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1.
Artigo em Russo | MEDLINE | ID: mdl-33834729

RESUMO

A clinical case of a genetically confirmed diagnosis of alternating hemiplegia associated with epilepsy is presented. The combination of two types of seizures in a child made it difficult to make a diagnosis. The result of video-EEG monitoring made it possible to understand that a child showed both epileptic seizures and non-epileptic seizures simultaneously with different periodicities. The mutation in the ATP1A3 gene was verified with genome-wide sequencing and targeted therapy was prescribed in a timely manner. As a result, both types of seizures stopped after treatment.


Assuntos
Epilepsia , ATPase Trocadora de Sódio-Potássio , Criança , Eletroencefalografia , Epilepsia/complicações , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Hemiplegia/complicações , Hemiplegia/diagnóstico , Hemiplegia/genética , Humanos , Convulsões , ATPase Trocadora de Sódio-Potássio/genética , ATPase Trocadora de Sódio-Potássio/metabolismo
2.
Arq Neuropsiquiatr ; 79(2): 133-138, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33759980

RESUMO

INTRODUCTION: People with epilepsy frequently complain of poor memory. OBJECTIVE: To assess the occurrence of memory complaints in older adults with epilepsy (OAE) and whether it is associated with clinical variables, objective cognitive performance, and quality of life (QoL). METHODS: The Memory Complaint Questionnaire (MAC-Q) was related to objective cognitive performance, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Quality of Life in Epilepsy Inventory (QOLIE-31), and the clinical characteristics of 83 OAE. RESULTS: OAE showed worse cognitive performance and higher MAC-Q scores when compared to a similar control group (n=40). Impairment in multiple cognitive domains occurred in 34 (41%) OAE and was associated with older age and lower educational level. Memory complaints (MAC-Q≥25) were reported by 45 (54.2%) OAE and associated with older age, lower educational level, onset at ≥60 years, higher NDDI-E scores, lower QOLIE-31 scores, and impairment in multiple cognitive domains. CONCLUSIONS: OAE presented worse cognitive performance and greater memory complaints. Episode onset at ≥60 years of age was associated with complaints, but not with objective cognitive deficit. We found an association between subjective and objective cognitive performance, with aspects of epilepsy and worse QoL scores.


Assuntos
Disfunção Cognitiva , Epilepsia , Idoso , Disfunção Cognitiva/etiologia , Epilepsia/complicações , Humanos , Memória , Transtornos da Memória/etiologia , Testes Neuropsicológicos , Qualidade de Vida
3.
Epilepsy Behav ; 117: 107849, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33631434

RESUMO

BACKGROUND: This study aimed to determine the relationship among the clinical, logistic, and psychological impacts of COVID-19 on people with epilepsy (PWE), and the impact of COVID-19 on the quality of life. METHOD: This is a cross-sectional anonymized web-based study on PWE, using an online questionnaire to assess the clinical, logistic, and psychological impacts of COVID-19, including Hospital Anxiety Depression Scale (HADS) and Quality of Life in Epilepsy Inventory (QOLIE-31). RESULT: 461 patients were recruited, with a mean age of 39.21 ±â€¯15.88 years, majority female (50.1%), with focal epilepsy (54.0%), and experienced seizures at least once yearly (62.5%). There were 13.0% experienced seizure worsening during COVID-19 period, which were associated with baseline seizures frequency ≥ 1 per month (32.0% vs. 6.2%, p < 0.001), worries of seizure worsening (18.0% vs. 10.9%, p < 0.001), difficulty to go emergency unit (24.4% vs. 10.4%, p < 0.001), AEDs ran out of stock (23.2% vs. 11.6%, p < 0.05), self-adjustment of AED dosages (26.4% vs. 11.3%, p < 0.001), inadequate sleep (22.4% vs. 9.2%, p < 0.001), and stress (23.4% vs.10.1%, p < 0.01). Participants experiencing seizure worsening reported greater anxiety (8.10 ±â€¯5.011 vs. 4.84 ±â€¯3.989, p < 0.001) and depression (6.05 ±â€¯3.868 vs. 3.86 ±â€¯3.589, p < 0.001). Logistic regression showed baseline seizures frequency >1 per month (OR, 14.10) followed by anxiety (OR, 3.90), inadequate sleep (OR, 0.37), and treated in UMMC (OR, 0.31) as the predictors for seizure worsening during COVID-19 period. Poorer total QOLIE-31 score was noted in those with seizure worsening (48.01 ±â€¯13.040 vs. 62.15 ±â€¯15.222, p < 0.001). Stepwise regression highlighted depression as the main negative predictor for quality of life (ß = -0.372, p < 0.001), followed by anxiety (ß = -0.345, p < 0.001). CONCLUSION: A significant number of PWE experienced seizure worsening during COVID-19 period, which was related to the clinical, logistic, and psychological factors. Quality of life was affected by the seizure worsening and the psychological stress.


