[The physiopathology and management of sexual dysfunction in epileptic patients]. / Fisiopatología y abordaje de la disfunción sexual en pacientes epilépticos.

AIM: To review sexual dysfunction in epileptic patients, which is an aspect of the disease that is often deemed as being of little importance, but which exerts a decisive influence on the quality of life of these patients. DEVELOPMENT: The alterations in sexual functioning in epilepsy have a complex physiopathology, can be of different types and occur during seizures, the aura or in the intercritical periods. Their clinical expression depends on the sex and age of the patient. The severity and incidence of sexual dysfunction are influenced by the treatment being used, the psychosocial adjustment of the individual, and certain aspects of epilepsy such as the age at onset, time to progression, location of the focus, the type of seizures and the degree of control the patient has over them. The therapeutic strategy is based on adjusting or modifying the antiepileptic therapy and then treating the sexual dysfunction and/or possible hormonal upsets. CONCLUSIONS: Sexuality is a fundamental human right and as a health provider, the physician must take this aspect of the disease into account when dealing with epileptic patients by attempting to detect and characterise the disorder. The patient must be informed of the possible effects of epilepsy and its treatment on sexual functioning, and also the therapeutic options the physician considers to be best suited to the patient's particular case. He or she should also be encouraged to play an active role in making decisions on the matter and it is necessary to carry out developmental monitoring that takes into account the impact that improved sexual functioning is going to have on the patient's psychosocial and family adjustment.

Fisiopatología y abordaje de la disfunción sexual en pacientes epilépticos / The physiopathology and management of sexual dysfunction in epileptic patients

Revisar la disfunción sexual en epilépticos, un aspecto de la enfermedad a menudo infravalorado, peroque puede influir decisivamente sobre la calidad de vida de estos pacientes. Desarrollo. Las alteraciones de la función sexual en la epilepsia tienen una fisiopatología compleja, pueden ser de diferentes tipos y acontecer durante las crisis, el aura o los períodos intercríticos. Su expresión clínica depende del sexo y la edad de los pacientes. El tratamiento utilizado, el ajuste psicosocial del individuo y determinados aspectos de la epilepsia, como la edad de comienzo, el tiempo de evolución, la localización del foco, el tipo de crisis y el grado de control de las mismas, influyen sobre la gravedad y la incidencia de la disfunción sexual. La estrategia terapéutica se basa en ajustar o modificar la terapia antiepiléptica y abordar después la disfunción sexual y/o las posibles alteraciones hormonales. Conclusiones. La sexualidad es un derecho fundamental del ser humano, y ante un paciente epiléptico es obligación del médico, como proveedor de salud, atender este aspecto de la enfermedadtratando de detectar y caracterizar la alteración, informando al paciente de los posibles efectos de la epilepsia y su tratamiento sobre la función sexual, exponiéndole las opciones terapéuticas que considera más adecuadas, animándole a participar activamente en la toma de decisiones al respecto, y realizando un control evolutivo que tenga en cuenta el impacto que la mejoría de la función sexual va a producir sobre el ajuste psicosocial y familiar del paciente

To review sexual dysfunction in epileptic patients, which is an aspect of the disease that is often deemed asbeing of little importance, but which exerts a decisive influence on the quality of life of these patients. Development. The alterations in sexual functioning in epilepsy have a complex physiopathology, can be of different types and occur during seizures, the aura or in the intercritical periods. Their clinical expression depends on the sex and age of the patient. Theseverity and incidence of sexual dysfunction are influenced by the treatment being used, the psychosocial adjustment of the individual, and certain aspects of epilepsy such as the age at onset, time to progression, location of the focus, the type of seizures and the degree of control the patient has over them. The therapeutic strategy is based on adjusting or modifying the antiepileptic therapy and then treating the sexual dysfunction and/or possible hormonal upsets. Conclusions. Sexuality is a fundamental human right and as a health provider, the physician must take this aspect of the disease into account whendealing with epileptic patients by attempting to detect and characterise the disorder. The patient must be informed of the possible effects of epilepsy and its treatment on sexual functioning, and also the therapeutic options the physician considers tobe best suited to the patient's particular case. He or she should also be encouraged to play an active role in making decisions on the matter and it is necessary to carry out developmental monitoring that takes into account the impact that improved sexual functioning is going to have on the patient’s psychosocial and family adjustment

[Epilepsy and sleep as seen on video encephalographic recordings]. / Epilepsia y sueño a través de la evidencia del registro vídeo-EEG

