Publications by authors named "Roger Walz"

150 Publications

Anxiety and depressive symptoms long after mesial temporal epilepsy surgery: A prospective study.

Epilepsy Behav 2021 Apr 8;118:107936. Epub 2021 Apr 8.

Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil.

Background: Anxiety and depressive symptoms are prevalent in patients with refractory mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) before and after anterior temporal lobectomy (ATL).

Aims: (1) To follow the levels of anxiety and depressive symptoms long-term after ATL among patients with refractory MTLE-HS; (2) To identify pre- and postsurgical variables associated with the levels of anxiety and depressive symptoms after surgery.

Methods: We compared the levels of anxiety and depressive symptoms determined by the Hospital Anxiety and Depression Scale (HADS) before and long after ATL (mean 104 months, range 70-130) in 41 consecutive patients refractory MTLE-HS. The last follow-up was between September 2018 and March 2020. We also determined pre- and postsurgical variables independently associated with the HADS scores after surgery.

Results: The scores of HADS and its subdomains related to anxiety and depression decreased significantly (p < 0.01) after ATL. After multiple linear regressions, the HADS-Anxiety scores before surgery (B = 0.47, CI 95% 0.20 to 0.75, p = 0.001) and at follow-up after surgery (B = 0.07, CI 0.00 to 0.14, p = 0.05) remain independently and positively associated with HADS-Anxiety scores after surgery. The HADS-Depression scores after surgery were independently positively associated with HADS-Depression scores before surgery (B = 0.39, CI 95% 0.10 to 0.76, p = 0.01) and worse seizure control after surgery (B = 1.55, CI 95% 0.23 to 2.87, p = 0.02).

Conclusion: Anxiety and depressive symptoms in patients with MTLE-HS significantly improved after ATL. Presurgical levels of anxiety and depressive symptoms, respectively, were positively associated with the postsurgical levels of those symptoms. Length of follow-up is associated with anxiety, and worse seizure control is associated with depressive symptoms after ATL. The results have implications for the surgical management of MTLE-HS patients.
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http://dx.doi.org/10.1016/j.yebeh.2021.107936DOI Listing
April 2021

SUDEP - more attention to the heart? A narrative review on molecular autopsy in epilepsy.

Seizure 2021 Mar 15;87:103-106. Epub 2021 Mar 15.

Medical Sciences Post-graduate Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil. Electronic address:

Sudden unexpected death in epilepsy (SUDEP) has been identified as one of the most prevalent causes of mortality in epilepsy, and SUDEP has consequently become an important topic of research. The causes appear multifactorial, including epilepsy-induced cardiac arrest. Current understanding of autopsy negative sudden unexplained death (SUD) in general population and its relation to sudden arrhythmic death syndrome (SADS) could shed some light in SUDEP. Mutual attention to the findings of sudden death in cardiology and epilepsy are discussed here. We performed a narrative review on SUDEP, epilepsy and molecular/genetic autopsy in this population. A proposal of an extended terminology for SUDEP classification is discussed in light of recent issues related to molecular autopsy and genetics. The extended classification might be a step forward in research protocols and a tool for better understanding SUDEP.
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http://dx.doi.org/10.1016/j.seizure.2021.03.010DOI Listing
March 2021

Echocardiography in epilepsy: A tool to be explored.

Epilepsia 2021 Mar 23. Epub 2021 Mar 23.

Medical Sciences Postgraduate Program, Federal University of Santa Catarina, Florianópolis, Brazil.

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http://dx.doi.org/10.1111/epi.16879DOI Listing
March 2021

Quality of life long after temporal lobe epilepsy surgery.

Acta Neurol Scand 2021 Mar 10. Epub 2021 Mar 10.

Center for Applied Neurosciences, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.

Objectives: To identify variables independently associated with a meaningful improvement in QOL long after surgical treatment of drug-resistant MTLE-HS patients.

Material & Methods: We prospectively evaluated 72 consecutive MTLE-HS surgically treated patients and analyzed pre and post-surgical variables independently associated with a meaningful improvement in QOL evaluated by the Quality of Life in Epilepsy-31 (QOLIE-31) overall score, and its domain scores determined at follow-up after 36 to 131 months (mean 93 months) after surgery.

Results: The mean overall QOLIE-31 score and its subdomain scores improved significantly after surgery (p < 0.01), and 55 patients (76.4%) had a meaningful QOL improvement. Being seizure-free (Engel IA) after surgery showed a non-significant association (OR 2.63, CI 95% 0.53 to 13.05, p = 0.23) and lower depressive symptoms a significant association (OR 4.15, CI 95% 1.19 to 14.53, p = 0.03) with meaningful improvement of QOL.

Conclusions: Patients with MTLE-HS who underwent epilepsy surgery show a sustained, meaningful improvement in their QOL. Pre-surgical variables do not predict long-term QOL improvement after surgery. Lower levels of depressive symptoms at postoperative evaluation are associated with meaningful QOL improvement.
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http://dx.doi.org/10.1111/ane.13406DOI Listing
March 2021

Severity and disability related to epilepsy from the perspective of patients and physicians: A cross-cultural adaptation of the GASE and GAD scales.

Seizure 2021 Mar 10. Epub 2021 Mar 10.

Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Hospital Universitário Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil. Electronic address:

Purpose: To perform a cross-cultural adaptation of the Global Assessment of Severity of Epilepsy (GASE) and Global Assessment of Disability (GAD) scales to Brazilian Portuguese and compare patients' self-rated scores with their attending physicians' ratings.

Methods: We conducted an observational, multicentre, cross-sectional study. Patients followed up in five epilepsy centres in Brazil responded to GASE and GAD questionnaires and to the Hospital Anxiety and Depression Scale and the Adverse Events Profile, both previously validated in Brazil. GASE and GAD scales were also completed by 20 attending physicians providing care to these patients.

