Dissertations / Theses on the topic 'Difficult to Control Epilepsy'

Resumo UCHÔA-FIGUEIREDO, L. R. O impacto da doença na vida cotidiana dos cuidadores de crianças com epilepsia de dificil controle. 2009. 260f. Tese (Doutorado) Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, São Paulo, 2009. A notícia de que o filho tem uma doença crônica remete os pais a uma crise em relação às expectativas decorrentes do desejo do filho idealizado. A família sofre pela incerteza da evolução da doença e suas possíveis consequências. A mãe, comumente, torna-se a cuidadora principal, ajudando a suprir necessidades, apresentando uma vida ocupacional deficitária, pois despende tempo, energia física e emocional, sofrendo perdas, sobrecarga de atividades e comprometendo a sua qualidade de vida. O objetivo desta pesquisa foi conhecer as mudanças que ocorrem na vida cotidiana do cuidador primário de pacientes, com diagnóstico de Epilepsia de Difícil Controle Infantil associado à encefalopatia crônica não evolutiva, avaliar a qualidade de vida e a sobrecarga em função da situação de adoecimento e verificar a relação desta sobrecarga emocional com a percepção dos cuidadores, sobre sua qualidade de vida. Avaliaram-se 50 cuidadores de crianças entre 7 e 12 anos, de ambos os sexos, com diagnóstico confirmado há cinco anos, e que estavam nesta função há pelo menos dois anos. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa Envolvendo Seres Humanos do HCFMRP e foi realizada no Serviço de Epilepsia Infantil do mesmo hospital. Foram utilizados: prontuários médicos das crianças, entrevista semi-estruturada enfocando o adoecimento, o cuidar e a vida cotidiana, os questionários de sobrecarga, Caregiver Burden Scale e de Qualidade de Vida, WHOQOL-bref. Os dados obtidos na entrevista foram analisados segundo o Sistema Quantitativo Interpretativo. Os dados do WHOQOL-bref e da Caregiver Burden Scale foram submetidos à análise estatística, de acordo com as normas do instrumento. Posteriormente, através da técnica dos quadrantes e da análise de coeficiente não paramétrica de Spearman, os dados foram correlacionados, no sentido de verificar possíveis relações entre aspectos da vida cotidiana, sobrecarga e percepção, por parte dos cuidadores, de sua qualidade de vida. Os resultados possibilitaram conhecer que houve mudança, diminuição do convívio social, alteração na vida profissional e estresse na vida do cuidador em decorrência do ato de cuidar. Em relação à qualidade de vida, pôde-se constatar que o domínio meio ambiente apresentou maior satisfação, enquanto que o menor índice ficou com as relações sociais, indicando assim a importância da rede de apoio social para o cuidador. A variável tempo de cuidado indicou que, quanto maior este for, maior a satisfação com relação ao bem-estar psicológico, meio ambiente e relações sociais. Identificaram-se dois tipos de sobrecarga, a velada e a declarada. Conclui-se que o impacto do adoecimento da criança interfere diretamente na vida cotidiana e nas relações dos cuidadores, assim como na qualidade de vida, porém, percebe-se que recursos estruturais e emocionais contribuem para minimizar os efeitos negativos sobre os cuidadores. Neste sentido ressalta-se a importância da equipe multidisciplinar oferecendo amparo informativo, técnico, troca de experiência e suporte aos cuidadores.<br>UCHÔA-FIGUEIREDO, L. R. Disease impact on the daily lives of caretakers of children with Difficult to Control Epilepsy. 2009. 260p. Thesis (PhD) Faculty of Philosophy, Science and Humanities of Ribeirao Preto, University of Sao Paulo, São Paulo, 2009. Acknowledging that a child has a chronic disease throws parents into a crisis related to expectations of a desired idealized descendant. The family is uncertain about disease evolution and possible consequences. However, it is the mother, who as a rule, becomes the main caretaker, helping to supply all necessities but showing a occupational life full of short-comings caused by spent time and physical and emotional energy. Her quality of life is further compromised by the suffered losses and work burden. This study aimed to investigate changes in the daily life of primary caretakers of patients diagnosed with Difficult to Control Child Epilepsy associated to non-evolutive chronic encephalopathy , and to evaluate effects of the overload as a function of disease onset on the quality of life. Perception by caretakers of disturbances in their own quality of life by the emotional burden was also verified. The fifty caretakers evaluated were taking care, for at least two years, of children 7 to 12 years old, from both sexes and with a confirmed diagnosis of five years. The study was approved by the Ethics Committee on Research with Human Beings of the University Hospital, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo (HCFMRP) and was conducted at the Child Epilepsy Service of the same Hospital. Data were obtained through the children medical records, half-structured interviews addressing onset of the disease and daily care, and completion of the overload questionnaires ,Caregiver Burden Scale and Quality of Life, WHOQOL-bref. Data from interviews were analyzed by the Interpretation Quantitative System and the ones from WHOQOL-bref and Caregiver Burden Scale submitted to statistical analysis according to the rules of the instruments. Using the quadrant technique and analysis of the non-parametric Spearman coefficient, the data were further correlated to verify the existence of a relationship between aspects of burdened daily life and perception of their quality of life by caretakers. Results showed that the act of care did produce changes in the life of the caretaker, characterized by decreased socializing , disturbed professional life and stress . Considering quality of life, environmental factors were more satisfying than the ones of social relations, emphasizing the importance of social support in the life of a caretaker. As to the variable related to care duration, the longer it lasted the higher satisfaction in psychological well being, environment and social interchange were achieved . Two types of burdens were identified, one concealed and one declared. It is concluded that onset of disease in children does directly interfere in the daily life and relationships of caretakers, thus in their quality of life. However, by showing the contribution of structural and emotional resources to minimize the negative effects on caretakers, the importance of supportive information, techniques and exchange of experiences provided by a multi-professional team is also emphasized.

