¿Es seguro el tratamiento con una dosis diaria de Depakine Crono? / Is treatment with a daily dose of Depakine Crono safe?

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Generalized spike-and-wave patterns in children: clinical correlates.

All electroencephalograms performed in our institution between 1980 and 1990 were reviewed. The clinical characteristics of children with epilepsy and generalized spike-and-wave (SW) patterns were analyzed. The SW patterns were classified according to their frequency. Electroencephalograms of 154 children with epilepsy revealed SW patterns. Absence seizures were the most common first seizure, but partial seizures were frequent. More than 40% had several types of seizures. Sixty percent of the epileptic syndromes were generalized, but almost 25% were partial. The typical SW pattern was associated with absence seizures, a normal examination and computed tomographic scan, idiopathic generalized epilepsies, monotherapy, freedom from seizures, and lack of recurrence. The slow SW pattern was associated with West syndrome; a younger age at seizure onset; atonic, myoclonic, tonic, and partial simple seizures; an abnormal examination and computed tomographic scan; cryptogenic or symptomatic generalized epilepsy or symptomatic partial epilepsy; polytherapy; and poor seizure control. The fast SW pattern was associated with secondary generalized, partial, tonic-clonic, and complex partial seizures; a normal computed tomographic scan; cryptogenic partial epilepsy; isolated seizures; and seizure recurrence. Epilepsy with a typical SW pattern should be considered benign, epilepsy with a slow SW pattern malignant, and epilepsy with a fast SW pattern treacherous.

[Estimation of the neurologic demand in a health care area of Madrid, Spain (area 11, University Hospital, 12 of October)]. / Estimación de la demanda neurológica en un área sanitaria de Madrid (area 11, Hospital Universitario 12 de Octubre).

OBJECTIVES: To analyse the demand for neurologic care and the neurological resources in a health district. PATIENTS AND METHODS: Demographic, medical care aspects, neurologic care demands and neurological resources of the health district 11 of Madrid (University Hospital "12 de Octubre"), referred to 1996, were reviewed. RESULTS: The rate of aging (17%) and the consulting rates in the National Health System (86%) versus private care were high in this health district. The neurologic care demands were 17.5-18.1 and 36 consultations respectively per 1,000 inhabitants/year. There were 2 patient-care neurologists and 3.7 neurologic beds per 100,000 inhabitants. CONCLUSIONS: The neurologic care was considered high and with a tendency to increase. The available neurological resources were judged to be insufficient.

[Febrile seizures: is EEG useful?]. / Tiene sentido realizar un EEG en las crisis febriles?

OBJECTIVE: The purpose of this study was to determine the clinical relevance of electroencephalograms (EEG) with generalized spike-wave (S-W) in pediatric patients, especially in children with febrile seizures. PATIENTS AND METHODS: One hundred and seventy pediatric patients with S-W were found from a register of 39,322 consecutive EEGs performed in an EEG laboratory dedicated to general clinical practice. Patients that only suffered febrile seizures were not considered epileptic. RESULTS: Of the 170 patients, 154 (90.6%) were epileptic and 16 (9.4%) were not. Mean follow-up was 4.5 years. Twelve of the 16 non-epileptic children with S-W suffered febrile seizures. CONCLUSIONS: The presence of S-W in EEGs is uncommon. Almost 10% of the children with S-W were not epileptic patients and none of them suffered from epilepsy during the follow-up period. Performance of an EEG on a child without epilepsy, especially those with febrile seizures, can be a factor of confusion.

[Perinatal antecedents, psychomotor retardation, learning difficulties and family history. Are they a risk factor for epilepsy?]. / Antecedentes perinatales, retraso psicomotor, dificultades del aprendizaje e historia familiar. Son un factor de riesgo para la epilepsia?

