1
|
Zhuo L, Zhang Y. Effects of new antiseizure medication on bone metabolism and bone mineral density in children: A meta-analysis. Front Pediatr 2022; 10:1015691. [PMID: 36458136 PMCID: PMC9705372 DOI: 10.3389/fped.2022.1015691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the effect of new antiseizure medication on bone metabolism and bone mineral density in children. METHODS The Chinese and English databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang and VIP) were systematically searched for observational studies evaluating the effects of new antiseizure medication on bone metabolism and bone mineral density in children with epilepsy. The effects of new antiseizure medication on serum calcium, phosphorus, alkaline phosphatase, bone alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D and bone mineral density in children were systematically evaluated. RESULTS After systematic retrieval and screening, 12 studies with high literature quality (including 629 epileptic children and 627 control subjects) were included in the systematic evaluation. Meta-analysis showed that new antiseizure medication decreased bone mineral density (MD: -0.05, 95%CI, -0.09, -0.02; P = 0.004). From different kinds of antiseizure medication, levetiracetam can reduce blood phosphorus concentration in children (MD: -0.04; 95%CI, -0.07, -0.01). Oxcarbazepine increased serum alkaline phosphatase in children (MD:17.98; 95%CI, 10.43,25.53; P < 0.00001), and the increase intensity was significantly higher than that of levetiracetam (MD: 7.66; 95%CI, 0.29, 15.02; P = 0.04). In addition, oxcarbazepine can cause a significant increase in parathyroid hormone in children (MD: 7.52; 95%CI, 3.37,11.66; P = 0.0004), and 25 - hydroxyvitamin D was reduced, and the difference was statistically significant (MD:-2.18; 95%CI, -3.23, -1.13; P = 0.00006). However, the effects of new antiseizure medication on serum calcium and bone alkaline phosphatase in children were not statistically significant. CONCLUSION New antiseizure medication have different effects on bone metabolism and bone mineral density in children with epilepsy, and the effects of different types of new antiseizure medication are different.
Collapse
Affiliation(s)
- La Zhuo
- Department of Pharmacy, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, Hohhot City, China
| | - Yong Zhang
- Department of Clinical Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
2
|
Muqtader A M, Fatima F, Khalid Anw M, F. Aldawsa M, A. Soliman G, H. Fayed M. Development and Characterization of Spray-dried Amorphous Solid Dispersion of Sildenafil: In vivo Evaluation. INT J PHARMACOL 2020. [DOI: 10.3923/ijp.2020.460.469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
3
|
Hamed SA, Attiah FA, Gabra RH, Sherif TK. Sexual functions in women with focal epilepsy: Relationship to demographic, clinical, hormonal and psychological variables. Clin Neurol Neurosurg 2020; 191:105697. [PMID: 32028129 DOI: 10.1016/j.clineuro.2020.105697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/12/2020] [Accepted: 01/28/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Sexual dysfunctions [SDs] are common in women with epilepsy [WWE] but related studies were neglected in our locality. We aimed to determine the frequencies and severities of SDs and their clinical, hormonal and psychological determinants in WWE. PATIENTS AND METHODS This study included 120 adults [mean age: 36.35 ± 2.89yrs] with temporal [63.33 %] and frontal [36.67 %] lobe epilepsies and treated with carbamazepine [CBZ] [n = 60] or oxcarbazepine [OXC] [n = 60] for mean duration of 18.63 ± 4.33yrs. Patients were assessed using Female Sexual Function Index [FSFI] questionnaire, Beck Depression Inventory [BDI-II] and Hamilton Anxiety Rating Scale [HAM-A]. Total testosterone, sex hormone binding globulin [SHBG] and free androgen index [FAI] were measured to assess endocrinal status. PATIENTS AND METHODS This study included 120 adults [mean age: 36.35 ± 2.89yrs] with temporal [63.33 %] and frontal [36.67 %] lobe epilepsies and treated with carbamazepine [CBZ] [n = 60] or oxcarbazepine [OXC] [n = 60] for mean duration of 18.63 ± 4.33yrs. Patients were assessed using Female Sexual Function Index [FSFI] questionnaire, Beck Depression Inventory [BDI-II] and Hamilton Anxiety Rating Scale [HAM-A]. Total testosterone, sex hormone binding globulin [SHBG] and free androgen index [FAI] were measured to assess endocrinal status. RESULTS The majority had occasional/rare frequency of seizures [76.67 %] and well controlled on antiepileptic drugs [AEDs] [81.67 %]. Compared to healthy women, WWE had lower total testosterone and FAI and higher SHBG levels. Compared to women on CBZ, those on OXC had lower frequency and well controlled seizures on medication [P = 0.0001 for both], higher testosterone [P = 0.01] and FAI [P = 0.001] and lower SHBG [P = 0.001] levels. Compared to controls, WWE had significantly higher frequencies and severities of SDs [total sexual function, desire, arousal, lubrication, orgasm, satisfaction and pain] and depression and anxiety symptoms. OXC therapy was associated with lower SDs [FSFI: P = 0.033] and anxiety symptoms [P = 0.025] compared to CBZ therapy. In multiple logistic regression analyses, determinants of SDs were the higher seizures frequency, increasing severities of depression and anxiety but not lower androgen levels or type of epilepsy or AEDs. CONCLUSIONS Different aspects of SD and depression and anxiety symptoms were frequent in WWE. Determinants of SDs were the higher frequency of seizures and increasing severities of depression and anxiety. OXC had better control on seizures and thus lower frequencies and severities of SDs and depression and anxiety symptoms. Thus optimizing seizure control is important for psychological state and healthy sexual function in WWE.
