[Telematic attention in a neuropediatrics consultation during the COVID-19 alarm state. Cross-sectional study and satisfaction survey]. / Valoración de la atención telemática en una consulta de Neuropediatría durante el estado de alarma por COVID-19. Estudio transversal y encuesta de satisfacción.

INTRODUCTION: Crisis caused by the SARS-CoV-2 virus limit face-to-face consultation to the minimum necessary, this was a change toward telephone activity. OBJECTIVE: To analyze the experience of a neuropediatric consultation, INRPC, and satisfaction survey with the telephone consultation during COVID-19 crisis. MATERIAL AND METHODS: Observational, cross-sectional, descriptive and analytical study of healthcare activity, as well as user satisfaction, during the State of Alarm in a neuropediatric consultation in a regional referral hospital. To measure satisfaction, a survey is conducted with parents and guardians. RESULTS: 416 children were attended by telephone. Most frequent diagnoses: neurodevelopmental disorder (27.8%), isolated ADD/ADHD (26.8%), and epilepsy (9.2%). 32.2% responded to the survey: 66.6% prior satisfaction. Global satisfaction with telephone consultation 59.9%; 77% would return to make the telephone consultation. CONCLUSIONS: User satisfaction with the telephone consultation, in a crisis situation, is similar to that perceived with the face-to-face consultation. 32% respond to the survey, and 60% are satisfied.

Intracranial arachnoid cysts and epilepsy in children: Should this be treated surgically? Our 29-year experience and review of the literature / Quistes aracnoideos intracraneales y epilepsia en niños: ¿Debemos tratarlos quirúrgicamente? Nuestra experiencia de 29 años y revisión de la literatura

Introduction and objective: Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. Material and methods: The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. Results: After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment(AU)

Introducción y objetivo: Los quistes aracnoideos (QAs) son lesiones relativamente comunes relacionados con diferentes síntomas neurológicos, siendo diagnosticados de forma incidental en su mayoría. Este estudio tiene como objetivo aclarar si la cirugía sobre el QA en pacientes epilépticos es útil en su tratamiento. Material y métodos: Se analizan retrospectivamente los pacientes registrados en la base de datos de la Sección de Neuropediatría desde mayo de 1990 a agosto de 2019. Se estudian los pacientes en los que coincide el diagnóstico de QA y epilepsia. Se analiza la localización, tamaño y número de los QA, el desarrollo neurológico, edad al diagnóstico, tiempo de seguimiento, realización de cirugía sobre el QA, evolución, relación anatómica entre la actividad eléctrica cerebral y la localización del QA, así como el tipo de epilepsia. Resultados: Tras el análisis de la base de datos encontramos 1.881 pacientes diagnosticados de epilepsia, entre ellos 25 con al menos un QA intracraneal. En nueve de los pacientes la patología cerebral o genética por sí misma era causa de epilepsia. De los otros 16, únicamente en dos casos se evidenció que el tipo de epilepsia y el foco epileptogénico coincidían con la localización del QA; uno de ellos fue tratado quirúrgicamente sin éxito y el otro permaneció asintomático sin recibir tratamiento médico ni quirúrgico. Conclusiones: Aunque es necesario diseñar un estudio prospectivo para establecer causalidad, los resultados de nuestro trabajo y la literatura disponible sugieren que no hay relación causal entre la presencia de QAs y epilepsia. El estudio y tratamiento de estos pacientes debería ser completado en una unidad multidisciplinar de cirugía de la epilepsia, sin asumir de inicio que el QA es la causa de la epilepsia(AU)

Neurological manifestations of neurofibromatosis type 1: our experience.

