Uso da lamotrigina no controle de impulso e na cognição social de pacientes com epilepsia do lobo temporal
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2023-09-28
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Universidade Estadual Paulista (Unesp)
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Introdução: A epilepsia do lobo temporal (ELT) é um tipo de epilepsia focal em que as crises iniciam em uma ou várias áreas do lobo temporal. Cerca de 60% dos pacientes com ELT não adquirem controle das crises mesmo após o tratamento otimizado com diferentes classes de medicações anticrise. Além disso, os indivíduos com Epilepsia do Lobo Temporal Mesial (ELTM) sofrem com estigmas associados aos transtornos psicológicos, o que afeta a qualidade de vida e funcionalidade dessas pessoas. Objetivos: Estudar a ação da lamotrigina na cognição e comportamento de pacientes com ELT. Métodos: Foram empregados na amostra de 66 pacientes com ELT o questionário de triagem Exame Internacional de Transtorno de Personalidade (do inglês International Personality Disorder Examination – IPDE) baseado na Classificação Internacional das Doenças (CID 10), é composto por 59 questões, apto para triagem de transtorno de personalidade (sendo a personalidade impulsiva a de interesse desse estudo) e o Inventário Neuropsicológico (do inglês Bear-Fedio) – BFI, um teste de negativo/positivo com 100 quesitos formulado para analisar os tipos de padrões de comportamento social, retratando 18 tipos de comportamentos comuns à ELT, a fim de obter dados sobre os demais tipos de personalidades prevalentes na população com ELT do ambulatório de epilepsia da UNESP, a fim de analisá-los futuramente além de se objetivar a evitar o viés de seleção. O poder do estudo foi de 80% com erro α de 0,05. O teste do Qui-quadrado foi aplicado para estudar a relação entre diferentes variáveis demográficas com a presença de transtorno de personalidade impulsiva do IPED e os quesitos de ódio/vingança e euforia do BFI. Resultados: A amostra de 66 pacientes foi composta por 23 homens e 43 mulheres, sendo a média de idade do estudo corrente de 49 anos nos dois grupos, com uma mediana de 51 anos, sendo o mais novo com 18 e o mais velho de 80 anos. A localização da alteração do eletroencefalograma e/ou ressonância magnética encéfalo à esquerda, respectivamente, 10 e 15 pacientes, num total de 25 pacientes, ou seja, 83% da amostra total em uso de lamotrigina apresentaram lesão temporal à esquerda, o que de teria maior relação com a irritabilidade intimamente relacionado ao transtorno de impulsividade. Foram obtidos 48 pacientes com critérios positivos para impulsividade de acordo com o questionário IPDE representando 80% da amostra de pacientes com ELT. Já em relação ao BFI, pelos critérios de raiva/ agressividade e euforia, respectivamente, 26 e 44 pacientes positivos, correspondendo a 46% positivos para a presença de raiva e agressividade e 76% positivos para o critério de euforia na amostra total. Enquanto esses critérios foram positivos para, respectivamente, 40% e 70%, em uso de lamotrigina. Porém não foi alcançada significância estatística ao se estudar o controle de impulso nos pacientes em uso de lamotrigina quando comparados com os grupos em uso de outras medicações anticrise. Conclusão: O estudo atual não conseguiu demonstrar se lamotrigina seria superior às outras medicações anticrise no controle da impulsividade, de acordo com a avaliação dos questionários IPDE e BFI.
