Epilepsy and electroencephalographic abnormalities in patients with diagnosis of idiopathic autism spectrum disorder in Medellín.

The objective of the present study was to make a clinical and electroencephalographic characterization of the electrical findings and types of seizures in patients with idiopathic autism. Pediatric patients of any age, with the diagnosis of idiopathic ASD, contained within the database of the research "Genetic in autism" were included. An electroencephalographic recording with epilepsy protocol was performed in all the patients. 20 pediatric patients were included with an age media of 10.5 years, SD 5.48 years. The median age for the diagnosis of ASD was 53 months, and epileptic seizures were documented in 45%. 66.6% of patients with epileptic events had anti-epileptic treatment, and only 33.3% had achieved seizure control with medication. Interictal abnormal EEG records were found in 8 patients (40%), with 6 of them having epileptic seizures. The abnormal EEG activity was multifocal in 62.5%, focal in 25% and generalized in 12.5% of the cases. The most frequently compromised location was the temporal lobe.

El objetivo del presente estudio fue caracterizar desde el punto de vista clínico y electroencefalográfico los hallazgos eléctricos y los tipos de crisis en pacientes con autismo idiopático. Se incluyeron pacientes de cualquier edad, con diagnóstico de TEA idiopático y pertenecientes a la base de datos de la investigación "Genética del Autismo". A todos los pacientes se les realizó electroencefalograma de rutina (EEG) con protocolo de epilepsia. Se recolectaron 20 pacientes en edad pediátrica con edad media de 10.5 años, DE de 5.84 años. Para la edad de diagnóstico del TEA, la media era de 53 meses. Se documentaron crisis epilépticas en 45% de los pacientes. De todos los pacientes con crisis, 66.6% tenían tratamiento con medicamentos antiepilépticos, y solo 33.3% habían logrado control de las crisis con el tratamiento. El EEG interictal fue anormal en 8 pacientes (40%), de los cuales 6 tenían crisis epilépticas. La actividad anormal fue multifocal en 62.5% de los pacientes, focal en 25% y generalizada en 12.5% de los casos. La localización más frecuente de las anomalías fue en el lóbulo temporal.

Epilepsy for primary health care: a cost-effective Latin American E-learning initiative.

A lack of neurologists in Latin America forces primary health care providers to manage epilepsy. With the main goal of improving diagnostic and therapeutic management of patients with epilepsy through training of physicians in the primary health care level, the International League Against Epilepsy Education Commission (2013-2017) created a low-cost, regional, virtual course. The course, set-up in Moodle platform, was structured in eight modules, each lasting for a week. Teaching was based on written didactic material, videos, and interactive discussions, both in Spanish and Portuguese. Topics included epidemiology, diagnosis, classification, treatment, prognosis, social issues, and epilepsy policies. Each course was limited to 50 participants and priority was given to general practitioners. Certification was given to those approving the final examination. Since 2015, five courses have been developed, involving 143 participants from 17 countries and 21 tutors. Of the participants, 61% worked in primary health care services. A total of 129 participants (90%) completed the course, and 110 submitted the final examination with an approval rate of 95%. From 85 participants completing the course evaluation, 98% would recommend the course to other colleagues, and 99% showed interest in taking other similar courses. High self-confidence for the management of patients with epilepsy increased from 21% at baseline to 73% after the course. The online course on epilepsy for primary care physicians in Latin America was shown to be a cost-effective course, with good retention and excellent approval rates. Our current challenges include periodic updating, complete self-sustainability, and exploring different strategies to reach our target audience more effectively.

Caracterización clínica y electroencefalográfica de pacientes con epilepsia generalizada genética, evaluados en el Centro Especializado CEC- LAB IPS Universitaria de Antioquia 2010 - 2012: estudio descriptivo retrospectivo / Clinical and electroencephalographic characterization of generalized genetic epilepsy patients assessed in specialized center cec-lab ips university of antioquia 2010 to 2012: descriptive and retrospective study