INTRODUCTION: The relation between epilepsy and sleep has been known for some time. Seizures are often not observed by the examiner and it is necessary to make prolonged recordings during sleep, both slow or no REM sleep and paradoxical or REM sleep. Objective. To show the way in which a video recording may be made of a patient s seizures, together with an electroencephalogram recorded on a suitable disk and both sets of data be synchronised and studied as often as necessary. PATIENTS AND METHODS: We describe some of the epileptic seizures, recorded by this technique, during sleep. At the same time we show other paroxystic non epileptic episodes occurring during sleep which may be needed to be ruled out of the differential diagnosis. CONCLUSIONS: We show that as a general rule the basic activity of paroxystic disorders seen on an electroencephalogram occurs during slow sleep phases and particularly during their early stages. These studies are especially relevant in children and in neonates a prolonged recording is essential

[Society, law and epilepsy]. / Sociedad, ley y epilepsia.

INTRODUCTION: Epilepsy is an important problem from a medical, social and legal point of view. Proof of this is the fact that it constitutes the second most commonly alleged cause for absolution of responsibility in Spain, according to the jurisprudence from the Supreme Court (1976 1995). METHOD: Throughout history it has been classified as a magical, supernatural disease and has been studied within psychiatry as an endogenous psychosis. It has therefore been considered a form of madness, which has led to court decisions that have taken this concept into account. The supposed dangerousness of suffers from epilepsy must be the exception, and their supposed epileptic characters and personalities that drive them to commit atrocious murders are no longer of any relevance. The problems stemming from epileptic seizures are to be seen in civil, penal, military, canonical and labour law, very often in an exclusive fashion. CONCLUSION: We think it is worthwhile reviewing these concepts with a view to their undergoing a later modification, which would lead to the full integration of these patients and to their being considered as suffering from a neurological illness.

Sociedad, ley y epilepsia / Society, law and epilepsy

Introducción. La epilepsia es un problema de primer orden desde el punto de vista médico, social y jurídico; prueba de ello es que constituye la segunda causa alegada como eximente de responsabilidad en España si nos atenemos a la jurisprudencia del Tribunal Supremo (1976-1995). Desarrollo. A lo largo de la historia se ha catalogado como una enfermedad mágica y sobrenatural, y se ha estudiado dentro de la psiquiatría como una psicosis endógena; por tanto, se ha considerado como locura, lo que ha llevado a fallos judiciales que recogen este concepto. La supuesta peligrosidad del enfermo epiléptico debe ser lo excepcional, y los supuestos carácter y personalidad epilépticos causantes de atroces crímenes, en la actualidad, no tienen relevancia. Los problemas derivados de los ataques epilépticos se manifiestan en las leyes civiles, penales, militares, canónicas y laborales, en muchas ocasiones de forma excluyente. Conclusión. Nos parece oportuno hacer una revisión de estos conceptos en orden a una posterior modificación de los mismos, que conduzca a una integración plena de estos enfermos y a su consideración como enfermos neurológicos (AU)

[Epilepsy and permission to drive]. / Epilepsia y permiso de conducir.

INTRODUCTION: At the present time it has become a social necessity for most people to be able to drive a motor vehicle. For this reason, obtention of a driving license is continuously regulated so as to be adapted to the psychophysical aptitudes required at any given moment, since these vary with medical and social advances. DEVELOPMENT: We review the doctrine on this subject in some of the major countries, finding that far from having similar criteria, there is disparity even between different jurisdictions of the same country. In Spain epilepsy is regulated regarding the difficulty in obtaining a driving license in the General Regulation for Drivers (RD 772/1997). We consider this in detail. CONCLUSIONS: We try to unify criteria regarding the periods free of seizures, modifying the language with respect to some of these, validity of the license, analysis of the medical report and its responsibility in case of third party injury in a road accident. We propose open debate to clarify these terms.

[Epilepsy equivalents: a term in disuse?]. / Equivalentes epilépticos: término en desuso?

The term 'epileptic equivalent' has had different meanings in recent years, for both doctors and lawyers (who have copied their reports). Our interest is due to finding that in the jurisprudence of the Supreme Court that we have reviewed, these terms are still taken into consideration when passing judgement or declaring a defendant immune from prosecution. This might mean a complete or partial defence, according to the grade of psychological illness of the person who commits the punishable act. Thus, there are still references to dysthymia, residual or larvate epilepsy, etcetera, and medical experts relate them directly to epileptic disorders, to judge from the references made in many of the sentences reviewed. This has influenced penal classification in one way or another. People who have never had an epileptic crisis have been considered to be epileptics. The same may also be said of the well-known epileptic character or epileptic personality. Therefore this paper considers the importance of language in this disorder. It invites relevant persons or institutions to unify opinions and modernize the terminology in accordance with modern scientific knowledge [REV NEUROL 1999; 28: 524-8].