[Video electroencephalographic diagnosis of epileptic and non-epileptic paroxysmal episodes in infants and children at the pre-school age]. / Diagnostico videoelectroencefalografico de los episodios paroxisticos epilepticos y no epilepticos en el lactante y el nino en edad preescolar.

The main usefulness of video electroencephalographic (video-EEG) monitoring lies in the fact that it allows proper classification of the type of epileptic seizure and epileptic syndrome, identification of minor seizures, location of the epileptogenic zone and differentiation between epileptic seizures and non-epileptic paroxysmal manifestations (NEPM). In infants and pre-school age children, the clinical signs with which epileptic seizures are expressed differ to those of older children, seizures with bilateral motor signs such as epileptic spasms, tonic and myoclonic seizures predominate, and seizures with interruption of activity or hypomotor seizures, and no prominent automatisms are observed. In children with focal epilepsies, focal and generalised signs are often superposed, both clinically and in the EEG. NEPM may be benign transitory disorders or they can be episodic symptoms of different neurological or psychopathological disorders. NEPM are often observed in children with mental retardation, neurological compromise or autism spectrum disorders, who present epileptic seizures and epileptiform abnormalities in the baseline EEG. It then becomes necessary to determine which episodes correspond to epileptic seizures and which do not. The NEPM that are most frequently registered in the video-EEG in infants and pre-school age children are unexpected sudden motor contractions ('spasms'), introspective tendencies, motor stereotypic movements and paroxysmal sleep disorders.

Diagnóstico videoelectroencefalográfico de los episodios paroxísticos epilépticos y no epilépticos en el lactante y el niño en edad preescolar / Video electroencephalographic diagnosis of epileptic and non-epileptic paroxysmal episodes in infants and children at the pre-school age

Resumen. Las principales utilidades de la monitorización videoelectroencefalográfica (video-EEG) son clasificar adecuadamente el tipo de crisis epiléptica y de síndrome epiléptico, identificar crisis menores, localizar la zona epileptógena y diferenciar las crisis epilépticas de las manifestaciones paroxísticas no epilépticas (MPNE). En el lactante y el niño en edad preescolar, las crisis epilépticas se expresan con signos clínicos diferentes a los del niño más mayor, predominan las crisis con signos motores bilaterales, como espasmos epilépticos, crisis tónicas y mioclonías, y las crisis con interrupción de la actividad o crisis hipomotoras, y no se observan automatismos prominentes. En niños con epilepsias focales, a menudo existe una superposición de signos focales y generalizados, tanto clínicos como en el EEG. Las MPNE pueden corresponder a trastornos benignos y transitorios o ser síntomas episódicos de diferentes trastornos neurológicos o psicopatológicos. A menudo, las MPNE se observan en niños con retraso mental, afectación neurológica o trastornos del espectro autista, que presentan crisis epilépticas y anomalías epileptiformes en el EEG basal, y es entonces necesario determinar los episodios que corresponden a crisis epilépticas y los que no. Las MPNE que con mayor frecuencia se registran en el video-EEG en lactantes y niños en edad preescolar son las contracciones motoras bruscas inesperadas (‘espasmos’), los ensimismamientos, las estereotipias motoras y los trastornos paroxísticos del sueño (AU)

Summary. The main usefulness of video electroencephalographic (video-EEG) monitoring lies in the fact that it allows proper classification of the type of epileptic seizure and epileptic syndrome, identification of minor seizures, location of the epileptogenic zone and differentiation between epileptic seizures and non-epileptic paroxysmal manifestations (NEPM). In infants and pre-school age children, the clinical signs with which epileptic seizures are expressed differ to those of older children, seizures with bilateral motor signs such as epileptic spasms, tonic and myoclonic seizures predominate, and seizures with interruption of activity or hypomotor seizures, and no prominent automatisms are observed. In children with focal epilepsies, focal and generalised signs are often superposed, both clinically and in the EEG. NEPM may be benign transitory disorders or they can be episodic symptoms of different neurological or psychopathological disorders. NEPM are often observed in children with mental retardation, neurological compromise or autism spectrum disorders, who present epileptic seizures and epileptiform abnormalities in the baseline EEG. It then becomes necessary to determine which episodes correspond to epileptic seizures and which do not. The NEPM that are most frequently registered in the video-EEG in infants and pre-school age children are unexpected sudden motor contractions (‘spasms’), introspective tendencies, motor stereotypic movements and paroxysmal sleep disorders (AU)

Epilepsy surgery in children with developmental tumours.

We report our experience regarding evaluation, surgical treatment and outcomes in a population of 21 children with histopathologically confirmed developmental tumours [nine dysembryoplastic neuroepithelial tumours (DNET), ten gangliogliomas (GG) and two gangliocytomas (GC)] and related epilepsy, analyzing video-EEG, MRI and neuropsychological data, before and after surgery. Most children had focal epilepsy correlating well with lesion location. One patient had epileptic spasms and generalized discharges. Tumours were located in the temporal lobe in 13 patients. Mean age at surgery was 11.16 years. Postsurgical MRI showed residual tumour growth in one DNET. One child had a recurrent ganglioglioma with anaplastic transformation. At latest follow-up (mean 4.68 years) 95.2% of patients were seizure-free and no significant neuropsychological declines were observed. Evidence from our study suggests that, in this setting, surgery should be performed before criteria for refractory epilepsy are met, particularly in cases with early seizure onset, in order to optimize cognitive outcome.

