Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Infants, Children, and Adolescents with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations.

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition to the outcomes identified for the ICHOM Epilepsy adult standard set, behavioral, motor, and cognitive/language development outcomes were voted as essential for all infants and children with epilepsy. The proposed set of outcomes and measurement methods will facilitate the implementation of the use of patient-centered outcomes in daily practice.

Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Adults with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations.

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient-clinician decision-making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross-cultural applicability. The essential outcomes included many non-seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep quality, functional status, and the social impact of epilepsy. The proposed set will facilitate the implementation of the use of patient-centered outcomes in daily practice, ensuring holistic care. They also encourage harmonization of outcome measurement, and if widely implemented should reduce the heterogeneity of outcome measurement, accelerate comparative research, and facilitate quality improvement efforts.

Three-year incidence and acute setting predictors of epilepsy after neonatal and childhood arterial ischaemic stroke: a disease-based cohort study.

To assess the association between clinical and MRI characteristics of arterial ischaemic stroke (AIS) and the 3-year risk of post-stroke epilepsy (PSE) in paediatric patients. Retrospective cohort study. Database from a single tertiary referral centre for paediatric stroke in Chile. Two hundred seven neonates and children (1 day to 18 years) with a first-ever supratentorial AIS diagnosed between January 2003 and December 2019 were evaluated. Diagnosis of PSE and explanatory variables were consecutively recorded from hospital inpatient and annual outpatient records in a predesigned database. Competing risk analysis (competing events: death and loss to follow-up) of multiple Cox proportional hazards regression was performed to estimate adjusted subhazard ratios (SHRs) of PSE. Confidence intervals (95% CI) were calculated using bootstrap resampling (1000 replications). Interaction terms were added to investigate moderating effects. The 3-year incidence rate of PSE was 166.5 per 1000 person-years (neonatal: 150.1; childhood: 173.9). The 3-year cumulative incidence was 33%. Patients with acute symptomatic non-status seizures (SHR = 3.13; 95% CI = 1.43-6.82), status epilepticus (SHR = 5.16; 95% CI = 1.90-13.96), abnormal discharge neurological status (SHR = 2.52; 95% CI = 1.12-5.63), cortical lesions (SHR = 2.93; 95% CI = 1.48-5.81), and multifocal infarcts with stroke size < 5% of supratentorial brain volume (SHR = 3.49; 95% CI = 1.44-8.46) had a higher risk of PSE. CONCLUSION: This study identified specific and reliable acute clinical and imaging predictors of PSE in paediatric patients, helping clinicians identify high-risk patients with potential implications for treatment decisions. WHAT IS KNOWN: • Numerous risk factors have been proposed for post-stroke epilepsy, but there is a lack of studies evaluating these variables while accounting for confounding factors and competing risks over time. WHAT IS NEW: • After adjustment for competing events, acute symptomatic seizures, both non-status and status epilepticus, abnormal mental status or motor neurological examination at hospital discharge, cortical involvement, and multifocal ischaemic lesions in small strokes are all independent predictors of post-stroke epilepsy. • Knowing the predictors of post-stroke epilepsy is essential for clinicians to make well-informed and effective decisions about treatment.

Perfil Neurocognitivo de una cohorte de menores de edad con vivencias de maltrato infantil / Neuropsychological profile of a cohort of children victims of child abuse

El maltrato infantil (MI) es un problema multidimensional. El estrés crónico producido por dicho fenómeno afecta el desarrollo cerebral de niños, niñas y adolescentes (NNA), incidiendo negativamente en la evolución de diversos aspectos del desarrollo, condicionando su vida futura. El objetivo de este estudio es analizar el desempeño sociocognitivo de NNA que han vivenciado MI, mediante el análisis de las funciones del neurodesarrollo, evaluado con subpruebas de la NEPSY II. Se analizan funciones ejecutivas y percepción social, bases del razonamiento y adaptación social. Se estudia el desempeño de 14 de NNA pertenecientes a un Programa de la Fundación Súmate, cuya Misión es la recuperación de la escolaridad NNA que han visto alterado el curso de su desarrollo por MI. Los resultados dan cuenta de alteraciones cerebrales asociadas al MI, las que se evidencian en un deficitario desarrollo funcional de las variables estudiadas. Existe grave descenso en los procesos y subprocesos del funcionamiento ejecutivo. En relación con la percepción social, la muestra estudiada presenta un mejor desarrollo, el que desciende a medida que aumenta la edad. Las funciones estudiadas tienen directa relación con el razonamiento cognitivo y desarrollo socio adaptativo, bases sobre las que se estructura el desarrollo académico. Los hallazgos, refuerzan la urgencia de abordar esta sensible realidad desde la práctica médica en la atención primaria y especializada. Los resultados también son de utilidad para orientar el desarrollo de políticas públicas que efectivamente contribuyan al progreso de nuestro país.

