Low-dose sodium valproate in the treatment of idiopathic generalized epilepsies.

OBJECTIVE: Most patients with idiopathic generalized epilepsies (IGEs) have good seizure control when on antiepileptic drugs. To analyze prospectively the response to low-dose sodium valproate (VPA) treatment (<1000 mg/day) together with plasma VPA levels in a cohort of patients with IGE. METHODS: Patients with IGE were selected and followed for almost 2 years. In patients on VPA with no seizures in the last year, VPA dose was lowered to <1000 mg/day. Newly diagnosed patients with IGE started treatment on VPA directly on this low dose. RESULTS: Fifty-four patients were included, with juvenile myoclonic epilepsy (JME) in 23 (42.6%), juvenile absence epilepsy (JAE) in 17 (31.5%), and generalized tonic-clonic seizures only (GTCS only) in 14 (25.9%). VPA at low dose was administered to 38 (70%) patients. Mean plasma VPA level was 44.21 mg/l (18-78; SD 15.18). Seizure relapse during the 2-year follow-up was observed in 8 (21%). A reduction in adverse events was observed (P < 0.048). The only factor related to efficacy of VPA at low dose was syndromic diagnosis. Low-dose VPA controlled 92.9% (13) of patients with GTCS only, 78.3% (18) of those with JME, and 29.5% (5) of those with JAE. CONCLUSIONS: Low-dose VPA was a highly effective treatment for the majority of those with JME and GTCS only. The seizures in JAE tended to be more resistant to treatment, usually requiring higher doses of VPA or polytherapy.

[Fiber endoscopy of the nasopharynx: its indications]. / La fibroendoscopia del cavum: sus indicaciones.

The AA have planned a series of indications regarding the endoscopy of the nasoopharynx. Among 631 explorations done in a three-year term, normal findings were seen in 260 subjects. In the other cases several aspects of the inflammatory or neoplastic pathology could be verified. One individual showed an esthesioneuroblastoma in an early evolutive stage.

[Inflammatory pseudotumor of the paranasal sinuses]. / Pseudotumor inflamatorio de senos paranasales.

The inflammatory pseudotumor of the head and of the neck is a lesion of unknown etiology which affects the orbita more frequently but cases have also been described in the paranasal sinuses, larynx, mouth, cervical column and by direct extension from the orbita in the Central Nervous System. In the majority of cases, it behaves as a limited benignant inflammation within the osseous walls of the area where it is to be found; other times it destroys the osseous limits and invades the surrounding areas, behaving as a neoplasia. It must be distinguished from sinusitis, granulomatous inflammations, vasculitis, diseases of the collagen, sarcoidosis, neoplasias and benignant tumours. We present a case of inflammatory pseudotumour, occupying the right maxillary sinus, nasal fossa and rhinopharynx. Surgical extirpation has been the treatment used.

[Nasal hemangiopericytoma]. / Hemangiopericitoma nasal.

We are submitting a case of haemangiopericytoma of the nasal fossae, diagnosed and treated in our department. This is the second case we have seen as the first one was published by J. Marin and al. (1) in 1979. The patient in question is male, 35 years of age, who suffered from a tumour in the nasal partition, in the left nasal fossa and which made itself evident through repetitious epistaxis. The tumour was removed and there has not, so far, been any relapse. We have carried out a study of the available literature concerning haemangiopericytomas located in the nasal fossae and in the paranasal sinuses and come across 50 cases. In 1987 Chawla compiled 23 cases (2). Of the 50 cases, only 6 are described as being located in the nasal wall. We are submitting a list of all the cases that we have published and gathered with the age and sex of each patient and year of their publication.

[Cortical evoked auditory evoked potentials in a series of patients who had bacterial meningitis during childhood]. / Potenciales evocados auditivos corticales (PEAC) en una serie de pacientes que han padecido meningitis bacteriana en la edad pediátrica.

Cortical auditory evoked potentials (CAEP) were recorded from scalp electrodes in 47 patients, who survived to bacterial meningitis in their childhood. CAEP were obtained from 1 month to 8 years after recovering from acute disease. Neisseria meningitidis was the microorganism more frequently isolated from CSF (43.5%). Exclusively abnormal values in amplitude of CAEP were registered in 15 cases (32%), mainly at the lower tones explored; 14 of them were subjected to conventional audiometric test, which demonstrated unilateral hearing loss only in 2. No alterations in the latency of P2 wave were seen. We recommend to include CAEP in search of hearing disorders in younger children after recovering from meningitis, since they can detect lesions in cortical-subcortical auditory tracts, which otherwise could go unnoticed.