Collapse
Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
| | - Fadia Ahmed Attiah
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Romany Hosny Gabra
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Tahra Kamel Sherif
- Department of Clinical Pathology, Assiut University Hospital, Assiut, Egypt
| |
Collapse
|
4
|
Dawson E, Stutzman SE, Olson DM, Hays RS. Performance of the International Index of Erectile Function tool in men with epilepsy. Epilepsy Behav 2019; 94:78-81. [PMID: 30893619 DOI: 10.1016/j.yebeh.2019.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 18 million men suffer from some type of erectile dysfunction (ED), which is primarily attributed to age, comorbid health conditions, or medications. Men with epilepsy encounter all of these issues, yet ED literature and research in men with epilepsy is not yet robust. The purpose of this study was to test the utility of a validated ED screening tool in a population of men with epilepsy, as well as to assess additional parameters that may contribute to ED in this specific patient population. The secondary aim of this study was to determine the prevalence of noncompliance of epilepsy medication which may be due to a perceived relationship with ED. METHODS This was a prospective pilot study to validate the International Index of Erectile Function (IIEF) in men with epilepsy. Enrolled men, between the ages of 18-45 years, were given an anonymous online survey that included the IIEF, as well as additional elements pertinent to their seizures and related treatment, including medication compliance. RESULTS A total of 164 men completed the IIEF survey. Of these, 28% of respondents indicated the presence of ED, for which specific treatment might be warranted. The IIEF has 5 subscales; mean scores for each subscale are the following: ED 17.48/30, orgasmic function 6.2/10, sexual desire 6.72/10, intercourse satisfaction 8.98/15, and overall satisfaction 5.18/10. Four additional variables were added to specify the needs of men with epilepsy. CONCLUSION The IIEF can be administered to men with epilepsy. The addition of specific targeted questions in this patient population may also provide better understanding and facilitate an open dialog about how male sexual function relates to epilepsy and/or treatment thereof.
Collapse
Affiliation(s)
- Elizabeth Dawson
- Department of Nursing, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8855, United States of America
| | - Sonja E Stutzman
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8855, United States of America
| | - DaiWai M Olson
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8855, United States of America.
| | - Ryan S Hays
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8855, United States of America
| |
Collapse
|
5
|
Association between epilepsy and risk of sexual dysfunction: A meta-analysis. Seizure 2019; 65:80-88. [DOI: 10.1016/j.seizure.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 12/21/2022] Open
|
6
|
Lai Q, Shen C, Zheng Y, Zhang Y, Guo Y, Ding M. Effects of Antiepileptic Drugs on the Carotid Artery Intima-Media Thickness in Epileptic Patients. J Clin Neurol 2017; 13:371-379. [PMID: 28884979 PMCID: PMC5653625 DOI: 10.3988/jcn.2017.13.4.371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND PURPOSE It has been reported that taking antiepileptic drugs (AEDs) may increase the risk of atherosclerosis. We performed a meta-analysis to evaluate the carotid artery intima-media thickness (CA-IMT) as a surrogate factor for atherosclerosis in epileptic patients. METHODS We searched NCBI (PubMed), ISI Web of Knowledge, EMBASE, and the Cochrane Library databases for studies of the association between AEDs and CA-IMT in epileptic patients. A random-effects meta-analysis was used to pool results across studies. RESULTS Fifteen studies involving 1,775 epileptic patients were included in the analysis. The overall CA-IMT was significantly larger among users of AEDs [mean difference (MD)=0.09 mm, 95% confidence interval (CI)=0.06-0.12 mm). When stratified by age, the MD was similar in adult patients (MD=0.09 mm, 95% CI=0.06-0.13 mm), but no significant difference was observed in children (MD=0.03 mm, 95% CI=0.00-0.07 mm). Regarding specific AEDs, monotherapy with carbamazepine (CBZ) or valproic acid (VPA) was associated with a larger CA-IMT, while phenytoin monotherapy was not and the result for lamotrigine was inconclusive. CONCLUSIONS This study suggests that using AEDs is associated with the CA-IMT in patients with epilepsy, particularly for adult patients. In particular, CBZ and VPA may be related to a significant increase in CA-IMT.