Abstract. Child maltreatment (MI) is a multidimensional problem. The chronic stress produced by this phenomenon affects the brain development of children and adolescents (NNA), negatively affecting the evolution of various aspects of development, conditioning their future life. The objective of this study is to analyze the sociocognitive performance of children and adolescents who have experienced IM, through the analysis of the performance of neurodevelopmental functions, evaluated through subtests of the NEPSY II. Executive functions and social perception, reasoning bases and social adaptation are studied. The performance of 14 NNA belonging to a Fundación Súmate Program is studied, whose mission is the recovery of NNA schooling that has seen the course of their development altered by IM. The results show brain alterations associated with MI, evidenced in a deficient functional development of the variables studied. There is a serious decline in the processes and threads of executive functioning. In relation to social perception, the studied sample presents a better development, which decreases as age increases. The functions studied are directly related to cognitive reasoning and socio-adaptive development, based on which academic development is structured. The findings reinforce the urgency of addressing this sensitive reality from medical practice in primary and specialized care. The results are also useful to guide the development of public policies that effectively contribute to the progress of our country.

Análisis de causas atribuidas a "BRUE" entre los años 2017 a 2020 / Analysis of etiologies attributed to "BRUE" between the years 2017 to 2020

El término BRUE describe un evento en un lactante menor, repentino, breve, ya resuelto y sólo aplica cuando no existe una explicación para este episodio. Es escasa la literatura nacional e internacional sobre el estudio etiológico en BRUE. Objetivos: Caracterizar lactantes con episodio de BRUE y hacer un análisis etiológico. Métodos: Estudio retrospectivo, descriptivo lactantes hospitalizados por BRUE. Resultados: Se encontraron 50 lactantes con BRUE, la mayoría de ellos presentó un solo evento y ninguno requirió reanimación cardiopulmonar. Las características principales de los eventos fueron apnea, cianosis y tono disminuido. Las etiologías encontradas, más habituales, fueron reflujo gastro-esofágico, infección respiratoria, mala técnica alimentaria y crisis epilépticas. La evaluación clínica fue el principal elemento diagnóstico. Discusión: Nuestro análisis etiológico concuerda con la literatura nacional e internacional. La anamnesis y examen físico son la principal herramienta diagnóstica. Es fundamental contar con guías, adaptadas a la realidad nacional y local, que dirijan el estudio de lactantes con BRUE.

BRUE is an event occurring in an infant when the observer reports a sudden, brief, and now-resolved episode. BRUE is a diagnosis of exclusion and is used only when there is no explanation for the event after conducting an appropriate history and physical examination. There is little literature on the etiological study in BRUE. Objectives: To characterize infants with a BRUE episode and to carry out an etiological analysis. Methods: A retrospective study including infants who have experienced a BRUE between the years 2017 to 2020. Results: 50 infants with BRUE, most of them presented a single event and none required cardiopulmonary resuscitation. The main characteristics of the events were apnea, cyanosis and decreased tone. The most common etiologies found were gastroesophageal reflux, respiratory infection, poor feeding technique, and seizures. History and physical examination are the fundamental diagnostic tools. Discussion: Our etiological analysis agrees with the national and international literature. The clinical evaluation was the main diagnostic tool. It is essential to create local guidelines for the evaluation investigation and management of infants with BRUE.

Polysomnographic findings in 320 infants evaluated for apneic events.

Apnea is a common problem that causes significant parental anxiety. The aim of this study was to describe polysomnographic findings in infants who were referred over a 4-year period for an apnea and/or cyanotic event. Our hypothesis was that most infants with apnea or cyanosis events will have normal polysomnography (PSG). In total, 320 patients younger than 2 years old were recruited sequentially and prospectively. Patients underwent a day or overnight PSG by computerized polysomnograph; 78% of studies were performed with pH probe in situ. Subjects' ages ranged from 10 days to 21 months (55% male and 84% full-term babies); 55% and 74% were younger than 3 and 6 months, respectively. The average total sleep time was 473.4 min (SD, 52.3), with mean sleep efficiency of 83.5%. The distribution of sleep stages was 56.5% active, 38.5%, quiet and 5.1% indeterminate sleep. Sixty-nine percent (n = 220) of PSG studies were done overnight. There were significant differences in average sleep efficiency (78.1% vs. 83.3%) and REM sleep time (63.6% vs. 59.1%) between PSGs done during the day and overnight (P < 0.05). In total, 34 patients with apneas were studied. The median apnea index for the whole study population was 1.01 (range, 0.1-9.1). In conclusion, our study showed a high prevalence of normal polysomnographic findings in infants referred because of apnea and/or cyanotic events. New clinical prospective studies should be conducted to evaluate whether there is a correlation between PSG findings and outcome at follow-up of infants with a history of apnea and cyanosis.