Introducción: Las características clínicas y electroencefalográficas de la Epilepsia Generalizada Genética permiten clasificarla en varios subsindromes, sin embargo, existen variaciones en las anormalidades del electroencefalograma y la presentación clínicas entre los síndromes. Objetivo: los datos epidemiológicos relacionados con las epilepsias generalizadas genéticas en Colombia son escasos. En el presente estudio se analizaron los síndromes de las Epilepsias Generalizadas Genéticas (EGG) de acuerdo a las características demográficas, clínicas y electroencefalográficas para determinar el endofenotipo local y poder establecer un punto de referencia que constituya el fundamento de las investigaciones genéticas. Materiales y métodos: estudio retrospectivo realizado en el Centro Especializado CEC-LAB de la Clínica IPS Universitaria León XIII, se reunieron los registros de pacientes entre el 2010 y 2012. Se describieron aquellos con diagnóstico de EGG a través de variables demográficas, clínicas y electroencefalográficas por síndrome. Para el análisis estadístico se utilizaron frecuencias, proporciones, promedios, medianas y medidas de dispersión. Resultados: se estudiaron 5.357 pacientes, de ellos 53(1%) presentó diagnóstico de EGG. La edad promedio fue de 19 años (+/- 15 años). La epilepsia de fenotipo variable obtuvo la mayor prevalencia (21%), la menor y mayor edad de inicio de crisis la presentaron la epilepsia de ausencia mioclónica y mioclónica juvenil respectivamente. Se evidenciaron todos los tipos de crisis usuales en cada síndrome, y una gran variedad de anormalidades electroencefalográficas. Conclusión: los síndromes electroclínicos no pueden ser aplicados a toda la población, su valoración debe ser individualizada, se debe intentar integrarlos a la clasificación actual, siendo cauteloso con los casos que se desvían de una descripción específica desde el punto de vista clínico y electroencefalográfico, por lo cual se debe usar un enfoque neurobiológico que permita comprender y orientar a estos pacientes.

Introduction: The clinical and electroencephalographic features in the Generalized Genetic Epilepsy define several subsyndromes, however, variations of the Electroencephalogram abnormalities and clinical presentation between the syndromes exist. Objective: Epidemiological data regarding genetic generalized epilepsies in Colombia are scarce. In the present study the Generalized Genetic Epilepsy (GGE) syndromes were analyzed based on the demographic, clinical and electroencephalographic to determine local endophenotype and to establish a benchmark that forms the basis of genetic research. Materials and methods: This retrospective study was carried out in the CEC-LAB Specialized Center University Clinic IPS Leo XIII, patient records between 2010 and 2012. It describes those patient diagnosed with EGG and their electroencephalographic, demographic and clinical features by the syndromic classification. For statistical analysis frequencies, proportions, means, medians and dispersion measures were used. Results: 5,357 patients were collected, of them 53 (1%) presented diagnosis of EGG. The average age was 19 years (+/- 15 years). The Variable epilepsy phenotype had the highest prevalence (21%), the younger and older start of seizures were presented in myoclonic absence epilepsy and juvenile myoclonic respectively. Each syndrome presented the classical type of seizures and a variety of EEG abnormalities. Conclusion: electroclinical syndromes cannot be applied to the entire population, their evaluation should be individualized and try to integrate them into the current syndromic classification, being cautious with cases that deviate from a specific electroencephalographic and clinical description whereupon the clinician must be prepared to use a neurobiological approach to understand and guide these patients.

[Correlation between the magnetic resonance imaging morphometry and the clinical and electroencephalographic findings in patients diagnosed with ulegyria and epilepsy]. / Correlación de la morfometría por resonancia magnética con los hallazgos clínicos y electroencefalográficos de pacientes con diagnóstico de ulegiria y epilepsia.

INTRODUCTION: Ulegyria is a cortical lesion affecting neighbouring vascular zones, which gives the convolutions a mushroom-like appearance. It is an important cause of occipital epilepsy. AIM. To correlate patients diagnosed clinically, electrically and morphometrically with ulegyria and epilepsy by comparing the thickness of the cortex in the zones affected by ulegyria with the normal cortical thickness reported in the literature and the average cortical thickness of healthy subjects. PATIENTS AND METHODS: Ten patients with ulegyria confirmed by magnetic resonance imaging were included in the study; all of them were submitted to a clinical interview, an electroencephalographic study and cortical morphometric analysis based on volumetric T1 sequences. RESULTS: Findings included a predominance in males, neurodevelopmental retardation and epilepsy. Ulegyria was mainly parietooccipital, frequently bilateral, with statistically significant thinning of the cortical thickness in the site of the lesion and an increase in the thickness of the cortex in the areas surrounding the lesion. CONCLUSIONS: We report on a series of patients with ulegyria with characteristics similar to those existing in the literature and by means of morphometry we detected an increase in the thickness of the cortex around the areas affected by ulegyria. These findings could point to the presence of adaptive neuroplasticity in the neurons that surround the scar tissue or they may be the result of mechanical changes of normal tissue in response to the loss of volume of the ulegyria-affected area, although these data need to be replicated in a study with a greater number of patients.

