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Interview with Dr. Elza Marcia Yacubian, Top Brazilian Epilepsy Specialist

October 7, 2015

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Epilepsy is considered an important neurological disorder that affects adults and children of different ages around the world. According to WHO (World Health Organization), it is estimated that about 1-3% of the worlds population is affected by this disease.
Clinical evaluation to confirm the correct diagnosis of the type of epilepsy and most appropriate treatment performed by professionals is critical in ensuring a comfortable quality of life for patients suffering from this disorder.
To learn more about Epilepsy, Neurovirtual News interviewed the medical director of the Research and Treatment of Epilepsy at Sao Paulo Hospital, Professor Dr. Elza Marcia Yacubian.

Neurovirtual News: Dr. Elza Yacubian, what is Epilepsy?
Dr. Elza Yacubian: Epilepsy is a disease characterized by the occurrence of spontaneous seizures or epilepsy provoked by stimuli, called reflex seizures such as those caused by flashing lights. In general, we can say that there are focal seizures, which involve neural networks restricted to a region of the brain, usually due to structural damage and generalized seizures in which neuronal hyperexcitability is diffuse and possibly related to genetic causes.

NN: What are the symptoms that can provide a positive diagnosis of Epilepsy?
Dr. Elza Yacubian: The diagnosis of Epilepsy is clinical with semiological characterization of epileptic seizures, the description from the patient and/or a witness to the events is considered essential for diagnosis. They can be supplemented by electroencephalographic recordings (EEG) and neuroimaging tests, structural and functional, such as MRI and PET studies.

NN: Physically, how can the damage characterized by Epilepsy be explained?
Dr. Elza Yacubian: The most common etiologies of focal seizures are typically in the brain repair areas called “gliosis”, or caused by developmental brain defects, infections, vascular disorders, and tumors among others.

NN:Is there a link between Epilepsy and sleep disorders?
Dr. Elza Yacubian: Yes. Sleep enhances the frequency of epileptic spikes in most forms of epilepsy. Focal seizures are more common in periods of relaxation and sleep.
Generalized seizures are also called ‘awakening seizures’ and usually occur within two hours after awakening, regardless of time of day, and are more likely to be triggered by sleep deprivation.

NN: Is there any genetic predisposition for the occurrence of Epilepsy twins individuals, or is it something acquired through varied events?
Dr. Elza Yacubian: Yes, there is a genetic component to Epilepsy. This is an area in which there has been significant progress in recent decades. Studies of families with multiple affected individuals have allowed the discovery of genes that determine various forms of epilepsy. The study of families affected can determine the risk of recurrence, which for generalized epilepsies is increased between 4 to 9 times; for focal epilepsies 2-3 and for febrile seizures, 3-5. Twin studies attest to greater agreement for epilepsy in monozygotic twins compared with dizygotic. For generalized epilepsies (8 versus 0.3); for focal epilepsies (0.4 versus 0.03) and febrile seizures (0.6 versus 0.1).

NN: What are the procedures / protocols recommended for the conclusive diagnosis of Epilepsy?
Dr. Elza Yacubian: Sometimes a clinical diagnosis is sufficient. Often it is strengthened by EEG and MRI findings.

NN: What types of seizures are considered the most challenging to define the most appropriate treatment, from a physiological point of view?
Dr. Elza Yacubian: All epileptic seizures are complex phenomena and all of them present significant challenges, since their characteristics are dependent on brain development.
Seizures in infants are different from children and adults, and there are also peculiarities in the elderly. The electroclinical characterization of each of these forms requires considerable expertise in research and treatment.

NN: Is there technology available in Brazil to support physicians in the proper diagnosis of epilepsy?
Dr. Elza Yacubian: Epileptic seizures are electrical phenomena and many have made significant efforts to develop acquisition systems of these electric paroxysms in the recent decades. There is still a pressing need to improve these systems to expand services dedicated to the hundreds of thousands of Brazilians with epileptic seizures who need diagnosis and treatment at an affordable cost.

NN: What are the treatments best suited for epilepsy control?
Dr. Elza Yacubian: Antiepileptic drugs, which, from 1912 with the advent of Phenobarbital, significantly changed the outlook on life of people with Epilepsy. The development of new drugs since 1990 with more suitable pharmacokinetic properties, further improved outlook from a therapeutic perspective. There is no way to compare the lives of people with epilepsy who lived in the 19th century with those living in the 21st century.

NN: What are the main objectives of the research department in Epilepsy UNIFESP?
Dr. Elza Yacubian: The Unit for Research and Treatment of Epilepsy is part of the Department of Neurology and Neurosurgery of UNIFESP. It brings together a multidisciplinary team of epileptologists (experts and neurologists in specialization), psychiatrists, neurosurgeons, neuropsychologists, EEG techs, social workers and other professionals needed for the development of care, teaching and research in the specialty of the Department.

NN: How many centers specializing in Epilepsy currently exist in Brazil?
Dr. Elza Yacubian: There are some, mainly located in the southern and southeastern regions of the country, although they have made significant advances in patient care awareness and research in epilepsy, we are still far from adequately being able to treat all of the Brazilians with epilepsy who require treatment.

NN: What should be the medical training to develop epilepsy specialists?
Dr. Elza Yacubian: The formation of an epileptologist is complex and must be performed after the residence of neurology or pediatric neurology. In general, specialized training for at least a year in electroencephalography and clinical epileptology and at least one more year of training in Epilepsy Monitoring Units is needed.

NN: In which cases is surgery recommended for epilepsy treatment?
Dr. Elza Yacubian: Surgery is recommended for people with refractory seizures, defined as the persistence of seizures despite the use of two antiepileptic drugs properly prescribed by doctors and used by the patient. Surgical indication is dependent on the precise location of the epileptogenic zone and the balance between risks and expected benefits of the surgical procedure.

NN: Is there any institution that promotes the scientific development of this area in the country?
Dr. Elza Yacubian: The creation of Epilepsy Centers by the Ministry of Health in Brazil since 1990 allowed a significant advance in our specialty, which is one of the most outstanding research areas in the Brazilian Neurology. Its value is attested by a number of research and international scientific publications.

Dr. Elza Marcia Yacubian
Professor, Department of Neurology and Neurosurgery of UNIFESP.
Head of the Research and Treatment of Epilepsy at Hospital Sao Paulo.


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