[Surgical treatment of epilepsies: criteria for the selection of patients and results]. / Tratamiento quirúrgico de las epilepsias: criterios de selección de pacientes y resultados.

INTRODUCTION: Approximately 20% of all epileptic patients are not satisfactorily controlled by the available antiepileptic drugs. Some of these patients have epileptic syndromes which could potentially be treated by surgery. DEVELOPMENT: The technological advances applied to diagnostic and therapeutic methods have improved the identification of epileptic patients who may benefit from surgery. Up to 80% of the patients with focal epilepsies symptomatic of well defined lesions may become free of seizures after excision of the lesion or epileptogenic focus. Other forms of epilepsy, such as the so-called catastrophic infantile forms, may improve temporarily when techniques such as hemispherectomy or callosotomy are used. The morbidity and mortality of these surgical procedures are minimal. The results depend on correct selection of the patients. A strict protocol for rigorous evaluation of the patients should be used, with the collaboration of neurologists, epileptologist neuropaediatricians, neuropsychologists, neurophysiologists, neuroimaging specialists, psychiatrists and neurosurgeons. There should first be clear answers to three key questions: 1. Who is a good candidate? 2. How should the selection be made? and 3. When is the best time for evaluation? CONCLUSIONS: At present it seems clear that the surgery of epilepsy is used less than it could be. It is therefore necessary to encourage the development of specialist units to select patients and treat them, and to develop the means whereby patients can obtain this highly specialized attention.

[Prolonged monitoring with video-EEG. Clinical applications]. / Monitorización prolongada de vídeo-EEG. Aplicaciones clínicas.

INTRODUCTION: The differential diagnosis of paroxysmal events include a large number of entities. A careful diagnosis is needed because of the specific treatment that most of them require. If a mistake is done in the diagnosis, the consequences in the treatment may be relevant, not only because the maintenance of the episodes but because the secondary effects of the wrong medications. The video-EEG monitoring is key when the diagnosis of epileptic seizures is suspected. However, this is not the exclusive indication for a video-EEG monitoring study. CONCLUSIONS: Nowadays, epilepsy surgery is not considered without a previous monitoring study. In this article we review the indications for a video-EEG monitoring must be included as an usual system of diagnosis in a Neurophysiology Unit.

[Tacrine]. / Tacrina.

Significant changes in cholinergic neurotransmission have been described in Alzheimer's disease (AD). These findings led to consider cholinergic deficit as the main disturbance in AD, due to degeneration of presynaptic cholinergic neurons, and that replacement of acetylcholine could restore the cognitive alterations characteristic of AD. Although it was soon demonstrated that cholinergic deficit was not the only change, cholinergic hypothesis has allowed to set several possible therapeutic strategies for these severe disease, the most promising is administration of acetylcholinesterase inhibitors. Of all the compounds investigated, tacrine (tetrahydroamineacridine) has shown in several clinical trials a positive effect on memory in patients with symptoms of slight to moderate severity. Although not all studies have given successful result, probably due to methodological differences, global clinical impression has justified the introduction of tacrine as the first palliative therapy in AD.

[Treatment of supratentorial glioma with intracarotid cisplatin and intravenous carmustine]. / Tratamiento del glioma supratentorial con cisplatino intracarotídeo y carmustina intravenosa.

We report the results of intracarotid (IC) cisplatinum and intravenous carmustine (BCNU) in 26 patients with supratentorial malignant glioma and recurrent low grade glioma. A response rate of 53.84% (95% confidence interval 33.3%-73.4%) was found. The median survival for the whole group was 11 months (range 3-70), with 35% of patients surviving for 2 years. At the present time, 5 patients are still alive, with a median follow up of 68 months (range 56-70). Neurological toxicity has been low and transient, being attributable to the technical degree of care in catheter positioning, cisplatin dosage and the technique of drug administration into the carotid artery.