Qualidade de vida em epilepsia e percepção de controle de crises

The individual affective-cognitive evaluations are important factors that control the way he feels the disease impact in his life. Then, the perception of seizure control is a more important factor to evaluate Quality of Life (QoL) than the illness characteristics, such as the severity, type, sickening period and seizure frequency. This study searched for the relationship among the subjective variables (perception of seizure control) and the illness characteristics to evaluate QoL. The sample consisted of 60 individuals with chronic epilepsy, aging 18 to 70 (M=37.05; SD=11.25), chosen at randon from the ambulatory of epilepsy - HC/UNICAMP, by the Questionnaire 65. The illness characteristics were not significant, except the seizures frequency, when associated to the impairment in QoL among controlled seizures and seizures with frequency higher than 10 per month (p=0.021). The perception of control was significantly associated to QoL (p=0.005).

A importância da Estratégia da Saúde da Família no controle das crises de asma bronquial em crianças atendidas em Petrolândia 1, em contagem, Minas Gerais

A asma brônquica (AB) é a doença crônica mais prevalente na infância, caracterizada por inflamação das vias aéreas, hiper-responsividade brônquica e crises de broncoespasmo com obstrução reversível do fluxo aéreo. Este trabalho teve como objetivo desenvolver um plano de intervenção com medidas preventivas efetuadas pela equipes de saúde da família para o controle das crises asmáticas na população infanto-juvenil atendida na ESF Petrolândia 1, em Contagem/MG, Para isso foi realizada uma revisão da literatura com o termos atenção primaria , asma bronquial e equipe de saúde da família e a metodologia do Planejamento Estratégico Situacional que possibilitou a identificação dos seguintes nós críticos: 1) A falta de informação das famílias de crianças que sofrem de AB sobre à doença: 2) O uso correto/incorreto das medicações propostas:3) A falta de uso de medidas preventivas: e 4) Os hábitos e estilo de vida incorretos. A partir disso foram construídas as estratégias junto as equipes da UBS como do NASF de forma multiprofissional a partir de grupos operativos e oficinas com familiares. Conclui-se que o trabalho da Equipe de Saúde da Família no desenvolvimento de estratégias de Intervenção, Prevenção e controle das crises asmáticas em pacientes buscar a aquisição de hábitos de vida mais saudáveis e o controle ambiental ensinado para melhorar a qualidade de vida.

Sexual dysfunction in epilepsy: identifying the psychological variables

In order to evaluate the psychological variables that affect sexual dysfunction (SD) in epilepsy, where compared 60 epileptics (Group 1) with 60 healthy individuals (Group 2), through the State-Trait Anxiety Inventory (Spielberger et al., 1970), Beck Depression Inventory (Beck, 1974) and Sexual Behavior Interview (Souza, 1995). Sexual dysfunction (SD), anxiety and depression were found more frequently in Group 1 than in Group 2 and were not related to sex. Variables such as the onset duration and frequency of seizures as well as the use to medication were not associated with SD. Temporal lobe epilepsy was related to SD (p = 0.035) but not to anxiety or depression. Anxiety and depression were related to SD in both groups. Perception in controlling the seizures was closely related to anxiety (p = 0) and depression (p = 0.009). We conclude that psychological factors play an important role in the alteration of sexual behavior in epileptics and that suitable attention must be given to the control of these variables.

Fatores que influenciam a qualidade de vida de pessoas com epilepsia

Epilepsy is a chronic disorder that impairs life quality (LQ) and interferes in emotional, personal, social and family relationship aspects. This study evaluated 165 people with epilepsy diagnosis, ranging from 18 to 75 years old (M=41,28; SD= 13,26), by means of the QQV-65 (Life Quality Questionnaire with 65 questions) and investigated the association between the questionnaire scores and the disease features, comparing patients who showed refrectory seizures with patients with partially controled seizures. There was no difference in relation to the two groups regarding the LQ factor. The QQV-65 emotional factor was the most affected in both groups, since the estimated mean z-escore was 51,0±14,4 for Group I and 49,9±14,7 for Group II. Regarding the type of crisis, the analysis of variance (ANOVA) revealed that Health was the only factor in QQV-65 that showed a statistically significant difference between the z-scores (P = 0.024). However, for the frequency of epileptic seizures, except Health (P = 0.185), other factors QQV-65 proved to be related in a statistically significant way (P> 0.05). The research demonstrated that seizure control perception is quite important in the evaluation of life quality in all its aspects (health, body, society, emotion, locus of control, self-concept and cognition).

