-Objective: To investigate the effect of three months of low-frequency repetitive transcranial magnetic stimulation (rTMS) treatment in intractable epilepsy. Methods: Five patients (four males, one female; ages 6 to 50 years), were enrolled in the study; their epilepsy could not be controlled by medical treatment and surgery was not indicated. rTMS was performed twice a week for three months; patients kept records of seizure frequency for an equal period of time before, during, and after rTMS sessions. rTMS was delivered to the vertex with a round coil, at an intensity 5 % below motor threshold. During rTMS sessions, 100 stimuli (five series of 20 stimuli, with one-minute intervals between series) were delivered at a frequency of 0.3 Hz. Results: Mean daily number of seizures (MDNS) decreased in three patients and increased in two during rTMS-one of these was treated for only one month; the best result was achieved in a patient with focal cortical dysplasia (reduction of 43.09 % in MDNS). In the whole patient group, there was a significant (p<0.01) decrease in MDNS of 22.8 %. Conclusions: Although prolonged rTMS treatment is safe and moderately decreases MDNS in a group of patients with intractable epilepsy, individual patient responses were mostly subtle and clinical relevance of this method is probably low. Our data suggest, however, that patients with focal cortical lesions may indeed benefit from this novel treatment. Further studies should concentrate on that patient subgroup.KEY WORDS: transcranial magnetic stimulation, rTMS, epilepsy.Terapia experimental da epilepsia com estimulação magnética transcraniana: ausência de melhora adicional com tratamento prolongado RESUMO -Objetivo: investigar o efeito de três meses de estimulação magnética transcraniana repetitiva (EMTr) de baixa freqüência, na epilepsia de difícil controle. Método: Cinco pacientes (quatro homens, uma mulher, idades entre 6 e 50 anos), participaram do estudo; suas crises epilépticas não puderam ser controlados por tratamento medicamentoso e não tinham indicação cirúrgica; a EMTr foi realizada duas vezes por semana durante três meses, sendo que os pacientes anotaram o número diário de crises neste perío-do, assim como nos três meses anteriores e posteriores ao tratamento. A aplicação da EMTr foi feita no vértex com bobina circular, com intensidade 5% abaixo do limiar motor. Durante as sessões de EMTr, 100 estímulos (5 séries de 20 estímulos, com um minuto de intervalo entre as séries) foram realizadas na freqüência de 0,3 Hz. Resultados: A média diária de crises (MDC) decresceu em três pacientes e aumentou em dois durante o uso da EMTr; um destes casos foi tratado somente por um mês; o melhor resultado foi encontrado em um paciente com displasia cortical focal (redução de 43,09% na MDC). Em todo o grupo de pacientes, houve decréscimo significativo na MDC de 22,8% (p<0,01). Conclusão: Embora o tratamento prolongado com a EMTr seja seguro e tenha sido registrado decréscimo moderado da MDC em um grupo de pacientes com epilepsia de difí...
-Objective: To assess the prevalence of celiac disease (CD) among a group of epileptic patients attending the Epilepsy Clinics of two general hospitals in the city of Brasilia (DF), Brazil. Method: Serum samples were collected from 255 epileptic patients (119 children, 136 adults) originating from Epilepsy Clinics, and from a control group composed by 4405 individuals (2034 children, 2371 adults) attending the Laboratory of Clinical Analysis, for routine blood testing. The diagnosis of CD was determined by the antiendomysium antibody (IgA-EMA) test and by small intestine biopsy. Results: two of the 255 epileptic patients (1:127) and fifteen subjects from the control group (1:293) tested positive for the IgA-EMA assay. Conclusion: the prevalence of CD was 2.3 times higher in epileptic patients than in controls (7.84 per 1000 versus 3.41 per 1000). Although still not statistically significant, this result is highly suggestive of an increased prevalence of CD among epileptic patients.KEY WORDS: celiac disease, gluten-sensitive enteropathy, epilepsy, prevalence A prevalência da doença celíaca é elevada entre pacientes com epilepsia? A prevalência da doença celíaca é elevada entre pacientes com epilepsia? A prevalência da doença celíaca é elevada entre pacientes com epilepsia? A prevalência da doença celíaca é elevada entre pacientes com epilepsia? A prevalência da doença celíaca é elevada entre pacientes com epilepsia? RESUMO -Objetivo: Determinar a prevalência da doença celíaca (DC) num grupo de pacientes epilépticos atendidos em ambulatórios de especialidade de dois hospitais gerais na cidade de Brasília (DF). Método: Amostras de soro foram colhidas de 255 pacientes epilépticos (119 crianças, 136 adultos) e de uma população formada por 4405 indivíduos (2034 crianças, 2371 adultos), atendidos no Laboratório de Análises Clínicas para exames de rotina. O diagnóstico de DC foi estabelecido por meio do teste de anticorpos antiendomísio (IgA-EMA) e por biópsia do intestino delgado. Resultados: dois dos 255 pacientes epilépticos (1:127) e quinze indivíduos do grupo controle (1:293) apresentaram biópsia compatível e resultados positivos no teste IgA-EMA. Conclusão: a prevalência de DC foi 2.3 vezes maior em pacientes epilépticos do que nos controles (7.84 per 1000 versus 3.41 per 1000). Apesar deste resultado não ser estatisticamente significativo pode, no entanto ser considerado altamente sugestivo da existência de prevalência aumentada de DC entre pacientes epilépticos. PALAVRAS-CHAVE: doença celíaca, enteropatia sensível ao glúten, epilepsia, prevalência.Celiac disease (CD), also known as gluten-sensitive enteropathy, is a lifelong disorder of variable severity characterized by malabsorption and specific, though not pathognomonic, lesions of the small intestinal mucosa. Mucosal lesions are occasioned by sensitivity to ingested wheat gluten or related barley or rye proteins in genetically susceptible individuals. A strict gluten free diet (GFD) results in regression of the small intestinal abnormalities and a r...
Our study found that, although surgical treatment was effective, its impact on social indicators was modest. Moreover, the self-reported quality of life relied not only on seizure control but also on depressive symptoms and antiepileptic drug burden.
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