Results: A total of 138 patients were interviewed, with a mean age of 39.9 ± 13.81 years and a median of 11 (interquartile range, IQR = 7.5-12) years of education. Eighty-five (61.6%) patients were female. Most patients were diagnosed with focal epilepsy (82.6%). Only 5.8% and 3.6% of respondents reported having difficulty understanding the GASE and GAD, respectively. The patients scored a median of 3 (IQR = 2-5) on the self-perceived GASE and 4 (IQR = 2-6) on the GAD. Physician ratings were moderately to highly correlated with patients' self-perceived scores on the GASE and GAD. Linear regression analysis demonstrated that physicians' GASE and GAD scores predicted 37% and 20% of the patients' self-reported GASE and GAD variation, respectively.

Conclusion: Brazilian Portuguese cross-cultural adaptation of the GASE and GAD was successful. These scales were found to be easy to use by patients and health professionals, and revealed the burden of epilepsy on patients' lives.
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http://dx.doi.org/10.1016/j.seizure.2021.03.006DOI Listing
March 2021

Return to work after severe traumatic brain injury: further investigation of the role of personality changes.

Braz J Psychiatry 2021 Feb 12. Epub 2021 Feb 12.

Programa de Pós-graduação em Ciências Médicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.

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http://dx.doi.org/10.1590/1516-4446-2020-1660DOI Listing
February 2021

Neuronal activity regulated pentraxin (narp) and GluA4 subunit of AMPA receptor may be targets for fluoxetine modulation.

Metab Brain Dis 2021 04 2;36(4):711-722. Epub 2021 Feb 2.

Graduate Program in Neuroscience, Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, 88040-900, SC, Brazil.

Fluoxetine is the foremost prescribed antidepressant. Drugs acting on monoaminergic system may also regulate glutamatergic system. Indeed, the investigation of proteins associated with this system, such as Narp (neuronal activity-dependent pentraxin) and GluA4 subunit of AMPA receptor may reveal poorly explored modulations triggered by conventional antidepressants. This study aimed to uncover neurochemical mechanisms underlying the chronic fluoxetine treatment, mainly by evaluating these protein targets in the prefrontal cortex and in the hippocampus. Mice received a daily administration of fluoxetine (0.1, 1 or 10 mg/kg, p.o.) or potable water (vehicle group) for 21 days. These animals were submitted to the forced swim test (FST) to verify antidepressant-like responses and the open-field test (OFT) to assess locomotor activity. Modulation of signaling proteins was analyzed by western blot. Chronic treatment with fluoxetine (1 and 10 mg/kg) was effective, since it reduced the immobility time in the FST, without altering locomotor activity. Fluoxetine 10 mg/kg increased CREB phosphorylation and BDNF expression in the prefrontal cortex and hippocampus. Noteworthy, in the hippocampus fluoxetine also promoted Akt activation and augmented Narp expression. In the prefrontal cortex, a significant decrease in the expression of the GluA4 subunit and Narp were observed following fluoxetine administration (10 mg/kg). The results provide evidence of novel molecular targets potentially involved in the antidepressant effects of fluoxetine, since in mature rodents Narp and GluA4 are mainly expressed in the GABAergic parvalbumin-positive (PV+) interneurons. This may bring new insights into the molecular elements involved in the mechanisms underlying the antidepressant effects of fluoxetine.
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http://dx.doi.org/10.1007/s11011-021-00675-xDOI Listing
April 2021

AMPAr GluA1 Phosphorylation at Serine 845 in Limbic System Is Associated with Cardiac Autonomic Tone.

Mol Neurobiol 2021 Apr 6;58(4):1859-1870. Epub 2021 Jan 6.

Center for Applied Neuroscience, University Hospital (HU), UFSC, Florianopolis, SC, Brazil.

The central autonomic network, which is connected to the limbic system structures including the amygdala (AMY) and anterior hippocampus (aHIP), regulates the sympathetic and parasympathetic modulation of visceromotor, neuroendocrine, pain, and behavior manifestations during stress responses. Heart rate variability (HRV) is useful to estimate the cardiac autonomic tone. The levels of phosphorylation on the Ser831 and Ser845 sites of the GluA1 subunit of the AMPAr (P-GluA1-Ser845 and P-GluA1-Ser831) are useful markers of synaptic plasticity. The relation between synaptic plasticity in the human limbic system structures and autonomic regulation in humans is unknown. This study investigated the association between HRV and neurochemistry biomarkers of synaptic plasticity in AMY and aHIP. HRV indices were obtained from the resting state electrocardiogram of patients with drug-resistant mesial temporal lobe epilepsy (MTLE, n = 18) and the levels of P-GluA1-Ser845 and P-GluA1-Ser831 in the AMY and aHIP resected during the epilepsy surgery. A backward stepwise multiple linear regression models were used to analyze the association between HRV and synaptic plasticity biomarkers controlling for imbalances in the distribution of sociodemographic, clinical, neuroimaging, and neurosurgical variables. P-GluA1-Ser845 levels in AMY show a negative association (p < 0.05) with the 3 investigated parasympathetic autonomic HRV indices (SDNN, rMSSD, and HF) predicting 24 to 40% of their variation. The final multiple linear regression models include disease duration and levels of P-GluA1-Ser845 and predict 24 to 56% of cardiac autonomic tone variation (p < 0.01). P-GluA1-Ser845 levels in AMY and aHIP are negatively associated with the resting HRV in MTLE-HS indicating that increased synaptic efficiency in amygdala is associated with a parasympathetic cardiac autonomic tone impairment. The results suggest that specific changes in synaptic plasticity may be involved in the brain-heart axis regulation by the limbic system.
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http://dx.doi.org/10.1007/s12035-020-02272-yDOI Listing
April 2021

Ictal fear is associated with anxiety symptoms and interictal dysphoric disorder in drug-resistant mesial temporal lobe epilepsy.

