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Clarice Lispector: The voice of the writer inspired me to talk about sudden unexpected death in epilepsy

2010; Elsevier BV; Volume: 17; Issue: 4 Linguagem: Inglês

10.1016/j.yebeh.2010.01.023

1525-5069

Fúlvio A. Scorza,

Psychology and Mental Health

Born in Tchetchelnik, a tiny Ukrainian village, on 10 December 1920, Clarice Lispector (Fig. 1) was the daughter of Pedro and Marieta Lispector [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. In March 1922, when she was just 1 year 3 months old, Clarice arrived in Maceió, Alagoas State, Brazil, with her parents and two sisters, Elisa and Tania [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. Three years later, the family moved to Recife, Pernambuco State. From that moment on, Clarice Lispector adopted Brazilian Portuguese as her native language [2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. After her mother and father died (1930 and 1940, respectively), Lispector started working as a writer for the Agência Nacional (Brazilian News Agency) during the Estado Novo (New State) period, under the presidency of Getúlio Vargas [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. While in law school in Rio de Janeiro, she published her first journalistic works and short stories, catapulting to fame with the publication of her first novel, Near to the Wild Heart (Perto do Coração Selvagem), written as a self-monologue in a style and language that was considered revolutionary in Brazil [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. For this book, the young author received in 1945 the Graça Aranha Prize, awarded by the Brazilian Academy of Letters [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. Lispector left Brazil in 1944, following her husband Maury Gurgel Valente, a Brazilian diplomat. She spent the next 16 years in Europe and the United States [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. On her return to Rio de Janeiro in 1959, she began producing her most famous works, including the stories of Family Ties (Laços de Família) and the great mystic novel The Passion According to G.H. (A Paixão Segundo G.H.) [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. She then published her “hymn to love”: An Apprenticeship or the Book of Pleasures (Uma Aprendizagem ou O Livro dos Prazeres), in 1969, and the novel Live Water (Água viva), in 1973. She also published books of short stories: Clandestine Happiness (Felicidade Clandestina), The Imitation of the Rose (A imitação da rosa), Via crucis of the Body (Via crucisdo corpo), and Where Were You at Night? (Onde estivestes de noite?) [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. Finally, in 1977 she published The Hour of the Star (A hora da estrela), and in the same year, one day before her birthday, Clarice Lispector died, a victim of ovarian cancer [1Clarice Lispector. Available from: http://www.vidaslusofonas.pt/clarice_lispector2.htm. Accessed, November 2009.Google Scholar, 2Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar, 3Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. Clarice is now considered one of the most outstanding Brazilian prose writers of the 20th century [[2]Gotlib NB. Clarice Fotobiografia. Imprensa Oficial do Estado de São Paulo/Edusp; 2008.Google Scholar]. Quite interestingly, Clarice Lispector had a peculiar personality. She was fascinated by the esoteric aspect of numbers [[3]Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. She believed that the number 7 was the heart of the secret numbers and, coincidently, she started telling stories at 7 years of age [[3]Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. As she described: “Your heart beats seventy times per minute. Seven is the rhythm of man. The deeper wound heals in seven days if the destroyer is not close by” [[3]Varin C. Línguas de Fogo—Ensaio sobre Clarice Lispector. Editora:Limiar Editora;2002. 192 páginas.Google Scholar]. Thus, because of her enormous talent and rare personality, Clarice Lispector’s fascination with the esoteric aspect of numbers inspired me to talk about sudden unexpected death in epilepsy from such a perspective. The history begins with a 7-year-old girl with uncontrolled epilepsy who died from an epileptic seizure while sleeping. Interestingly, the little girl died on Saturday, traditionally recognized as the seventh day of the week. Her first spontaneous seizure was at the age of 2. From then on, the little girl had seizures daily (or seven seizures/week)—complex motor seizures with exuberant automatisms, which occurred mostly during sleep. Furthermore, the seizures frequently evolved into tonic and then generalized tonic–clonic seizures. According to the epilepsy vocabulary, the little girl died from what is called sudden unexplained death in epilepsy (SUDEP). As neuroscientists, we seek to conduct research on SUDEP and to develop effective means for its prevention. Understanding the mechanisms underlying SUDEP is the key to prevention. However, our knowledge is limited. As we know, SUDEP is the commonest cause of death directly related to epilepsy and occurs frequently in people with chronic epilepsy [4Surges R. Thijs R.D. Tan H.L. Sander J.W. Sudden unexpected death in epilepsy: risk factors and potential pathomechanisms.Nat Rev Neurol. 