The first part of my thesis presents an overview of the different approaches used in the past two decades in the attempt to forecast epileptic seizure on the basis of intracranial and scalp EEG. Past research could reveal some value of linear and nonlinear algorithms to detect EEG features changing over different phases of the epileptic cycle. However, their exact value for seizure prediction, in terms of sensitivity and specificity, is still discussed and has to be evaluated. In particular, the monitored EEG features may fluctuate with the vigilance state and lead to false alarms. Recently, such a dependency on vigilance states has been reported for some seizure prediction methods, suggesting a reduced reliability. An additional factor limiting application and validation of most seizure-prediction techniques is their computational load. For the first time, the reliability of permutation entropy [PE] was verified in seizure prediction on scalp EEG data, contemporarily controlling for its dependency on different vigilance states. PE was recently introduced as an extremely fast and robust complexity measure for chaotic time series and thus suitable for online application even in portable systems. The capability of PE to distinguish between preictal and interictal state has been demonstrated using Receiver Operating Characteristics (ROC) analysis. Correlation analysis was used to assess dependency of PE on vigilance states. Scalp EEG-Data from two right temporal epileptic lobe (RTLE) patients and from one patient with right frontal lobe epilepsy were analysed. The last patient was included only in the correlation analysis, since no datasets including seizures have been available for him. The ROC analysis showed a good separability of interictal and preictal phases for both RTLE patients, suggesting that PE could be sensitive to EEG modifications, not visible on visual inspection, that might occur well in advance respect to the EEG and clinical onset of seizures. However, the simultaneous assessment of the changes in vigilance showed that: a) all seizures occurred in association with the transition of vigilance states; b) PE was sensitive in detecting different vigilance states, independently of seizure occurrences. Due to the limitations of the datasets, these results cannot rule out the capability of PE to detect preictal states. However, the good separability between pre- and interictal phases might depend exclusively on the coincidence of epileptic seizure onset with a transition from a state of low vigilance to a state of increased vigilance. The finding of a dependency of PE on vigilance state is an original finding, not reported in literature, and suggesting the possibility to classify vigilance states by means of PE in an authomatic and objectic way. The second part of my thesis provides the description of a novel behavioral task based on motor imagery skills, firstly introduced (Bruzzo et al. 2007), in order to study mental simulation of biological and non-biological movement in paranoid schizophrenics (PS). Immediately after the presentation of a real movement, participants had to imagine or re-enact the very same movement. By key release and key press respectively, participants had to indicate when they started and ended the mental simulation or the re-enactment, making it feasible to measure the duration of the simulated or re-enacted movements. The proportional error between duration of the re-enacted/simulated movement and the template movement were compared between different conditions, as well as between PS and healthy subjects. Results revealed a double dissociation between the mechanisms of mental simulation involved in biological and non-biologial movement simulation. While for PS were found large errors for simulation of biological movements, while being more acurate than healthy subjects during simulation of non-biological movements. Healthy subjects showed the opposite relationship, making errors during simulation of non-biological movements, but being most accurate during simulation of non-biological movements. However, the good timing precision during re-enactment of the movements in all conditions and in both groups of participants suggests that perception, memory and attention, as well as motor control processes were not affected. Based upon a long history of literature reporting the existence of psychotic episodes in epileptic patients, a longitudinal study, using a slightly modified behavioral paradigm, was carried out with two RTLE patients, one patient with idiopathic generalized epilepsy and one patient with extratemporal lobe epilepsy. Results provide strong evidence for a possibility to predict upcoming seizures in RTLE patients behaviorally. In the last part of the thesis it has been validated a behavioural strategy based on neurobiofeedback training, to voluntarily control seizures and to reduce there frequency. Three epileptic patients were included in this study. The biofeedback was based on monitoring of slow cortical potentials (SCPs) extracted online from scalp EEG. Patients were trained to produce positive shifts of SCPs. After a training phase patients were monitored for 6 months in order to validate the ability of the learned strategy to reduce seizure frequency. Two of the three refractory epileptic patients recruited for this study showed improvements in self-management and reduction of ictal episodes, even six months after the last training session.

We investigate the application of machine learning methods for the detection and control of seizure-like behavior in in vitro models of epilepsy. This research will form the basis for a new class of adaptive neurostimulation devices for the treatment of drug-resistant cases of epilepsy in humans. There are many technical obstacles to creating an adaptive control algorithm for these devices. At present, science has an incomplete understanding of the mechanisms and dynamics underlying both epilepsy and its treatments. This is reflected both in the long-standing problem of the detection or prediction of seizures and in the lack of clear criteria for optimizing an adaptive control algorithm. As in many medical problems, clinical data is sparse, expensive, and highly variable. We address the detection of epileptic states using boosted ensemble methods with a set of simple frequency spectrum features derived from electrophysiological recordings. While typical boosting methods are not designed for use with time series data, we present a recurrent boosting method that improves classification accuracy in our application domain. We also present an implementation of a biologically plausible model of epileptic neural tissue using a network of integrate and fire neurons with partially stochastic inputs and two time scales of refractory behavior. Finally, we train a reinforcement learning agent to control the dynamics of this network, reducing the occurrence of seizure-like events. This agent is intended to be a component of a closed-loop electrical stimulation device with a set of sensors and an adaptive stimulation strategy.<br>Nous étudions l'application des méthodes d'apprentissage automatique pour la détection et le contrôle d'activité semblable à une crise convulsive dans les modèles d'épilepsie in vitro. Cette recherche formera la base d'une nouvelle classe de dispositifs de neurostimulation auto-adaptatifs pour le traitement des patients qui ne répondent pas aux drogues antiépileptiques. Il y a beaucoup d'obstacles techniques pour créer un algorithme adaptatif pour ces dispositifs. Actuellement, la science n'a pas encore expliqué entièrement les mécanismes définissant l'épilepsie et ses traitements. Ceci est important à deux niveaux: Pour le problème de la détection ou de la prévision des crises, et pour établir des critères clairs pour optimiser un algorithme de contrôle adaptatif. Comme beaucoup de problèmes médicaux, les données cliniques sont rares, chères, et fortement variables. Nous adressons la détection des états épileptiques en utilisant les méthodes “boosting” avec un groupe de traits simples de spectre de fréquences dérivés des enregistrements électrophysiologiques. Tandis que les méthodes boosting typiques n'ont pas été conçues pour utiliser l'information disponible avec des données de séries chronologiques, nous présentons une méthode boosting récurrente qui améliore le taux de classification dans notre domaine d'application. Nous présentons également une exécution d'un modèle biologiquement plausible d'un système neural épileptique employant un réseau de neurones intègre-et tire ayant les signals d'entrées partiellement stochastiques et ayant deux échelles de temps de comportement réfractaire. En conclusion, nous formons un agent d'apprentissage par renforcement pour réduire l'occurrence d'activité semblable à une crise. Cet agent est prévu pour être une composante d'un dispositif en boucle fermée de stimulation électrique ayant un ensemble de capteurs et un algorithme adaptatif.

