EPITRANS. Quality assessment of the epilepsy transition process.

OBJECTIVE: To analyze the differences in clinical management during the epilepsy transition process from pediatric to adult care and to determine the quality of life and degree of satisfaction of patients and caregivers during the transition. METHODS: This is a longitudinal study including patients with epilepsy transferred from pediatric to adult epilepsy care between 2013 and 2017. Patients had a minimum follow-up of 3 years before the transition visit and at least 3 years consulting in the adults section. Clinical characteristics were retrieved from the medical chart. Quality of life and satisfaction questionnaires were administered by online access to patients and caregivers at the end of the adult follow-up period. RESULTS: 99 patients (50.5 % women, mean transition age 16.5 ± 1 years old) were included. Before the transition visit, 90 % of patients received a transition discussion and 88 % had a formal clinical report. In the pediatric period, patients were visited more frequently, had more EEGs and genetic studies, and were seen by the same neuropediatrician (P<0.05). In the adult period, patients underwent a larger number of prolonged video EEGs and were prescribed polytherapy more often (P<0.05). Quality of life remained steady during the entire transition, but satisfaction with the care received was significantly higher during the pediatric period. CONCLUSIONS: Significant differences were seen in epilepsy care during transition from pediatric to adult management, and this had an impact on the degree of satisfaction reported by patients and caregivers. Our results provide evidence of the potential value of development and early implementation of a protocolled transition program.

Rufinamide in children and adults in routine clinical practice.

OBJECTIVE: To explore the long-term effectiveness of rufinamide in managing Lennox-Gastaut Syndrome (LGS), other epileptic encephalopathies, and intractable focal epilepsies in adults and children in routine clinical practice. METHODS: A multicentre, retrospective chart review of patients prescribed adjunctive rufinamide at seven Spanish epilepsy centres, with assessments at six and 12 months. RESULTS: We evaluated data from 58 patients (40 male, age range 7-57 years), 25 of whom were diagnosed with LGS, 12 with other epileptic encephalopathies and 21 of whom were diagnosed with focal epilepsies, mainly frontal lobe. The mean daily rufinamide dose was 32.0 mg/kg (range 12.5-66.7 mg/kg) in children and 24.7 mg/kg (range 5.0-47.0 mg/kg) in adults, and the most commonly used concomitant antiepileptic drugs were levetiracetam and valproate. Rufinamide was discontinued in 25 patients (43.1%) during the 1-year follow-up, and the most common reason was lack of effectiveness (n = 12, 20.7% of total). The frequency of generalized tonic-clonic seizures was significantly reduced from baseline at 6 and 12 months (P = 0.001), both in patients with generalized epilepsies and in patients with focal epilepsies. Significant seizure frequency reduction from baseline was observed at 12 months (P = 0.01) for tonic/atonic seizures and at 6 months (P = 0.001) for focal seizures. Side effects were reported in 21 patients (36.2%): nausea, vomiting and weight loss were most frequent. CONCLUSIONS: Rufinamide was well tolerated and was effective in reducing frequency of generalized tonic-clonic, tonic/atonic and focal seizures in both children and adults with severe refractory epilepsies, primarily LGS.

Angiosarcoma de mama tras tratamiento conservador en cáncer de mama / Breast angiosarcoma after conservative treatment for breast carcinoma

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[Locoregional recurrences after conservative treatment of breast cancer stage I-II]. / Recidivas locorregionales tras el tratamiento conservador del cáncer de mama en estadios I y II.

BACKGROUND: Since 1992 conservative treatment of breast cancer (stage I and II: clinical TNM) has been established as an alternative to mastectomy in our hospital. The aim of this retrospective study was to analyse locoregional recurrence features and to compare prognosis with regard to to site of recurrence. METHOD: Between 1987 and 1993, 489 patients with breast cancer (stages I and II) were treated with conservative surgery and radiation therapy at the Hospital Sant Pau of Barcelona. Mean follow-up was 58.8 months [between 12-144]. 35 patients developed locoregional recurrence. We considered two groups: local recurrence in breast only; and locoregional recurrence such as nodal recurrence with or without simultaneous breast recurrence. Diagnosis was confirmed by histopathologic analysis. An extensive study was performed in all patients to rule out distant metastasis. Last follow-up was December 1999. RESULTS: The locoregional recurrence rate after conservative treatment was 7.5% and that of local recurrence was 3.06%. Recurrences were diagnosed in 80% of patients by physical examination, while 20% of patients had noticed the tumor recurrence themselves. Histologic grade III tumors had a higher number of locoregional recurrences than local recurrences (p = 0.030). Locoregional recurrences had lower overall survival rate (p = 0.0005), lower disease-free survival rate (p = 0.0012) and shorter time period without distant metastasis (p < 0.0005) than local recurrences. CONCLUSIONS: Most recurrences were diagnosed by clinical examination during follow up. Histologic grade III was related to locoregional recurrences. Local recurrences had a better prognosis than locoregional recurrences.

Recidivas locorregionales tras el tratamiento conservador del cáncer de mama en estadios I y II / Locoregional recurrences after conservative treatment of breast cancer stage I-II

FUNDAMENTO: Desde 1992 el tratamiento conservador del cáncer de mama (estadios I y II, TNM clínico) se establece en nuestro hospital como la alternativa a la mastectomía. La finalidad de este estudio retrospectivo fue analizar las características de estos casos de recidiva locorregional y comparar el pronóstico en relación con la localización de las recidivas. MÉTODO: Entre 1987 y 1993 en el Hospital de la Santa Creu i Sant Pau de Barcelona se trataron 489 pacientes afectadas de carcinoma de mama en estadios I y II con cirugía conservadora y radioterapia. La mediana de seguimiento fue de 58,8 meses (extremos, 12 y 144). Presentaron recidiva locorregional 35 pacientes. La recidiva locorregional se clasificó en dos grupos: recidiva local, en mama únicamente; recidiva locorregional, como la presentada en ganglios regionales con recidiva simultánea en mama o sin ella. El diagnóstico se confirmó con estudio anatomopatológico y en todos los casos se efectuó estudio de extensión para descartar metástasis. La última revisión fue en diciembre de 1999. RESULTADOS: La tasa de recidiva locorregional después del tratamiento conservador fue de un 7,5 por ciento y la de recidiva local del 3,06 por ciento. La recidiva fue diagnosticada en el 80 por ciento de los casos en la exploración física y sólo en el 20 por ciento fue detectada por la misma paciente. Los tumores con grado histológico III presentaron mayor número de recidivas locorregionales que locales (p = 0,030). Las recidivas locorregionales se asociaron a una tasa de supervivencia global (p = 0,0005), una supervivencia libre de enfermedad (p = 0,0012) y un intervalo libre de metástasis (p < 0,0005) inferiores a los observados en la recidiva local. CONCLUSIONES: La mayor parte de las recidivas locorregionales fueron diagnosticadas en el control clínico durante el seguimiento. El grado histológico III se relacionó con las recidivas locorregionales. La recidiva local tuvo mejor pronóstico que la recidiva locorregional. (AU)