Luís Marques-Assis

Influencia da menstruação sobre as epilepsias

From 3.457 epileptic patients, 1.574 females from 12 to 50 years old, considered probably in ovulatory age, were studied regarding the influence of menstruation upon epileptic fits. The females were compared with a group of epilepsies in general and with a group of male epileptic patients (476 cases) of same age exhibiting monthly seizures, a rhythm similar to the menstrual cycle in woman. The results led the author to the following conclusions: 1) In 353 epileptic females (22,4%) the epilepsy was influenced by the menstruation. 2) The exacerbation of fits predominate in the premenstrual and menstrual periods. 3) No significant differences was observed when compared females in ovulatory age exhibiting monthly seizures (14%) with male of similar age and similar frequency of seizures (16%); this fact is against the correlation between the cyclical events represented by epileptic fits and menstruation. 4) Focal non-temporal abnormalities predominate in the females that was influenced by menstruation.From 3.457 epileptic patients, 1.574 females from 12 to 50 years old, considered probably in ovulatory age, were studied regarding the influence of menstruation upon epileptic fits. The females were compared with a group of epilepsies in general and with a group of male epileptic patients (476 cases) of same age exhibiting monthly seizures, a rhythm similar to the menstrual cycle in woman. The results led the author to the following conclusions: 1) In 353 epileptic females (22,4%) the epilepsy was influenced by the menstruation. 2) The exacerbation of fits predominate in the premenstrual and menstrual periods. 3) No significant differences was observed when compared females in ovulatory age exhibiting monthly seizures (14%) with male of similar age and similar frequency of seizures (16%); this fact is against the correlation between the cyclical events represented by epileptic fits and menstruation. 4) Focal non-temporal abnormalities predominate in the females that was influenced by menstruation.

Tratamento medicamentoso de 1217 pacientes epilépticos. II: estudo em relação à idade de início, ao tempo de doença e à freqüência das crises

The evolution of 1217 epileptic patients submitted to anti-epileptic drug treatment is studied. Barbiturates, hydantoin, primidone and/or trimethadione were administered. The study was made in regard to the age of onset, the disease duration and the frequency os seizures. Concerning the age of onset the author draws the following conclusions: the evolution was worse in the cases with onset in the first decade; considering only these cases, a worse evolution was not found in the patients whose disease had begun in the first year; when the disease started at 10 years or more, the age did not influence the evolution. The greatest the disease duration the lowest the remission index; the cases with less than one year of disease presented the best evolution. The evolution was worse in the most severe cases: 30,5% of remission in the cases with more frequent fits against 47,6% in the cases with less than one seizure each 90 days. Since some initial forms, even when submitted to early treatment, had bad evolution, the presence of imponderable and unpredictable factors exercting negative influences in the prognosis of the epilepsies is admissible.

Estudo clínico de 68 casos de epilepsia occipital

Foram estudados 68 pacientes epilepticos, com disritmia occipital no eletrencefalograma. A investigacao foi desenvolvida quanto ao tipo de crise, a idade de inicio da doenca, ao tempo de doenca, a frequencia das crises e a evolucao com tratamento medicamentoso, relativamente as disritmias occipitais paroxisticas e continuas. Os resultados obtidos foram comparados com as epilepsias de modo geral e analisados em indices percentuais, tendo os autores chegado as seguintes conclusoes: 1) em 65 casos (94%) havia manifestacoes convulsivas, sendo que em 50 (73%) as convulsoes eram secundarias; 2) em apenas 7% dos casos havia sintomas visuais precedendo as convulsoes; 3) a doenca teve inicio precoce nas epilepsias occipitais em relacao as epilepsias em geral; 4) o tempo de doenca foi menor nas epilepsias occipitais; 5) as formas mais severas da doenca predominaram nas epilepsias em geral; 6) nao houve diferencas marcantes, quanto a evolucao, entre as epilepsias occipitais paroxisticas e continuas; 7) a evolucao global das epilepsias occipitais nao foi tao favoravel quanto a das epilepsias em geral.