This thesis focuses on using Wireless Sensor Networks (WSNs) for monitoring applications on epilepsy patients (EPs). With the increase of these types of patients and the necessity of continuous daily monitoring and the need for an immediate response to their seizures, the main objective of this thesis is to decrease the response time in order to save them from severe consequences, as well as to make them comfortable with the monitoring procedure. Our proposed Epilepsy Patients Monitoring System (EPMS) consists of five ordinary nodes distributed over the patient’s body, as well as a coordinator node and a receive node. These nodes detect the seizures and forward the data to the coordinator, which, in turn, collects the data and transmits it to the receiver, triggering an alarm concerning the seizure occurrence. We focus on the Medium Access Control (MAC) protocol, using the Sensor Medium Access Control (SMAC) protocol to decrease the generated delay, and the Carrier Sense Multiple Access/ Collision Avoidance (CSMA/CA) scheme to prevent collisions that can prolong the response time.

This professional doctorate in psychoanalytic psychotherapy considers the role of psychoanalytic thinking in contemporary child protection social work particularly in relation to communication with adult clients . The dual mandate of social workers to care and control creates conflict in the role which is well recognised. Less well understood is how such conflict affects communication between social workers and clients in subtle and often unconscious ways. This study uses psychoanalytically informed observations and interviews to investigate an area of defensiveness which may be evident in the ‘micro-process’ of conversations where difficult matters are being discussed. The study asks whether identifiable ‘moments of avoidance’ occur during these conversations at points of heightened tension between care and control. Results suggest that despite good communication skills, there is evidence of practitioner anxiety within the psychodynamic process of interviews; this can lead to transitory avoidance which can affect engagement and throw practitioners off course. These diversions are discussed with reference to Kleinian theories of enactment and projective identification with an emphasis on the internal pressures that initiate defensive manoeuvres of this kind. This is a timely and detailed study which illuminates the nuances of real practice and hopes to contribute to training initiatives for frontline, family social workers.

<p> In the learning and cognitive fields it has been well established that a two-way interaction between instructor and participant is more beneficial for learning. Within Motor Control and Learning, this process comes to fruition through what is known as self-controlled practice. The purpose of this study is to determine how goals influence the process of self-controlled practice. It was hypothesized that there will be a difference in learning between the self-controlled group (SC) and a yoked group (Y) as well as a difference in learning between the SC groups with respect to timing goal. One hundred and twenty young adults participated in this experiment. Participants in the self-control group were provided control over the amount of practice trials they completed during practice while participants in the yoked group received the same amount of practice trials as the individuals in the self-control group. Additionally, self-control participants were grouped according to timing goals. Error score measures were collected to assess changes in performance. Results indicated partial confirmation of differences due to stringency of the timing goal, as well as, no differences between self-control and yoked groups.</p>

Thesis (MSc(Med)(Pharmacy))-- University of Limpopo, 2012.<br>i THE ROLE OF COUNSELLING, MONITORING OF SERUM CARBAMAZEPINE CONCENTRATION, AND OF COMPLIANCE IN EPILEPSY CONTROL Non-compliance with the patient’s prescribed medication regimen has been identified in several publications as a major factor responsible for insufficient seizure control. Non-compliance is also held by some workers in this field to be closely interlinked with inadequate serum anti-epileptic drug concentration. The early identification of non-compliance may therefore play an important role in epilepsy therapy. A study was undertaken at Kalafong Hospital to explore the efficacy of monitoring serum carbamazepine concentration in order to detect compliance or otherwise. Intrinsic in such study was exploration of the role played by counselling in the promotion of compliance. Samples of blood were drawn from 78 outpatient volunteers at intervals as close to 28 days as possible, and the serum carbamazepine concentration of these samples was then determined by means of the TDx FLx System (ABBOTT). Items such as conscientious attendance at the Kalafong epilepsy clinics (“visits”), serum carbamazepine concentration, patient’s age, gender and weight, concomitant drug interactions, occurrence of epileptic seizures and dosage of Tegretol®CR were examined to ascertain whether they could be correlated with compliance and used as indicators thereof. It was, however, constantly borne in mind that these are not the only elements of compliance; other factors such as difficult fundamental behavioural changes, such as avoiding stress, may also play a part. Conscientious attendance at Kalafong epilepsy clinics (“visits”) was found to be a usable (albeit not strong) indicator of compliance. Serum carbamazepine concentration was used as another, with, however, reservations arising from the relationship between the patient’s actual compliance on the one hand, and whether v the daily dosage was sub-therapeutic or excessive on the other. The statistical agreement between visits and these concentration values was, however, very poor (8.2%). Using visits as an indicator, 66.7% of the participants were assessed as compliant. Using ‘compliant concentration’, only 25.6% were assessed as compliant. The data acquired during the study was, unfortunately, too variable to warrant anything more than descriptive statistical treatment. To a large extent this was because the participants were out-patients, not in-patients over whom strict therapeutic control could be exercised. Age, gender and patient’s weight were not significantly linked to compliance. The correlation between expected and measured serum carbamazepine concentrations was not statistically significant (p = 0.062). The Kalafong data in respect of seizures indicate that the relationship between seizures and compliance is not a simple one and that the occurrence or otherwise of break-through seizures should not be used as an indicator of compliance, as has indeed been done by other research workers. Drug interaction was as expected in 20 of the 26 patients concerned, this agreement being statistically significant (p = 0.0074). Improved compliance was the outcome expected from counselling but it was not possible to quantify the enhancement of compliance achieved, if any. Conventional verbal counselling, particularly when not done in the patient’s mother tongue and supported by interventions such as visual counselling material, may not be adequate.

Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates < 80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.

Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.<br>The Pharmaceutical Trust for Educational and Charitable Objects (PTECO) (now known as Pharmacy Research UK).

Replay of spike sequences can be seen during sharp wave – ripple population burst activity in the hippocampus. It is thought that this activity, which occurs during rest and sleep, is involved in memory consolidation. The cellular mechanisms underlying the initiation of these replay events are not well understood. To investigate this, a hippocampal slice model, showing spontaneous sharp wave – ripple activity, and a combination of planar multi-electrode array recordings and whole-cell patch-clamp recordings of anatomically identified hippocampal neurons were used. Firstly, the spatial and temporal profile of sharp waves in vitro was analysed in detail. Sharp waves were generated by changing subpopulations of pyramidal neurons in the CA3 region and had characteristics similar to those found in vivo. Secondly, four major receptor types present in hippocampal CA3, namely NMDA, AMPA, GABAA and GABAB receptors, were investigated for their involvement in sharp wave generation. Surprisingly, not only AMPA receptor-mediated events, but also phasic GABAA receptor-mediated inhibition, were necessary for sharp wave generation. Thirdly, single perisomatic-targeting interneurons were activated. This experiment showed that induced spiking activity of an individual perisomatic-targeting interneuron can both suppress and subsequently enhance local sharp wave generation. Spiking activity of other neuron types (i.e. pyramidal neurons, dendritic-targeting interneurons and interneuron-selective interneurons) had no significant effect on sharp wave incidence. Finally, it is suggested that this post-inhibitory enhancement of sharp wave generation can be mediated by a transient increase in the ratio of excitation to inhibition in the local network. In conclusion, these results suggest a new role for perisomatic-targeting interneurons in controlling the local initiation of sharp waves by selectively suppressing and subsequently enhancing recruitment of a subpopulation of pyramidal neurons. These results further imply that interneurons may play an integral part in the local information processing that takes place in the hippocampal network.

Base teórica: A epilepsia é uma doença neurológica crônica, que causa grande impacto na qualidade de vida dos pacientes afetados. Isto se deve a fatores psicossociais e outros associados à própria epilepsia, além dos efeitos adversos das medicações utilizadas no tratamento. Estima-se que o controle satisfatório das crises seja alcançado em apenas uma parte dos pacientes e, muitas vezes, às custas de efeitos adversos significativos, principalmente nos pacientes com epilepsia refratária. Devido à falta de padronização na definição de epilepsia refratária, que dificulta a sua identificação e o cuidado dos pacientes, em 2010 a ILAE (International League Against Epilepsy) propôs uma classificação para identificar pacientes controlado e não controlados e às custas de efeitos adversos ou não. Objetivo: O presente trabalho tem como objetivo aplicar os critérios de epilepsia fármaco-resistente, propostos pela ILAE em 2010, em pacientes com epilepsia em acompanhamento em um centro de referência e avaliar os efeitos adversos de medicações sobre a qualidade de vida, através da aplicação de questionários padronizados.Métodos: Foram incluídos 81 pacientes com diagnostico definido de epilepsia em acompanhamento em um centro terciário. Todos os pacientes tinham mais de 18 anos, estavam em uso de droga antiepiléptica em dose estável por pelo menos 3 meses, não foram diagnosticados com outras comorbidades clinicas ou psiquiátricas e não estavam em uso regular de nenhuma outra medicação que não o DAE. Os pacientes foram classificados em quatro grupos seguindo as orientações da ILAE: 1A (crises controladas, sem efeitos adversos); 2A (crises não controladas, sem efeitos adversos); 1B (crises controladas, com efeitos adversos), 2B (crises não controladas, com efeitos adversos). Na avaliação da qualidade de vida foi utilizado o questionário QOLIE-31 (Quality of life in epilepsy-31) e para auxiliar na avaliação da presença de efeitos adversos foi utilizada a escala LAEP (Liverpool adverse effects profile). Conclusão: Os pacientes dos grupos com pior controle de crises (2A e 2B) mostraram piores escores de qualidade de vida, enquanto que os grupos com controle de crises (1A e 1B) mostraram melhor qualidade de vida, independente da presença de efeitos adversos. A escala LAEP foi útil na avaliação de efeitos adversos por ajudar a diminuir a subjetividade desta avaliação. É conhecido da literatura que o controle de crises e a presença de efeitos adversos podem impactar negativamente na qualidade de vida dos pacientes com epilepsia. No nosso trabalho, a presença de efeitos adversos não foi um fator que influenciou na qualidade de vida, o que pode estar associado ao número das amostras.<br>Background: Epilepsy is a chronic neurological disease that causes a great impact in the quality of life of the patients. This is related not only due to psychosocial factors but also due to factors associated with the disease itself, as well as to the antiepileptic drugs adverse effects. It is estimated that the good seizure control will be achieved for only some patients and many times with significant adverse effects, mainly in patients with drug resistant epilepsy. Since there was no defined criteria for refractory epilepsy, making the identification and care of these patients more difficult, in 2010 the International League Against Epilepsy (ILAE) suggested a classification to identify patients with good seizure control or uncontrolled seizures, with or without adverse effects. Objectives: Our work aims to use the ILAE 2010 criteria to identify patients with drug resistant epilepsy in patients of a referral center and to evaluate their quality of life and the presence of antiepileptic drugs adverse effects. Methods: It was included 81 patients with a defined diagnosis of epilepsy, all patients were 18 years old or older, were using an antiepileptic drug in a stable dose for at least 3 months, did not have other clinical or psychiatric diagnosis and were not using any other medication than the antiepileptic drug. Patients were classified in four groups, according to ILAE guidelines: 1A (good seizure control, no adverse effects); 2A (no seizure control, no adverse effects); 1B (good seizure control, with adverse effects), 2B (no seizure control, with adverse effects). For the evaluation of quality of life it was used the QOLIE-31 (Quality of life in epilepsy-31) questionnaire and for the evaluation of adverse effects it was used the LAEP (Liverpool adverse effects profile) questionnaire. Conclusion: Patients from groups with poor seizure control (2A and 2B) showed worse scores for quality of life while patients from groups with good seizure control (1A and 2A) showed better scores, regardless the presence of adverse effects. The LAEP scale was useful for the evaluation of adverse effects, since it helped to decrease the subjectivity in the evaluation. It is known from literature that seizure control and adverse effects have a negative impact the quality of life in patients with epilepsy. In our study, we were not able to show that the presence of adverse effects influenced the quality of life, this may be associated with the sample size.