2009; 5: 492-504Crossref PubMed Scopus (318) Google Scholar, 5Scorza F.A. Cysneiros R.M. Arida R.M. Terra-Bustamante V.C. de Albuquerque M. Cavalheiro E.A. The other side of the coin: beneficiary effect of omega-3 fatty acids in sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 279-283Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 6Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions.Lancet Neurol. 2008; 7: 1021-1031Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar]. The main risk factor for SUDEP is poorly controlled seizures, suggesting that most cases of SUDEP are seizure-related events [4Surges R. Thijs R.D. Tan H.L. Sander J.W. Sudden unexpected death in epilepsy: risk factors and potential pathomechanisms.Nat Rev Neurol. 2009; 5: 492-504Crossref PubMed Scopus (318) Google Scholar, 5Scorza F.A. Cysneiros R.M. Arida R.M. Terra-Bustamante V.C. de Albuquerque M. Cavalheiro E.A. The other side of the coin: beneficiary effect of omega-3 fatty acids in sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 279-283Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 6Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions.Lancet Neurol. 2008; 7: 1021-1031Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar]. Furthermore, although the pathomechanisms underlying SUDEP remain unknown, cardiac abnormalities during and between seizures may contribute to SUDEP [4Surges R. Thijs R.D. Tan H.L. Sander J.W. Sudden unexpected death in epilepsy: risk factors and potential pathomechanisms.Nat Rev Neurol. 2009; 5: 492-504Crossref PubMed Scopus (318) Google Scholar, 5Scorza F.A. Cysneiros R.M. Arida R.M. Terra-Bustamante V.C. de Albuquerque M. Cavalheiro E.A. The other side of the coin: beneficiary effect of omega-3 fatty acids in sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 279-283Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 6Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions.Lancet Neurol. 2008; 7: 1021-1031Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar]. In consideration of the preceding facts and the relevance of Clarice Lispector’s book to Brazilian literature, the relationship between the SUDEP case described here and aspects of the number 7 could be understood by what scientists have called medical chronobiology. By definition, medical chronobiology is related to circadian (24-h) and other bioperiodic influences on human diseases, that is, their occurrence or variation in severity over the 24-h or other time scale, the response of patients to diagnostic procedures and tests, and the effect of pharmacological therapy [[7]Smolensky M.H. D’Alonzo G.E. Medical chronobiology: concepts and applications.Am Rev Respir Dis. 1993; 147: S2-19Crossref PubMed Google Scholar]. Moreover, the symptoms of several chronic diseases, especially epilepsy, commonly exhibit circadian, menstrual cycle, and seasonal patterns [7Smolensky M.H. D’Alonzo G.E. Medical chronobiology: concepts and applications.Am Rev Respir Dis. 1993; 147: S2-19Crossref PubMed Google Scholar, 8Terra V.C. Machado H.R. Sakamoto A.C. et al.The influence of circadian rhythms on sudden unexpected death in epilepsy.Arq Neuropsiquiatr. 2009; 67: 314-315Crossref PubMed Scopus (3) Google Scholar, 9Hofstra W.A. de Weerd A.W. The circadian rhythm and its interaction with human epilepsy: a review of literature.Sleep Med Rev. 2009; 13: 413-420Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 10Luef G. Female issues in epilepsy: a critical review.Epilepsy Behav. 2009; 15: 78-82Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar]. With respect to people with epilepsy, neurologists have to keep in mind that bodily rhythms also affect the pharmacokinetics and dynamics of antiepileptic drugs. In this context, the major goal of medical chronobiology is chronotherapeutics, the optimization of pharmacotherapies taking into consideration rhythm dependencies in the kinetics and dynamics of medications plus predictable-in-time variability in the manifestation and severity of human disease [[7]Smolensky M.H. D’Alonzo G.E. Medical chronobiology: concepts and applications.Am Rev Respir Dis. 1993; 147: S2-19Crossref PubMed Google Scholar]. In sum, there is a consensus among reviewers that Clarice Lispector’s works, her biography, and even her mysticism are fascinating. Obviously, for me, Lispector’s predilection for the number 7 was a convenient excuse to describe here the importance of circadian rhythms in the life of people with refractory epilepsy. Although studies of the chronobiology of epilepsy and the chronopharmacology of the antiepileptic drugs used in their treatment began three decades ago, we raise the possibility that a clear relationship between circadian rhythms and SUDEP remains to be demonstrated in both experimental animals and human beings. The author thanks Professor Nádia B. Gotlib for her suggestions and helpful review of this article.