Introduction: Temporal lobe epilepsy (TLE) is a type of focal epilepsy in which seizures begin in one or more areas of the temporal lobe. Around 60% of patients with TLE do not gain seizure control even after optimized treatment with different classes of anti-seizure medications. furthermore, individuals with MTLE suffer from stigma associated with psychological disorders, which affects their quality of life and functionality. Objectives: To study the action of lamotrigine on the cognition and behavior of patients with TLE. Methods: The International Personality Disorder Examination (IPDE) screening questionnaire was used in the sample of 66 patients with TLE, based on The International Classification of Diseases (ICD10), consisting of 59 questions, suitable for personality disorder screening (impulsive personality being the one of interest in this study) and the Neuropsychological Inventory (from the english Bear-Fedio) – BFI, a negative/positive test with 100 questions formulated to analyze the types of social behavior patterns, portraying 18 types of behaviors common to TLE, in order to obtain data on the other types of personalities prevalent in the population with TLE at the UNESP epilepsy outpatient clinic, in order to analyze them in the future, in addition to aiming to avoid selection bias. The power of the study was 80% with an α error of 0.05. The chi-square test was applied to study the relationship between different demographic variables with the presence of impulsive personality disorder from the IPED and the hatred/revenge and euphoria items from the BFI. Results: the sample of 66 patients was composed of 23 men and 43 women, with the average age in the current study being 49 years in both groups, with a median of 51 years, the youngest being 18 and the oldest being 80. Years. The location of the change in the EEG and/or brain MRI on the left, respectively, 10 and 15 patients, in a total of 25 patients, that is, 83% of the total sample using lamotrigine presented a temporal lesion on the left, which would have been greater relationship with irritability closely related to impulsivity disorder. 48 patients with positive criteria for impulsivity were obtained according to the IPDE questionnaire, representing 80% of the sample of patients with TLE. Regarding the BFI, according to the criteria of anger/aggressiveness and euphoria, respectively, 26 and 44 positive patients, corresponding to 46% positive for the presence of anger and aggressiveness and 76% positive for the euphoria criterion in the total sample. While these criteria were positive for, respectively, 40% and 70%, using lamotrigine. However, statistical significance was not achieved when studying impulse control in patients using lamotrigine when compared with groups using other anti-seizure medications. Conclusion: The current study was unable to demonstrate whether lamotrigine would be superior to other anti-seizure medications in controlling impulsivity, according to the evaluation of the IPDE and BFI questionnaires.
Introduction: Temporal lobe epilepsy (TLE) is a type of focal epilepsy in which seizures begin in one or more areas of the temporal lobe. Around 60% of patients with TLE do not gain seizure control even after optimized treatment with different classes of anti-seizure medications. furthermore, individuals with MTLE suffer from stigma associated with psychological disorders, which affects their quality of life and functionality. Objectives: To study the action of lamotrigine on the cognition and behavior of patients with TLE. Methods: The International Personality Disorder Examination (IPDE) screening questionnaire was used in the sample of 66 patients with TLE, based on The International Classification of Diseases (ICD10), consisting of 59 questions, suitable for personality disorder screening (impulsive personality being the one of interest in this study) and the Neuropsychological Inventory (from the english Bear-Fedio) – BFI, a negative/positive test with 100 questions formulated to analyze the types of social behavior patterns, portraying 18 types of behaviors common to TLE, in order to obtain data on the other types of personalities prevalent in the population with TLE at the UNESP epilepsy outpatient clinic, in order to analyze them in the future, in addition to aiming to avoid selection bias. The power of the study was 80% with an α error of 0.05. The chi-square test was applied to study the relationship between different demographic variables with the presence of impulsive personality disorder from the IPED and the hatred/revenge and euphoria items from the BFI. Results: the sample of 66 patients was composed of 23 men and 43 women, with the average age in the current study being 49 years in both groups, with a median of 51 years, the youngest being 18 and the oldest being 80. Years. The location of the change in the EEG and/or brain MRI on the left, respectively, 10 and 15 patients, in a total of 25 patients, that is, 83% of the total sample using lamotrigine presented a temporal lesion on the left, which would have been greater relationship with irritability closely related to impulsivity disorder. 48 patients with positive criteria for impulsivity were obtained according to the IPDE questionnaire, representing 80% of the sample of patients with TLE. Regarding the BFI, according to the criteria of anger/aggressiveness and euphoria, respectively, 26 and 44 positive patients, corresponding to 46% positive for the presence of anger and aggressiveness and 76% positive for the euphoria criterion in the total sample. While these criteria were positive for, respectively, 40% and 70%, using lamotrigine. However, statistical significance was not achieved when studying impulse control in patients using lamotrigine when compared with groups using other anti-seizure medications. Conclusion: The current study was unable to demonstrate whether lamotrigine would be superior to other anti-seizure medications in controlling impulsivity, according to the evaluation of the IPDE and BFI questionnaires.
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Epilepsia do lobo temporal mesial, Impulsividade, Lamotrigina