Epilepsy affects up to 1% of the world's population and approximately 2.5 million people in the United States. A considerable portion (30%) of epilepsy patients are refractory to antiepileptic drugs (AEDs), and surgery can not be an effective candidate if the focus of the seizure is on the eloquent cortex. To overcome the problems with existing solutions, a notable portion of biomedical research is focused on developing an implantable or wearable system for automated seizure detection and control. Seizure detection algorithms based on signal rejection algorithms (SRA), deep neural networks (DNN), and neighborhood component analysis (NCA) have been proposed in the IoMT framework. The algorithms proposed in this work have been validated with both scalp and intracranial electroencephalography (EEG, icEEG), and demonstrate high classification accuracy, sensitivity, and specificity. The occurrence of seizure can be controlled by direct drug injection into the epileptogenic zone, which enhances the efficacy of the AEDs. Piezoelectric and electromagnetic micropumps have been explored for the use of a drug delivery unit, as they provide accurate drug flow and reduce power consumption. The reduction in power consumption as a result of minimal circuitry employed by the drug delivery system is making it suitable for practical biomedical applications. The IoMT inclusion enables remote health activity monitoring, remote data sharing, and access, which advances the current healthcare modality for epilepsy considerably.

Epilepsy is the most common, chronic, serious neurological disease in the world, with an estimated 65 million people affected worldwide. Recent studies on people diagnosed with epilepsy suggest that stress might trigger epileptic seizures. Interventions aimed at lowering stress might be able to reduce the risk for epileptic seizures among epileptics. In an attempt to explore this possibility, I conducted a systematic review addressing the efficacy of behavioral interventions targeted at lowering stress on seizure frequency among an epileptic population. This article also investigated the efficacy of these interventions on lowering self-perceived stress in the same population. Three databases were searched for obtaining 54 references. After a systematic filtering process, a set of 2 studies was retained after the full search procedure. The results suggest stress-reducing behavioral interventions do not have any statistically significant effects on lowering seizure frequency but have a statistically significant effect on lowering self-perceived stress ratings among an epileptic population. The small but promising results from trials and systematic reviews not included in this review warrant further research into the topic. Limitations regarding search procedure included studies and consideration for further research and reading for the presented topics are discussed.

