Guía de práctica clínica de consenso de la Sociedad Andaluza de Epilepsia: recomendaciones terapéuticas ante una crisis epiléptica y en el estado epiléptico / Consensus clinical practice guidelines of the andalusian epilepsy society: Therapeutic recommendations when dealing with a first epileptic seizure and in epileptic status

Introducción. La gran mayoría de crisis epilépticas son breves y autolimitadas, pero, en ocasiones, su duración puede ser mayor de la esperada, lo que, en el caso de las crisis convulsivas generalizadas, comporta un alto riesgo de morbimortalidad, que aumenta con su duración. Esta gravedad justifica la realización de una guía de práctica clínica de consenso, basada en evidencias implícitas sobre aspectos relacionados con el manejo terapéutico recomendado a un paciente con una crisis prolongada asistido en los servicios de urgencias. Materiales y métodos. Se ha realizado una búsqueda selectiva de la información científica relacionada con el tema propuesto en Pubmed-Medline, utilizando filtros de evidencia científica. Dicha búsqueda se completó en otros buscadores de evidencia científica, como Tripdatabase, Biblioteca Cochrane Plus o DARE. Las referencias seleccionadas se analizaron y discutieron por los autores y se extrajeron las evidencias disponibles y las recomendaciones de ellas derivadas. Resultados. Se identificaron 33 documentos primarios y seis guías de práctica o protocolos relacionados con el tema propuesto. Las recomendaciones se insertaron en el texto de manera explícita. Conclusiones. El protocolo terapéutico debe iniciarse ante cualquier crisis convulsiva con una duración superior a cinco minutos, asegurando, en primer lugar, la correcta función respiratoria y cardiocirculatoria, y administrando fármacos antiepilépticos por vía intravenosa de acción rápida y con dosis altas, mantenidos hasta que se identifica y controla la causa. Las crisis no convulsivas prolongadas, por su menor morbimortalidad, no precisan generalmente de una terapia tan enérgica y con riesgo de complicaciones (AU)

Introduction. Most epileptic seizures are brief and self-limiting, but sometimes they can last longer than expected and this entails (in the case of generalised seizures) a high risk of morbidity and mortality, which increases as they get longer. This severity justifies the need to draw up a set of consensus-based practice guidelines based on implicit evidence, to use Liberati’s nomenclature, concerning aspects related to the recommended therapeutic management of a patient with prolonged seizures who is being attended in an emergency department. Materials and methods. A selective search was conducted on PubMed-Medline for scientific information related to the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. Results. The search revealed the existence of 33 primary documents and six practice guidelines or protocols related with the topic under study. The recommendations were inserted in the text explicitly. Conclusions. The therapeutic protocol must be started when faced with any seizures that last more than five minutes. First, steps must be taken to ensure proper respiratory and cardiocirculatory functioning, and then fast-acting antiepileptic drugs are administered intravenously and in high doses until the cause is identified and controlled. Due to their lower level of morbidity and mortality, prolonged non-convulsive seizures do not generally require therapy that is so vigorous and with such a high risk of complications (AU)

[Consensus clinical practice guidelines of the Andalusian Epilepsy Society: therapeutic recommendations when dealing with a first epileptic seizure and in epileptic status]. / Guia de practica clinica de consenso de la Sociedad Andaluza de Epilepsia: recomendaciones terapeuticas ante una crisis epileptica y en el estado epileptico.

INTRODUCTION: Most epileptic seizures are brief and self-limiting, but sometimes they can last longer than expected and this entails (in the case of generalised seizures) a high risk of morbidity and mortality, which increases as they get longer. This severity justifies the need to draw up a set of consensus-based practice guidelines based on implicit evidence, to use Liberati's nomenclature, concerning aspects related to the recommended therapeutic management of a patient with prolonged seizures who is being attended in an emergency department. MATERIALS AND METHODS: A selective search was conducted on PubMed-Medline for scientific information related to the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. RESULTS: The search revealed the existence of 33 primary documents and six practice guidelines or protocols related with the topic under study. The recommendations were inserted in the text explicitly. CONCLUSIONS: The therapeutic protocol must be started when faced with any seizures that last more than five minutes. First, steps must be taken to ensure proper respiratory and cardiocirculatory functioning, and then fast-acting antiepileptic drugs are administered intravenously and in high doses until the cause is identified and controlled. Due to their lower level of morbidity and mortality, prolonged non-convulsive seizures do not generally require therapy that is so vigorous and with such a high risk of complications.

[Consensus clinical practice guidelines of the Sociedad Andaluza de Epilepsia for the diagnosis and treatment of patients with their first epileptic seizure in emergencies]. / Guía de práctica clínica de consenso de la Sociedad Andaluza de Epilepsia para el diagnóstico y tratamiento del paciente con una primera crisis epiléptica en situaciones de urgencia.

