service. RESULTS A total of 122 patients were diagnosed with epileptic seizures in the emergency service. 50.8% of the patients were women. The mean age was 69.8 years. Neurological assessment was requested for 47.6%. 50.8% presented their first seizure. No diagnosis was performed in 46% of the cases, of which only 10 were evaluated by the neurology service. The most common etiology was vascular. An electroencephalogram was performed on 41.8%. Levetiracetam was practically the only drug administered when the neurology department was not consulted. CONCLUSIONS Early evaluation of patients with their first seizure in the emergency service by a neurological specialist is crucial for the diagnosis of epilepsy. The same anti-seizure medication is almost always prescribed when no cross-consultation takes place. (AU)

Estudio poblacional forense de la muerte súbita inexplicada en la epilepsia en niños y jóvenes durante el periodo 1991-2021 / Forensic population study of sudden unexplained death in epilepsy in children and young people during the period 1991–2021

Introducción la muerte súbita inexplicada en la epilepsia (MSIEP) es una causa importante de mortalidad en los pacientes epilépticos jóvenes; sin embargo, su existencia es poco conocida en el ámbito forense. El objetivo del trabajo es analizar la frecuencia y características clínico-patológicas de la MSIEP en los epilépticos menores de 35 años. Métodos estudio observacional de todas MSIEP ocurridas en personas de 1-35 años en Bizkaia (periodo 1991-2021) y Sevilla (2004-2021) investigadas en los servicios de patología forense (SPF). Además, se examinaron las muertes por epilepsia de los registros de mortalidad. Resultados se registraron 101 muertes por epilepsia en los registros de mortalidad y 46 MSIEP en los SPF, representando el 6% de las muertes súbitas en esta edad. Se registró una alta frecuencia de casos de epilepsia postraumática (n = 5), o con anomalías cerebrales (n = 5) o asociadas a trastornos del desarrollo (n = 4) o retraso mental (n = 3). El estudio toxicológico fue positivo en el 75%, destacando la presencia de fármacos antiepilépticos (n = 26). Se detectaron drogas ilegales en 5 jóvenes, principalmente cocaína (n = 3). La muerte fue no presenciada en la mayoría de los sujetos (85%) y sucedió por la noche (n = 63%) durante el sueño. Conclusiones la MSIEP en los niños y los jóvenes es infrecuente, pero constituye una causa importante de mortalidad en los epilépticos. Aunque los mecanismos de la MSIEP no son bien conocidos, se recomienda reforzar el control médico de la epilepsia en la juventud, principalmente en los pacientes con epilepsia postraumática o posquirúrgica o en aquellos con trastornos del desarrollo o retraso mental asociados. (AU)

Introduction Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in young epileptic patients. The objective of the work is to analyze its frequency and clinical-pathological characteristics as a cause of sudden death in epileptics under 35 years of age. Methods Retrospective population study of all SUDEP in people aged 1–35 years in Bizkaia (period 1991–2021) and Seville (2004–2021) investigated in the Forensic Pathology Services (FPS). In each case, a complete autopsy was carried out with histopathological and toxicological studies, and review of clinical and circumstantial data. Data from the Mortality Registry for deaths by epilepsy were examined. Results 101 deaths due to epilepsy were registered in the Mortality Registries and 46 SUDEP cases in the FPS, representing 6% of forensic sudden deaths in this age population. A high frequency of post-traumatic epilepsy cases (n = 5), brain abnormalities (n = 5) or epilepsy associated to developmental disorders (n = 4) or mental retardation (n = 3) was observed. The toxicological analysis was positive in 75%, highlighting the presence of antiepileptic drugs (n = 26). Illegal drugs were detected in 5 young people, mainly cocaine (n = 3). Death was unwitnessed in most subjects (85%) and occurred at night (n = 63%) while sleeping. Conclusions SUDEP in children and young people is infrequent, however it is an important cause of mortality in epileptics. Although the mechanisms are not well understood, it is recommended to strengthen the medical control of epilepsy in youth, mainly in patients with post-traumatic or post-surgical epilepsy or in those who have associated developmental disorders or mental retardation. (AU)

Long-term Effect of Multichannel tDCS Protocol in Patients with Central Cortex Epilepsies Associated with Epilepsia Partialis Continua.

Epilepsia partialis continua (EPC) is a rare type of focal motor status epilepticus that causes continuous muscle jerking in a specific part of the body. Experiencing this type of seizure, along with other seizure types, such as focal motor seizures and focal to bilateral tonic-clonic seizures, can result in a disabling situation. Non-invasive brain stimulation methods like transcranial direct current stimulation (tDCS) show promise in reducing seizure frequency (SF) when medications are ineffective. However, research on tDCS for EPC and related seizures is limited. We evaluated personalized multichannel tDCS in drug-resistant EPC of diverse etiologies for long-term clinical efficacy We report three EPC patients undergoing a long-term protocol of multichannel tDCS. The patients received several cycles (11, 9, and 3) of five consecutive days of stimulation at 2 mA for 2 × 20 min, targeting the epileptogenic zone (EZ), including the central motor cortex with cathodal electrodes. The primary measurement was SF changes. In three cases, EPC was due to Rasmussen's Encephalitis (case 1), focal cortical dysplasia (case 2), or remained unknown (case 3). tDCS cycles were administered over 6 to 22 months. The outcomes comprised a reduction of at least 75% in seizure frequency for two patients, and in one case, a complete cessation of severe motor seizures. However, tDCS had no substantial impact on the continuous myoclonus characterizing EPC. No serious side effects were reported. Long-term application of tDCS cycles is well tolerated and can lead to a considerable reduction in disabling seizures in patients with various forms of epilepsy with EPC.