INTRODUCTION: Neurofibromatosis type 1 (NF1) is a progressive multisystem disorder following an autosomal dominant inheritance pattern that presents with multiple neurological manifestations. METHODS: We reviewed medical histories of patients with NF1 followed up at our hospital's paediatric neurology department from May 1990 to 31 December 2018. We collected data on neurological symptoms. RESULTS: A total of 128 patients with NF1 were identified. Mean age (SD) at NF1 diagnosis was 4.43 (3.38) years (range, 0.5-14.5 years). There was a slight female predominance (53.1%). Macrocephaly (head circumference over 2 SDs above average for age) was present in 37.5% of cases. Attention-deficit/hyperactivity disorder was recorded in 28.9% of patients (37): combined type in 20 patients, predominantly inattentive in 15, and predominantly impulsive/hyperactive in 2. Other manifestations included headache (18.6%), cognitive impairment (7.8%), motor deficit (6.2%), and epilepsy (4.68%). Brain MRI was performed in 85 patients, revealing T2-weighted hyperintensities in the basal ganglia and/or cerebellum in 60 patients (70.5%), Chiari malformation type 1 in 4 cases, and arachnoid cysts in 3. Optic nerve gliomas were identified by MRI in 22 patients (25.8%). Other MRI findings included plexiform neurofibromas (9.3%) and central nervous system gliomas (3.1%). CONCLUSIONS: The neurological manifestations identified in our sample are consistent with those reported in the literature. Effective transfer strategies from paediatric neurology departments and subsequent clinical follow-up by adult neurology departments are needed to prevent loss to follow-up in adulthood.

Manifestaciones neurológicas en neurofibromatosis tipo 1. Nuestra experiencia / Neurological manifestations of neurofibromatosis type 1: our experience

Introducción: La neurofibromatosis tipo 1 (NF1) es un desorden progresivo multisistémico de herencia autosómica dominante que presenta numerosas manifestaciones neurológicas. Métodos: Revisión de historias clínicas de pacientes afectos de NF1 controlados en una Unidad de Neuropediatría de mayo de 1990 a 31 de diciembre de 2018 y sus manifestaciones neurológicas asociadas. Resultados: Se revisaron 128 pacientes afectos de NF1. Edad media al diagnóstico de NF1, 4,43 años ± 3,38 SDS (rango 6 meses-14,5 años) con discreto predominio femenino (53,1%). Se asocia macrocefalia (PC> 2SDS) en el 37,5% de los casos. TDAH en el 28,9% de los casos (37), subtipo combinado 20, inatento 15 casos y predominantemente hiperactivo 2 casos. Otras manifestaciones incluyen; cefalea (18,7%), déficit cognitivo (7,8%), afectación motora (6,2%) y epilepsia (4,68%). Se realizó RM cerebral a 85 pacientes, mostrando 60 (70,5%) hiperseñales en T2 en ganglios basales y/o cerebelo, junto con otras alteraciones como Chiari I (4 casos) y quistes aracnoideos (3 casos). Se identificaron gliomas de nervio óptico en 22 casos (25,8%). Otros hallazgos diagnosticados por RM incluyen neurofibromas plexiformes (9,3%) y otros gliomas localizados en sistema nervioso central (3,1%). Conclusiones: Las manifestaciones neurológicas encontradas concuerdan con lo recogido en la literatura. El seguimiento de estos pacientes se pierde en la edad adulta, siendo necesario establecer adecuadas estrategias de transferencia y posterior seguimiento de pacientes a los servicios de adultos. (AU)

Introduction: Neurofibromatosis type 1 (NF1) is a progressive multisystem disorder following an autosomal dominant inheritance pattern that presents with multiple neurological manifestations. Methods: We reviewed medical histories of patients with NF1 followed up at our hospital's paediatric neurology department from May 1990 to 31 December 2018. We collected data on neurological symptoms. Results: A total of 128 patients with NF1 were identified. Mean age (SD) at NF1 diagnosis was 4.43 (3.38) years (range, 0.5-14.5 years). There was a slight female predominance (53.1%). Macrocephaly (head circumference over 2 SDs above average for age) was present in 37.5% of cases. Attention-deficit/hyperactivity disorder was recorded in 28.9% of patients (37): combined type in 20 patients, predominantly inattentive in 15, and predominantly impulsive/hyperactive in 2. Other manifestations included headache (18.6%), cognitive impairment (7.8%), motor deficit (6.2%), and epilepsy (4.68%). Brain MRI was performed in 85 patients, revealing T2-weighted hyperintensities in the basal ganglia and/or cerebellum in 60 patients (70.5%), Chiari malformation type 1 in 4 cases, and arachnoid cysts in 3. Optic nerve gliomas were identified by MRI in 22 patients (25.8%). Other MRI findings included plexiform neurofibromas (9.3%) and central nervous system gliomas (3.1%). Conclusions: The neurological manifestations identified in our sample are consistent with those reported in the literature. Effective transfer strategies from paediatric neurology departments and subsequent clinical follow-up by adult neurology departments are needed to prevent loss to follow-up in adulthood. (AU)

Patología neurológica en una unidad de cuidados intensivos pediátricos de tercer nivel. Evolución funcional. Nuestra experiencia / Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience

