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2.
Medicina (B Aires) ; 79 Suppl 3: 20-24, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603838

RESUMO

Neurometabolic diseases that manifest seizures and epilepsy are a large group of inherited disorders. They can present at any age from the neonatal period to adolescence. The epileptic manifestations can be very varied and, in general, they are epilepsies refractory to antiepileptic drugs. Epileptic phenomenology does not contribute to the diagnosis. The inborn errors of metabolism that respond to the use of cofactors should be known. In acute decompensation, it is essential to provide nutritional, hydroelectrolytic and respiratory support. It is possible that in a few years we can detect the metabolomic profile of these diseases, thus knowing better the diagnosis non-invasively and offering greater therapeutic possibilities for their epilepsy and especially for the underlying disease. We must not forget the transitory metabolic disorders and the electrolyte imbalances within the causes of seizures, especially in the neonatal period, and must be identified and treated early to avoid major damages.


Assuntos
Epilepsia/etiologia , Doenças Metabólicas/complicações , Eletroencefalografia , Epilepsia/diagnóstico , Epilepsia/terapia , Humanos , Recém-Nascido , Convulsões/classificação , Convulsões/etiologia , Convulsões/terapia
3.
Nurs Clin North Am ; 54(3): 425-435, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31331628

RESUMO

Epilepsy is a complex neurologic disease that requires both medical management and self-management. People with epilepsy and their families complete many transitions throughout the health care system in managing this disease. This article reviews key transitions for people with epilepsy and discusses strategies for improving these transitions.


Assuntos
Continuidade da Assistência ao Paciente/normas , Cuidados Críticos/normas , Serviços Médicos de Emergência/normas , Epilepsia/terapia , Alta do Paciente/normas , Enfermagem em Reabilitação/normas , Cuidado Transicional/normas , Humanos , Guias de Prática Clínica como Assunto
5.
Artigo em Russo | MEDLINE | ID: mdl-31317885

RESUMO

AIM: To evaluate the effect of modified therapy on the course of epilepsy in patients with the low cerebral-spinal-fluid-cranial (CSF-cranial) index. MATERIAL AND METHODS: One hundred and twenty-four patients with cryptogenic epilepsy were prospectively analyzed. Group I consisted of 36 patients with a normal volume of reserve cerebrospinal fluid and a level of the CSF-cranial index within the physiological norm (from 1.2 to 3.6), who received standard therapy. Group II consisted of 42 patients with a small volume of reserve cerebrospinal fluid spaces and a CSF-cranial index lower than the physiological norm (from 0.8 to 1.2), who received standard therapy. Group III (n=46) was characterized by a small volume of reserve cerebrospinal spaces and a CSF-cranial index lower than the physiological norm. Patients of this group received modified therapy. RESULTS AND CONCLUSION: Normalization of the level of intracranial pressure in patients with a low cerebrovascular index reduced the frequency of epileptic seizures. After one year follow-up, the proportion of patients with very frequent seizures decreased by 25.3%, with frequent seizures by 23.9%, after 2 years by another 33.1 and 15.7%, respectively. A correlation was found between the frequency of seizures and the level of intracranial pressure (G=0.24, p=0.043).


Assuntos
Epilepsia , Pressão Intracraniana , Líquido Cefalorraquidiano , Epilepsia/terapia , Humanos , Convulsões
6.
Int J Evid Based Healthc ; 17 Suppl 1: S6-S8, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283568

RESUMO

The current article provides an overview of an approach to incorporating a range of evidence, including qualitative research findings, which the authors piloted when developing a clinical guideline on epilepsies in children and young people. We describe methods used for incorporating literature types not usually included in Scottish Intercollegiate Guidelines Network guidelines, including critical appraisal, and establishing dependability and credibility of qualitative findings. We highlight limitations encountered and make suggestions for future work.


