[Quality of life in adult patients with idiopathic generalised epilepsy. The EPILAK study]. / Calidad de vida en pacientes adultos con epilepsia generalizada idiopática. Estudio EPILAK.

INTRODUCTION: Quality of life (QoL) is an important aspect in the treatment of patients with epilepsy. AIM: To analyse the QoL using the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) in adults with idiopathic generalised epilepsy and to study factors associated with a worse QoL. PATIENTS AND METHODS: A cross-sectional, multicentre, observational study conducted by 141 neurologists in all the autonomous communities of Spain. Each researcher analysed the QOLIE-10 of two males and two females over 18 years of age with idiopathic generalised epilepsy seen consecutively in public or private practice. The results were standardised: 0 was the worst QoL and 100 was the best. RESULTS: A total of 546 patients were analysed. Women: 51.1% (n = 279). Mean age: 36 ± 15.3 years old (18-87). Childhood absence seizures: 7.5% (n = 41); juvenile absence seizures: 9.2% (n = 50); juvenile myoclonic seizures: 29.8% (n = 163); only tonic-clonic seizures: 53.5% (n = 292). Monotherapy: 63.2% (n = 345). Seizure-free in the last year: 53.1% (n = 290). Psychiatric comorbidity: anxiety: 28.4% (n = 155); depression: 14.1% (n = 77); attention deficit: 10.1% (n = 55). Employment status: in active employment: 47.2% (n = 258); student: 20% (n = 109); housewife/husband: 7.3% (n = 40); pensioner: 10.2% (n = 56); unemployed: 14.3% (n = 78). Marital status: married or in a relationship: 49.1% (n = 268); single: 43.7% (n = 239). Mean score on the QOLIE-10: 71.4 ± 19.1. Being female (p = 0.006), greater frequency of seizures (p < 0.001), polytherapy (p < 0.001), psychiatric comorbidity (p < 0.001) and unemployment (p < 0.001) were significantly associated with a worse QoL. CONCLUSIONS: The QoL of patients with idiopathic/genetic generalised epilepsy is affected by poor seizure control, psychiatric comorbidity and unemployment, and women are more affected than men.

TITLE: Calidad de vida en pacientes adultos con epilepsia generalizada idiopática. Estudio EPILAK.Introducción. La calidad de vida (CV) es un aspecto importante en el tratamiento de los pacientes con epilepsia. Objetivo. Analizar la CV mediante el Quality of Life in Epilepsy Inventory-10 (QOLIE-10) en adultos con epilepsia generalizada idiopática y estudiar factores asociados a una peor CV. Pacientes y método. Estudio transversal, multicéntrico, observacional, realizado por 141 neurólogos de todas las comunidades autónomas de España. Cada investigador analizaba el QOLIE-10 de dos varones y dos mujeres mayores de 18 años con epilepsia generalizada idiopática visitados de forma consecutiva en consulta pública o privada. Los resultados se estandarizaron: 0 era la peor CV y 100, la mejor. Resultados. Se analizó a 546 pacientes. Mujeres: 51,1% (n = 279). Edad media: 36 ± 15,3 años (18-87). Ausencias infantiles: 7,5% (n = 41); ausencias juveniles: 9,2% (n = 50); mioclónica juvenil: 29,8% (n = 163); sólo crisis tonicoclónicas: 53,5% (n = 292). Monoterapia: 63,2% (n = 345). Libres de crisis en el último año: 53,1% (n = 290). Comorbilidad psiquiátrica: ansiedad: 28,4% (n = 155); depresión: 14,1% (n = 77); déficit de atención: 10,1% (n = 55). Condición laboral: trabajador/a en activo: 47,2% (n = 258); estudiante: 20% (n = 109); amo/a de casa: 7,3% (n = 40); pensionista: 10,2% (n = 56); en paro: 14,3% (n = 78). Estado civil: casado/a o en pareja: 49,1% (n = 268); soltero/a: 43,7% (n = 239). Puntuación media en el QOLIE-10: 71,4 ± 19,1. Sexo femenino (p = 0,006), mayor frecuencia de crisis (p menor de 0,001), politerapia (p menor de 0,001), comorbilidad psiquiátrica (p menor de 0,001) y desempleo (p menor de 0,001) se asociaron de forma significativa con una peor CV. Conclusiones. La CV de los pacientes con epilepsia generalizada idiopática/genética está afectada por el mal control de las crisis, la comorbilidad psiquiátrica y el desempleo, y las mujeres presentan una mayor afectación que los hombres.

