Pronóstico a largo plazo de la epilepsia ausencia juvenil / Long term prognosis of juvenile absence epilepsy

Introducción: La epilepsia ausencia juvenil (EAJ) es un tipo de epilepsia generalizada idiopática que se caracteriza por la presencia de crisis de ausencia (CA) que comienzan en la adolescencia, con un EEG típico de punta-onda generalizada, y que puede acompañarse de mioclonías y crisis tónico-clónicas generalizadas (CTCG). El pronóstico a largo plazo es incierto. Material y métodos: Seleccionamos de manera retrospectiva todos los pacientes que cumplían los criterios diagnósticos de EAJ de la ILAE 1989, analizamos las variables clínicas, el tratamiento farmacológico, el estar libre de crisis y la posibilidad de retirar el tratamiento. Resultados: Encontramos 21 pacientes, 17 mujeres y 4 varones, el 86% presentó también CTCG y el 14% mioclonías. La edad de inicio de las CA fue de 17 años (rango: 10-44). Cuatro pacientes comenzaron con CA en la edad adulta. El seguimiento medio fue de 25 años (intervalo: 10-43). El 90% recibió tratamiento con valproato y el 62% requirió politerapia. El 43% de los pacientes están actualmente libres de crisis, aunque todos ellos en tratamiento farmacológico. Todos los intentos de retirar la medicación fracasaron, pese a largos períodos sin crisis.Conclusiones: Menos de la mitad de los pacientes con EAJ están libres de crisis. El tratamiento antiepiléptico es necesario durante toda la vida a pesar de largos períodos de remisiones (AU)

Introduction: Juvenile absence epilepsy (JAE) is a generalized form of epilepsy, characterizedby absence seizures (AS) initiated in adolescence, with a typical EEG showing generalized spikewavedischarges. Apart from absences, other seizure types may be observed such as myocloniaand generalized tonic-clonic seizures (GTCS). Its long-term prognosis is uncertain Material and methods: We retrospectively selected all patients who met the 1989 ILAE diagnostic criteria for JAE. We analysed clinical variables, pharmacological treatment, and seizure remission with medical treatment and seizure relapse after stopping medical treatment. Results: We identified 21 patients, 17 women and 4 men, 86% of whom had suffered GTCS and 14% myoclonias. Mean age at AS onset was 17 years old (range 10-44), 4 patients debuted with AS in adulthood. Mean follow up duration was 25 years (range 14-43). Ninety per cent of the patients were treated with valproate and 62% needed polytherapy. Currently 43% have achieved seizure freedom under medical treatment. All attempts to stop treatment failed, in some cases after long periods of seizure remission. Conclusions: Less than fifty per cent of patients with JAE achieve remission, antiepileptictreatment is mandatory during all life, despite having long periods of remission (AU)

Long term prognosis of juvenile absence epilepsy.

INTRODUCTION: Juvenile absence epilepsy (JAE) is a generalized form of epilepsy, characterized by absence seizures (AS) initiated in adolescence, with a typical EEG showing generalized spike-wave discharges. Apart from absences, other seizure types may be observed such as myoclonia and generalized tonic-clonic seizures (GTCS). Its long-term prognosis is uncertain. MATERIAL AND METHODS: We retrospectively selected all patients who met the 1989 ILAE diagnostic criteria for JAE. We analysed clinical variables, pharmacological treatment, and seizure remission with medical treatment and seizure relapse after stopping medical treatment. RESULTS: We identified 21 patients, 17 women and 4 men, 86% of whom had suffered GTCS and 14% myoclonias. Mean age at AS onset was 17 years old (range 10-44), 4 patients debuted with AS in adulthood. Mean follow up duration was 25 years (range 10-43). Ninety per cent of the patients were treated with valproate and 62% needed polytherapy. Currently 43% have achieved seizure freedom under medical treatment. All attempts to stop treatment failed, in some cases after long periods of seizure remission. CONCLUSIONS: Less than fifty per cent of patients with JAE achieve remission, antiepileptic treatment is mandatory during all life, despite having long periods of remission.