Assuntos
Medicina Baseada em Evidências/normas , Guias como Assunto/normas , Adolescente , Criança , Pré-Escolar , Epilepsia/terapia , Medicina Baseada em Evidências/métodos , Humanos , Pesquisa Qualitativa , Escócia
7.
Pan Afr Med J ; 33: 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303955

RESUMO

Epilepsy in Sudan accounts for 1.6 annual mortality rates and 238.7 disability adjusted life years per 100 000. These figures are higher among females; children and young adults. It is associated with notable stigma and social burdens. Patients of epilepsy are subjected to various forms of social discrimination that affect their quality of life. They are isolated, neglected and deprived of their education and employments rights and not able to achieve normal social and family life. Aiming at highlighting social implications of epilepsy among Sudanese patients, this study found that social encumbrances due to epilepsy in Sudan are more prevalent among highly vulnerable groups like women, children and poor populations living in remote areas. Lack of trained medical personnel in neurology and the medical equipment's required for proper diagnosis and treatment of epilepsy in Sudan are key reasons aggravating social and health burden of epilepsy both among patients and their caregivers.


Assuntos
Epilepsia/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Qualidade de Vida , Serviços Urbanos de Saúde/normas , Criança , Epilepsia/economia , Epilepsia/epidemiologia , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pobreza , Discriminação Social , Sudão/epidemiologia , Serviços Urbanos de Saúde/economia , População Urbana/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
8.
Med. clín (Ed. impr.) ; 153(2): 70-77, jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183367

RESUMO

El estado de mal epiléptico (EE) es una emergencia neurológica que requiere tratamiento urgente con terapias antiepilépticas, y un rápido tratamiento de su causa. En los últimos años se ha actualizado su definición para adaptarla a todos los tipos de EE y estandarizar el tratamiento. La nueva definición se basa en 2 tiempos: un tiempo t1 tras el cual una crisis no cede espontáneamente, y un tiempo t2 tras el que aparece daño neuronal. En el tratamiento hay 3 líneas: la primera son las benzodiacepinas; la segunda línea de tratamiento, los fármacos antiepilépticos; y una tercera, los anestésicos intravenosos. La aplicación de las diferentes líneas de tratamiento plantea cuestiones aún sin responder, ya que el pronóstico depende también de la etiología y la edad; por este motivo se están desarrollando diferentes escalas pronósticas con el fin de ayudarnos a prever la evolución y, por tanto, adaptar la agresividad del tratamiento a cada paciente


Status epilepticus (SE) is a neurological emergency that requires urgent antiepileptic therapies, and a rapid treatment of its cause. In recent years, its definition has been updated to adapt it to all types of SE; this update helps to standardise the treatment. The new definition is based on two times: point t1, after which the event will not spontaneously cease, and period t2, after which neuronal damage may appear. There are three lines of treatment: first, benzodiazepines; second, antiepileptic drugs; and third, intravenous anaesthetics. The application of the different lines of treatment raises still unanswered questions, since the prognosis also depends on the aetiology, age and duration. For this reason, different prognostic scales are being developed to help us to assess its evolution and in turn, adapt the aggressiveness of the treatment to each patient


Assuntos
Humanos , Criança , Adulto , Epilepsia/etiologia , Epilepsia/terapia , Anticonvulsivantes/uso terapêutico , Olanzapina/uso terapêutico , Epilepsia/classificação
9.
Nervenarzt ; 90(8): 773-780, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31243507

RESUMO

Epilepsy is a frequent and disabling neurological disease with a significant burden for patients and their relatives worldwide. Epileptogenesis is understood as the plastic process that after an insult (in acquired epilepsies) finally leads to seizures with a latent period. In some cases, epileptogenesis has been clarified down to the molecular level. In parallel, the discovery of genetic defects has decisively contributed to unravel epileptic disease mechanisms. Both research directions have enabled first personalized treatment options. In addition, genetic variants associated with epilepsy can not only directly cause seizures but likely also induce an epileptogenic process (similar as in acquired epilepsies) and interact with developmental processes of the brain, finally leading to the typical age-dependent manifestation of genetic epilepsy syndromes. This article describes these correlations and the consequences for personalized treatment possibilities.


