Priscila Camile Barioni Salgado

Neuroimaging changes in mesial temporal lobe epilepsy are magnified in the presence of depression

OBJECTIVE The aim of this study was to investigate differences in gray matter volume between patients with mesial temporal lobe epilepsy (MTLE) with and without depression using voxel-based morphometry. METHOD We included 48 adults with refractory MTLE (31 women, 39.18 ± 8.4 years) and 96 healthy controls (75 women, 37.11 ± 8.9 years). For the psychiatric evaluation, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Axis I, was used for the diagnosis of depression, and the Beck Depression Inventory, for the determination of symptom intensity. All patients underwent an MRI scan. Patients were separated into two groups: those with MTLE with depression (n = 24) and those with MTLE without depression (n = 24). We performed voxel-based morphometric analysis, comparing patients with controls using the t test. RESULTS The number of areas of gray matter volume loss was higher in patients with MTLE with depression than in those with MTLE without depression. CONCLUSIONS The evidence of more widespread gray matter volume loss in patients with MTLE and depression calls our attention to the importance of timely recognition and treatment of depression in patients with MTLE and also to the bidirectional relationship between the two disorders and their frequent co-occurrence.

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.

Impacto da epilepsia no trabalho: avaliação da qualidade de vida

This study searched for the knowledge of the most affected aspects in the quality of life (QoL) of patients with epilepsy. The sample consisted of 134 individuals with epilepsy, aging 18 to 59 years (M=35.38; DP=9.86) chosen at random from the Ambulatory of Epilepsy of HC/UNICAMP, interviewed by the QoL-65. Most of the subjects have not completed elementary school (58.2%), have not had any paid work (69.5%) and were single (48.5%). The most affected factor in epilepsy was the work area (31.29%), what reinforces studies showing the high level of unemployment or subemployment in epileptic population and aware to the importance of the insertion in the work-market as an economic and social integration factor and as a way of improving self-esteem.

The second step in the construction of a stigma scale of epilepsy

RATIONALE The issue of stigmatization is one of the most common psychosocial problems faced by people with epilepsy. PURPOSE A second step towards the development of a scale to measure epilepsy stigma. METHOD We applied a closed questionnaire to 12 patients and 32 relatives from the Epilepsy Outpatient Clinic at the University Hospital of Campinas. RESULTS The results are grouped in three main domains: medical, social and personal areas. Medical: the subjects did not know exactly what epilepsy is or how it is caused; nonetheless they know how to treat it. Social: the most important areas that people with epilepsy are discriminated are at work and social relationships. Patients also complained about their lack of freedom and limits on recreation activities. Personal Area: subjects apparently have the same feelings and thoughts about epilepsy and seizures. CONCLUSION This study analyzed the most common aspects presented in the questionnaire to assess epilepsy stigma for the Brazilian culture which are the base to the elaboration of a stigma scale of epilepsy.

Qualidade de vida em epilepsia e percepção de controle de crises

The individual affective-cognitive evaluations are important factors that control the way he feels the disease impact in his life. Then, the perception of seizure control is a more important factor to evaluate Quality of Life (QoL) than the illness characteristics, such as the severity, type, sickening period and seizure frequency. This study searched for the relationship among the subjective variables (perception of seizure control) and the illness characteristics to evaluate QoL. The sample consisted of 60 individuals with chronic epilepsy, aging 18 to 70 (M=37.05; SD=11.25), chosen at randon from the ambulatory of epilepsy - HC/UNICAMP, by the Questionnaire 65. The illness characteristics were not significant, except the seizures frequency, when associated to the impairment in QoL among controlled seizures and seizures with frequency higher than 10 per month (p=0.021). The perception of control was significantly associated to QoL (p=0.005).

Variáveis psicológicas envolvidas na qualidade de vida de portadores de epilepsia

Psychological variables involved in the quality of life of patients with epilepsy. The epilepsy diagnostic breaks the way people used to perceive themselves, and tends to destroy their social and economical life, as well as their plans for the future. This study searched for the evaluation of psychological variables (perception of seizure control) and the illness characteristics determining the quality of life (QoL) in patients with the diagnostic of epilepsy for over two years. The sample consisted of 60 individuals with chronic epilepsy, aging 18 to 70 (M = 37.05; SD = 11.25), chosen at random from the outpatient clinic of epilepsy - University Hospital of Campinas /UNICAMP and evaluated by means of the Questionnaire of Quality of Life 65 (QQV-65). The illness characteristics were not statistically significant, except the seizures frequency, when associated to the impairment in QoL among controlled seizures and seizures with frequency higher than 10 per month (p = 0.021). The perception of control was significantly associated to QoL (p = 0.005). The seizures subjective understanding controls the adjustment to the disease and the sense of well being and explains why the QoL is better when the individual does not have any seizure.

