Moacir Alves Borges

Prevalence and Pattern of Epilepsy Treatment in Different Socioeconomic Classes in Brazil

Summary:  Purpose: The worldwide prevalence of epilepsy is variable, estimated at 10//1,000 people, and access to treatment is also variable. Many people go untreated, particularly in resource‐poor countries.

Urban prevalence of epilepsy: populational study in São José do Rio Preto, a medium-sized city in Brazil

ANTECEDENTES: O objetivo deste estudo foi determinar a prevalencia da epilepsia na populacao urbana de Sao Jose do Rio Preto, com 336000 habitantes, localizada no noroeste do Estado de Sao Paulo/ Brasil. METODO: O estudo populacional, tipo corte transversal, em amostra aleatoria, constituiuse de uma fase de rastreamento, mediante um questionario. O padrao ouro para confirmacao diagnostica foi a historia clinica e o exame neurologico. Os testes do c2 e intervalo de confianca de 95% (IC95%) foram usados para analise dos resultados, tendo sido considerados significantes os de valor p< 0,05. RESULTADOS: A amostra estudada foi de 17293 pessoas, cuja distribuicao quanto ao sexo, a faixa etaria e a raca foram semelhantes a da populacao em geral. A prevalencia de epilepsia por 1000 hab. foi 18,6, sendo 8,2 para ativa considerandose, pelo menos, uma crise no periodo dos ultimos 2 anos. A prevalencia na faixa etaria de 0 a 4 anos foi 4,9, de 5 a 14, 11,7; de 15 a 64, 20,3; e acima dos 65 anos foi 32,8. CONCLUSAO: As prevalencias de epilepsia acumulada e ativa foram elevadas, semelhantes as dos paises em desenvolvimento, em particular, aos da America Latina. A prevalencia de epilepsia na infância foi baixa, enquanto que nos idosos foi elevada, semelhantes as observadas em paises desenvolvidos. Estes resultados sao relevantes no planejamento de medidas sanitarias, adequacao ao tratamento da populacao, considerando a alta prevalencia encontrada, para minimizar o impacto da epilepsia na populacao.UNLABELLED The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil. METHOD A cross-sectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval. RESULTS The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population. The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (04), 11.7 (514), 20.3 (1564) and 32.8 (65 or over). CONCLUSION Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.

Demonstration project on epilepsy in Brazil: outcome assessment

PURPOSE To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. METHOD We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patients and the physicians point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. RESULTS A total of 181 patients (93 women - 51%) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (>10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients and relatives opinions were that in the majority (59%) the health status had improved a lot, some (19%) had improved a little, 20% experienced no change and in 2% the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. DISCUSSION The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward in accordance with local health providers and managers.

Assessment of the epilepsy treatment gap in two cities of south-east of Brazil.

OBJECTIVE To assess the epilepsy treatment gap in Campinas and São Josédo Rio Preto, two cities in the State of São Paulo, Brazil. METHOD The treatment gap was estimated using the formula n1-n2/n1x100, where n1 was calculated using 1.86% prevalence and represented the number of individuals with epilepsy, while n2 represented the number of people who could be treated with an adult standard dose for a year utilizing the antiepileptic drugs supplied by the public health system. RESULTS Our estimates revealed that in 2001, approximately 50% of the population with epilepsy was treated with the recommended antiepileptic medication. CONCLUSION These results suggest that a relevant percentage of patients with epilepsy are not untreated. Further epidemiological studies are needed to investigate the reasons for this treatment gap so that interventions can reduce this gap and improve the quality of life of patients with epilepsy.

Oral and maxillofacial trauma in patients with epilepsy: prospective study based on an outpatient population

OBJECTIVE This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. METHOD A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95% confidence interval, dependency analysis and the Pearson χ(2) test were used for statistical analysis, and the significance level was set at p≤0.05. RESULTS A total of 159 patients with epilepsy (91 males; 57.3%) and 68 control individuals (28 males; 41.1%) were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9% and 4.4%, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9%), followed by tooth avulsion (7.6%), tooth luxation (5%) and fracturing of prostheses in edentulous patients (3.8%). CONCLUSION This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected.

Emergency EEG: study of survival

OBJECTIVE To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. METHOD In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing Kaplan-Meyer survival curves. RESULTS A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3%) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3%) cases with 119 (17.5%) having liver disease [91 (76.0%) were men, p-value=0.001], 105 (15.4%) suffering strokes, 67 (9.9%) having metabolic disorders, 51 (7.5%) central nervous system infections and 49 (7.2%) epilepsy. In the three months following EEG, a survival rate of 75% was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50% for those with continuous delta activity and generalized epileptiform discharges, and of 25% for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. CONCLUSION The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies.

Giant intracranial aneurysms: morphology and clinical presentation

The purpose of this study was to correlate the morphology of giant intracranial aneurysms (GIA) with their clinical presentation. Eighty patients with GIA, 14 males and 66 females, were studied. Univariate and multivariate analyses were made to test the associations between morphological and clinical features. The main locations of the unruptured GIA included the carotid cavernous segment, and for the ruptured GIA, the most frequent were the carotid supraclinoid and middle cerebral arteries. There was a significant association among communicating arteries (CA) of “bad” quality and presence of thrombus and calcification (TC). The risk of rupture is 8 times higher in patients with CA of “bad” quality and 11 times higher in patients without TC. GIA are more frequent in the cavernous segment. There is a high rupture risk in the middle cerebral artery. CA of “bad” quality are associated with TC. The rupture risk is significantly higher in patients without TC.