Sleep disorders in children with epilepsy.

INTRODUCTION: Children with epilepsy present greater prevalence of sleep disorders than the general population. Their diagnosis is essential, since epilepsy and sleep disorders have a bidirectional relationship. OBJECTIVE: Determine the incidence of sleep disorders and poor sleep habits in children with epilepsy. METHODS: We conducted a cross-sectional study of patients under 18 years of age with epilepsy, assessing sleep disorders using the Spanish-language version of the Sleep Disturbance Scale for Children (SDSC), and sleep habits using an original questionnaire. RESULTS: The sample included 153 patients. Eighty-four percent of our sample presented some type of sleep alteration. The most frequent alterations were sleep-wake transition disorders (53%), sleep initiation and maintenance disorders (47.7%), and daytime sleepiness (44.4%). In 70% of cases, the patients' parents reported that their child "slept well," although sleep disorders were detected in up to 75.7% of these patients. Many patients had poor sleep habits, such as using electronic devices in bed (16.3%), requiring the presence of a family member to fall asleep (39%), or co-sleeping or sharing a room (23.5% and 30.5%, respectively). Those with generalised epilepsy, refractory epilepsy, nocturnal seizures, and intellectual disability were more likely to present sleep disorders. In contrast, poor sleep habits were frequent regardless of seizure characteristics. CONCLUSIONS: Sleep disorders and poor sleep habits are common in children with epilepsy. Their treatment can lead to an improvement in the quality of life of the patient and his/her family, as well as an improvement in the prognosis of epilepsy.

Memoria episódica verbal en pacientes pediátricos intervenidos de cirugía de la epilepsia del lóbulo temporal: un estudio de seguimiento al año / Verbal episodic memory in children undergoing temporal lobe epilepsy surgery: a one-year follow-up study

Introducción La memoria episódica verbal (MEV) no suele resultar alterada en niños con epilepsia focal sometidos a resecciones del lóbulo temporal izquierdo, a diferencia de lo que cabría esperar si se tratara de un cerebro adulto. Los últimos hallazgos sugieren que la actividad epileptógena en los primeros años de vida disrumpe la lateralización del sistema mnésico, lo que conduce al desarrollo de una representación bilateral de la memoria. El presente estudio pretende analizar si la lateralidad de la epilepsia es un predictor significativo de cara al pronóstico posquirúrgico de la MEV en la cirugía de la epilepsia del lóbulo temporal (ELT) en edad pediátrica. Esta investigación también pretende aportar evidencias sobre la relación de la MEV con otros factores demográficos y clínicos relevantes, como el sexo, la edad de inicio de las crisis, la edad quirúrgica y la duración de la epilepsia, así como estudiar el impacto del rendimiento prequirúrgico en la MEV sobre los resultados posquirúrgicos. Pacientes y métodos Se extrajeron de la base de datos del Hospital Sant Joan de Déu y se analizaron retrospectivamente las puntuaciones prequirúrgicas y al año de seguimiento postoperatorio de una tarea de recuerdo de lista de palabras correspondientes a 25 niños intervenidos de ELT (ELT izquierdo, n = 11; ELT derecho, n = 14). Resultados No se encontraron diferencias intergrupales prequirúrgicas significativas al comparar las puntuaciones en MEV sobre la base de la lateralidad de la epilepsia (p > 0,5). En cuanto al grupo de ELT izquierdo, se encontró una alta correlación negativa entre la edad de inicio y la puntuación prequirúrgica del recuerdo libre a largo plazo (rho = –0,72; p = 0,01). No se encontraron cambios intragrupo significativos entre el pre- y el postoperatorio en relación con el rendimiento en la MEV, independientemente de la lateralidad de la epilepsia (grupo de ELT izquierdo, p > 0,56; grupo de ELT derecho, p > 0,12). Conclusiones ... (AU)

INTRODUCTION Verbal episodic memory (VEM) is often unimpaired in children with focal epilepsy undergoing left temporal lobe resections, unlike what we might expect in the adult brain. The latter findings suggest that epileptiform activity in early life disrupts memory system lateralization, leading to the development of bilateral memory representation. The present study aims to analyze whether the laterality of epilepsy is a major predictor for post-operative VEM prognosis in pediatric temporal lobe epilepsy (TLE) surgery. This research also pretends to provide evidence about the relationship of VEM performance with other relevant demographical and clinical factors such as sex, age at onset of seizures, age at surgery and duration of epilepsy, as well as to study the impact of presurgical VEM performance on postsurgical outcomes. PATIENTS AND METHODS Pre-operative and one-year follow-up post-operative word-list recall scores from 25 children who underwent TLE surgery (left-sided, n = 11; right-sided, n = 14) were extracted from the Hospital Sant Joan de Déu database and were retrospectively analyzed. RESULTS No significant presurgical intergroup differences were found when comparing VEM scores by laterality of epilepsy (p > 0.5). Looking at the left TLE group, a high negative correlation was found between the onset age and the pre-operative long-term free recall score (rho = –0.72, p = 0.01). No significant pre- to post-operative intragroup changes were found regarding VEM performance, regardless of epilepsy laterality (left TLE group, p > 0.56; right TLE group, p > 0.12). CONCLUSIONS The laterality of epilepsy does not show to be a significant factor in and of itself (AU)

Antidepressant use and the risk of seizure: a meta-analysis of observational studies.