OBJECTIVE: Epilepsy has been associated with certain circumstances such as perinatal pathology, learning difficulties, head trauma, infections of the central nervous system, febrile seizures and family history of epilepsy. The objective of our study was to analyze the association of the mentioned circumstances with epilepsy in a group of children with generalized spike-wave (S-W) in the electroencephalogram (EEG). PATIENTS AND METHODS: One hundred seventy pediatric patients with, S-W were found from a register of 39,322 consecutive EEGs. The patients were classified into 2 groups: epileptic and non-epileptic. Both groups were compared for the presence of known risk factors of epilepsy. RESULTS: Of the 170 patients, 154 (90.6%) were epileptic and 16 (9.4%) were not. Mean follow-up was 4.5 years. Neither past medical antecedents nor family history was found to be associated with epilepsy. CONCLUSIONS: The risk of epilepsy in children with S-W in the EEG is not associated with problems in pregnancy, the birth or neonatal period, learning difficulties or family history of epilepsy.

[The prognosis of epilepsy in children with generalized spikes and wave disc charges in electroencephalographic recording]. / Pronóstico de la epilepsia en niños con trazado electroencefalográfico de descargas de punta-onda generalizadas.

INTRODUCTION: Epilepsy is a chronic disorder. The prognosis of one particular subtype, that of children with generalized spike and wave discharges (P-O) on the electroencephalogram (EEG), is unknown. OBJECTIVE: To determine the prognosis of children with epilepsy with P-O on EEG and the factors which affect this. PATIENTS AND METHODS: All EEGs done over ten years (39,322) were reviewed, and the epileptic patients under 14 years old identified. Absence and recurrence of crises were evaluated and the factors influencing them analyzed. Minimum significance was p < 0.05. The chi square test, Student's t test and Kaplan-Meier method were used. Logistic regression models were devised. RESULTS: Of the children studied, 78% became crisis-free. After monovariant and multivariant analysis the only conditions which fitted the regression models were: abnormal pregnancy; West syndrome or learning difficulties; having certain types of crises, myoclonic, clonic-tonic, partial simple or complex crises; a normal EEG with hypsarrhythmia, slow or fast P-O and requiring multiple medication. When medication ceased, 31.4% had recurrence of the episodes. On monovariant and multivariant analysis, protective factors were absence of attacks and risk factors were a family history of epilepsy or an EEG with rapid P-O. CONCLUSIONS: The overall prognosis for epileptic children with P-O is good. There are factors which improve or worsen the pronosis, but these cannot be modified.

[Cerebral SPECT in adult epileptics with neuronal migration disorders]. / SPECT cerebral en adultos epilépticos con trastornos de la migración neuronal.

The neuronal migration disorders are a rare group of congenital malformations of the brain that may present with epilepsy resistant to medical treatment. We studied with brain interictal SPECT 8 epileptic adult patients (3 man and 5 women) who wore affected by different neuronal migration disorders (pachygyria, megaloencephaly, squizencephaly and neuronal heterotopias), diagnosed by cranial MRI. SPECT was pathologic in six patients (75%), showing more sensibility than CT in the diagnosis of heterotopias.

[Toxic effects of antiepileptic drugs: review of 100 cases (author's transl)]. / Efectos tóxicos de la medicación anticomicial: revisión de 100 casos.

A series of 100 epileptic patients in whom the incidence of toxic effects due to antiepileptic drugs was retrospectively studied form the basis of this report. The appearance of toxic effects depended mainly on the number of drugs used, the length of therapy and the evolution of the epileptic crisis; they were more important in focal epilepsies, which were those with more resistance to therapeutic control and requiring increasing number and doses of antiepileptic drugs. Some side effects were observed in 60% of the patients involving generally the nervous system, skin, connective tissue, skeletal system, and hematopoietic organs. The drugs had to be reduced in 19% of these patients because of excessive sedation, mild central nervous system intoxication and various psychological effects, while treatment had to be changed in 11% due to acute intoxication with skin involvement, hematologic alterations and excessive sedation.