Existencia de materiales educativos sobre epilepsia en Latinoamérica: fase exploratoria / Existence of epilepsy educational materials in Latin America: exploratory phase

La epilepsia, afecta al 2-4% de la población general, siendo más frecuente en países en desarrollo, debido al deficiente entorno, condiciones y calidad de vida de las personas. El tratamiento de las crisis epilépticas es fundamental, pero tan importante como aquello, es el manejo del estigma y la discriminación que en muchos casos lleva aparejado a esta condición. El International Bureau for Epilepsy (IBE), International League Against Epilepsy (ILAE), Organización Panamericana de la Salud (OPS), Organización Mundial de la Salud (OMS) y los diferentes ministerios y organizaciones regionales latinoamericanos y del caribe, han estado trabajando sobre esta problemática. Es así como se hizo el documento de las Estrategias y Plan de acción sobre Epilepsia, en el cual, en uno de sus cuatro ejes programáticos está muy destacado, la educación a todo nivel. El Comité Regional Latinoamericano del IBE (REC-LA), en consonancia con dicho Plan Estratégico, se ha propuesto indagar en una primera fase, sobre el material educativo en epilepsia que existe en Latinoamérica, para posteriormente poder tener acceso y compartirlo. El objetivo es entrenar y educarnos respectivamente ya sea a profesionales de la salud como público en general y poder contribuir a sacar la epilepsia de las sombras, mejorando de esta manera la calidad de vida de las personas con epilepsia y su entorno. Aquí se muestra la primera etapa exploratoria del material educativo existente.

Epilepsy affects 2-4% of the general population, being more common in developing countries, due to the population's poor environment, conditions and quality of life. Treatment of seizures is essential, but just as important is the management of stigma and discrimination. The International Bureau for Epilepsy (IBE), International League Against Epilepsy (ILAE), Pan American Health Organization (PAHO), World Health Organization (WHO) and the various ministries and regional organizations have been working on this problem. This is how the document of the Strategies and Plan of Action on Epilepsy was made, in which one of its four programmatic axes, education at all levels, is very prominent. The Latin American Regional Committee of the IBE (REC-LA), in line with this Strategic Plan, has proposed a first phase to investigate the educational material in epilepsy that exists in Latin America, to be later able to access and share it. The goal is to train and educate both health professionals and the general public, and to help cast light on epilepsy, improving the quality of life of people with epilepsy and their environment. Here is the first exploratory stage of the existing educational material.

Epilepsia y pandemia por COVID-19: recomendaciones para un manejo integral / Epilepsy and pandemic by COVID-19: recommendations for an integral management

La pandemia de COVID-19, nos ha enfrentado una situación de emergencia que ha impactado múltiples aspectos de la vida diaria y además dificultades asociadas al manejo de las enfermedades crónicas como la epilepsia, en la cual la adherencia al tratamiento, los costos y las comorbilidades, juegan un rol importante. También el personal que trabaja o que atiende a los pacientes con epilepsia, su entorno y familiares han debido modificar su accionar. Hay pacientes, que han mejorado el control de sus crisis por diferentes motivos y otros en cambio, han empeorado y además han evolucionado con mayor ansiedad. El objetivo de este artículo es revisar diferentes elementos a considerar en el manejo de las epilepsias en el contexto de la pandemia por COVID-19.

The COVID-19 pandemic has faced us with an emergency situation that has impacted multiple aspects of daily life and also difficulties associated with the management of chronic diseases such as epilepsy, in which adherence to treatment, costs and comorbidities, play an important role. Also, the staff who work with or care for patients with epilepsy, their environment and family members have had to modify their actions. There are patients, who have improved the control of their seizures for different reasons while others have worsened and have also presented with greater anxiety. The objective of this article is to review different elements to consider in the management of epilepsy in the context of the Pandemic by COVID-19.