PURPOSE: The association between antidepressant use and the risk of seizures remains controversial. Therefore, this meta-analysis examined whether antidepressant use affects the risk of seizures. METHODS: To identify relevant observational studies, we conducted systematic searches in PubMed and Embase of studies published through May 2023. Random-effects models were used to estimate overall relative risk. RESULTS: Our meta-analysis included eight studies involving 1,709,878 individuals. Our results showed that selective serotonin reuptake inhibitors (SSRI) (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.32-1.66; P < 0.001) and selective noradrenalin reuptake inhibitors (SNRI) (OR 1.65, 95% CI 1.24-2.19; P = 0.001), but not tricyclic antidepressants (TCA) (OR 1.27, 95% CI 0.84-1.92; P = 0.249), were associated with an increased risk of seizures. Subgroup analyses revealed an OR of 2.35 (95% CI 1.7, 3.24; P < 0.001) among short-term (< 30 days) antidepressant users. CONCLUSIONS: The findings of this meta-analysis support an increased risk of seizures in new-generation antidepressant users, expanding previous knowledge by demonstrating a more pronounced risk in short-term users.

Rasmussen's syndrome treated with anakinra.

BACKGROUND AND OBJECTIVE: Rasmussen's encephalitis (RE) is a rare chronic neurological disorder, characterized by unilateral inflammation of the cerebral cortex, refractory focal epilepsy or epilepsia partialis continua, hemiparesis, and progressive cognitive decline. Interleukin-1 (IL-1) plays an important role in neuroinflammation as a key element in the activation of the inflammatory IL-1ß-IL-1 receptor type 1 (IL-1R1) axis. Anakinra, an IL-1 inhibitor, is successfully used in patients with new onset refractory status epilepticus and febrile infection-related epilepsy syndrome. METHODS AND RESULTS: We present 38-year-old male with RE having right-sided hemiparesis and continuous spasms being unresponsive to immune modulatory therapies like pulse steroid, intravenous immunoglobulin and anti-seizure drugs. After treatment with anakinra for three weeks, the continuous spasms almost completely subsided, and his muscle strength returned to normal. DISCUSSION: Anakinra may be considered as a treatment option in patients with RE and refractory seizures.

Enfermedades raras con crisis epilépticas / Rare diseases with epileptic seizures

Las enfermedades raras (ER) con epilepsia son un grupo heterogéneo de entidades en las que existe frecuentemente una causa genética. En una mayoría de casos, la epilepsia que aparece en estos pacientes puede encuadrarse dentro de las “Encefalopatías Epilépticas y del Desarrollo”, mostrando fenotipos clínicos en los que existe una interacción entre epilepsia a menudo refractaria con regresión y afectación del neurodesarrollo, en un contexto de síndromes epilépticos más o menos definidos. Las causas genéticas subyacentes hoy en día pueden identificarse con precisión en muchos casos, permitiendo un acercamiento terapéutico precoz e individualizado en un contexto de Medicina de Precisión. Existen múltiples ejemplos pero es particularmente significativo el de la epilepsia ligada a SCN1A, incluyendo el síndrome de Dravet. En muchos casos la mutación específica permite delinear la historia natural futura, por lo que puede ofrecerse una guía anticipatoria exhaustiva que cubre múltiples necesidades del paciente más allá del uso específico de fármacos.(AU)

Rare diseases with epilepsy are a heterogeneous group of entities in which there is frequently a genetic cause. In the majority of cases, the epilepsy that appears in these patients can be classified as “Developmental and Epileptical Encephalopathies”, showing clinical phenotypes in which there is an interaction between often refractory epilepsy with regression and impairment of neurodevelopment, in a context of epileptic syndromes more or less defined. The underlying genetic causes can today be precisely identified in many cases, allowing an early and individualized therapeutic approach in a Precision Medicine context. There are multiple examples, but epilepsy linked to SCN1A is particularly significant, including Dravet syndrome. In many cases, the specific mutation allows the future natural history to be delineated, so comprehensive anticipatory guidance can be offered that covers multiple patient needs beyond the specific use of drugs.(AU)

Ketogenic diet in pharmacoresistant epilepsies: a clinical nutritional assessment / Dieta cetogênica na epilepsia fármaco-resistente: avaliação clínica-nutricional

