Estudo vídeo-eletroencefalográfico do efeito de fatores precipitantes em pacientes com epilepsia mioclonica juvenil
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Data
2006
Autores
Sousa, Patrícia da Silva [UNIFESP]
Orientadores
Yacubian, Elza Márcia Targas [UNIFESP]
Tipo
Tese de doutorado
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Resumo
As crises epilépticas podem ser precipitadas por vários fatores, endógenos ou exógenos. O conhecimento de fatores precipitantes e inibitórios de crises pode auxiliar o tratamento e propiciar ao paciente uma melhor qualidade de vida. O presente estudo objetivou detectar o efeito dos fatores precipitantes, representados pela ativação neuropsicológica, hiperventilação, fotoestimulação e sono, como desencadeantes de crises clínicas e/ou eletroencefalográficas em pacientes com Epilepsia Mioclônica Juvenil (EMJ), através do vídeo-eletroencefalograma. A EMJ corresponde de 2,8% a 11,9% de todas as epilepsias, mas, os pacientes
não são facilmente diagnosticados. Dificuldades de interpretação dos fatores clínicos e eletroencefalográficos têm
sido mencionadas em estudos de vários países. No entanto, os pacientes conseguem identificar fatores em seu estilo de vida, ou em eventos externos, que consideram precipitantes de suas crises. No período compreendido entre 2002 e 2005 foram avaliados 86 pacientes com diagnóstico de EMJ no Ambulatório de Epilepsia da Escola Paulista de Medicina.
Dando continuidade a pesquisas já realizadas nesse ambulatório, implicadas no retardo do diagnóstico e no prognóstico após tratamento adequado, constatou-se que entre 41 pacientes avaliados, 19,5% haviam recebido diagnóstico sindrômico. Os outros 80,5% haviam sido classificados como portadores de epilepsia indeterminada. A fase 1 da pesquisa constou da aplicação de um questionário sobre a identificação de fatores precipitantes e dela participaram 75 pacientes. Na fase 2, 65 pacientes foram submetidos a um Protocolo Neuropsicológico durante estudo Vídeo-eletroencefalográfico. Os dados coletados no estudo estão apresentados sob a forma de artigos publicados (6) e a ser submetido à publicação (1). Em respostas ao questionário aplicado, 92% dos pacientes conseguiram identificar, pelo menos, um fator precipitante de suas crises. A aplicação do Protocolo Neuropsicológico durante a Vídeo-letroencefalografia
visou estudar o efeito dos fatores precipitantes e/ou inibitórios de crises epilépticas. Foi possível observar que a mesma função pôde ser algumas vezes provocativa ou inibitória, no mesmo paciente, mas, o efeito de uma tarefa específica teve sempre respostas idênticas, sugerindo um mecanismo reflexo verdadeiro. Em conclusão, podemos considerar que: a) a aplicação de um questionário estrutura
do a respeito de fatores precipitantes e inibitórios de crises é um valoroso auxílio ao paciente a praticar a autopercepção e
a relatar estes fatores; b) a aplicação de testes neuropsicológicos durante a Vídeo-eletroencefalografia torna-se um instrumento de investigação eletroclínica para comprovação dos fatores precipitantes de crises, tanto em
pacientes tratados como em não tratados; pode confirmar a existência de traços reflexos; permite avaliar a relação entre
função cognitiva e as crises epilépticas e, no caso de pouca resposta à terapêutica medicamentosa pode auxiliar no reconhecimento dos fatores precipitantes de crises.