Assuntos
Epilepsia , Medicina de Precisão , Encéfalo/patologia , Epilepsia/terapia , Humanos , Convulsões/patologia , Convulsões/terapia
10.
Neurochirurgie ; 65(4): 178-186, 2019 Aug.
Artigo em Francês | MEDLINE | ID: mdl-31100348

RESUMO

Prophylaxis or treatment of tumor-associated seizures is adaily concern in neurosurgical practice but is often guided by the surgeon's habits rather than evidence from clinical trials, which is lacking. The present study reviews the literature on the incidence, clinical aspects and treatment of epilepsy and epileptic seizures in patients undergoing surgery for meningioma. Based on the published data, we then performed a French nationwide survey of neurosurgeons' practices regarding perioperative management of meningioma-related epilepsy and epileptic seizures.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Epilepsia/etiologia , Epilepsia/terapia , Meningioma/complicações , Meningioma/cirurgia , França , Humanos , Complicações Intraoperatórias , Assistência Perioperatória , Convulsões/etiologia , Convulsões/terapia
11.
EBioMedicine ; 43: 641-649, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31078519

RESUMO

Epilepsy remains refractory to medical treatment in ~30% of patients despite decades of new drug development. Neurosurgery to remove or disconnect the seizure focus is often curative but frequently contraindicated by risks of irreversible impairment to brain function. Novel therapies are therefore required that better balance seizure suppression against the risks of side effects. Among experimental gene therapies, chemogenetics has the major advantage that the action on the epileptogenic zone can be modulated on demand. Two broad approaches are to use a designer G-protein-coupled receptor or a modified ligand gated ion channel, targeted to specific neurons in the epileptogenic zone using viral vectors and cell-type selective promoters. The receptor can be activated on demand by either an exogenous compound or by pathological levels of extracellular glutamate that occur in epileptogenic tissue. We review the principal designer receptor technologies and their modes of action. We compare the drawbacks and benefits of each designer receptor with particular focus on the drug activators and the potential for clinical translation in epilepsy.


Assuntos
Desenho de Drogas , Epilepsia/etiologia , Epilepsia/terapia , Receptores Acoplados a Proteínas-G/genética , Animais , Epilepsia/metabolismo , Humanos , Ativação do Canal Iônico , Ligantes , Terapia de Alvo Molecular , Relação Quantitativa Estrutura-Atividade , Receptores Acoplados a Proteínas-G/química , Receptores Acoplados a Proteínas-G/metabolismo
12.
Rev. neurol. (Ed. impr.) ; 68(9): 369-374, 1 mayo, 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180673

RESUMO

Introducción. El síndrome de Panayiotopulos (SP) es un síndrome epiléptico sobre el que hasta la fecha se ha publicado únicamente un pequeño número de estudios. Objetivo. Estudiar la frecuencia, la semiología y el pronóstico del SP. Pacientes y métodos. Todos los pacientes con una o más crisis epilépticas no provocadas que consultaron en nuestro hospital entre el 1 de junio de 1994 y el 1 de marzo de 2011 (n = 827) fueron incluidos y seguidos prospectivamente hasta el 30 de abril de 2018. Se diagnosticó de SP a los pacientes que cumplieron los siguientes criterios a los seis meses de evolución: una o más crisis no provocadas con síntomas predominantemente autonómicos, presencia de complejos de puntas y ondas lentas focales de gran amplitud y «morfología funcional», ausencia de déficit neurológico previo y neuroimagen normal. Resultados. Cumplieron los criterios de SP 27 casos (3,3%). La semiología de las crisis fue similar a la descrita por otros autores. Un 88% de casos alcanzó una remisión inicial de tres años sin tratamiento antiepiléptico (sin crisis y sin tratamiento durante tres años). Sesenta y dos pacientes (7,5%) cumplieron todos los criterios de SP, a excepción de la presencia de las típicas alteraciones en el electroencefalograma. La semiología de estos casos fue similar, y un 85% alcanzó una remisión inicial de tres años sin tratamiento antiepiléptico. Conclusiones. En la práctica diaria son frecuentes los pacientes con crisis sugestivas de SP, pero sin las típicas alteraciones en el electroencefalograma. Este grupo de pacientes también presenta un buen pronóstico