Questionário de qualidade de vida na epilepsia: resultados preliminares

Seizures happen for brief periods of time, but the feelings of anxiety and helplessness, adaptation to the restrictions impose by the life-style and variety of other problems affect more the quality of life in epilepsy. This study proposes a protocol that regards the objectives of a quality of life assessment in health and is applied to a population that attends a university hospital. It contains 65 items and assesses the psychosocial performance, physical limitation, cognitive aspects, perception of control, self-concept, as well as perception of health and quality of life. The results of reliability and validity are discussed.

Locus de controle e reação a frustração

Este estudo visa analisar a interrelação teórica e epistemológica entre a teoria da aprendizagem social, mais precisamente em termos de seu constructo "locus de controle" de Rotter e a teoria da frustração, tal como desenvolvida por S. Rosenzweig. Através de um reestudo das ·teorias da frustração e proposto um modelo, capaz de avaliar a influência da percepção social determinada pela direção do "locus de controle" na reação à frustração. São examinadas três possíveis explicações teóricas para determinação das diferenças na percepção do controle a primeira em função da teoria da aprendizagem, a segunda em termos psicodinâmicos e a terceira em função de disposições inatas. E apresentada uma revisão das tentativas e comprovações experimentais quanto ao constructo "locus de controle " e à reação à frustração. A verificação empírica do modelo aqui proposto ' consistiu numa pesquisa piloto apta a comprovar, sob alguns aspectos, a relação entre a variável "locus de controle" e a tolerância à frustração. Paralelamente foi possível examinar o papel da variável "formação universitária". Utilizou-se um grupo de estudante e universitários e os resultados ' indicaram que, sujeitos com "locus interno" apresentam um nível mais amadurecido de tolerância à frustração por revelarem maior persistência .em seus objetivos e capacidade de iniciativa em situação frustrante. Quanto ao tipo de formação universitária. estudantes de pedagogia mostraram-se mais intrapunitivos que estudantes de outras áreas independentemente da direção do "locus de controle”. Um exame da influência do tipo de situação frustradora permitiu concluir que "circunstâncias que envolvem "ameaça do eu" levam a uma descarga emocional do tipo culpa em detrimento da iniciativa e aquelas situações em que o sujeito e bloqueado em um objetivo ressaltam as reações extra punitivas.

Hemiparesia congênita e adquirida na criança: interrelação entre presença de crises epilépticas, os achados eletrencefalográficos e de neuroimagem por ressonância nuclear magnética

The purpose of this paper was to study patients with congenital and acquired hemiparesis, their clinical aspects, the presence or not of epileptic seizures, and electroencephalographic (EEG) and Magnetic Resonance Imaging (MRI) findings. We analyzed the interrelation between etiology, the presence and seriousness of epileptic seizures (ES) and the possible causes of refractoriness. This is a prospective study using the clinical diagnosis of a child neurologist, who attested to the presence of unilateral motor lesions. We compared the electroencephalographic findings in patients with or without epileptic seizures, and investigated if among the former, these seizures were controlled or not, their likely etiology and risks of refractoriness. EEG background activity on the lesion and contralateral side was analyzed, in addition to the presence of concomitant epileptiform activity. Encephalon MRIs of all the patients were studied to correlate etiology and the control or not of epileptic seizures. The disorganization of bilateral EEG activity correlated with the difficult-to-control epileptic seizures. Suitably organized background activity contralateral to the lesion is a good prognosis in relation to epileptic seizures. Focal epileptogenic activity does not necessarily predispose to epileptic manifestation. The MRI is more important in determining etiology than in prognosing epileptic seizures. This study used a multidisciplinary approach involving child neurologists, a physical therapist and a neuroradiologist. This meets the criteria of multidisciplinarity of the Postgraduate Program in Health Sciences