Abstract Background Epilepsies are among the most prevalent chronic neurological diseases, usually beginning in childhood. About 30% of children with epilepsies develop seizures that are difficult to control with medication. Recurrent epileptic seizures hinder diet intake, impairing the nutritional status. Although non-pharmacological interventions (e.g., ketogenic diet therapy) can improve epileptic seizure frequency, few studies analyzed their impact on the nutritional status of children and adolescents with epilepsies. Objective The aim was to evaluate the effects of a ketogenic diet on the nutritional status and clinical course of patients with pharmacoresistant epilepsies. Methods This cross-sectional study included patients under 18 years of age followed up at the Ketogenic Diet Ambulatory Clinic of the Instituto de Medicina Integral Prof. Fernando Figueira between December 2015 and December 2021. Socioeconomic, clinical, nutritional, and laboratory data were collected from medical records at different time points during the ketogenic diet. Results The sample comprised 49 patients aged between 5 months and 17 years (median = 4.4 years), mostly male (62.1%), and from Recife and the metropolitan region (51%). Underweight patients (BMI-for-age) improved their nutritional status in six months. However, patients who were normal weight and overweight maintained their nutritional status. Dyslipidemia was a common and short-term adverse effect. Moreover, the treatment decreased epileptic seizure frequency and antiseizure medication intake. Conclusion The ketogenic diet prevented malnutrition from worsening and reduced epileptic seizures and antiseizure medication intake.

Resumo Antecedentes A epilepsia, uma das doenças neurológicas crônicas mais prevalentes, tem geralmente início na infância. Cerca de 30% das crianças com epilepsia desenvolvem crises de difícil controle medicamentoso. As crises epilépticas recorrentes dificultam a ingestão alimentar, prejudicando o estado nutricional. Intervenções não farmacológicas, como a terapia com dieta cetogênica, podem melhorar a frequência das crises epilépticas, mas existem poucos estudos sobre a repercussão no estado nutricional da criança/adolescente. Objetivo Avaliar o efeito da terapia cetogênica sobre o estado nutricional e a evolução clínica da epilepsia fármaco-resistente. Métodos Estudo tipo corte transversal envolvendo menores de 18 anos acompanhados no Ambulatório de Dieta Cetogênica do Instituto de Medicina Integral Prof. Fernando Figueira entre dezembro de 2015 e dezembro de 2021. Dados socioeconômicos, clínicos, nutricionais e laboratoriais foram coletados nos prontuários dos pacientes em vários momentos da terapia cetogênica. Resultados A amostra foi composta por 49 pacientes com idades entre cinco meses e 17 anos (mediana = 4,4 anos), a maioria do sexo masculino (62,1%) e procedentes de Recife e região metropolitana (51%). Pacientes com baixo peso (de acordo com o IMC para idade) melhoraram seu estado nutricional em seis meses. No entanto, os pacientes com peso adequado e com sobrepeso mantiveram seu estado nutricional. A dislipidemia foi um efeito adverso frequente e de curta duração. Além disso, o tratamento reduziu a frequência de crises epilépticas e a dose de fármacos anticrises. Conclusão A dieta cetogênica preveniu o agravamento da desnutrição e reduziu as crises epilépticas e a dosagem de fármacos anticrises.

Epilepsia do lobo temporal com esclerose hipocampal mesial / Temporal lobe epilepsy with mesial hippocampal sclerosis / Epilepsia del lóbulo temporal con esclerosis del hipocampo mesial

Objetivo:Compreender o cenário atual da ELT-HS, caracterizado por sua fisiopatologia, manifestações clínicas, métodos diagnósticos e tratamentos. Método:Trata-se de uma revisão integrativa da literatura, com caráter descritivo, de artigos indexados no Sistema de Análise e Recuperação da Literatura Médica Online MEDLINE/Pubmed, Literatura Latino-Americana e do Caribe em Ciências da Saúde LILACS, e nas bases de dados Científicas Electronic Library Online (SciELO), pesquisados na período compreendido entre outubro de 2022 e março de 2023. Foram incluídos artigos em português e inglês que contemplassem os objetivos da revisão, publicados nos últimos dez anos (2011-2021).Resultados: Inicialmente foram encontrados 144 artigos nas bases de dados, que após a leitura, foramselecionados na pesquisa 40 artigos que correspondiam ao objetivo proposto. Os artigos analisados correspondem aos anos de 2011 a 2021. Conclusão:O tratamento cirúrgico da ELT-HS tem se mostrado eficaz para resolução completa das crises na maioria dos pacientes. O conhecimento sobre sua fisiopatologia, manifestações clínicas, diagnóstico e tratamentos são de fundamental importância para os médicos que atendem pacientes com epilepsia.

Objective: To understand the current scenario of TLE-HS, characterized by its pathophysiology, clinical manifestations, diagnostic methods and treatments. Method:This is an integrative literature review with descriptive character, of articles indexed in the Medical Literature Analysis And Retrieval System Online MEDLINE/Pubmed, Latin American and Caribbean Literature in Health Sciences LILACS, and Scientic databases Electronic Library Online (SciELO), researched in the period between october 2022 and march 2023. Articles in Portuguese and English that contemplated the objectives of the review, published in the last ten years (2011-2021), were included. Results:Initially, 144 articles were found in the databases, which after reading, 40 articles were selected in the research that corresponded to the proposed objective. The articles analyzed are equivalent to the years 2011 to 2021. Conclusion:The surgical treatment of TLE-HS has been shown to be effective for the complete resolution of crises in most patients. Knowledge about its pathophysiology, clinical manifestations, diagnosis and treatments are of fundamental importance for physicians who treat patients with epilepsy