Pre-surgery expectations and post-surgery life-changing validation process

This study aimed to validate two instruments that evaluate pre-surgery expectations and post-surgery life changes of people with epilepsy. The expectations questionnaire comprises 18 yes/no questions and the life changes questionnaire 25 yes/no questions, which includes the 18 questions of the expectations questionnaire plus seven negative questions, considering that the surgery could have a negative effect on the patient quality of life. There were also questions asking the patients to state if they consider the surgery to be a success or a failure, and about the frequency of seizures and their intensity. Patients were interviewed in three different phases: pre-surgery, post-surgery 1 (six months after surgery) and post-surgery 2 (12 months after surgery). The internal consistency of the instruments showed a general Kuder-Richardson coefficient of 0.855 (pre-surgery), 0.833 (post-surgery 1), 0.756 (post-surgery 2), showing that both instruments have a satisfactory content validity and high internal consistency. In this context, the answers obtained in this study are important because they represent the development of a complete set of categorical instruments to evaluate pre-surgery epilepsy expectations and post-surgery life changes.

Screening symptoms of depression and suicidal ideation in people with epilepsy using the Beck depression inventory

OBJETIVO: Avaliar a gravidade dos sintomas de depressao e ideacao suicida em pessoas com epilepsia (PCE), antes e apos o tratamento cirurgico utilizando o Inventario de Depressao de Beck (BDI). Nosso objetivo foi determinar os fatores associados a depressao em PCE. METODOS: PCE, independentemente do tipo de epilepsia, tipo de crises, duracao ou frequencia das crises, e DAEs, foram investigados. Os pacientes (n=468) foram divididos em dois grupos: pre-operatorio (n=346) e de pos-operatorio (n=122). RESULTADOS: Antes do tratamento cirurgico, o sexo feminino, o desemprego e a alta frequencia de crises foram fatores associados a ocorrencia de sintomas de depressao. Apos a cirurgia de epilepsia, o unico fator associado ao alto nivel de sintomas de depressao foi a falta de remissao de crises. Ideacao suicida foi associada a frequencia de crises antes e apos a cirurgia de epilepsia. CONCLUSAO: Nossos resultados confirmam a opiniao generalizada de que a depressao e comum nas PCE e proporcionam mais evidencia para a associacao de depressao com alguns fatores socio demograficos e relacionados as crises antes e apos o tratamento cirurgico das epilepsias.

A voxel based morphometry (VBM) analysis of gray matter volume (GMV) loss in patients with refractory mesial temporal lobe epilepsy (MTLE) with and without depression

Objective: Study GMV differences in patients with depression, and mesial temporal lobe epilepsy (MTLE) with and without depression, compared to normal controls, by applying VBM technique. Method:We included 24 adults with MTLE without depression (17 women, 38.7 mean age), 24 adults with MTLE with depression (13 women, 39.6 mean age), and 96 healthy controls (75 women, 35.1 mean age). All MTLE patients were diagnosed by clinical, eletro and image features. Depression was diagnosed by a structured clinical interview (SCID I) and its sympomatology was checked by the Beck Depression Inventory. All patients underwent highresolution MRI scan. We performed VBM analysis on SPM5 and MATLAB7, comparing groups of patients with control group. The statistical analysis for all comparisons was performed with grand mean scaling, proportional threshold masking and implicit masking. The results were corrected for multiple comparisons using a false discovery rate of 5%. We also investigated the regional correlation between GMV in MTLE with depression, checking their performance on the BDI. This form of VBM was performed on the whole brain, using the general linear model protocols built into SPM5. Results: Half of the patients with MTLE also had depression. There wasno significative difference in termsof sex (p=0.371), epilepsyonset (p=0.495), epilepsy duration (p=0.129) and frequency of seizures (p=0.285) in thegroups ofMTLEwithorwithout depression.We found no significant difference between groups when the group of MTLE with depression was divided in right and left MTLE with depression (p=0.147). Besides the fact that the laterality was not a significant factor for depression in MTLE, the group of left MTLE with depression had a more severe depression than the group of right MTLE with depression (p=0.014). Therewasno regional correlation betweenGMV in MTLE with depression and their performance on the BDI. Patients with MTLE with depression had more areas of reduced volume. Conclusions: The neuropathologic changes of MTLE seem to be magnified in the presence of a chronic untreated depression disorder. The evidence of GMV loss in patients with MTLE with depression calls our attention to the importance of timely recognition and treatment of depression in patients with MTLE and also to the bidirectional relation between the two disorders and their frequent comorbid occurrence.