Evelyn Kuczynski

Which factors may play a pivotal role on determining the type of psychiatric disorder in children and adolescents with epilepsy

Physicians have become aware of the high prevalence of psychiatric disorders (PDs) in children and adolescents with epilepsy; however, there are many controversies as to which factors may have an important role in the different types of PD. This study was designed to assess the main PD; verify the age of onset compared with the age of diagnosis of the PD; and determine which factors may be correlated with the type of PD described. For this purpose, a multidisciplinary team evaluated children and adolescents (4-18 years) with epilepsy and analyzed patient-related factors such as age (grouped according to Piagets cognitive scale: <6 years, 7-13 years, >13 years), sex, family history of PDs, and cognitive status. With respect to epilepsy features, we considered age of onset, duration, seizure control at the time of psychiatric evaluation, refractoriness, antiepileptic drugs (mono- vs polytherapy), seizure type (generalized vs focal), and epilepsy type (idiopathic vs symptomatic/probably symptomatic). Depression occurred in 36.4% and attention-deficit hyperactivity disorder (ADHD) in 29.1%, these being the most frequent PDs in this series. Focal epilepsy was significantly more frequent in children and adolescents with PDs. As to the type of PD, age was an important factor, with a predominance of ADHD in children and depression in adolescents (P<0.0001). Family history was contributory for depression, but not for others PDs (P<0.0001). Depression remained underdiagnosed and untreated for a longer period. Impact of early diagnosis and treatment remains unknown.

Escala de avaliação de qualidade de vida: (AUQEI - Autoquestionnaire Qualité de Vie Enfant Imagé) validade e confiabilidade de uma escala para qualidade de vida em crianças de 4 a 12 anos

It should take into account the pediatric context and the childs development moment to evaluate the quality of life in childhood from a standardized instrument. We present the questionnaire AUQEI validation by its application in 353 children, between 4 and 12 years-old, obtaining a cut off point of 48, internal consistency with a Crombachs alpha of 0.71 and construct validity (r = 0.497). With these psychometrical qualities, the scale shows its importance as a diagnostic tool.It should take into account the pediatric context and the childs development moment to evaluate the quality of life in childhood from a standardized instrument. We present the questionnaire AUQEI validation by its application in 353 children, between 4 and 12 years-old, obtaining a cut off point of 48, internal consistency with a Crombachs alpha of 0.71 and construct validity (r = 0.497). With these psychometrical qualities, the scale shows its importance as a diagnostic tool.Avaliar a qualidade de vida da crianca, a partir de um instrumento padronizado, deve levar em conta o contexto pediatrico e o momento de desenvolvimento da crianca. Apresentamos a validacao do questionario AUQEI, a partir de sua aplicacao em 353 criancas, com idade entre 4 e 12 anos, obtendo um ponto de corte de 48, consistencia interna representada por um alfa de Crombach da ordem de 0,71 e validade externa (r= 0,497). Com essas qualidades psicometricas, a escala mostra-se, assim, importante como instrumento diagnostico.

Sertraline and fluoxetine: Safe treatments for children and adolescents with epilepsy and depression

OBJECTIVE Depression is frequent, underdiagnosed, and untreated in people with epilepsy. The lack of treatment is partially explained by the concerns over the proconvulsive effects of psychoactive drugs. There are few studies on the effects of selective serotonin reuptake inhibitors (SSRIs) in adults with epilepsy and none in children. The main purpose of the present study was to analyze the impact of SSRIs on the severity and frequency of seizures in children and adolescents with epilepsy and major depressive disorders. In addition, we also evaluated the efficacy of SSRIs in the treatment of depressive symptoms and side effects other than seizure aggravation. METHODS Monthly frequency of seizures was recorded in the 3-6 months preceding the introduction of SSRIs. According to the criteria proposed by A.M. Kanner, A.M. Kozak and M. Frey (Epilepsy Behav 2000;1:100-5), a positive correlation between introduction of SSRIs and seizure worsening should be considered in the following circumstances: (1) occurrence of de novo generalized tonic-clonic (GTC) seizures; (2) recurrence of GTC seizures following a period of at least 1 year without such episodes; and (3) increase in monthly seizure frequency compared with that reported before introduction of SSRIs. Seizure worsening was considered as probably caused by an SSRI when the increase in monthly frequency occurred in a period up to 3 months after the beginning of SSRI use. RESULTS Thirty-six children with epilepsy had a depressive disorder. Seizures worsened in two patients. Among this group of patients with depression, all had an improvement in their depressive symptoms. One patient taking fluoxetine had a facial rash and one patient taking sertraline had gastrointestinal disorders. These conditions improved, with total remission, when fluoxetine was replaced with sertraline and vice versa. CONCLUSION In this sample of children and adolescents with epilepsy and depressive disorders, we observed that SSRIs are a good therapeutic option, considering their efficacy in remission of depressive symptoms, their few adverse effects, and their maintenance of satisfactory seizure control. Treatment of depression should be considered relevant in the treatment of patients with epilepsy.

Validity and reliability of a scale for the assessment of austistic behaviour

O objetivo deste estudo foi, a partir da analise de uma populacao de 31 pacientes portadores de deficiencia mental e de 30 pacientes diagnosticados como portadores de autismo, conforme os criterios diagnosticos do DSM-IV, traduzir, adaptar e validar a escala de tracos autisticos, construida em Barcelona por Ballabriga e colaboradores. O ponto de corte encontrado foi 15 (p= 0,05); o coeficiente de variacao (confiabilidade), 0,27; a validade externa mostrou baixa concordância (kappa= 0,04) e a validade interna foi 100%, mostrando que, em todos os pacientes avaliados, os diagnosticos clinicos concordaram com os realizados atraves da escala. O indice de correlacao foi 0,42, mostrando-se especifico para os quadros autisticos. Apresentou ainda, capacidade de discriminacao e consistencia interna, com alfa de Cronbach 0,71 . Consideramos, assim, que a escala mostra-se confiavel para a sua utilizacao em nosso meio.