Aproximación a la diabetes mellitus oculta en un servicio de urgencias hospitalario / Estimation of hidden diabetes mellitus in a hospital emergency department

Objetivos. Determinar la prevalencia de diabetes oculta en los pacientes que presentan hiperglucemia en un servicio de urgencias. Diseño del estudio. Estudio descriptivo transversal (de prevalencia).Emplazamiento. El marco de atención sanitaria ha sido el servicio de urgencias hospitalario. Participantes. Pacientes mayores de 20 años que acudieron al Servicio de Urgencias del Hospital General de Ciudad Real durante 2007, y con valores de glucemia plasmática mayor o igual de 140mg/dl. El número total de pacientes con glucemia mayor o igual a 140 fue de 4.559.Mediciones principales: Variables sociodemográficas y causas de hiperglucemia. Resultados. La edad media de los pacientes con glucemia mayor o igual a 140 mg/dl fue de 68,5años ± 13,8 DE. El 50% fueron menores de 71 años. La moda en la muestra fue de 75 años. El 52,2%(2.381) eran hombres. Las causas de hiperglucemia fueron: diabetes mellitus ya conocida (75,1% dela muestra, 3.423 pacientes), diabetes mellitus oculta (5,3% de la muestra, 240 pacientes), hiperglucemia secundaria a otras causas (19,7% de la muestra, 896 pacientes). Por lo tanto, la prevalencia de diabetes oculta en nuestra población fue del 5,3% (IC 95%: 4,3 - 5,6%). De los diabéticos conocidos, el 10,3% eran del tipo 1 (351 pacientes) y el 89,7% del tipo 2 (3.072 pacientes). Entre las hiperglucemias secundarias, el 18% lo fueron por tratamiento con corticoides (165 personas), el 32% por tratamiento oncológico (238 pacientes), el 3% por algún problema biliar-pancreático (28 pacientes),el 32% por hiperglucemias aisladas en relación con el estrés del proceso actual (291 pacientes) y el15% por intolerancia a la glucosa (131 pacientes).Conclusiones. La prevalencia de diabetes oculta es parecida a la encontrada en estudios similares. La diabetes oculta se confirma como un problema sanitario de peso epidemiológico (5,3% de nuestros pacientes) del que podrían derivarse importantes repercusiones sociosanitarias (AU)

Objectives. To determine the prevalence of hidden diabetes in patients presenting with hyperglycaemia at a hospital emergency department. Study design. Cross-sectional descriptive study (prevalence) studio. Setting. Hospital emergency department. Participants. Patients over 20 years who attended the Emergency Department of the Hospital General de Ciudad Real during 2007 with plasma glucose levels over 140 mg/dl. The total number of patients with glucose levels higher than 140 mg/dl was 4,559.Main measurements. Socio-demographic variables and cause of hyperglycaemia. Results. The mean age of patients with glucose levels greater than or equal to 140 mg/dl was 68.5years ± 13.8 SD, 50% were less than 71 years. The mean in the sample was 75 years and 52.2%(2.381) were men. The causes of hyperglycaemia were: known diabetes mellitus (75.1% of the sample,3,423 patients), hidden diabetes mellitus (5.3% of the sample, 240 patients), hyperglycaemia secondary to other causes (19.7% of sample, 896 patients). Therefore, the prevalence of hidden diabetes in our population was 5.3% (95% CI: 4.3 – 5.6%). Of those patients with known diabetes,10.3% had type 1 (351 patients) and 89.7% had type 2 (3,072 patients). In 18% of cases, hyperglycaemia was secondary to corticoid treatment (238 patients), in 3% to a biliar-pancreatic problem (28patients), in 32% to isolated hyperglycaemia related to the stress of their current illness (291 patients)and in 15% to glucose intolerance (131 patients).Conclusions. The prevalence of hidden diabetes is comparable to that found in similar studies. Hidden diabetes is confirmed as being a healthcare problem of epidemiological weight (5.3% of our patients) which could have serious socio-healthcare repercussions (AU)

Continuous giggling and autistic disorder associated with hypothalamic hamartoma.

We present the case of a child affected since early infancy from recurring episodes of giggling mixed with stereotypical behaviours, mingled with head drops, and eventually with falls, in the context of an autistic disorder. Scalp video-EEG recordings revealed an epileptic encephalopathy with generalized slow spike-and-wave complexes alternating with electrodecremental periods, which generally corresponded to the onset of the aforementioned clinical sequences. A resection of a hypothalamic hamartoma was achieved at the age of two. Since then, after 22 months of follow-up, the child is totally free from the giggling and the drops, and the autistic behaviour significantly improved during the second year of follow-up. This case illustrates the difficulties to recognize some subtle ictal manifestations during infancy and childhood, and encourages the early surgical treatment of hypothalamic hamartomas when associated with epileptic encephalopathy and when technically possible.