[Potential interactions with ivermectin as adjuvant therapy for refractory epilepsy. Reply]. / Interacciones potenciales con ivermectina como tratamiento coadyuvante en la epilepsia refractaria. Replica.

TITLE: Interacciones potenciales con ivermectina como tratamiento coadyuvante en la epilepsia refractaria. Replica.

[Ivermectin as an adjunct in the treatment of refractory epilepsy]. / Ivermectina como coadyuvante en la epilepsia refractaria.

INTRODUCTION: Ivermectin, a 22'23 dihydro derivative of avermectins beta-1a, is a highly effective veterinary and human anti parasitic, used to treat endoparasites of difficult control such as filariasis and onchocerciasis, with a median plasma life of at least of 16 hours. The recommended therapeutic doses range from 0.05 to 0.40 mg/kg, without undesirable effects or risk to human life. It went from being a great success in animal health to its application in humans, where it has had great impact. Studies in basic sciences have shown that ivermectin has anticonvulsive effects in different epileptic animal models, where five different mechanisms of action have been described. PATIENTS AND METHODS: Descriptive, prospective observational study, performed between 2013 and 2015, with 32 refractory epileptic patients, who received ivermectin as an a dose of adjunctive treatment of 10 mg/day three or seven times a week, controlled every three months, followed by 12-24 months, without withdrawal of anticonvulsant medications that they received previously. RESULTS: Progressively, patients entered into crisis control, at the end of the programmed follow-up period, the total percentage of crisis reduction was 97%, of which 57% did not return to crisis from the beginning of treatment, all patients being free of crisis according to International League Against Epilepsy criteria. CONCLUSION: Ivermectin has been useful as an adjuvant, achieving a significant decrease in seizures in this group of drug resistant patients.

TITLE: Ivermectina como coadyuvante en la epilepsia refractaria.Introduccion. La ivermectina es un 22'23 dihidroderivado de las avermectinas beta-1a, un antiparasitario de uso veterinario y humano de gran eficacia, utilizado para tratar endoparasitos de dificil control, como la filariasis y la oncocercosis. Tiene una vida media plasmatica de al menos 16 horas. Las dosis terapeuticas recomendadas varian entre 0,05 y 0,40 mg/kg, sin efectos indeseados ni riesgo para la vida humana. Paso de ser un gran exito en sanidad animal a su aplicacion en seres humanos, donde ha tenido gran impacto. Estudios en ciencias basicas han demostrado que la ivermectina tiene efectos anticonvulsionantes en diferentes modelos animales epilepticos, donde se han descritos cinco diferentes mecanismos de accion. Pacientes y metodos. Estudio descriptivo, observacional prospectivo, realizado entre 2013 y 2015, con 32 pacientes epilepticos refractarios, quienes recibieron ivermectina como tratamiento coadyuvante en dosis de 10 mg/dia, tres o siete veces por semana, controlados cada tres meses, seguidos durante 12-24 meses, sin retirada de los medicamentos anticonvulsionantes que recibian previamente. Resultados. Progresivamente, los pacientes entraron en control de las crisis. Al final del periodo de seguimiento programado, el porcentaje total de reduccion de las crisis fue del 97%. El 57% de estos pacientes no volvio a presentar crisis desde el inicio del tratamiento, y todos los pacientes se encontraron libres de crisis segun los criterios de la Liga Internacional contra la Epilepsia. Conclusion. La ivermectina ha sido util como coadyuvante y ha logrado una significativa disminucion de crisis en este grupo de pacientes farmacorresistentes.

Ivermectina como alternativa terapéutica en neurocisticercosis resistente al tratamiento farmacológico convencional / Ivermectin as therapeutic alternative in neurocysticercosis that is resistant to conventional pharmacological treatment

La neurocisticercosis es un problema de salud pública con amplia distribución en el mundo, especialmenteen países en vías de desarrollo, y cada vez más creciente en países desarrollados, debido a las altas tasas de inmigración. El tratamiento cisticida en neurocisticercosis ha sido controvertido, porque su eficacia es parcial contra formas quísticasvesiculares y coloidales ante la persistencia del parásito después de un curso de albendazol o praziquantel, las dos únicas opciones terapéuticas disponibles actualmente. La ivermectina es un antiparasitario veterinario y humano de gran eficacia, seguro, con ocasionales y mínimos efectos colaterales, usada desde hace más de 25 años en endoparasitosis de difícil control, como filariasis, oncocercasis, estrongiloidiasis, etc., y también en ectoparasitosis, como pediculosis capitis y miasis.Actúa en la unión mioneural sobre los receptores en el canal de cloro, aumentando su permeabilidad causando parálisis en gusanos adultos, o por un mecanismo inmune mediado cuando actúa sobre formas inmaduras. Casos clínicos. Se presentan cuatro pacientes tratados previamente con albendazol en forma reiterada con evidencia radiológica, que demuestra la persistenciade quistes viables en forma vesicular o coloidal y crisis epilépticas persistentes, a quienes se les suministró ivermectina 10 mg/día durante 15 días consecutivos o 10 mg/día por medio durante 30 días, con excelente evolución clínica y radiológica.Conclusiones. La ivermectina fue eficaz y careció de eventos adversos al tratar a estos cuatro pacientes resistentes al tratamiento convencional con albendazol y/o praziquantel

