Browsing by Author "Bentes, Carla"
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- 24-hour rhythmicity of seizures in refractory focal epilepsyPublication . Nzwalo, Hipólito; Cordeiro, Inês Menezes; Santos, Ana Catarina; Peralta, Rita; Paiva, Teresa; Bentes, CarlaThe occurrence of seizures in specific types of epilepsies can follow a 24-hour nonuniform or nonrandom pattern. We described the 24-hour pattern of clinical seizures in patients with focal refractory epilepsy who underwent video-electroencephalography monitoring. Only patients who were candidates for epilepsy surgery with an unequivocal seizure focus were included in the study. A total of 544 seizures from 123 consecutive patients were analyzed. Specific time of seizures were distributed along 3- or 4-hour time blocks or bins throughout the 24-hour period. The mean age of the subjects was 37.7 years, with standard deviation of 11.5 years, median of 37. The majority were females (70/56%). The majority of patients had a seizure focus located in the mesial temporal lobe (102/83%) and in the neocortical temporal lobe (13/11%). The remaining patients had a seizure focus located in the extratemporal lobe (8/6%). The most common etiology was mesial temporal sclerosis (86/69.9%). Nonuniform seizure distribution was observed in seizures arising from the temporal lobe (mesial temporal lobe and neocortical temporal lobe), with two peaks found in both 3- and 4-hour bins: 10:00-13:00/16:00-19:00 and 08:00-12:00/16:00-20:00 respectively (p = 0.004). No specific 24-hour pattern was identified in seizures from extratemporal location. The 24-hour rhythmicity of seizure distribution is recognized in certain types of epilepsy, but studies on the topic are scarce. Their replication and validation is therefore needed. Our study confirms the bimodal pattern of temporal lobe epilepsy independently of the nature of the lesion. However, peak times differ between different studies, suggesting that the ambient, rhythmic exogenous factors or environmental/social zeitgebers, may modulate the 24-hour rhythmicity of seizures. Characterization of these 24-hour patterns of seizure occurrence can influence diagnosis and treatment in selected types of epilepsy, such as the case of temporal lobe epilepsy, the most common drug-resistant epilepsy. (C) 2015 Elsevier Inc. All rights reserved.
- Fine particulate air pollution and occurrence of spontaneous intracerebral hemorrhage in an area of low air pollutionPublication . Nzwalo, Hipólito; Guilherme, Patricia; Nogueira, Jerina; Felix, Catarina; S. André, Ana; Teles, Joana; Mouzinho, Maria; Ferreira, Fatima; Marreiros, Ana; Logallo, Nicola; Bentes, CarlaObjectives:The association between short-term ambient particulate matter ≤ 2.5 μm diameter (PM2.5) andspontaneous intracerebral hemorrhage (SICH) occurrence is unclear. We aimed to study the association ofambient PM2.5 with occurrence of SICH in an area of low air pollution in southern Portugal.Patientsandmethods:PM2.5 levels from the 3 days before the SICH event (Lag 1, 2, 3) was compared with onecontrol period (Lag 15–17) using a case-crossover analysis. Conditional logistic regression was used to estimatethe odds ratio (OR) with 95% confidence interval (CI). Analysis was stratified by gender, age, functional neu-rological status, type of SICH, environmental factors (temperature, humidity, time of day and season).Results:Three-hundred and eight patients were included (2010–2015); mean age 70.8 years, 62.8% were males.The mean values (μg/l) of PM2.5 were higher on the case days (Lag1 = 7.76, Lag2 = 7.64, Lag3 = 7.74)compared to control period (Lag14-17 = 6.77). For each 10 μg/l increase, the likelihood of SICH increased 5.7%(95% CI = 1.020-1.095. P = .002). The strength of the association was higher in patients younger than 70 years(OR = 1.064, 95% CI = 1.009–1.122); without prior to SICH neurological disability (OR = 1.061, 95% CI1.022–1.101); with non-lobar type (OR = 1.054, 95% CI = 1.012–1.099). A circadian and circannual patternwas present with increased strength of the association when SICH occurred in the morning time (OR = 1,067,95% CI = 1.012–1.125), in the fall (OR = 1.118, 95% CI = 1.031–1.213) and the in the winter (OR = 1.064,95% CI = 1.002–1.129). The association was also potentiated at lower temperature values.Conclusion:Short-term increases of PM2.5 are associated with occurrence of SICH in Algarve, a region of lowambient pollution. Patient and ambient level factors can influence the strength of this association.