[Adult attention-deficit/hyperactivity disorder: descriptive study in a Memory Unit]. / Trastorno por déficit de atención/hiperactividad del adulto: estudio descriptivo en una Unidad de Memoria.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is the main neurological diagnosis in Chilean children. Its profile and evolution in adults has not been appropriately studied, despise its personal and social impact. AIM: To describe the characteristics of adults with ADHD evaluated in a memory unit, verifying the existence of differences depending on gender. PATIENTS AND METHODS: A demographic and symptomatic evaluation protocol was applied to all patients diagnosed with ADHD who consulted at the Memory Unit of the Pontificia Universidad Católica de Chile, during the year 2004. RESULTS: Eighty six patients were included. Average age was 37, being 53% male. Most patients were diagnosed for the first time in adulthood, corresponding to an ADHD of combined type. The main patients' complaints were forgetfulness and distraction. A stressing factor capable of worsening the symptoms was identified in 59% of patients. Depression was the principal comorbidity, with a significantly higher incidence in women. CONCLUSIONS: The limitations of ADHD diagnostic criteria available for adult patients are discussed. Differences depending on gender were analyzed, describing a predominantly disruptive profile in men and depressive profile in women. There is a clear under-diagnosis of female children with ADHD, with a potential negative impact on their neuropsychological development. The differential diagnosis with mild cognitive impairment, in patients complaining of recent memory decline is discussed.

Trastorno por déficit de atención/hiperactividad del adulto: estudio descriptivo en una Unidad de Memoria / Adult attention-deficit/hiperactivity disorder: descriptive study in a memory unit

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) constituye el diagnóstico neurológico más frecuente en niños chilenos. Su evolución en el adulto se ha reconocido recientemente y no se ha estudiado suficientemente en nuestro medio, a pesar de su constatado impacto personal y social. Objetivo. Describir las características de los adultos diagnosticados como TDAH en una Unidad de Memoria, verificando la existencia de diferencias según sexo. Pacientes y métodos. Se aplicó una escala de evaluación demográfica y sintomática a todos los pacientes con diagnóstico de TDAH, ingresados en la Unidad de Memoria de la Pontificia Universidad Católica de Chile, durante el año 2004. Resultados. Se incluyó a 86 pacientes. El promedio de edad fue de 37 años, el 53% del sexo masculino. La mayoría de los diagnósticos correspondió a TDAH de tipo combinado, sin existir diagnóstico previo. Los motivos de consulta principales fueron los problemas de memoria y distracción. En el 59% de los pacientes se identificó un factor estresante que pudo haber empeorado los síntomas, favoreciendo la consulta. La comorbilidad principal fue la depresión, con una incidencia significativamente mayor en mujeres. Conclusiones. Se plantean las limitaciones de los criterios diagnósticos de TDAH en el adulto. Se analizan las diferencias por sexo, encontrándose en varones un perfil más disruptivo y en mujeres uno más depresivo. Existe un subdiagnóstico evidente en mujeres con TDAH de la infancia, con un impacto potencial importante en la evolución neuropsicológica de esa población. Se discute el diagnóstico diferencial con deterioro cognitivo leve, en los pacientes que refieren un deterioro reciente de la memoria

Introduction. Attention-deficit/hyperactivity disorder (ADHD) is the main neurological diagnosis in Chilean children. Its profile and evolution in adults has not been appropriately studied, despise its personal and social impact. Aim. To describe the characteristics of adults with ADHD evaluated in a memory unit, verifying the existence of differences depending on gender. Patients and methods. A demographic and symptomatic evaluation protocol was applied to all patients diagnosed with ADHD who consulted at the Memory Unit of the Pontificia Universidad Católica de Chile, during the year 2004. Results. Eighty six patients were included. Average age was 37, being 53% male. Most patients were diagnosed for the first time in adulthood, corresponding to an ADHD of combined type. The main patients’ complaints were forgetfulness and distraction. A stressing factor capable of worsening the symptoms was identified in 59% of patients. Depression was the principal comorbidity, with a significantly higher incidence in women. Conclusions. The limitations of ADHD diagnostic criteria available for adult patients are discussed. Differences depending on gender were analyzed, describing a predominantly disruptive profile in men and depressive profile in women. There is a clear under-diagnosis of female children with ADHD, with a potential negative impact on their neuropsychological development. The differential diagnosis with mild cognitive impairment, in patients complaining of recent memory decline is discussed

[Intramuscular midazolam in the initial treatment of status epilepticus]. / Midazolam intramuscular en el tratamiento inicial del estado epiléptico.