Epilepsy Behav 2021 Feb 18;115:107548. Epub 2020 Dec 18.

Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Epilepsy Center of Santa Catarina (CEPESC), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Unit, Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil. Electronic address:

Interictal dysphoric disorder (IDD) is a poorly understood psychiatric disorder of epilepsy patients. Interictal dysphoric disorder is characterized by depressive, somatoform, and affective symptoms observed in up to 5.9% of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This study aimed to evaluate the association between ictal fear (IF) and the psychiatric symptoms and diagnosis in MTLE-HS patients. We included 116 (54.3% male) consecutive adult patients (36 ± 11 years) with MTLE-HS. Anxiety and depression symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS) and the psychiatric diagnosis were according to Fourth Edition of the Diagnosis and Statistical Manual of Mental Disorders (DSM-IV). The independent association between the occurrence of IF aura and the psychiatric diagnosis was determined by binary regression. When compared to those with other auras or without aura, patients reporting IF have higher HADS anxiety, but not HADS depression, scores. Ictal fear was independently associated with the diagnosis of interictal dysphoric disorder (OR, IC 95% = 7.6, 1.3-43.2, p = 0.02), but not with the diagnosis of anxiety (OR, CI 95% = 0.72, 0.08-6.0, p = 0.73), depression (OR, CI 95% = 0.94, 0.19-4.8, p = 0.94) or psychotic disorders (p = 0.99). Only patients with drug-resistant MTLE-HS were included and the small number of cases with DD diagnosis in the sample. In MTLE-HS patients, the occurrence of IF is associated with higher levels of anxiety symptoms and IDD. The results provide insights about fear-related neural network connections with anxiety symptoms and the IDD in MTLE-HS.
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http://dx.doi.org/10.1016/j.yebeh.2020.107548DOI Listing
February 2021

Employment status as a major determinant for lower physical activity of patients with epilepsy: A case-control study.

Epilepsy Behav 2021 Feb 17;115:107655. Epub 2020 Dec 17.

Medical Sciences Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil. Electronic address:

Background: People with epilepsy (PWE) may have a sedentary lifestyle and less physical activity (PA) as they are often advised against engaging in sports, despite a plethora of evidence suggesting seizure control, major health and psychosocial benefits associated with PA. We aimed to investigate PWE's beliefs on PA and their level of PA compared to controls.

Methods: The Baecke questionnaire for measuring habitual PA in adults, comprising three domains (occupational PA, leisure, and locomotion), was applied in 97 consecutive PWE (96.9% with focal epilepsy, 39.2% well controlled with pharmacological treatment) and 45 healthy controls matched for gender, age, and socioeconomic characteristics.

Results: The total Baecke score was significantly lower in PWE than controls (7.6 ± 1.5 versus 8.2 ± 1.2; p < 0.01). PWE showed a significantly lower employment rate than controls (34.0% versus 73.3%; p < 0.01), and consequently lower occupational PA (p < 0.01). Physical exercise during sports time (p = 0.23) and leisure activities (p = 0.55) scores were similar between patients and controls. When PWE and controls' sociodemographic characteristics were analyzed together by multiple linear regression, 21% of the Baecke total score variation was explained by diagnosis of epilepsy (B = -0.26; p = 0.05), years of education (B = -0.35; p = 0.03), and occupational status (B = -0.41; p < 0.01). However, diagnosis of epilepsy alone explained only 4% (B = -0.64; p = 0.01) of Baecke total score variation.

Conclusion: The level of PA in PWE is only slightly lower than in controls (8% lower score) and it may be explained by lower occupational PA, probably related to lower employment rate among PWE.
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http://dx.doi.org/10.1016/j.yebeh.2020.107655DOI Listing
February 2021

How predictable is cognitive performance in Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy?

Epilepsy Behav 2020 11 28;112:107453. Epub 2020 Sep 28.

Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Epilepsy Center of Santa Catarina (CEPESC), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Unit, Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil. Electronic address:

Objective: The objective of the study was to investigate the independent association between clinical, demographic, psychiatric, radiologic, electrophysiological, and pharmacologic variables and cognitive performance of Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy (MTLE).

Methods: Ninety-three patients with pharmacoresistant MTLE related to hippocampal sclerosis (HS) were included in the study. Multiple linear regressions were done to identify predictor variables for 24 cognitive tests. Independent variables analyzed were sex, hand dominance, age, years of education, marital status, work activity, history for an initial precipitant injury (IPI), family history of epilepsy, lesion side, antiseizure medication (ASM) treatment type, ASM serum levels, benzodiazepine (BDZ) treatment, age at epilepsy onset, disease duration, monthly frequency of seizures, and Hospital Anxiety and Depression Scale (HADS) scores.

Results: Years of education was an independent and positive predictor in 22 of the 24 cognitive tests evaluated. Male sex was also a positive predictor of one cognitive test. Variables negatively associated with cognitive performance were left side lesion (10 tests), disease duration (5 tests), polytherapy (3 tests), ASM serum levels (3 tests), and BDZ treatment or not working (1 test each). The regression model explained between 6% and 44% of the cognitive test scores variation.