INTRODUCTION AND AIMS: Epileptic seizures are the cause of between 0.3 and 1.2% of all visits to hospital emergency departments. Twenty-five per cent of patients visit after having their first seizure. Such an impact seems to justify the development of a health care protocol. Our proposal is to draw up a set of implicit evidence-based consensus practice guidelines, to use Liberati's nomenclature, concerning aspects related to the diagnostic procedure and recommended therapeutic management of patients with a first seizure who are being attended in an emergency department. MATERIALS AND METHODS: A selective search was conducted on PubMed-Medline for quality scientific information on the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. RESULTS: A total of 47 primary documents and 10 practice guidelines or protocols related with the proposed topic were identified. The recommendations were inserted in the text explicitly. CONCLUSIONS: The diagnostic and therapeutic protocol for all paroxysmal phenomena in emergencies consists of three successive phases: diagnosis of the cause of the epilepsy, integration of the significance of the seizure within the clinical context, and designing the therapeutic scheme. Each phase will depend on the outcomes of the previous one as a decision algorithm. The fundamental tools in each phase are: patient record and examination (phase 1), and complementary tests (phase 2). They are then used to produce a therapeutic decision scheme.

Encefalopatía hiperamoniémica por ácido valproicomage / Hyperammonaemic encephalopathy due to valproic acid

Uno de los efectos adversos idiosincrásicos menos frecuentes del ácido valproico (VPA) es la encefalopatía.Presentamos un caso. Caso clínico. Mujer de 83 años sin antecedentes de interés, que tras sufrir una hemorragiasubaracnoidea postraumática y dos crisis epilépticas, recibe tratamiento con VPA. Pocos días después ingresa en Urgencias por cuadro progresivo de torpeza mental, náuseas y apatía. La exploración sistémica era normal. Neurológicamente destacaba la inatención y la desorientación a pesar de un buen nivel de conciencia y la confusión mental. Los niveles de VPA estabanen rango infraterapéutico y la analítica básica (incluido el perfil hepático) era normal, salvo por una hiperamoniemia. También eran normales los estudios de neuroimagen y el análisis del líquido cefalorraquídeo. Un electroencefalograma (EEG) reveló signos de encefalopatía difusa grave con ondas trifásicas y ondas lentas, por lo que se descartó un estado epiléptico noconvulsivo. Tras retirar el VPA, la paciente mejoró hasta su situación basal en 48 horas, y el EEG se normalizó, al igual que los niveles de amonio. Conclusión. Ante cualquier paciente al que se le haya instaurado VPA recientemente, y que presente uncuadro de confusión mental, es preciso considerar una encefalopatía por dicho fármaco

One of the less frequent idiosyncratic side effects of valproic acid (VPA) is encephalopathy. Here wereport one case. Case report. An 83-year-old female with no relevant past history, who received treatment with VPA following a post-traumatic subarachnoid haemorrhage and two convulsive seizures. A few days later, she was admitted to the Emergency Department because of a progressive clinical picture of mental slowness, nauseas and apathy. The systemic examination wasnormal. Neurologically, the most striking features were inattention and disorientation, despite her having a good level of consciousness, and mental confusion. Levels of VPA were within the below-therapeutic range and the basic lab findings (including hepatic profile) were normal, except for hyperammonaemia. Neuroimaging studies and cerebrospinal fluid analysiswere also normal. An electroencephalogram (EEG) showed signs of severe diffuse encephalopathy with slow, triphasic waves and a non-convulsive epileptic status was therefore ruled out. After withdrawing the VPA, the patient’s condition improved untilher basal situation was reached in 48 hours and the EEG became normal, as did her ammonium levels. Conclusion. When faced with a patient who has recently been taking VPA and who presents a clinical picture of mental confusion, the possibility of encephalopathy due to said drug must be taken into consideration

Ceguera cortical transitoria tras la administración de contrastes angiográficos / Transient cortical blindness following the administration of angiographic contrasts

No disponible

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: II. Chronic therapy with antiepileptic drugs in adults and in children]. / Guia terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: II. Terapéutica antiepiléptica crónica en el adulto y en el nino.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: IV. General principles of antiepileptic polytherapy and therapeutic strategies in refractory epilepsy]. / Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: IV. Principios generales de politerapia antiepiléptica y estrategias terapéuticas en epilepsia refractaria.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: III. Antiepileptic therapy in special situations]. / Guia terapeutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: III. Tratamiento antiepileptico en situaciones especiales.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: IV. Principios generales de politerapia antiepiléptica y estrategias terapéuticas en epilepsia refractaria / The andalusia epilepsy society´s guide to epilesy therapy 2005: IV general principles of antiepileptic polytherapy and therapeutic strategies in refractory epilepsy

Aims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care (AU)

