Treatment of epilepsy in childhood

Objective: due to the development of new antiepileptic drugs, epilepsy treatment has presented substantial progress in the last decade. In spite of presenting more adequate profile, these drugs have not shown better efficiency in seizure control than the traditional drugs. The objective of this revision is to provide up-to-date data for the treatment of epilepsy in childhood and the role of the new antiepileptic drugs. Sources: bibliographic review has been performed at Medline for the last 10 years, and the most pertinent papers and abstracts presented in International Epilepsy Meetings were selected. Summary of the findings: the new antiepileptic drugs could be indicated in the treatment of some specific epileptic syndromes. Serious side effects have been described with the use of these drugs. Conclusions: the traditional drugs must be considered as the primary choice in the treatment of ordinary epilepsy.Objetivo: com o desenvolvimento de novas drogas antiepilépticas, a terapêutica das epilepsias apresentou substancial progresso na última década. No entanto, apesar do perfil farmacocinético mais adequado, estas não têm mostrado maior eficácia no controle das crises do que as drogas tradicionais. O objetivo desta revisão é fornecer dados atuais do tratamento das epilepsias da infância e sobre o papel das novas drogas antiepilépticas. Fontes dos dados: procedemos a um levantamento bibliográfico no Medline, abrangendo os últimos dez anos, e selecionamos os artigos publicados na literatura e os últimos trabalhos apresentados em congressos internacionais, que relatam resultados do tratamento da epilepsia na infância com drogas antiepilépticas. Síntese dos dados: as novas drogas antiepilépticas podem ser indicadas no tratamento de algumas síndromes epilépticas específicas. Efeitos colaterais sérios são descritos com algumas delas. Conclusões: as drogas tradicionais devem ser consideradas como as de primeira escolha no tratamento das epilepsias em geral.Universidade Federal de São Paulo (UNIFESP) Departamento Escola Paulista de Medicina de Neurologia e NeurocirurgiaUNIFESP, Depto. Escola Paulista de Medicina de Neurologia e NeurocirurgiaSciEL

Generics in the treatment of epilepsy: a reflection

OBJECTIVE: We discuss some controversial aspects with prescription of generic drugs (GD) and the problems concerning bioequivalence in the treatment of epilepsy. Some antiepileptic drugs (AED) are poorly soluble in water, have nonlinear kinetics and a narrow therapeutic range, implying that problems with bioequivalence are likely to occur. There are clearly advantages (cost saving) and disadvantages (loss of seizure control or drug toxicity) in prescribing generics AED. METHODS: Review of literature. RESULTS AND CONCLUSION: The main information is about classical AED (phenytoin, carbamazepine and valproate). Regarding the new AED we found only one poster presentation related to lamotrigine substitution. The level of evidence is, generally, weak, based on case-series and expert opinion without explicit critical appraisal (except in phenytoin with level of evidence moderate, based on some analytical studies). We may allow the use of generics for epilepsy treatment. However, this opens the possibility of successive substitution of different formulations which may even be life threatening.OBJETIVOS: Discutimos aspectos controversos para a prescrição de medicamentos genéricos no tratamento das epilepsias e problemas relacionados à biodisponilidade e bioequivalência. Algumas drogas antiepilépticas (DAE) apresentam baixa solubilidade em água, apresentam cinética não linear e faixa terapêutica estreita, dados sugestivos da ocorrência de problemas relacionados à bioequivalência. MÉTODOS: Revisão da literatura. RESULTADOS E CONCLUSÕES: Há mais informações sobre as DAE tradicionais (fenitoína, carbamazepina e valproato) e apenas uma comunicação em congresso foi encontrada sobre a substituição de uma nova DAE, a lamotrigina. O nível de evidência é fraco, baseado em séries de casos e opinião de especialistas, com exceção talvez da fenitoína para a qual há alguns estudos analíticos. Podemos permitir o uso de genéricos para o tratamento das epilepsias, desde que tenhamos em mente que este abrirá a possibilidade de substituições sucessivas de formulações durante o tratamento, com conseqüências imprevisíveis como a recorrência de crises e suas conseqüências ou o aparecimento de efeitos adversos.UNIFESP Departamento de Neurologia e Neurocirurgia Unidade de Pesquisa e Tratamento de EpilepsiasUNIFESP, Depto. de Neurologia e Neurocirurgia Unidade de Pesquisa e Tratamento de EpilepsiasSciEL

