Eventos no epilépticos psicógenos: El desafío constante de su diagnóstico y tratamiento.

Psychogenic Non-Epileptic Events (PNEE) are paroxysmal episodes described as behavioral changes, sensory- sensitive disturbances, or motor manifestations that resemble epileptic seizures without showing underlying epileptiform activity, are not deliberately produced by the individual, and respond to multifactorial biopsychosocial mechanisms. Epidemiological information is limited due to the heterogeneous nature of the affected population, and to the limited accessibility to the video electroencephalogram (vEEG) necessary for its diagnosis. In such context, the convergence of two important elements is necessary: a detailed clinical history (clinical characteristics suggestive of PNEE, and identification of the associated factors), and the absence of electroencephalographic “ictal” changes in the vEEG. A psychological evaluation provides additional information, relevant for the diagnostic corroboration and management. The diagnosis must be made in a timely manner, to avoid complications in its evolution and treatment. A positive and encouraging attitude to the patient is vital when informing him/her of the diagnosis, as it also is the coordination between the treating neurologist and mental health professionals involved in the management and monitoring of the case. Cognitive behavioral psychotherapy, associated with psychopharmacotherapy -when needed-- constitute the most effective treatment approach for these patients. There are limited studies on the current epidemiological and clinical evolution of patients with PNEE in Latin America, and additional research regarding this problem is much needed, given its impact on the quality of life of the patients and on the cost of its management in the health care systems.Los eventos no epilépticos psicógenos (ENEP) son episodios paroxísticos descritos como cambios conductuales, alteraciones sensorio-sensitivas, o manifestaciones motoras que se asemejan a las crisis epilépticas pero sin mostrar actividad epileptiforme subyacente, no son producidos deliberadamente por el individuo, y responden a mecanismos multifactoriales de índole biopsicosocial. La información epidemiológica es limitada debido a la naturaleza heterogénea de la población afectada, así como a la escasa accesibilidad al videoelectroencefalograma (vEEG) necesario para su diagnóstico. En este contexto, es necesaria la convergencia de dos elementos importantes: historia clínica detallada (características clínicas sugerentes de ENEP e identificación de los factores asociados) y la ausencia de cambios electroencefalográficos en el vEEG durante el episodio. La evaluación psicológica provee información adicional relevante para la corroboración diagnóstica y para su manejo. El diagnóstico debe realizarse de manera oportuna, para evitar complicaciones en su evolución y tratamiento. Es vital una actitud positiva y alentadora hacia el/la paciente al momento de comunicarle su diagnóstico, así como la coordinación entre el neurólogo tratante y los profesionales de salud mental involucrados en el manejo y seguimiento del caso. La psicoterapia cognitiva conductual, asociada a psicofármacoterapia -cuando pertinente-, constituyen el tratamiento más eficaz de estos pacientes. Existen limitados estudios en Latinoamérica sobre aspectos epidemiológicos y clínico-evolutivos de pacientes con ENEP, por lo que más investigación y publicaciones respecto a esta problemática son indispensables dado su impacto sobre la calidad de vida de los pacientes y sobre el costo de su manejo en los sistemas de salud

An exploration into the impact of exposure to community violence and hope on children's perceptions of well-being: a South African perspective

The study aims to explore the relationship between exposure to community violence, hope, and well-being. More specifically, the study aims to ascertain whether hope is a stronger predictor of well-being than exposure to violence. Stratified random sampling was used to select a sample of 566 adolescents aged 14–17 years, from both high violence and low violence areas in Cape Town, South Africa. A questionnaire consisting of Snyder’s Children’s Hope Scale, the Recent Exposure to Violence Scale and the KIDSCREEN-52 was used. Data analysis techniques included descriptive statistics, correlations, and multiple regression. A positive, significant relationship was found between children’s hope and their well-being. Although exposure to community violence was found to be significantly correlated with wellbeing, the relationship was negligible.While exposure to community violence and hope were found to be significant predictors of well-being, hope emerged as a stronger predictor of child well-being than exposure to community violence.Department of HE and Training approved lis

Role of cytoskeletal abnormalities in the neuropathology and pathophysiology of type I lissencephaly

