Marly de Albuquerque

Evaluation of physical exercise habits in Brazilian patients with epilepsy

In this study we present data from a survey that aimed to assess the physical activity of a sample of adult outpatients with epilepsy. One hundred adult outpatients of both sexes with epilepsy answered a survey addressing exercise habits. Fifty-eight males and forty-two females participated in this study. The mean age of onset of seizures was 18.6 years and the mean duration of epilepsy was 16.1 years. Sixty patients had controlled or rare seizures, 8 infrequent seizures, 17 frequent seizures, and 11 very frequent seizures. Eighty-six had partial epilepsy and only 3 had abnormal neurological examinations. Of the total, 51 engaged in physical activity, 85 did not believe that sports precipitate seizures, and 15 were forbidden by their physicians to engage in physical activities. Moreover, 14 were cautioned against participation in sports by their relatives and friends. Eight-four patients had never experienced seizures during physical exercise, 36 believed that physical activity has a positive influence on treatment, and only 1 related injuries associated with seizures. Forty-five are afraid of having seizures during exercise because the seizures might attract the attention of others and they would make fools of themselves. Our data show that although most of our patients do not regularly engage in physical activity, they believe that it might improve medical treatment.

Evaluation of physical activity habits in patients with posttraumatic stress disorder.

OBJECTIVE In this study, we present data from a survey that aimed to assess the physical activity habits of adult Brazilian patients with Posttraumatic Stress Disorder. METHOD Fifty male and female patients with Posttraumatic Stress Disorder participated in this study. The mean age at onset was 37±12 years, and the mean time between diagnosis and follow-up was 3.6±4.2 years. RESULTS Substantial changes in physical activity habits were observed following the onset of PTSD. While more than half of the patients participated in physical activities prior to Posttraumatic Stress Disorder onset, there was a significant reduction in their participation afterwards. The justifications for stopping physical activities or sport participation were lack of time and lack of motivation. DISCUSSION Several studies have shown that physical exercise decreases reverts symptoms of psychiatric disorders such as depression, anxiety and social isolation. We could therefore hypothesize that patients with Posttraumatic Stress Disorder who exercise should experience the same benefits. CONCLUSION Our findings demonstrated that patients with Posttraumatic Stress Disorder have low levels of participation in sports or physical activities.

The other side of the coin: Beneficiary effect of omega-3 fatty acids in sudden unexpected death in epilepsy.

The epilepsies are the most common serious neurological condition. People with epilepsy have a two- to threefold increased risk of dying prematurely than those without epilepsy, and the most common epilepsy-related category of death is sudden unexpected death in epilepsy (SUDEP). The exact pathophysiological causes of SUDEP remain unknown, but it is very probable that cardiac arrhythmia during and between seizures plays a potential role. Although the pharmacological treatments available for the epilepsies have expanded, antiepileptic drugs are still limited in clinical efficacy. In this regard, several factors such as genetic, environmental, and social can contribute to the inefficacy of therapeutic outcome in patients with epilepsy. Among these factors, nutritional aspects, that is, omega-3 fatty acid deficiency, have an interesting role in this scenario. Animal and clinical studies have demonstrated that omega-3 fatty acids may be useful in the prevention and treatment of epilepsy. Moreover, as omega-3 fatty acids per se have been shown to reduce cardiac arrhythmias and sudden cardiac deaths, it has been proposed that omega-3 fatty acid supplementation in patients with refractory seizures may reduce seizures and seizure-associated cardiac arrhythmias and, hence, SUDEP. Given their relative safety and general health benefits, our update article summarizes the knowledge of the role of dietary omega-3 fatty acids in epilepsy.

Acute and chronic exercise modulates the expression of MOR opioid receptors in the hippocampal formation of rats.

Exercise stimulates the release of beta-endorphin and other endogenous opioid peptides that are believed to be responsible for changes in mood, perception of pain and also performance. Although the vast majority of literature data support the role of physical exercise in increasing beta-endorphin levels, indirect measures such as increased endorphin levels in peripheral blood do not reflect opioid levels in the central nervous system. The purpose of the present study was to verify whether acute and chronic exercise using both voluntary and forced exercise procedures could modify the expression of μ-opioid receptors (MOR) in rat hippocampal formation. Immunoblotting analysis showed significantly enhanced MOR expression in the hippocampal formation in the acute (forced and voluntary) exercise groups when compared to the control group. Conversely, a significant reduction of MOR expression was noted in the chronic forced and chronic voluntary exercise groups compared to the acute forced and voluntary groups respectively. MOR expression was not significantly different in rats trained using both acute or chronic exercise. Immunohistochemistry analysis showed a higher number of MOR-positive cells for acute forced and voluntary exercise groups in the CA1, CA3, hilus and dentate gyrus regions compared to the control group. Our findings indicate that acute and chronic exercise modulates MOR expression in the hippocampal formation of rats.