Manifestações neurológicas da COVID-19 na população pediátrica - revisão de literatura e desenvolvimento de casos clínicos com finalidades didáticas

O COVID-19 é uma síndrome respiratória aguda com diferentes sintomas não respiratórios relatados, incluindo manifestações neurológicas. O comprometimento do sistema nervoso durante a infecção ocorre em adultos e crianças, porém a população pediátrica apresenta particularidades no curso clínico da doença. Discutimos as manifestações neurológicas da COVID-19 em crianças, desenvolvendo casos para serem aplicados em disciplinas dentro da metodologia baseada em problemas. A pesquisa foi desenvolvida tendo em vista os graduandos em medicina: foi realizada uma revisão da literatura sobre o tema; em seguida, observado pela seleção de 16 artigos revisados, resumidos e discutidos. Este artigo discute os procedimentos, desafios e resultados de cada etapa da agenda de pesquisa. Na revisão da literatura encontramos diferentes manifestações neurológicas na população pediátrica. Outros aspectos relevantes ao tema também foram encontrados, como: associação de comorbidades, alterações em exames complementares, prognósticos e hipóteses fisiopatológicas. Com base nos achados, criamos três casos clínicos para aplicação na graduação. Concluímos que o tema tem grande importância clínica e de aprendizado, mas ainda são necessárias mais pesquisas sobre o assunto.The COVID-19 is an acute respiratory syndrome with different reported non-respiratory symptoms, neurological manifestations included. The nervous system impairment during the infection occurs in adults and children, yet the pediatric population has particularities in the clinical course of the disease. We discuss the neurological manifestations of COVID-19 in children, developing cases to be applied in disciplines within a “problem-based” learning methodology. The proceedings of the research were developed with undergraduate medicine students in mind: a literature review on the topic was performed; then observed by the selection of 16 articles reviewed, summarized and discussed. This paper discusses proceedings, challenges and outcomes, of each stage of the research’s agenda. In the literature review, we found many neurological manifestations in the pediatric population. Other aspects relevant to the topic were also found, such as: association of comorbidities, alterations in complementary exams, prognoses and pathophysiological hypotheses. Based on the findings, we created three clinical cases for application in undergraduate studies. We concluded that the topic has great clinical and learning importance, yet more research is needed on the subject

Hot Topics: Critical information literacy for global citizenship, social justice, and community participation

Justification for embedding information literacy instruction as part of the college curriculum can come in many forms. From responding to the proliferation of unreliable sources of news in hyper-partisan times, to heeding employers’ calls for improved workplace information-seeking skills, to addressing the integral role of information literacy in critical thinking, there are numerous avenues at our disposal when promoting the value of librarian instruction. But, what about the more entrenched social issues that impact our campuses and communities more broadly? What role does information literacy instruction have in addressing long held prejudices? How might it be a component of efforts to expose and redress hidden injustices? Librarians and a faculty member from one small college will discuss new curriculum developed collaboratively on their campus that embeds and advocates information literacy as a means of action against important issues that today’s students are keen to address. In this session, the presenters will discuss the development of an embedded set of instruction sessions that explore information literacy outcomes through a social justice lens, and situate critical information literacy as integral to integrative thinking and interdisciplinary ways of knowing. Emphasis is placed on exploring ways in which students could apply critical awareness to become active, global citizens and make positive change to their communities, through personal and professional choices. A range of topics, rotating and transforming each academic year, are addressed through the lens of informational and professional/disciplinary perspectives. These topics, which will continue to evolve over time, have included the impact of elections on local and professional communities; gender discrimination in professional settings; contemporary social justice movements; and human trafficking. This session will discuss how the presenters have developed adaptable lessons that address these evolving, highly relevant topics through the lens of critical information literacy. The presenters will outline the steps they have taken to meet both the integrative and interdisciplinary needs of the faculty, as well as the information literacy outcomes of the library. In doing so, this presentation will highlight new paths towards meaningful and sustainable models of librarian and faculty collaboration. This session will also illustrate how librarians can expand the scope of information literacy for their students by relying less on ‘library-centric’ instruction. Through guided inquiry and dialogue, students are encouraged to draw connections between available information, their professional/disciplinary expertise, and efforts to remedy various forms of injustice. This method emphasizes the “real world” implications of the skills, practices, and dispositions that librarian instruction seeks to promote