Significance: In Brazilian patients with pharmacoresistant MTLE-HS, up to 44% of cognitive test scores variation is predictable by clinical, demographic, psychiatric, radiologic, electrophysiology, and pharmacological variables. The identification of predictors of cognitive performance may be helpful for better planning of patient care.
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http://dx.doi.org/10.1016/j.yebeh.2020.107453DOI Listing
November 2020

Does Epilepsy Have an Impact on Locus of Control?

Front Psychol 2020 9;11:2251. Epub 2020 Sep 9.

Center for Applied Neuroscience, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, Brazil.

Many chronic diseases impair patients' quality of life and may also affect their control perceptions. This could particularly happen for patients with epilepsy whose seizures often imply loss of control as a deeply disturbing experience. In 1980, a study on learned helplessness in epilepsy found a highly significant reduction of internal general locus of control (GLOC) and an increase of chance and powerful others health-related LOC (HLOC). In consequence, LOC became a frequent target of investigations relating to depression and anxiety, quality of life, coping, compliance, and other psychosocial aspects of epilepsy. Both GLOC and HLOC were investigated, and special groups like children, elderly, mentally handicapped persons, and those with psychogenic non-epileptic seizures were addressed. Most studies attempted to relate in-group differences of LOC to other parameters. Seizure-free patients were found to have a more internal HLOC, and patients with severe epilepsies have a more external HLOC. Patients with a high external HLOC seem to have more difficulties with coping and to be more anxious. Whereas external GLOC was correlated with learned helplessness, internal GLOC was associated with high self-efficacy and better life quality. An association of external LOC with depression seemed not to be a stable co-relation as clinical improvement following epilepsy surgery dissociated the two. A hypothesis was confirmed that the ability of some patients to counteract seizures at their onset, thus preserving control, was correlated with a higher internal HLOC. Some other theoretically well-founded hypotheses were not supported. Absolute figures as reported in several papers are of limited use because the only normative data for comparison come from a local sample of 1976 from Tennessee, whereas LOC scores may differ largely dependent on cultural and societal conditions. Very few controlled studies exist, and the early finding of a generally externalized LOC in epilepsy was confirmed only in one study performed in a South Indian community known for strong stigma against epilepsy. A recent transcultural investigation conducted in Brazil and Lithuania found no differences from healthy controls and between countries. It seems worthwhile to further investigate relations of LOC with epilepsy stigma.
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http://dx.doi.org/10.3389/fpsyg.2020.02251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509065PMC
September 2020

Left ventricle end-systolic elastance, arterial-effective elastance, and ventricle-arterial coupling in Epilepsy.

Acta Neurol Scand 2021 Jan 26;143(1):34-38. Epub 2020 Aug 26.

Medical Sciences Post-graduate Program, Federal University of Santa Catarina, (UFSC), Florianópolis, Brazil.

Objective: Sudden unexpected death in epilepsy (SUDEP) is a tragic event. Cardiac models of sudden death state that, paradoxically, healthy individuals compose most of the victims of this event. Exploration of cardiac physiological variables related to outcome could help unveil risk markers for sudden death in epilepsy. We investigated left ventricle end-systolic elastance, arterial-effective elastance and ventricle-arterial coupling (VAC) in PWE compared with controls.

Material & Methods: Adult patients with temporal lobe epilepsy without known cardiovascular diseases were submitted to treadmill test and transthoracic echocardiogram. Individuals without epilepsy matched by sex, age, and body mass index composed the control group. Cardiac risk factors, exercise performance, autonomic data from treadmill test, systolic and diastolic function, morphological cardiac data, and left ventricle pressure-volume loop were recorded.

Results: Sixty subjects were consecutively enrolled (30 PWE and 30 controls). Epilepsy duration was 22.5 ± 10.7 years (age of onset 15.2 ± 10.1 years). Treadmill variables were significantly worse in TLE patients compared with controls. End-systolic elastance, arterial-effective elastance, and ventricle-arterial coupling were similar between groups. Female sex, percentage of maximal predicted heart rate achieved in exercise, exercise time, and epilepsy duration explained 28,4% of VAC in PWE in multiple stepwise linear regression (P = .018).

Conclusions: Some aspects of the cardiac pressure-volume curves, mainly linked to left ventricle systolic performance, contractile function and their interaction with afterload appears normal in young PWE and cannot explain their increase risk to adverse outcomes or lower physical fitness.
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http://dx.doi.org/10.1111/ane.13334DOI Listing
January 2021

Neuroprotective effects of melatonin against neurotoxicity induced by intranasal sodium dimethyldithiocarbamate administration in mice.

Neurotoxicology 2020 09 30;80:144-154. Epub 2020 Jul 30.

Department of Pharmacology, Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil. Electronic address:

Exposure to fungicide ziram (zinc dimethyldithiocarbamate) has been associated with increased incidence of Parkinson's disease (PD). We recently demonstrated that the intranasal (i.n.) administration of sodium dimethyldithiocarbamate (NaDMDC, a more soluble salt than ziram) induces PD-like behavioral and neurochemical alterations in mice. We now investigated the putative neuroprotective effects of melatonin on behavioral dificits and neurochemical alterations induced by i.n. NaDMDC. Melatonin treatment (3, 10 or 30 mg/kg, i.p.) was given 1 h before NaDMDC administration (1 mg/nostril) during 4 consecutive days and we evaluated early (up to 7 days) and late (up to 35 days) NaDMDC-induced behavioral and neurochemical alterations. Melatonin treatment protected against early motor and general neurological impairments observed in the open field and neurological score of severity, respectively, and late deficits in rotarod test. Melatonin prevented the NaDMDC-induced alterations in the striatal tyrosine hydroxylase immunocontent. Melatonin also protected against increased levels of oxidative stress markers (4-hydroxynonenal and 3-nitrotyrosine) in the striatum, as well as the NaDMDC-induced increase of 4-hydroxynonenal and TNF, markers of oxidative stress and inflammation, respectively, in the olfactory bulb. These results further detail the mechanisms underlying NaDMDC toxicity and demonstrate the neuroprotective effects of melatonin against the neuronal damage induced by NaDMDC.
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http://dx.doi.org/10.1016/j.neuro.2020.07.008DOI Listing
September 2020

Early Alpha Reactivity is Associated with Long-Term Mental Fatigue Behavioral Impairments.