Ambiente de moradia e controle primário em idosos

Este trabalho investigou a relação entre ambiente de moradia e duas modalidades de controle percebido controle primário (CP) e controle secundário (CS), referentes a esforços empreendidos para adaptar o ambiente às próprias necessidades e realizar metas (CP); adaptar-se ao ambiente (CS). Participaram 315 idosos (105 homens; 210 mulheres) residentes em Brasília-DF, entre 60 e 92 anos, selecionados de forma não-probabilística, por cotas de gênero. Os dados foram coletados no domicílio por meio de entrevista incluindo questões sócio-demográficas e uma escala de controle. Os resultados apontam: (1) Relação inversa entre CP e densidade social do ambiente de moradia - DESAM (r = -0,119; p ≤ 0,05); (2) Percepção de controle significativamente maior nos que dispunham de quarto exclusivo (t = 2,21; df = 313; p ≤ 0,05). Conclui-se que baixa DESAM facilita o CP nessa fase da vida em que muitas atividades são realizadas no domicílio, convertendo a liberdade de ação e a privacidade em necessidades importantes.

Qualidade de vida de crianças e adolescentes com epilepsia no município de Maringá

Pós-graduação em Saúde Coletiva - FMB

Epilepsias parciais familiares

OBJECTIVE: To investigate the clinical and genetic characteristics of familial partial epilepsies. METHOD: Family history of seizures was questioned in all patients followed in our epilepsy clinics, from October 1997 to December 1998. Those with positive family history were further investigated and detailed pedigrees were obtained. All possibly affected individuals available underwent clinical evaluation. Seizures and epilepsy syndromes were classified according to the ILAE recommendations. Whenever possible, EEG and MRI were performed. RESULTS: Positive family history was identified in 32 unrelated patients. A total of 213 possibly affected individuals were identified, 161 of whom have been evaluated. The number of affected subjects per family ranged from two to 23. Temporal lobe epilepsy (TLE) was identified in 22 families (68%), frontal lobe epilepsy in one family (3%), partial epilepsy with centrotemporal spikes in five families (15%), and other benign partial epilepsies of childhood in four families (12%). Most of the affected individuals in the TLE families (69%) had clinical and/or EEG characteristics of typical TLE. However, the severity of epilepsy was variable, with 76% of patients with spontaneous seizure remission or good control with medication and 24% with refractory seizures, including 7 patients that underwent surgical treatment. In the other 10 families, we identified 39 possibly affected subjects, 23 of whom were evaluated. All had good seizure control (with or without medication) except for one patient with frontal lobe epilepsy. Pedigree analysis suggested autosomal dominant inheritance with incomplete penetrance in all families. CONCLUSION: Family history of seizures is frequent among patients with partial epilepsies. The majority of our families had TLE and its expression was not different from that observed in sporadic cases. The identification of genes involved in partial epilepsies may be usefull in classification of syndromes, to stablish prognosis and optimal treatment.

Interictal hyposexuality in male patients with epilepsy

The purpose of this study was to compare the serum levels of androgens between hyposexual and non-hyposexual patients with epilepsy. Adult male patients with epilepsy were investigated. Serum levels of testosterone (T) and free-T, estradiol, and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. While there were no differences between hyposexual and non-hyposexual patients in the serum levels of T, free-T, and estradiol, or to the FAI, the serum levels of SHBG were significantly higher in hyposexual patients than in non-hyposexual patients. Thus, the effects of increased SHBG upon serum levels of testosterone biologically active in patients with epilepsy and hyposexuality were not detected by the methods used in this study. Four (44%) of nine hyposexual patients who were re-evaluated after two years follow-up improved sexual performance. Thus, clinical treatment that results in good seizure control may improve sexual performance in some patients with epilepsy.

Instrumento de Medida do Sentimento de Impotência para pacientes adultos

O objetivo deste artigo é relatar a construção de um instrumento para medir o sentimento de impotência em pacientes adultos internados. Para a construção deste instrumento, utilizamos procedimentos teóricos, empíricos e analíticos (estatísticos) com base na psicometria. O instrumento foi testado com 210 pacientes para seleção de itens, confiabilidade e validade e ficou constituído por 12 itens com três domínios: capacidade de realizar comportamento (alfa=0,845), percepção da capacidade de tomar decisões (alfa=0,834); e resposta emocional ao controle das situações (alfa=0,578). O alfa total foi de 0,799. Estimativas de validade de critério foram obtidas por associação entre o instrumento desenvolvido e uma afirmação geral sobre a percepção de controle (p<0,000). O instrumento de Medida do Sentimento de Impotência para pacientes adultos servirá de base para avaliar esse diagnóstico de enfermagem, definir e apreciar intervenções clínicas.

