ABSTRACT
Introducción. La epilepsia afecta a 50 millones de personas. Hasta un 30% no se controla con fármacos antiepilépticos. El estimulador del nervio vago (ENV) constituye una alternativa terapéutica que hay que valorar. Objetivo. Determinar el efecto del ENV en una cohorte pediátrica con epilepsia refractaria. Pacientes y métodos. Estudio retrospectivo de niños con ENV implantado entre 2008 y 2017 en un hospital terciario. Se han analizado datos epidemiológicos, etiológicos, clínicos, electrofisiológicos y parámetros del ENV. Resultados. Se incluyó a 35 pacientes, con una mediana de edad de implantación de 12,84 años (rango: 3,1-18,7 años) y una mediana de evolución entre el inicio de la epilepsia y la implantación de 7,2 años (rango: 1,3-17,7 años). La etiología fue estructural en el 62,9% de los casos. Cuadros epilépticos más frecuentes: síndrome de Lennox-Gastaut y epilepsia focal, con predominio de las crisis tónicas (57,1%). El videoelectroencefalograma mostró anomalías multifocales (54%) y un patrón de encefalopatía epiléptica (34,3%). El 94% asociaba discapacidad intelectual. La media de fármacos antiepilépticos previos fue de 9,6 ± 3 (rango: 4-16). El 43% fueron respondedores (>= 50% reducción de crisis), con una media de reducción del 67,3%, mejor cuanto mayor era la edad de inicio de la epilepsia. Tres pacientes quedaron libres de crisis (8,5%). La reducción de crisis fue del 33% a los 6 meses y del 47,4% a los 24 meses. Mejoría cognitiva (57%) y conductual (53%). El 28% tuvo efectos secundarios, generalmente leves. Conclusiones. El ENV es una opción válida en la epilepsia refractaria con mejoría no sólo de las crisis, sino también cognitiva y conductual, con la importancia que ello tiene para la población pediátrica
Introduction. Fifty million people are aff ected by epilepsy. Up to 30% are not controlled with the aid of antiepileptic drugs. The vagus nerve stimulator (VNS) is a therapeutic alternative that must be taken into account. Aim. To determine the eff ect of the VNS in a cohort of paediatric patients with refractory epilepsy. Patients and methods. A retrospective study of children with a VNS implanted between 2008 and 2017 in a tertiary hospital. Epidemiological, aetiological, clinical and electrophysiological data, along with VNS parameters were analysed. Results. The study included 35 patients, with a mean age when the VNS was implanted of 12.84 years (range: 3.1-18.7 years) and a mean time between onset of epilepsy and implantation of 7.2 years (range: 1.3-17.7 years). The causation was structural in 62.9% of cases. The most frequent epileptic conditions were: Lennox-Gastaut syndrome and focal epilepsy, with a redominance of tonic seizures (57.1%). The video electroencephalogram showed multifocal anomalies (54%) and a pattern of epileptic encephalopathies (34.3%). Intellectual disability was associated in 94% of the cases. The mean of previous antiepileptic drugs was 9.6 ± 3 (range: 4-16). 43% responded to treatment (≥ 50% reduction in number of seizures), with a mean reduction of 67.3%, which improved with higher ages of onset of epilepsy. Three patients were seizure-free (8.5%). The number of seizures decreased by 33% at six months and by 47.4% at 24 months. There was also a notable degree of cognitive (57%) and behavioural improvement (53%). In 28% of cases there were some side eff ects, but in general they were mild. Conclusions. The VNS is a valid option in refractory epilepsy, with improvements not only in terms of seizures but also regarding cognitive-behavioural aspects, this being very important for the paediatric population
Subject(s)
Humans , Male , Female , Child , Adolescent , Vagus Nerve Stimulation/methods , Epilepsy/epidemiology , Epilepsy/etiology , Electrophysiology/methods , Reproducibility of Results , Vagus Nerve Stimulation/trends , Retrospective Studies , Electroencephalography/methods , Anticonvulsants , NeuropsychologyABSTRACT
BACKGROUND AND AIMS: There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline. PATIENTS AND METHODS: We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay. RESULTS: A total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively). CONCLUSIONS: In our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before. TRIAL REGISTRATION: EudraCT 2009-016042-57.
