Accident risk in patients with epilepsy

Objective: To compare the risk of accidents in patients with uncontrolled seizures, in seizure-free patients, and inpatients with chronic headache. Method: This was a prospective longitudinal case-controlled study with interviews. A semi-structured questionnaire was used in the epilepsy and headache outpatient clinics of the Hospital das Clinicas of UNICAMP. Results: Group I was composed of 48 patients with uncontrolled seizures, group II was composed of 24 seizure-free patients and group III was composed of 32 patients with headache. Thirty-nine patients (81%) in group 1, 13 (54%) in group II, and 19 (59%) in group III reported accidents in the last two years. In the first group, 649 accidents (89%) were related to epileptic seizures and the average number of accidents not related to seizures was 1.7. The average number of accidents in groups II and III were both2.4. Conclusion: Epileptic seizure was the most important factor determining the occurrence of accidents in people with epilepsy.662A17517

ELECTROENCEPHALOGRAPHIC EVOLUTION IN WOMEN WITH MEDICALLY REFRACTORY EPILEPSY

We reviewed 444 EEGs of 62 women with medically refractary epilepsy, followed up for at least 5 years and that had 5 or more EEGs. According to our definitions we found 18 patients (29%) with frequent seizures, 16 (25.8%) with very frequent seizures, 16 (25.8%) with controlled seizures and 12 (19.3%) with occasional seizures. Four patients (6.5%) always showed normal EEGs, 30 (48.4%) had normal and abnormal EEGs and 28 (45.2%) only abnormal EEGs. Among the patients who had only normal EEGs, two had all seizures controlled, one had occasional seizures and one had frequent seizures. Among the patients who had normal and abnormal EEGs, 10 had controlled seizures, 5 had occasional seizures, 9 had frequent seizures and 6 had very frequent seizures. In the group of patients with always abnormal EEGs, 4 had controlled seizures, 6 had occasional seizures, 8 had frequent seizures, and IO had very frequent seizures. In relation to the last EEG, it was normal in 7 (43.7%) of 16 patients with controlled seizures, in 3 (25%) of 12 patients with occasional seizures and in 7 (38.9%) of 18 patients with frequent seizures, and in none of the patients with very frequent seizures. The patients who had only normal EEGs seem to have a better outcome than those with abnormal EEGs. We observed that the last EEG was normal in 43.7% of the patients with controlled seizures. These data may suggest a relative importance of the EEG considering the long-term prognosis regarding seizure control.533A38438

Is low antiepileptic drug dose effective in long-term seizure-free patients?

Objective: To investigate the value of leaving seizure-free patients on low-dose medication. Method: This was an exploratory prospective randomized study conducted at our University Hospital. We evaluated the frequency of seizure recurrence and its risk factors following complete or partial antiepileptic drug (AED) withdrawal in seizure free patients for at least two years with focal, secondarily generalized and undetermined generalized epilepsies. For this reason, patients were divided into two groups: Group 1 (complete AED withdrawal), and Group 2 (partial AED withdrawal). Partial AED withdrawal was established as a reduction of 50% of the initial dose. Medication was tapered off slowly on both groups. Follow-up period was 24 months. Results: Ninety-four patients were followed up: 45 were assigned to complete (Group 1) AED withdrawal and 49 to partial (Group 2) AED withdrawal. Seizure recurrence frequency after two years follow-up were 34.04% in group 1 and 32.69% in Group 2. Survival analysis showed that the probability of remaining seizure free at 6, 12, 18 and 24 months after randomization did not differ between the two groups (p = 0.8). Group 1: 0.89, 0.80, 0.71 and 0.69; group 2: 0.86, 0.82, 0.75 and 0.71. The analysis of risk factors for seizure recurrence showed that more than 10 seizures prior to seizure control was a significant predictive factor for recurrence after AED withdrawal (hazard ratio = 2.73). Conclusion: Leaving seizure free patients on low AED dose did not reduce the risk for seizure recurrence. That is, once the decision of AED withdrawal has been established, it should be complete.613A56657

Amyotrophic lateral sclerosis Prospective study on respiratory parameters

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Objective: To verify how efficient respiratory parameters are in the follow-up of subjects with amyotrophic lateral sclerosis (ALS) and to observe possible correlations between respiratory and nutritional functions. Method: Sixteen patients with probable or defined ALS were selected and evaluated over eight months using the following respiratory parameters: spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), arterial gasometry and pulse oximetry; and nutritional parameters such as body mass index (BMI) and percentage weight loss. Results: P(a)CO(2) was a significant parameter to follow up disease evolution (p=0.051). There was significant correlation between MIP and MEP (r: 0.83); BMI and MIP (r: 0.70); BMI and MEP (r: 0.72); pulse oximetry and forced vital capacity (r: 0.57). Conclusion: P(a)CO(2) was shown to be an efficient and significant parameter in the measurement of respiratory impairment; the correlations among MIP, MEP and BMI indicated that these are significant parameters for periodic clinical evaluation.682258262Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Sexual dysfunction in epilepsy - Identifying the psychological variables

