Paula Teixeira Fernandes

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.

Partial Reversibility of Hypothalamic Dysfunction and Changes in Brain Activity After Body Mass Reduction in Obese Subjects

OBJECTIVE Inflammation and dysfunction of the hypothalamus are common features of experimental obesity. However, it is unknown whether obesity and massive loss of body mass can modify the immunologic status or the functional activity of the human brain. Therefore, the aim of this study was to determine the effect of body mass reduction on brain functionality. RESEARCH DESIGN AND METHODS In humans, changes in hypothalamic activity after a meal or glucose intake can be detected by functional magnetic resonance imaging (fMRI). Distinct fMRI analytic methods have been developed to explore changes in the brain’s activity in several physiologic and pathologic conditions. We used two analytic methods of fMRI to explore the changes in the brain activity after body mass reduction. RESULTS Obese patients present distinct functional activity patterns in selected brain regions compared with lean subjects. On massive loss of body mass, after bariatric surgery, increases in the cerebrospinal fluid (CSF) concentrations of interleukin (IL)-10 and IL-6 are accompanied by changes in fMRI patterns, particularly in the hypothalamus. CONCLUSIONS Massive reduction of body mass promotes a partial reversal of hypothalamic dysfunction and increases anti-inflammatory activity in the CSF.

Practice and perfect: length of training and structural brain changes in experienced typists.

Motor training results in performance improvement. It is not yet fully understood the extent to which functional improvement is reflected in changes in brain structure. To investigate the presence and degree of structural brain plasticity induced by long-term bimanual motor activity, we studied 17 right-handed professional typists with average duration of typing practice of 11 years. Using optimized voxel-based morphometry, we correlated the duration of practice and grey matter volume. Regions of interest were applied using 116 previously segmented predefined brain sites. We found a significant positive regression between grey matter volume and duration of practice in brain regions related to the programming of motor tasks. Long-term bimanual training may increase grey matter volume in the brains of professional typists.

Can exercise shape your brain? Cortical differences associated with judo practice.

Experimental animal studies have shown that physical exercise, associated with planning and execution of complex movements, are related to changes in brain structure. In humans, changes in cortical tissue density in relation to physical activity are yet to be fully determined and quantified. We investigated differences on gray matter volume in judo players by using voxel-based morphometry. Comparison between a group of eight internationally competitive judo players and a group of 18 healthy controls showed a significantly higher gray matter tissue density in brain areas of judo players.

Psychiatric comorbidity and suicidal behavior in epilepsy: A community-based case-control study

Purpose:  To provide information about psychiatric comorbidity and suicidal behavior in people with epilepsy compared to those without epilepsy from a community sample in Brazil.

Epilepsy stigma perception in an urban area of a limited-resource country

OBJECTIVE To estimate the perception of stigma attached to epilepsy in an urban society of a limited-resource country, Brazil. METHODS We applied a validated Stigma Scale of Epilepsy (SSE) cross-sectionally to 1850 people from all regions within the metropolitan area of Campinas, following a sampling selection methodology (95% confidence interval and error of 2.3). RESULTS The overall score for epilepsy stigma perception was 42 (range, 3-98; SD, 14). The SSE score for women was higher (43) than that for men (40). With respect to religion, Spiritism had the lowest SSE score (35) compared with Catholic, Evangelical, other, and no religion. Level of education was inversely related to SSE scores; illiterate people had higher SSE scores (45) than people with higher education (37). CONCLUSION This is one of the first systematic assessments of epilepsy stigma perception in an urban area of a limited-resource country. It was found that the magnitude of stigma is different within segments of the local society, highlighting that sociocultural factors such as gender, religion, and level of education may be important predictors of stigma.