Correlación de la morfometría por resonancia magnética con los hallazgos clínicos y electroencefalográficos de pacientes con diagnóstico de ulegiria y epilepsia / Correlation between the magnetic resonance imaging morphometry and the clinical and electroencephalographic findings in patients diagnosed with ulegyria and epilepsy

Introducción. La ulegiria es una lesión cortical propia de zonas vasculares limítrofe, que da a las circunvoluciones unaspecto de hongo. Es una causa importante de epilepsia occipital. Objetivo. Correlacionar clínica, eléctrica y morfométricamente a los pacientes con diagnóstico de ulegiria y epilepsia comparando el espesor cortical de las zonas ulegíricas con el espesor cortical normal comunicado en la bibliografía y el promediodel espesor cortical de sujetos sanos.Pacientes y métodos. Se incluyeron diez pacientes con ulegiria comprobada imaginológicamente con resonancia magnética,los cuales se sometieron a una entrevista clínica, un estudio electroencefalográfico y un análisis morfométrico cortical a partir de secuencias T1 volumétricas. Resultados. Encontramos un predominio del sexo masculino, retraso en el neurodesarrollo y epilepsia. La ulegiria fueen su mayoría parietooccipital, frecuentemente bilateral, con adelgazamiento del espesor cortical en el sitio de la lesiónsignificativamente estadístico y aumento del grosor de la corteza en las zonas periféricas a la lesión.Conclusión. Describimos una serie de pacientes con ulegiria con características similares a las existentes en la bibliografíay detectamos en morfometría un aumento en el espesor cortical que rodea las zonas ulegíricas. Estos hallazgos podrían indicar bien la presencia de neuroplasticidad adaptativa en las neuronas que rodean el tejido cicatricial o el resultado de cambios mecánicos del tejido normal en respuesta a la pérdida de volumen de la zona ulegírica, datos que se deben replicaren un estudio con un mayor número de pacientes (AU)

Introduction. Ulegyria is a cortical lesion affecting neighbouring vascular zones, which gives the convolutions a mushroomlikeappearance. It is an important cause of occipital epilepsy. Aim. To correlate patients diagnosed clinically, electrically and morphometrically with ulegyria and epilepsy by comparing the thickness of the cortex in the zones affected by ulegyria with the normal cortical thickness reported in the literatureand the average cortical thickness of healthy subjects. Patients and methods. Ten patients with ulegyria confirmed by magnetic resonance imaging were included in the study;all of them were submitted to a clinical interview, an electroencephalographic study and cortical morphometric analysisbased on volumetric T1 sequences.Results. Findings included a predominance in males, neurodevelopmental retardation and epilepsy. Ulegyria was mainlyparietooccipital, frequently bilateral, with statistically significant thinning of the cortical thickness in the site of the lesion and an increase in the thickness of the cortex in the areas surrounding the lesion. Conclusions. We report on a series of patients with ulegyria with characteristics similar to those existing in the literature and by means of morphometry we detected an increase in the thickness of the cortex around the areas affected byulegyria. These findings could point to the presence of adaptive neuroplasticity in the neurons that surround the scar tissue or they may be the result of mechanical changes of normal tissue in response to the loss of volume of the legyriaaffectedarea, although these data need to be replicated in a study with a greater number of patients (AU)

Electroencefalografía y vídeo-EEG enestatus epiléptico / Electroencephalogram and continuous EEG monitoring in status epilepticus

El registro electroencefalográfico en especial cuando se combina con video (Video-EEG / Videotelemetria) aunquecon frecuencia subutilizado; es de gran utilidad en el diagnóstico y seguimiento de pacientes en estatus epilépticoo con sospecha de él.Algunos patrones ictales del electroencefalograma que son la clave en el diagnóstico de estatus epiléptico, son difícilesde interpretar y requieren de un neurólogo o neuropediatra con entrenamiento adecuado en neurofisiología clínicaque sepa reconocerlos, entrenamiento que usualmente es de 1 a 2 años una vez terminado el tiempo de residencia.El video-EEG continuo ayuda a determinar si el paciente está en estatus, si el tratamiento instaurado es efectivo,si se requiere más medicación o sedación y por último si él se ha controlado del todo.Algunos pacientes con estatus convulsivo evolucionan hacia uno no convulsivo, el cual es de difícil diagnóstico,con manifestándose diversas que van desde un cuadro confusional hasta el coma; en estos pacientes el video-EEGcontinuo permite reconocer que el paciente esta aun en estatus epiléptico.Una vez controlado el estatus epiléptico, se debe continuarse con registro de video-EEG por 24 o 48 horas adicionalescon el fin de evidenciar si hay recurrencia de las crisis y si el paciente requiere un tratamiento más agresivo.