Appl Psychophysiol Biofeedback 2021 03;46(1):103-113

Brain and Education Laboratory (LEC), Psychology Department, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.

The quantitative analysis of electroencephalogram (qEEG) is a suitable tool for mental fatigue (MF) assessment. Here, we evaluated the effects of MF on behavioral performance and alpha power spectral density (PSD) and the association between early alpha PSD reactivity and long-term behavioral MF impairments. Nineteen right-handed adults (21.21 ± 1.77 years old) had their EEG measured during five blocks of the visual oddball paradigm (~ 60 min). A paired t-test was used to compare first and last block values of cognitive performance and alpha PSD. The sample was divided into high (HAG) and low alpha group (LAG) by early alpha PSD median values. The behavioral performance of the HAG and LAG was compared across the blocks by a two-way ANOVA with repeated measures (groups and blocks). MF impairs general behavioral performance and increases alpha PSD. The HAG presents more behavioral impairment when compared to LAG across the task. Simple linear regression between early alpha PSD and behavioral performance across the task can predict 19 to 39% of variation in general behavior impairment by MF. In conclusion, MF induction impairs general behavioral and increases alpha PSD. The other finding was that higher alpha PSD reactivity is associated to higher long-term behavioral impairments of MF. This work contributes to existing knowledge of MF by providing evidence that the possibility of investigating early electrophysiological biomarkers to predict long-term MF impairments.
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http://dx.doi.org/10.1007/s10484-020-09475-yDOI Listing
March 2021

The "Epileptic Heart" and the "cardiovascular continuum".

Epilepsy Behav 2020 07 2;108:107044. Epub 2020 Apr 2.

Medical Sciences Post-graduate Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil.

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http://dx.doi.org/10.1016/j.yebeh.2020.107044DOI Listing
July 2020

Self-reported adherence among people with epilepsy in Brazil.

Epilepsy Behav 2020 02 22;103(Pt A):106498. Epub 2019 Oct 22.

Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil.

Background: Nonadherence rates among people with epilepsy (PWE) are widely variable, ranging from 26% to 95.4%. We aimed to identify nonadherence in Brazil, its determinant factors, its impact on patients' management, and to compare it with other chronic nonparoxysmal diseases.

Methods: A multicenter observational case-control study was conducted between March 2015 and October 2016, and 153 subjects were included. Subjects' clinical-epidemiological data were surveyed with the Morisky-Green test (MGT), Brief Medication Questionnaire (BMQ), and the Liverpool adverse events profile (LAEP).

Results: One hundred three PWE and 50 controls with other, nonparoxysmal chronic conditions were interviewed; both groups were matched according to age and socioeducational level. People with epilepsy were aged 36.4 ± 13.9 (range 18-67), 55% were women, mean age at epilepsy onset was 18.1 ± 15.5 years, 51.5% had pharmacoresistant epilepsy, and 48.5% were on monotherapy. 74.8% of patients and 70.0% controls were nonadherent to treatment according to MGT (p = 0.58); and barrier of recall (BMQ) was associated with nonadherence in 78% of PWE and 76% of controls (p = 0.84). Binary logistic regression analysis revealed LAEP (OR 1.05; 95%CI = 1.01-1.09; p = 0.03) and self-reported frequency of forgetfulness on the last three months (OR 19.13; 95%CI = 2.40-152.28; p < 0.01) as the main factors associated with nonadherence. Nonadherent subjects did not have more seizures and did not need emergency treatment more often than adherent ones.

Conclusion: Three of four PWE were not fully adherent to their treatment. Adherence assessment should be routine in all outpatient visits as well as interventions aimed to improving it. Adverse events are important predictors of adherence, and they should be considered when choosing the initial treatment of epilepsy.
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http://dx.doi.org/10.1016/j.yebeh.2019.106498DOI Listing
February 2020

Yellow Fever Vaccine as a Possible Trigger of Inflammatory Myopathy: A Case Report.

J Clin Rheumatol 2019 Oct 22. Epub 2019 Oct 22.

Department of Neurology Hospital Governador Celso Ramos Florianópolis, Santa Catarina Brazil Internal Medicine Department University Hospital Universidade Federal de Santa Catarina Florianópolis, Santa Catarina Brazil Division of Neuropathology Universidade Federal de Santa Catarina and Neurodiagnostic Brasil-Diagnósticos em Neuropatologia Florianópolis, Santa Catarina Brazil

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http://dx.doi.org/10.1097/RHU.0000000000001147DOI Listing
October 2019

Predictors of Pain Recurrence After Lumbar Facet Joint Injections.

Front Neurosci 2019 20;13:958. Epub 2019 Sep 20.

Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.

Introduction: Facet joint injections (FJIs) of anesthetic and corticosteroids are useful for the diagnosis and treatment of low back pain (LBP). In the current study, we evaluated the efficacy of FJI on LBP treatment and the predictive variables of pain recurrence after FJI.

Methods: We included and followed prospectively forty-three consecutive patients with chronic LBP treated with FJI. Clinical assessments were carried out at a baseline 1 week before FJIs and after a 6-month follow-up visit using the visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) for disability-specific measure and MacNab criteria for global effectiveness, and compared through analysis using paired-samples "" tests. Multiple cox-regression analysis was used to identify the presurgical variables independently associated with pain recurrence anytime during the follow-up. In addition to the demographic, clinical, and surgical data, we also analyzed psychometric scales: Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI).