Stigma scale of epilepsy: validation process

PURPOSE To validate a Stigma Scale of Epilepsy (SSE). METHODS The SSE was completed by 40 adult with epilepsy attending an Outpatient Epilepsy Clinic at the University Hospital of UNICAMP, and by 40 people from the community. People were interviewed on an individual basis; a psychologist read the questions to the subjects who wrote the answers in a sheet. The procedure was the same for all the subjects and completion took around ten minutes. RESULTS The SSE has 24 items. The internal consistency of the SSE showed alpha Cronbachs coefficient 0.88 for the patients with epilepsy and 0.81 for the community. The overall mean scores of the Stigma Scale of Epilepsy formula were: 46 (SD=18.22) for patients and 49 (SD=13.25) for the community where a score of 0 would suggest no stigma, and 100 maximum stigma. DISCUSSION The SSE has satisfactory content validity and high internal consistency. It allows the quantification of the perception of stigma by patients and people from community; this can then be used for interventional studies, such as mass media campaign in minimizing the negative facets of stigma.

Percepção de estigma na epilepsia

INTRODUCTION: People with epilepsy often need to deal with the stigma, usually worse than the epilepsy itself. In general, epilepsy is a condition that affects the behavior and the quality of life, not only for the person with epilepsy, but also for the entire family, especially because of stigma. For this reason, we can say that epilepsy has an bio-psycho-social impact on the peoples life. Paradoxically, this facet of epilepsy is not often studied, especially in resource-poor countries, as Brazil, where superstitions, negative attitudes and lack of knowledge impair the relation between the community and people with epilepsy. PURPOSE: This article has the objective to introduce important aspects of stigma in epilepsy: conceptualization and models of stigma in the medical and social area; stigma and quality of life; neurobiological aspects and strategies to deal with it. CONCLUSIONS: This paper provides an overview of the stigma, including its different aspects. Stigma is a multifactorial concept and for this reason, to combat stigma it requires a broad intervention, involving medical, psychological and social areas. The understanding of the process of stigma contributes to a change of the social interpretation of the epilepsy, in a direction of a construction of a society more tolerant, where the differences are respected.

Stigma scale of epilepsy: the perception of epilepsy stigma in different cities in Brazil

PURPOSE To assess the perception of epilepsy stigma in different regions of Brazil. METHOD The Stigma Scale of Epilepsy (SSE) questionnaire was applied to people in different Brazilian urban settings. The survey was performed on individual basis; an interviewer read the questions to the subjects and wrote down the answers. The same procedure was applied to all the subjects and took around 10 minutes. RESULTS 266 questionnaires were completed in four different towns of Brazil (Curitiba=83; São Paulo=47; Vila Velha=79; Ipatinga=57). The overall stigma score was 49.7 (median). Different scores were obtained in each locality. Vila Velha=42; Curitiba=49; São Paulo=52; Ipatinga=54 (ANOVA [2.262]=3.82; p=0.01). CONCLUSION This study showed differences in the perception of stigma, which may depend on cultural and regional aspects. The concept of stigma has cultural perspectives, depending on the region and the context where each person lives. The understanding of this aspect of epilepsy is important to promote better de-stigmatization campaigns, considering the cultural and social differences.

Kids’ perception about epilepsy

PURPOSE Epilepsy remains a stigmatized condition. Lack of information has been pointed to as a cause of the perpetuation of stigma. Our goal was to survey childrens perception of epilepsy. METHODS We used a questionnaire to determine if the children knew what epilepsy is and, if they did not know, what did they think epilepsy is. Twenty-nine children (15 girls; mean age 10 years, range 9-11 years) from a fourth-grade class of an elementary school in Campinas, Sao Paulo, Brazil, completed the questionnaires individually at the same time in the classroom. This took about 20 minutes. RESULTS Only four children said they knew what epilepsy is: a disease of swallowing the tongue (3) and a disease that can kill (1). The perceptions of children who said they did not know what epilepsy is were: a disease that can kill, a disease of swallowing the tongue, a contagious disease, a serious illness, a head injury. Three children knew someone with epilepsy, and only two of them had said they knew what epilepsy is. CONCLUSION The perceptions elicited from the children had a negative connotation; only one child mentioned a relationship between epilepsy and the brain. The spontaneous thoughts of children in this age group, without the contamination of political correctness, may reflect societys collective unconsciousness of the prejudice toward epilepsy and people with epilepsy and needs to be further investigated. Continuous, repetitive educational efforts are necessary in elementary school to change these negative perceptions of epilepsy in our society.