Assuntos
Epilepsia , Adulto , Estudos Transversais , Epilepsia/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
5.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504534

RESUMO

A 47-year-old woman with history of seizure disorder (semiology of seizure unknown), not well controlled with antiepileptic drugs since last 30 years presented with 1-year history of intermittent throbbing headache. On the day prior to admission, she experienced worst headache, followed by loss of consciousness. On regaining consciousness, she had neck pain without any focal neurological deficit, but examination was marked by positive meningeal signs. She had history of oral ulceration, photosensitivity and small joints pain for which no medical consultancy was sought until. Following relevant investigations, this case came out to be moyamoya angiopathy secondary to underlying systemic lupus erythematosus. She was put on immunosuppressive and immunomodulator as per recommendations. Among neurological symptoms, headache improved dramatically without any further seizure recurrence till the 6 months of follow-up.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico , Doença de Moyamoya/diagnóstico por imagem , Albuminúria , Angiografia Digital , Anticorpos Antinucleares/imunologia , Anticonvulsivantes/uso terapêutico , Antirreumáticos/uso terapêutico , Angiografia Cerebral , Hemorragia Cerebral/etiologia , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Doença de Moyamoya/complicações , Tomografia Computadorizada por Raios X
6.
Arq Neuropsiquiatr ; 78(12): 772-777, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33331513

RESUMO

INTRODUCTION: We aimed to identify sleep disorders in patients with epilepsy and compare this group with a healthy population. We also analyzed the features of sleep disorders in patients with epilepsy to demonstrate the effect of seizures and seizure types on sleep. METHODS: Our study assessed 43 patients with epilepsy and 53 age- and gender-matched healthy controls. The demographic and clinical data of all participants were recorded. The Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI), International Restless Legs Syndrome Study Group Rating Scale, Berlin Questionnaire, and Beck Depression Inventory (BDI) were administered to all study subjects. The interview used to evaluate insomnia is based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition - DSM-5 diagnostic criteria. RESULTS: Twenty-four patients (55.8%) and 26 controls (49.1%) are women. The mean age of patients and controls was 34.2±11.37 (16-71) and 34.6±11.28 (16-77), respectively. Patients with epilepsy had depression more often than controls, a result that was statistically significant (p<0.0001). We found no statistically significant difference between sleep parameters of patients and controls with normal BDI scores (p>0.05). Patients with depression had worse results on the Berlin Questionnaire and PSQI total score, with statistical significance (p=0.002). Nocturnal seizures, seizure type, and drug treatment had no effect on sleep (p>0.05). CONCLUSION: We concluded that depression rather than epilepsy negatively affects sleep, suggesting that all patients should be asked about their mood and sleep complaints.