Type I lissencephaly or agyria-pachygyria is a rare developmental disorder which results from a defect of neuronal migration. It is characterized by the absence of gyri and a thickening of the cerebral cortex and can be associated with other brain and visceral anomalies. Since the discovery of the first genetic cause (deletion of chromosome 17p13.3), six additional genes have been found to be responsible for agyria–pachygyria. In this review, we summarize the current knowledge concerning these genetic disorders including clinical, neuropathological and molecular results. Genetic alterations of LIS1, DCX, ARX, TUBA1A, VLDLR, RELN and more recently WDR62 genes cause migrational abnormalities along with more complex and subtle anomalies affecting cell proliferation and differentiation, i.e., neurite outgrowth, axonal pathfinding, axonal transport, connectivity and even myelination. The number and heterogeneity of clinical, neuropathological and radiological defects suggest that type I lissencephaly now includes several forms of cerebral malformations. In vitro experiments and mutant animal studies, along with neuropathological abnormalities in humans are of invaluable interest for the understanding of pathophysiological mechanisms, highlighting the central role of cytoskeletal dynamics required for a proper achievement of cell proliferation, neuronal migration and differentiation

Interpersonal violence: an important risk factor for disease and injury in South Africa

<p>Abstract</p> <p>Background</p> <p>Burden of disease estimates for South Africa have highlighted the particularly high rates of injuries related to interpersonal violence compared with other regions of the world, but these figures tell only part of the story. In addition to direct physical injury, violence survivors are at an increased risk of a wide range of psychological and behavioral problems. This study aimed to comprehensively quantify the excess disease burden attributable to exposure to interpersonal violence as a risk factor for disease and injury in South Africa.</p> <p>Methods</p> <p>The World Health Organization framework of interpersonal violence was adapted. Physical injury mortality and disability were categorically attributed to interpersonal violence. In addition, exposure to child sexual abuse and intimate partner violence, subcategories of interpersonal violence, were treated as risk factors for disease and injury using counterfactual estimation and comparative risk assessment methods. Adjustments were made to account for the combined exposure state of having experienced both child sexual abuse and intimate partner violence.</p> <p>Results</p> <p>Of the 17 risk factors included in the South African Comparative Risk Assessment study, interpersonal violence was the second leading cause of healthy years of life lost, after unsafe sex, accounting for 1.7 million disability-adjusted life years (DALYs) or 10.5% of all DALYs (95% uncertainty interval: 8.5%-12.5%) in 2000. In women, intimate partner violence accounted for 50% and child sexual abuse for 32% of the total attributable DALYs.</p> <p>Conclusions</p> <p>The implications of our findings are that estimates that include only the direct injury burden seriously underrepresent the full health impact of interpersonal violence. Violence is an important direct and indirect cause of health loss and should be recognized as a priority health problem as well as a human rights and social issue. This study highlights the difficulties in measuring the disease burden from interpersonal violence as a risk factor and the need to improve the epidemiological data on the prevalence and risks for the different forms of interpersonal violence to complete the picture. Given the extent of the burden, it is essential that innovative research be supported to identify social policy and other interventions that address both the individual and societal aspects of violence.</p

Growing Up in Violent Contexts: Differential Effects of Community, Family, and School Violence on Child Adjustment

Although different than in war-torn areas, violence affects children even in the most economically developed countries. In this chapter we review the empirical evidence supporting the detrimental effects of early violence exposure on a wide range of developmental outcomes. We also provide an examination of mechanisms linking violence exposure to negative developmental outcomes, as well as the predisposing and precipitating factors that intervene in these complex relationships. We conclude that the problem of exposure to violence in children is often underestimated and discuss the implications for child welfare policy and preventive interventions

An international pilot study of K-12 teachers' computer science self-esteem

Session: Computing in Schools IIComputer Science (CS) is a new subject area for many K-12 teachers around the world, requiring new disciplinary knowledge and skills. Teacher social-behavioral factors (e.g. self-esteem) have been found to impact learning and teaching, and a key part of CS curriculum implementation will need to ensure teachers feel confident to deliver CS. However, studies about CS teacher self-esteem are lacking. This paper presents an analysis of publicly available data (n=219) from a pilot study using a Teacher CS Self-Esteem scale. Analysis revealed significant differences, including 1) females reported significantly lower CS self-esteem than males, 2) primary teachers reported lower levels of CS self-esteem than secondary teachers, 3) those with no CS teaching experience reported significantly lower CS self-esteem, 4) teachers with 0-3 years experience had a negative CS self-esteem, but after four years, teachers had a positive CS self-esteem, and 5) teachers who lived further from metropolitan areas and in some countries reported lower CS self-esteem. These initial findings suggest a pressing need for future research to look further into teacher CS self-esteem to inform teacher CS professional development.Rebecca Vivian, Keith Quille, Monica M. McGill, Katrina Falkner, Sue Sentance, Sarah Barksdale, Leonard Busuttil, Elizabeth Cole, Christine Liebe, Francesco Maioran