Carmen Silvia Molleis Galego Miziara

Impact of benign childhood epilepsy with centrotemporal spikes (BECTS) on school performance

UNLABELLED BECTS represents the vast majority of childhood focal epilepsy. Owing to the age peculiarity of children who suffer from this disease, i.e., school-going age of between 6 and 9 years, the condition is often referred to as a school disorder by parents and teachers. OBJECTIVE The aim of this study was to evaluate the academic performance of children with BECTS, according to the clinical and electroencephalographic ILAE criteria, and compare the results of neuropsychological tests of language and attention to the frequency of epileptic discharges. METHODS The performances of 40 school children with BECTS were evaluated by applying a school performance test (SBT), neuropsychological tests (WISC and Trail-Making), and language tests (Illinois Test Psycholinguistic Abilities-ITPA--and Staggered Spondaic Word-SSW). The same tests were applied in the control group. RESULTS Children with BECTS, when compared to those in the control group, showed lower scores in academic performance (SPT), digits and similarities subtests of WISC, auditory processing subtest of SSW, and ITPA--representational and automatic level. The study showed that epileptic discharges did not influence the results. CONCLUSION Children with BECTS scored significantly lower scores in tests on academic performance, when compared with those in the control group probably due to executive dysfunction.

Aspectos bioéticos e médico-legais do implante coclear em crianças

UNLABELLED Cochlear implants are the best treatment for congenital profound deafness. Pediatric candidates to implantation are seen as vulnerable citizens, and the decision of implanting cochlear devices is ultimately in the hands of their parents/guardians. The Brazilian Penal Code dictates that deaf people may enjoy diminished criminal capacity. Many are the bioethical controversies around cochlear implants, as representatives from the deaf community have seen in them a means of decimating their culture and intrinsic values. OBJECTIVE This paper aims to discuss, in bioethical terms, the validity of implanting cochlear hearing aids in children by analyzing their vulnerability and the social/cultural implications of the procedure itself, aside from looking into the medical/legal aspects connected to their criminal capacity. MATERIALS AND METHODS The topic was searched on databases Medline and Lilacs; ethical analysis was done based on principialist bioethics. RESULTS Cochlear implants are the best therapeutic option for people with profound deafness and are morally justified. The level of criminal capacity attributed to deaf people requires careful analysis of the subjects degree of understanding and determination when carrying out the acts for which he/she has been charged. CONCLUSION Cochlear implants are morally valid. Implantations must be analyzed on an each case basis. ENT physicians bear the ethical responsibility for indicating cochlear implants and must properly inform the childs parents/guardians and get their written consent before performing the procedure.Cochlear implants are the best treatment for congenital profound deafness. Pediatric candidates to implantation are seen as vulnerable citizens, and the decision of implanting cochlear devices is ultimately in the hands of their parents/guardians. The Brazilian Penal Code dictates that deaf people may enjoy diminished criminal capacity. Many are the bioethical controversies around cochlear implants, as representatives from the deaf community have seen in them a means of decimating their culture and intrinsic values. OBJECTIVE: This paper aims to discuss, in bioethical terms, the validity of implanting cochlear hearing aids in children by analyzing their vulnerability and the social/cultural implications of the procedure itself, aside from looking into the medical/legal aspects connected to their criminal capacity. MATERIALS AND METHODS: The topic was searched on databases Medline and Lilacs; ethical analysis was done based on principialist bioethics. RESULTS: Cochlear implants are the best therapeutic option for people with profound deafness and are morally justified. The level of criminal capacity attributed to deaf people requires careful analysis of the subjects degree of understanding and determination when carrying out the acts for which he/she has been charged. CONCLUSION: Cochlear implants are morally valid. Implantations must be analyzed on an each case basis. ENT physicians bear the ethical responsibility for indicating cochlear implants and must properly inform the childs parents/guardians and get their written consent before performing the procedure.

Electrophysiological and auditory behavioral evaluation of individuals with left temporal lobe epilepsy

The purpose of this study was to determine the repercussions of left temporal lobe epilepsy (TLE) for subjects with left mesial temporal sclerosis (LMTS) in relation to the behavioral test-Dichotic Digits Test (DDT), event-related potential (P300), and to compare the two temporal lobes in terms of P300 latency and amplitude. We studied 12 subjects with LMTS and 12 control subjects without LMTS. Relationships between P300 latency and P300 amplitude at sites C3A1,C3A2,C4A1, and C4A2, together with DDT results, were studied in inter-and intra-group analyses. On the DDT, subjects with LMTS performed poorly in comparison to controls. This difference was statistically significant for both ears. The P300 was absent in 6 individuals with LMTS. Regarding P300 latency and amplitude, as a group, LMTS subjects presented trend toward greater P300 latency and lower P300 amplitude at all positions in relation to controls, difference being statistically significant for C3A1 and C4A2. However, it was not possible to determine laterality effect of P300 between affected and unaffected hemispheres.