Assuntos
Epilepsia , Transtornos do Sono-Vigília , Depressão/epidemiologia , Epilepsia/complicações , Feminino , Humanos , Escalas de Graduação Psiquiátrica , Sono , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários
8.
Arq. neuropsiquiatr ; 78(12): 772-777, Dec. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1142375

RESUMO

ABSTRACT Introduction: We aimed to identify sleep disorders in patients with epilepsy and compare this group with a healthy population. We also analyzed the features of sleep disorders in patients with epilepsy to demonstrate the effect of seizures and seizure types on sleep. Methods: Our study assessed 43 patients with epilepsy and 53 age- and gender-matched healthy controls. The demographic and clinical data of all participants were recorded. The Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI), International Restless Legs Syndrome Study Group Rating Scale, Berlin Questionnaire, and Beck Depression Inventory (BDI) were administered to all study subjects. The interview used to evaluate insomnia is based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition - DSM-5 diagnostic criteria. Results: Twenty-four patients (55.8%) and 26 controls (49.1%) are women. The mean age of patients and controls was 34.2±11.37 (16-71) and 34.6±11.28 (16-77), respectively. Patients with epilepsy had depression more often than controls, a result that was statistically significant (p<0.0001). We found no statistically significant difference between sleep parameters of patients and controls with normal BDI scores (p>0.05). Patients with depression had worse results on the Berlin Questionnaire and PSQI total score, with statistical significance (p=0.002). Nocturnal seizures, seizure type, and drug treatment had no effect on sleep (p>0.05). Conclusion: We concluded that depression rather than epilepsy negatively affects sleep, suggesting that all patients should be asked about their mood and sleep complaints.


RESUMO Introdução: O objetivo deste estudo foi identificar distúrbios do sono em pacientes com epilepsia e compará-los com uma população saudável. Também foram examinadas as características dos distúrbios do sono em pacientes com epilepsia para demonstrar o efeito e os tipos de convulsões no sono. Métodos: O estudo consistiu em 43 pacientes com epilepsia e 53 controles saudáveis ​​pareados por idade e sexo. Os dados demográficos e clínicos de todos os participantes foram registrados. Todos os participantes do estudo receberam a Escala de Sonolência de Epworth, o Índice de Qualidade do Sono de Pittsburgh (Pittsburch Sleep QUality Index - PSQI), o Questionário do Grupo Internacional de Estudos das Pernas Inquietas, o Questionário de Berlim e o Inventário de Depressão de Beck. A entrevista usada para avaliar a insônia é baseada nos critérios do DSM-V. Resultados: Vinte e quatro pacientes (55,8%) são do sexo feminino e vinte e seis do grupo controle (49,1%) são do sexo feminino. A média de idade dos pacientes e do grupo controle é de 34,2±11,37 (16-71) e 34,6±11,28 (16-77), respectivamente. Pacientes com epilepsia sofrem mais de depressão do que os controles e esse resultado é estatisticamente significativo (p<0,0001). Não houve diferença estatisticamente significativa entre os parâmetros do sono dos pacientes e dos controles que apresentaram escores de Beck normais (p>0,05). Pacientes com depressão apresentam resultados piores no escore total do PSQI de Berlim, o que é estatisticamente significativo (p=0,002). As convulsões noturnas, o tipo de convulsão e o tratamento medicamentoso não afetaram o sono (p>0,05). Conclusão: Determinamos que a depressão, e não a epilepsia, afeta negativamente o sono dos pacientes, sugerindo que todos os pacientes devem ser questionados sobre seu humor e queixas de sono.


Assuntos
Humanos , Feminino , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/epidemiologia , Epilepsia/complicações , Escalas de Graduação Psiquiátrica , Sono , Inquéritos e Questionários , Depressão/epidemiologia
9.
Wiad Lek ; 73(9 cz. 2): 2090-2094, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148866

RESUMO

OBJECTIVE: The aim: To draw attention to the need for careful analysis of patients with epilepsy in terms of the possibility of co-occurring arrhythmia. PATIENTS AND METHODS: Material and methods: Analysis of video-EEG registration in the inter-seizure period in a patient with diagnosed epilepsy. RESULTS: Case study: The authors present a 33-year-old patient with generalised epilepsy of unknown etiology diagnosed in childhood. In this subject, generalised seizure discharges without clinical manifestation of epileptic seizure and with concomitant cardiac arrhythmias in the form of atrial fibrillation were recorded during video-EEG registration. This was carried out during the patient's of hospitalisation at the neurology ward. CONCLUSION: Conclusions: The case study presented is as an example of existing complex and not fully understood interactions between epilepsy and arrhythmia. A mutation within the SCN1B encoding genes, which is responsible for channelopathy within the voltage-dependent Nav sodium channels, may be considered as a potential cause for this state. However, further analysis and research is needed that would eventually allow to find out the reason for these relationships.


