Idiopathic Generalized Epilepsies Misdiagnosed As Partial Epilepsies [epilepsias Generalizadas Idiopáticas Diagnosticadas Incorretamente Como Epilepsias Parciais]

Idiopathic generalized epilepsy (IGE) is often not recognized with serious consequences on the sufferers. We examined factors contributing to the missed diagnosis of IGE in 41 adults attending our epilepsy clinic with diagnosis of partial epilepsy who had semiology or EEG findings suggesting a possible differential diagnosis. After careful re-evaluation, the diagnosis of IGE was established in 25 patients: 22 (88%) with JME, one with juvenile absence, one with perioral myoclonia with absences, one with eyelid myoclonia with typical absences. Myoclonic jerks, the hallmark of the JME and other IGE, were not usually reported by patients or misdiagnosed as focal motor seizures. Brief and infrequent absence seizures and focal EEG abnormalities were other factors contributing to not recognizing JME. All 25 patients did not achieve seizure control before re-evaluation of diagnosis. After appropriate diagnosis of IGE and change of AED to valproate or valproic acid, 19 (76%) became seizure free and six (24%) had a significant improvement on seizure control. Association with lamotrigine provided further improvement in three of these patients. An appropriate questioning to identify myoclonic and absence seizures and a proper interpretation in the context of whole clinical constellation are essential for a correct seizure classification and diagnosis of IGE in adults.603 B788796Proposal for revised clinical and electroencephalographic classification of epileptic seizures (1981) Epilepsia, 22, pp. 489-501Proposal for revised classification of epilepsies and epileptic syndromes (1989) Epilepsia, 30, pp. 389-399Panayiotopoulos, C.P., Tahan, R., Obeid, T., Juvenile myoclonic epilepsy: Factors of error involved in the diagnosis and treatment (1991) Epilepsia, 32, pp. 672-676Panayiotopoulos, C.P., Obeid, T., Waheed, G., Differentiation of typical absence seizures in epileptic syndromes: A video EEG study of 224 seizures in 20 patients (1989) Brain, 112, pp. 1039-1056Aliberti, V., Grunewald, R.A., Panayiotopoulos, C.P., Chroni, E., Focal electroencephalographic abnormalities in juvenile myoclonic epilepsy (1994) Epilepsia, 35, pp. 297-301Panayiotopoulos, C.P., Koutroumanidis, M., Giannakodimos, S., Agathonikou, A., Idiopathic generalised epilepsy in adults manifested by phantom absences, generalised tonic-clonic seizures, and frequent absence status (1997) J Neurol Neurosurg Psychiatry, 63, pp. 622-627Berkovic, S.F., Andermann, F., Andermann, E., Gloor, P., Concepts of absence epilepsies: Discrete syndromes or biological continuum (1987) Neurology, 37, pp. 993-1000Guideline seven: A proposal for standard montages to be used in clinical EEG (1994) J Clin Neurophysiol, 11, pp. 30-36Panayiotopoulos, C.P., Perioral myoclonia with abscences: A new syndrome (1994) Epileptic Seizures and Syndromes, pp. 143-153. , Wolf P. (ed) London: John Libbey & CompanyAppleton, R.E., Panayiotopoulos, C.P., Acomb, B.A., Beirne, M., Eyelid myoclonia with typical absences: An epilepsy syndrome (1993) J Neurol Neurosurg Psychiatry, 56, pp. 1312-1316Williamson, P., Spencer, S.S., Clinical and EEG features of complex partial seizures of extratemporal origin (1986) Epilepsia, 27 (SUPPL.), pp. 46-63Quesney, L.F., Cendes, F., Olivier, A., Dubeau, F., Andermann, F., Intracranial electroencephalographic investigation in frontal lobe epilepsy (1995) Adv Neurol, 66, pp. 243-258Panayiotopoulos, C.P., Chroni, E., Daskalopoulos, C., Baker, A., Rowlinson, S., Walsh, P., Typical absence seizures in adults: Clinical, EEG, video-EEG findings and diagnostic/syndromic considerations (1992) J Neurol Neurosurg Psychiatry, 55, pp. 1002-1008Gelisse, P., Genton, P., Thomas, P., Rev, M., Samuelian, J.C., Dravet, C., Clinical factors of drug resistance in juvenile myoclonic epilepsy (2001) J Neurol Neurosurg Psychiatry, 70, pp. 240-243Lombroso, C.T., Consistent EEG focalities detected in subjects with primary generalized epilepsies monitored for two decades (1997) Epilepsia, 38, pp. 797-812Janz, D., Juvenile myoclonic epilepsy: Epilepsy with impulsive petit mal (1989) Cleve Clin J Med, 56 (SUPPL.), pp. S23-33Yacubian, E.M.T., Epilepsia mioclonica juvenil (2000) Epilepsia, pp. 215-222. , Guerreiro CAM, Guerreiro MM, Cendes F, Lopes-Cendes I (eds.) São Paulo: Lemos EditorialMontalenti, E., Imperiale, D., Rovera, A., Bergamasco, B., Benna, P., Clinical features, EEG findings and diagnostic pitfalls in juvenile myoclonic epilepsy: A series of 63 patients (2001) J Neurol Sci, 184, pp. 65-70Janz, D., The idiopathic generalized epilepsies of adolescence with childhood and juvenile age of onset (1997) Epilepsia, 38, pp. 4-11Panayiotopoulos, C.P., Obeid, T., Tahan, A.R., Juvenile myoclonic epilepsy: A 5-year prospective study (1994) Epilepsia, 35, pp. 285-296Delgado-Escueta, A.V., Enrile-Bacsal, F., Juvenile myoclonic epilepsy of Janz (1984) Neurology, 34, pp. 285-294Capovilla, G., Rubboli, G., Beccaria, F., Lorenzetti, M.E., Montagnini, A., Resi, C., A clinical spectrum of the myoclonic manifestations associated with typical absences in childhood absence epilepsy. A video-polygraphic study (2001) Epileptic Disord, 3, pp. 57-62King, M.A., Newton, M.R., Jackson, G.D., Epileptology of the first-seizure presentation: A clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients (1998) Lancet, 352, pp. 1007-1011Meencke, H.J., Janz, D., Neuropathological findings in primary generalized epilepsy: A study of eight cases (1984) Epilepsia, 25, pp. 8-21Opeskin, K., Kalnins, R.M., Halliday, G., Cartwright, H., Berkovic, S.F., Idiopathic generalized epilepsy: Lack of significant microdysgenesis (2000) Neurology, 55, pp. 1101-1106Genton, P., Gelisse, P., Thomas, P., Dravet, C., Do carbamazepine and phenytoin aggravate juvenile myoclonic epilepsy? (2000) Neurology, 55, pp. 1106-1109Fernando-Dongas, M.C., Radtke, R.A., Vanlandingham, K.E., Husain, A.M., Characteristics of valproic acid resistant juvenile myoclonic epilepsy (2000) Seizure, 9, pp. 385-388Genton, P., When antiepileptic drugs aggravate epilepsy (2000) Brain Dev, 22, pp. 75-80Liporace, J.D., Sperling, M.R., Dichter, M.A., Absence seizures and carbamazepine in adults (1994) Epilepsia, 35, pp. 1026-102