Cognitive impact in children with “benign” childhood focal epilepsy with centrotemporal spikes

Background Cognitive alterations are associated with benign childhood focal epilepsy with centrotemporal spikes (BCECTS) including aspects of executive functions. Objectives This study presents the performance profile on attention and executive function tests of fifty-eight children (BCECTS, n = 30 and controls, n = 28) aged 8-13 years. Methods The following tools were employed: Vocabulary and Block Design subtests from the Wechsler Intelligence Scale for Children III, Stroop Test, Modified Card Sorting Test, Controlled Oral Word Association – FAS and Tower of London. Results Children with BCECTS presented average IQ measure, although their performance was statistically worse when compared to the control group. Children with BCECTS showed significantly lower performance compared to the control group in the following variables: total number of recollected words on the oral fluency test, total number of categories, categorization effect and total number of errors in MCST; and execution time for the Stroop Test Card 1. After controlling for the IQ effect, the total number of errors in the MCST did not show any significant difference between the groups. Discussion Children with BCECTS showed lower performance in attention and executive functions when compared to healthy children. The results suggest that the concept of “benign” BCECTS should be reconsidered.

Sequential motor task (Luria's Fist-Edge-Palm Test) in children with benign focal epilepsy of childhood with centrotemporal spikes

This study evaluated the sequential motor manual actions in children with benign focal epilepsy of childhood with centrotemporal spikes (BECTS) and compares the results with matched control group, through the application of Lurias fist-edge-palm test. The children with BECTS underwent interictal single photon emission computed tomography (SPECT) and School Performance Test (SPT). Significant difference occurred between the study and control groups for manual motor action through three equal and three different movements. Children with lower school performance had higher error rate in the imitation of hand gestures. Another factor significantly associated with the failure was the abnormality in SPECT. Children with BECTS showed abnormalities in the test that evaluated manual motor programming/planning. This study may suggest that the functional changes related to epileptiform activity in rolandic region interfere with the executive function in children with BECTS.

Edmund Pellegrino: moralidade médica e a teoria do consenso moral

Os autores apresentam e comentam as ideias de Edmund Pellegrino, eticista americano, acerca da existencia de uma moralidade interna a Medicina, relacionada ao fim inerente a arte medica, ou seja, a cura do paciente, assim como acerca da existencia de uma moralidade externa a medicina, aquela relacionada a todos os outros aspectos da atividade medica que nao tenham como proposito final a cura do paciente. Apresentam os comentarios de outros eticistas, contra ou a favor dos argumentos apresentados por Pellegrino e fazem comparacao entre os aspectos da moralidade externa referida com a “teoria do consenso moral” desenvolvida pelos autores anteriormente.The authors present and comment on the ideas of Edmund Pellegrino, a bioethics specialist born in New Jersey, USA, regarding the existence of a morality intrinsic to medicine, related to the inherent goal of the medical art, that is, the cure of the patient, as well as the existence of a morality external to medicine, which concerns all other aspects of medical activity whose ultimate purpose is not the cure of the patient. The authors also present the comments of other ethicists, for or against the arguments presented by Pellegrino, and compare aspects of this external morality to the moral consensus theory previously developed by the authors.

The Perceived Social Stigma of People with Epilepsy with regard to the Question of Employability

Objective To evaluate the perceived social stigma of people with epilepsy with regard to the question of employability. Methods A structured questionnaire was given to two groups of people with chronic diseases: those with epilepsy (study group) and those with heart disease (control group). The questions concerned employability. Results Having epilepsy was more strongly associated with higher unemployment rates (p < 0.0001); job layoffs (p = 0.001); being unfit to work (p < 0.0001); feeling shame for having the disease (p = 0.014); absence of partners (p = 0.026); and depression (p = 0.004). The tendency to hide their disease from their employers was similar for the two groups. Conclusion The age discrepancy between groups was an important limiting factor of this study. However, despite the limited number of participants and the age difference between the groups, there is no impediment in stating that people with epilepsy show high rates of unemployment, depression, and stigma.