Results: After a 6-month follow-up, thirty-two patients (74.4%) showed a clinically significant reduction of pain and twenty-seven (62.8%) reported a clinically significant improvement of disability. Presurgical catastrophizing (PCS score ≥ 5, adjusted HR 4.4, CI 95% 1.7-11.3, = 0.002) and smoking (Adjusted HR 12.5, CI 95% 1.1-138.9, = 0.04) remains associated with pain recurrence.

Conclusion: FJI reduces LBP and disability of patients with unresponsive LBP. Pain-related cognitive and behavioral factors determined by pain catastrophizing and smoking were independently associated with pain recurrence after lumbar FJI. The results support the need of a multidisciplinary approach for presurgical evaluation of patients with chronic pain.
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http://dx.doi.org/10.3389/fnins.2019.00958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6763569PMC
September 2019

Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation.

Braz J Psychiatry 2020 Apr 5;42(2):190-194. Epub 2019 Aug 5.

Faculdade de Medicina, Universidade do Porto, Porto, Portugal.

Objective: Parkinson's disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS).

Methods: We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society-sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson's Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable.

Results: After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03).

Conclusions: Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.
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http://dx.doi.org/10.1590/1516-4446-2018-0333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115448PMC
April 2020

Epilepsy and ultra-structural heart changes: The role of catecholaminergic toxicity and myocardial fibrosis. What can we learn from cardiology?

Seizure 2019 Oct 2;71:105-109. Epub 2019 Jul 2.

Medical Sciences Post-graduate Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil. Electronic address:

In this article, we explore the interaction of brain and heart in patients with epilepsy (PWE), focusing on new insights into possible pathways from epilepsy, catecholaminergic toxicity, subtle cardiac changes and sudden death. Initial evidence and biological plausibility point to an interaction between autonomic dysfunction, higher sympathetic drive, myocardial catecholaminergic toxicity and cardiac fibrosis resulting in subtle myocardial changes in structure, function, arrhythmogenesis and/or a heart failure-like phenotype in PWE. Non invasive imaging and biomarkers of cardiac injury and fibrosis are emerging as possible diagnostic tools to better stratify the risk of such individuals. Translational lessons from cardiac models of disease and ultra-structural lesions are used to support these considerations.
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http://dx.doi.org/10.1016/j.seizure.2019.07.002DOI Listing
October 2019

Resting Cardiac Vagal Tone is Associated with Long-Term Frustration Level of Mental Workload: Ultra-short Term Recording Reliability.

Appl Psychophysiol Biofeedback 2020 03;45(1):1-9

Laboratory of Brain Education (LEC), Department of Psychology, Federal University of Santa Catarina, Florianópolis, 88049-900, Brazil.

Excessive mental workload represent a critical risk factor for workplace accidents. Heart rate variability (HRV) is a non-invasive low cost electrophysiological autonomic biomarker related to emotional and cognitive regulation. Several studies report that mental overload impairs parasympathetic-mediated HRV indices (e.g. rMSSD). However, the influence of resting state HRV as a predictor of long-term mental workload impairments remains unknown. Thirty participants (22 males; 8 females) had their HRV measured (5-min period) before performing the number search task. After the task, the mental load was accessed by the NASA-TLX questionnaire. A simple linear regression model between HRV and NASA-TLX dimensions showed that resting state rMSSD is associated to physical demand (ND-2, R = 0.143, p = 0.03) and frustration level (ND-6, R = 0.175, p = 0.02) dimensions of mental workload. The comparison between 1 and 5-min epochs suggests that regression models remain reliable even using the ultra-short term HRV (< 1 min) recording values (R values from 0.11 to 0.15 for ND-2 and R values from 0.16 to 0.19 for ND-6). These results suggest that resting state HRV is associated to long-term effects of mental workload on physical and emotional demands. In addition, the ultra-short term HRV indices remains reliable to assess ND-2 and ND-6 dimensions of mental workload when compared to gold-standard time interval (> 5 min). The resting state cardiac autonomic tone assessment optimizes the physiological approach with a quick, non-invasive and low-cost assessment that can provide insights about mental load adjustments to prevent work-related accidents.
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http://dx.doi.org/10.1007/s10484-019-09445-zDOI Listing
March 2020

Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil.

Front Neurol 2019 25;10:432. Epub 2019 Apr 25.

Centro de Neurociências Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, Brazil.

Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male ( = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% ( = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels.
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http://dx.doi.org/10.3389/fneur.2019.00432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494964PMC
April 2019

Deep Brain Stimulation for Obesity: A Review and Future Directions.

Front Neurosci 2019 18;13:323. Epub 2019 Apr 18.

Center for Applied Neuroscience, University Hospital, Federal University of Santa Catarina, Florianópolis, Brazil.

