Epilepsia y embarazo / Epilepsy and pregnancy

Introducción. El tratamiento de la paciente con epilepsia durante la gestación constituye un importante dilema clínico. Por un lado, hay que mantener a la paciente libre de crisis, y por otro, procurar mantener a la paciente en monoterapia y con la menor dosis posible, por los efectos que éstos pueden tener sobre la descendencia. Desarrollo. Existe un síndrome relacionado con la exposición intraútero de fármacos epilépticos clásicos, que no se puede asociar a un determinado fármaco. Sin embargo, todavía hay una gran incógnita sobre los efectos de los nuevos fármacos antiepilépticos sobre los futuros hijos. Hasta el momento no se ha descrito ningún patrón de malformaciones específico para ninguno de estos fármacos. Entre ellos, la lamotrigina es con el que se tiene una experiencia clínica más amplia, y aunque el número de casos registrados hasta la actualidad es insuficiente para obtener conclusiones definitivas, de momento no se ha observado que haya una mayor incidencia de anomalías congénitas en comparación con la población normal. Conclusiones. Los nuevos fármacos antiepilépticos presentan una importante ventaja terapéutica, no sólo en el manejo de la epilepsia en diferentes situaciones clínicas, sino con los buenos resultados que se han observado con la utilización de lamotrigina en la paciente epiléptica en edad reproductiva (AU)

[Epilepsy and pregnancy]. / Epilepsia y embarazo.

INTRODUCTION: Treatment of the epileptic patient during pregnancy poses a major clinical dilemma. For one thing the patient has to be kept free of seizures, but she also should be kept on monotherapy at the lowest possible dose, due to the effect such medication may have on the unborn child. DEVELOPMENT: There is a syndrome related to intra uterine exposure to the classical antiepileptic drugs, but which is not associated with any particular drug. However, the effect of the new antiepileptic drugs on unborn children is still unknown. To date, no specific pattern of malformations has been described in relation to any of these drugs. Lamotrigine is the one with which there is most clinical experience. Although there are still not enough cases studied to permit definite conclusions to be drawn, at the moment the incidence of congenital anomalies is the same as in the general population. CONCLUSIONS: The new anti-epileptic drugs have a major therapeutic advantage, not only in the management of epilepsy in different clinical situations, but also in the good results observed when using lamotrigine in patients of fertile age.

[Neuropsychology of temporal partial epilepsy: a comparison of drug resistant and pharmacologically controlled patients]. / Neuropsicología de la epilepsia parcial temporal: comparación entre pacientes farmacorresistentes y pacientes controlados farmacológicamente.

INTRODUCTION: Various factors may contribute to cognitive deterioration in temporal lobe epilepsy, and there is controversy as to which has the greatest effect. PATIENTS AND METHODS: In this study, we establish a comparison between patients with temporal lobe epilepsy controlled by drugs and drug-resistant patients, with the object of discovering the effect of different factors in causing cognitive damage. RESULTS: The persons whose disorder was controlled by pharmacological means had better results in memory and intelligence tests than those with drug-resistance. The latter had alterations of declarative memory for verbal material (left) and for visio-spatial material (right) in delayed free recall tests. Also, the greater proportion of symptomatic epilepsies in the drug-resistant group affected their greater cognitive deterioration. CONCLUSIONS: Our results show that having long-standing epilepsy with great frequency of seizures and symptomatic epilepsy is correlated with cognitive alterations in memory function in temporal lobe epilepsy. Most deterioration is seen in patients with long-standing drug resistant symptomatic left mesial temporal epilepsy.

Hereditary branchial myoclonus with spastic paraparesis and cerebellar ataxia: a new autosomal dominant disorder.

We report a family with branchial myoclonus, spastic paraparesis, and cerebellar ataxia in which six members were affected in two generations and the inheritance appeared to be autosomal dominant. Age at onset ranged from 40 to 50 years. Rhythmic myoclonus involving the palate, pharynx, larynx, and face was followed by truncal ataxia and spastic paraparesis in most patients. CT and MRI revealed mild atrophy of the cerebral and cerebellar cortex and severe atrophy of the medulla and spinal cord. The pons appeared normal and the olives not hypertrophic. CSF studies revealed severe reduction of the serotonin metabolite 5-hydroxyindoleacetic acid. Treatment with 5-hydroxytryptophan and carbidopa at highest tolerated dose mildly improved ataxia but did not modify the myoclonus. Treatment with anticholinergics, benzodiazepines, phenytoin, valproate, carbamazepine, and baclofen was unsuccessful. The clinical symptoms were progressive, leading to death or severe disability 5 to 10 years after the onset of the disease.