INTRODUCCIÓN: La enfermedad neurológica representa una parte importante en las unidades de cuidados intensivos pediátricos (UCIP) y es causa de morbimortalidad. El objetivo de este trabajo es analizar la evolución funcional del niño crítico con enfermedad neurológica. MATERIAL Y MÉTODO: Estudio retrospectivo descriptivo, de niños con enfermedad neurológica ingresados en una UCIP durante 3 años (2012-2014), valorando pronóstico vital y funcional, al alta y al año del ingreso, según las Categorías de estado general y cerebral pediátrico (CEGP-CECP) y la Escala de estado funcional (FSS). Los resultados se comparan con nuestros datos previos (años 1990-1999) y con los del estudio multicéntrico internacional PANGEA. RESULTADOS: Se estudió a 266 niños. La mortalidad fue del 3%, sin que los modelos PRISM-II y PIM2 muestren capacidad predictiva. La salud funcional refleja empeoramiento clínicamente significativo al alta de UCIP, en el 30% según CEGP, en el 15% según CECP y en el 5% según FSS. Transcurrido un año, la funcionalidad mejora según CEGP-CECP, pero no según FSS. Los niños sin enfermedad neurológica de base presentan afectación funcional en mayor porcentaje, que se mantiene en el tiempo. Comparada con nuestros datos previos, la mortalidad global y neurocrítica disminuye (5,60 vs. 2,1%; p = 0,0003 y 8,44 vs. 2,63%; p = 0,0014, respectivamente). En relación con el estudio multicéntrico PANGEA, tanto la mortalidad como el empeoramiento funcional cerebral del niño neurocrítico son menores en el estudio actual (1,05 vs. 13,32%; p < 0,0001 y 10,47 vs. 23,79%; p < 0,0001, respectivamente). CONCLUSIONES: Alrededor de un tercio de los niños críticos muestran enfermedad neurológica. Un porcentaje importante, sobre todo de niños sin enfermedad neurológica basal, presenta repercusión funcional clínicamente significativa al alta de UCIP y transcurrido un año. La repercusión en el pronóstico funcional del niño crítico apoya la importancia de la neuromonitorización y neuroprotección, medidas necesarias para mejorar la asistencia del niño crítico y la valoración evolutiva de la salud funcional

INTRODUCTION: Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. MATERIAL AND METHODS: Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. RESULTS: A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P = .0003, and 8.44 vs. 2.63%, P = .0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P < .0001, and 10.47% vs. 23.79%, P < .0001, respectively). CONCLUSIONS: Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care

Valoración funcional tras tratamiento neurointensivo pediátrico. Nueva escala de estado funcional (FSS) / Functional assessment of a series of paediatric patients receiving neurointensive treatment: New Functional status scale

INTRODUCCIÓN: La salud funcional, parámetro adecuado de morbilidad, debería constituir un estándar pronóstico de las unidades de cuidados intensivos pediátricos (UCIP), siendo fundamental el desarrollo de escalas para su valoración. Las categorías de estado global y cerebral pediátrico (CEGP-CECP) se han empleado clásicamente en estudios pediátricos; el desarrollo de la nueva Escala de estado funcional (FSS) busca mejorar la objetividad. El objetivo del trabajo es comprobar si la escala FSS es un instrumento válido frente a la clásica CEGP-CECP, y si, incluso, posee mejores cualidades evaluadoras de la funcionalidad neurológica. PACIENTES Y MÉTODO: Estudio retrospectivo descriptivo de los 266 niños con enfermedad neurológica ingresados en la UCIP durante 3 años (2012-2014). Se valora su salud funcional al alta y tras un año del ingreso en UCIP, según las categorías CEGP-CECP y la nueva FSS, comparando ambas escalas mediante análisis de correlación (Rho de Spearman). RESULTADOS: La comparación de varianzas de FSSglobal en cada intervalo de CEGP muestra buena correlación para todas las comparaciones (p < 0,001), excepto en la categoría «5 = coma-vegetativo». La dispersión de FSSglobal aumenta a medida que lo hace la categoría CEGP. La correlación es similar en la versión neurológica de ambas escalas. DISCUSIÓN: La nueva escala FSS parece ser un método útil para evaluar salud funcional en nuestro medio, tras su comparación con las clásicas categorías CEGP-CECP. La dispersión de los valores de la escala FSS indica falta de precisión del sistema CEGP-CECP, comparado con la nueva escala FSS, más desglosada y objetiva