Mutación de protocadherina 19 (PC-DH19), en paciente con epilepsia refractaria / Mutation of protocadherin 19 (PCDH19), in patients with refractory epilepsy

Paciente de 4 años de edad, con epilepsia de difícil manejo, cuya etiología se atribuye a patología autoinmune y que finalmente se diagnostica una mutación de protocadherina (PCDH19). Se discute la fisiopatología, características clínicas, exámenes y los posibles tratamientos.

Four-year-old patient with intractable epilepsy, whose etiology is attributed to autoimmune pathology and who is eventually diagnosed with a protocadherin mutation (PCDH19). Pathophysiology, clinical characteristics, examinations and possible treatments are discussed.

Nutrición y sueño / Nutrition and sleep

La nutrición correcta es relevante para un buen sueño, conocidos son los beneficios del sueño en la fisiología metabólica y cognitiva; su papel en la genética y la inmunidad a lo largo de la vida. Se presenta a continuación cómo la nutrición podría contribuir por varios factores, tanto en los genes reloj y su papel en el ritmo circadiano y hormonal, así como en la formación de neurotransmisores relacionados con el sueño. También se menciona su papel en los cronotipos y varios alimentos que mejorarían nuestro sueño. Concluimos que es importante como medida de salud pública en nuestros pacientes en un contexto de vida agitada, con altas tasas de exceso de desnutrición, y evitando la automedicación con hipnóticos para lograr un buen sueño. Palabras clave: Crononutrición, genes del reloj, cronotipos, nutrientes, sueño.

The right nutrition is relevant for good sleep, the benefits of sleep on metabolic and cognitive physiology are well known, as is their role in genetics and immunity throughout life. We explore how nutrition could contribute through several factors, both in the clock genes and their role in circadian and hormonal rhythm, as well as through the formation of sleep-related neurotransmitters. Its role in chronotypes and various foods that would improve our sleep is also mentioned. We conclude that it is important to intervene nutrition as a public health measure in our patients, who have a hectic life context, with high rates of excess malnutrition, and thus avoiding self-medication with hypnotics to achieve a good sleep. Keywords: Timeline, clock genes, chronotypes, nutrients, sleep

Diagnostic accuracy of the Spanish version of the Pediatric Sleep Questionnaire for screening of obstructive sleep apnea in habitually snoring children.

OBJECTIVES: We aimed to determine the diagnostic test accuracy of the Spanish version of the respiratory symptoms scale of the Pediatric Sleep Questionnaire (PSQ) in habitually snoring children for identifying obstructive sleep apnea (OSA). METHODS: Habitually snoring children referred for polysomnography (PSG) were recruited. Parents answered the PSQ prior to PSG. Based on an apnea-hypopnea index (AHI) >1.0 in PSG, children were divided into OSA and primary snorers. Correlations to PSG indices and diagnostic test accuracy measures were calculated. RESULTS: Of the 83 (n = 53 males, mean age 9.5 ± 3.6 years) habitually snoring children included, 35 had OSA. The previously validated PSQ cutoff value of 0.33 showed a specificity of 0.72 and sensitivity of 0.78. The PSQ score correlated significantly with the AHI rs = 0.313 (p-value = 0.004). Six items of the PSQ were significantly different between cases and controls. A subscale constructed on these six PSQ items concerning respiratory symptoms showed a good sensitivity (0.886) and an excellent negative likelihood ratio (0.261). PSQ was able to identify 89% of the children with OSA correctly. CONCLUSIONS: This version of the PSQ was able to identify children with OSA, separating them from those with primary snoring. The use of this simple, standardized questionnaire tool seems to be helpful and may improve clinical decision making in habitually snoring children.

Recomendación de experto: apneas respiratorias y parámetros de sueño en el recién nacido y lactantes menores de 3 meses / Expert consensus: management of respiratory apneas and sleep parameters in newborn and infants under 3 months

El diagnóstico de apneas en lactantes menores de tres meses constituye un gran desafío y es un área en pleno desarrollo. Es por esto, que diferentes especialistas en sueño, pertenecientes a dos Sociedades Científicas de Chile: la Comisión de Sueño, de la Sociedad Chilena de Neumología Pediátrica (SOCHINEP) y el Grupo de Trabajo Trastornos del Sueño en Pediatría de la Sociedad de Psiquiatría y Neurología de la Infancia y Adolescencia (SOPNIA), se han puesto de acuerdo en proponer un consenso básico sobre los parámetros de sueño y del manejo de las apneas en los menores de 3 meses de vida. El objetivo, es que podamos contribuir al manejo de estos pacientes, con un lenguaje y manejo similar, y valores de referencia apropiados para ese grupo etario, respaldado con las últimas investigaciones al respecto.

