[Show abstract][Hide abstract] ABSTRACT: RESUMO Introdução: A não adesão à medicação na epilepsia é prevalente, pelo que a compreensão dos fatores associados deve ser promovida. Objetivos: Analisar a capacidade preditiva das estratégias de coping e da espiritualidade em relação à adesão à medicação ao longo do tempo. Metodologia: Foram avaliados 60 indivíduos através de um Questionário Sociodemográfico e Clínico, a Medida de Adesão aos Tratamentos, o COPER e a Escala de Avaliação de Espiritualidade em Contextos de Saúde, em dois momentos. Resultados A espiritualidade Momento 1 não se relacionou com adesão à medicação no Momento 3, e as estratégias de coping: Desinvestimento Comportamental e Aceitação no Momento 1 predizem negativamente a adesão à medicação no Momento 2. Conclusão: A relação entre a adesão à medicação, estratégias de coping e espiritualidade varia em função do tempo, o que deve ser considerado ao nível da intervenção. Palavras-chave: epilepsia, adesão à medicação, coping, espiritualidade ABSTRACT Introduction: The nonmedication adherence in epilepsy is prevalent by which the understanding of associated factors should be promoted. Objectives: To analyze the predictive capacity of the coping strategies and spirituality in relation to medication adherence over time. Methodology: A sociodemographic and clinical questionnaire, medical adherence to treatment, COPER and spirituality evaluation scale in health contexts was undertaken to evaluate 60 individuals with epilepsy, in three moments. Results: Spirituality at Moment 1 is not related to medication adherence at Moment 3, and the coping strategies: behavioral disinvestment and acceptance at Moment 1 predict medication adherence at moment 2. Conclusion: The relation between medication adherence, coping strategies and spirituality change according to time, which should be considered on the level intervention.
Journal of Epilepsy and Clinical Neurophysiology 11/2014; 20:154-156.
[Show abstract][Hide abstract] ABSTRACT: Ainda que a saúde mental dos doentes crónicos seja cada vez mais uma preocupação dos profissionais de saúde, não é generalizada a avaliação rotineira do seu funcionamento sexual, que poderá ter impacto sobre a sua saúde mental. O objectivo do presente estudo é explorar a relação entre funcionamento sexual e saúde mental em doentes crónicos. Foram avaliados 77 adultos com diabetes tipo 1, 40 com diabetes tipo 2, 100 com esclerose múltipla, 79 com epilepsia, 205 com obesidade e 106 com cancro, recorrendo a um Questionário Sócio-demográfico e Clínico, à Escala de Função Sexual do MSQOL-54 e à Escala de Saúde Mental do SF-36. Na amostra total, verificaram-se correlações lineares estatisticamente significativas entre Funcionamento Sexual e Saúde Mental nos dois sexos
II Congresso Ibero-Americano de Psicologia da Saúde e III Congresso Luso-Brasileiro de Psicologia da Saúde, Atas do II Congresso Ibero-Americano de Psicologia da Saúde e III Congresso Luso-Brasileiro de Psicologia da Saúde (s. pag.). Faro Portugal: CIEO-Universidade do Algarve- ISBN: 978-989-20-3934-3; 07/2013
[Show abstract][Hide abstract] ABSTRACT: Purpose
Neuroinflammation appears as an important epileptogenic mechanism. Evidence from animal models demonstrated a rapid-onset inflammatory response to acute seizures involving interleukin-1β (IL-1β). It was reported that a polymorphism (-511 T>C) in the promoter region of IL-1β gene leads to a higher protein production. The -511T allele has been well accepted as associated with Febrile Seizures (FS) nevertheless the association with Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis (MTLE-HS) development is still controversial. In this study we proposed to analyse the association between -511T>C polymorphism and the development and clinical features of MTLE-HS in a cohort of Portuguese population.
Ninety-four MTLE-HS patients (49F, 45M, mean age=39.16±10.21 years, 49 with FS antecedents), 95 patients with other focal epilepsies (OEF) and 217 healthy controls were studied. Genotyping was performed using Taqman Real Time PCR methodology.
The -511T allele frequency was higher in MTLE-HS when compared to controls (39% vs.32%, p=0.06 OR=1.40[0.99 – 2.00]). Considering the antecedents of FS we constitute 2 MTLE-HS sub-groups and no differences in -511T>C allelic or genotypic frequencies were found. There were no differences between the OEF group and controls or MTLE-HS patients.
Our data suggests that -511T allele may be a susceptibility factor to MTLE-HS, independently of FS antecedents. The exacerbated inflammatory reaction associated with this allele could lead to cell loss and progression of seizures. These observations must be confirmed in a higher cohort.