Revisitando o eletrocorticograma intra-operatório na epilepsia mesial do lobo temporal: relevância das oscilações de alta frequência

Epilepsies are neurological disorders characterized by recurrent and spontaneous seizures due to an abnormal electric activity in a brain network. The mesial temporal lobe epilepsy (MTLE) is the most prevalent type of epilepsy in adulthood, and it occurs frequently in association with hippocampal sclerosis. Unfortunately, not all patients benefit from pharmacological treatment (drug-resistant patients), and therefore become candidates for surgery, a procedure of high complexity and cost. Nowadays, the most common surgery is the anterior temporal lobectomy with selective amygdalohippocampectomy, a procedure standardized by anatomical markers. However, part of patients still present seizure after the procedure. Then, to increase the efficiency of this kind of procedure, it is fundamental to know the epileptic human brain in order to create new tools for auxiliary an individualized surgery procedure. The aim of this work was to identify and quantify the occurrence of epilepticform activity -such as interictal spikes (IS) and high frequency oscillations (HFO) - in electrocorticographic (ECoG) signals acutely recorded during the surgery procedure in drug-resistant patients with MTLE. The ECoG recording (32 channels at sample rate of 1 kHz) was performed in the surface of temporal lobe in three moments: without any cortical resection, after anterior temporal lobectomy and after amygdalohippocampectomy (mean duration of each record: 10 min; N = 17 patients; ethic approval #1038/03 in Research Ethic Committee of Federal University of São Paulo). The occurrence of IS and HFO was quantified automatically by MATLAB routines and validated manually. The events rate (number of events/channels) in each recording time was correlated with seizure control outcome. In 8 hours and 40 minutes of record, we identified 36,858 IS and 1.756 HFO. We observed that seizure-free outcome patients had more HFO rate before the resection than non-seizure free, however do not differentiate in relation of frequency, morphology and distribution of IS. The HFO rate in the first record was better than IS rate on prediction of seizure-free patients (IS: AUC = 57%, Sens = 70%, Spec = 71% vs HFO: AUC = 77%, Sens = 100%, Spec = 70%). We observed the same for the difference of the rate of pre and post-resection (IS: AUC = 54%, Sens = 60%, Spec = 71%; vs HFO: AUC = 84%, Sens = 100%, Spec = 80%). In this case, the algorithm identifies all seizure-free patients (N = 7) with two false positives. To conclude, we observed that the IS and HFO can be found in intra-operative ECoG record, despite the anesthesia and the short time of record. The possibility to classify the patients before any cortical resection suggest that ECoG can be important to decide the use of adjuvant pharmacological treatment or to change for tailored resection procedure. The mechanism responsible for this effect is still unknown, thus more studies are necessary to clarify the processes related to it

O riso sério: o cômico nos primórdios do pensamento moderno

Este texto aborda a trajetória do cômico conforme a modificação sofrida da passagem da Idade Média para o pensamento moderno. A expressão mais alta do cômico, no período medieval, encontra-se nas festas populares, espaço universal da destruição/regeneração, próprio do dinamismo da realidade social. Mas, se no período medieval, o caráter universal do cômico e do riso predominavam, não acontece o mesmo no seio da modernidade, quando o riso se torna sério e voltado para objetos singulares, sofrendo transformações no modo de sua expressão, ou seja, no cotidiano e nos dias de festividade. Tais mudanças suscitam algumas questões: Quais razões foram determinantes para a mudança e o processo engendrado na maneira de pensar e vivenciar o cotidiano? Qual o espaço cedido para o cômico, encarado como o riso sério? O indizível, próprio da percepção de mudanças e crises, encontrou sua manifestação em quais vozes?

Valores de futuros engenheiros ambientais sobre o meio ambiente

Pós-graduação em Educação - FFC