Objetivo: Comprender el escenario actual de la TLE-HS, caracterizado por su fisiopatología, manifestaciones clínicas, métodos diagnósticos y tratamientos. Método: Se trata de una revisión bibliográfica integradora con carácter descriptivo, de artículos indexados en el Sistema de Análisis y Recuperación de Literatura Médica en Línea MEDLINE/Pubmed, Literatura Latinoamericana y del Caribe en Ciencias de la Salud LILACS, y bases de datos Scientic Electronic Library Online (SciELO), investigados en el período comprendido entre octubre de 2022 y marzo de 2023. Se incluyeron artículos en portugués e inglés que contemplaran los objetivos de la revisión, publicados en los últimos diez años (2011-2021). Resultados:Inicialmente se encontraron 144 artículos en las bases de datos, de los cuales luego de la lectura se seleccionaron 40 artículos en la investigación que correspondía al objetivo propuesto. Los artículos analizadoscorresponden a los años 2011 a 2021. Conclusión:El tratamiento quirúrgico del ELT-HS se ha mostrado eficaz para la resolución completa de las crisis en la mayoría de los pacientes. El conocimiento sobre su fisiopatología, manifestaciones clínicas, diagnóstico y tratamientos es de fundamental importancia para los médicos que tratan pacientes con epilepsia

Self-reported attention and hyperactivity symptoms among adults with epilepsy / Sintomas de desatenção e hiperatividade autorrelatados entre adultos com epilepsia

Abstract Background Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population. Objective This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population. Methods This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test. Results Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p< 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p= 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p= 0.001. Conclusion PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.

Resumo Antecedentes Pacientes com epilepsia (PCE) frequentemente apresentam comorbidades psiquiátricas, principalmente depressão e ansiedade. O transtorno do déficit de atenção e hiperatividade (TDAH) também é mais frequente nos PCE, porém foi pouco estudado na população adulta de PCE. Objetivo Comparar a presença de sintomas de TDAH entre PCE adultos e a população geral. Métodos Noventa e cinco PCE adultos de um centro terciário no Sul do Brasil foram comparados a 100 controles saudáveis. Todos os sujeitos foram submetidos a três escalas estruturadas: 1) a Escala Autorrelatada de TDAH em Adultos da Organização Mundial da Saúde, versão 1.1 (ASRS); 2) a Escala Hospitalar de Ansiedade e Depressão (HADS); e 3) o Perfil de Eventos Adversos (AEP). Variáveis dicotômicas foram analisadas através dos testes chi-quadrado e exato de Fisher, conforme apropriado, e as variáveis não paramétricas foram analisadas através do teste U de Mann-Whitney. Resultados As medianas e os intervalos interquartis (IIQ) foram: 1) ASRS: 26.00 (IIQ: 18 a 38) em PCE versus 17.00 (IIQ: 11 a 24) nos controles, p< 0,001; 2) HADS: 14.00 (IIQ: 8 a 21) em PCE versus 11.00 (IIQ: 8 a 16) nos controles, p= 0,007; 3) AEP: 38.00 (IIQ: 31 a 49) em PCE versus 33.00 (IIQ: 23 a 43) nos controles, p= 0,001. Conclusão PCE apresentaram uma maior carga de sintomas de TDAH, depressão e ansiedade quando comparados aos controles, o que replica na população brasileira os achados da literatura atual, que apontam para uma maior prevalência de tais transtornos entre PCE.

Effect of levetiracetam on ocular perfusion measure with optical coherence tomography angiography / Efeito do levetiracetam na medição da pressão de perfusão ocular com angiotomografia de coerência óptica

ABSTRACT Purpose: To evaluate using optical coherence tomography angiography the macular and optic nerve head blood flow in pediatric patients with epilepsy treated with levetiracetam for at least 12 months. Methods: This study included 33 pediatric patients with epilepsy and 30 sex- and age-matched healthy volunteer children were included in the study. Optical coherence tomography angiography was used to evaluate the optic nerve head and macular perfusion changes. The mean ocular perfusion pressures were also calculated. Patients who were using multiple antiepileptic drugs or had a prior history of using different drugs were excluded. Results: The choriocapillaris flow area was significantly lower in the Study Group than in the Control Group (p=0.006). However, the foveal avascular zone and vessel densities of the macula in the superficial capillary plexus, deep capillary plexus, and optic nerve head of the study group were not significantly different from those of the control group (p>0.05). Moreover, no significant difference in means of mean ocular perfusion pressure was found between the two groups (p=0.211). No obvious correlation was found between treatment duration and optical coherence tomography angiography parameters or mean ocular perfusion pressure. Conclusion: Choroidal perfusion was reduced in children taking levetiracetam compared with that in the control group, whereas retinal perfusion was not affected in this optical coherence tomography angiography study.

