National epilepsy movement in Brazil

Purpose: To establish a social network of epilepsy lay organization in Brazil to provide advocacy for people with epilepsy and eventually forma powerful National Epilepsy movement. Method.-We actively searched for any associations, support groups or organizations related to epilepsy in the country by personal contacts, internet search and by telephone search. Contact was then established with any entity found. Results: The first meeting was held in Campinas in March 2003, and was attended by 270 people, including many people with epilepsy, members of all eleven epilepsy associations found, health professionals and representatives of the Brazilian chapters of IBE and ILAE and the Brazilian Ministry of Health. This first meeting resulted in a National Movement expressed every year through the National Week of Epilepsy and National Meeting of Lay Associations. Discussion: This strategy, developed by ASPE, was simple and effective, and in a very short time a national movement was active. These actions could be reproduced in any country developing a campaign against epilepsy. it is important to consider that this is a process of empowerment, thus people with epilepsy need to take actions into their own hands and to be active participants

Stigma and attitudes on epilepsy - A study with secondary school students

Purpose: To evaluate whether an inappropriate attitude towards a person having an epileptic seizure contributes to the stigma found in society and whether an appropriate attitude helps to diminish it in the short term; to perform a long term investigation about information remembered and stigma perception after an educational lecture. Method. This study was performed in two steps: Step 1. students of first year of high school of two schools in Campinas completed a questionnaire including the Stigma Scale of Epilepsy following a seizure demonstration. They were divided into three groups: a) one group had a demonstration of proper attitudes towards someone having an epileptic seizure; b) one group was shown incorrect procedures; c) control group. After the completion of the questionnaire, an educational lecture about epilepsy was given. Step 2: six months later, the questionnaire was re-administered. Results: The comparison between the four groups (step 1 and step 2) show a significant difference (Anova (3,339)=2.77; p=0.042). Pairwise comparison using Fisher's Least-Significant-Difference Test showed a significant difference between the group shown incorrect procedures (step 1) versus step 2, and the control group (step 1) versus step 2, but no difference between the group shown correct procedures (step 1) versus step 2. Discussion: Exhibiting proper attitudes towards a person experiencing an epileptic seizure may cause significant differences among the subjects' degrees of stigma towards people with epilepsy. It is therefore fundamental that there should be de-stigmatization campaigns provided, to correct information and provide appropriate education

Stigma scale of epilepsy - Validation process

Purpose: To validate a Stigma Scale of Epilepsy (SSE). Methods: The SSE was completed by 40 adult with epilepsy attending an Outpatient Epilepsy Clinic at the University Hospital of UNICAMP, and by 40 people from the community. People were interviewed on an individual basis; a psychologist read the questions to the subjects who wrote the answers in a sheet. The procedure was the same for all the subjects and completion took around ten minutes. Results: The SSE has 24 items. The internal consistency of the SSE showed alpha. Cronbach's coefficient 0.88 for the patients with epilepsy and 0.81 for the community. The overall mean scores of the Stigma Scale of Epilepsy formula were: 46 (SD=18.22) for patients and 49 (SD=13.25) for the community where a score of 0 would suggest no stigma, and 100 maximum stigma. Discussion: The SSE has satisfactory content validity and high internal consistency. It allows the quantification of the perception of stigma by patients and people from community; this can then be used for interventional studies, such as mass media campaign in minimizing the negative facets of stigma

Psychosocial aspects of epilepsy: a wider approach.

SUMMARY: Epilepsy is one of the most serious neurological conditions and has an impact not only on the affected individual but also on the family and, indirectly, on the community. A global approach to the individual must take into account cognitive problems, psychiatric comorbidities and all psychosocial complications that often accompany epilepsy. We discuss psychosocial issues in epilepsy with special focus on the relationship between stigma and psychiatric comorbidities. Social barriers to optimal care and health outcomes for people with epilepsy result in huge disparities, and the public health system needs to invest in awareness programmes to increase public knowledge and reduce stigma in order to minimise such disparities

