[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.
Full-text · Article · Nov 2014 · Journal of Epilepsy and Clinical Neurophysiology
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT- Epilepsy is one of the most common neurological pathologies in the world, with important repercussions in the individuals’ Quality of Life (QOL). In this way, the goal of treatment surpasses the total remission of seizures, since it also prioritizes the improving the QOL of individuals with epilepsy. The QOL has been associated with some important modifying factors, for its promotion. In this way, with the present study we pretend to identify whether Adherence to Therapy, Coping Strategies and Spirituality are predictors of QOL of individuals with epilepsy. The SF-36 v1.0, the Measure Treatment Adherence, The COPE-R and The Spirituality Assessment Scale in Health Contexts were administered to 94 individuals with epilepsy diagnosis between four and forty-nine years. The relation between the variables was analysed through multiple linear regression model.
The results reveal that the Adherence to Therapy and Hope/Optimism predict positively QOL. Whereas Coping Strategies: Behavioral Disengagement, Venting and Religion predict it negatively. These results are important for the health professionals seeing that the identification of modifying predictors of the QOL suggest hints for interventions, which promote the QOL of individuals with epilepsy.
Keywords: epilepsy, quality of life, adherence to therapy, coping, spirituality
[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
[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
[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.
No preview · Article · Sep 2012 · Handbook of Clinical Neurology
[Show abstract][Hide abstract] ABSTRACT: Purpose: Commission baseline values of the multi-leaf collimator (MLC) using Varian's dynalog file viewer software (DFV) and establish tolerance levels to use as a periodic quality assurance tool in intensity modulated radiotherapy (IMRT). Methods: A sliding window test was created to have all leafs moving at a constant high speed of 2.5cm/s. This test was performed for 100 days at gantry angles of 0°, 90° and 270° during the morning quality checks in an accelerator performing RapidArc treatments with a Millennium 120 MLC. The DFV was used to collect the percentage of counts in bins 1 (0.05mm) to 8 (deviations in steps of 0.5mm) and the root mean square error (RMS). These were analyzed statistically and a baseline value and tolerance levels were established. Results: Results show that the greater percentage of counts is found at bin 4 with an average of 97%. Bins 1 to 3 have less than 1 % and bin 5 presents an average of 1.7%. As for bin 6, the average was below 0.1%. Bins 7 and 8 presented no counts. When comparing the results of the different gantry angles, significant differences are only found in bin 4 and 5, with a better performance for the 0° gantry. As for the RMS error, no difference was found between different carriages or gantry angles and the average value was 0.129. A tolerance level was established for bins that correspond to greater deviations - bins 5 to 8, with an upper limit equivalent to twice the standard deviation of each bin. Conclusions: With the introduction of IMRT, the MLC quality assurance became more extensive and thorough. However a quantitative analysis is often difficult to interpret and time consuming. The purposed method allows the monitorization of the stability and performance of the MLC in a quantitative and easy way.
[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.