INTRODUCTION: Functional health, a reliable parameter of the impact of disease, should be used systematically to assess prognosis in paediatric intensive care units (PICU). Developing scales for the assessment of functional health is therefore essential. The Paediatric Overall and Cerebral Performance Category (POPC, PCPC) scales have traditionally been used in paediatric studies. The new Functional Status Scale (FSS) was designed to provide more objective results. This study aims to confirm the validity of the FSS compared to the classic POPC and PCPC scales, and to evaluate whether it may also be superior to the latter in assessing of neurological function. PATIENTS AND METHOD: We conducted a retrospective descriptive study of 266 children with neurological diseases admitted to intensive care between 2012 and 2014. Functional health at discharge and at one year after discharge was evaluated using the PCPC and POPC scales and the new FSS. RESULTS: Global FSS scores were found to be well correlated with all POPC scores (P < .001), except in category 5 (coma/vegetative state). Global FSS score dispersion increases with POPC category. The neurological versions of both scales show a similar correlation. DISCUSSION: Comparison with classic POPC and PCPC categories suggests that the new FSS scale is a useful method for evaluating functional health in our setting. The dispersion of FSS values underlines the poor accuracy of POPC-PCPC compared to the new FSS scale, which is more disaggregated and objective

Functional assessment of a series of paediatric patients receiving neurointensive treatment: New Functional status scale. / Valoración funcional tras tratamiento neurointensivo pediátrico. Nueva escala de estado funcional (FSS).

INTRODUCTION: Functional health, a reliable parameter of the impact of disease, should be used systematically to assess prognosis in paediatric intensive care units (PICU). Developing scales for the assessment of functional health is therefore essential. The Paediatric Overall and Cerebral Performance Category (POPC, PCPC) scales have traditionally been used in paediatric studies. The new Functional Status Scale (FSS) was designed to provide more objective results. This study aims to confirm the validity of the FSS compared to the classic POPC and PCPC scales, and to evaluate whether it may also be superior to the latter in assessing of neurological function. PATIENTS AND METHOD: We conducted a retrospective descriptive study of 266 children with neurological diseases admitted to intensive care between 2012 and 2014. Functional health at discharge and at one year after discharge was evaluated using the PCPC and POPC scales and the new FSS. RESULTS: Global FSS scores were found to be well correlated with all POPC scores (P<.001), except in category 5 (coma/vegetative state). Global FSS score dispersion increases with POPC category. The neurological versions of both scales show a similar correlation. DISCUSSION: Comparison with classic POPC and PCPC categories suggests that the new FSS scale is a useful method for evaluating functional health in our setting. The dispersion of FSS values underlines the poor accuracy of POPC-PCPC compared to the new FSS scale, which is more disaggregated and objective.

Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience. / Patología neurológica en una unidad de cuidados intensivos pediátricos de tercer nivel. Evolución funcional. Nuestra experiencia.

INTRODUCTION: Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. MATERIAL AND METHODS: Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. RESULTS: A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P=.0003, and 8.44 vs. 2.63%, P=.0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P<.0001, and 10.47% vs. 23.79%, P<.0001, respectively). CONCLUSIONS: Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care.

Neurological manifestations of neurofibromatosis type 1: our experience. / Manifestaciones neurológicas en neurofibromatosis tipo 1. Nuestra experiencia.

INTRODUCTION: Neurofibromatosis type 1 (NF1) is a progressive multisystem disorder following an autosomal dominant inheritance pattern that presents with multiple neurological manifestations. METHODS: We reviewed medical histories of patients with NF1 followed up at our hospital's paediatric neurology department from May 1990 to 31 December 2018. We collected data on neurological symptoms. RESULTS: A total of 128 patients with NF1 were identified. Mean age (SD) at NF1 diagnosis was 4.43 (3.38) years (range, 0.5-14.5 years). There was a slight female predominance (53.1%). Macrocephaly (head circumference over 2 SDs above average for age) was present in 37.5% of cases. Attention-deficit/hyperactivity disorder was recorded in 28.9% of patients (37): combined type in 20 patients, predominantly inattentive in 15, and predominantly impulsive/hyperactive in 2. Other manifestations included headache (18.6%), cognitive impairment (7.8%), motor deficit (6.2%), and epilepsy (4.68%). Brain MRI was performed in 85 patients, revealing T2-weighted hyperintensities in the basal ganglia and/or cerebellum in 60 patients (70.5%), Chiari malformation type 1 in 4 cases, and arachnoid cysts in 3. Optic nerve gliomas were identified by MRI in 22 patients (25.8%). Other MRI findings included plexiform neurofibromas (9.3%) and central nervous system gliomas (3.1%). CONCLUSIONS: The neurological manifestations identified in our sample are consistent with those reported in the literature. Effective transfer strategies from paediatric neurology departments and subsequent clinical follow-up by adult neurology departments are needed to prevent loss to follow-up in adulthood.

