[Functional hemispherectomy: long-term follow-up in a series of five patients]. / Hemisferectomia funcional: seguimiento a largo plazo en una serie de cinco casos.

INTRODUCTION: Functional hemispherectomy consists in palliative epilepsy surgical procedure usually performed in patients with pharmaco-resistant epilepsy and hemispheric syndromes. It is based on the neural disconnection of the affected hemisphere with preservation of the vascular supply. AIM: To analyze long-term prognosis and safety of the hemispherectomies performed in our institution. PATIENTS AND METHODS: Retrospective analysis collecting the following variables: age, gender, age of epilepsy onset, type of seizures, etiology, age of epilepsy surgery, prognosis and potential surgical complications. All patients had a minimum of five years of follow up. RESULTS: Five patients (60% females) underwent hemispherotomy between 1999 and 2010. Age of epilepsy onset was 36 months and time of evolution until surgery was 7 years. The most frequent type of seizures were simple motor seizures with secondary generalization (n = 5). Three patients remained seizure free persistently after surgery and another patient had a more than 90% improvement. Time of follow up was 13 years. One patient suffered a bacterial meningitis without sequelae. Six years after surgery a patient suffered hydrocephalous requiring ventriculoperitoneal shunt. CONCLUSIONS: Functional hemispherectomy constitutes an effective method to treat patients with pharmaco-resistant epilepsy, extensive unihemispheric pathology and seizures limited to that hemisphere. Late complications may occur thus long-term follow-up is needed.

TITLE: Hemisferectomia funcional: seguimiento a largo plazo en una serie de cinco casos.Introduccion. La hemisferectomia funcional es una de las tecnicas quirurgicas con intencion paliativa que se pueden realizar en pacientes con epilepsia farmacorresistente y sindromes hemisfericos. Se basa en la desconexion neuronal del hemisferio afectado preservando el arbol vascular. Objetivo. Analizar el pronostico y la seguridad a largo plazo de las hemisferectomias realizadas en nuestro centro. Pacientes y metodos. Revision retrospectiva de los casos intervenidos, recogiendo las siguientes variables clinicas: edad, sexo, edad de inicio de la epilepsia, tipo de crisis, etiologia de la epilepsia, edad de intervencion, pronostico posquirurgico y posibles complicaciones. El seguimiento minimo fue de cinco años. Resultados. Cinco pacientes (60% mujeres) fueron intervenidos entre 1999 y 2010. La edad de inicio de la epilepsia fue de 36 meses, y el tiempo de evolucion hasta la cirugia, de 7 años. El tipo de crisis mas habitual fueron las crisis parciales simples motoras con generalizacion secundaria (n = 5). Tres pacientes permanecieron libres de crisis tras la cirugia, y otro paciente mejoro mas de un 90%. El tiempo medio de seguimiento fue de 13 años. Como complicaciones, una paciente sufrio una meningitis bacteriana sin secuelas posteriores. A los seis años de la cirugia, un paciente presento una hidrocefalia que requirio la implantacion de una valvula de derivacion ventriculoperitoneal. Conclusiones. La hemisferectomia funcional constituye un procedimiento quirurgico eficaz para el tratamiento de pacientes con epilepsia farmacorresistente, patologia hemisferica extensa y crisis limitadas a ese hemisferio. Hay complicaciones que pueden aparecer tardiamente, por lo que se aconseja un seguimiento a largo plazo de estos pacientes.

Drug-resistant epilepsy: definition and treatment alternatives.

INTRODUCTION: Drug-resistant epilepsy affects 25% of all epileptic patients, and quality of life decreases in these patients due to their seizures. Early detection is crucial in order to establish potential treatment alternatives and determine if the patient is a surgical candidate. DEVELOPMENT: PubMed search for articles, recommendations published by major medical societies, and clinical practice guidelines for drug-resistant epilepsy and its medical and surgical treatment options. Evidence and recommendations are classified according to the criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions. CONCLUSIONS: Identifying patients with drug-resistant epilepsy is important for optimising drug therapy. Experts recommend rational polytherapy with antiepileptic drugs to find more effective combinations with fewer adverse effects. When adequate seizure control is not achieved, a presurgical evaluation in an epilepsy referral centre is recommended. These evaluations explore how to resect the epileptogenic zone without causing functional deficits in cases in which this is feasible. If resective surgery is not achievable, palliative surgery or neurostimulation systems (including vagus nerve, trigeminal nerve, or deep brain stimulation) may be an option. Other treatment alternatives such as ketogenic diet may also be considered in selected patients.

Levetiracetam following liver and kidney failure in late-onset anticonvulsant hypersensitivity syndrome.

Anticonvulsant hypersensitivity syndrome is an adverse drug reaction usually occurring from 1 to 8 weeks after exposure to antiepileptic drugs. It can threaten life by affecting the liver, kidneys, central nervous system or lungs. We present a 47-year-old patient treated with phenytoin, lamotrigine and clobazam for 7 years. He presented with hepatic and renal failure in relation to this syndrome demonstrated by renal biopsy. Prognosis was excellent due to an early diagnosis leading to cessation of the causative agents. Levetiracetam was started with a good response.

[Morbidity due to intracerebral hemorrhage]. / Morbilidad de la hemorragia intracerebral.

INTRODUCTION: Intracerebral hemorrhage (HIC) represents 10-30% of all stroke. Epidemiological studies have shown factors associated with its high mortality, but those which might lead to lower morbidity are little known. OBJECTIVE: To find the factors which may influence the functional state of a series of patients with intracerebral hemorrhage. PATIENTS AND METHODS: We made a prospective study of 203 patients with intracerebral hemorrhage. We recorded vascular risk factors, arterial blood pressure, laboratory and neuroimaging parameters obtained on admission. The functional condition when discharged from hospital was evaluated on the Rankin Scale, in three categories: independent (Rankin 0-1), partially dependent (Rankin 2-3) and totally dependent patients (Rankin 4-5). RESULTS: There was a 23.2% death rate. Of the 156 patients who survived, at the time of hospital discharge 35.8% had a score of 0-1, 50.6% a score of 2-3 and 13.4% a score of 4-5 on the Rankin Scale. Age (p < 0.005), hyperglycaemia (p < 0.05) and size of hemorrhage (p < 0.05) were associated with increased morbidity. CONCLUSIONS: The functional condition on hospital discharge was better in younger patients with lower levels of glycemia on admission and smaller hematomas on CT.