Introduction. Panayiotopoulos syndrome (PS) is an epileptic syndrome of childhood. Until now only a small number of studies have been published about this syndrome. Aim. To study the frequency, semiology and prognosis of PS. Patients and methods. all patients with one or more unprovoked seizures seen at our hospital between 1 June 1994 and 1 March 2011 (n = 827) were included and prospectively followed until 30 April 2018. A diagnosis of PS was made in patients that fulfilled all the following criteria at six month of evolution: seizures with predominantly autonomic symptoms, presence of high amplitude, ‘functional morphology’, focal spikes and slow wave complexes in any location, absence of previous neurological deficit and normal neuroimaging. Results. 27 cases (3,3%) met the diagnostic criteria. Semiology of the seizures was similar to that described by other authors. 88% of these cases attained a 3-year initial remission without antiepileptic treatment (three years both without seizures and without treatment). 62 cases (7,5%) met all the diagnostic criteria with the exception of the presence of the EEG features. Semiology of these cases was similar and 85% attained a 3-year initial remission without antiepileptic treatment. Conclusions. In daily practice, patients with a clinical picture suggestive of PS but without the typical EEG features are common. This group of patients also have a good outcome


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Epilepsia/fisiopatologia , Epilepsia/terapia , Prognóstico , Síndrome , Estudos Prospectivos , Seguimentos
13.
Epilepsy Res ; 153: 83-84, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30952581

RESUMO

Transcutaneous vagus nerve stimulation (tVNS) is a newly developed method which intends to overcome the disadvantage of surgical implantation of the stimulation device. The tVNS device is designed to stimulate the auricular branch of the vagus nerve via a bipolar electrode attached to the skin of the left ear conch. A randomized, double-blind controlled trial assessed efficacy and safety over 20 weeks of tVNS (n=39) vs. active control tVNS (n=37) in patients with drug-resistant epilepsy. While the mean seizure reduction per 28 days at end of treatment (2.9% reduction from baseline in the control group vs 23.4% in the active group) did not reach statistical significance, there was a significant reduction in seizure frequency (34 %) in patients in the tVNS group at the end of the treatment period (20 weeks). TVNS was well-tolerated. The results justify further trials with longer observation periods and possibly at earlier stages of epilepsy.


Assuntos
Epilepsia/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação do Nervo Vago/métodos , Nervo Vago/fisiologia , Animais , Humanos
14.
Epilepsy Res ; 153: 85-87, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30952582

RESUMO

The traditional models of epilepsy care provision have not changed substantially in more than a century, despite rapid advances in computing, technology and materials science. One consequence of these advances has been the near universal prevalence of smartphones. Wearable devices with a complex sensor arrays are an emerging technology. These devices provide a coalescence of digital computing and communication tools that offer a new way to detect, report and communicate about seizures. The pilot of a smartphone-based application for patients and cares allowing real-time reporting of seizures securely to the relevant epilepsy care team is described. Wrist-worn devices were evaluated for their ability to detect epileptic seizures. Relevant information, such as seizure notifications and live alerts for notification of emergency attendance or admission to the hospital, are sent securely to the epilepsy care team in real time. Tailored specialist advice following notification is provided along traditional lines. Compared to the year preceding the pilot, the interval between seizure occurrence in the community and notification of the specialist team reduced, with faster response times in terms of advice. There was a 30% reduction in admissions for patients with epilepsy and 10% reduction in length of stay. Patients using the technology report an increased feeling of empowerment. This model of care has several challenges and requires modification of existing working practices if benefits for patients are to be fully realised. The benefits and challenges of technology-enabled care in are discussed from the perspective of the experience from development to clinical deployment.


