Summary:Purpose: To evaluate the recurrence risk after a first unprovoked seizure in a large population of children and adolescents of a developing country.Methods: This prospective study was conducted at two tertiary hospitals, between September 1989 and August 1998. Children were enrolled if they had a first unprovoked cryptogenic/idiopathic seizure and maximal interval to the enrollment ≤90 days. EEG and computed tomography (CT) were performed in most patients. Potential predictors of recurrence were compared by using the Cox proportional hazards model in univariate and multivariate analyses. Survival analysis was performed by using the Kaplan-Meier curves.Results: Two hundred thirteen children were included. Recurrence occurred in 34% of the patients, and mean time for recurrence was 12 months. Statistical analysis showed significance for seizure recurrence only for patients with abnormal EEGs. CT was performed in 182 patients, and abnormalities were found in 9.5%. Small calcifications were the most frequent finding, and this was not a predictor for recurrence.Conclusions: The risk of recurrence after a first unprovoked seizure in children from a developing country is similar to that found in developed countries. An abnormal EEG is a risk factor for seizure recurrence in children with a cryptogenic/idiopathic seizure. Calcifications on CT do not increase the risk of recurrence. Key Words: Unprovoked seizure-Children-Recurrence rate-Risk factorsCalcifications.The recurrence rate after a first unprovoked seizure varies widely depending mainly on the design of the study and the inclusion criteria of the subjects (1-13). Risks of recurrence vary from 26 to 71%. Retrospective studies usually show higher recurrence rates than do prospective studies.Most studies that address this issue have been conducted in developed countries. The aim of this study was to evaluate the recurrence risk after a first unprovoked seizure in a large population of children and adolescents of a developing country and examine whether the outcome of first nonsymptomatic seizures in Brazil is similar to that seen in other countries. METHODSThis prospective study was conducted at the Pediatric Epilepsy Clinics of two tertiary hospitals,

RESUMO -Objetivos: Identificar as crenças e os sentimentos dos pais frente à epilepsia e relacioná-los com os comportamentos de seus filhos. Avaliar a eficácia dos grupos de pais na diminuição da ansiedade, esclarecimento sobre a doença e comportamentos. Método: Foram aplicados 18 protocolos que avaliaram sentimentos, crenças e comportamento dos pais e filhos, respondidos antes e depois das sessões de grupos de apoio. Resultados: Diante do diagnóstico foram observados mágoa (94,4%), medo (72,2%), susto (27,8%), tristeza (33,3%) e rejeição (38,9%). Estes sentimentos foram associados a superproteção (83,3%) e falta de limites (38,9%). Segurança foi associada a percepção do controle de crise. Depois do grupo, 94,4% dos pais relatam menos ansiedade e 77,8% associam muitas das dificuldades a falta de informação e a presença de crenças irracionais. Conclusão: Grupos de apoio desmistificam crenças, ajudam na identificação das relações parentais e previnem dificuldades comportamentais.PALAVRAS-CHAVE: epilepsia infantil, grupo de pais, comportamento. Feelings and behaviors of parents of children with epilepsyABSTRACT -Purpose: To assess the efficacy of support groups in identifying parents feelings and behaviors facing the diagnosis of epilepsy in their children. Methods: Protocols were applied to 18 parents before and after the sessions. Each protocol consisted of questions concerning feelings and beliefs toward epilepsy as well as children-parent interactions. Results: The following feelings were observed: disappointment (94.4%), fear (72.2%), frightening (27.8%), sadness (33.3%), anxiety (27.8%) and rejection (38.9%). These feelings were associated with overprotection (83.3%) and a lack of limits (38.9%). Parents reported feeling of safety after seizure control and 77.8% associate major of difficulties to the lack of information and the inadequated beliefs involved. After support sessions, 94.4% of the parents reported less anxiety. Conclusion: Support groups dispel misconception, clarify child parent relationships and prevent behavioral difficulties.KEY WORDS: infantile epilepsy, support groups, behavior.A epilepsia é considerada como uma experiência frustante para a família 5 . Seu diagnóstico gera nos familiares um desajuste emocional, mobilizando-os no sentido de se adaptarem a uma doença crônica. O ajustamento familiar, por sua vez, tem profundo impacto em como as crianças reagem. Crianças e adolescentes epilépticos reconhecem que têm uma condição que os diferencia de outras crianças 4 . Pais percebem seus filhos como imaturos e com várias dificuldades em habilidades psicológicas diversas. Eles falam de sentimentos de culpa, do medo 10 gerados por crenças irracionais e desinformação 10,16 .Os sentimentos de medo, ansiedade, raiva, mágoa, culpa e as reações de superproteção, permissividade, superindulgência dos pais -expressas nas excessivas restrições às atividades infantis

