Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross-sectional study.

OBJECTIVE: To describe the sociodemographic and clinical characteristics of imprisoned patients with epilepsy seen at Samaritana University Hospital (HUS) in Bogotá D.C., between January 2017 and November 2020. METHODS: Cross-sectional cohort study of inmate patients over 18 years of age seen at HUS between January 2017 and November 2020, with a discharge diagnosis of epilepsy. A descriptive univariate analysis of patient sociodemographic and clinical characteristics was carried out. RESULTS: Overall, 92 patients were included, 95.7% were males with a median age of 32 years (IQR: 26-44); 65% were assessed in the outpatient clinic; median hospital length of stay was 2 days (IQR: 0) and 7.6% required admission to the intensive care unit; 75% had focal onset epilepsy, 63.04% with undetermined etiology 31.52% with structural causes. Polytherapy was found in 53.3%, valproic acid being the most frequently used antiseizure medication in 59.78%; lack of adherence was reported in 15.22% and inadequate seizure control in 81.52%; status epilepticus occurred in 5.34%. A total of 31 EEG recordings and 53 brain images were performed, of which, 29% and 39.62%, respectively, were abnormal. Non-epileptic paroxysmal events were diagnosed in 5.34%, while organic or psychiatric comorbidities were found in 25%, and the use of psychoactive substances was documented in 17.39%. Upon discharge, 93.47% had no disability, and only 45.65% returned for outpatient follow-up. SIGNIFICANCE: The clinical profile was of men in the fourth decade of life with focal onset epilepsy characterized by high seizure frequency, most of whom were receiving antiseizure medication, with a high proportion of polytherapy. The results are a point of departure for prospective studies designed to identify points to intervene and improve healthcare for inmates with epilepsy. PLAIN LANGUAGE SUMMARY: Inmates are a vulnerable proportion of persons with epilepsy. In this group there are significant differences compared to the general population, especially with greater psychiatric comorbidity and worse control of epileptic seizures due to difficulties in accessing medical care, antiseizure medication and diagnostic tests. We found that the most characteristic population is made up of men in the fourth decade of life with a high frequency of seizures, most of whom were receiving multiple antiseizure medication This study is the first of its kind in Latin America and it is an initial approach to epilepsy in inmates.

Estudio comparativo del EEG con privación de sueño y el EEG convencional seriado en pacientes con diagnóstico de epilepsia / Comparative study of EEG with sleep deprivation and a conventional serial EEG in patients with epilepsy

El diagnóstico de epilepsia se hace con base en la información de la historia clínica. Un EEG, único puede ser normal en 35.50/100 de los pacientes con epilepsia; y por ello se realizan EEG seriados, o se utilizan métodos que buscan activar el EEG como la privación de sueño y los de registros continuos. El objetivo del estudio fue evaluar la utilidad, del electroencefalograma con privación de sueño frente al convencional seriado de vigilia en el diagnóstico de la epilepsia. El estudio concluye que el electroencefalograma con privación de sueño y el tercer EEG seriado de vigilia duplican la sensibilidad del segundo EEG de vigilia, el primerotiene una especificidad similar a la de un tercer EEG seriado de vigilia y probabilidades muy superiores de evidenciar la actividad epileptiforme interictal con una menor tasa de falsos positivos, y mejores VPP, VP, PPP