Assessment of efficacy and safety of eslicarbazepine acetate for the treatment of trigeminal neuralgia.

BACKGROUND: Antiepileptic drugs are the first-line treatment for trigeminal neuralgia (TN). Carbamazepine and oxcarbazepine are the most studied with well-known efficacy. Eslicarbazepine acetate is a third-generation antiepileptic drug that has not previously been evaluated for the treatment of TN. We aim to assess the efficacy, tolerability and safety of eslicarbazepine for TN. DESIGN AND METHODS: Retrospective, open-label, multicentric, intention-to-treat study. We included patients older than 18 years who met the ICHD-3 beta diagnostic criteria for TN. We evaluated the variation of intensity and frequency of pain paroxysms before and after treatment with eslicarbazepine. Secondary objectives assessed were tolerability and safety of eslicarbazepine. RESULTS: Eighteen patients were included, 15 women, mean age 65.2 years old, mean follow-up 21.1 months. The mean number of drugs tested before eslicarbazepine was 2; 10 patients used eslicarbazepine as monotherapy. After the treatment with ESL, the median of pain intensity improved from 9.5 to 2.5 (p < 0.001) and the median of pain paroxysms frequency improved from 70 episodes per week to 0.37 (p < 0.001). Responder rate was 88.9%; 44.4% became asymptomatic after treatment. Sixty-one per cent of patients presented some adverse event; four patients discontinued eslicarbazepine for this reason. Despite this, 16 patients (88.9%) noticed a good subjective tolerance to eslicarbazepine. The retention rate at 6 months was 77.8% and at 12 months 61.1%. CONCLUSIONS: Our study supports the hypothesis that eslicarbazepine acetate is an effective, safe and well-tolerated treatment for the treatment of TN. Further studies are warranted to corroborate these results. SIGNIFICANCE: Eslicarbazepine acetate has shown to be an effective, safe and well-tolerated drug for TN. This is the first study that evaluated the efficacy of this drug on TN in humans.

[Benefit of the implementation of on-call neurology physicians in a general hospital]. / Beneficio de la instauración de guardias de neurología de presencia física en un hospital general.

INTRODUCTION: Most Spanish hospitals have no oncall neurologist (OCN) for emergency patients. This study was designed to highlight the benefits in patient management when an OCN system is implemented. METHODS: We conducted a prospective study in the University Hospital of Albacete during the first year of OCN implementation (2004). We also compared stroke patients admissions from emergency department (ED) in 2004 with respect to 2003. FINDINGS: OCN attended 2,745 patients (7.6 per day), 73.1% of these calls coming from ED between 3 PM and 10 PM. Acute stroke was the most frequent consultation. A total of 118 calls were made to determine the need for thrombolytic therapy and 323 emergency neurosonologic examinations were performed by the OCN during the duty. A total of 44.8% of the attended patients were admitted and 30.1% were referred to outpatient clinics. Our hospital had a significant decrease (12.3%) in stroke patients admissions over 2004 compared with 2003 despite an actual increase of total admissions in the neurological ward. The mean hospital stay of stroke patients was shorter in the neurology department than in the internal medicine one. CONCLUSIONS: OCN improves the quality of attention to the neurological patient, reduces the number of unnecessary hospital admissions and increases the status of the neurological department. Implementation of on-call neurology physicians for 24 hours is necessary in all those sites that provide care to emergency patients and have neurology services.