The most effective treatment that addresses the cause of sialorrhea in children with cerebral palsy is training of sensory awareness and oral motor skills, performed by a speech therapist. Botulinum toxin injection and the use of anticholinergics have a transient effect and are adjuvant to speech therapy; they should be considered in cases of moderate to severe sialorrhea or respiratory complications. Atropine sulfate is inexpensive and appears to have good clinical response combined with good safety profile. The use of trihexyphenidyl for the treatment of sialorrhea can be considered in dyskinetic forms of cerebral palsy or in selected cases.
-It was evaluated the patient antiepileptic drug (AED) intake adherence in a pilot cross-sectional study carried out at a neurologic out-patient clinic of a university hospital. Ninety-three AED blood concentration (phenobarbital, phenytoin, carbamazepine) were analyzed from 24 patients. The variability of the AED blood level was measured (in the steady state period by means of the variation coefficient) and compared with the selfreported antiepileptic medication non-adherence, AED blood level according to the range (therapeutic or not), and the seizure control. It was not observed any strong correlation between the higher value of variability and the other three parameters of no adherence. The highest correlation was with the blood drug level (therapeutic or not). The evaluation of blood drug measurement alone, except in cases of extreme low adherence and variability of drug intake, is not enough for the recognition of incorrect drug intake, but the clinical markers and the selfreported adherence have to be also considered for this sort of evaluation.KEY WORDS: epilepsy, adherence, therapeutic blood monitoring, antiepileptic drugs. Aderência à ingestão de medicamentos antiepilépticos: o valor da avaliação dos níveis sanguíneos e a abordagem clínicaRESUMO -Avaliou-se a aderência à ingesta de drogas antiepilépticas (DAE) em estudo piloto transversal conduzido em ambulatório de hospital neurológico universitário. Noventa e três amostras sanguíneas com concentração de DAE (fenobarbital, fenitoína, carbamazepina) foram analisadas de 24 pacientes. A variabilidade dos níveis sanguíneos das DAE (em estado estável -steady state period, analizada por meio do coeficiente de variação) foi comparada com a auto-referida não aderência à ingesta da DAE, níveis sanguíneos das DAE de acordo com a faixa (terapêutica ou não) e o controle das crises epilépticas. Não foi observada correlação forte entre o maior valor da variabilidade e os outros três parâmetros de aderência, apesar da maior correlação com o nível sanguíneo (terapêutico ou não). A avaliação do nível sérico isolado, exceto em caso de extrema baixa aderência e variabilidade da ingesta das DAE, não é suficiente para o reconhecimento da ingesta inadequada, mas os marcadores clínicos e a auto-aderência referida também têm que ser consideradas para esse tipo de avaliação.PALAVRAS-CHAVE: epilepsia, aderência, monitorização de níveis sanguíneos, drogas antiepilépticas.Poor adherence is considered the most important cause for unsuccessful treatment in epilepsy. Consequently, drug intake adherence is a fundamental process in effective therapy, and in clinical practice its measurement has to be done frequently to apply adherence-improving interventions [1][2][3][4][5][6][7][8] .
Childhood epilepsy is a chronic neurological disorder associated with profound psychosocial limitations epileptic children's routine. Lack of information and inappropriate beliefs are still the factors that most contribute to the stigma and discrimination. This study aimed at characterizing teacher's beliefs and attitudes at regular and special schools in two cities of southeastern Brazil where students with epilepsy studied. Fifty-six teachers of public regular schools and specialized educational institutions for children with disabilities from two cities of Southeast Brazil who had epileptic children in their classroom completed the Brazilian version of The Epilepsy Beliefs and Attitudes Scale: Adult Version and answered a data sheet about sociodemographic characteristics. The results showed that no significant differences (P ≤ 0.05) have been found between the beliefs and attitudes of teachers in mainstream and special schools but both schoolteachers had more inappropriate beliefs and attitudes than appropriate ones against childhood epilepsy. These findings raise an important issue, providing us with the knowledge that epilepsy is still a condition which is surrounded by wrong beliefs. Also, educational programs could help reduce the gaps in knowledge about how such disease has been perceived worldwide.
INTRODUÇÃO: o desconhecimento acerca da epilepsia tem fomentado o interesse em desenvolver ferramentas voltadas para detecção das crenças e atitudes da comunidade em geral acerca da doença. OBJETIVO: apresentar o processo de adaptação transcultural do instrumento The Epilepsy Beliefs and Attitudes Scale (EBAS) - Adult Version e uma versão em português para uso no Brasil. MÉTODO: o processo de adaptação envolveu a equivalência conceitual, de itens, semântica e operacional. RESULTADOS: os conceitos apreendidos foram considerados pertinentes à nossa cultura e seus itens adequados quanto à sua capacidade de representar tais conceitos na população-alvo, além de apresentar boa equivalência semântica entre a versão final em português e o original. CONCLUSÃO: o instrumento mostrou-se adequado para uso na população em geral e seus resultados serão revistos em estudos futuros a luz de avaliações psicométricas.
