Randomized double-blind placebo-controlled clinical trial to evaluate the effect of a mixture of probiotic strains on symptom severity and use of corticosteroids in children and adolescents with atopic dermatitis.

BACKGROUND: The intestinal microbiota is altered in patients with atopic dermatitis (AD) when compared with those of the healthy population. Some interventions with specific probiotic preparations already demonstrate a change in composition of this microbiota accompanied by improvement in the disease. OBJECTIVES: This research work was designed to evaluate clinical efficacy of the probiotic preparation, and to measure the effect of the intervention on the total dose of corticosteroids administered to subjects. METHODS: This double-blind, randomized, placebo-controlled clinical trial including 70 participants with AD aged 4-17 years was designed to evaluate the clinical effect, compared with placebo, of a probiotic mixture of Bifidobacterium lactis, Bifidobacterium longum and Lactobacillus casei at a total daily consumption of 1 × 109 colony-forming units per capsule, over 12 weeks. After randomization and exclusion, 35 patients were allocated to probiotic and 35 to placebo. Clinical variables analysed were SCORAD (SCORing of Atopic Dermatitis) and Investigator Global Assessment (IGA) indices; effect on the amount of topical corticosteroids used; and assessment of safety. RESULTS: Mean SCORAD index at 12 weeks showed a statistically significant difference of -5.43 (95% confidence interval -10.65 to -0.21) between probiotic (SCORAD 13.52) and placebo groups (SCORAD 18.96); P = 0.04. Comparison between groups showed a statistically significant difference in the number of patients with IGA score improvement over the 12-week intervention: 29 of 32 (90.5%) in the probiotic group vs. 17 of 30 (56.7%) in the placebo group (P < 0.002). A comparison between groups of the proportions of days using corticosteroids and the total dose (g) of corticosteroids between baseline and end of study showed no significant difference, but between weeks 6 and 12 there was a statistically significant reduction in the probiotic group when compared with the placebo group in both variables. Numbers of adverse events were similar in both groups of treatment. CONCLUSIONS: The probiotic mix used in this clinical trial demonstrated efficacy on the change in activity index of AD compared with placebo. Furthermore, the total number of days and total amount of topical corticosteroids required by participants in the probiotic group showed a significant reduction compared with placebo between 6 and 12 weeks.

Aura sin migraña o síndrome de Alicia en el País de las Maravillas: Caso clínico pediátrico / Aura without migraine or Alice in Wonderland syndrome: Pediatric clinical case

La migraña con aura en pacientes pediátricos es reportada con frecuencia; el aura típica sin migraña, en raras ocasiones, y el aura persistente asociada al denominado síndrome de Alicia en el País de las Maravillas, excepcionalmente. El objetivo de este reporte es presentar un caso clínico correspondiente a la última variedad mencionada. Se trata de una paciente de 6 años de edad, quien tuvo, al menos, dos episodios con estas características antes de presentar un cuadro clínico completo de aura y, consecutivamente, cefalea con más frecuencia. Los estudios complementarios practicados de manera sistemática a la paciente fueron normales, con mejoría clínica con el tratamiento convencional. Se debe sospechar el síndrome en todo paciente que se presente con las características descritas a fin de aproximarse al diagnóstico de aura sin migraña, descartar patologías orgánicas o de otra naturaleza e instaurar la terapéutica adecuada.

Migraine with aura in children is often reported, typical aura without headache is reported sometimes, but persistent aura and Alice in Wonderland syndrome is exceptionally reported. We present a case corresponding to the last one mentioned in a 6-year-old patient who had at least two episodes with the typical characteristics of aura without migraine before developing more frequently the complete clinical picture of aura and subsequently headache. The complementary studies systematically done to the patient were normal and she improved with conventional therapy. It is important to emphasize that the syndrome should be suspected in any patient who presents the described manifestations in order to approach to the diagnosis of aura without migraine, to discard either organic pathology or another cause and to indicate adequate therapeutic measures.

[Aura without migraine or Alice in Wonderland syndrome: Pediatric clinical case]. / Aura sin migraña o síndrome de Alicia en el País de las Maravillas: Caso clínico pediátrico.

Migraine with aura in children is often reported, typical aura without headache is reported sometimes, but persistent aura and Alice in Wonderland syndrome is exceptionally reported. We present a case corresponding to the last one mentioned in a 6-year-old patient who had at least two episodes with the typical characteristics of aura without migraine before developing more frequently the complete clinical picture of aura and subsequently headache. The complementary studies systematically done to the patient were normal and she improved with conventional therapy.It is important to emphasize that the syndrome should be suspected in any patient who presents the described manifestations in order to approach to the diagnosis of aura without migraine, to discard either organic pathology or another cause and to indicate adequate therapeutic measures.