Mental deterioration in lafora's disease

Laforas disease is included among the progressive myoclonic epilepsies. Despite the fact that dementia is a constant finding in this disease only a few papers have studied the timing of mental deterioration. We have performed wide neuropsychological testing in two cases early diagnosed as Lafora disease. The initial neuropsychological testing was carried out by the time there were no complaints of mental deterioration in both cases. In the first case consecutive neuropsychological testing demonstrated the rapidly progressive dementia. All neuropsychological testings in these cases showed severe impairment of right parietal lobe functions. Higher cortical functions related to language and intellectual processes were best preserved in both cases. The functions related to constructional praxis, memory and abstract concepts and processes were severely impaired. Our data suggest that mental deterioration is an early manifestation in Lafora disease, even by the time normal social life is not yet disturbed. Dominant hemisphere cognitive functions have been less impaired than the non-dominant ones. How a diffuse illness such as Lafora disease can cause such an asymmetrical higher cortical function deficit is not yet clear.

Estudo clínico do RO-5-4023 no tratamento de epilepsias

Seventy six epileptic patients (children and adults) submitted to treatment with RO-5-4023 were studied. RO-5-4023 was administered alone (34 cases) or in association with other antiepileptic drugs. The average dose was 5 mg/day. The cerebrospinal fluid examination was performed in all cases with normal results. In 32 cases the elertoencephalogram was made before and after the treatment. The study allows the authors to draw the following conclusions: 1) the results of therapy were good in 61 cases (81%); 2) the better results were obtained in cases of generalized epilepsy (GM and PM) and in cases of focal non convulsive epilepsy; 3) the results were better when RO-5-4023 was administered in association with other antiepileptics drugs; 4) the electroencephalogram normalized in 46,8% of the 32 cases controled before and after essay; 5) side effects occurred in 32,8% of the cases, consisting of drowsines, ataxia, excitation, fatigue and agressivity; these manifestations disappeared within 10 days after the begining of the treatment.

A epilepsia na neurocisticercose

One hundred and thirty one cases of epilepsy with neurocysticercosis were studied. The investigation was made in regard to the type of epilepsy, the disease duration, the frequency of seizures and the electroencephalographic pattern regarding the epilepsies in general. The study was also done concerning the headache, the neurological findings, the cerebrospinal fluid, plain and contrasted radiologic examination and histopathology. The author draw the following conclusions: 1) In the neurocysticercosis group the onset of disease predominate in the first decada and from the fourth decada. 2) Concerning the type of seizures, the convulsions predominate; the Jacksonian fits were the less frequent. 3) Concerning the duration of disease the epilepsy with short duration (one year or less) predominate in the neurocysticercosis group. 4) The severity of epilepsy (frequency of seizures) was smaller in the neurocysticercosis group. 5) Excluding the cases with continuous EEG abnormalities, there were more normal EEG in neurocysticercosis group than in epilepsies in general. 6) The headache was present in 68% of cases, with paroxysmal pattern in the greater number (78%); in 67% of cases with paroxysmal headache the intracranial hypertension signs were absent; in the cases with continuous headache these signs were not present in only two cases (13%). 7) In the greater number (62%) th3 patients have presented only epileptic manifestations without focal neurological signs or intracranial hypertension.

