Epilepsia muy refractaria en una muestra escasamente definida. Réplica / Highly refractory epilepsy in a poorly defined sample. Reply

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Severity of anxiety and depression are related to a higher perception of adverse effects of antiepileptic drugs.

UNLABELLED: After reviewing the negative effects of antiepileptic drugs (AEDs) on general health and quality of life, the Commission on Outcome Measurement from the International League Against Epilepsy (ILAE) recommended incorporating reliable and valid tools in clinical essays in order to achieve a more accurate assessment of the subjective adverse effects rate and disease severity when using AEDs. PURPOSE: The aim of this study was to correlate the severity of adverse effects of AEDs, with the presence of anxiety and depression in patients with epilepsy. METHODS: The Spanish version of the Liverpool Adverse Events Profile (LAEP) and the hospital anxiety and depression scale (HADS) were applied on 130 consecutive outpatients with epilepsy from the epilepsy clinic at the Mexico's National Institute of Neurology and Neurosurgery. A correlation analysis was carried out to determine if the presence of depression and anxiety was related to the adverse effects of AEDs. The relation between LAEP scores with other epidemiological variables was also assessed. RESULTS: Our study found a positive correlation between the LAEP and the HADS scores (p < or = 0.01). The most common adverse effects were drowsiness (81.5% [n=106]), difficulty in concentrating (76% [n=99]), and nervousness and/or agitation (75% [n=97]). Female gender, a history of febrile seizures, persistent seizures and polytherapy were associated with a higher toxicity on LAEP. In our study, age at epilepsy onset, duration of epilepsy, type of epilepsy and patients' age were not related to higher LAEP scores. CONCLUSION: Adverse effects to AEDs can be related with the presence of psychiatric disorders such as anxiety and depression in patients with epilepsy.

Epilepsia farmacorresistente: uso de la nueva definición y factores de riesgo relacionados. Estudio en población mexicana de un centro de tercer nivel / Refractory epilepsy: use of the new definition and related risk factors. A study in the Mexican population of a third-level centre

Introducción. Recientemente, la Liga Internacional contra la Epilepsia (ILAE) ha propuesto un consenso para definir la epilepsiafarmacorresistente. Pacientes y métodos. Estudio retrospectivo, analítico y descriptivo. Se incluyeron 206 pacientes atendidos en la clínica de epilepsia de un centro de tercer nivel en México. Se utilizó la nueva definición de la ILAE de farmacorresistencia paraclasificar a los pacientes. Se describieron la frecuencia y factores de riesgo involucrados en la refractariedad. Se analizó deforma secundaria la tendencia de prescripción de fármacos antiepilépticos (FAE) en esta población. Resultados. De los 206 pacientes analizados, 57 (28%) se encontraban libres de crisis, 115 (56%) persistían con crisis, 17(8%) fueron clasificados como no determinados y 17 (8%) fueron pseudorrefractarios. Los factores estadísticamente significativosasociados a farmacorresistencia encontrados en nuestra población fueron: epilepsia focal frente a generalizada (p = 0,02), epilepsia catamenial (p = 0,02), desarrollo psicomotor anormal (p = 0,02), historia familiar de epilepsia (p =0,025), examen neurológico con anormalidad focal (p = 0,04), hipoxia perinatal (p = 0,06) y enfermedad psiquiátricaprevia (p = 0,03). Los FAE más prescritos en mono y politerapia fueron valproato y carbamacepina. Del total de los pacienteslibres de crisis, el 47% utilizaba monoterapia. Conclusiones. La frecuencia de farmacorresistencia en la población analizada se estimó en un 56%. La identificación delos factores asociados a farmacorresistencia permite considerar el tratamiento quirúrgico o bien optimizar el tratamientocon FAE. Hay una tendencia en el uso de nuevos FAE, sobre todo en politerapia. Nuestros hallazgos son concordantes con lo descrito en la bibliografía (AU)

Introduction. The International League against Epilepsy (ILAE) has recently proposed a consensus to define refractory epilepsy.Patients and methods. A retrospective, analytical, descriptive study was conducted involving 206 patients who wereattended at the epilepsy clinic of a third-level centre in Mexico. The ILAE’s new definition of pharmacoresistance wasused to classify the patients. The frequency and risk factors involved in the refractoriness were reported. The tendency to prescribe antiepileptic drugs (AED) in this population was analysed using secondary data. Results. Of the 206 patients analysed, 57 (28%) were free of seizures, 115 (56%) continued to have seizures, 17 (8%) were classified as undetermined and 17 (8%) were pseudo-refractory. The statistically significant factors associated to pharmacoresistancethat were found in our population were: focal versus generalised epilepsy (p = 0.02), catamenial epilepsy (p = 0.02), abnormal psychomotor development (p = 0.02), history of epilepsy in the family (p = 0.025), neurological examination with focal abnormality (p = 0.04), perinatal hypoxia (p = 0.06) and prior psychiatric illness (p = 0.03). The mostly frequently AED used in mono- and polytherapy were valproate and carbamazepine. Of all the patients who were free ofseizures, 47% were treated using monotherapy. Conclusions. The frequency of pharmacoresistance in the population analysed was estimated to be 56%. Identificationof the factors associated with pharmacoresistance makes it possible to consider surgical treatment or to optimise thetreatment with AED. There is a tendency to use the new AED, above all in combination therapy. Our findings are consistent with those described in the literature (AU)

[Refractory epilepsy: use of the new definition and related risk factors. A study in the Mexican population of a third-level centre]. / Epilepsia farmacorresistente: uso de la nueva definición y factores de riesgo relacionados. Estudio en poblacion mexicana de un centro de tercer nivel.

INTRODUCTION: The International League against Epilepsy (ILAE) has recently proposed a consensus to define refractory epilepsy. PATIENTS AND METHODS: A retrospective, analytical, descriptive study was conducted involving 206 patients who were attended at the epilepsy clinic of a third-level centre in Mexico. The ILAE's new definition of pharmacoresistance was used to classify the patients. The frequency and risk factors involved in the refractoriness were reported. The tendency to prescribe antiepileptic drugs (AED) in this population was analysed using secondary data. RESULTS: Of the 206 patients analysed, 57 (28%) were free of seizures, 115 (56%) continued to have seizures, 17 (8%) were classified as undetermined and 17 (8%) were pseudo-refractory. The statistically significant factors associated to pharmaco-resistance that were found in our population were: focal versus generalised epilepsy (p = 0.02), catamenial epilepsy (p = 0.02), abnormal psychomotor development (p = 0.02), history of epilepsy in the family (p = 0.025), neurological examination with focal abnormality (p = 0.04), perinatal hypoxia (p = 0.06) and prior psychiatric illness (p = 0.03). The mostly frequently AED used in mono- and polytherapy were valproate and carbamazepine. Of all the patients who were free of seizures, 47% were treated using monotherapy. CONCLUSIONS: The frequency of pharmacoresistance in the population analysed was estimated to be 56%. Identification of the factors associated with pharmacoresistance makes it possible to consider surgical treatment or to optimise the treatment with AED. There is a tendency to use the new AED, above all in combination therapy. Our findings are consistent with those described in the literature.