Praxis induction. Definition, relation to epilepsy syndromes, nosological and prognostic significance. A focused review

Purpose: There is increasing awareness that reflex epileptic mechanisms provide unique insight into ictogenesis in human epilepsies. Several of the described triggers have in common that they imply complex visuomotor coordination and decision-making; they are today regarded as variations of one principle, i.e. praxis induction (PI). This focused review considers PI from the aspects of history and delineation, clinical and electroencephalographic presentation, syndromatic relations, prevalence, mechanisms of ictogenesis and nosological implications, treatment and prognosis.Methods: We reviewed a series of published articles and case reports on PI in order to clarify clinical and electroencephalographic findings, treatment and outcome.Results: Findings of both induction and inhibition by the same stimuli suggest widening the reflex epilepsy concept into a broader one of epilepsies with exogenous modification of ictogenesis. PI is closely related to juvenile myoclonic epilepsy (JME) where hyperexcitability and hyperconnectivity of the entire network of visuomotor coordination seem to provide the precondition for eliciting reflex myocloni in the musculature active in the precipitating task.Conclusion: the conclusions on ictogenesis derived from PI support the concept of JME as a system disorder of the brain. (C) 2014 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Neurol & Neurosurg, São Paulo, BrazilDanish Epilepsy Ctr, Dept Neurol, Dianalund, DenmarkUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, São Paulo, BrazilWeb of Scienc

A Critical Discourse Analysis Of The Professoriate And The Embodiment Of Epistemic Coloniality/whiteness: A Call For A Contemplative Approach To Academic Freedom

Higher education in the United States has largely been influenced by colonial discourse. Archetypes of the academy, namely the professoriate, reflect and inhabit traces of Western or European schools of thought and colonial genealogy. Inspired by Black, Indigenous Students of Color (BISOC) at a small, private college in the Northeast, this writing aims to unveil the colonial lineage embodied by the professoriate through habits of whiteness. With the use of Critical Discourse Analysis and reflective anecdotes, observations are made about the professoriate’s epistemology and academic freedom’s role in reinforcing colonial epistemic principles, such as objectivity, mastery and autonomy. In so doing, critical questions about the epistemological tenets that prime the professoriate and academic freedom call upon more complex theories, such as sociomateriality, to rethink, or reorient, the professoriate

IV Latin-American Summer School on Epilepsy: special call to the brazilian epileptologists

INTRODUCTION: The development of new treatments and effective means to prevent the epilepsies, the most prevalent neurological disorder and that affects around 1% of worldwide population, must be the main goal of the health systems of a nation. OBJETIVES: Following these reasoning, the goal of our article is to promote the IV Latin-American Summer School on Epilepsy (LASSE) among Brazilian epileptologists.INTRODUÇÃO: Produzir tratamentos novos e efetivos aliados à prevenção adequada das epilepsias, a doença neurológica crônica grave mais comum e que acomete aproximadamente 1% da população mundial, deve ser o principal objetivo dos sistemas de saúde de uma nação. OBJETIVOS: Nesse sentido, o principal objetivo de nosso artigo é divulgar a IV Escola Latino-Americana de Verão em Epilepsia entre os epileptologistas brasileiros.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Unidade de Pesquisa e Tratamento das Epilepsias (UNIPETE)UNIFESP, EPM, Unidade de Pesquisa e Tratamento das Epilepsias (UNIPETE)SciEL