Duração e faixa etária da epilepsia e suas correlações com trabalho: estudo prospectivo ambulatorial em 379 epilépticos

O objetivo desta pesquisa e avaliar, prospectivamente, a relacao da duracao de epilepsia ativa sobre o trabalho de 379 pacientes do ambulatorio do Hospital de Base de Sao Jose do Rio Preto. A duracao da epilepsia dos pacientes foi subdividida em 5 faixas de tempo e a idade em 3 faixas etarias. A duracao da epilepsia, nao levando em conta a idade do paciente, nao prejudicou a capacidade laborativa dos epilepticos. No entanto, as epilepsias recentes (0 a 5 anos de duracao) causaram mais perda de trabalho nos epilepticos mais jovens (14 a 29 anos de idade) que nos epilepticos adultos e idosos.This study aims to evaluate, prospectively, the relationship of the active epilepsy length and the work, of the 379 out-patients from Hospital de Base, São José do Rio Preto. Epilepsy length was subdivided into 5 time rates and by age, into 3 age-groups. There was no relationship, not considering the age of patient among the epilepsy length and the work, but young patient (14 at 29 years old) and with recent epilepsy (length of 0 at 5 years) lost more work than the adult and elderly epileptic.

Migração de 81 epilépticos entre as modalidades de trabalho, desemprego e aposentadoria: três anos de seguimento ambulatorial

This study aims to assess epileptic patients migration in different sorts of paid/non paid and formal/informal work, unemployment and retirement. Eighty one epileptic patients were evolutively analyzed (cohort) at the Epilepsy Department of Hospital de Base, Medical School, Sao Jose do Rio Preto, Brazil. The epileptic percentages in different sorts of work, in March 1996 was compared with the one after three-year follow-up period in March 1999. There were no statistical significant changes among the same sorts of work in this period. However, there were intense migrations in relation to different sorts of work. Paid work showed migration to unemployment and retirement. This research shows the significant migration of epileptic patient either to some kind of a less qualified work or to some social security dependence as well as to early retirement.This study aims to assess epileptic patients migration in different sorts of paid/non paid and formal/informal work, unemployment and retirement. Eighty one epileptic patients were evolutively analyzed (cohort) at the Epilepsy Department of Hospital de Base, Medical School, Sao Jose do Rio Preto, Brazil. The epileptic percentages in different sorts of work, in March 1996 was compared with the one after three-year follow-up period in March 1999. There were no statistical significant changes among the same sorts of work in this period. However, there were intense migrations in relation to different sorts of work. Paid work showed migration to unemployment and retirement. This research shows the significant migration of epileptic patient either to some kind of a less qualified work or to some social security dependence as well as to early retirement.

Idade de aparecimento e desaparecimento das pontas rolândicas em 160 crianças acompanhadas ambulatorialmente: estudo atuarial

UNLABELLED This study aims to determine the age at which the rolandic spikes (RS) appear and disappear in routine EEGs. METHOD It has been carried out a hospital based prospective study of 412 EEGs records of 160 children who had been assisted at the neuropediatric out-patient department during the period between March, 1989 and March, 1998. Recordings were made on 8-channel instruments and 10/20 system has been to place the electrodes. The children have been divided into 4 groups, according to their age (1 to 4; 5 to 8; 9 to 16; 1 to 16), and the actuarial curve method has been used to show the disappearance of the rolandic spikes. RESULTS RS distribution between boys and girls has been 64/36 ratio. RS have been found at average age of 7 years (boys, 7.2 and girls, 6.6). In a small group of children with normal EEGs previous to the RS appearance, the average age has been 6.8 years old. After this 7-year follow up period, the percentage of patients free from RSs was 60% for 1 to 4 year old group at admission; 84% for the 5 to 8 year old group and for the 9 to 16 year old group. For the total group (1 to 16 year old), the percentage of those free from RSs after this 7 year follow up period was 78%. CONCLUSION This study shows that RSs appear at the average age of 7 years old, and are likely to disappear up to the end of a 7-year follow up period, independently on the appearance age.This study aims to determine the age at which the rolandic spikes (RS) appear and disappear in routine EEGs. METHOD: It has been carried out a hospital based prospective study of 412 EEGs records of 160 children who had been assisted at the neuropediatric out-patient department during the period between March, 1989 and March,1998. Recordings were made on 8-channel instruments and 10/20 system has been to place the electrodes. The children have been divided into 4 groups, according to their age (1 to 4; 5 to 8; 9 to 16; 1 to 16), and the actuarial curve method has been used to show the disappearance of the rolandic spikes. RESULTS: RS distribution between boys and girls has been 64/36 ratio. RS have been found at average age of 7 years (boys, 7.2 and girls, 6.6). In a small group of children with normal EEGs previous to the RS appearance, the average age has been 6.8 years old. After this 7-year follow up period, the percentage of patients free from RSs was 60% for 1 to 4 year old group at admission; 84% for the 5 to 8 year old group and for the 9 to 16 year old group. For the total group (1 to 16 year old), the percentage of those free from RSs after this 7 year follow up period was 78%.CONCLUSION: This study shows that RSs appear at the average age of 7 years old, and are likely to disappear up to the end of a 7-year follow up period, independently on the appearance age.