Recently Diagnosed Epilepsies: Adherence, Tolerance And Prognosis Of The First Epileptic Drug [epilepsias Recem-diagnosticadas: Aderencia, Tolerancia E Prognostico Com A Primeira Droga]

There are few data related to recently diagnosed epilepsy (RDE) in Brazil. We followed up 78 patients ages ranging from 6 to 61 years (average 17.96) with RDE for 12.68 months (1-29 months) aiming to evaluate adherence, tolerance and efficacy of the first epileptic drug used. All patients had partial seizures with or without secondarily generalized and tonic-clonic seizures for an average of 7.68 months (4 days to 7 years). We found 11 patients (14.10%) not adherent to the treatment and 14 (17.94%) with side-effects that provoked the drug substitution. The most prevalent side-effects were dysmorphic signs such as hirsutism and gingival hyperplasia, gastro-intestinal symptoms, idiosyncratic reations and sedation. Sixty-six per cent of the patients were seizure-free after 8 weeks and 63.8% for 56 weeks of treatment. These data are consistent with the international literature. The ratio of non-adherent to the treatment was high (14.10%), probably due to socio-economic and cultural aspects of the studied population. We stressed that 17.94% of the patients do not tolerate the first antiepileptic drug, requiring substitution. Approximately 2/3 of the patients with RDE obtained good results with the first medication.81151

Desempenho de cinco clones jovens de seringueira na região do Planalto Ocidental Paulista Performance of five young clones of rubber tree in the São Paulo Occidental plateau region

A Região do Planalto Ocidental Paulista tem se destacado como pólo produtor de borracha natural. Visando fornecer informações sobre a adaptação dos clones de seringueira [Hevea brasiliensis (Wildd. ex. Adr. de Juss) Müell. Arg.] RRIM 600, GT 1, RRIM 701, IAN 873 e PB 235, em São José do Rio Preto (SP), realizaram-se avaliações de alguns caracteres de sua biologia, pelo acompanhamento das trocas gasosas e mensuração do desenvolvimento vegetativo durante os primeiros 18 meses após o enxerto sobre Tjir 16. A altura de RRIM 600 atingiu, em média, 3,74 m e o diâmetro do caule de IAN 873 e RRIM 600, 2,50 cm. PB 235 apresentou o menor índice relativo de crescimento durante o período. No período úmido, os valores das trocas gasosas não diferiram significativamente entre os clones, com valores médios da taxa fotossintética de 9,45 mmol.m-2.s-1; para a taxa de transpiração, 3,84 mmol.m-2.s-1, e para a condutância estomática, de 0,096 mol.m-2.s-1. Diferenças entre os valores de trocas gasosas ocorreram apenas no período seco, com redução mais acentuada para PB 235. Considerando o conjunto dos caracteres analisados, o desempenho dos clones IAN 873 e RRIM 600 foi superior, e do clone PB 235, inferior.<br>The region of São Paulo Occidental Plateau is well known for its part as a major producer of natural rubber. In order to obtain information about adaptation of rubber tree clones [Hevea brasiliensis (Wildd. ex. Adr. de Juss) Müell. Arg.] RRIM 600, RRIM 701, IAN 873, PB 235 and GT 1, in the city of São José do Rio Preto some biologic characteristics were evaluated. Analysis were performed by monitoring gas exchanges and by measuring vegetative development, during the 18 months after engraft on the Tjir 16 clonal rootstocks. The height of RRIM 600 reached a mean of 3,74 m, and the diameter of the stem of IAN 873 and RRIM 600 reached the mean of 2,50 cm. Clone PB 235 presented the lowest relative growth during the period. During the wet period, the values of the gas exchange did not show significant variation among the clones; the mean value of photosynthetic rates was 9,45 mmol.m-2.s-1; of transpiration rates was 3,84 mmol.m-2 s-1, and of stomatic conductance was 0,096 mol.m-2 s-1. Differences in values of gas exchanges were observed only during the dry period, with notably large reduction for clone PB 235. The characteristics analyzed lead to the conclusion that performances of clones IAN 873 and RRIM 600 were superior, and that of clone PB 235 were inferior