La migraña con aura en pacientes pediátricos es reportada con frecuencia; el aura típica sin migraña, en raras ocasiones, y el aura persistente asociada al denominado síndrome de Alicia en el País de las Maravillas, excepcionalmente.El objetivo de este reporte es presentar un caso clínico correspondiente a la última variedad mencionada. Se trata de una paciente de 6 años de edad, quien tuvo, al menos, dos episodios con estas características antes de presentar un cuadro clínico completo de aura y, consecutivamente, cefalea con más frecuencia. Los estudios complementarios practicados de manera sistemática a la paciente fueron normales, con mejoría clínica con el tratamiento convencional.Se debe sospechar el síndrome en todo paciente que se presente con las características descritas a fin de aproximarse al diagnóstico de aura sin migraña, descartar patologías orgánicas o de otra naturaleza e instaurar la terapéutica adecuada.

[Pharmacological management of attention deficit hyperactivity disorder with methylphenidate and atomoxetine within a context of epilepsy]. / Manejo farmacológico del trastorno por deficit de atención/hiperactividad con metilfenidato y atomoxetina en un contexto de epilepsia.

INTRODUCTION: The prevalence of attention deficit hyperactivity disorder (ADHD) in patients with epilepsy stands at around 30-40%, especially the inattentive subtype, while other studies on children diagnosed with ADHD show figures that vary from 6.1% to 30% which present alterations in the electroencephalogram and epilepsy problems. Although clinical practice guidelines advise against treatment with psychostimulants in ADHD that is comorbid with epilepsy, especially when the latter is not considered active, some researchers and practitioners recommend caution as regards beginning this pharmacological therapy, while less research has been conducted on the use of non-psychostimulants. AIM: To review the patient records of children with epilepsy and ADHD who received pharmacological treatment with psychostimulants and non-psychostimulants for an attention disorder. PATIENTS AND METHODS: The study involved a sample of 23 patients aged 5-16 years. The type of epilepsy and the clinical course and electroencephalogram were analysed at both one and two years after beginning pharmacological treatment of ADHD. RESULTS: At two years, one patient presented a crisis and two patients continued to display paroxysmal activity in the electroencephalogram. CONCLUSIONS: The data presented show that pharmacological treatment of ADHD does not exacerbate the epilepsy in well-controlled patients, although it is advisable to take into account factors such as the type of antiepileptic drug, the type of drug for ADHD and the cognitive profile, in order to favour a satisfactory development. In epileptic children with learning difficulties, it is necessary to evaluate the mechanisms involved in attentional processes, since they may well be compromised and in need of a more specific treatment.

TITLE: Manejo farmacologico del trastorno por deficit de atencion/hiperactividad con metilfenidato y atomoxetina en un contexto de epilepsia.Introduccion. La prevalencia del trastorno por deficit de atencion/hiperactividad (TDAH) en pacientes con epilepsia se situa en torno al 30-40%, especialmente del subtipo inatento, mientras que, a su vez, distintos estudios sobre niños diagnosticados de TDAH muestran cifras variables del 6,1-30% que presentan alteraciones en el electroencefalograma y problemas de epilepsia. Aunque las guias de practica clinica no desaconsejan el tratamiento con psicoestimulantes en el TDAH comorbido con epilepsia, en especial si esta no se considera activa, algunos investigadores y clinicos recomiendan ser cautos en el inicio de esta terapia farmacologica, mientras que el uso de no psicoestimulantes esta menos estudiado. Objetivo. Revisar las historias clinicas de niños con epilepsia y TDAH que recibieron tratamiento farmacologico con psicoestimulantes y no psicoestimulantes para el trastorno de atencion. Pacientes y metodos. Muestra de 23 pacientes de 5-16 años. Se analizo el tipo de epilepsia y la evolucion clinica y electroencefalografica al año y a los dos años tras el inicio del tratamiento farmacologico del TDAH. Resultados. A los dos años, un paciente presento una crisis y dos pacientes continuaban mostrando actividad paroxistica en el electroencefalograma. Conclusion. Los datos presentados muestran que el tratamiento farmacologico del TDAH no empeora la epilepsia en pacientes bien controlados, aunque se recomienda tener en cuenta factores como el tipo de farmaco antiepileptico, el tipo de farmaco para el TDAH, asi como el perfil cognitivo, para favorecer un desarrollo adecuado. En los niños epilepticos con dificultades del aprendizaje, deben valorarse los mecanismos de los procesos atencionales que puedan estar alterados y que precisen un tratamiento especifico.