Psychiatric and behavioral effects of the antiepileptic drugs and their action as mood stabilizers

INTRODUCTION: The association between epilepsy, psychiatric disorders (PD) and antiepileptic drugs (AED) is among the most frequent and important aspects of epileptology. According to most recent data in literature, AED can act as protecting or predisposing to psychiatric disorders. OBJECTIVE: Data regarding the psychiatric and behavioral effects of AED and its action as mood stabilizers were reviewed. In addition, we discuss the relationship between AED effects in predisposing or protect against PD and its respective mechanism of action. CONCLUSION: AED do not have only antiepileptic properties, but may be associated to positive or negative behaviors. However, the appearance of PD is associated to both AED mechanism of action and the patient's individual predisposing.INTRODUÇÃO: Um dos aspectos mais estudados da epileptologia atual é a associação existente entre os transtornos psiquiátricos (TP) e as drogas antiepilépticas (DAE). De acordo com dados recentes na literatura, as DAE podem exercer um papel protetor ou de predisposição ao aparecimento de TP. OBJETIVO: O presente trabalho tem como objetivo fazer uma revisão dos efeitos psiquiátricos e comportamentais das DAE e de sua ação como estabilizadores do humor, bem como de relacionar seu papel protetor ou de predisposição ao aparecimento de TP com seus respectivos mecanismos de ação. CONCLUSÃO: As DAE não apresentam apenas propriedades antiepilépticas, possuindo também efeitos comportamentais positivos ou negativos. O aparecimento de TP, no entanto, está associado tanto ao mecanismo de ação da DAE como à predisposição individual e à condição emocional preexistente do paciente.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurologia e NeurocirurgiaUNIFESP, Depto. de Neurologia e NeurocirurgiaSciEL

Psychiatric disorders in epilepsy: a proposal for classification by the ILAE commission on neuropsychiatry

INTRODUCTION: The relationship between psychiatric disorders (PD) and epilepsy is among the most frequent and important aspects of epileptology. PD are present in all epileptic syndromes and contribute to increase the difficulties in treating these patients. OBJECTIVE: We reviewed the classifications for the PD in epilepsy and highlighted the proposal by the ILAE Commission on Neuropsychiatry. CONCLUSION: The classification proposal by the ILAE attempted to separate disorders comorbid with epilepsy and those that reflect ongoing epileptiform activity from epilepsy-specific disorders and are based on clinical and descriptive symptoms rather than in etiological classification. It also presents clear and operational criteria that could be of greater utility for future studies of PD in epilepsy.INTRODUÇÃO: Um dos aspectos mais importantes da epileptologia é o da sua relação com as comorbidades psiquiátricas. Transtornos psiquiátricos (TP) são associados a praticamente todas as síndromes epilépticas e contribuem para uma maior dificuldade no manejo desses pacientes. OBJETIVO: O presente trabalho tem como objetivo fazer uma revisão das classificações dos TP na epilepsia e destacar a proposta elaborada pela Comissão de Neuropsiquiatria da ILAE. CONCLUSÃO: A proposta de classificação elaborada pela ILAE procurou diferenciar os TP que ocorrem em comorbidade daqueles que refletem atividade epileptiforme ou que ocorrem especificamente na epilepsia, sendo baseada em aspectos clínicos e descritivos mais do que em etiologias. Apresenta ainda critérios bastante claros e operacionais, constituindo-se de grande utilidade para futuros estudos dos quadros psiquiátricos na epilepsia.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) UNIPETEUNIFESP, EPM, UNIPETESciEL