Hip-DBS was effective in significantly reducing seizure frequency in patients with refractory TLE in the active group, as compared to the control group. Fifty-percent of the patients in the active group became seizure-free. The present study is the larger prospective, controlled, double-blind study to evaluate the effects of Hip-DBS published to date.

Introdução: As Diretrizes Curriculares Nacionais para o curso de Medicina sinalizaram a necessidade de formar um médico capaz de atuar conforme as necessidades de saúde da população visando o fortalecimento do Sistema Único de Saúde. A implantação de um estágio, na área de Atenção Primaria à saúde, na Faculdade de Medicina ABC, resultou em uma reforma mais ampliada do internato médico. Objetivo: Identificar a percepção dos estudantes quanto a inserção do ciclo de Atenção Primária à Saúde (CAPS) no internato médico. Métodos: Estudo transversal que utilizou um questionário fechado, aplicados aos estudantes do 5º e 6º anos, totalizando 157 participantes, em 2011 abordando os aspectos teóricos e práticos do CAPS. Resultados: Chamou a atenção na comparação entre o 5º e 6º anos do Ciclo de Atenção Primaria à Saúde: o CAPS no 5º ano teve o maior número de quesitos respondidos com regular e fraco, enquanto que o 6º ano teve um grande número respondido com ótimo e bom. Observaram-se diferenças marcantes quanto à percepção dos estudantes entre os aspectos abordados do CAPS entre os estudantes do 5º e 6º, com destaque para maior grau de satisfação com o 6º ano (UBS tradicional) do que com o 5º ano Estratégia de saúde da família (ESF). Conclusão: Há indícios de que os respondentes validaram a implementação do CAPS, mas ainda restam desafios e tensões quanto à estruturação e integração ensino e serviço.Palavras-chave: educação médica; serviços de integração docente-assistencial; internato e residência.

IntroductionVagus nerve stimulation (VNS) therapy is an established treatment for patients with drug-resistant epilepsy that reduces seizure frequency by at least 50% in approximately half of patients; however, the characteristics of the patients with the best response have not yet been identified. Thus, it is important to identify the profile of patients who would have the best response to guide early indications and better patient selection.MethodsThis retrospective study evaluated vagus nerve stimulation (VNS) as an adjuvant therapy for patients with drug-resistant epilepsy from six epilepsy centers in Brazil. Data from 192 patients aged 2–66 years were analyzed, and all patients received at least 6 months of therapy to be included.ResultsIncluded patients were aged 2–66 years (25.6 ± 14.3), 105 (54.7%) males and 87 (45.8%) females. Median follow-up interval was 5 years (range, 2005—2018). Overall, the response rate (≥50% seizure reduction) after VNS implantation was 65.6% (126/192 patients). Most patients had 50–90% seizure reduction (60.9%) and nine patients became seizure-free. There were no serious complications associated with VNS implantation. The rate of a ≥ 50% seizure reduction response was significantly higher in patients with no history of neurosurgery. The presence of focal without generalized seizures and focal discharges on interictal EEG was associated with better response. Overall, etiological predictors of a better VNS response profile were tumors while a worse response to VNS was related to the presence of vascular malformations and Lennox–Gastaut Syndrome.DiscussionWe observed an association between a better response to VNS therapy no history of neurosurgery, focal interictal epileptiform activity, and focal seizure pattern. Additionally, it is important to highlight that age was not a determinant factor of the response, as children and adults had similar response rates. Thus, VNS therapy should be considered in both adults and children with DRE.