Sleep apnea diagnosis in infants younger than 3 months has been a major challenge for modern medicine. Using current literature, experts from the Chilean Society of Pediatric Pulmonology Sleep Commission, and the Chilean Society of Psychiatry and Neurology for Children and Adolescents, have produced a national state-of-the-art consensus. The main goal of this statement is to unify our language in this matter, based on the latest evidence.

Síndrome de piernas inquietas en niños: caracterización clínica / Characterization of restless leg syndrome in children

El Síndrome de piernas inquietas (SPI) o Enfermedad de Willis­Ekbom, es una condición neurológica que afecta al 2-4% de los niños en edad escolar. Etiológicamente se ha relacionado al metabolismo del hierro y a factores genéticos entre otros. En niños aun es una patología poco diagnosticada. Trabajo observacional descriptivo, en el cual se realiza caracterización clínica, según criterios internacionales, en 14 pacientes menores de 18 años, 9 varones. Edad promedio 8 años. Sintomatología inicial variada, desde resistencia a ir a la cama, hasta dibujar sus molestias. En 10 se comprobó déficit de hierro. En 11 pacientes se realizó un polisomnograma, 10 de ellos con un índice elevado de movimientos periódicos de extremidades. El uso de pregabalina y aporte de hierro fue el tratamiento más utilizado. Dos pacientes tenían padres diagnosticados con SPI.

Abstract. The Restless Legs Syndrome (RLS) or Willis-Ekbom Disease is a neurological condition that affects 2-4% of school-age children. Its etiology has been related to the metabolism of iron and genetic factors among others. In children it is still a frequently undiagnosed disorder. This is a descriptive observational report, in which clinical characterization is carried out according to international criteria in 14 patients under 18 years old, 9 boys. Average age is 8 years old. The initial symptomatology was varied, from resistance to comply with bedtime, to drawing their discomfort. In 9, iron deficiency was found. A polysomnogram was performed in 11 patients, 10 of which had a high periodic limb movements index. The use of pregabalin and supplementary iron were the most used treatments. Two patients had parents diagnosed with RLS.

¿Qué sabemos sobre superdotación? Nueva visión y desafíos futuros / What do we know about giftedness? New vision and future challenges

La superdotación es una condición que genera interés y curiosidad en nuestra sociedad. Lamentablemente es un tema muchas veces omitido en la educación médica, especialmente en nuestro país, por lo que es posible que los profesionales de la salud tengamos escasos conocimientos y muchas preguntas acerca de esta condición. El objetivo de esta revisión narrativa es recopilar la evidencia disponible a la fecha sobre la superdotación, para así ampliar nuestro conocimiento sobre esta condición y mejorar la forma de enfrentar a aquellos que la presentan. ¿Qué se entiende por superdotación? ¿existen bases neurobiológicas que la sustenten? ¿tienen mayor o menor riesgo de psicopatología? estas y otras preguntas se abordan en el presente artículo.

Giftedness is a condition that generates interest and curiousness in our society. Unfortunately, it is a topic often omitted in medical education, especially in our country, so it is possible that health professionals have little knowledge and many questions about it. The aim of this narrative review is to collect the evidence available to date on giftedness, in order to expand our knowledge about this condition and improve the way of dealing with those who present it. What do we understand when we talk about giftedness? Are there neurobiological bases that support it? Do they have a greater or lesser risk of psychopathology? These and other questions are addressed in this article.

Episodios Ictales: Descripción de un Caso Clínico / Ictal events: a case report

Caso clínico de una paciente de once años que debuta con episodios de pérdida de tono y luego hipersomnolencia. Consulta en reiteradas ocasiones con el diagnóstico de epilepsia, con estudios electroencefalográficos y resonancia magnética cerebral, normales. Tratada durante un año con ac. valproico. Posteriormente se indica realización de Polisomnograma y Test de latencias múltiples de Sueño, confirmándose diagnóstico de narcolepsia y un trastorno del ánimo. Se inicia tratamiento con psicoestimulantes y antidepresivos. Evoluciona, con una mejoría de su cataplejía, hipersomnia y aspecto anímico. Se analiza caso, como diagnóstico diferencial de niños con episodios de pérdida de tono muscular e hipersomnolencia diurna, con conservación de conciencia y además se discute el manejo y las comorbilidades asociadas.Palabras claves: Episodios ictales, hipersomnolencia, narcolepsia, cataplejía, síncope