Assuntos
Epilepsia Generalizada , Epilepsia , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Criança , Eletroencefalografia , Epilepsia/complicações , Epilepsia Generalizada/complicações , Humanos , Convulsões
10.
Reumatol. clín. (Barc.) ; 16(5,pt.1): 356-358, sept.-oct. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-195893

RESUMO

Case history of a small girl outlet with epilepsy, followed by scleroderma skin damage and uveitis, neurovasculitis with white matter foci in brain on the side of skin lesion in two months, immunologic disease activity. Resistance to conventional immunosuppressive therapy forced us to initiate the treatment with tocilizumab. It was well tolerated and led to significant improvement of brain, ocular and skin manifestations


Historia de la enfermedad de una niña con epilepsia, así como las lesiones cutáneas de la esclerodermia y la uveítis, la neurovasculitis con materia blanca se centra en el cerebro en el lado de la lesión de la piel en 2 meses, la actividad de las enfermedades inmunológicas. La resistencia a la terapia inmunosupresora tradicional nos hizo comenzar el tratamiento con tocilizumab. Fue bien tolerado y condujo a una mejoría significativa en las manifestaciones cerebrales, oculares y de la piel


Assuntos
Humanos , Feminino , Pré-Escolar , Esclerodermia Localizada/complicações , Esclerodermia Localizada/tratamento farmacológico , Epilepsia/complicações , Uveíte/complicações , Anticorpos Monoclonais Humanizados/uso terapêutico , Esclerodermia Localizada/diagnóstico , Eletroencefalografia , Doenças Autoimunes do Sistema Nervoso , Imagem por Ressonância Magnética
11.
PLoS One ; 15(9): e0239040, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915911

RESUMO

BACKGROUND: Individuals with Down syndrome are predisposed to a number of chronic health conditions, but the relationship between these conditions and cognitive ability is not clear. The primary objective of this systematic review is to assess this relationship by evaluating studies that measure cognitive performance in the context of Down syndrome-associated chronic health conditions. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies included in this review (1) included children, adolescent, and young adult participants with Down syndrome and one or more co-occurring health conditions; (2) were quantitative; and (3) reported outcomes related to both chronic health conditions and cognitive performance. A set of predetermined chronic health conditions that are common in Down syndrome (e.g. sleep disorders, congenital heart disease, thyroid disease, seizure disorders, and pulmonary hypertension) were selected based on prevalence rates in Down syndrome. RESULTS: Fifteen studies met inclusion criteria. The majority these of studies assessed cognitive performance in association with sleep disorders (47%) and congenital heart disease (47%). Fewer studies reported on the effect of thyroid disease (7%) and seizure disorders (7%) on cognitive ability. None of the studies reported cognitive outcomes related to pulmonary hypertension. Of the chronic health conditions evaluated, associations between sleep disorders and cognitive dysfunction were most common among individuals with Down syndrome. CONCLUSIONS: Individuals with Down syndrome exhibit deficits in cognitive ability, particularly related to attention, executive function and verbal processing. These deficits may be further exacerbated by the presence of chronic health conditions, particularly sleep disorders. Individuals with Down syndrome and co-occurring sleep disorders may benefit from early interventions to mitigate their risk for adverse cognitive outcomes.


Assuntos
Transtornos Cognitivos/complicações , Síndrome de Down/complicações , Síndrome de Down/psicologia , Adolescente , Doenças Cardiovasculares/complicações , Criança , Doença Crônica , Transtornos Cognitivos/psicologia , Epilepsia/complicações , Feminino , Humanos , Pneumopatias/complicações , Masculino , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/psicologia , Doenças da Glândula Tireoide/complicações , Adulto Jovem
12.
Ann Afr Med ; 19(3): 164-169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820727

