Cutaneous adverse reactions associated with antiseizure medication: clinical characteristics and implications in epilepsy treatment.

OBJECTIVE: To describe the clinical characteristics of cutaneous adverse reactions and cross-sensitivity induced by antiseizure medications and compare the pattern of use of antiseizure medications in patients with epilepsy according to skin rash history. METHODS: We analysed patients with a history of skin rash presenting for up to 12 weeks after initiating antiseizure medication. The history of skin rash was verified by medical charts, interviews, and identification of skin lesions by patients based on illustrative images. The minimum follow-up period was eight months. The control group comprised epilepsy patients with regular antiseizure medication use for at least 12 weeks without skin rash. We included 109 cases and 99 controls. RESULTS: The median (interquartile range) period from the index rash was six years (2-11). Carbamazepine was the trigger medication in 48% of cases and induced skin rashes in all patients with cross-sensitivity and carbamazepine exposure. Stevens-Johnson syndrome, toxic epidermal necrolysis, or drug reactions with eosinophilia and systemic symptoms affected 36% of cases. Carbamazepine- or oxcarbazepine-induced maculopapular exanthema occurred earlier (median: one week) than that induced by other antiseizure medications (median: three weeks) (p=0.006). Cross-sensitivity was more common in patients with at least one episode of Stevens-Johnson syndrome (29%) and Stevens-Johnson/toxic epidermal necrolysis overlap (50%) than in patients with maculopapular exanthema (8%) (p=0.01). Although most cases were mild, the pattern of antiseizure medication use differed from that of controls, with a lower proportion of antiseizure medication typically associated with severe cutaneous adverse reactions (carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, and lamotrigine) (p<0.001). Most cases exposed to high-risk medication, however, did not develop cross-sensitivity. SIGNIFICANCE: Cutaneous adverse reaction history may influence antiseizure medication use. Cross-sensitivity is more common in severe cases and most patients are affected by mild, self-limited skin rashes. Further research should consider the relevance of mild skin rashes in lifelong epilepsy treatment.

Avaliação da percepção do conhecimento sobre o sono e suas implicações entre médicos e internos / Assessment of the perception of knowledge about sleep and its implications between physicians and interns

Introdução: O sono é essencial para a qualidade de vida e possui funções fundamentais para o funcionamento do corpo. Sua privação traz consequências negativas na homeostase corporal e na cognição. Essa privação pode tornar-se fator de risco para diversas doenças. Há deficiências no currículo de graduação médica acerca do conhecimento sobre a saúde do sono, acarretando subdiagnósticos e subtratamentos, além de ter consequências no sono para os próprios doutorandos e médicos, afetando assim na sua saúde e no seu desempenho profissional. Objetivo: Avaliar se a percepção do conhecimento do médico sobre o sono adquirido na graduação interfere na promoção da saúde do sono nas esferas pessoal e profissional. Métodos: Estudo observacional de abordagem quantitativa e recorte transversal através de formulário digital. Médicos e internos fizeram parte do estudo. O questionário teve as seguintes etapas: epidemiologia; avaliação subjetiva do conhecimento sobre saúde do sono; aplicação de conhecimentos na vida profissional e pessoal; avaliação da qualidade de sono através do Índice de Qualidade de Sono de Pittsburgh (PSQI). Resultados: A amostra foi de 103 participantes. A maioria concordou em ter adquirido conhecimentos sobre a saúde do sono durante a graduação. Durante a anamnese o sono foi o tema menos perguntado. As medidas que favorecem a higiene do sono mais relatadas foram dormir em ambiente adequado e praticar exercícios físicos. Já as desfavoráveis foram uso de eletrônicos no quarto. Não houve diferença significativa entre ano e nível de formação em relação a qualidade de sono. Os índices significativamente mais alterados do índice foram disfunções diurnas e uso de medicamentos para dormir. Conclusão: A importância da saúde do sono é bem estabelecida, porém a qualidade de sono entre médicos e internos é ruim. Portanto se faz necessário futuras mudanças na área de ensino, atuação e pesquisa.

Introduction: Sleep is essential for the quality of life and has fundamental functions for the functioning of the body. Its deprivation has negative consequences on body homeostasis and cognition. Sleep deprivation can become a risk factor for several diseases. There are deficiencies in the undergraduate medical curriculum regarding knowledge about sleep health, leading to underdiagnosis and undertreatment for patients. In addition to having consequences on sleep for doctoral students and physicians, thus affecting their health and professional performance. Objective: To assess whether the physician's perception of knowledge about sleep acquired during graduation interferes with the promotion of sleep health in the personal and professional spheres. Methods: Observational study with a quantitative approach and a cross-sectional approach using a digital form. Physicians and interns were part of the study. The questionnaire had the following stages: epidemiology; subjective assessment of knowledge about sleep health; application of knowledge in professional and personal life; assessment of sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Results: The sample consisted of 103 participants. Most agreed to have acquired knowledge about sleep health during graduation. During the anamnesis, sleep was the least asked topic. The most reported measures that were positive to sleep hygiene were sleeping in a suitable environment and practicing physical exercises. The unfavorable ones were the use of electronics in the bedroom. There was no significant difference between year and level of training in relation to sleep quality. The most altered components of the index were daytime disorders and use of sleeping pills. Conclusion: The importance of sleep health is well established, but sleep quality among physicians and interns is poor. Therefore, future changes in teaching, performance and research are necessary

Treatment of epilepsy in patients with myasthenia gravis: Is really harder than it looks?

The relationship between myasthenia gravis (MG) and epilepsy has been rarely reported. As consequence, there are no specific guidelines for the management of these conditions when they mutually occur. We reported on three patients in whom epilepsy and MG are coexisting, but in different clinical settings. Two patients were treated with antiepileptic drugs which improved their symptoms. One patient has controlled the seizures after a successful anterior temporal lobectomy with no appreciable consequences to her MG. We discuss the difficulties in the management of epilepsy in patients with MG. In addition, we report on the first epileptic surgery in a MG patient, indicating that this surgical procedure as a safe option for the treatment of intractable epilepsy in patients with MG.