The global prevalence of obesity has been steadily increasing. Although pharmacotherapy and bariatric surgeries can be useful adjuvants in the treatment of morbid obesity, they may lose long-term effectiveness. Obesity result largely from unbalanced energy homeostasis. Palatable and densely caloric foods may affect the brain overlapped circuits involved with homeostatic hypothalamus and hedonic feeding. Deep brain stimulation (DBS) consists of delivering electrical impulses to specific brain targets to modulate a disturbed neuronal network. In selected patients, DBS has been shown to be safe and effective for movement disorders. We review all the cases reports and series of patients treated with DBS for obesity using a PubMed search and will address the following obesity-related issues: (i) the hypothalamic regulation of homeostatic feeding; (ii) the reward mesolimbic circuit and hedonic feeding; (iii) basic concepts of DBS as well as the rationale for obesity treatment; (iv) perspectives and challenges in obesity DBS. The small number of cases provides preliminary evidence for the safety and the tolerability of a potential DBS approach. The ventromedial ( = 2) and lateral ( = 8) hypothalamic nuclei targets have shown mixed and disappointing outcomes. Although nucleus accumbens ( = 7) targets were more encouraging for the outcomes of body weight reduction and behavioral control for eating, there was one suicide reported after 27 months of follow-up. The authors did not attribute the suicide to DBS therapy. The identification of optimal brain targets, appropriate programming strategies and the development of novel technologies will be important as next steps to move DBS closer to a clinical application. The identification of electrical control signals may provide an opportunity for closed-loop adaptive DBS systems to address obesity. Metabolic and hormonal sensors such as glycemic levels, leptin, and ghrelin levels are candidate control signals for DBS. Focused excitation or alternatively inhibition of regions of the hypothalamus may provide better outcomes compared to non-selective DBS. Utilization of the NA delta oscillation or other physiological markers from one or multiple regions in obesity-related brain network is a promising approach. Experienced multidisciplinary team will be critical to improve the risk-benefit ratio for this approach.
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http://dx.doi.org/10.3389/fnins.2019.00323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482165PMC
April 2019

Anti-NMDA Receptor Autoantibody Is an Independent Predictor of Hospital Mortality but Not Brain Dysfunction in Septic Patients.

Front Neurol 2019 15;10:221. Epub 2019 Mar 15.

Laboratório de Fisiopatologia Experimental, Universidade do Extremo Sul Catarinense, Criciúma, Brazil.

The presence of autoantibodies against neuronal cell surface or synaptic proteins and their relationship to autoimmune encephalitis have recently been characterized. These autoantibodies have been also reported in other pathologic conditions; however, their role during sepsis is not known. This study detected the presence of autoantibodies against neuronal cell surface or synaptic proteins in the serum of septic patients and determined their relationship to the occurrence of brain dysfunction and mortality. This prospective, observational cohort study was performed in four Brazilian intensive care units (ICUs). Sixty patients with community-acquired severe sepsis or septic shock admitted to the ICU were included. Blood samples were collected from patients within 24 h of ICU admission. Antibodies to six neuronal proteins were assessed, including glutamate receptors (types NMDA, AMPA1, and AMPA2); voltage-gated potassium channel complex (VGKC) proteins, leucine-rich glioma-inactivated protein 1 (LGI1), and contactin-associated protein-2 (Caspr2), as well as the GABAB1 receptor. There was no independent association between any of the measured autoantibodies and the occurrence of brain dysfunction (delirium or coma). However, there was an independent and significant relationship between anti-NMDAR fluorescence intensity and hospital mortality. In conclusion, anti-NMDAR was independently associated with hospital mortality but none of the measured antibodies were associated with brain dysfunction in septic patients.
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http://dx.doi.org/10.3389/fneur.2019.00221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428735PMC
March 2019

Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory (STAI) accuracy for anxiety disorders detection in drug-resistant mesial temporal lobe epilepsy patients.

J Affect Disord 2019 03 24;246:452-457. Epub 2018 Dec 24.

Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil.

Background: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most prevalent type of surgically remediable epilepsy and highly associated with psychiatric comorbidities. This study aimed to evaluate Hospital anxiety and depression scale-anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory - Trait subscale (STAI-T) accuracy for detection of anxiety disorders in patients with drug-resistant MTLE-HS.

Methods: One hundred three consecutive patients with drug-resistant MTLE-HS were enrolled. Diagnosis was based on the anamnesis, neurological examination, video-electroencephalogram (VEEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HADS-A and STAI-T were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores.

Results: The areas under the curve (AUCs) were higher than 0.7 (0.6-0.8) for both scales. The STAI-T cutoff point of ˃53 and the HADS-A cutoff point of ˃7 showed both around of 80% (44.4-97.7) sensitivity and 80% (66.9-86.9) and 60% (46.5-68.6) of specificity, respectively. In this sample the prevalence of anxiety disorders was 11.7% and both scales showed a high negative predictive value such as 96% (87.1-99.0) but low positive predictive value such as 30% (22.1-45.2) and 20% (15.0-27.2) respectively.

Limitations: The small number of cases in the diagnostic population; the results are only applied to drug resistant MTLE-HS; the psychiatric diagnosis were not based on a structured psychiatric interview; possible observer bias in 7 illiterate patients; the antidepressant treatment was not controlled.

Conclusions: In MTLE-HS, STAI-T and HADS-A had a similar and low positive predictive value and high negative predictive value. The implications for the HADS-A and STAI-T usefulness for anxiety disorders screening in patients with other epilepsies types deserve further investigations. If replicated in other populations, these findings may have important relevance for the presurgical screening of anxiety disorders in MTLE-HS patients who are candidates to epilepsy surgery.
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http://dx.doi.org/10.1016/j.jad.2018.12.072DOI Listing
March 2019

Determinants for Meaningful Clinical Improvement of Pain and Health-Related Quality of Life After Spinal Cord Stimulation for Chronic Intractable Pain.

Neuromodulation 2019 Apr 10;22(3):280-289. Epub 2018 Dec 10.

Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, SC, Brazil.

Objectives: Previous studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS.

Materials And Methods: Thirty-four patients with chronic intractable pain completed scales of pain (visual analogue scale [VAS]), QOL (SF-36), and psychological dimensions during a 22-month follow-up period (mean). Patient-centered MCI of the VAS and SF-36 domain scores were determined based on the MacNab criteria of surgical global effectiveness. Independent presurgical predictors for MCI in the VAS and SF-36 domains were analyzed using multiple binary logistic regression.