Collapse
Affiliation(s)
- Qilun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Chunhong Shen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Zheng
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinxi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Guo
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| |
Collapse
|
7
|
Rodrigues FL, Fais RS, Pereira MGAG, Garcia-Cairasco N, Tostes RC, Carneiro FS. Erectile Dysfunction in Wistar Audiogenic Rats Is Associated With Increased Cavernosal Contraction and Decreased Neuronal Nitric Oxide Synthase Protein Expression. Urology 2017; 106:237.e1-237.e8. [PMID: 28483592 DOI: 10.1016/j.urology.2017.04.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To test the hypothesis that naive Wistar audiogenic rats (WARs) display erectile dysfunction (ED), which is associated with increased sympathetic-mediated contractile tone and decreased nitric oxide-mediated relaxation responses of the cavernous tissue. METHODS Changes in the ratio of the maximal intracavernosal pressure-mean arterial pressure after the electrical stimulation of the right major pelvic ganglion were determined in vivo. Cavernosal contractility was induced by electrical field stimulation and phenylephrine. In addition, nonadrenergic-noncholinergic (NANC)-induced relaxation was determined. Rho-kinase (ROCK) pathway proteins, neuronal nitric oxide synthase (nNOS) protein expression, and endothelial nitric oxide synthase (eNOS) and extracellular signal-regulated kinase 1/2 activities were determined by Western blot. RESULTS WARs display a significant decrease in maximal intracavernosal pressure-mean arterial pressure responses suggesting ED in this strain. Sympathetic-mediated contractile responses were increased in WARs and contractile responses to phenylephrine were not changed. The increased sympathetic-mediated contractile responses were not associated with changes in the ROCK pathway. On the other hand, NANC-mediated relaxation responses were significantly reduced in WARs. This functional response was accompanied by decreased nNOS and total eNOS protein expressions, augmented phosphorylated eNOS, and decreased extracellular signal-regulated kinase 1/2 phosphorylation levels. CONCLUSION Our data have demonstrated that naive WARs display ED in vivo that is associated with increased sympathetic-mediated contractile responses and decreased NANC-mediated relaxation responses. The increase in contractile responses is independent of the ROCK pathway, and the changes in relaxation responses are associated with a decrease in nNOS protein expression, which may activate compensatory mechanisms in the cavernous tissue.
Collapse
Affiliation(s)
- Fernanda Luciano Rodrigues
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Rafael S Fais
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Marília G A G Pereira
- Department of Biochemistry, Biomedical Sciences Institute, University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Norberto Garcia-Cairasco
- Department of Physiology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Rita C Tostes
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fernando S Carneiro
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil.
| |
Collapse
|
8
|
Atif M, Sarwar MR, Scahill S. The relationship between epilepsy and sexual dysfunction: a review of the literature. SPRINGERPLUS 2016; 5:2070. [PMID: 27995047 PMCID: PMC5135706 DOI: 10.1186/s40064-016-3753-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 11/26/2016] [Indexed: 12/31/2022]
Abstract
Background and objectives Regardless of the disease states that people suffer from, maintaining sexual function is an important indicator of quality of life. The objective of this review was to figure out the relationship between epilepsy, antiepileptic drugs (AEDs) and sexual dysfunction. Results In various epidemiological and clinical studies, epilepsy has been correlated with a reduction in sexual function. This sexual dysfunction is not always detected in epileptic patients until systematic efforts are put in place, as part of the assessment and treatment process. Therefore, precise evaluations of the incidence of treatment related sexual dysfunction in epileptic patients is still lacking. Conclusions This literature review concluded that sexual function is influenced by the pathophysiology of epilepsy, as well as through the use of AEDs. To maximize quality of care in patients with epilepsy and those patients with other disease states who receive AEDs, it is important to address the status of the patient’s sexual function as part of the initial routine assessment and with any treatment related follow-up. Minimizing the effects of AED related sexual dysfunction can be achieved by raising awareness among patients, providing education and training for physicians regarding sexual dysfunction and obtaining a baseline sexual history from the patient so are important recommendations. In addition, systematic studies are needed to explore the risk and mechanism of such treatment related side effects on sexual function.