Summary: Case report of an eleven year old patient who debuts with hypersomnolence and episodes of muscle tone loss. She repeatedly receives a diagnosis of epilepsy, with normal EEG studies and brain MRI. She received a 12 month course of valproic acid treatment. A polysomnogram and multiple sleep latency test were subsequently performed, confirming a diagnosis of narcolepsy and a mood disorder. She begins treatment with antidepressants and psychostimulants. At follow up, she shows an improvement of her cataplexy, hypersomnia and mood disorder.We analyze this case to consider this pathology in the differential diagnosis of children with daytime hypersomnolence and episodes of muscle tone loss, with conserved awareness, as well as to discuss management and associated comorbidities. Key words: Ictal hypersomnolence, narcolepsy, cataplexy, syncopal episodes.

Intervenciones de niños, niñas y adolescentes con vulneración de derechos: Evaluación de funciones ejecutivas y habilidades parentales / Interventions for infringement on rights of children and adolescents: Executive functions and parental skills evaluation

La interacción con los padres o adultos significativos (P/AS) en los primeros años de vida, afecta el desarrollo de las funciones ejecutivas (FE), y éstas a su vez, en el rendimiento escolar de niños y niñas (NN). El maltrato se asocia a trastornos en el desarrollo de las FE. En Chile, 173000 NN se encuentran judicializados por algún tipo de maltrato y han sido derivados al SENAME. Pruebas estandarizadas miden FE y Habilidades Parentales (HP). Se busca explorar las FE en NN judicializados (NNj) y las HP de sus P/AS. Objetivo. Medición de FE en NNj y de HP en sus P/AS y establecer la relación entre sus resultados y compararlas con un grupo control. Metodología: NN de 2° ciclo escolar básico y uno de sus P/AS: Estudio 25 NNM (promedio 10,3 años) del Programa de Prevención Focalizada San José de Peñalolén; Control 24 NN no judicializados (NNn) (10,6 años) de dos colegios (de Ñuñoa y Peñalolén). Consentimiento informado firmado de cada participante. El estudio ingresó al Comité de ética de la Pontificia Universidad Católica de Chile (PUC). Enero-Julio/2017, se aplicó el Test ENFEN© a los NN (mide FE) y la Prueba E2P© (mide HP) a sus P/AS. Se calcula promedio ± DE a cada prueba y se realiza prueba t y de Levene para comparar grupos. Resultados: (NNM; NNn) ENFEN 3.09 ±1.66; 6.45 ±0.75; IC: [-4,1- -2,1] α: 0,005. E2P©: 76.3 ±12.06; 81.8±5. IC [-10,1- -0,06] α 0,001. Discusión: Los resultados demuestran que existe relación entre HP y FE en el contexto del maltrato. Palabras Clave: Funciones ejecutivas, maltrato infantil, habilidades parentales, vulneración de derechos

Summary. Introduction. Interaction with parents or significant adults (P/AS) in early childhood affects the development of executive functions (FE), and these in turn, in school performance of boys and girls (NN). Child abuse is associated with disorders in the development of the FE. In Chile, there are 173000 NN involved in legal cases prosecuted for child abuse, who have been referred to SENAME. There are standardized tests that measure FE and parental skills (HP). This study seeks to explore the FE in these NN (NNM) and the HP of their P/AS. Goal. Measurement of FE in NNM and HP on their P/AS to establish a relationship between its results and compared to a control group. Methodology: NN of 2nd cycle basic school and one of their P/AS: study of 25 NNM (average 10.3 years) of the Focused Prevention Program San Jose of Peñalolén; control group are 24 NN not involved in child abuse cases (NNn) from two schools (in Ñuñoa and Peñalolén) (10.6 years). A signed informed consent of each participant was obtained. The study was approved by the Ethics Committee of PUC. From January to July / 2017, the Test ENFEN © was applied to NN (measured on FE) and the E2P © test (measures HP) to their P/AS. The average ±SD to each test, t and Levene tests were calculated to compare the groups. Results: (NNM; NNn) ENFEN 3.09 ±1. 66; 6.45 ±0. 75; CI: [- 4.1-2.1] Α: 0.005. E2P ©: 76.3 ±12. 06; 81. 8±5. IC [- 10.1-0.06] Α 0.001. Discussion: The results show that there is a relationship between HP and FE in the context of child abuse. Key words: Executive functions, parenting skills, child abuse, violation of rights, focused prevention.