Executive dysfunction in children and adolescents with temporal lobe epilepsy: is the Wisconsin Card Sorting Test enough?

The Wisconsin Card Sorting Test (WCST) is the gold standard in the evaluation of executive dysfunction (ED) in patients with temporal lobe epilepsy (TLE). We evaluated 35 children with TLE and 25 healthy controls with the WCST and with a more comprehensive battery. Among the children with TLE, 77.14% showed impairment on the WCST. On other tests (Wechsler Intelligence Scale for Children-Digit Forward, Matching Familiar Figures Test, Trail Making Test, Word Fluency, Finger Windows, and Number-Letter Memory), impairment was demonstrated in 94.29%. The authors concluded that the WCST is a good paradigm to measure executive impairment in children with TLE; however, it may be not enough. Evaluation performed only with the WCST not only underestimated the number of patients with ED, but also missed relevant information regarding the type of ED.

Assessment of psychosocial adjustment in patients with temporal lobe epilepsy using a standard measure

Despite the growing evidence of poor psychosocial adjustment, at present there is no formal method of assessment of social adjustment in patients with temporal lobe epilepsy (TLE). First, we assessed social adjustment in patients with TLE using a self-report questionnaire and compared the results with those from quality-of-life (QOL) scales. Second, we verified the influence of cognitive performance and clinical variables of epilepsy on social adjustment and QOL. We evaluated 35 people with TLE and 38 healthy controls. Patients had worse social adjustment, and it was correlated with worse perception of cognitive function. Attention and verbal memory dysfunctions were negatively correlated with social adjustment. However, there was no significant correlation between cognitive performance and QOL. Regarding clinical variables, persons with left TLE showed worse social adjustment and patients with frequent seizures showed worse QOL. These findings indicate the relevance of evaluating social adjustment and emphasize the importance of cognitive rehabilitation to improved social adjustment.

Evaluación de la calidad de vida en niños y adolescentes portadores de enfermedades crónicas y/o incapacitadoras: un estudio brasileño

Objetivo Evaluar la calidad de vida de ninos y adolescentes portadores de leucemia linfocitica aguda (LLA) y artritis reumatoide juvenil (ARJ). Material y metodos Se aplico la Children’s Global Assessment Scale (CGAS), la Vineland Adaptative Behavior Scale (VABS) y el Autoquestionnaire Qualite de Vie Enfant Image (AUQEI) en 28 portadores de LLA, 28 portadores de ARJ y 28 escolares sanos pareados, de 4 a 13 anos incompletos y diagnostico entre 1 y 5 anos. Resultados Hubo discreta diferencia entre los grupos LLA y ARJ respecto a la edad. No hubo diferencias significativas en relacion al tiempo de tratamiento, ni a la puntuacion de la CGAS. Hubo diferencia significativa en la puntuacion total de la VABS, asi como del dominio comunicacional de la VABS. La diferencia ente los grupos ARJ y Sanos en relacion a la puntuacion de la VABS, dominio de actividades de vida cotidiana, no fue significativa. No hubo diferencia significativa entre los grupos respecto a la puntuacion del dominio socializacion de la VABS ni del AUQEI. Conclusion En nuestro estudio, es nitido el peor desempeno de los ninos cronicamente enfermos en lo que se refiere al desarrollo de comportamientos adaptables. No obstante, refieren una calidad de vida compatible con los controles sanos. Urge que se desarrollen metodos de evaluacion habilitados en captar la percepcion de la enfermedad y del tratamiento proveniente del propio paciente pediatrico.

Escala de avaliação da reação de retração no bebê: Um estudo de validade

It should take into account the psychopatologic context and the childs development moment to evaluate the baby alarm distress from a standardized instrument. We present the BADS questionnaire validation by its application in 90 children, from 0 to 2 years-old, obtaining a K=0.783 to p<0.01, with a Spearman coeficient of 0.866 and factorial analysis to 4 factors to 63.5% of the population studied. With these psychometrical qualities, the scale shows its importance as a screening but is important its study in others populations.

Infantile autism and 47,XYY karyotype

Dra. Evelyn Kuczynski – Rua Borges Lagoa 1080/908 04038-002 Sao Paulo SP Brasil. E-mail: ekuczynski@uol.com.br There is growing evidence that genetic and chromosomal factors are important in the genesis of autism spectrum disorders. The most commonly reported cytogenetic abnormalities are deletions involving chromosomes 7q, 22q13, 2q37, 18q, and Xp, as well as sex chromosome aneuplodies (47,XYY and 45,X/ 46,XY mosaicism). Sex chromosomes seem to be of major importance in the genesis of some cases of autism. We report an adolescent with a diagnosis of infantile autism, in which genetic investigation disclosed the 47, XYY karyotype (also known as “double Y”). Informed consent was obtained with the patient’s parents.

Autismo infantil, transtorno bipolar e retardo mental em portador de síndrome da rubéola congênita: relato de caso

We describe an autistic male adolescent with congenital rubella who has developed bipolar disorder, discussing possible diagnostic and therapeutic implications.