Bradicardia asociada a crisis epilépticas: Casos clínicos / Bradycardia during epileptic seizures: Report of two patients

Cardiac rate and rhythm due to autonomic activation, may occur during epileptic seizures. They are probably a consequence of the spreading seizure activity to structures involved in the autonomic control of cardiac rhythm. Sinus tachycardia is the most frequent finding (90 percent). Letal bradycardia is rare and life threatening asystoles require cardiac pacemaker insertion. We report two patients with a right frontal seizure associated to bradycardia, during simultaneous EEG/ECG monitoring. Interictal autonomic function tests showed preserved sympathetic and cardiac vagal responses. Normal interictal autonomic function tests, suggested a transient failure of sympatho-vagal balance.

Uso de CPAP nasal en el largo plazo en síndrome de apnea-hipopnea del sueño / Long-term continuous positive airway pressure (CPAP) use in obstructive sleep apnea

Background: The use of CPAP is the conventional therapy for the Obstructive Sleep Apnea Syndrome (OSAS). Aim To establish the proportion of OSAS patients with CPAP indication who use it in the long-term and to determine predictive factors of adherence. Patients and Methods: Structured survey through personal interview or phone call, applied to all patients who had polisomnographically documented OSAS and CPAP titration at the Pontificia Universidad Católica de Chile Sleep Disorders Center between January 1998 and November 2001. Patients were divided in "Permanent Users" (Group I) and "Non Users" (Group II). Results: Of 440 patients that fulfilled inclusion criteria, 162 (32.8 percent) answered the survey. Seventy percent (114/162) of these patients had used CPAP and 86 percent (98/114) continued to use it at the time of the interview, with a mean follow-up of 12.3 months (Group I 60.5 percent of the interviewed population). Group II included 64 patients (39.5 percent of the interviewed patients). Among the latter, 25 percent (16/64) stopped using CPAP due to intolerance, 25 percent (16/64) could not use it because of economical restrictions, 20.5 percent (13/64) preferred other therapies and 29.5 percent (15/64) merely refused treatment. Predictors of long-term use of CPAP were number of respiratory events (p <0.01), hypersomnolence (p <0.01) and age (p =0.03). Conclusions: Approximately two thirds of patients with OSAS, with an indication for CPAP, continue to use this therapy in the long term in a Chilean population. This figure is similar to other reports from abroad. It is also possible to identify predictive factors for CPAP discontinuation in this population.

Trastorno conductual del sueño REM en dos casos documentados con polisomnogragía / REM sleep behavior disorder: report of two cases

We report a 69 years old male with a parkinsonian syndrome and a 50 years old female without neurological problems who showed violent behavior during REM sleep. Polysomnography showed that both had tonic or phasic muscular activity during REM sleep and a REM sleep behavior disorder was diagnosed. Clonazepam was used in both, with good clinical response. This condition is frequently unrecognized and confused with nightmares, nocturnal delirium or other parasomnias

Electroencefalograma poligráfico computarizado continuo en el diagnóstico de convulsiones ocultas en recién nacido de muy bajo peso / Prolonged computarized poligraphic electroencephalogram in the diagnosis of occult convulsions in very low birth weight newborns

El desarrollo de unidades de cuidados intensivos neonatales (UCIN) ha permitido elevar la supervivenvia de recién nacidos de muy bajo peso (RNMBP; menos de 1.500 g al nacer). Este grupo muestra morbilidad neurológica aguda crónica en 35 a 75 porciento de los casos, siendo una de las más frecuentes las convulsiones neonatales. Por otra parte, existe una grave dificultad clínica para reconocer y determinar la naturaleza de eventos episódicos presentes en RNMBP. Un importante obstáculo se debe a que el electrocardiograma (EEG) estándar si bien es útil como pronóstico global, se estima muy insuficiente como método diagnóstico complementario en eventos episódicos, tanto por la limitada duración del muestreo (30 minutos) como por la casi ausencia de actividad irritativa interictal (espigas, puntas) en el neonato. Así un registro ictal es el método definitivo para establecer el caracter comicial o no de un episodio, el que puede obtenerse sólo con monitoreo EEG continuo. El presente estudio analiza monitoreo poligráfico video/EEG computarizado portátil continuo en 52 neonatos hospitalizados en la UCIN del Hospital Clínico de la PUC, 33 prematuros <2kg al nacer (63 porciento, grupo A, RNMBP) y 19 RN >2 kg al nacer (37 porciento, grupo B). Este registro permitió demostrar convulsiones ocultas en un tercio de los RNMBP (33 porciento de los prematuros y ninguno del grupo B), demostrando ser un método diagnóstico de gran utilidad, ya que la precocidad diagnóstica en convulsiones ocultas es esencial para el pronóstico neurológico del recién nacido