[Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic]. / Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.

INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.

TITLE: Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.Introducción. El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos. Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados. Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones. La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.

[Minimally invasive surgery in intracranial aneurysms]. / Cirugía de mínima invasión en aneurismas intracraneales.

INTRODUCTION: The use of minimally invasive procedures in neurosurgery permits a significant reduction in peri-operative morbidity and duration of hospital stay. The fronto-latero-basal (FLB) approach gives good exposure of the structures of the anterior and middle fossas with access to most aneurysms of the anterior circulation, thus avoiding extensive craniotomies and the use of brain retractors. OBJECTIVE: We present an analysis of 27 patients operated on to clip 29 aneurysms of the anterior circulation using the FLB approach. PATIENTS AND METHODS: The study included 27 patients, 18 women and 9 men with an average age of 47.53 years. On clinical staging, using the Hunt and Hess scale, 12 patients were between 0 and 1, 8 at stage II, 6 at stage III and 1 at stage IV. RESULTS: The aneurysms were mainly on the internal carotid artery (16), middle cerebral artery (5), anterior communicating artery (5) and bifurcation of the carotid and middle cerebral arteries (3). The surgical operation lasted an average of 166.15 minutes; it was possible to clip the artery in 28 cases (96.5%). Two patients died (of renal failure and of disseminated intravascular coagulation). Most patients were discharged with a score of 5 points on the Glasgow prognosis scale 7.6 days after operation. CONCLUSIONS: Use of minimally invasive procedures such as FLB gives optimal functional and aesthetic results, with the advantage of being possible using the basic instruments available in any neurosurgical department, without depending on advanced technology.

Cranial epidural empyema with osteomyelitis caused by actinomyces, CT, and MRI appearance.

Actinomycosis is an uncommon cause of intracranial infection. Epidural empyema represents about 6% of CNS actinomycotic lesions. A case of an epidural empyema with parietal bone osteomyelitis caused by Actinomyces israelii is presented. Relevant neuroimaging features were bone erosions and a multiloculated collection with annular contrast enhancing on CT. Postoperative MRI revealed extensive involvement of the neighbor dura, falx, and subdural space. MRI was crucial to follow-up the response to antibiotic treatment.