Nivat's conjecture holds for sums of two periodic configurations

Nivat's conjecture is a long-standing open combinatorial problem. It concerns two-dimensional configurations, that is, maps $\mathbb Z^2 \rightarrow \mathcal A$ where $\mathcal A$ is a finite set of symbols. Such configurations are often understood as colorings of a two-dimensional square grid. Let $P_c(m,n)$ denote the number of distinct $m \times n$ block patterns occurring in a configuration $c$. Configurations satisfying $P_c(m,n) \leq mn$ for some $m,n \in \mathbb N$ are said to have low rectangular complexity. Nivat conjectured that such configurations are necessarily periodic. Recently, Kari and the author showed that low complexity configurations can be decomposed into a sum of periodic configurations. In this paper we show that if there are at most two components, Nivat's conjecture holds. As a corollary we obtain an alternative proof of a result of Cyr and Kra: If there exist $m,n \in \mathbb N$ such that $P_c(m,n) \leq mn/2$, then $c$ is periodic. The technique used in this paper combines the algebraic approach of Kari and the author with balanced sets of Cyr and Kra.Comment: Accepted for SOFSEM 2018. This version includes an appendix with proofs. 12 pages + references + appendi

Age, Comorbidity, Frailty in Observational and Analytic Studies of Neurological Diseases

BACKGROUND: Comorbidities are rarely taken into account in studies of neurological conditions although they may be a confounder of the outcome and treatment. The relationship between comorbidities and neurological conditions is also problematic as comorbidities may be symptoms of the underlying cause of the neurologic condition or long-term adverse effects of the treatment. SUMMARY: There is evidence that several common neurological conditions have an increased burden of somatic and psychiatric comorbidities compared with matched samples from the general population. Depression is probably the most common comorbidity. Both psychiatric and somatic comorbidities have been shown to account for some of the premature mortality encountered in these neurological conditions. Comorbidities and age can also be important factors in the response and tolerance to treatment, and can alter the general outcome of a disease. KEY MESSAGES: Age and comorbidities should not be overlooked in the observation and assessment of neurological conditions and their treatment

Learning from the comorbidities of epilepsy

PURPOSE OF REVIEW: Comorbidities are a common feature in epilepsy, but neither the entire spectrum nor the significance of such comorbidities has been fully explored. We review comorbidities associated with epilepsy and their associated burden, provide an overview of relationships, and discuss a new conceptualization of the comorbidities. RECENT FINDINGS: The epidemiology of the comorbidities of epilepsy and effects on health outcomes, healthcare use, and healthcare expenditures have been partly delineated. Distinct mechanisms of the associations have been suggested but not entirely ascertained. Movement from conceptualizing epilepsy as a condition to a symptom-complex has occurred. SUMMARY: Comorbidities are common among people with epilepsy and are associated with poorer clinical outcomes and quality of life, greater use of health resources, and increased expenditure. Becoming aware of the associated mechanisms and their uncertainty is central to understanding the relationships between epilepsy and comorbid health conditions, which have implications for diagnosis and screening, medical management, and surgical management. Conceptualizing comorbidities of epilepsy as precipitating factors and epilepsy as the symptom will improve the understanding of epilepsy and catalyze research and improvements in clinical practice

Effects of the COVID-19 pandemic on medication adherence: In the case of antiseizure medications, A scoping review

Since early 2020, an unprecedented public global health emergency caused by coronavirus (COVID-19) resulted in national governments' imposing confinement measures. Lockdowns and isolation during pandemics complicate disease management and medication adherence. Chronic conditions, such as epilepsy, require linear adherence patterns to prevent breakthrough seizures and to reduce the risk of sudden unexpected death. Limited access to health care facilities for routine care and medicines management further hampers this. Social isolation exacerbates stress, depression and decreases social support, which may combine to reduce adherence to antiseizure medication (ASM) during the pandemic. METHODS: We conducted a literature scoping review to explore ASM adherence among people with epilepsy, non-infected or infected SARS-CoV-2 or recovered from COVID-19 during the pandemic and explore risk factors for adherence. We search Pubmed for articles up to 16 September 2021. Search terms included the thematic of ASM adherence and COVID-19. We adhered to the PRISMA guidelines for reporting scoping reviews. RESULTS: Six articles were retained after the screening, which covered four overarching themes: change of ASM compliance and as risk factors, lack of follow-up, difficulties accessing ASM, and behavioural risk factors. Our review underscores the lack of evidence on ASM adherence among people with epilepsy infected or recovered from COVID-19. No study retrieved took place in a low-income setting, warranting a cautionary approach to be employed when extrapolating findings on a global scale. RECOMMENDATIONS FOR PRACTICE: Missing information on past SARS-CoV2 infections impact people with epilepsy precludes exploring a direct effect of SARS-CoV2 on ASM adherence. A more comprehensive chronic disease model based on the burden of co-cardiovascular and neuro-behavioural comorbidities should be envisaged for this population in preparation for future pandemics. A monitoring algorithm needs to be in place to establish a telemedicine framework and community pharmacists' potential to contribute to the model recognised