Assuntos
Epilepsia/diagnóstico , Epilepsia/terapia , Tecnologia de Sensoriamento Remoto/métodos , Tecnologia sem Fio , Eletroencefalografia , Humanos , Monitorização Fisiológica
15.
Epileptic Disord ; 21(2): 197-205, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31010799

RESUMO

Epilepsy is a life-changing disease, and patients with epilepsy may face a number of issues. Paediatricians and general practitioners are often the first to be asked for advice. This cross-sectional study was performed to gain information on the knowledge and experiences of paediatricians and general practitioners on epilepsy. From September 2015 to July 2017, paediatricians and general practitioners in Leipzig, Germany, were asked to take part in a face-to-face interview. Overall, 40 paediatricians and 60 general practitioners participated in the study. A total of 99/100 (99%) kept emergency medication available and 96/100 (96%) would administer it during a seizure. Also, 40/40 (100%) of the paediatricians and 34/60 (57%) of the general practitioners recommended that non-professionals should administer emergency medication, and 18/40 (45%) of the paediatricians and 35/60 (58%) of the general practitioners would put an object in the patient's mouth during a seizure. With regards to safety precautions, paediatricians mentioned the risks associated with swimming (30/40; 75%) and the potential of falling from a height (23/40; 58%), whereas general practitioners focused on being around vehicles including driving regulations (43/60; 72%). Only 5/60 (8%) of the general practitioners advised that precautions should be taken during swimming. Fatigue/exhaustion was the most common adverse drug event associated with long-term anticonvulsive therapy mentioned by paediatricians (13/40; 33%) and general practitioners (27/60; 45%). Of all the participants, 23/100 (23%) recommended epilepsy training programmes for patients and families, however, none were able to name a specific programme. Nearly half of the general practitioners did not recommend the use of rescue medication by non-professionals. This measure, however, can prevent the occurrence of prolonged non-treatable seizures. Both paediatricians and general practitioners should bear in mind that placing an object in the mouth during a seizure should be avoided due to the risk of additional injury. To reduce the risk of drowning, physicians should recommend safety precautions during swimming. Information on epilepsy training programmes for patients and families should be diffused to all physicians taking care of patients with epilepsy.


Assuntos
Anticonvulsivantes/administração & dosagem , Epilepsia/terapia , Clínicos Gerais , Conhecimentos, Atitudes e Prática em Saúde , Pediatras , Adulto , Estudos Transversais , Epilepsia/tratamento farmacológico , Feminino , Clínicos Gerais/estatística & dados numéricos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Pediatras/estatística & dados numéricos
16.
Biomed Res Int ; 2019: 4518160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30941363

RESUMO

Epilepsy is one of the most devastating neurological diseases and despite significant efforts there is no cure available. Occurrence of spontaneous seizures in epilepsy is preceded by numerous functional and structural pathophysiological reorganizations in the brain-a process called epileptogenesis. Treatment strategies targeting this process may be efficient for preventing spontaneous recurrent seizures (SRS) in epilepsy, or for modification of disease progression. We have previously shown that (i) myoinositol (MI) pretreatment significantly decreases severity of acute seizures (status epilepticus: SE) induced by kainic acid (KA) in experimental animals and (ii) that daily post-SE administration of MI for 4 weeks prevents certain biochemical changes triggered by SE. However it was not established whether such MI treatment also exerts long-term effects on the frequency of SRS. In the present study we have shown that, in KA-induced post-SE epilepsy model in rats, MI treatment for 28 days reduces frequency and duration of behavioural SRS not only during the treatment, but also after its termination for the following 4 weeks. Moreover, MI has significant effects on molecular changes in the hippocampus, including mi-RNA expression spectrum, as well as mRNA levels of sodium-MI transporter and LRRC8A subunit of the volume regulated anionic channel. Taken together, these data suggest that molecular changes induced by MI treatment may counteract epileptogenesis. Thus, here we provide data indicating antiepileptogenic properties of MI, which further supports the idea of developing new antiepileptogenic and disease modifying drug that targets MI system.