Caracterización del Insomnio en Lactantes a través de Actigrafía / Characterization of Insomnia In Infants through Actigraphy

Resumen. El Insomnio infantil definido como la dificultad mantenida, a pesar de la oportunidad y en función etaria, para iniciar o mantener el sueño o su calidad que provoca alteraciones funcionales en el niño y/o familia. Puede repercutir significativamente en la conducta, aprendizaje y metabolismo del niño y en su familia afectando su calidad de vida. La actigrafía nos permite a través de un dispositivo identificar periodos de vigilia y sueño. El objetivo de este trabajo es caracterizar a través de la actigrafía el patrón sueño-vigilia y evaluar la exposición a luz azul en niños menores de 2 años que consultan por insomnio. Se realizó un estudio observacional, descriptivo, transversal de lactantes derivados por insomnio al Centro de Sueño de Red de Salud UC Christus, durante: Marzo 2017-2018, con actigrafía. Fueron 20 actigrafías de 7 días. Edades entre 5 y 22 meses con diagnóstico de insomnio que no respondió al manejo inicial. 8 hombres, 12 mujeres. Horarios promedios: Acostarse: 20:31 hrs. Levantarse: 7:43 hrs. Horarios variables para acostarse: 15/20. 10/20 siestas después de las 16 hrs. Todos presentaron tiempo total de sueño disminuido, con aumentos del tiempo despierto una vez iniciado el sueño. Latencias del sueño aumentadas: 6/20. Eficiencia del sueño disminuidas en 4/20. Despertares nocturnos: promedio: 10.58. Expuestos a luz azul: 14/20. Horas exposición media: 2,4 hr/evento. Concluimos de este estudio que las principales dificultades fueron los despertares nocturnos con largos tiempo de vigilia, con disminución del tiempo total de sueño para la edad, y la actigrafía fue una herramienta de apoyo para objetivar conductas que dificultan la adquisición de un buen patrón de sueño.Palabras Clave: Insomnio infantil, sueño en lactantes, actigrafía, luz azul, despertares.

Abstract. Child insomnia is defined as sustained difficulty, despite the opportunity and according to age group, to initiate or maintain sleep, or a sleep quality causing that causes alterations in the child or family. It can significantly impact behavior, learning and metabolism of the child and his or her family, affecting their quality of life. The actigraphy through a device allows us to identify periods of wakefulness and sleep. The purpose of this work is to characterize sleep-wake patterns through actigraphy and to determine exposure to blue light in children younger than 2 years old, consulting for insomnia. An observational, descriptive, cross-sectional study of infants consulting for insomnia at the Sleep Center of UC Christus health network, in the period from March 2017 to 2018, with actigraphy. Twenty week long actigraphies were performed. The ages of the patients varied between 5 and 22 months, all had a diagnosis of insomnia that did not respond to initial management. Eight patients were male and 12 female. Hourly averages: bedtime: 8:31 PM. Waking up: 7:43 AM. Time variable for bedtime: 15/20. 10/20 NAPs after 16 hrs. All showed decreased sleep, with increases of total awake time once sleep began. Increased sleep latency: 6/20. Sleep efficiency decreased in 4/20. Nighttime Awakenings: average: 10.58. Exposed to blue light: 14/20. Average exposure in hours: 2.4 hr/event. We conclude from this study that the main difficulties were the nighttime awakenings with long time vigil, with decrease of the total sleep time for the age, and the actigraphy was a support tool to record behaviors that hinder a normal sleep pattern acquisition.Key words: Child insomnia, sleep in infants, actigraphy, blue light, awakenings

[Refractory status epilepticus in children: characterisation of epilepsies, continuous electroencephalographic monitoring and response to treatment]. / Estado epileptico refractario en ninos: caracterizacion de las epilepsias, monitorizacion electroencefalografica continua y respuesta al tratamiento.