RESUMO Objetivo: Avaliar através de angiotomografia de coerência óptica o fluxo sanguíneo macular e da cabeça do nervo óptico em pacientes pediátricos com epilepsia tratados com levetiracetam por pelo menos 12 meses. Método: Trinta e três pacientes pediátricos com epilepsia e 30 crianças voluntárias saudáveis pareadas por sexo e idade foram incluídos no estudo. A angiotomografia de coerência óptica foi utilizada para avaliar as alterações da perfusão da cabeça do nervo óptico e da macular. As médias das pressões de perfusão ocular também foram calculadas. Pacientes em uso de múltiplas drogas antiepilépticas ou com história prévia de uso de diferentes drogas foram excluídos do estudo. Resultado: A área do fluxo coriocapilar foi significativamente menor no Grupo Estudo do que no Grupo Controle (p=0,006). Entretanto, a zona avascular foveal e as densidades vasculares no plexo capilar superficial e profundo da região macular e na cabeça do nervo óptico não foram significativamente diferentes daquelas de olhos saudáveis (p>0,05). Também não houve diferença significativa entre os dois grupos em relação às médias da pressão de perfusão ocular (p=0,211). Nenhuma correlação aparente foi encontrada entre a duração do tratamento e os parâmetros da angiotomografia de coerência óptica ou a média da pressão de perfusão ocular. Conclusão: Em crianças usando levetiracetam, a perfusão coroidal mostrou-se reduzida em comparação ao grupo controle, enquanto a perfusão retiniana não foi afetada neste estudo com angiotomografia de coerência óptica.

Epilepsia y desigualdad: descripción demográfica y análisis de la dificultad para el acceso a recursos avanzados en una población de un área de salud pequeña / Epilepsy and inequality: demographic description and analysis of the difficulty in accessing advanced resources in a population in a small health area

Introducción: La epilepsia es una enfermedad neurológica muy frecuente que implica una elevada morbimortalidad. La epilepsia farmacorresistente (EFR) supone un desafío terapéutico superior, incluso para expertos en la materia. A pesar de ello, el acceso a recursos avanzados para este tipo de pacientes continúa siendo dificultoso y desigual. El objetivo de este estudio es analizar la desigualdad en una población perteneciente a un hospital de primer nivel. Pacientes y métodos Se llevó a cabo un estudio transversal observacional analítico con pacientes epilépticos que acuden a consultas de neurología del área IX del Servicio Murciano de Salud. Se describen variables demográficas, clínicas, terapéuticas, pronósticas y de equidad, y se analizan diferencias significativas entre distintos subgrupos. Resultados En el estudio se incluyó a 68 pacientes con una media de edad de 42,93 años. El tipo de epilepsia principal fue la focal (64,7%), y los fármacos más usados fueron el levetiracetam (33,8%), el ácido valproico (27,9%) y la lamotrigina (22,1%). La EFR se dio en 18 pacientes (el 26,5% del total) y sólo cuatro se encontraban en seguimiento activo en una unidad de epilepsia, lo que implica que el 71% no accedía a un recurso necesario (advanced therapeutic gap). Conclusiones Este estudio demuestra que la desigualdad en la epilepsia continúa siendo un problema, especialmente en ciertas áreas geográficas, con una falta de acceso a atención avanzada en pacientes que más lo necesitan. La solución puede conseguirse aumentando recursos humanos y materiales que mejoren la atención global del paciente, reforzando así tanto los hospitales de referencia como las unidades de epilepsia. (AU)

INTRODUCTION: Epilepsy is a very common neurological disease with high morbidity and mortality. Drug-resistant epilepsy (DRE) poses a major therapeutic challenge, even for experts in the field. Despite this, access to advanced resources for this type of patient remains difficult and unequal. The aim of this study is to analyse inequality in a population belonging to a first level hospital. PATIENTS AND METHODS An analytical observational cross-sectional study was conducted on epileptic patients attending neurology consultations in Area IX of the Murcian Health Service. Demographic, clinical, therapeutic, prognostic and equity variables are described, and significant differences between different subgroups are analysed. RESULTS The study included 68 patients with a mean age of 42.93 years. Focal epilepsy was the main type (64.7%), and the most commonly used drugs were levetiracetam (33.8%), valproic acid (27.9%) and lamotrigine (22.1%). DRE occurred in 18 patients (26.5% of the total) and only four were under active follow-up in an epilepsy unit, meaning that 71% did not have access to a necessary resource (advanced therapeutic gap). CONCLUSIONS This study demonstrates that epilepsy inequality continues to be a problem, especially in certain geographical areas, with a lack of access to advanced care for patients who need it most. The solution can be achieved by increasing human and material resources to improve overall patient care, thus strengthening both referral hospitals and epilepsy units. (AU)

EPICAP: intervención educativa mediante cápsulas audiovisuales en pacientes con epilepsia. Ensayo clínico aleatorizado / EPICAP: educational intervention using instructional clips in patients with epilepsy. A randomised clinical trial