Epileptic seizures can be related to many internal and external factors. The awareness of precipitant and inhibitory factors of seizures can assist the treatment and give the patient a better quality of life. One of the objectives of this study was the characterization of factors represented by higher mental function, hyperventilation, photic stimulation and sleep, as clinical and/or electroencephalographycal triggers in patients with Juvenile Myoclonic Epilepsy (JME) through the Video-electroencephalogram Neuropsychological Protocol. Albeit frequent, corresponding to 2.8%-11.9% of all epileptic syndromes, JME is not easily diagnosed. Difficulties in cl inical and electroencephalographical interpretation have been mentioned in studies from many countries. However, patients can identify the factors in their lifestyle, or in external events, that are considered triggers for their seizures. In the period between 2002 and 2005, 86 patients with JME were evaluated in the Outpatient’s Epilepsy Clinic of Disciplina de Neurologia e Neurocirurgia at Escola Paulista de Medicina, Univesidade Federal de São Paulo. In one of the clinical researches done in this clinic aiming at characterizing factors implied in the delay of di agnoses and prognosis after adequate treatment in JME it was observed that only in 8 (19.5%) out of 41 evaluated patients had had syndromic diagnosis. The other 80.5% were classified as indeterminate seizure types. Phase 1 research involved 75 patients and consisted of application of a questionnaire about the identification of the trigger factors of seizures. In phase 2, 65 patients were submitted to a Video-electroencephalogram Neuropsychological Protocol to evaluate the effect of precipitating and/or inhibiting seizure factors. The data collected in these two phases are presented as six published articles and one submitted to publication. In the questionnaire 92% of the patients were able to identify at least one factor as precipitant for their seizures while 23% identified one inhibitory factor. It was possible to verify that the same function could elicit provocative or inhibitory effect in the same patient. However, the effect of a specific task had always identical responses suggesting a true reflex mechanism. As conclusions, we can consider that: a) The application of a structured questionnaire related to precipitating and inhibitory seizure factors is of great help for the patients to practice self-perception of their seizures and to report these factors; b) The Video–electroencephalogram Neuropsychological Protocol becomes an electroclinical tool to state the precipitating and inhibitory factors, not only in treated but also in non-treated patient s; the existence of reflex traces can be confirmed; the link between seizures and cognitive function can be performed and in the case of low therapeutic response, could help in the recognition of trigger factors of seizures.
Epileptic seizures can be related to many internal and external factors. The awareness of precipitant and inhibitory factors of seizures can assist the treatment and give the patient a better quality of life. One of the objectives of this study was the characterization of factors represented by higher mental function, hyperventilation, photic stimulation and sleep, as clinical and/or electroencephalographycal triggers in patients with Juvenile Myoclonic Epilepsy (JME) through the Video-electroencephalogram Neuropsychological Protocol. Albeit frequent, corresponding to 2.8%-11.9% of all epileptic syndromes, JME is not easily diagnosed. Difficulties in cl inical and electroencephalographical interpretation have been mentioned in studies from many countries. However, patients can identify the factors in their lifestyle, or in external events, that are considered triggers for their seizures. In the period between 2002 and 2005, 86 patients with JME were evaluated in the Outpatient’s Epilepsy Clinic of Disciplina de Neurologia e Neurocirurgia at Escola Paulista de Medicina, Univesidade Federal de São Paulo. In one of the clinical researches done in this clinic aiming at characterizing factors implied in the delay of di agnoses and prognosis after adequate treatment in JME it was observed that only in 8 (19.5%) out of 41 evaluated patients had had syndromic diagnosis. The other 80.5% were classified as indeterminate seizure types. Phase 1 research involved 75 patients and consisted of application of a questionnaire about the identification of the trigger factors of seizures. In phase 2, 65 patients were submitted to a Video-electroencephalogram Neuropsychological Protocol to evaluate the effect of precipitating and/or inhibiting seizure factors. The data collected in these two phases are presented as six published articles and one submitted to publication. In the questionnaire 92% of the patients were able to identify at least one factor as precipitant for their seizures while 23% identified one inhibitory factor. It was possible to verify that the same function could elicit provocative or inhibitory effect in the same patient. However, the effect of a specific task had always identical responses suggesting a true reflex mechanism. As conclusions, we can consider that: a) The application of a structured questionnaire related to precipitating and inhibitory seizure factors is of great help for the patients to practice self-perception of their seizures and to report these factors; b) The Video–electroencephalogram Neuropsychological Protocol becomes an electroclinical tool to state the precipitating and inhibitory factors, not only in treated but also in non-treated patient s; the existence of reflex traces can be confirmed; the link between seizures and cognitive function can be performed and in the case of low therapeutic response, could help in the recognition of trigger factors of seizures.
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Citação
SOUSA, Patrícia da Silva. Estudo vídeo-eletroencefalográfico do efeito de fatores precipitantes em pacientes com epilepsia mioclônica juvenil. 2006. 166 f. Tese (Doutorado) - Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2006.