INTRODUCTION: Patients with refractory status epilepticus (RSE) have high morbidity and mortality rates, are hospitalised for longer periods of time, suffer greater neurological damage and progress to symptomatic epilepsy. Continuous electroencephalogram (cEEG) monitoring is a valuable aid in the early detection of RSE, especially in the case of non-convulsive status epilepticus (NCSE). In this study we describe the clinical characteristics, treatment and use of cEEG in paediatric patients with RSE. PATIENTS AND METHODS: A retrospective study was conducted at the Hospital Clinico de la Pontificia Universidad Catolica de Chile between November 2005 and March 2011 in patients aged between 1 month and 15 years diagnosed with RSE and cEEG. Demographic characteristics, baseline and final conditions, and therapy were recorded. RESULTS: A total of 15 patients, 12 of whom were males, with a mean age of 4 years (1.5 months-13 years) were identified. Eight patients had a history of epilepsy. The most frequent aetiologies were progressive symptomatic and acute symptomatic. Convulsive epileptic status (CSE) was present in 11 patients and NCSE in the other four. During the cEEG, six of the 11 patients with CSE later progressed to NCSE. The mean amount of time with RSE was 10.2 days. Of the 15 patients, 13 responded to anticonvulsive drugs and the main secondary complications were respiratory depression and hypotension. Patients with CSE tended to evolve in a more torpid manner than patients with NCSE. On discharge from hospital, 13 patients (86.6%) presented new neurological deficit or difficult-to-manage epilepsy, one still had RSE and one died (6%). CONCLUSIONS: The aggregate neurological morbidity and mortality rates of RSE were high. The use of cEEG monitoring should be considered for use in the management of such cases of status epilepticus.

Educando en epilepsia a escolares de enseñanza básica y secundaria: mediante un video / Video Training elementary and high school students on Epilepsy

Resumen: Existe gran desinformación sobre epilepsias; mitos, prejuicios y estigma institucionalizado en el sistema escolar. Además, dificultades de participación social en las personas con epilepsia. Todo esto produce un impacto negativo en la calidad de vida de las personas con epilepsia. El objetivo de este trabajo es probar un método para educar en Epilepsias a escolares, mediante técnicas audiovisuales adecuadas a su lenguaje, intereses, nivel de atención y comprensión. Capacitación directa de 1.000 niños. Se realiza, por expertos en epilepsia y profesionales con experiencia en material audiovisual, un guión de 4 capítulos, sobre una historia de crisis de epilepsia en un niño, representado por marionetas. Se presenta el video a establecimientos educacionales públicos y privados. Se aplica Pre y Post test de 10 preguntas, para medir nivel de conocimientos y aprendizajes básicos en epilepsias. Un año post presentación de video, se mide en una muestra de estudiantes, la persistencia de conocimientos enseñados. Hubo un total de 1.111 escolares. Las respuestas pre-test correctas, incorrectas y que no sabían fueron en un 44%, 37% y 19% respectivamente. Las respuestas post-test correctas, incorrectas y que no sabían fueron en un 94%, 5% y 1% respectivamente. El análisis estadístico con las pruebas de McNemar mostraron diferencias altamente significativas entre el pre y post test en cada una de las 10 preguntas (p<0.0001). El estudio de persistencia, un año después (2011) fueron las siguientes: Correctas: 74%. Incorrectas: 8%. No sabe: 18%.Hubo cambios significativos de adquisición de conocimientos entre el pre y post test, con niveles de persistencia de conocimientos aceptables, un año después. El mensaje que la epilepsia puede afectar a cualquier persona, se visualiza como potente para sensibilizar y mejorar las actitudes sociales. Palabras Claves: Video educacional, epilepsia, convulsiones, estigma, estudiantes de escuelas primarias

There is a lack of information on Epilepsies, myths, prejudices and stigma institutionalized in the school system. In addition, people with epilepsy face a difficult time when trying to engage socially. All these produce a negative impact on the quality of life of people with epilepsy. The objective of this study is to test a method to educate schoolchildren in elementary and high school by audiovisual techniques appropriate to their language, interests, level of care and understanding in Epilepsies. Direct training of 1,000 children was performed by epilepsy experts and professionals with experience in audiovisual material through 4 chapters on a history of epileptic seizure in a child represented by puppets. The video was screened at public and private schools. A 10-item questionnaire was applied before and after the video, to measure level of knowledge and basic learning about Epilepsies. The knowledge about epilepsy was retested one year later in a sample of students. A total of 1,111 schoolage children participated. The results before the video screening were: correct 44%, incorrect 37%, and "I don't know" 19%. After the screening, there was a marked improvement, where correct answers were 94%, incorrect 5% and "I don't know" 1%. Statistical analysis with McNemar tests showed highly significant differences between the questionnaires before and after the video screening in each of the 10 questions (p < 0.0001). The test was repeated a year later (2011), with the following results: correct: 74%. Incorrect: 8%. I don't know: 18%. There was significant acquisition of knowledge after the video screening, with persistence of knowledge at acceptable levels a year later. The message that epilepsy can affect anyone is seen as potent to raise awareness and improve social attitudes. Key Words: educational video, epilepsy, seizures, stigma, elementary school students.