Epilepsy: Is there hope?

Epilepsy is a highly prevalent chronic neurologic disorder and leads to social, behavioural, health and economic consequences. 'Treatment gap' varies from 10 per cent in developed countries to 75 per cent in low-income countries. Stigma and discrimination related to epilepsy are prevalent worldwide.

Delineating behavioral and cognitive phenotypes in juvenile myoclonic epilepsy: Are we missing the forest for the trees?

Introduction: Patients with juvenile myoclonic epilepsy (JME) have executive dysfunction and impulsive traits. There are lines of evidence that JME is a heterogeneous epilepsy syndrome considering outcome. In this study, we aimed to analyze this heterogeneity beyond seizure control.

Patterns of seizure control in patients with mesial temporal lobe epilepsy with and without hippocampus sclerosis.

Objective: Patients with mesial temporal lobe epilepsy (MTLE) may present unstable pattern of seizures. We aimed to evaluate the occurrence of relapse-remitting seizures in MTLE with (MTLE-HS) and without (MTLE-NL) hippocampal sclerosis.

Method: We evaluated 172 patients with MTLE-HS (122) or MTLE-NL (50).

Comorbidities associated with epilepsy and headaches.

Unlabelled: Comorbidities are often associated with chronic neurological diseases, such as headache and epilepsy.

Objectives: To identify comorbidities associated with epilepsy and headaches, and to determine possible drug interactions.

Methods: A standardized questionnaire with information about type of epilepsy/headache, medical history, and medication was administered to 80 adult subjects (40 with epilepsy and 40 with chronic headache).

Structural abnormalities of the thalamus in juvenile myoclonic epilepsy.

Studies have suggested that the thalamus is a key structure in the pathophysiology of juvenile myoclonic epilepsy. The objective of the present investigation was to examine the thalami of patients with juvenile myoclonic epilepsy using a combination of multiple structural neuroimaging modalities. The association between these techniques may reveal the mechanisms underlying juvenile myoclonic epilepsy and help to identify the neuroanatomical structures involved.

Quality of life in pregnant women with epilepsy versus women with epilepsy.

It is assumed that 25% of patients with epilepsy are women of fertile age and 0.3% to 0.6% of all children are born of mothers with epilepsy.

Modification in body weight associated with antiepileptic drugs.

Unlabelled: Antiepileptic drugs (AED) may cause body weight changes.

Objective: To evaluate the dietary habits and body weight associated with AED in epileptic patients.

Method: Sixty-six patients were subjected to two interviews, and had their weight and body mass index calculated and compared at both times, interval between six to eight months.

Amyotrophic lateral sclerosis: prospective study on respiratory parameters.

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.

Correlation between quantitative EEG and MRI in idiopathic generalized epilepsy.

The objective of this study was to investigate the relationship between the focal discharges sometimes observed in the electroencephalogram of patients with idiopathic generalized epilepsies and subtle structural magnetic resonance imaging abnormalities. The main hypothesis to be assessed is that focal discharges may arise from areas of structural abnormality which can be detected by quantitative neuroimaging. Focal discharges were used for quantitative electroencephalogram source detection.

Focal electrical status (FES): a new finding associated with polymicrogyria.

Polymicrogyria (PMG), a malformation of cortical organization, may, occasionally, be associated with electrical status epilepticus of sleep and focal electrical status. The aim of this study was to better characterize the latter association. This was an historic cohort study.

Guidelines for drug treatment of epilepsy: a critical review.

This article critically reviews the role of evidence-based medicine and its guidelines, from their logistic preparation to their interpretation. The strengths and weaknesses of the methodological points are presented, as well the reasons for the extreme popularity of the guidelines in developed countries. The review discusses the main foundations of the most cited guidelines and some recent large studies.

Accident risk in patients with epilepsy.

Objective: To compare the risk of accidents in patients with uncontrolled seizures, in seizure-free patients, and in patients 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 Clínicas of UNICAMP.

The clinical spectrum of malformations of cortical development.

Background: Malformations of cortical development (MCD) usually manifest in childhood with epilepsy, developmental delay and focal neurological abnormalities.

Objective: To evaluate the presentation and severity of epilepsy in the different types of MCD.

Method: We evaluated the first 100 consecutive patients with a neuroimaging diagnosis of MCD.

Headache during gestation: evaluation of 1101 women.

Objective: The purpose of this study was to evaluate the presence of headache in women with a previous history or new-onset headache during the current gestation, classify the findings, and describe the clinical characteristics and outcome of the headache.

Methods: From January/1998 to June/2002 we prospectively evaluated 1101 pregnant women (12-45 years old), with a history of headache, at two prenatal clinics and an inpatient obstetric public hospital. Women were interviewed using a semi-structured questionnaire during the first, second, and third gestation trimesters and immediately after delivery.

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.

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.

Clinical and electroencephalographic features of patients with polymicrogyria.

Polymicrogyria is a malformation of cortical organization. The aim of this historic cohort study was to describe clinical and EEG features of patients with polymicrogyria. Patients underwent clinical and neurologic examination and a prolonged routine EEG to allow recording during sleep.

First, do no harm: the risks of overtreating children with epilepsy.

Background: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated.

Objective: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control.

Method: This was a prospective study.

Interictal EEG in temporal lobe epilepsy in childhood.

The authors clarified the value of interictal discharges and verified which extratemporal regions may also show epileptiform activity in temporal lobe epilepsy (TLE) in childhood. Thirty consecutive patients aged 3 to 18 years (mean age = 12.16 years; 16 male) with TLE associated with hippocampal atrophy were studied.

First-bite syndrome after resection of the styloid process.

Background: First-bite syndrome (FBS) may occur after operations on parapharyngeal space. The main symptom is excruciating pain only after the first one or two bites of meals.

Objective: The objective of this article is to report a case of FBS after resection of the styloid process (SP).

Effectiveness of clobazam as add-on therapy in children with refractory focal epilepsy.

The objective of this study was to evaluate the safety and efficacy of clobazam in children with refractory focal epilepsy. We investigated 100 consecutive patients concerning etiology of epilepsy, previously used antiepileptic drugs, seizure frequency and adverse events. Clobazam was introduced as add-on therapy in patients with previous failure of at least two monotherapies.