Collapse
Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Muhammad Rehan Sarwar
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Shane Scahill
- School of Management, Massey University, Auckland, New Zealand
| |
Collapse
|
9
|
Hamed SA. The effect of epilepsy and antiepileptic drugs on sexual, reproductive and gonadal health of adults with epilepsy. Expert Rev Clin Pharmacol 2016; 9:807-19. [PMID: 26934627 DOI: 10.1586/17512433.2016.1160777] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Sherifa A. Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| |
Collapse
|
10
|
Hamed SA. Markers of bone turnover in patients with epilepsy and their relationship to management of bone diseases induced by antiepileptic drugs. Expert Rev Clin Pharmacol 2015; 9:267-86. [DOI: 10.1586/17512433.2016.1123617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
11
|
Markers of bone turnover in patients with epilepsy and their relationship to management of bone diseases induced by antiepileptic drugs. Expert Rev Clin Pharmacol 2015. [PMID: 26589104 DOI: org/10.1586/17512433.2016.1123617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Data from cross-sectional and prospective studies revealed that patients with epilepsy and on long-term treatment with antiepileptic drugs (AEDs) are at increased risk for metabolic bone diseases. Bone diseases were reported in about 50% of patients on AEDs. Low bone mineral density, osteopenia/osteoporosis, osteomalacia, rickets, altered concentration of bone turnover markers and fractures were reported with phenobarbital, phenytoin, carbamazepine, valproate, oxcarbazepine and lamotrigine. The mechanisms for AEDs-induced bone diseases are heterogeneous and include hypovitaminosis D, hypocalcemia and direct acceleration of bone loss and/or reduction of bone formation. This article reviews the evidence, predictors and mechanisms of AEDs-induced bone abnormalities and its clinical implications. For patients on AEDs, regular monitoring of bone health is recommended. Prophylactic administration of calcium and vitamin D is recommended for all patients. Treatment doses of calcium and vitamin D and even anti-resorptive drug therapy are reserved for patients at high risk of pathological fracture.
Collapse
|
12
|
Vieira FCDF, Ronsoni MF, Hohl A, Claudino LS, Diaz AP, Schwarzbold ML, Guarnieri R, Nunes JC, Lin K, Walz R. How predictable is the erectile function of patients with epilepsy? Epilepsy Behav 2015; 47:61-5. [PMID: 26043165 DOI: 10.1016/j.yebeh.2015.04.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/23/2015] [Accepted: 04/29/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties. AIMS This study aimed to identify independent predictor factors for ED in patients with epilepsy. MAIN OUTCOME MEASURES the five-question form of the International Index of Erectile Function (IIEF-5). METHODS Independent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis. RESULTS Eight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B=0.005; p=0.05), education levels in years (B=0.54; p=0.03), depressive symptoms determined by HADS depression subscale (B=-0.49; p=0.03), and prolactin levels (B=-0.45; p=0.07) showed a moderate association (r=0.64) with the IIEF questionnaire and explained 41% (r(2)=0.41) of its variation. CONCLUSIONS Erectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy.
Collapse
Affiliation(s)
| | - Marcelo Fernando Ronsoni
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
| | - Alexandre Hohl
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
| | - Lúcia Sukis Claudino
- Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
| | - Alexandre Paim Diaz
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil; Ambulatório de Transtornos Psiquiátricos Resistentes ao Tratamento Farmacológico (REFRACTA), Serviço de Psiquiatria, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil; Centro de Epilepsia do Estado de Santa Catarina (CEPES), Hospital Governador Celso Ramos, Florianópolis, Brazil
| | - Marcelo Libório Schwarzbold
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil; Ambulatório de Transtornos Psiquiátricos Resistentes ao Tratamento Farmacológico (REFRACTA), Serviço de Psiquiatria, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
| | - Ricardo Guarnieri
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil; Ambulatório de Transtornos Psiquiátricos Resistentes ao Tratamento Farmacológico (REFRACTA), Serviço de Psiquiatria, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil; Centro de Epilepsia do Estado de Santa Catarina (CEPES), Hospital Governador Celso Ramos, Florianópolis, Brazil
| | - Jean Costa Nunes
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Unidade de Neuropatologia, Serviço de Patologia, HU, UFSC, Florianópolis, Brazil
| | - Kátia Lin
- Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, Brazil.
| |
Collapse
|