RESUMO

Background: Quality of life (QOL) is a vital outcome measure in people living with epilepsy. The aim of this study is to determine the sociodemographic and clinical factors that predict poor QOL in patients with epilepsy. Materials and Methods: This is a descriptive cross-sectional study that was carried out at the outpatient psychiatric clinic of Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria, for 6 months. Seventy-four patients with epilepsy who met the inclusion criteria were recruited to participate in the study. The mental health of these patients and their QOL were assessed using the Mini-International Neuropsychiatric Interview and the short form of the World Health Organization QOL instrument, respectively. Data were analyzed using epi-info version 6.04d, and logistic regression analysis was performed to determine factors that predict poor QOL. Results: Psychiatric disorder was found in 33 (44.6%) of the respondents. The presence of these psychiatric disorders was predictive of poor score on the overall QOL (odds ratio [OR] = 0.382; 95% confidence interval [CI] = 0.145-0.983; P = 0.0046), physical (OR = 0.269; 95% CI = 0.100-1.722; P = 0.009), and psychological health domain (OR = 0.269; 95% CI = 0.102-0.709; P = 0.008). Longer duration of epilepsy was predictive of a poor score on the health satisfaction item (OR = 0.202; 95% CI = 0.06-0.679; P = 0.010) while being single was predictive of poor score on the social relationship domain (OR = 0.177; 95% CI = 0.065-0.482; P = 0.001). Conclusion: The presence of psychiatric disorder, long duration of epilepsy, and being single were predictive of poor QOL. The importance of social relation, prompt seizure control, and efficient collaboration between psychiatrist and other medical professionals in the care of patients with epilepsy cannot be overemphasized.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Epilepsia/complicações , Epilepsia/psicologia , Qualidade de Vida/psicologia , Adulto , Anticonvulsivantes/uso terapêutico , Ansiedade/psicologia , Estudos Transversais , Depressão/psicologia , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Escalas de Graduação Psiquiátrica , Convulsões/epidemiologia , Convulsões/psicologia , Inquéritos e Questionários , Organização Mundial da Saúde
13.
Epilepsy Behav ; 112: 107335, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32739397

RESUMO

BACKGROUND: Coronavirus Disease 2019 (COVID-19) has rapidly become a global pandemic, with over 1.8 million confirmed cases worldwide to date. Preliminary reports suggest that the disease may present in diverse ways, including with neurological symptoms, but few published reports in the literature describe seizures in patients with COVID-19. OBJECTIVE: The objective of the study was to characterize the risk factors, clinical features, and outcomes of seizures in patients with COVID-19. METHODS: This is a retrospective case series. Cases were identified through a review of admissions and consultations to the neurology and neurocritical care services between April 1, 2020 and May 15, 2020. SETTING: The study setting was in a tertiary care, safety-net hospital in Boston, MA. PARTICIPANTS: Patients presenting with seizures and COVID-19 during the study period were included in the study. RESULTS: Seven patients met inclusion criteria (5 females, 71%). Patients ranged in age from 37 to 88 years (median: 75 years). Three patients had a prior history of well-controlled epilepsy (43%), while 4 patients had new-onset seizures, including 2 patients with prior history of remote stroke. Three patients had no preceding symptoms of COVID-19 prior to presentation (57%), and in all cases, seizures were the symptom that prompted presentation to the emergency department, regardless of prior symptoms of COVID-19. CONCLUSIONS: Provoking factors for seizures in patients with COVID-19 may include metabolic factors, systemic illness, and possibly direct effects of the virus. In endemic areas with community spread of COVID-19, clinicians should be vigilant for the infection in patients who present with seizures, which may precede respiratory symptoms or prompt presentation to medical care. Early testing, isolation, and contact tracking of these patients can prevent further transmission of the virus.


