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Abstract(s)
Introdução: A epilepsia é uma patologia neurológica crónica na qual um indivíduo sofre crises epiléticas recorrentes e frequentes. As crises epiléticas são eventos paroxísticos que se originam devido a uma excessiva, anormal e síncrona atividade neuronal no cérebro. Estas podem variar desde atividade convulsiva dramática até fenómenos dificilmente identificáveis. Por ser uma patologia de elevada prevalência e associada a elevados encargos económicos bem como a sofrimento físico e diminuição da qualidade de vida dos doentes, a epilepsia tem suscitado grande interesse da comunidade científica. Placencia et al desenvolveram em 1992 um importante estudo de prevalência da doença com base no preenchimento de um questionário que permitiu predizer com elevado grau de fidedignidade a presença ou ausência de crises epiléticas. Pretende-se com o presente trabalho, validar o instrumento utilizado por este autor para que possa ser aplicado à população portuguesa.
Métodos: Foi efetuado um estudo estatístico observacional, descritivo e inferencial em 196 indivíduos, dos quais 100 não possuíam patologia epilética e 96 eram comprovadamente epiléticos. Os doentes epiléticos foram submetidos a um questionário no Hospital Sousa Martins (Guarda) e no Centro Hospitalar do Porto (Hospital Sto. António) nas respetivas consultas de epilepsia. Os indivíduos não epiléticos foram inquiridos no Centro de Saúde da Covilhã. A todos foi aplicado um questionário validado por Placencia et al (1992), que foi alvo de duas traduções independentes da língua inglesa para português, após as quais foi elaborada uma versão intermédia do questionário em português. A partir desta versão intermédia foi feita novamente uma retroversão para língua inglesa, a partir da qual se fizeram as comparações com a versão original e os necessários ajustes à versão portuguesa. As traduções e revisões foram efetuadas por profissionais especialistas em português e inglês, tendo sido supervisionadas por um especialista em Neurologia. O tratamento dos dados foi realizado recorrendo ao programa SPSS através do qual foram procuradas associações estatísticas, tendo-se construído um modelo de regressão logística que prevê a presença de patologia epilética de acordo com as respostas fornecidas no questionário. Foram criados dois modelos de regressão logística, o primeiro incluindo as duas primeiras questões do questionário, e o segundo uma parte das restantes sete questões.
Resultados: Os modelos criados permitiram prever a presença de crises epiléticas com elevados graus de sensibilidade e especificidade. No caso do modelo de avaliação das duas primeiras questões foi possível classificar corretamente 93,9% dos doentes, com uma sensibilidade de 92,7% e uma especificidade de 95%. O valor preditivo positivo foi de 94,6% e o valor preditivo negativo foi de 93,1%. No caso do modelo que avaliou as restantes questões, após terem sido retiradas da análise as questões 3, 6, 8 e 9, foram classificados corretamente 88,4% dos doentes, com sensibilidade de 92,7% e 84% de especificidade, valor preditivo positivo de 84,8% e valor preditivo negativo de 92,3%. Uma análise ROC definiu para ambos os modelos uma capacidade de discriminação excecional.
Conclusão: O rigor e a metodologia utilizados durante os processos de tradução, validação e aplicação permitem a utilização em mais larga escala desta versão portuguesa do questionário de Placencia. Este instrumento tem como grandes vantagens, o facto de ter reduzidos custos, para além de uma elevada sensibilidade e especificidade associados ao facto de poder ser utilizado por profissionais não especializados em neurologia para triar doentes em trabalhos de campo para posteriores consultas de neurologia, agilizando desta forma todo o processo de referenciação do doente.
