[A multicentre epilepsy registry in Mexico]. / Registro multicéntrico de epilepsia en México.

INTRODUCTION: The National Epilepsy Registry in Mexico was carried out, from March 2021 to December 2022, in public hospitals of the Priority Epilepsy Program 'PPE', with the aim of describing the current situation in our pediatric and adult population. PATIENTS AND METHODS: Observational, cross-sectional, multicenter study. We used a database, according to classifications of the International League Against Epilepsy (ILAE) 2017. Patients of all ages were included, with a diagnosis of epilepsy according to the practical clinical definition ILAE 2014. RESULTS: We registered 10,852 patients, 5,495 men (50.6%) and 5,357 women (49.4%). Family history of epilepsy in 1,714 patients (15.8%), febrile seizures in 987 (9.1%). Type of seizure: 5,542 (51.1%) presented focal onset, of which 1,889 (34.1%) evolved to bilateral tonic-clonic seizures; generalized onset 4,861 (44.8%), unknown 33 (3.1%) and unclassified 115 (1.1%). Almost half had unknown etiology and 40% were structural, of which hypoxic ischemic encephalopathy was the most frequent (21.6%) and neurocysticercosis was 1%. Comorbidities appeared in 6,326 patients (58.3%). Anti-seizure medications (ASM) were used in 96.4% patients, mainly valproate. Status epilepticus was found in 1,383 patients (12.7%) and drug-resistant epilepsy in 18.9%. Paraclinical studies: 79.3% with at least one electroencephalogram and 76.9% with a neuroimaging study. Epilepsy surgery occurred in 275 patients (2.5%). CONCLUSIONS: Despite the efforts of the Pan American Health Organization in its Strategy and Action Plan on epilepsy, diagnostic technologies and ASM supply are still lagging behind.

TITLE: Registro multicéntrico de epilepsia en México.Introducción. Se realizó el Registro Nacional de Epilepsia en México, de marzo de 2021 a diciembre de 2022, en hospitales del sector público del Programa Prioritario de Epilepsia, para conocer la situación actual en población pediátrica y adulta. Pacientes y métodos. Es un estudio observacional, transversal y multicéntrico. Se utilizó una base de datos, acorde con las clasificaciones de la Liga Internacional Contra la Epilepsia (ILAE) de 2017. Se incluyó a pacientes de todas las edades, con diagnóstico de epilepsia según la definición clínica práctica de la ILAE de 2014. Resultados. Se registró a 10.852 pacientes, 5.495 hombres (50,6%) y 5.357 mujeres (49,4%). Había antecedente familiar de epilepsia en 1.714 pacientes (15,8%) y crisis febriles en 987 (9,1%). Los tipos de crisis eran: 5.542 (51,1%) de inicio focal, de las que 1.889 (34,1%) evolucionaban a bilateral tonicoclónica; 4.861 (44,8%) de inicio generalizado; 33 (3,1%) de inicio desconocido; y 115 (1,1%) no clasificadas. Casi la mitad tuvo etiología desconocida y el 40% fueron estructurales; de ellas, la encefalopatía hipóxico-isquémica fue la más frecuente (21,6%) y la neurocisticercosis fue el 1%. Las comorbilidades aparecieron en 6.326 pacientes (58,3%). El 96,4% fueron tratados con fármacos anticrisis epilépticas (FACE), principalmente ácido valproico. El estado epiléptico se encontró en 1.383 pacientes (12,7%), y la farmacorresistencia, en 18,9%. Respecto a los estudios paraclínicos, al 79,3% se le realizó al menos un electroencefalograma, y al 76,9%, un estudio de neuroimagen. Se realizó cirugía de epilepsia a 275 pacientes (2,5%). Conclusiones. A pesar del esfuerzo de la Organización Panamericana de la Salud en su Estrategia y Plan de Acción sobre la Epilepsia, las tecnologías diagnósticas y el abasto de los FACE aún se encuentran rezagados.

Actividad epileptiforme en trastornos psiquiátricos infantiles / Epileptiform activity in psychiatric disorders in children

Con frecuencia se observan anormalidades en la actividad eléctrica cerebral en pacientes con disfuncióncerebral. Pacientes y métodos. Analizamos de manera retrospectiva los resultados de los estudios electroencefalográficos realizados de agosto a diciembre de 2006, de niños con diagnóstico clínico de trastorno psiquiátrico, sin tener en cuentaa aquéllos con epilepsia. Resultados. Se revisaron 1.000 estudios de electroencefalogramas (EEG); la edad de los pacientes fue de 0 a 18 años, con un promedio de 9,7 años, y la relación por sexo fue de 67,9% varones y 32,1% mujeres. Los cuatro trastornos psiquiátricos más frecuentes fueron: trastorno por déficit de atención/hiperactividad, 422; trastorno depresivo,103; retraso mental, 99, y trastorno conductual, 96. Los EEG se dividieron en trazos normales (37,8%) y anormales (61,9%). La anormalidad más frecuente fue inmadurez bioeléctrica (56,4% de los casos). Al analizar actividades epileptiformes, encontramos26 estudios (2,6%) y datos de irritabilidad corticosubcortical en el 6,7%. El total de niños con grafoelementos epileptiformes fue 71. El grafoelemento más común fue la onda aguda (97,2%) y la localización en el lóbulo temporal (42,3%). Conclusiones. Un alto porcentaje de pacientes con trastornos psiquiátricos cursan anormalidades en su actividad eléctricacerebral, e incluso actividad epileptiforme. En la bibliografía se han comunicado anormalidades eléctricas en la población general de niños sanos, pero las cifras que encontramos son mayores para pacientes con trastorno psiquiátrico. Las neuronas funcionan mal y nos da diversidad de patologías. Es cuestionable la repercusión de la actividad eléctrica cerebral anormal, sobre los datos clínicos de los pacientes, y consideramos que se trata de un epifenómeno