Neurocysticercosis is a public health problem that can be found in many parts of the world, especiallyin developing countries, and today’s high rates of immigration are making it increasingly more common in developed countries. Cysticidal treatment of neurocysticercosis is a controversial issue because it is only partially effective againstvesicular and colloidal-shaped cysts when the parasite persists after a course of albendazole or praziquantel, the only two therapeutic options that are currently available. Ivermectin is a very effective, safe veterinary and human antiparasitic drug,with occasional very mild side effects. It has been used for over 25 years in cases of endoparasitosis that do not respond well to treatment, such as filariasis, oncocerciasis, strongyloidiasis, etc. and also in ectoparasitoses, such as pediculolsis capitisand myasis. It acts in the myoneural junction on the receptors in the chloride channel by increasing their permeability and causing paralysis in adult worms or by a mediated immune mechanism when it acts on immature forms. Case reports. We report the cases of four patients who were previously treated with albendazole reiteratively with radiological evidence, whichshows the persistence of viable vesicular or colloidal-shaped cysts. These patients were given 10 mg/day of ivermectin for 15 consecutive days or 10 mg/day as an average for 30 days, with excellent clinical and radiological progress. Conclusions.Ivermectin was effective and did not give rise to any side effects when used to treat these four patients, who were resistant to conventional treatment with albendazole and/or praziquantel

[Ivermectin as a therapeutic alternative in neurocysticercosis that is resistant to conventional pharmacological treatment]. / Ivermectina como alternativa terapéutica en neurocisticercosis resistente al tratamiento farmacológico convencional.

INTRODUCTION: Neurocysticercosis is a public health problem that can be found in many parts of the world, especially in developing countries, and today's high rates of immigration are making it increasingly more common in developed countries. Cysticidal treatment of neurocysticercosis is a controversial issue because it is only partially effective against vesicular and colloidal-shaped cysts when the parasite persists after a course of albendazole or praziquantel, the only two therapeutic options that are currently available. Ivermectin is a very effective, safe veterinary and human antiparasitic drug, with occasional very mild side effects. It has been used for over 25 years in cases of endoparasitosis that do not respond well to treatment, such as filariasis, oncocerciasis, strongyloidiasis, etc. and also in ectoparasitoses, such as pediculolsis capitis and myasis. It acts in the myoneural junction on the receptors in the chloride channel by increasing their permeability and causing paralysis in adult worms or by a mediated immune mechanism when it acts on immature forms. CASE REPORTS: We report the cases of four patients who were previously treated with albendazole reiteratively with radiological evidence, which shows the persistence of viable vesicular or colloidal-shaped cysts. These patients were given 10 mg/day of ivermectin for 15 consecutive days or 10 mg/day as an average for 30 days, with excellent clinical and radiological progress. CONCLUSIONS: Ivermectin was effective and did not give rise to any side effects when used to treat these four patients, who were resistant to conventional treatment with albendazole and/or praziquantel.

Drematomal somatosensory evoked potentials (DSSEP) in patients with proved lumbosacral radiculopathies

Se llevó a cabo el estudio de potenciales evocados dermatómicos en 14 pacientes con afectación probada de raíces L5 o S1 o ambas unilateralmente. El estímulo se produjo en el área de piel correspondiente a la metamera deseada y el registro se efectuó en la corteza parietal de recepción contralateral. Los resultados fueron comparados con un grupo control sano, se observó que la técnica fue capaz de identificar a la lesión a través de dos tipos de hallazgos, uno fue el retraso en la latencia de la onda N1 y el segundo la ausencia de respuesta evocada

Drematomal somatosensory evoked potentials (DSSEP) in patients with proved lumbosacral radiculopathies

Se llevó a cabo el estudio de potenciales evocados dermatómicos en 14 pacientes con afectación probada de raíces L5 o S1 o ambas unilateralmente. El estímulo se produjo en el área de piel correspondiente a la metamera deseada y el registro se efectuó en la corteza parietal de recepción contralateral. Los resultados fueron comparados con un grupo control sano, se observó que la técnica fue capaz de identificar a la lesión a través de dos tipos de hallazgos, uno fue el retraso en la latencia de la onda N1 y el segundo la ausencia de respuesta evocada