INTRODUÇÃO: A asma grave acomete menos de 10% dos asmáticos, mas tem um impacto desproporcional sobre a utilização de recursos de saúde, contribuindo para, pelo menos, metade dos custos diretos e indiretos da doença. A proporção de indivíduos obesos ou com sobrepeso é elevada em pacientes com asma grave. Na verdade, a obesidade é um fator de risco para a asma, está associada com a gravidade da doença, com pior resposta a corticosteroides e pior controle clínico. Estudos sobre os efeitos da perda de peso em pacientes com asma ainda são escassos. OBJETIVOS: Avaliar o impacto da perda de peso com medidas clínicas em pacientes com asma grave e obesidade. MÉTODOS: Este é um estudo prospectivo randomizado aberto com dois grupos paralelos. Os participantes eram obesos e com asma grave e que, depois de um período de run-in de três meses, não estavam controlados de acordo com critérios da GINA. Os pacientes elegíveis foram randomizados em uma proporção de 2:1 (perda de peso: controle). Todos os participantes passaram por consultas bimensais no ambulatório de asma e foram acompanhados por seis meses. O desfecho primário foi o nível de controle da asma seis meses após o início do programa de redução de peso medido pelo Questionário de Controle da Asma (ACQ). Os desfechos secundários incluíram o Teste de Controle da Asma (ACT), resultados de função pulmonar, o Questionário Respiratório de St. George (SGRQ), a mudança na reatividade brônquica à metacolina, o uso diário de medicação de alívio para asma, percentagem de dias livres de sintomas, número de visitas ao pronto-socorro e exacerbações, marcadores de inflamação das vias aéreas medidos pelo escarro induzido e pelo óxido nítrico exalado (FeNO). IgE, proteína C reactiva, eotaxina, leptina e Transforming Growth Factor beta 1 (TGF 1) também foram medidos. RESULTADOS: Trinta e três foram randomizados. O grupo era composto predominantemente de mulheres com obstrução moderada, aprisionamento de ar, aumento da resistência das vias aéreas e marcada eosinofilia no escarro. O aumento dos níveis séricos de IgE foram consistentes com uma predominância de asma atópica. Dos 22 pacientes randomizados para submeterem-se a tratamento para a obesidade, 12 atingiram a meta de perda de peso de, pelo menos, 10% do peso corporal. A redução de peso no grupo de tratamento foi associada com melhor controle da asma medido pelo ACQ, ACT e SGRQ. Houve aumento de dias sem sintomas, menor uso de medicação de resgate e menos visitas ao serviço de emergência durante o período de estudo. Não houve diferença no número de exacerbações. A capacidade vital forçada (CVF) aumentou significativamente no grupo de tratamento e permaneceu inalterada no grupo de controle. As outras medidas da função pulmonar não mostraram diferenças entre os grupos. A hiperreatividade das vias aéreas, níveis de óxido nítrico exalado e celularidade do escarro induzido não se alterou ao longo do estudo. Os níveis de leptina diminuíram em ambos os grupos. Os níveis séricos de IgE, proteína C-reactiva, eotaxina, e TGF-1 não se alteraram. CONCLUSÃO: Nosso estudo adiciona informações à controvérsia sobre o impacto da obesidade e seu tratamento no controle da asma. Nossos resultados sugerem que a redução de peso em pacientes obesos com asma grave melhore os resultados de asma por mecanismos não relacionados com a inflamação das vias aéreas e que o controle da asma pobre em pessoas obesas é, pelo menos em parte, o resultado de fatores relacionados com a obesidade. A abordagem terapêutica para pacientes obesos com dificuldade de tratar a asma deve ser destinada à redução de peso, bem como à intensificação do tratamento anti-inflamatório<br>INTRODUTION: Severe asthma affects less than 10% of asthmatics, but has a disproportionate impact on the use of health resources, contributing to at least half of the direct and indirect costs of the disease. The proportion of obese or overweight individuals is elevated in patients with severe asthma. In fact, obesity is a risk factor for asthma, is associated with the severity of the disease, a poor response to corticosteroids and worse clinical control. Studies on the effects of weight loss in patients with asthma are still scarce. OBJECTIVES: Assess the impact of weight loss with a medical weight loss program in patients with severe asthma associated with obesity. METHODS: This is a prospective open study with two randomized parallel groups. The participants were obese and with severe asthma and, after a three month run-in period, were not controlled according to GINA criteria. Eligible patients were randomized in a 2:1 ratio (weight loss:control). All participants attended bimonthly consultations in the asthma clinic and were followed for six months. The primary outcome measure was the level of asthma control 6 months after initiation of the weight reduction program quantified by using the Asthma Control Questionnaire (ACQ). Secondary clinical outcomes included the Asthma Control Test (ACT), lung function results, score on the St. Georges Respiratory Questionnaire (SGRQ), change in metacholine reactivity, daily use of asthma reliever medication, percentage of asthma symptom free days, number of visits to emergency room and exacerbations, markers of airway cellular inflammation measured in induced sputum and with exhaled nitric oxide (FeNO). IgE, C reactive protein, leptin, eotaxin and Transforming Growth Factor beta 1 (TGF1) levels in serum were also measured. RESULTS: Thirty-three patients were randomized. The group consisted predominantly of women with moderate airflow obstruction, air trapping, increased airway resistance and marked eosinophilia in the sputum. The increased serum levels of IgE were consistent with a predominance of atopic asthma. Of the 22 patients randomized to undergo treatment for obesity, 12 achieved the weight loss goal of at least 10% of body weight. The reduction in weight in the treatment group was associated with improvement in the control as measured by ACQ, ACT and SGRQ. There was increase of symptom-free days, less use of rescue medication and fewer visits to the emergency room during the study period. There were no differences in the number of exacerbations. The forced vital capacity (FVC) increased significantly in the treatment group and remained unchanged in the control group. The other measures of the pulmonary function showed no differences between groups. The airway hyperresponsiveness, exhaled nitric oxide levels and induced sputum cellularity did not change throughout the study. Leptin levels decreased in both groups. Serum levels of IgE, C-reactive protein, eotaxin, and TGF-1 did not change. CONCLUSION: Our study adds information to the controversy about the impact of obesity and its treatment on asthma control. Our results suggest that weight reduction in obese patients with severe asthma improves asthma outcomes by mechanisms not related to airway inflammation and that poor asthma control in people who are obese is at least in part the result of obesity-related factors. The therapeutic approach for obese patients with difficult-to-treat asthma should therefore be aimed at weight reduction as well as on intensifying antiinflammatory treatment