Incidencia y epidemiología del cáncer infantil en Aragón y La Rioja entre 2002 y 2012 / Childhood cancer incidence and epidemiology in Aragón and La Rioja between 2002 and 2012

Introducción: El cáncer es la primera causa de muerte por enfermedad en la infancia a partir del primer año de vida. En los últimos años ha mejorado la supervivencia de los pacientes, aunque esto contrasta con el desconocimiento de sus causas. Objetivo: Conocer los factores de riesgo, la incidencia, la epidemiología y la evolución del cáncer en niños de 0-14 años de edad residentes en Aragón y La Rioja entre 2002 y 2012. Analizar el conocimiento sobre la etiopatogenia del cáncer pediátrico. Pacientes y métodos: Estudio retrospectivo de 327 pacientes de 5 unidades de oncopediatría españolas. El Registro Nacional de Tumores Infantiles facilitó una serie de datos básicos de dichos casos; se estudiaron datos complementarios en los casos controlados en el Hospital Universitario Miguel Servet consultando los archivos del Servicio de Oncopediatría. Resultados: En los 327 pacientes hubo 338 casos nuevos, con una tasa de incidencia de 131 casos anuales por millón. El sexo predominante fue masculino. La mediana de tiempo desde el primer síntoma hasta el diagnóstico fue de 4 semanas. La incidencia tumoral por edad y tipo de neoplasia fue similar a la de la bibliografía revisada. Hubo 68 fallecidos (un 64,2% debido al cáncer como causa inmediata), y la supervivencia a los 5 años fue del 76,8%. Un total de 270 pacientes eran españoles y 20 extranjeros. De los españoles, 235 nacieron en Aragón, 28 en La Rioja y 7 en otra comunidad autónoma. El 28,6% residía en un ámbito rural en el momento del diagnóstico y el 71,4% en áreas urbanas, el 83,2% en Aragón y el 16,8% en La Rioja. En el 55,9% de los casos la familia estaba compuesta por 2 hijos, y en el 22,1% por 1 hijo. El paciente era el primogénito en el 47,2% de los casos

Introduction: Cancer is the leading cause of death by disease in children from the first year of life. The overall outlook for children with cancer has improved but the causes of most childhood cancers are still unknown. Objective: To know the risk factors, incidence, epidemiology and evolution of cancer among children aged 0-14 years living in Aragón and La Rioja between 2002-2012. Analyze the knowledge of the pathogenesis of pediatric cancer. Materials and methods: Retrospective study of 327 patients of 5 Oncopediatrics Units of Spain. The National Childhood Tumor Registry provided the basic data of these cases; the additional data were obtained from the files of the Oncopediatrics Unit in the Miguel Servet University Hospital. Results: There were 338 new cases and the incidence rate was of 131 cases per million with a predominance of male gender. The median time from first symptoms to diagnosis was 4 weeks. Cancer incidence was similar to the literature reviewed. There were 68 deaths (64.2% immediately due to cancer), the 5-year survival rate was of 76.8%. 270 patients were Spanish (235 were born in Aragón, 28 in La Rioja and 7 in other Autonomous Community) and 20 foreigners. At the time of diagnosis 28.6% lived in rural areas and 71.4% in urban areas (Aragón: 83.2%; La Rioja: 16.8%). The 55.9 percent of the families were composed of 2 children at diagnosis. The patient was the firstborn in the 47.2% of cases

Estudio descriptivo de las epilepsias sintomáticas según edad de inicio controladas durante 3 años en una Unidad de Neuropediatría de referencia regional / Descriptive study of symptomatic epilepsy by age of onset in patients with a 3-year follow-up at the Neuropaediatric Department of a reference centre

