Fábio Galvão Dantas

Restless legs syndrome in institutionalized elderly

Restless legs syndrome (RLS) is characterized by disturbing leg sensations associated to sleep complaints and excessive daytime somnolence. In the elderly, it affects 10 to 35%. Our objective was to determine the prevalence of RLS in institutionalized elderly, analyzing its relationship with clinical, laboratorial and neurophysiological features. We conducted a cross-sectional study of all the subjects under treatment on a chronic-care geriatric service by using face-to-face interviews, which include sleep complaints, the Epworth Sleepiness Scale and standardized questions addressing the four minimal criteria for RLS. The patients with RLS diagnosis received neurological examination, laboratorial tests and three of them, neurophysiological evaluation. The prevalence of RLS was 15.6%. Women were more affected and sleep complaints were frequent. There was no significance on other clinical, laboratorial or neurophysiological findings. We conclude that RLS is a prevalent condition in elderly, may lead to sleep complaints and is often underdiagnosed.

The role of EEG in patients with syncope.

Abstract EEG is a popular, low-cost examination used in neurologic and nonneurologic evaluations. Nevertheless, the diagnostic usefulness of EEG has some limitations, and it may increase medical costs. The manifestations of syncope may lead to misdiagnoses, and frequently, it is mislabeled as epilepsy. An EEG is usually obtained, yet some studies have suggested that EEGs have little value in diagnosing this condition. We aimed to determine the diagnostic usefulness of EEG in patients with syncope. We retrospectively examined EEG recordings of 10,408 patients. EEG findings were evaluated for all patients with a diagnosis of syncope (syncope, convulsive syncope, loss of consciousness, or sudden unexplained falls), including requests from neurologists and nonneurologists. EEGs were classified into (1) normal, (2) epileptiform discharges (spike/sharp waves), and (3) slow waves. The EEGs were separated according to gender and age. From 1,003 patients with the diagnosis of syncope, 899 (89.53%) were normal, 62 (6.18%) showed bilateral slow waves, 19 (1.89%) right slow waves, 18 (1.79%) epileptiform discharges, and 6 (0.6%) left slow waves. Epileptiform discharges only occurred among females. Left focal sharp waves were disclosed in 18 (50%), generalized discharges in 8 (44.4%), and right focal discharges in 1 (5.6%). Bilateral slow waves were more prevalent among adults. We conclude that EEG is not useful for evaluating the diagnosis of syncope because of its very low diagnostic yield. Patients with syncope must have a correct history and physical examination plus cardiovascular tests.

Epilepsy and Marijuana - A Review

RESUMO O uso medicinal de componentes de cannabis sativa (maconha) vem sendo objeto de pesquisa em diversas partes do mundo. Alguns destes componentes podem ter acao anticonvulsivante, embora os estudos sejam controversos, limitados, e, muitas vezes, de origem anedotica. Devido aos aspectos eticos (especialmente por seus componentes psicotropicos e pela possibilidade de levar a dependencia), o assunto deve ser profundamente discutido. Novas pesquisas vem demonstrando a possibilidade para a utilizacao de componentes nao-psicotropicos para o controle de crises epilepticas. Este artigo apresenta uma revisao da literatura acerca do tema.

Papel do EEG em casos de suspeita ou diagnóstico de epilepsia

INTRODUCTION: Since it was discovered, EEG has been used as an important auxiliary diagnostic method in neurology, especially in epilepsy. OBJECTIVE: To verify the value of EEG for supporting the diagnosis of epilepsy. METHOD: We retrospectively analyzed 1015 pre-admission reports from an outpatient clinic of Campina Grande (PB) selecting the ones with suspected or confirmed epilepsy diagnosis. RESULTS: Analyzing 259 EEG reports, which were in accordance with the methodology, we found abnormalities in 113 (43.6%). Generalized discharges occurred in 30 (11.6%), focal discharges in 44 (17%) and multifocal discharges in 4 (1.5%). Abnormal slow waves occurred in 19 (7.3%), being focal in 11 (4.2%) and diffuse in 8 (3.1%). Background asymmetry occurred in 16 (6.2%). CONCLUSION: EEG is important for supporting the diagnosis of epilepsy and our results were similar to other reports in the literature.

Hemispheric assymetry of abnormal focal EEG findings

Embora sejam morfologicamente semelhantes, os hemisferios cerebrais apresentam diferencas funcionais geneticamente determinadas. Ainda assim, anormalidades eletrencefalograficas focais deveriam ocorrer simetricamente numa populacao geral, embora a literatura tenha referido um predominio a esquerda. Nosso objetivo e relatar o primeiro estudo latino-americano sobre uma grande serie de EEGs, no intuito de observar se ha lateralizacao de anormalidades focais. METODO: Foram estudados retrospectivamente 10.408 EEGs, realizados de abril de 2001 a abril de 2010, os quais foram classificados de acordo com a presenca de anormalidades focais especificas (descargas) e inespecificas (ondas lentas focais). Os EEGs foram divididos de acordo com o genero e a idade, e foram analisados achados clinicos associados. RESULTADOS: As descargas foram mais prevalentes no hemisferio cerebral esquerdo, no lobo temporal, observando-se uma lateralizacao mais forte entre os adultos. A direita, elas prevaleceram no lobo frontal. Ondas lentas focais prevaleceram tambem a esquerda e no lobo temporal, especialmente entre os adultos. Entre os que apresentaram ondas lentas a esquerda, observou-se maior prevalencia entre as mulheres. Os homens prevaleceram entre os que apresentaram ondas lentas a direita. A esquerda, ondas lentas prevaleceram nos lobos temporal e parietal. A direita, nos lobos frontal e occipital. Epilepsia foi o achado clinico mais associado a presenca de descargas em ambos os hemisferios cerebrais. Ondas lentas a direita foram mais associadas a epilepsia, enquanto que, a esquerda, elas foram mais associadas a cefaleia. CONCLUSAO: Houve diferencas entre os hemisferios cerebrais quanto a lateralizacao das anormalidades focais, assim como entre os generos, faixas etarias analisadas e quadro clinico associado.

Epilepsia em celebridades

Persons with epilepsy almost always have been seen as lunatic, hysterical or insane people, mainly during medieval times. Thus, they were segregated and left beside social and scientific communities. Nevertheless, several famous persons have been described as suffering from epilepsy, and it is believed that at least some of their important contributions may have resulted from ictal and interictal epileptic phenomena. This paper reviews some evidences of epilepsy diagnosis in five famous persons, who left us a legacy of knowledge and a wonderful artistic production, in spite of having had a very suffering and difficult life.