Introduction: Epilepsy is a chronic neurological disorder in which a person suffers recurrent and frequent epileptic attacks or seizures. Seizures are paroxysmal events that are due to an excessive, abnormal and synchronous neuronal activity in the brain. These can vary from dramatic convulsive activity to hardly identifiable phenomena. Given the high prevalence of the disease as well as the economical burden associated, physical suffering and life’s quality impact, epilepsy has rised great interest in the scientific community. Placencia et al (1992) developed an important prevalence study based in a questionnaire which allowed the prediction of presence VS absence of seizures with a high degree of reliability. It is intended by this study the validation of this instrument so that it can be applied to the Portuguese population. Methods: An observational, descriptive, and inferential statistical study was carried out in 196 patients, of whom 100 had no epileptic pathology and 96 had confirmed epilepsy. The epileptic patients filled in the epilepsy questionnaire at Sousa Martins Hospital (Guarda) and at Porto Hospital Centre (Sto. António Hospital). The non-epileptic individuals filled in the questionnaire at Covilhã Healthcare Centre. The questionnaire given to all individuals was validated by Placencia et al. It was translated from the English language to Portuguese by two independent translators, to create an intermediate version of the questionnaire in Portuguese. This intermediate version was translated back into English, compared with the original version and the necessary adjustments to the Portuguese version there were also made. Translations and revisions were made by specialists in Portuguese and English and were supervised by a specialist in Neurology. Data analysis was carried out by using the SPSS programme and statistical associations were sought based upon a model of logistic regression that was developed and which predicts the presence of the epileptic pathology according to the answers given in the questionnaire. Two models of logistic regression were created. The first model included the two first questions of the questionnaire, and the second model a part of the remaining seven questions. Results: The created models allowed the prediction of the presence of epilepsy with high degrees of sensitivity and specificity. In the case of the evaluation model of the first two issues it was possible to correctly classify 93.9% of the patients, with a sensitivity of 92.7% and a specificity of 95%. The positive predictive value was 94.6% and the negative predictive value was 93.1%. In the case of the model that evaluated the remaining issues, and after questions 3, 6, 8 and 9 were removed from the analysis, the model correctly classified 88.4% of the patients, with a sensitivity of 92.7%, a specificity of 84%, a positive predictive value of 84.8% and a negative predictive value of 92.3%. A ROC analysis defined for both models an exceptional capacity of discrimination. Conclusion: The precision and methodology used during the process of translation, validation and application allow the use, on a wider scale, of this Portuguese version of Placencia’s questionnaire. This instrument has as clear advantages, reduced costs, high sensitivity and specificity and the fact that it can be used by non-specialized professionals in neurology to sort patients in fieldworks for further neurology consultations, thereby speeding the whole referral process.
Introduction: Epilepsy is a chronic neurological disorder in which a person suffers recurrent and frequent epileptic attacks or seizures. Seizures are paroxysmal events that are due to an excessive, abnormal and synchronous neuronal activity in the brain. These can vary from dramatic convulsive activity to hardly identifiable phenomena. Given the high prevalence of the disease as well as the economical burden associated, physical suffering and life’s quality impact, epilepsy has rised great interest in the scientific community. Placencia et al (1992) developed an important prevalence study based in a questionnaire which allowed the prediction of presence VS absence of seizures with a high degree of reliability. It is intended by this study the validation of this instrument so that it can be applied to the Portuguese population. Methods: An observational, descriptive, and inferential statistical study was carried out in 196 patients, of whom 100 had no epileptic pathology and 96 had confirmed epilepsy. The epileptic patients filled in the epilepsy questionnaire at Sousa Martins Hospital (Guarda) and at Porto Hospital Centre (Sto. António Hospital). The non-epileptic individuals filled in the questionnaire at Covilhã Healthcare Centre. The questionnaire given to all individuals was validated by Placencia et al. It was translated from the English language to Portuguese by two independent translators, to create an intermediate version of the questionnaire in Portuguese. This intermediate version was translated back into English, compared with the original version and the necessary adjustments to the Portuguese version there were also made. Translations and revisions were made by specialists in Portuguese and English and were supervised by a specialist in Neurology. Data analysis was carried out by using the SPSS programme and statistical associations were sought based upon a model of logistic regression that was developed and which predicts the presence of the epileptic pathology according to the answers given in the questionnaire. Two models of logistic regression were created. The first model included the two first questions of the questionnaire, and the second model a part of the remaining seven questions. Results: The created models allowed the prediction of the presence of epilepsy with high degrees of sensitivity and specificity. In the case of the evaluation model of the first two issues it was possible to correctly classify 93.9% of the patients, with a sensitivity of 92.7% and a specificity of 95%. The positive predictive value was 94.6% and the negative predictive value was 93.1%. In the case of the model that evaluated the remaining issues, and after questions 3, 6, 8 and 9 were removed from the analysis, the model correctly classified 88.4% of the patients, with a sensitivity of 92.7%, a specificity of 84%, a positive predictive value of 84.8% and a negative predictive value of 92.3%. A ROC analysis defined for both models an exceptional capacity of discrimination. Conclusion: The precision and methodology used during the process of translation, validation and application allow the use, on a wider scale, of this Portuguese version of Placencia’s questionnaire. This instrument has as clear advantages, reduced costs, high sensitivity and specificity and the fact that it can be used by non-specialized professionals in neurology to sort patients in fieldworks for further neurology consultations, thereby speeding the whole referral process.
Description
Keywords
Epilepsia Crises epilépticas - Deteção - Questionário - Validação
Pedagogical Context
Citation
Publisher
Universidade da Beira Interior