Objetivo: Estudio descriptivo de epilepsias sintomáticas, según edad de inicio, controladas en una Unidad de Neuropediatría de referencia regional durante 3 años. Pacientes y métodos: Niños con diagnóstico de epilepsia sintomática, controlados del 1 de enero del 2008 hasta el 31 de diciembre del 2010. Resultados: De 4595 niños en el periodo de estudio, recibieron el diagnóstico de epilepsia 605 (13,17%), siendo 277 (45,79%) epilepsias sintomáticas. Entre los pacientes que iniciaron la epilepsia por debajo del año de vida predominan las de etiología sintomática (67,72%). Entre los que la iniciaron entre 1-3 años, fueron sintomáticas el 61,39%. En cuanto a su etiología, ha sido: encefalopatías prenatales (24,46% del total de epilepsias), encefalopatías perinatales (9,26%), encefalopatías posnatales (3,14%), encefalopatías metabólicas y degenerativas (1,98%), esclerosis mesial temporal (1,32%), síndromes neurocutáneos (2,64%), malformaciones vasculares (0,17%), cavernomas (0,17%) y tumores intracraneales (2,48%). Algunas etiologías inician sus manifestaciones epilépticas por debajo del año de vida, como el síndrome de Down, la lisencefalia genética, la infección congénita por citomegalovirus, la encefalopatía hipóxico-isquémica, las encefalopatías metabólicas o la esclerosis tuberosa. Conclusiones: La ausencia de una clasificación universalmente aceptada de los síndromes epilépticos dificulta comparaciones entre series. Sugerimos que todas las epilepsias son sintomáticas puesto que tienen causa, genética o adquirida. La edad de inicio orienta a determinadas etiologías. Una clasificación útil es la etiológica, con 2 grupos: un gran grupo con las etiologías establecidas o síndromes genéticos muy probables y otro de casos sin causa establecida, que con los avances en neuroimagen y genética cada vez será menor (AU)

Objective: We conducted a descriptive study of symptomatic epilepsy by age at onset in a cohort of patients who were followed up at a neuropaediatric department of a reference hospital over a 3-year period. Patients and methods: We included all children with epilepsy who were followed up from January 1, 2008 to December 31, 2010. Results: Of the 4595 children seen during the study period, 605 (13.17%) were diagnosed with epilepsy; 277 (45.79%) of these had symptomatic epilepsy. Symptomatic epilepsy accounted for 67.72% and 61.39% of all epilepsies starting before one year of age, or between the ages of one and 3, respectively. The aetiologies of symptomatic epilepsy in our sample were: prenatal encephalopathies (24.46% of all epileptic patients), perinatal encephalopathies (9.26%), post-natal encephalopathies (3.14%), metabolic and degenerative encephalopathies (1.98%), mesial temporal sclerosis (1.32%), neurocutaneous syndromes (2.64%), vascular malformations (0.17%), cavernomas (0.17%), and intracranial tumours (2.48%). In some aetiologies, seizures begin before the age of one; these include Down syndrome, genetic lissencephaly, congenital cytomegalovirus infection, hypoxic-ischaemic encephalopathy, metabolic encephalopathies, and tuberous sclerosis. Conclusions: The lack of a universally accepted classification of epileptic syndromes makes it difficult to compare series from different studies. We suggest that all epilepsies are symptomatic because they have a cause, whether genetic or acquired. The age of onset may point to specific aetiologies. Classifying epilepsy by aetiology might be a useful approach. We could establish 2 groups: a large group including epileptic syndromes with known aetiologies or associated with genetic syndromes which are very likely to cause epilepsy, and another group including epileptic syndromes with no known cause. Thanks to the advances in neuroimaging and genetics, the latter group is expected to become increasingly smaller (AU)

Descriptive study of symptomatic epilepsy by age of onset in patients with a 3-year follow-up at the Neuropaediatric Department of a reference centre. / Estudio descriptivo de las epilepsias sintomáticas según edad de inicio controladas durante 3 años en una Unidad de Neuropediatría de referencia regional.