Assuntos
Comportamento Animal , Epilepsia/induzido quimicamente , Epilepsia/metabolismo , Inositol/uso terapêutico , Convulsões/tratamento farmacológico , Animais , Epilepsia/terapia , Inositol/farmacologia , Ácido Caínico , Fatores de Tempo
17.
Behav Neurol ; 2019: 5048794, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30863463

RESUMO

Purpose: To measure fidelity with which a group seizure first aid training intervention was delivered within a pilot randomized controlled trial underway in the UK for adults with epilepsy who visit emergency departments (ED) and informal carers. Estimates of its effects, including on ED use, will be produced by the trial. Whilst hardly ever reported for trials of epilepsy interventions-only one publication on this topic exists-this study provides the information on treatment fidelity necessary to allow the trial's estimates to be accurately interpreted. This rare worked example of how fidelity can be assessed could also provide guidance sought by neurology trialists on how to assess fidelity. Methods: 53 patients who had visited ED on ≥2 occasions in prior year were recruited for the trial; 26 were randomized to the intervention. 7 intervention courses were delivered for them by one facilitator. Using audio recordings, treatment "adherence" and "competence" were assessed. Adherence was assessed by a checklist of the items comprising the intervention. Using computer software, competence was measured by calculating facilitator speech during the intervention (didacticism). Interrater reliability was evaluated by two independent raters assessing each course using the measures and their ratings being compared. Results: The fidelity measures were found to be reliable. For the adherence instrument, raters agreed 96% of the time, PABAK-OS kappa 0.91. For didacticism, raters' scores had an intraclass coefficient of 0.96. In terms of treatment fidelity, not only were courses found to have been delivered with excellent adherence (88% of its items were fully delivered) but also as intended they were highly interactive, with the facilitator speaking for, on average, 55% of course time. Conclusions: The fidelity measures used were reliable and showed that the intervention was delivered as attended. Therefore, any estimates of intervention effect will not be influenced by poor implementation fidelity.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Epilepsia/terapia , Primeiros Socorros , Convulsões/terapia , Adolescente , Adulto , Idoso , Epilepsia/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Convulsões/diagnóstico , Resultado do Tratamento , Adulto Jovem
18.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30877146

RESUMO

Drowning is a leading cause of injury-related death in children. In 2017, drowning claimed the lives of almost 1000 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.


Assuntos
Academias e Institutos/normas , Afogamento/prevenção & controle , Pediatria/normas , Natação/educação , Natação/normas , Adolescente , Transtorno Autístico/epidemiologia , Transtorno Autístico/terapia , Criança , Pré-Escolar , Afogamento/epidemiologia , Epilepsia/epidemiologia , Epilepsia/terapia , Cardiopatias/epidemiologia , Cardiopatias/terapia , Humanos , Adulto Jovem
20.
Epilepsy Res ; 153: 68-70, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30850259

RESUMO

Controlled clinical trials in adults with medically intractable focal seizures treated with the RNS® System demonstrate that closed-loop responsive neurostimulation to the seizure focus reduces the frequency of disabling seizures, is well tolerated, and is acceptably safe. Seizure reductions begin with initiation of treatment and continue over time, reaching median reductions of 75% after 9 years of treatment. Treatment with responsive cortical stimulation is also associated with improvement in quality of life and cognitive function related to the functional area being treated. In addition, the RNS System's chronic ambulatory electrocorticographic monitoring provides unprecedented insight into each patient's disease management, and into the study of epilepsy itself, in ways that may enhance the treatment of epilepsy in the future.


Assuntos
Encéfalo/fisiologia , Estimulação Encefálica Profunda/métodos , Epilepsia/terapia , Neuroestimuladores Implantáveis , Animais , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/terapia , Epilepsia Resistente a Medicamentos/terapia , Eletrodos Implantados , Eletroencefalografia , Epilepsia/complicações , Epilepsia/psicologia , Humanos , Qualidade de Vida
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