Assuntos
Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Convulsões/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Betacoronavirus , Boston , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Convulsões/tratamento farmacológico , Convulsões/etiologia
14.
PLoS One ; 15(8): e0237064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32823271

RESUMO

A major source of epilepsy is Neurocysticercosis (NCC), caused by Taenia solium infection. Solitary cysticercus granuloma (SCG), a sub-group of NCC induced epilepsy, is the most common form of NCC in India. Current diagnostic criteria for SCG epilepsy require brain imaging which may not be available in communities where the disease is endemic. Identification of serum changes and potential biomolecules that could distinguish SCG epilepsy from idiopathic generalized epilepsy (IE), without the initial need for imaging, could assist in disease identification, understanding, and treatment. The objective here was to investigate, using mass spectrometry (MS), sera biomolecule differences between patients with SCG epilepsy or IE to help distinguish these disorders based on physiological differences, to understand underlying phenotypes and mechanisms, and to lay ground work for future therapeutic and biomarker analyses. Sera were obtained from patients with SCG or IE (N = 29 each group). Serum mass peak profiling was performed with electrospray ionization (ESI) MS, and mass peak area means in the two groups were compared using leave one [serum sample] out cross validation (LOOCV). Serum LOOCV analysis identified significant differences between SCG and IE patient groups (p = 10-20), which became non-significant (p = 0.074) when the samples were randomly allocated to the groups and reanalyzed. Tandem MS/MS peptide analysis of serum mass peaks from SCG or IE patients was performed to help identify potential peptide/protein biochemical and phenotypic changes involving these two forms of epilepsy. Bioinformatic analysis of these peptide/protein changes suggested neurological, inflammatory, seizure, blood brain barrier, cognition, ion channel, cell death, and behavior related biochemical systems were being altered in these disease states. This study provides groundwork for aiding in distinguishing SCG and IE patients in minimally invasive, lower-cost manners, for improving understanding of underlying epilepsy mechanisms, and for further identifying discriminatory biomarkers and potential therapeutic targets.


Assuntos
Epilepsia Generalizada/diagnóstico , Neurocisticercose/diagnóstico , Adulto , Animais , Biomarcadores/sangue , Cysticercus/patogenicidade , Diagnóstico Diferencial , Epilepsia/complicações , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Epilepsia Generalizada/tratamento farmacológico , Epilepsia Generalizada/metabolismo , Feminino , Granuloma/tratamento farmacológico , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Neurocisticercose/tratamento farmacológico , Neurocisticercose/metabolismo , Convulsões/tratamento farmacológico , Espectrometria de Massas por Ionização por Electrospray/métodos , Espectrometria de Massas em Tandem/métodos
15.
Epileptic Disord ; 22(4): 439-442, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32759092

RESUMO

The COVID-19 pandemic shook European healthcare systems, with unavoidable gaps in the management of patients with chronic diseases. We describe the impact of the pandemic on epilepsy care in three tertiary epilepsy centres from Spain and Italy, the most affected European countries. The three epilepsy centres, members of the European EpiCARE network, manage more than 5,700 people with epilepsy. In Bologna and Barcelona, the hospitals housing the epilepsy centres were fully converted into COVID-19 units. We describe the reorganization of the clinics and report on the frequency of SARS-CoV-2 in people with epilepsy as well as the frequency of seizures in patients admitted to the COVID units. Finally, we elaborate on critical issues regarding the second phase of the pandemic. The activities related to epilepsy care were reduced to less than 10% and were deprioritized. Discharges were expedited and elective epilepsy surgeries, including vagal nerve stimulator implantations, cancelled. Hospitalizations and EEG examinations were limited to emergencies. The outpatient visits for new patients were postponed, and follow-up visits mostly managed by telehealth. Antiseizure medication weaning plans and changes in vagal nerve stimulator settings were halted. Among the 5,700 people with epilepsy managed in our centres, only 14 tested positive for SARS-CoV-2, without obvious impact on their epilepsy. None of the 2,122 patients admitted to COVID units experienced seizures among the early symptoms. Epilepsy care was negatively impacted by the pandemic, irrespective of COVID-19 epidemiology or conversion of the hospital into a COVID-19 centre. The pandemic did not silence the needs of people with epilepsy, and this must be considered in the planning of the second phase.