OBJECTIVE: We conducted a descriptive study of symptomatic epilepsy by age at onset in a cohort of patients who were followed up at a neuropaediatric department of a reference hospital over a 3-year period PATIENTS AND METHODS: We included all children with epilepsy who were followed up from January 1, 2008 to December 31, 2010 RESULTS: Of the 4595 children seen during the study period, 605 (13.17%) were diagnosed with epilepsy; 277 (45.79%) of these had symptomatic epilepsy. Symptomatic epilepsy accounted for 67.72% and 61.39% of all epilepsies starting before one year of age, or between the ages of one and 3, respectively. The aetiologies of symptomatic epilepsy in our sample were: prenatal encephalopathies (24.46% of all epileptic patients), perinatal encephalopathies (9.26%), post-natal encephalopathies (3.14%), metabolic and degenerative encephalopathies (1.98%), mesial temporal sclerosis (1.32%), neurocutaneous syndromes (2.64%), vascular malformations (0.17%), cavernomas (0.17%), and intracranial tumours (2.48%). In some aetiologies, seizures begin before the age of one; these include Down syndrome, genetic lissencephaly, congenital cytomegalovirus infection, hypoxic-ischaemic encephalopathy, metabolic encephalopathies, and tuberous sclerosis. CONCLUSIONS: The lack of a universally accepted classification of epileptic syndromes makes it difficult to compare series from different studies. We suggest that all epilepsies are symptomatic because they have a cause, whether genetic or acquired. The age of onset may point to specific aetiologies. Classifying epilepsy by aetiology might be a useful approach. We could establish 2 groups: a large group including epileptic syndromes with known aetiologies or associated with genetic syndromes which are very likely to cause epilepsy, and another group including epileptic syndromes with no known cause. Thanks to the advances in neuroimaging and genetics, the latter group is expected to become increasingly smaller.

[A descriptive study of non-symptomatic epilepsy according to age at onset at a Neuropediatric Section of regional reference]. / Estudio descriptivo de las epilepsias no sintomaticas segun la edad de inicio en una unidad de neuropediatria de referencia regional.

AIM: A descriptive study of non-symptomatic epilepsy (idiopathic and cryptogenic), according to age at onset, monitored at a Neuropediatric Section of regional reference over a period of three years. PATIENTS AND METHODS: A review of neuropediatric database medical records of children with non-symptomatic epilepsy supervised from Jan 1, 2008 till December 31, 2010. RESULTS: Of the 4595 children attended during the period, 605 were diagnosed with epilepsy (13.17%): 156 (25.79%) idiopathic epilepsies and 172 (28.43%) cryptogenic epilepsies. The average age at onset of the total was 4.78 years: 6.31 years in idiopathic epilepsies and 5.43 years in cryptogenic epilepsies. 26.12% of all the epilepsies began in the first year of life. Idiopathic epilepsy predominates in the startup group of 6-10 years and cryptogenic epilepsy in 3-6 years. Absence epilepsy and benign childhood epilepsy with centro-temporal spikes are the idiopathic epileptic syndromes most prevalent. CONCLUSIONS: Many differences exist among published epidemiological data on childhood epilepsy due to the difficulty of a syndromic diagnosis in children, caused by clinical and electroencephalographic variability. The absence of a universally accepted classification of epileptic syndromes makes it difficult to compare publications. All epilepsies are symptomatic as they have a cause, whether it be genetic or acquired. A useful classification would be etiological, with two groups: one large with established etiology or very likely genetic syndromes and another with no established cause. The age at onset indicates specific etiologies.

TITLE: Estudio descriptivo de las epilepsias no sintomaticas segun la edad de inicio en una unidad de neuropediatria de referencia regional.Objetivo. Estudio descriptivo de las epilepsias no sintomaticas (idiopaticas y criptogenicas), segun la edad de inicio, controladas en una unidad de neuropediatria de referencia regional durante tres años. Pacientes y metodos. Revision de historias de niños con epilepsia no sintomatica de la base de datos de neuropediatria controlados del 1 de enero de 2008 al 31 de diciembre de 2010. Resultados. De 4.595 niños atendidos en el periodo, se diagnosticaron de epilepsia 605 (13,17%), de las cuales 156 (25,79%) fueron idiopaticas, y 172 (28,43%), criptogenicas. La edad media de inicio del total fue de 4,78 años; 6,31 años en las idiopaticas y 5,43 años en las criptogenicas. El 26,12% del total de epilepsias se inicio en el primer año. Las epilepsias idiopaticas predominan en el grupo de inicio de 6-10 años, y las criptogenicas, en el de 3-6 años. La epilepsia de ausencias y la epilepsia benigna de la infancia con paroxismos centrotemporales son los sindromes epilepticos idiopaticos mas prevalentes. Conclusiones. Existen muchas diferencias de datos epidemiologicos publicados sobre epilepsia infantil por la dificultad que entraña un diagnostico sindromico en la edad pediatrica, debido a la variabilidad clinica y electroencefalografica. La ausencia de una clasificacion universalmente aceptada de los sindromes epilepticos dificulta comparaciones entre series. Todas las epilepsias son sintomaticas, puesto que tienen causa, sea genetica o adquirida. Una clasificacion util es la etiologica, con dos grupos: un gran grupo con las etiologias establecidas o sindromes geneticos muy probables y otro de casos sin causa establecida. La edad de inicio orienta a determinadas etiologias.