Abnormalities are often observed in the electrical activity of the brain in patients with brain dysfunction.Patients and methods. We conducted a retrospective analysis of the results of electroencephalogram studies carried out between August and December 2006 on children who had been clinically diagnosed with a psychiatric disorder, without taking into account those with epilepsy. Results. A total of 1000 electroencephalogram (EEG) studies were reviewed; the age of thepatients ranged from 0 to 18 years, with an average of 9.7 years, and the ratio between sexes was 67.9% males and 32.1% females. The four most frequently observed psychiatric disorders were: attention deficit hyperactivity disorder, 422; depressive disorder, 103; mental retardation, 99; and behavioural disorder, 96. The EEG findings were divided into normal(37.8%) and abnormal patterns (61.9%). The most frequent abnormality was bioelectric immaturity (56.4% of cases). On analysing epileptiform activities, we found 26 studies (2.6%) and evidence of cortico-subcortical irritability in 6.7%. The total number of children with epileptiform patterns was 71. The most common pattern was the sharp wave (97.2%) and the mostfrequent location was the temporal lobe (42.3%). Conclusions. A high percentage of patients with psychiatric disorders also have abnormalities in the electrical activity of their brains, and even epileptiform activity. Electrical abnormalities in the general population of healthy children have been reported in the literature, but the figures that we found are higher for patients with psychiatric disorders. Functioning of the neurons is incorrect and this results in a range of different pathologies.The repercussion of abnormal electrical activity of the brain on the clinical data of the patients is open to discussion, and we consider it to be an epiphenomenon

[Epileptiform activity in psychiatric disorders in children]. / Actividad epileptiforme en trastornos psiquiátricos infantiles.

INTRODUCTION: Abnormalities are often observed in the electrical activity of the brain in patients with brain dysfunction. PATIENTS AND METHODS: We conducted a retrospective analysis of the results of electroencephalogram studies carried out between August and December 2006 on children who had been clinically diagnosed with a psychiatric disorder, without taking into account those with epilepsy. RESULTS: A total of 1000 electroencephalogram (EEG) studies were reviewed; the age of the patients ranged from 0 to 18 years, with an average of 9.7 years, and the ratio between sexes was 67.9% males and 32.1% females. The four most frequently observed psychiatric disorders were: attention deficit hyperactivity disorder, 422; depressive disorder, 103; mental retardation, 99; and behavioural disorder, 96. The EEG findings were divided into normal (37.8%) and abnormal patterns (61.9%). The most frequent abnormality was bioelectric immaturity (56.4% of cases). On analysing epileptiform activities, we found 26 studies (2.6%) and evidence of cortico-subcortical irritability in 6.7%. The total number of children with epileptiform patterns was 71. The most common pattern was the sharp wave (97.2%) and the most frequent location was the temporal lobe (42.3%). CONCLUSIONS: A high percentage of patients with psychiatric disorders also have abnormalities in the electrical activity of their brains, and even epileptiform activity. Electrical abnormalities in the general population of healthy children have been reported in the literature, but the figures that we found are higher for patients with psychiatric disorders. Functioning of the neurons is incorrect and this results in a range of different pathologies. The repercussion of abnormal electrical activity of the brain on the clinical data of the patients is open to discussion, and we consider it to be an epiphenomenon.

[A randomised open trial comparing monotherapy with topiramate versus carbamazepine in the treatment of paediatric patients with recently diagnosed epilepsy]. / Estudio abierto aleatorio y comparativo de monoterapia con topiramato frente a carbamacepina en el tratamiento de pacientes pediátricos con epilepsia de reciente diagnóstico.

INTRODUCTION: In some studies in children, topiramate showed efficacy. AIM: To evaluate efficacy, tolerability and safety of topiramate in monotherapy in newly diagnosed epilepsy vs carbamazepine in children. PATIENTS AND METHODS: In a multicentre, open-label, comparative and randomized study patients with partial epilepsy, were randomized to received topiramate or carbamazepine treatment. Patients with degenerative disease were excluded. Data were analysed by SPSS statistical program v. 11.0, and non parametric test. Comparisons between groups were made with chi square test and t Student's test. RESULTS: In total were included 88 patients, 33 in group 1 (topiramate), 32 group 2 (carbamazepine), 23 were drop-outs because adverse events and lost in follow-up (13 in group 1 y 10 group 2). In both groups were observed good efficacy, in month 6 and 9 of follow-up, the average of seizures in group 1 were better than group 2 (p = 0.01, t Student's test). The percentage of free seizure patients was greater in group 1 than group 2 (statistical significance p = 0.02 chi square test). The adverse events were similar in both groups and mild, somnolence 9%, weight loss 6% in group 1 and somnolence 19%, dizziness 3% and seizure discontrol 3% in group 2. CONCLUSIONS: Good efficacy in both groups, and topiramate in good treatment choice in newly diagnosed epilepsy in children because it's the efficacy and tolerability in comparison with the gold standard carbamazepine.