RESUMEN
PURPOSE: To perform a cross-cultural adaptation of the Global Assessment of Severity of Epilepsy (GASE) and Global Assessment of Disability (GAD) scales to Brazilian Portuguese and compare patients' self-rated scores with their attending physicians' ratings. METHODS: We conducted an observational, multicentre, cross-sectional study. Patients followed up in five epilepsy centres in Brazil responded to GASE and GAD questionnaires and to the Hospital Anxiety and Depression Scale and the Adverse Events Profile, both previously validated in Brazil. GASE and GAD scales were also completed by 20 attending physicians providing care to these patients. RESULTS: A total of 138 patients were interviewed, with a mean age of 39.9 ± 13.81 years and a median of 11 (interquartile range, IQR = 7.5-12) years of education. Eighty-five (61.6%) patients were female. Most patients were diagnosed with focal epilepsy (82.6%). Only 5.8% and 3.6% of respondents reported having difficulty understanding the GASE and GAD, respectively. The patients scored a median of 3 (IQR = 2-5) on the self-perceived GASE and 4 (IQR = 2-6) on the GAD. Physician ratings were moderately to highly correlated with patients' self-perceived scores on the GASE and GAD. Linear regression analysis demonstrated that physicians' GASE and GAD scores predicted 37% and 20% of the patients' self-reported GASE and GAD variation, respectively. CONCLUSION: Brazilian Portuguese cross-cultural adaptation of the GASE and GAD was successful. These scales were found to be easy to use by patients and health professionals, and revealed the burden of epilepsy on patients' lives.
Asunto(s)
Epilepsia , Médicos , Niño , Comparación Transcultural , Estudios Transversales , Epilepsia/diagnóstico , Femenino , Humanos , Calidad de Vida , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
The importance of engaging the next generation in broad ranging initiatives cannot be over emphasized. This is reflected by a proliferation of publications related to next-generation, training, and healthcare professionals or scientists, with almost 2000 articles published in the last 30 years, showing a marked increase in the previous two decades. Several multilateral organizations, such as the United Nations, UNESCO and the World Health Organization, have recognized the importance of engaging youth in the global agenda. Accordingly, in 2017 The International League Against Epilepsy (ILAE) created organizational entities focused on epilepsy and the next generation of epilepsy professionals. At the core of these is the ILAE Young Epilepsy Section (YES). Its mission is to create a new generation of epilepsy experts poised to discover and deliver state-of-the-art care for people with epilepsy well into the future, with several initiatives worldwide, including education, research collaborations, and advocacy tasks, among others. The Latin American Summer School on Epilepsy, which turns 15 in 2021, has been a steady source of early career epilepsy professional participating in YES, who are moving forward the epilepsy agenda in Latin America.
Asunto(s)
Epilepsia , Adolescente , Epilepsia/terapia , Personal de Salud , Humanos , Organización Mundial de la SaludRESUMEN
PURPOSE: The purpose of this study was to investigate the following: i) the objective impairment in neuropsychological tests that were associated with the subjective perception of cognitive function decline in Brazilian patients who underwent mesial temporal lobe epilepsy (MTLE) surgery and ii) the predictive variables for those impaired objective neuropsychological tests. METHODS: Forty-eight adults with MTLE (27 right HS and 23 male) were divided according to their perception of changes (Decline or No-decline) of cognitive function domain of the QOLIE-31 questionnaire applied before and 1year after the ATL. The mean (SD) of changes in the raw score difference of the neuropsychological tests before and after the ATL was compared between Decline and No-decline groups. Receiver Operating Characteristic curves, sensitivity, specificity, and predictive values were used to assess the optimum cutoff points of neuropsychological test score changes to predict patient-reported subjective cognitive decline. KEY FINDINGS: Six (12.5%) patients reported a perception of cognitive function decline after ATL. Among the 25 cognitive tests analyzed, only changes in the Boston Naming Test (BNT) were associated with subjective cognitive decline reported by patients. A reduction of ≥8 points in the raw score of BNT after surgery had 91% of sensitivity and 45% specificity for predicting subjective perception of cognitive function decline by the patient. Left side surgery and age older than 40years were more associated with an important BNT reduction with overall accuracy of 91.7%, 95% predictive ability for no impairment, and 75% for impairment of cognitive function. SIGNIFICANCE: Impairment in word-finding seems to be the objective cognitive finding most relevant to Brazilian patients after mesial temporal lobe epilepsy surgery. Similar to American patients, the side of surgery and age are good predictors for no decline in the BNT, but shows a lower accuracy to predict its decline. If replicated in other populations, the results may have wider implications for the surgical management of patients with drug-resistant MTLE.
Asunto(s)
Cognición/fisiología , Disfunción Cognitiva/etiología , Epilepsia del Lóbulo Temporal/fisiopatología , Epilepsia del Lóbulo Temporal/cirugía , Complicaciones Posoperatorias , Adulto , Atención/fisiología , Brasil , Epilepsia Refractaria/cirugía , Función Ejecutiva/fisiología , Femenino , Humanos , Masculino , Memoria/fisiología , Persona de Mediana Edad , Destreza Motora/fisiología , Pruebas Neuropsicológicas , Calidad de Vida , Percepción Espacial/fisiología , Lóbulo Temporal/fisiopatología , Percepción Visual/fisiologíaRESUMEN
OBJECTIVES: To investigate prospectively the independent predictors of a minimum clinically important change (MCIC) in quality of life (QOL) after anterior temporal lobectomy (ATL) for drug-resistant mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) in Brazilian patients. METHODS: Multiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy-31 Inventory (QOLIE-31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE-HS. RESULTS: The overall QOLIE-31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2-14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity. SIGNIFICANCE: These results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients.
Asunto(s)
Lobectomía Temporal Anterior/psicología , Epilepsia Refractaria/psicología , Epilepsia Refractaria/cirugía , Epilepsia del Lóbulo Temporal/psicología , Epilepsia del Lóbulo Temporal/cirugía , Evaluación de Resultado en la Atención de Salud , Calidad de Vida/psicología , Adulto , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Epilepsia Refractaria/diagnóstico , Epilepsia del Lóbulo Temporal/diagnóstico , Femenino , Estudios de Seguimiento , Hipocampo/patología , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/psicología , Estudios Prospectivos , Psicometría , Esclerosis , Adulto JovenRESUMEN
Se presentan dos casos de enfermedad de Castleman generalizada (ECG). De ésta existen dos tipos: el hialino-vascular con hiperplasia folicular y prominente vascularidad interfolicular con vasos radiales, frecuente hialinización y ausencia de síntomas clínicos y el de células plasmáticas con grandes folículos y capas interfoliculares de células plasmáticas maduras y habitualmente con fiebre, anemia e hiperglobulinemia. Existen formas transicionales y la hipótesis de que la variedad de células plasmáticas es una etapa más temprana, más activa que la hialino-vascular. El primer caso es una forma transicional con síntomas generales y remisión completa con quimioterapia combinada; la duración de la remisión fue de siete meses. El caso dos corresponde a la variedad de células plasmáticas con síntomas generales y localización poco frecuente (mesenterio). En el tratamiento de la ECG se han utilizado con poco éxito, esteroides, esteroides más agentes anticoplásicos y cirugía. En el caso uno se utilizó MEPP (mostaza, etopósido, procarbazina y prednisona) con lo que se logró remisión completa de siete meses, así como una segunda remisión. En el caso dos, con la misma combinación, la remisión ha sido parcial. Es un hecho que, en algunos casos, esta combinación o una parecida obtienen remisiones completas o parciales