-Objective: To study the most important characteristics of antiepileptic drug (AED) taking behavior in epileptic people. Methods: In a cross-sectional study, 45 consecutively seen patients answered a standardized questionnaire including questions about drug intake behavior. Results: Both genders were equally represented (22M x 23F). The mean age was 30.2 years. No specific characteristic were presented in all patients. The selfreported non-use of the drug at any moment one week before (self-reported non-adherence) was 40.0%. Patients took the drug more than once in most cases (75.0%), and the only precipitating factor of seizures more frequently avoided was alcohol intake (66.7%). Forty-four percent said to be afraid of becoming addicted to the medicine, 61.4% reduced or stopped the medicine just to see what would happen, and 47.7% changed the prescription with the same purpose. There is no relationship among socio-demographic, behavior aspects or treatment characteristics, and self-reported non-adherence. Conclusions: Several patient's aspects do not seem to be strongly correlated with self-reported adherence. Nevertheless, drug self-regulation is probably related to the drug-intake behavior, and it is important for the physician to understand this parallel influence on treatment for a more realistic approach.KEY WORDS: epilepsy, adherence, antiepileptic drug. Comportamento de auto regulação da ingesta de medicamentos em pessoas com epilepsiaRESUMO -Objetivo: Estudar as mais importantes características do comportamento de ingesta das drogas antiepilépticas (DAE) em pessoas com epilepsia. Método: Em estudo transversal, 45 pacientes consecutivamente vistos responderam a questionário padronizado sobre o comportamento de ingesta de DAE. Resultados: Ambos os sexos foram igualmente representados. A idade média foi 30,2 anos. Não há uma característica específica comum em todos os pacientes. O auto-referido não uso da DAE na semana anterior, em qualquer momento, (auto-referida não-aderência) foi de 40,0%. Pacientes ingeriram a droga mais de uma vez, em muitos casos (75,0%) e o único fator precipitante de crises epilépticas mais frequentemente evitado foi a ingesta de álcool (66,7%). Quarenta e quatro por cento se diziam preocupados em se tornarem dependentes do medicamento, 61,4% reduziram ou suspenderam a DAE apenas para ver o que acontecia e 47,7% mudaram as prescrições com o mesmo propósito. Não houve relação entre características sócio-demográficas, aspectos comportamentais ou características de tratamento, e auto-referida não aderência. Conclusões: Vários aspectos dos pacientes não parecem estar relacionados fortemente com a aderência auto-referida. No entanto, a auto regulação da ingesta de drogas é provavelmente relacionada ao comportamento íntimo de sua ingesta, e é importante para o médico entender essa influência paralela no tratamento para uma abordagem mais realística. PALAVRAS-CHAVE: epilepsia, aderência, droga antiepiléptica.Low adherence to prescribed medication by the physician is considered th...
Children with epilepsy present significant problems concerning attention and comorbidity with attention deficit hyperactivity disorder (ADHD). Objective: To determine the prevalence of attention complaints, ADHD diagnosis and attention profile in a sample of children and adolescents with idiopathic epilepsy. Method: 36 children and adolescents with idiopathic epilepsy and 37 genre and age matched healthy controls underwent several procedures to diagnose their neuropsychological profile and comorbidity with ADHD. Results: The prevalence of ADHD was higher in patients with epilepsy [x 2 = 4.1, p = 0.043, 6 (16.7%) vs 1 (2.7%)], with worse results in attention related WISC items and factors in patients with epilepsy comparing to the controls, but not between patients with and without ADHD. Clinical characteristics did not influence those results. Conclusion: This study found a greater prevalence of problems wih attention in pediatric patients with idiopathic epilepsy, but not a distinct profile between those with or without ADHD.Keywords: epilepsy, attention, ADHD, childhood, adolescence. RESUMOCrianças com epilepsia podem apresentar problemas de atenção e comorbidade com transtorno de atenção e hiperatividade (TDAH). Objetivo: Determinar a prevalência de queixas de atenção, diagnóstico de TDAH e perfil atentivo em uma amostra de crianças e adolescentes com epilepsia idiopática. Método: 36 crianças e adolescentes com epilepsia idiopática e 37 controles saudáveis foram submetidos a vários procedimentos para diagnosticar perfil neuropsicológico e comorbidade com TDAH. Resultados: A prevalência de TDAH foi maior em pacientes com epilepsia [x 2 = 4,1, p = 0,043, 6 ( 16,7%) vs 1 (2,7%)] , que também apresentaram piores resultados em itens e fatores dependentes de atenção do WISC. Não foram observadas diferenças entre pacientes com e sem TDAH. As características clínicas não influenciaram resultados. Conclusão: Este estudo encontrou uma maior prevalência de problemas com atenção em pacientes pediátricos com epilepsia idiopática , mas não um perfil distinto entre aqueles com ou sem TDAH.Palavras-chave: epilepsia, atenção, TDAH, infância, adolescência.Children and adolescents with epilepsy have more problems with attention, and therefore, more behavioral complaints and learning deficits 1,2 . In addition to epilepsy-related variables, many comorbidities contribute to attention deficits in this population, such as learning and psychiatric (mood and anxiety) disorders and attention deficit hyperactivity disorder (ADHD) 1 . ADHD is the most prevalent neuropsychiatric disorder among children in school age (5% in Brazilian sutides) 3,4 . The prevalence of ADHD is higher in children with epilepsy, ranging from 28.6% to 37.7% 1,5,6 . Some authors argue that this prevalence must be equal of the general population (3%-5%) when only patients with normal intelligence and controlled seizures were analyzed 7 . Even though, recent
QVCE-50 is a promissing Brazilian HRQL questionnaire for children with epilepsy. It needs to be applied in a larger population to confirm its psychometric properties.
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