Lovastatin reduces neuronal cell death in hippocampal CA1 subfield after pilocarpine-induced status epilepticus: preliminary results

OBJECTIVE To further characterize the capacity of lovastatin to prevent hippocampal neuronal loss after pilocarpine-induced status epilepticus (SE) METHOD: Adult male Wistar rats were divided into four groups: (A) control rats, received neither pilocarpine nor lovastatin (n=5); (B) control rats, received just lovastatin (n=5); (C) rats that received just pilocarpine (n=5); (D) rats that received pilocarpine and lovastatin (n=5). After pilocarpine injection (350 mg/kg, i.p.), only rats that displayed continuous, convulsive seizure activity were included in our study. Seizure activity was monitored behaviorally and terminated with an injection of diazepam (10 mg/kg, i.p.) after 4 h of convulsive SE. The rats treated with lovastatin received two doses of 20 mg/kg via an oesophagic probe immediately and 24 hours after SE induction. Seven days after pilocarpine-induced SE, all the animals were perfused and their brains were processed for histological analysis through Nissl method. RESULTS The cell counts in the Nissl-stained sections performed within the hippocampal formation showed a significant cell loss in rats that received pilocarpine and presented SE (CA1=26.8 +/- 13.67; CA3=38.1 +/- 7.2; hilus=43.8 +/- 3.95) when compared with control group animals (Group A: CA1=53.2 +/- 9.63; CA3=63.5 +/- 13.35; hilus=59.08 +/- 10.24; Group B: CA1=74.3 +/- 8.16; CA3=70.1 +/- 3.83; hilus=70.6 +/- 5.10). The average neuronal cell number of CA1 subfield of rats that present SE and received lovastatin (44.4 +/- 17.88) was statically significant increased when compared with animals that just presented SE. CONCLUSION Lovastatin exert a neuroprotective role in the attenuation of brain damage after SE.

Cardiorespiratory and electroencephalographic responses to exhaustive acute physical exercise in people with temporal lobe epilepsy

We evaluated physiological and electroencephalographic responses during a cardiopulmonary exercise test (CPET) in people with epilepsy. Behavioral outcomes of people with epilepsy were also compared with those of healthy controls. Thirty-eight subjects (19 people with epilepsy and 19 controls) participated in this study. Poor outcomes in the behavioral analyses (habitual level of physical activity and quality of life) were observed in the people with epilepsy. With respect to the CPET, V.O(2max) (14.6%) and V.O(2) at anaerobic threshold (16.1%) were significantly lower in the epilepsy group than in the control group. Although not statistically significant, a decrease in the number of epileptiform discharges was observed between the rest state and exercise (82%) and between the rest state and recovery period (74%). In conclusion, the lower aerobic fitness in people with epilepsy observed may be associated with their sedentary habits. Moreover, our findings reinforce the hypothesis that exhaustive exercise is not a seizure-inducing factor.

Dreams and Epilepsy

SUMMARY: The relationship between dreams and epilepsy is illustrated by two patients whose awake epileptic seizures and recurrent dreams during night sleep had similar content. In both of our cases the EEG showed right anterior temporal spike discharge, suggesting a role for the temporal lobe in the association between dreams and seizures.

Mothers of children with cerebral palsy with or without epilepsy: a quality of life perspective

Purpose. Disability in a child affects not only the childs life but also the familys life. The aim of our study is to verify the quality of life (QOL) of mothers of disabled children with cerebral palsy (CP) with epilepsy compared with non-epilepsy children evaluated in a Brazilian center. Methods. Thirty mothers of disabled children participated in the study. The control group comprised of 18 healthy mothers of children without disabilities. All mothers agreed to participate in the study. They completed the evaluation forms of the SF-36 health survey, a well-documented, self-administered QOL scoring system. Results. The results of our study support the premise that mothers of children with CP, as a group, have poorer QOL than mothers of not disabled children. Conclusions. We also observed that mothers of children with CP and epilepsy have poorer QOL than mothers of children with CP without epilepsy.

Association between leisure time, physical activity, and mood disorder levels in individuals with epilepsy

The aim of this study was to investigate the association between physical activity levels (occupational, sports, and leisure time activities), depression, anxiety, and epilepsy. The behavioral outcomes of individuals with epilepsy (E) were also compared with healthy control subjects (C). The sample included 31 individuals with epilepsy (12 with idiopathic generalized epilepsy and 19 with partial epilepsy) and 31 control subjects. Self-rating questionnaires were used to assess mood (State-Trait Anxiety Inventory and Beck Depression Inventory), anxiety, and depression as well as habitual physical activity. Patients with epilepsy were more severely impaired compared to control subjects in both mood questionnaires and presented higher levels of depression (35%), state anxiety (18%), and trait anxiety (12.6%) when compared to the C group. Although physical activity level did not differ significantly between groups, linear regression analyses showed that the physical activity leisure level predicted 31% of depression levels and 26% of anxiety levels in the E group. These data suggest that low levels of physical activity may be considered a risk factor for the development of depression and anxiety and can play an important role in the quality of life of individuals with epilepsy.

Evaluation of intense physical effort in subjects with temporal lobe epilepsy.

People with epilepsy have been discouraged from participating in physical activity due to the fear that it will exacerbate seizures. Although the beneficial effect of aerobic exercise in people with epilepsy, little objective evidence regarding the intensity of exercise has been reported. We investigated the effect of incremental physical exercise to exhaustion in people with epilepsy. Seventeen persons with temporal lobe epilepsy and twenty one control healthy subjects participated in this study. Both groups were submitted to echo-color-doppler and electrocardiogram at rest and during physical effort. None of patients reported seizures during physical effort or in the recovery period of ergometric test. Both groups presented physiological heart rate and blood pressure responses during the different stages of the ergometric test. Only few patients presented electrocardiography or echocardiography alterations at rest or during effort. In conclusion, this work suggests that physical effort to exhaustion is not a seizure-induced component.