[The prevalence of different types of epilepsy in clinical practice]. / Prevalencia de los distintos tipos de epilepsia en la práctica clínica.

INTRODUCTION: The author reviews the frequency with which different parameters are observed in the 7,500 patients included in his database, created in 1974 and last reviewed in June 2000. The objective of this review is not to do an epidemiological study, but exclusively for the evaluation of the characteristics of the patients who have attended the clinic in recent years. Since the population considered is not complete, but a particular transverse sector, strictly speaking it cannot be considered to be an epidemiological study. It is possible to make a hypothetical extrapolation from this data of a selected population to a general population. PATIENTS AND METHODS: We made a retrospective study of the database including 3,000 patients seen between 1974 and 1985. Between 1985 and 2000, 4,500 cases were analyzed prospectively. There were 7,500 patients altogether. RESULTS: Regarding the types of seizures and their associations, the commonest were the association of simple partial crises and secondarily generalized partial seizures as seen in 661 patients (8.81%). Rather less often there were complex partial crises associated with secondarily generalized partial crises, seen in 640 patients (8.53%). We thus show the frequency of seizures of partial epilepsy. With regard to the types of epilepsy, we point out that the commonest is partial epilepsy (40.86%), to which one should add the cases of so called unilateral epilepsy (398 patients, 5.3%) which was greater than those with generalized epilepsy (idiopathic and systemic and/or cryptogenic) (40.8%), with possible bias due to the origin of the cases. Finally, we mention the frequency of epileptic syndromes. The commonest syndrome seen we have labelled as partial, secondarily generalized epilepsy (6.57%). However, when the syndromes were strictly classified according to established criteria, this was only possible in 2,013 of the 7,500 patients (26.84%). We interpret this, as recently described by Lombroso, as indicating a need for extension of the current classification of epileptic syndromes.

[A review of idiopathic generalized epilepsies: absence epilepsy]. / Revisión de la epilepsia generalizada idiopática: epilepsia ausencias.

We studied the clinical characteristics observed at diagnosis of the initial seizure in different types of epilepsy, particularly in idiopathic generalized epilepsy (IGE), and evaluated the importance of these in the classification of syndromes. The present study analyzes only those IGE initiated by absences leaving the cases initiated by GTC or myoclonic onset for a successive report. We observed differences between cases initiated by absences, those presenting simultaneously with absences and TCG, and those where TCG preceded the absences. Prognosis and evolution are considerably more favourable in cases initiated by absences than in cases with onset preceded by, or simultaneously with, other types of seizures. Besides this difference regarding evolution, it should also be emphasized that the form initiated by absences are more frequent in females, are generally pycnoleptic, appear more often in childhood with a second more moderate peak between 10 and 11 years of age, present more typical clinical-EEG characteristics, and the presence of previous febrile seizures is more notable.

Influence of the 'lost time' on the outcome of epilepsy.

A review of a series of epileptic patients revealed the importance of the 'lost time' in the future time course of a patient. The 'lost time' is regarded as the period of time elapsed since the onset of symptoms and the implementation of adequate treatment. An assessment of the follow-up of 3,529 epileptic patients showed that the shorter the 'lost time', the greater the efficacy of anticonvulsant treatment. Even the incidence of relapses after discontinuation of antiepileptic drugs correlates with the 'lost time' before diagnosis. These findings emphasize the importance of establishing an early diagnosis of the type of epilepsy and the prescription of adequate antiepileptic medication.

Partial epilepsy with seizures appearing in the first three years of life.

We reviewed records of 5,000 epileptic patients and identified 154 cases of partial epilepsy with seizure onset in the first 3 years of life. Of these, 35 patients had initial partial seizures. In 57 patients, partial seizures were preceded by a hemiclonic seizure, which manifested as status epilepticus in 70%. Generalized seizures were the initial manifestation in 62 patients: 17 grand mal, 14 clonic or myoclonic, and 31 tonic or atonic seizures. Of the 119 patients, 31 showed a seizure free-interval of several years between the initial seizure and the occurrence of partial epilepsy. The atypical initial clinical presentation and the seizure-free interval before occurrence of more characteristic partial seizures raise the possibility that the diagnosis of partial epilepsies in the first years of life may be missed.