Results: There was significant improvement of pain and QOL after the SCS (p < 0.00001). Twenty-three patients (67.6%) reached an MCI of pain, and 16 (47.7%)-23 (67.7%) reported an MCI of QOL. Predictors of MCI included ≥80% paresthesia coverage of the painful area, lower levels of anxiety and catastrophizing symptoms, shorter pain duration, female gender and no use of opioids before surgery. MCI of pain and QOL was observed in 50%-70% of patients with chronic pain after SCS.

Conclusions: The identification of determinants for MCI is a challenge to improve the accuracy of prognostic models in SCS for patients with chronic pain. Our results, if confirmed in other populations with a larger sample size, have implications for patients with chronic pain who are candidates for SCS treatment.
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http://dx.doi.org/10.1111/ner.12891DOI Listing
April 2019

Is self-report sleepiness associated with cognitive performance in temporal lobe epilepsy?

Arq Neuropsiquiatr 2018 09;76(9):575-581

Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Clínica Médica, Serviço de Neurologia, Florianópolis SC, Brasil.

Objectives: Sleepiness and cognitive impairment are common symptoms observed in patients with epilepsy. We investigate whether self-reported sleepiness is associated with cognitive performance in patients with refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Seventy-one consecutive patients with MTLE-HS were evaluated with the Stanford Sleepiness Scale (SSS) before neuropsychological evaluation. Their mean SSS scores were compared with controls. Each cognitive test was compared between patients with (SSS ≥ 3) or without sleepiness (SSS < 3). Imbalances were controlled by regression analysis. Patients reported a significantly higher degree of sleepiness than controls (p < 0.0001). After multiple linear regression analysis, only one test (RAVLT total) remained associated with self-reported sleepiness.

Conclusion: Self-reported sleepiness was significantly higher in MTLE-HS patients than controls, but did not affect their cognitive performance. If confirmed in other populations, our results may have implications for decision making about sleepiness screening in neuropsychological settings.
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http://dx.doi.org/10.1590/0004-282X20180089DOI Listing
September 2018

Control perceptions in epilepsy: A transcultural case-control study with focus on auras.

Epilepsy Behav 2018 11 28;88:130-138. Epub 2018 Sep 28.

Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark. Electronic address:

Objective: General Locus of Control (GLoC) is used to measure the extent to which people perceive life events as results of their own actions or external factors. This study analyzes the relationship between GLoC and people with epilepsy's (PWE) clinical characteristics, levels of anxiety, depression, religiosity/spirituality, and quality of life, with particular attention to possible influences of auras.

Methods: A case-control study was carried out with 186 consecutive patients with a definite diagnosis of epilepsy in Brazil and Lithuania. Besides clinical and demographic data, all patients answered to internationally validated scales: Rotter's GLoC, Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy (QOLIE-31), and Index of Core Spiritual Experiences-Revised (INSPIRIT-R).

Results: Patient's mean age was 36.15 ± 13.75 years, 61.3% were female, mean age at onset of epilepsy was 17.27 ± 13.59 years, and monthly seizure frequency was 8.22 ± 20.00. People with epilepsy were more depressed than controls, (p = 0.03). Within the group with epilepsy, patients reporting auras and reacting to them had higher levels of depression (p = 0.002) and anxiety (p = 0.004) and lower QOLIE-31 (p = 0.01) score but did not differ in GLoC (p = 0.73) or INSPIRIT-R (p = 0.71). Patients with perceived ability to prevent seizures in response to auras had no increased levels of depression and anxiety.

Conclusions: General Locus of Control externalization in PWE was not confirmed. To perceive and be able to react to auras is associated with increased anxiety and depressive symptoms in PWE but not if it results in preventing seizures. No transcultural differences in these parameters were found.
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http://dx.doi.org/10.1016/j.yebeh.2018.09.005DOI Listing
November 2018

Single antiepileptic drug levels do not predict adherence and nonadherence.

Acta Neurol Scand 2019 Feb 11;139(2):199-203. Epub 2018 Oct 11.

Medical Sciences Post-graduate Program, Federal University of Santa Catarina, (UFSC), Florianópolis, Brazil.

Objectives: To investigate the significance of "subtherapeutic" vs "therapeutic" antiepileptic drug (AED) plasma levels with respect to treatment adherence.

Material And Methods: One hundred and seventy patients with refractory temporal lobe epilepsy who underwent video-EEG monitoring in view of a surgical indication had their AEDs (carbamazepine, phenobarbital, phenytoin, and valproate) rapidly withdrawn following a standardized schedule. Plasma levels were measured at admission, and during the 2 days of drug withdrawal. Adherence and nonadherence were identified by the development of plasma levels from day 1 through day 3. Frequencies of an initial level below the reference range in both groups were compared.

Results: Adherence was found in 73.2% of cases, and nonadherence in 26.8%. Low levels were seen equally often (about 1/4 of cases) in adherent and nonadherent cases. The vast majority (73.7%) of low levels had another explanation than nonadherence (eg low-dose treatment or enzyme induction). Of 42 nonadherent cases, the vast majority of 76.2% had unsuspicious plasma levels at admission.

Conclusions: "Subtherapeutic" AED plasma levels only rarely are caused by nonadherence whereas levels in the "therapeutic range" by no means prove that the patient is adherent to treatment. For meaningful interpretation, any level needs to be compared with other levels of the same patient. Our findings strongly emphasize the principle of individualized therapeutic AED monitoring as promoted by the Therapeutic Strategies Commission of the ILAE.
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http://dx.doi.org/10.1111/ane.13033DOI Listing
February 2019