Objetivos La educación sanitaria en pacientes con epilepsia influye positivamente en el autocontrol de la enfermedad, mejora su pronóstico y favorece el bienestar del paciente. El objetivo de este estudio fue evaluar una intervención educativa mediante cápsulas audiovisuales en pacientes con epilepsia en una unidad de monitorización videoelectroencefalográfica.Sujetos y métodosEs un ensayo clínico aleatorizado con dos grupos (intervención y control). Se reclutó a pacientes adultos con epilepsia que ingresaron en la unidad de monitorización videoelectroencefalográfica. Se crearon nueve vídeos sobre el diagnóstico y el tratamiento de la epilepsia, y recomendaciones de estilo de vida, que se administraron al grupo de intervención durante el ingreso. Se evaluó el conocimiento del paciente sobre su enfermedad con un cuestionario diseñado específicamente para este estudio. Se realizó una evaluación previa en el inicio del estudio, en el alta hospitalaria y a los tres meses, y se comparó el conocimiento sobre la epilepsia en ambos grupos en cada momento del estudio.ResultadosSe incluyó a 66 pacientes, con edad media de 39 ± 14,7 años (rango: 17-76) y una mediana de 8 años de evolución de la enfermedad (rango: 1-60 años). Un 53% eran mujeres. El tipo de epilepsia más frecuente fue el focal (95,5%). La puntuación media en el test preintervención fue de 57,2 ± 15,3. Los pacientes que recibieron la intervención educativa mostraron mejores puntuaciones en el postest en el alta hospitalaria (81,8 ± 11,2 frente a 62,8 ± 13,7; p = 0,001) y a los tres meses (76 ± 9,6 frente a 63,2 ± 12,8; p = 0,001).ConclusionesLa intervención educativa EPICAP mediante píldoras audiovisuales mejora de forma significativa el conocimiento de los pacientes sobre aspectos diagnósticos, terapéuticos y estilo de vida relacionados con la epilepsia. (AU)

AIMS. In patients with epilepsy health education has a positive influence on self-management of the disease, improves prognosis and enhances patient well-being. The aim of this study was to evaluate an educational intervention using instructional clips in patients with epilepsy in a video-electroencephalographic monitoring unit.SUBJECTS AND METHODSWe conducted a randomised clinical trial with two groups (intervention and control). Adult patients with epilepsy admitted to the video-electroencephalographic monitoring unit were recruited. Nine videos about the diagnosis and treatment of epilepsy, together with recommendations on lifestyle, were produced and administered to the intervention group while admitted. Patients’ knowledge of their disease was assessed by means of a questionnaire designed specifically for this study. A pre-assessment was conducted at the beginning of the study, at hospital discharge and at three months, and the knowledge of epilepsy in the two groups was compared at each time considered in the study.RESULTSSixty-six patients were included, with a mean age of 39 ± 14.7 years (range: 17-76) and a median of 8 years since disease onset (range: 1-60 years). Fifty-three per cent of the patients were women. Focal epilepsy was the most frequent type (95.5%). The mean score on the pre-intervention test was 57.2 ± 15.3. Patients who received the educational intervention showed better post-test scores at discharge from hospital (81.8 ± 11.2 versus 62.8 ± 13.7; p = 0.001) and at three months (76 ± 9.6 versus 63.2 ± 12.8; p = 0.001).CONCLUSIONSThe EPICAP educational intervention using instructional clips significantly improves patients’ knowledge of epilepsy-related diagnostic, therapeutic and lifestyle issues. (AU)

Implicaciones de iniciar fármacos antiepilépticos previo a la realización de EEG en primeras crisis epilépticas / Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures

Introducción: Determinar si la administración de fármacos antiepilépticos (FAE) puede alterar la probabilidad de encontrar anomalías epileptiformes en EEG realizados de forma precoz tras una primera crisis epiléptica (CE). Método: Estudio observacional retrospectivo en el que se incluyó a los pacientes atendidos en urgencias de nuestro centro por una primera CE entre julio del 2014 y noviembre del 2019. Se recogieron los datos clínicos, las características técnicas de adquisición e interpretación de los EEG efectuados durante las primeras 72 h tras la CE y los factores relacionados con la recurrencia. Resultados: Se recogieron 155 pacientes; edad media 48,6 ±22,5 años; 61,3% hombres. El 51% presentó crisis tónico-clónicas de inicio desconocido y el 12% focales con progresión a tónico-clónica bilateral. El 25,2% (39/155) recibió tratamiento con FAE antes de la realización del EEG; en 33 pacientes se administró un FAE no benzodiacepínico y en 6 una benzodiacepina. Se observaron anomalías epileptiformes en 29,7% de los pacientes. La administración previa de FAE no se asoció de forma significativa ni con la probabilidad de detectar anomalías epileptiformes (p = 0,25) ni con el riesgo de recurrencia a los 6 meses (p = 0,63). Conclusiones: La administración de un FAE previo a la realización del EEG precoz tras una primera CE no disminuye la probabilidad de detectar anomalías epileptiformes. Estos hallazgos sugieren que iniciar un FAE de forma inmediata en aquellos pacientes con alto riesgo de recurrencia precoz no implica un menor rendimiento diagnóstico de dicha prueba.(AU)

Introduction: This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. Method: We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. Results: We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63). Conclusions: Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.(AU)

Adaptación lingüística y cultural de la escala de trastorno de ansiedad generalizado para pacientes con epilepsias en el contexto cubano

