Twin-twin transfusion syndrome: neurodevelopment of infants treated with laser surgery / Síndrome de transfusão feto-fetal: neurodesenvolvimento de lactentes tratados com cirurgia a laser

ABSTRACT Objective To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. Method This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. Results There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. Conclusion Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study.

RESUMO Objetivo Avaliar o desenvolvimento neurológico de sobreviventes da sindrome de transfusão feto-fetal (STFF) submetidos à coagulação a laser por fetoscopia (CLF), durante o primeiro ano de vida, comparando estes ao grupo controle; e verificar a influência de variáveis específicas no desenvolvimento. Método Tratou-se de estudo prospectivo, longitudinal. A amostra foi composta por 33 gêmeos diamnióticos monocoriônicos submetidos à CLF para tratamento da STFF e 22 lactentes a termo de gestação única. Bayley Scales of Infant and Toddler Development Screening Test foram utilizadas para avaliação. Informações pré-natal, perinatal e pós-natal foram coletadas. Resultados Houve maior número de lactentes com desempenho inadequado no grupo STFF do que no controle. As variáveis identificadas (feto doador, baixa renda econômica e doença cárdio-respiratória) influenciaram negativamente a comunicação expressiva e as habilidades motoras finas. Conclusão Embora o acompanhamento seja recomendado para todos lactentes com STFF, especial atenção deve ser dada àqueles que apresentam fatores de risco.

Pharmacovigilance in epileptic patients using antiepileptic drugs

OBJECTIVE: To investigate the occurrence of adverse effects of antiepileptic drugs (AED) in chronic epileptic patients in mono or polytherapy. METHOD: We evaluated consecutive patients that met the following inclusion criteria: age of 18 years or older, diagnosis of epilepsy for at least one year, stable dose of AED for at least three months. Patients were asked if they had any adverse event related to the AED. After that, they were interviewed according to a detailed semi-structure questionnaire. We also assessed specifically the adverse events in the last four weeks. The data were analyzed regarding the use of monotherapy x polytherapy, and the presence of probable depression (score >15) according to the Center for Epidemiologic Studies Depression Scale. RESULTS: Sixty-five patients were evaluated, 35 women, mean age 38.3 years; 35 patients were in use of monotherapy and 35 in polytherapy. Only 45 (69.2 percent) patients spontaneously reported adverse effects. After the formal questionnaire, 63 (97 percent) patients referred experiencing an adverse event (p<0.001). Seventeen men had adverse events, as opposed to 28 women (p=0.042). When the last four weeks were evaluated, patients with probable depression presented adverse events more frequently (p<0.0001). CONCLUSION: Our data suggest that adverse events are highly prevalent when a detailed questionnaire is applied and that depression may aggravate the number and intensity of side effects in patients using AEDs.

Public awareness and attitudes toward epilepsy in different social segments in Brazil

Purpose: To assess public awareness and attitudes toward epilepsy in Brazilians of different cultural and socioeconomic backgrounds. Background: Several studies have examined public awareness and attitudes toward epilepsy in various countries but there are no equivalent data for Brazil or South America. Material and Methods: We have applied the survery proposed by Caveness and Gallup, with some modifications and adaptations to four groups (I-IV) of subjects: I-105 individuals accompanying patients to the Ophthalmologic outpatient clinic of the Hospital das Clínicas of the State University of Campinas (UNICAMP); II-93 students recently admitted to medical and nursing school; III- 101 senior non-medical students; and IV- 69 senior medical students. Groups II, III, and IV were students at UNICAMP. Results: Individuals with a low socioeconomic standing had a poor profile of familiarity, knowledge and attitudes toward epilepsy. The pre-university and university students had a relatively good profile when compared to the published international polls. Senior medical students had an excellent level of familiarity and knowledge, but showed no change in their objection to having a son or a daughter marry an epileptic person. Conclusions: Our data suggest that there is a clear-cut relationship between the level of education and the individual's familiarity and atitudes toward epilepsy. Effective elimination of the prejudice toward epilepsy requires specific training and not just general, superficial information about the condition.

Sentimentos e reaçöes de pais de crianças epiléticas / Feelings and behaviors of parents of children with epilepsy

Objetivos: Identificar as crenças e os sentimentos dos pais frente à epilepsia e relacioná-los com os comportamentos de seus filhos. Avaliar e eficácia dos grupos de pais diminuiçao da ansiedade, esclarecimento sobre a doença e comportamentos. Método: Foram aplicados 18 protocolos que avaliaram sentimentos, crenças e comportamento dos pais e filhos, respondidos antes e depois das sessoes de grupos de apoio. Resutados: Diante do diagnóstico foram observados mágoa (94,4 por cento), medo (72,2 por cento), susto (27,8 por cento), tristeza (33,3 por cento) e rejeiçao (38,9 por cento). Estes sentimentos foram associados a superproteçao (83,3 por cento) e falta de limites (38,9 por cento). Segurança foi associada a percepçao do controle de crise. Depois do grupo, 94,4 por cento dos pais relatam menos ansiedade e 77,8 por cento associam muitas das dificuldades a falta de informaçao e a presença de crenças irracionais. Conclusao: Grupos de apoio desmitificam crenças, ajudam na identificaçao das relaçoes parentais e previnem dificuldades comportamentais.