Supported by a BICE Tecnifar Grant 2009
10th European Congress on Epileptology, London; 09/2012
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury has been identified since antiquity as being associated with chronic seizures. Mechanisms of injury include blunt head trauma, high-velocity penetration of the brain during military conflict, and motor vehicle accidents, all causing cavitation and rotational forces with cortical laceration and contusion. Risks of an injured military veteran developing posttraumatic epilepsy are 40-50%. Among civilians, the incidence ranges from 7% to 25%. Risk factors for the development of epilepsy are important in clinical trials to interrupt epileptogenesis. Drug trials using valproic acid or phenytoin failed to interrupt epileptogenesis, although the latter drug did prevent seizures during the first weeks after injury. Methods of study in animals include focal injection of blood components into the neuropil, fluid percussion through a craniectomy, undercutting the cortex, and amygdalar kindling. Contusion and intracerebral hemorrhage cause focal encephalomalacia and hemosiderin deposition. Fluid percussion causes mechanical injury with isocortical encephalomalacia and ipsilateral hippocampal atrophy. Mossy fiber sprouting is observed in the hippocampus. Partial isolation of a neocortical island with intact circulation allows development of hyperexcitability and mimics epileptogenesis. Cortical regions are reorganized and this model allows longitudinal assessment as well as serving as a platform for evaluation of methods for interruption of epileptogenesis.
Handbook of Clinical Neurology 09/2012; 108:585-99. DOI:10.1016/B978-0-444-52899-5.00017-4
[Show abstract][Hide abstract] ABSTRACT: To describe 16 patients with a coincidence of 2 rare diseases: aquaporin-4 antibody (AQP4-Ab)-mediated neuromyelitis optica spectrum disorder (AQP4-NMOSD) and acetylcholine receptor antibody (AChR-Ab)-mediated myasthenia gravis (AChR-MG).
The clinical details and antibody results of 16 patients with AChR-MG and AQP4-NMOSD were analyzed retrospectively.
All had early-onset AChR-MG, the majority with mild generalized disease, and a high proportion achieved remission. Fifteen were female; 11 were Caucasian. In 14/16, the MG preceded NMOSD (median interval: 16 years) and 11 of these had had a thymectomy although 1 only after NMOSD onset. In 4/5 patients tested, AQP4-Abs were detectable between 4 and 16 years prior to disease onset, including 2 patients with detectable AQP4-Abs prior to thymectomy. AChR-Abs decreased and the AQP4-Ab levels increased over time in concordance with the relevant disease. AChR-Abs were detectable at NMOSD onset in the one sample available from 1 of the 2 patients with NMOSD before MG.
Although both conditions are rare, the association of MG and NMOSD occurs much more frequently than by chance and the MG appears to follow a benign course. AChR-Abs or AQP4-Abs may be present years before onset of the relevant disease and the antibody titers against AQP4 and AChR tend to change in opposite directions. Although most cases had MG prior to NMOSD onset, and had undergone thymectomy, NMOSD can occur first and in patients who have not had their thymus removed.
Psicologia da saúde: Desafios à promoção da Saúde em Doenças crónicas, Lisboa,PT edited by J.Pais-Ribeiro, I. Leal, A.Pereira, S.Monteiro, 02/2012: chapter Preditores da qualidade de vida de pessoas com doenças crónicas: pages 283-291; Editora Placebo., ISBN: 978-989-8463-30-2
[Show abstract][Hide abstract] ABSTRACT: Efficacy measurement of epilepsy treatment is frequently overwhelmed by the multiple variables involved: interactions between
antiepileptic drugs are sometimes inextricable (Gram et al., 1981); and seizure factors (pattern, severity and frequency)have different degrees of importance on patient status (neurological, psychiatric or psychological well—being) influencing
epilepsy evolution. These variables are important not only for epilepsy prognosis but they also tend to operate whatever the
stage of epilepsy (Shorvon, 1984). The lack of objective measures of data, the quantification of all intervening variables (from the seizures and from the
patients), the side-effects of drugs, the patient—to—patient differences, the length of disease, the duration of study design
and sample dimensions are supplementary difficulties in epilepsy assessment. How to manage such variables in order to establish
stable and reproducible criteria to assess epilepsy evolution or how to measure the relevance of factors as indexes of the
evolution of this clinical phenomena are questions to be addressed by a clinimetric approach (Feinstein, 1987). Introducing concepts of clinimetrics with parametrization of appropriate epilepsy indexes, seizure components were used
to assess epilepsy evolution. Rating scales were developed in order to solve some difficulties in the assessment of antiepileptic
drugs (AED) efficacy.
Quantitative Assessment in Epilepsy Care, 07/2011: pages 35-42;
Psicologia da Saúde: Sexualidade Género e Saúde, ISPA Edição edited by Isabel Leal & J. Pais Ribeiro, 02/2010: chapter O Optimismo como Mediador entre a Personalidade e a Qualidade de Vida em Pessoas com Doença Crónica: pages 101-109;