Fundamento: la escala de trastorno de ansiedad generalizado es útil para evaluar esta afección psiquiátrica en pacientes con epilepsias; sin embargo, no ha sido adaptada ni lingüística ni culturalmente para pacientes con esta enfermedad en el contexto cubano. Objetivo adaptar lingüística y culturalmente la escala de trastorno de ansiedad generalizado para pacientes con epilepsias en el contexto cubano. Métodos trabajo de desarrollo tecnológico I+D+i, realizado en tres etapas: adaptación lingüística y cultural, evaluación por criterios de expertos en el tema y pilotaje en pacientes con epilepsias. Se combinaron técnicas cualitativas y cuantitativas: consulta a lingüistas y expertos, pilotaje, debriefing, alfa de Cronbach (α) y análisis de eliminación de los ítems. Resultados los lingüistas propusieron cambios semánticos mínimos a dos ítems de la escala. El debriefing arrojó que la escala puede administrarse en menos de cinco minutos, con ítems adecuados e inofensivos. El α = 0,83 del pilotaje evidenció buena fiabilidad del test. No fue necesario eliminar ningún ítem de la escala y las correlaciones ítem total se mantuvieron por encima del nivel mínimo (>0,300). Conclusiones: la adaptación semántica y cultural de la escala al español, como se habla en Cuba, preserva equivalencia con la versión original. Se recomienda comprobar la fiabilidad y validez de la escala GAD-7 en una muestra representativa de pacientes con epilepsias en el contexto cubano.

Foundation: the generalized anxiety disorder scale is useful to evaluate this psychiatric condition in patients with epilepsy; however, it has not been adapted linguistically or culturally for patients with this disease in the Cuban context. Objective: linguistically and culturally adapt the generalized anxiety disorder scale for patients with epilepsy in the Cuban context. Methods: I+D+i technological development work, carried out in three stages: linguistic and cultural adaptation, evaluation by criteria of experts on the subject and trial in patients with epilepsy. Qualitative and quantitative techniques were combined: consultation with linguists and experts, trial, debriefing, Cronbach's alpha (α) and item elimination analysis. Results: the linguists proposed minimal semantic changes to two items of the scale. The debriefing showed that the scale can be administered in less than five minutes, with appropriate and harmless items. The α = 0.83 of the trial showed good reliability of the test. It was not necessary to eliminate any items from the scale and the item-total correlations remained above the minimum level (>0.300). Conclusions: the semantic and cultural adaptation of the scale to Spanish, as spoken in Cuba, preserves equivalence with the original version. It is recommended to verify the reliability and validity of the GAD-7 scale in a representative of patients with epilepsy in the Cuban context.

Exploring the rt and zxperiences of painters with epilepsy / Explorando a arte e as experiências de pintores com epilepsia

This narrative review addresses the world of artists who linked their creative journeys alongside their battles with epilepsy, a neurological condition engineered by recurrent epileptic seizures, with multifaceted implications in biopsychosocial domains. By examining the lives and works of celebrated artists such as Vincent Van Gogh and contemporary painters, particularly those possibly affected by epilepsy, a narrative transcends clinical elucidations, investigating historical contexts, artistic expressions, and therapeutic interventions. The focus is on uncovering the transformative influence of engaging in artistic activities for individuals struggling with epilepsy. It investigates the profound impact of artistic pursuits on people affected by epilepsy, showing the resilience of the human spirit in harnessing adversity as a source of creativity. This exploration illuminates the potential of art, not only as a means of self-expression, but also as a therapeutic medium in the setting of epilepsy and associated neurorehabilitation.

Esta revisão narrativa aborda o mundo dos artistas que associaram as suas jornadas criativas paralelamente às suas batalhas contra a epilepsia, uma condição neurológica caracterizada por ataques epilépticos recorrentes, com implicações multifacetadas em domínios biopsicossociais. Ao examinar as vidas e obras de artistas célebres como Vincent Van Gogh e pintores contemporâneos, particularmente aqueles possivelmente afetados pela epilepsia, a narrativa transcende as elucidações clínicas, investigando contextos históricos, expressão artística e intervenções terapêuticas. O foco está em desvendar a influência transformadora do envolvimento em atividades artísticas para indivíduos que lutam contra a epilepsia. Ele investiga o profundo impacto das atividades artísticas nas pessoas afetadas pela epilepsia, mostrando a resiliência do espírito humano ao aproveitar a adversidade como uma fonte de criatividade. Esta exploração ilumina o potencial da arte, não apenas como meio de autoexpressão, mas também como meio terapêutico no cenário da epilepsia e da neurorreabilitação associada.

Epilepsy in art: a historical exploration of representations across eras / Epilepsia na arte: uma exploração histórica de representações através de épocas

This narrative review explores the diverse representations of epilepsy in art across different historical periods, examining the intersection of artistic expression with evolving cultural, medical, and societal perceptions. Beginning with ancient and medieval depictions intertwined with religious symbolism, the paper progresses through the Renaissance, and Baroque, and transitions into modern and avant-garde movements. Each period reflects changing attitudes towards epilepsy, from divine interpretations, and religious concerns to anatomical realism and, later, explorations of psychological themes. The contemporary lens focuses on inclusive and empathetic portrayals, utilizing digital media to challenge stigmas and foster understanding.

Esta revisão narrativa explora as diversas representações da epilepsia na arte em diferentes períodos históricos, examinando a intersecção da expressão artística com a evolução das percepções culturais, médicas e sociais. Começando com representações antigas e medievais entrelaçadas com simbolismo religioso, o artigo avança através da Renascença e do Barroco, e transita para movimentos modernos e de vanguarda. Cada período reflete mudanças de atitudes em relação à epilepsia, desde interpretações divinas e preocupações religiosas até o realismo anatômico e, mais tarde, explorações de temas psicológicos. A lente contemporânea centra-se em representações inclusivas e empáticas, utilizando meios digitais para desafiar estigmas e promover a compreensão.