Assuntos
Infecções por Coronavirus , Epilepsia/terapia , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Eletroencefalografia/estatística & dados numéricos , Epilepsia/complicações , Epilepsia/cirurgia , Europa (Continente) , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Itália , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/complicações , Convulsões/epidemiologia , Convulsões/etiologia , Espanha , Telemedicina
17.
Neurology ; 95(12): e1686-e1693, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32680951

RESUMO

OBJECTIVE: To determine the association of epilepsy with incident dementia by conducting a nationwide, retrospective data-linkage, cohort study to examine whether the association varies according to dementia subtypes and to investigate whether risk factors modify the association. METHODS: We used linked health data from hospitalization, mortality records, and primary care consultations to follow up 563,151 Welsh residents from their 60th birthday to estimate dementia rate and associated risk factors. Dementia, epilepsy, and covariates (medication, smoking, comorbid conditions) were classified with the use of previously validated code lists. We studied rate of dementia and dementia subtypes in people with epilepsy (PWE) and without epilepsy using (stratified) Kaplan-Meier plots and flexible parametric survival models. RESULTS: PWE had a 2.5 (95% confidence interval [CI] 2.3-2.6) times higher hazard of incident dementia, a 1.6 (95% CI 1.4-1.8) times higher hazard of incident Alzheimer disease (AD), and a 3.1 (95% CI 2.8-3.4) times higher hazard of incident Vascular dementia (VaD). A history of stroke modified the increased incidence in PWE. PWE who were first diagnosed at ≤25 years of age had a dementia rate similar to that of those diagnosed later in life. PWE who had ever been prescribed sodium valproate compared to those who had not were at higher risk of dementia (hazard ratio [HR] 1.6, 99% CI 1.4-1.9) and VaD (HR 1.7, 99% CI 1.4-2.1) but not AD (HR 1.2, 99% CI 0.9-1.5). CONCLUSION: PWE compared to those without epilepsy have an increased dementia risk.


Assuntos
Demência/epidemiologia , Epilepsia/complicações , Distribuição por Idade , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , País de Gales/epidemiologia
18.
Epilepsia ; 61(7): 1341-1351, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32544279

RESUMO

Seizures are a well-recognized and often prominent manifestation of autoimmune encephalitic syndromes. Progress in detection of pathogenic neural autoantibodies has led to increased awareness of autoimmune causes of seizures. Clinical studies of patients with these autoantibodies have improved our understanding of the seizure characteristics, treatments, and seizure prognosis in these disorders. The International League Against Epilepsy (ILAE) Autoimmunity and Inflammation Taskforce proposes conceptual definitions for two main diagnostic entities: (a) acute symptomatic seizures secondary to autoimmune encephalitis, and (b) autoimmune-associated epilepsy, the latter of which suggests an enduring predisposition to seizures. Such a distinction is relevant when discussing the pathophysiology, treatment, prognosis, and social consequences of these disorders. We discuss the role of biomarkers in the application of these conceptual definitions and illustrate their use in patients cared for by members of the task force.


Assuntos
Encefalite/sangue , Encefalite/diagnóstico , Epilepsia/sangue , Epilepsia/diagnóstico , Doença de Hashimoto/sangue , Doença de Hashimoto/diagnóstico , Convulsões/sangue , Convulsões/diagnóstico , Doença Aguda , Adolescente , Adulto , Autoanticorpos/sangue , Biomarcadores/sangue , Encefalite/complicações , Epilepsia/complicações , Feminino , Doença de Hashimoto/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/etiologia , Adulto Jovem
19.
PLoS One ; 15(6): e0234095, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530968

RESUMO

BACKGROUND: Patients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda. METHOD: PHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of ≥15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden's index was considered for cut-offs. RESULTS: Four hundred and thirty-four PwE, mean age 30.5 years (SD ±13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63-0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68-0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (≥5) for mild and moderate depression and ≥7 for severe depression. CONCLUSION: PHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of ≥5 for mild or moderate and ≥7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment.


Assuntos
Depressão/diagnóstico , Epilepsia/patologia , Questionário de Saúde do Paciente , Adolescente , Adulto , Área Sob a Curva , Depressão/etiologia , Epilepsia/complicações , Feminino , Humanos , Masculino , Psicometria/métodos , Curva ROC , Reprodutibilidade dos Testes , Ruanda , Índice de Gravidade de Doença , Tradução , Adulto Jovem
20.
Seizure ; 80: 53-55, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32540636
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