Objetivo. Elaborar una guía de práctica clínica basada en la evidencia científica que aborde las cuestiones básicas acerca del tratamiento de la epilepsia. Desarrollo. Un comité de 11 expertos pertenecientes a la Sociedad Andaluza de Epilepsia, en el que se incluían seis neurólogos, tres neuropediatras, un neurocirujano y una farmacóloga, todos con especial dedicación y competencia en epilepsia, realizó una revisión bibliográfica exhaustiva en busca de las evidencias disponibles relacionadas con el tema propuesto. Se utilizaron las siguientes bases de datos: MEDLINE, Cochrane Library y bases de datos de guías de práctica clínica (National Guideline Clearinghouse, National Institute of Clinical Excellence y Guías Clínicas de la Academia Americana de Neurología). La guía se estructuró en siete secciones y se dividió para su publicación en cuatro partes. Se identificaron 187 documentos relevantes, de los que se extrajeron un total de 63 evidencias científicas y 91 recomendaciones terapéuticas, que se tabularon y clasificaron según los criterios de elaboración de Guías de Práctica Clínica de la Federación Europea de Sociedades Neurológicas. Conclusión. Los resultados de esta revisión proveen unas guías de práctica clínica basadas en la evidencia científica útiles, sencillas y aplicables en los diferentes niveles asistenciales (AU)

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: I. Criteria for starting and discontinuing and the pharmacological bases of antiepileptic treatment]. / Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: I. Criterios de inicio y cese y bases farmacológicas del tratamiento antiepiléptico.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: I. Criterios de inicio y cese y bases farmacológicas del tratamiento antiepiléptico / The Andalusia epilepsy society’s guide to epilepsy therapy 2005: I. criteria for starting and discontinuing and the pharmacological bases of antiepileptic treatment

Objetivo. Elaborar una guía de práctica clínica basada en la evidencia científica que aborde las cuestiones básicas acerca del tratamiento de la epilepsia. Desarrollo. Un comité de 11 expertos pertenecientes a la Sociedad Andaluza de Epilepsia, en el que se incluían seis neurólogos, tres neuropediatras, un neurocirujano y una farmacóloga, todos con especial dedicación y competencia en epilepsia, realizó una revisión bibliográfica exhaustiva en busca de las evidencias disponibles relacionadas con el tema propuesto. Se utilizaron las siguientes bases de datos: MEDLINE, Cochrane Library y bases de datos de guías de práctica clínica (National Guideline Clearinghouse, National Institute of Clinical Excellence y Guías Clínicas de la Academia Americana de Neurología). La guía se estructuró en siete secciones y se dividió para su publicación en cuatro partes. Se identificaron 187 documentos relevantes de los que se extrajeron un total de 63 evidencias científicas y 91 recomendaciones terapéuticas, que se tabularon y clasificaron según los criterios de elaboración de Guías de Práctica Clínica de la Federación Europea de Sociedades Neurológicas. Conclusión. Los resultados de esta revisión proveen unas guías de práctica clínica basadas en la evidencia científica útiles, sencillas y aplicables en los diferentes niveles asistenciales

Aims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health careAims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care

Guía terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: II. Terapéutica antiepiléptica crónica en el adulto y en el niño / The Andalusia epilepsy society’s guide to epilepsy therapy 2005: II. chronic therapy with antiepileptic drugs in adults and in children

Objetivo. Elaborar una guía de práctica clínica basada en la evidencia científica que aborde las cuestiones básicas acerca del tratamiento de la epilepsia. Desarrollo. Un comité de 11 expertos pertenecientes a la Sociedad Andaluza de Epilepsia, en el que se incluían seis neurólogos, tres neuropediatras, un neurocirujano y una farmacóloga, todos con especial dedicación y competencia en epilepsia, realizó una revisión bibliográfica exhaustiva en busca de las evidencias disponibles relacionadas con el tema propuesto. Se utilizaron las siguientes bases de datos: MEDLINE, Cochrane-Library y bases de datos de guías de práctica clínica (National Guideline Clearinghouse, National Institute of Clinical Excellence y Guías Clínicas de la Academia Americana de Neurología). La guía se estructuró en siete secciones y se dividió para su publicación en cuatro partes. Se identificaron 187 documentos relevantes, de los que se extrajeron un total de 63 evidencias científicas y 91 recomendaciones terapéuticas, que se tabularon clasificándolas según los criterios de elaboración de Guías de Práctica Clínica de la Federación Europea de Sociedades Neurológicas. Conclusión. Los resultados de esta revisión proveen unas guías de práctica clínica basadas en la evidencia científica útiles, sencillas y aplicables en los diferentes niveles asistenciales

Aims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health careAims. The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. Development. A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology’s Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies’ criteria for producing Clinical Practice Guidelines. Conclusions. The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care