Factors associated with treatment delays in pediatric refractory convulsive status epilepticus.

OBJECTIVE: To identify factors associated with treatment delays in pediatric patients with convulsive refractory status epilepticus (rSE). METHODS: This prospective, observational study was performed from June 2011 to March 2017 on pediatric patients (1 month to 21 years of age) with rSE. We evaluated potential factors associated with increased treatment delays in a Cox proportional hazards model. RESULTS: We studied 219 patients (53% males) with a median (25th-75th percentiles [p25-p75]) age of 3.9 (1.2-9.5) years in whom rSE started out of hospital (141 [64.4%]) or in hospital (78 [35.6%]). The median (p25-p75) time from seizure onset to treatment was 16 (5-45) minutes to first benzodiazepine (BZD), 63 (33-146) minutes to first non-BZD antiepileptic drug (AED), and 170 (107-539) minutes to first continuous infusion. Factors associated with more delays to administration of the first BZD were intermittent rSE (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.14-2.09; p = 0.0467) and out-of-hospital rSE onset (HR 1.5, 95% CI 1.11-2.04; p = 0.0467). Factors associated with more delays to administration of the first non-BZD AED were intermittent rSE (HR 1.78, 95% CI 1.32-2.4; p = 0.001) and out-of-hospital rSE onset (HR 2.25, 95% CI 1.67-3.02; p < 0.0001). None of the studied factors were associated with a delayed administration of continuous infusion. CONCLUSION: Intermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to administration of the first BZD and the first non-BZD AED in pediatric rSE. These factors identify potential targets for intervention to reduce time to treatment.

Early thalamic lesions in patients with sleep-potentiated epileptiform activity.

OBJECTIVE: To compare the prevalence and type of early developmental lesions in patients with a clinical presentation consistent with electrical status epilepticus in sleep either with or without prominent sleep-potentiated epileptiform activity (PSPEA). METHODS: We performed a case-control study and enrolled patients with 1) clinical features consistent with electrical status epilepticus in sleep, 2) ≥1 brain MRI scan, and 3) ≥1 overnight EEG recording. We quantified epileptiform activity using spike percentage, the percentage of 1-second bins in the EEG tracing containing at least 1 spike. PSPEA was present when spike percentage during non-REM sleep was ≥50% than spike percentage during wakefulness. RESULTS: One hundred patients with PSPEA (cases) and 47 patients without PSPEA (controls) met the inclusion criteria during a 14-year period. Both groups were comparable in terms of clinical and epidemiologic features. Early developmental lesions were more frequent in cases (48% vs 19.2%, p = 0.002). Thalamic lesions were more frequent in cases (14% vs 2.1%, p = 0.037). The main types of early developmental lesions found in cases were vascular lesions (14%), periventricular leukomalacia (9%), and malformation of cortical development (5%). Vascular lesions were the only type of early developmental lesions that were more frequent in cases (14% vs 0%, p = 0.005). CONCLUSIONS: Patients with PSPEA have a higher frequency of early developmental lesions and thalamic lesions than a comparable population of patients without PSPEA. Vascular lesions were the type of early developmental lesions most related to PSPEA.

Síndrome metabólico en pacientes tratados con antipsicóticos de segunda generación en monoterapia / Metabolic syndrome in patients treated with second-generation antipsychotic medication monotherapy

Introducción: El objetivo de este trabajo es determinarla presencia de síndrome metabólico en pacientes atratamiento con nuevos antipsicóticos y comprobar quétratamiento reciben con el fin de corregir estas alteracionesmetabólicas.Métodos: Son seleccionados 44 pacientes en una unidadde salud mental, con diagnósticos de patologíasmentales diversos. Se diagnostican de síndrome metabólicosegún los criterios de la ATP-III.Resultados: Cumple criterios diagnósticos para síndromemetabólico un 25% de los pacientes incluidos enel estudio. Al menos el 80% de los pacientes con algunaalteración metabólica no recibe el tratamiento adecuado.Conclusiones: En caso de evidenciarse datos similaresen muestras de este tipo de población, implicaría lanecesidad de aplicar protocolos de tratamiento paramejorar la salud física de pacientes

Introduction: The aim of this study is to clarify thepresence of metabolic syndrome in patients treated withsecond-generation antipsychotic medication and tocheck what therapy they are having for these metabolicabnormalities.Methods: 44 patients at a mental health unit areincluded, with different mental disorders diagnosis.They are diagnosed with metabolic syndrome accordingto ATP-III diagnostic criteria.Results: Among the patients included in the study25% conform to the metabolic syndrome diagnostic criteria.At least 80% of the patients with some metabolicabnormality are not being appropriately treated.Conclusions: These data would imply the need toapply treatment guidelines In case of evidence of similardata in the same kind of population samples toimprove patients’ physic health (AU)