In order to evaluate the psychological variables that affect sexual dysfunction (SD) in epilepsy, where compared 60 epileptics (Group 1) with 60 healthy individuals (Group 2), through the State-Trait Anxiety Inventory (Spielberger et al., 1970), Beck Depression Inventory (Beck, 1974) and Sexual Behavior Interview (Souza, 1995). Sexual dysfunction (SD), anxiety and depression were found more frequently in Group 1 than in Group 2 and were not related to sex. Variables such as the onset duration and frequency of seizures as well as the use to medication were not associated with SD. Temporal lobe epilepsy was related to SD (p = 0.035) but net to anxiety or depression. Anxiety and depression were related to SD in both groups. Perception in controlling the seizures was closely related to anxiety (p = 0) and depression (p = 0.009). We conclude that psychological factors play an important role in the alteration of sexual behavior in epileptics and that suitable attention must be given to the control of these variables.582A21422

Demonstration project on epilepsy in Brazil - Outcome assessment

Purpose: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. Method. We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patient's and the physician's point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. Results: A total of 181 patients (93 women - 51%) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (> 10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients' and relatives' opinions were that in the majority (59%) the health status had improved a lot, some (19%) had improved a little, 20% experienced no change and in 2% the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. Discussion: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward in accordance with local health providers and managers

Cysticidal therapy - Impact on seizure control in epilepsy associated with neurocysticercosis

Objective: To evaluate the clinical features and seizure control of epilepsy related to neurocysticercosis. Method: 18 patients with partial epilepsy and neurocysticercosis were treated with albendazol or praziquantel and followed from 3 months to 12 years. We analyzed results from the CSF exam, interictal electroencephalogram (EEG), head computerized tomography and/or magnetic resonance imaging. Results: The patients' mean age was 36.4 years. The mean duration of epilepsy was 16 years, 83% patients had simple partial seizures; 17% had complex partial seizures. All patients underwent routine EEGs; 62% had abnormalities and 38% were normal. A relationship was observed between focal EEG abnormality and the location of cyst in 28% of the patients. The CSF exams showed pleocytosis in 33% of the patients, and 28% had elevated protein levels. Only 22% of patients had positive titer for cysticercosis in the CSF. In all patients who had somatosensory and special sensory seizures there was a relationship between location of the cysts and seizure semiology (n = 11). After cysticidal therapy, 83% patients had a significant improvement in controlling seizures. Conclusion: In this group, we found a predominance of simple partial seizures and a relationship between somatosensory and special sensory seizures and the location of the cysts. Cysticidal therapy was effective in controlling seizures in these patients and should be considered for patients with partial seizures and semiology related to cyst location.5841014102

Demonstration project on epilepsy in Brazil - Situation assessment

Purpose: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. Methods: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. Results: The lifetime prevalence of epilepsy was 9.2/1,000 people [95% Cl 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19% who were taking no medication. The survey of health workers showed that they estimated that 60% of patients under their care were seizure-free. They estimated that 55% of patients were on monotherapy and that 59% had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56%. Most of the physicians (73%) did not feel confident in managing people with epilepsy. Discussion: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de lnformacao da Atencao Basica - SIAB) and iv) continuous education of health professionals. The educational program should be broad spectrum and include not only medical management, but also psycho-social aspects of epilepsy

Lateralization of epileptiform discharges in patients with epilepsy and precocious destructive brain insults

Unilateral destructive brain lesions of early development can result in compensatory thickening of the ipsilateral cranial vault. The aim of this study was to determine the frequency of these bone changes among patients with epilepsy and precocious destructive lesions, and whether a relationship exists between these changes and epileptiform discharges lateralization. Fifty-one patients had their ictal/inter-ictal scalp EEG and skull thickness symmetry on MRI analyzed. Patients were divided into three main groups according to the topographic distribution of the lesion on the MRI: hemispheric (H) (n=9); main arterial territory (AT) (n=25); arterial borderzone (Bdz) (n=17). The EEG background activity was abnormal in 26 patients and were more frequent among patients of group H (p=0.044). Thickening of the skull was more frequent among patients of group H (p=0.004). Five patients (9.8%) showed discordant lateralization between epileptiform discharges and structural lesion (four of them with an abnormal background, and only two of them with skull changes). in one of these patients, ictal SPECT provided strong evidence for scalp EEG false lateralization. The findings suggest that compensatory skull thickening in patients with precocious destructive brain insults are more frequent among patients with unilateral and large lesions. However, EEG lateralization discordance among these patients seems to be more related to EEG background abnormalities and extent of cerebral damage than to skull changes.6211