Orientador: Fernando Cendes<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-08-26T23:40:05Z (GMT). No. of bitstreams: 1 Fernandes_DanielaAlves_D.pdf: 7319654 bytes, checksum: db061970bef101957f53339b302dc1a9 (MD5) Previous issue date: 2015<br>Resumo: A quantificação da atrofia das estruturas temporais mesiais pelas imagens de RM em pacientes com ELTM permite a identificação "in vivo" das alterações anatômicas associadas à esta patologia e sua correlação com dados neuropsicológicos, permitem a definição de um bom diagnóstico. Apesar da comprovação da eficácia do tratamento cirúrgico para o controle das crises, ainda não são claros os efeitos da ressecção de estruturas mesiais do lobo temporal na performance cognitiva, a longo prazo. O objetivo deste trabalho foi realizar um estudo prospectivo de uma série de pacientes com ELTM submetidos ao tratamento cirúrgico, comparando os resultados pré/pós-cirúrgicos obtidos a partir da análise de dados de avaliação neuropsicológica (ANP) e imagens de RM. No estudo avaliamos 119 indivíduos, 88 pacientes e 31 controles saudáveis. Os pacientes foram classificados de acordo com a escala proposta por Engel para controle de crises após a cirurgia. Avaliamos o coeficiente de inteligência estimado (QIe), as memórias verbal e não verbal com testes utilizados na rotina de investigação pré-operatória do nosso serviço. Utilizamos análises longitudinais específicas realizadas com o software SPSS®22. Consideramos p?0,05. Quanto à classificação de Engel observamos que 73,7% dos pacientes foram classificados em Engel I; 17,1% foram classificados em Engel II; 8,0% foram classificados em Engel III e 1,1% classificado em Engel IV com tempo médio de seguimento de 8,8 anos após a cirurgia. Para as ANP pré/pós-operatória observamos um declínio de memória para esses pacientes relacionado ao controle de crises e lado da cirurgia (p<0,0001). Para as ANP pós-operatórias realizadas em dois tempos diferentes e separadas em grupos quanto ao controle de crises e lado da cirurgia, não observamos diferença significativa, entretanto todos os testes indicaram uma tendência de melhora no desempenho de memória e QIe. Observamos maior volume hipocampal para os controles (média=3706±842), volume reduzido do hipocampo contralateral para pacientes livre de crises (média=3602±711) e menor ainda para os pacientes com presença de crises (média=3284±521). Para a análise de intensidade de sinal no lobo temporal contralateral dos pacientes, observamos uma diferença significativa (p=0,005) entre controles e pacientes com média menor para os controles. Também observamos alterações com diferença significativa para os tratos analisados em imagens de DTI, no lado ipsilateral à cirurgia comparados aos controles. Nossos resultados mostram bom controle de crises após a cirurgia, mesmo após um longo período. Entretanto observamos que após a cirurgia existe um declínio na performance dos testes neuropsicológicos para muitos pacientes, independente do lado operado. Porém, a análise a longo prazo mostra que existe uma recuperação parcial desse declínio, que pode estar associada a interação entre fatores de aprendizado e plasticidade cerebral; ou seja, podemos inferir que de alguma forma a melhora no controle das crises permite uma "recuperação" da eficiência cognitiva a longo prazo<br>Abstract: The quantification of the atrophy of the mesial temporal structures by MR images in patients with TLE allows identification "in vivo" of the anatomical changes associated with this disease and its correlation with neuropsychological data, allowing for the establishment of a proper diagnosis. Despite the evidence of the effectiveness of surgical treatment for seizure control, it is not yet clear the effects of resection of the mesial temporal lobe structures in cognitive performance in the long-term follow up. The aim of this study was to evaluate prospectively of a series of patients with TLE undergoing epilepsy surgery, comparing pre/post-surgical results obtained from neuropsychological assessment (NPA). We included 119 subjects, 88 patients and 31 healthy controls. Of the 113 patients, 88 had two NPA and 60 underwent two MRIs after surgery. Patients were classified according to Engel¿s scale. We evaluated the estimated intelligence coefficient (eIQ), the verbal and non-verbal memories with tests used in preoperative routine. We use specific longitudinal analyzes with SPSS®22 software. We observed that 73.7% of patients were classified as Engel I; 17.1% were classified as Engel II; 8.0% were classified as Engel III and 1.1% classified as Engel IV after surgery with a mean follow up of 8.8 years. The NPA pre/postoperative showed a memory decline for these patients related to seizures control and side of surgery (p<0.0001). We found no significant difference between the postoperative NPAs carried out in two different times and separated in groups regarding seizure control and side of surgery; however, all tests indicated a trend towards improvement trend in memory performance and eIQ. We observed a larger hippocampal volume for the controls (mean=3706±842), in comparison with seizure free patients (mean=3602±711) and smaller hippocampal contralateral volumes for patients with persistent seizures after surgery (mean=3284±521). We observed a significant difference (p=0.005) in T2 signal between patients and controls (increase in patients). We also observed changes with a significant difference to the white matter tracts analyzed with diffusion tensor images, in the ipsilateral side of surgery compared to controls. Our results show good seizure control after surgery, even after a long period of follow up. However, our results showed that after surgery there is a decline in the performance on neuropsychological tests for most patients, regardless of the side of surgery. However, the long-term repeated analysis showed that there is partial recovery that may be associated with the interaction between learning effect and brain plasticity. We can hypothesize that the improvement in seizure control after surgery allows "recovery" of the long-term cognitive efficiency<br>Doutorado<br>Fisiopatologia Médica<br>Doutora em Ciências

Deep Brain Simulation (DBS) has received attention in the scientific community for its potential to suppress epileptic seizures. To date, DBS has only achieved marginal positive results. We believe that a highly complex possibly chaotic (HPC) biologically inspired stimulation is superior to periodic stimulation. Using Radial Basis Functions (RBFs), we modeled interictal and postictal time series based on electroencephalograms (EEGs) of rat hippocampus slices while under low Mg2+. We then compared the RBF based interictal and postictal stimulations to the periodic stimulation using a Cognitive Rhythm Generator (CRG) model for spontaneous Seizure-Like Events (SLEs). What resulted was a significant improvement in seizure suppression with the HPC stimulators at lower gains as opposed to the periodic signal. This suggests that the use of biologically inspired HPC stimulators will achieve better results while confining the stimulation to a narrow region of the brain.

abstract: Epilepsy is a chronic illness impacting the lives of over 300,000 children nationally. Sexson and Madan-Swain offer a theory that addresses successful school reentry in children that are chronically ill. Their theory posits that successful school reentry is influenced by school personnel with appropriate attitudes, training experiences, and by factors relating to the child's illness. The parents of 74 students, between second and twelfth grades, completed a questionnaire addressing their child's epilepsy and their current level of seizure control. Each child's homeroom teacher also completed a survey regarding their training experiences about epilepsy and their attitudes towards individuals with epilepsy. Additional information was gathered from the child's school regarding attendance rates, most recent Terra Nova test scores (a group achievement test), and special education enrollment status. Data were analyzed via four multiple regression analyses and one logistic regression analysis. It was found that seizure control was a significant predictor for attendance, academic achievement (i.e., mathematics, writing, and reading), and special education enrollment. Additionally, teachers' attitudes towards epilepsy were a significant predictor of academic achievement (writing and reading) and special education enrollment. Teacher training experience was not a significant predictor in any of the analyses.<br>Dissertation/Thesis<br>Ph.D. Educational Psychology 2011

