RESUMO
INTRODUCTION: The factors that affect adherence to pharmacological treatment with anticonvulsive drugs are manifold and can be classified as psychosocial, educational and related to the medication and the relation between physician and patient. Non-compliance with pharmacological treatment leads to: lack of control over seizures, recurrence, increased absenteeism from work and, possibly, injury to oneself or to others. AIMS: To determine and to analyse the variables associated to compliance with pharmacological treatment in a sector of the population in Peru. PATIENTS AND METHODS: The sample consisted of 114 patients evaluated between June 2001 and December 2002 at the Epilepsy and Clinical Electroencephalography Department of the National Neurological Sciences Institute Oscar Trelles Montes in Lima. RESULTS: In this study the rate of non-compliance with the pharmacological regimen was 67.2% and those who did not adhere to the anticonvulsive therapy had poorer control over their seizures. The variables that were significantly associated to non-compliance with the pharmacological treatment were: lack of money to buy the medicine, patient's failure to acknowledge the disease, poor response to treatment, belief that the treatment is of no use or has no beneficial effects, and factors linked to the relationship between physician and patient. Patients who did not comply claimed that not being able to afford the medication was the most frequent reason why they had stopped following the treatment.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Cooperação do Paciente , Adulto , Epilepsia/fisiopatologia , Feminino , Humanos , Masculino , Peru , Relações Médico-Paciente , Estudos Retrospectivos , Recusa do Paciente ao TratamentoRESUMO
OBJECTIVE: To make a revision of the general point of view on late-onset epilepsy, known as epilepsy that starts in the mature age after 25 years old; around 25% of the patients with epilepsy had their first crisis after that age, with an increase in the incidence in the course of the age. DEVELOPMENT: The main ethiologies are discussed, standing out: alcoholism (22%), stroke (18%), tumors (10%), metabolic imbalances (10%), infections of the CNS, trauma, atrophies and cisticercosis. For the diagnosis is required a complete clinical evaluation, cardiovascular examination, metabolic tests, EEG and neuroimage studies. CONCLUSIONS: Monotherapy with phenobarbital, carbamazepine and valproate, control 80% of cases and failure related to patients with wide spread cerebral damage.
Assuntos
Epilepsia/epidemiologia , Epilepsia/etiologia , Adulto , Idade de Início , Alcoolismo/complicações , Anticonvulsivantes/uso terapêutico , Sistema Nervoso Central/lesões , Sistema Nervoso Central/metabolismo , Sistema Nervoso Central/patologia , Neoplasias do Sistema Nervoso Central/complicações , Diagnóstico Diferencial , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Humanos , Neurocisticercose , Prognóstico , Acidente Vascular Cerebral/complicaçõesRESUMO
INTRODUCTION: Late-onset epilepsy is considered the epilepsy that starts after 25 years old. PATIENTS AND METHODS: To determine the etiology and value of the clinical and paraclinical studies in the diagnosis, we evaluated 300 patients older than 25 years admitted in the Institute of Neurology and Neurosurgery of the city of La Havana between 1980 and 1990. Data about the illness, family and personal history and physical exploration were picked up. EEG, CT, MRI and carotid arteriography were performed. RESULTS: The main prevalence was 25 to 29 years (15.3%) and those older than 60 years (14.3%). We determined the diagnosis in 56% of the patients. Stroke was present in 19.3%, degenerative diseases in 16.6%, cerebral tumors in 9%, severe cranial trauma in 7.6% and infections, perinatal damage and toxic and metabolic causes in 3.3%. CONCLUSIONS: The symptomatic epilepsy is the most frequent type of late-onset epilepsy, the vascular and degenerative etiology are the most important in those older than 40 years old, these findings are similar to those of the developed countries.