Clinical study of 84 epileptic patients with abnormal cerebrospinal fluid

Foram estudados 84 pacientes epilepticos com exame do liquido cefalorraqueano alterado. Em nenhum paciente havia alteracoes neurologicas focais ou sinais de hipertensao intracraniana. Os casos foram estudados, juntamente com um sub-grupo de pacientes com meningencefalite cronica especifica (cisticercotica ou luetica) relativamente as epilepsias em geral, sendo valorizados os dados eletrencefalograficos, o tempo de doenca, a idade de inicio da doenca, a frequencia das crises e a evolucao com tratamento medicamentoso. Os resultados foram analisados em indices percentuais e levaram os autores as seguintes conclusoes; 1) em 76 casos (90%) havia manifestacoes convulsivas, em 59 dos quais (70%) as convulsoes eram secundarias; 2) em apenas tres casos haviam crises de tipo psicomotor; 3) no grupo estudado houve predominio das disritmias difusas ao eletrencefalograma em relacao as epilepsias em geral; 4) predominou o inicio tardio da epilepsia nos casos estudados; 5) o tempo da epilepsia foi menor no grupo estudado em relacao as epilepsias em geral; 6) em 18% dos casos de meningencefalite cronica especifica o tempo de epilepsia foi superior a 10 anos; 7) as formas mais severas da epilepsia predominaram nos pacientes com processos especificos em relacao as epilepsias em geral; 8) nos casos estudados a evolucao nao foi tao favoravel quanto nas epilepsias em geral. Levando em conta os resultados obtidos os autores consideram que as alteracoes liquoricas, isoladamente consideradas, nao trazem serias implicacoes relativamente ao prognostico da epilepsia, pois resposta favoravel foi obtida mediante tratamento medicamentoso antiepileptico adequado, em cerca de 80% dos casos.

Evolução sócio-profissional de 140 pacientes epilépticos submetidos a tratamento medicamentoso

The socio-professional evolution of 140 epileptic patients submitted to antiepileptic drug therapy is studied. Only barbiturates, hydantoin, primidone and trimethadione were administered to the patients, isolated or in association. The school, house keeper and professional activities were considered in the investigation. The socio-professional follow-up was investigated regarding to clinic manifestations, time of disease, frequency of seizures and electroencephalographic pattern. The results, analysed in percentage, led the author to the conclusion that in most epileptic patients, adequately controlled with drugs, the social and the professional problems can be avoided.

Ensaio clínico com novo psicotrópico (P-4657B) em pacientes hospitalizados

A new psychotropic drug (P-4657B, Thiothixene) was tried in 14 patients with chronic syndromes (12 schizophrenics, one oligophrenic with psychotic reaction and one with involutional depression). The dosis varied between a minimal of 20 mg to a maximal of 75 mg per dien, per os, for 22 to 130 days. The results were as follows: very good improvement in two cases; three cases with good results; 8 cases remained unchanged and one case impaired. The best results, on account of the symptoms, were observed on the interpersonal communication and on pragmatism. Severe side effects were not present. Neurodisleptic manifestations, in mild degree, were observed only in three cases. The authors concluded that the Thiothixene is a useful neuroleptic in the treatment of chronic mental syndroms, specially in schizophrenics with bad personal communication and apragmatism. They also suggest the trial in acute psychosis.

Supressão do tratamento medicamentoso nas epilepsias

A group of 36 epileptic patients is studied; in 35 the drug was suppressed and in 1 the treatment was not started. The group was compared with epilepsy in general regarding to the age of onset, the time of the disease, the frequency of the seizures, the clinical manifestations and the EEG pattern. In view of the results attained by the investigation the author draws the following conclusions: 1) in the group studied the onset of the disease prevailed at the second decade of life; 2) the disease duration was lower than 1 year in 55% of the cases; 3) the cases submitted to early treatment predominate in the group studied; 4) the patients with pure convulsive seizures predominate when compared to those with focal convulsive fits; significant differences were not found when the EEG pattern of the group studied was compared with epilepsy in general; the rate of normal EEG was similar in both groups.A group of 36 epileptic patients is studied; in 35 the drug was suppressed and in 1 the treatment was not started. The group was compared with epilepsy in general regarding to the age of onset, the time of the disease, the frequency of the seizures, the clinical manifestations and the EEG pattern. In view of the results attained by the investigation the author draws the following conclusions: 1) in the group studied the onset of the disease prevailed at the second decade of life; 2) the disease duration was lower than 1 year in 55% of the cases; 3) the cases submitted to early treatment predominate in the group studied; 4) the patients with pure convulsive seizures predominate when compared to those with focal convulsive fits; significant differences were not found when the EEG patern of the group studied was compared with epilepsy in general; the rate of normal EEG was similar in both groups.