INTRODUCTION: The status epilepticus a serious complication of the epileptic syndrome with high rates of morbidity and mortality. Treatment is aimed to a fast control of the crisis. AIM: To evaluate the efficacy and security of intramuscular (IM) midazolam in the initial treatment of status epilepticus. PATIENTS AND METHODS: A prospective open clinical trial that included 43 status epilepticus in 38 adult patients. All of the cases received an initial dose of 15 mg IM of midazolam, with a simultaneous oral dose of phenytoin (15 to 20 mg/kg) or carbamazepine (15 mg/kg). If there was immediate control of the seizure but recurrence occurred during the next hours, 15 mg im of midazolam every 8 hours were given, for 24 hours. If there was immediate failure intravenous (IV) midazolam was given. RESULTS: 36 of the 43 status epilepticus were controlled: 30 with only one dose, 3 required additional IM doses, and 3 needed administration of IV midazolam, no patient had neither cardiovascular, respiratory or local complications. The only adverse effect was drowsiness in a variable grade. CONCLUSIONS: The use of IM midazolam is suggested as the initial treatment in status epilepticus in adults, especially in a low complexity setting, due to its effectiveness, quick action and security.

Midazolam intramuscular en el tratamiento inicial del estado epiléptico / Intramuscular midazolam in the initial treatment of status epilepticus

Introducción. El estado epiléptico es una complicación grave del síndrome epiléptico que presenta tasas elevadas de morbilidad y letalidad. El tratamiento se dirige a un rápido control delas crisis epilépticas. Objetivos. Evaluar la eficacia y seguridad del midazolam intramuscular (IM) en el tratamiento inicial del estado epiléptico en el adulto. Pacientes y métodos. Ensayo clínico abierto prospectivo que incluyó 43 episodios de estado epiléptico en 38enfermos. Todos los casos recibieron una dosis inicial de 15 mg IMde midazolam, con una dosis de carga oral simultánea de fenitoína (15-20 mg/kg) o carbamacepina (15 mg/kg). Si hubo control inmediato, pero con recurrencia de las crisis en las horas siguientes, se indicaron 15 mg IM cada 8 horas, durante 24 horas. Ante su fracaso inmediato se administró midazolam en infusión endovenosa (EV).Resultados. Se controlaron 36 de los 43 episodios de estado epiléptico:30 con 15 mg IM por una vez, tres necesitaron administración IM adicional y tres midazolam EV, sin complicación cardiovascular, respiratoria ni tisular local. El único efecto adverso fue somnolencia de grado variable. Conclusiones. Se sugiere el uso de midazolam IM en el tratamiento inicial del estado epiléptico en adultos, especialmente en un ambiente de baja complejidad tecnológica debido a su efectividad, rapidez de acción y seguridad (AU)

Introduction. The status epilepticus a serious complication of the epileptic syndrome with high rates of morbidity and mortality. Treatment is aimed to a fast control of the crisis. Aim. To evaluate the efficacy and security of intramuscular(IM) midazolam in the initial treatment of status epilepticus. Patients and methods. A prospective open clinical trial that included 43 status epilepticus in 38 adult patients. All of the cases received an initial dose of 15 mg IM of midazolam, with a simultaneous oral dose of phenytoin (15 to 20 mg/kg) or carbamazepine (15 mg/kg). If there was immediate control of the seizure but recurrence occurred during the next hours, 15 mg IM of midazolam every 8 hours were given, for 24 hours. If there was immediate failure intravenous (IV) midazolam was given. Results. 36 of the 43 status epilepticus were controlled: 30 with only one dose, 3 required additional IM doses, and 3 needed administration of IV midazolam, no patient had neither cardiovascular, respiratory or local complications. The only adverse effect was drowsiness in a variable grade. Conclusions. The use of IM midazolam is suggested as the initial treatment in status epilepticus in adults, especially in a low complexity setting, due to its effectiveness, quick action and security (AU)