Randomised comparison of the efficacy and safety of a novelDES with biodegradable polymer and cobalt-chromium alloy -Inspiron I trial

Aims: The efficacy of a novel drug eluting stents with biodegradable polymer andcobalt-chromium alloy should be tested in the context of randomised trials, evenwhen using drugs known to be effective, such as sirolimus. The objective of thepresent study was to evaluate the safety and efficacy of a novel formulation of asirolimus-eluting stent with biodegradable polymer and cobalt-chromium alloyagainst a stent with the same metallic structure but without polymer coating or drugelution.Methods and results: The INSPIRON-I trial is a multicenter 2-arm randomisedtrial, conducted in 4 Brazilian institutions, which included 58 patients allocated forthe Inspiron sirolimus-eluting stent or the Cronus bare metal stent in a 2:1 ratio.Patients had de novo coronary lesions in native vessels with a diameter between2.5 and 3.5 mm, amenable for treatment with a single stent of 19 mm or less in length. The primary objective was to compare the in-stent late loss at 6 months of the sirolimus-eluting versus the control bare metal stent. Important secondary objectives included the comparison of major adverse cardiac events (MACE) ofdeath, myocardial infarction and target lesion revascularisation at 12 months. The study randomised 58 patients, 39 in the Inspiron group and 19 in the Cronusgroup. The great majority of the patients included had stable angina (76%).Baseline clinical and angiographic characteristics from both groups were similar, and 55.6% of the lesions were B2/C. The angiographic restudy at 6 months showed that percent diameter stenosis was significantly lower in the Inspiron group (15.8% vs. 38.7%, respectively; p=0.03), as well as late lumen loss (0.18 vs. 0.67 mm; p=0.009). Binary restenosis was also lower for Inspiron group, but without statistical difference (p=0.42)...

Intracoronary brachytherapy in the treatment of in-stent restenosis. Initial experience in Brazil.

Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in Brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial). The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment.

High versus low-pressure balloon inflation during multilinktrade mark stent implantation: acute and long-term angiographic results.

We compared the impact of low and high-pressure balloon inflation on acute and late angiographic results of Multilink stent. Low-pressure balloon inflation (9.5 +/- 1.9 atm) was used in 43 stents and high pressure (17.1 +/- 1.5 atm) in 44. A larger immediate luminal gain was achieved in stents with high-pressure balloon inflation (1.80 +/- 0.26 vs. 1.47 +/- 0.62; P = 0.002), resulting in a larger mean diameter in this group (2.71 +/- 0.37 vs. 2.48 +/- 0.47; P = 0.017). At follow-up, a larger luminal diameter was achieved in the high pressure group (1.93 +/- 0.72 vs. 1.45 +/- 0.66; P = 0.002) and a trend to a lower rate of angiographic restenosis (15% vs. 38%, P = 0.08).

Single coronary arteries: two cases with distinct and previously undescribed angiographic patterns.

Single coronary artery is a rare congenital anomaly, sometimes associated with myocardial ischemia. We present the clinical and angiographic features of two symptomatic patients with documented myocardial ischemia and with distinct and previously undescribed patterns of single right coronary arteries. These cases are new variants of the types R-I and R-II-A, in which the most probable mechanisms of ischemia are the insufficient blood supply, due to the long trajectories of the single arteries and the presence of underdeveloped vessels. Also, our second case presented with a fistulae from the LCX to the left ventricle, which is another determinant of myocardial ischemia.

Ductus arteriosus rupture as a balloon catheter atrioseptostomy complication.

A newborn with transposition of the great arteries presented with rupture of the ductus arteriosus after balloon catheter atrioseptostomy. The necropsy study demonstrated persistent ductus patency, and a 0.5-cm-long horizontal fissure could be observed. On microscopy, there was laceration of the intimal layer, with wall dissection and focal hemorrhage extending to the adventitia. Ductus rupture was attributed to the wall weakness, as a consequence of prostaglandin E1 administration.