RESUMO -Entre 1990 e 1998 foram analisadas, do ponto de vista clínico, 42 crianças com diagnóstico de doença cerebrovascular, internadas no Hospital das Clínicas da FCM-UNICAMP. O distúrbio cerebrovascular mais frequente foi do tipo isquêmico com acometimento predominante da artéria cerebral média, sendo o quadro clínico agudo caracterizado por manifestações epilépticas e alterações motoras, principalmente em crianças de idade precoce. A avaliação do seguimento das crianças mostrou predomínio de sequelas motoras.PALAVRAS-CHAVE: doença cerebrovascular aguda, infância. Cerebrovascular disease in children: II. Clinical aspects in 42 casesABSTRACT -We report the findings recorded in 42 children suffering cerebrovascular disease and assisted at the Hospital das Clínicas FCM-UNICAMP, over a 8 years period (January 1990 until April 1998). The ischemic type was the most common, and involvement of the middle cerebral artery, sudden onset of clinical manifestation with seizures and motor disability were more common in early aged children. Motor sequelae predominated in the follow-up of these children.KEY WORDS: cerebrovascular disease, stroke, children.Com o advento dos recursos técnicos não invasivos por imagem (ultrassom transfontanela, doppler transcraniano, tomografia computadorizada, ressonância magnética, angio-ressonância, SPECT, PET), tornou-se possível estabelecer o diagnóstico de anormalidades vasculares em crianças e adolescentes [1][2][3][4][5][6] . Para o entendimento dos fatores envolvidos no fenômeno agudo em recém-nascidos a termo, lactentes e crianças, consideramos relevantes não somente a atualização dos conhecimentos sobre a anatomia, e fisiologia vascular normal do sistema nervoso central, como também a compreensão dos mecanismos associados à suplência vascular em condições normais e patológicas 3,6 . Assim, na criança a rede anastomótica ampara o cérebro em desenvolvimento, restabelecendo e mantendo o fluxo sanguíneo nas áreas danificadas. Também o reconhecimento da causa básica da doença cerebrovascular (DCV) é essencial visando à prevenção de surtos subsequentes, uma vez que esses pacientes se mantêm expostos a fatores de risco, existindo possibilidade de recorrência dos fenômenos vasculares com expressividade clínica ou mesmo silentes 2,7-13 . Em lactentes, quando a sintomatologia marcante se manifesta através de crises epilépticas, o raciocínio fisiopatológico não pode ser encimado unicamente em modificações da eletrogênese do cérebro em desenvolvimento, devendo-se ampliar em objetividade a avaliação clínica e também a laboratorial.

Five right-handed children with Landau-Kleffner syndrome (LKS) who had disease onset between the ages of 3 and 9 years were studied with EEG and single-photon emission computed tomography (SPECT) before and, in four cases, after 6 months of corticosteroid treatment. EEG findings included both focal and generalized spikes as well as spike-wave discharges with bilateral temporal predominance. These increased markedly during sleep in 1 child, and continuous spike-and-wave complexes appeared during slow-wave sleep in another patient. Neuropsychological testing demonstrated verbal auditory agnosia. Magnetic resonance imaging (MRI) was performed in 4 children and was normal. Brain SPECT imaging demonstrated abnormal perfusion in the left temporal lobe in all patients. The response to corticosteroid therapy was mixed. Our findings reinforce the concept that LKS is a functional disease affecting the language-dominant brain areas. We conclude that SPECT imaging may be of diagnostic assistance in the evaluation of this syndrome of unknown etiology.

-Phenytoin is an effective antiepileptic drug, although, it can be associated with many side effects, including dyskinesia. Objective: To describe the clinical characteristics of phenytoin induced dyskinesia. Methods: We investigated the occurrence of involuntary movements in patients followed at our adult and pediatric epilepsy clinics during the period of one year. Results: Three patients presented with phenytoin-induced dyskinesia: one adult with axial and orofacial dyskinesia, and two children with choreoathetosis. They did not have other signs of phenytoin intoxication and had complete recovery after phenytoin withdrawal. Conclusion: Phenytoin induced dyskinesia may occur during either chronic or initial treatment and with normal serum phenytoin levels. However, it occurs most often in patients on polytherapy, usually after increasing dosage and with toxic serum levels. Other signs of phenytoin intoxication may be present in these patients, but often the dyskinesia is the only side effect, which may delay the diagnosis and treatment. The clinical characteristics of the involuntary movements vary and may be focal or generalized, most often characterized by choreoathetosis and dyskinesias. These may last for hours, days or even years, but frequently disappear completely after phenytoin withdrawal. KEY WORDS: phenytoin, dyskinesia, involuntary movementDiscinesia induzida por fenitoína.RESUMO -Fenitoína é droga anti-epiléptica eficaz, mas pode estar associada a vários efeitos colaterais, inclusive discinesia. Objetivo: Descrever as características clínicas da discinesia induzida por fenitoína. Método: Avaliamos a ocorrência de movimentos involuntários em pacientes seguidos nos ambulatórios de epilepsia durante o período de um ano. Resultados: Três pacientes apresentaram discinesia induzida por fenitoína: um adulto com discinesia orofacial e duas crianças com coreoatetose. Eles não tinham outros sinais de intoxicação por fenitoína e apresentaram recuperação completa após a retirada da fenitoína. Conclusão: Discinesia induzida pela fenitoína pode ocorrer durante tratamento crônico ou no início do tratamento e com níveis séricos normais de fenitoína. Entretanto, na maioria das vezes ocorre em politerapia e geralmente após aumento da dose e com níveis tóxicos de fenitoína. Outros sinais de intoxicação podem estar presentes, mas muitas vezes a discinesia é o único efeito adverso, o que pode atrasar o diagnóstico e tratamento. Os movimentos involuntários podem ser focais ou generalizados. Podem durar horas, dias ou até anos, mas freqüentemente desaparecem completamente após a retirada da fenitoína.PALAVRA-CHAVE: fenitoína, discinesia, movimento involuntário.Phenytoin is a widely used anticonvulsant, considered to be one of the first line drugs for partial seizures as well as for most forms of generalized seizures 1 . Despite its complex and unpredictable pharmacokinetic properties, phenytoin is usually safe, efficient, inexpensive and relatively easy to use. However, the use of this major anticonvulsant is l...