Thesis (M.S.)--University of Wisconsin--Madison, 1995.<br>Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 30-34).

abstract: From time immemorial, epilepsy has persisted to be one of the greatest impediments to human life for those stricken by it. As the fourth most common neurological disorder, epilepsy causes paroxysmal electrical discharges in the brain that manifest as seizures. Seizures have the effect of debilitating patients on a physical and psychological level. Although not lethal by themselves, they can bring about total disruption in consciousness which can, in hazardous conditions, lead to fatality. Roughly 1\% of the world population suffer from epilepsy and another 30 to 50 new cases per 100,000 increase the number of affected annually. Controlling seizures in epileptic patients has therefore become a great medical and, in recent years, engineering challenge. In this study, the conditions of human seizures are recreated in an animal model of temporal lobe epilepsy. The rodents used in this study are chemically induced to become chronically epileptic. Their Electroencephalogram (EEG) data is then recorded and analyzed to detect and predict seizures; with the ultimate goal being the control and complete suppression of seizures. Two methods, the maximum Lyapunov exponent and the Generalized Partial Directed Coherence (GPDC), are applied on EEG data to extract meaningful information. Their effectiveness have been reported in the literature for the purpose of prediction of seizures and seizure focus localization. This study integrates these measures, through some modifications, to robustly detect seizures and separately find precursors to them and in consequence provide stimulation to the epileptic brain of rats in order to suppress seizures. Additionally open-loop stimulation with biphasic currents of various pairs of sites in differing lengths of time have helped us create control efficacy maps. While GPDC tells us about the possible location of the focus, control efficacy maps tells us how effective stimulating a certain pair of sites will be. The results from computations performed on the data are presented and the feasibility of the control problem is discussed. The results show a new reliable means of seizure detection even in the presence of artifacts in the data. The seizure precursors provide a means of prediction, in the order of tens of minutes, prior to seizures. Closed loop stimulation experiments based on these precursors and control efficacy maps on the epileptic animals show a maximum reduction of seizure frequency by 24.26\% in one animal and reduction of length of seizures by 51.77\% in another. Thus, through this study it was shown that the implementation of the methods can ameliorate seizures in an epileptic patient. It is expected that the new knowledge and experimental techniques will provide a guide for future research in an effort to ultimately eliminate seizures in epileptic patients.<br>Dissertation/Thesis<br>Doctoral Dissertation Electrical Engineering 2016

碩士<br>國立成功大學<br>資訊工程學系碩博士班<br>98<br>Epilepsy is one of the most common neurological disorders with a prevalence of 0.6–0.8% of the world’s population. Two-thirds of the patients achieve sufficient seizure control from anticonvulsive medication, and another 8–10% could benefit from respective surgery. For the remaining 25% of patients, no sufficient treatment is currently available. Epilepsy is caused by abnormal discharges in the brain, thus electroencephalogram (EEG) has been an especially valuable clinical tool for the evaluation, seizure detection, and treatment of epilepsy. Brain stimulation with closed-loop seizure control has recently been proposed as an innovative and effective alternative. At present, two closed-loop epilepsy control system developed by NeuroPace called RNS and Medtronic called the Intercept? Epilepsy Control System are in U.S. FDA clinical trials. In this study, we have successfully integrated electrical circuit and system-on-a-chip (SOC) technology, brain signal and real-time computing to develop a wireless and portable real-time closed-loop epilepsy detection and control system. It has several aspects of advantages. The seizure detection rate is about 92-99% during wake-sleep states, false detection rate is less than 2.5%. The seizure detection and electrical stimulation latency is less than 0.6 s after seizure onset. A wireless communication improves and can mobility of users, and also provided flexibility for subjects freeing from the hassle of wires. In the future, our system can also be extended for a variety of biomedical device development applications. Currently, we had applying this system to implement response-induced features of drug delivery system on epilepsy.

碩士<br>國立雲林科技大學<br>國際企業管理研究所碩士班<br>101<br>The present research included two 2 x 2 factorial design studies, with Study 1 investigating the effects of emotional type (hopefulness/loneliness) and temporal distance (distant future/near future) on self-control (hedonic product consumption intention), and Study 2 probing into the effects of emotional type (hopefulness/loneliness) and choice frame (a isolated choice/broader choices) on self-control (hedonic product consumption intention). The results in Study 1 revealed that: (1) Emotional type was significantly related to hedonic product consumption intention, in which hedonic product consumption intention of the hopefulness group was significant higher than that of the loneliness group. (2) Temporal distance was not significantly related to hedonic product consumption intention. (3) There were interactive effects of emotional type and temporal distance on hedonic product consumption intention. In the loneliness group, distant-future hedonic product consumption intention was significantly higher than near-distant hedonic product consumption intention. In the hopefulness group, however, temporal distance did not contribute to significant differences in hedonic product consumption intention. The results in Studies 2 indicated that: (1) Emotional type has a significant effect on hedonic product consumption intention, in which hedonic product consumption intention of the hopefulness group was significant higher than that of the loneliness group. (2) Choice frame significantly affected hedonic product consumption intention. (3) There were interactive effects of choice frame and emotional type on hedonic product consumption intention. In the loneliness group, hedonic product consumption intention in the context of broader choices was significantly higher than that in the context of an isolated choice. In the hopefulness group, however, choice frame did not lead to significant differences in hedonic product consumption intention.