Epidemiología de los defectos estructurales cardíacos en una población infantil / Epidemiology of heart structural defects in a child population

Introducción. La auscultación de un soplo constituye con frecuencia el principal motivo de consulta en Cardiología Pediátrica. Un pequeño porcentaje de pacientes (0.8-1%) presentan cardiopatía estructural; entre los defectos más graves, la morbimortalidad continúa siendo elevada, recomendándose la evaluación ecocardiográfica ante la sospecha de patología. Material y métodos. Estudio retrospectivo descriptivo de 1.529 niños entre 0 y 16 años atendidos en la consulta de Cardiología del Hospital Clínico Universitario Lozano Blesa, de Zaragoza, entre enero de 2010 y diciembre de 2012. Se analizaron los hallazgos más frecuentes de la muestra y cada grupo de edad. Resultados. El principal motivo de consulta fue la auscultación de un soplo, el 43,4% (649) de los pacientes procedían de Atención Primaria. Los hallazgos más frecuentes fueron los defectos del tabique intraventricular en un 6,5% (99), interauricular 5,8% (89%) y las valvulopatías 5,2% (80). Entre los neonatos se evidenció patología en el 5.2% (80). Entre los neonatos se evidenció patología en el 65,4% (208) frente al 16,7% (112) de los escolares. Conclusiones. La mayoría de los pacientes son remitidos desde Atención Primaria, siendo el principal motivo de consulta la auscultación de un soplo. En un porcentaje elevado de casos la ecocardiografía es normal, siendo frecuente el diagnóstico de soplo inocente, especialmente entre los pacientes de mayor edad (AU)

Introduction. The finding of an innocent murmur in the child frequently represents the first cause to consult in Cardiology. A small percentage of patients (0.8-1%) presents a congenital heart disease; between the severest defects, the morbimortality continues being high, which leads to tecommend the ecochardiografic evaluation due to suspicion of disease. Material and methods. A descriptive research of 1529 patients between 0 to 16 years old assessed at the Paediatric Cardiology consult at the Hospital Clínico Universitario Lozano Blesa in Zaragoza between January 2010 to December 2012. The most frequent findings were analized from the whole and each age group. Outcomes. The first cause to consult was the finding of a murmur with the stethoscope; 42,4% (649) of the patients came from Primary Attention. The principal findings were the ventricular septal defects in 6,5% (99), atrial septal defects 5,8% (89)and the valvulopathies 5,2% (80). There was pathology in the 65.4% (208) between neonates, but in the 16,7 (112) between the schoolchildren. Conclusions. Most of the patients came from Primary Attention, due to the finding of a murmur. In a high percentage the echocardiography is normal, the diagnostic of an innocent murmur is frequent specially in the oldest age range (AU)

Evolución de la demanda asistencial neuropediátrica en un hospital español de tercer nivel a lo largo de 20 años / Changes in the demand for paediatric neurology care in a spanish tertiary care hospital over a 20-year period

Objetivo: El objetivo de este trabajo es conocer el perfil de la demanda asistencial neuropediátrica en un hospital español de tercer nivel a lo largo de los últimos 20 años. Método: Se estudiaron datos epidemiológicos, motivos de consulta, diagnósticos y exámenes complementarios de todos los pacientes valorados en nuestra Unidad de Neuropediatría en sus 20 años de funcionamiento (de mayo de 1990 a marzo del 2010). También se revisaron estos mismos datos centrándonos en pacientes cuya primera visita se efectuó en los últimos 5 años (2005-2010), para compararlos con los obtenidos en un estudio previo desarrollado de 1990 a 1995 en esta unidad. Para comparar los 5 primeros años (grupo 1) con los últimos 5 años (grupo 2), se calcularon los intervalos de confianza para p < 0,05 para la distribución en frecuencias (%) de cada categoría. Resultados: Los principales motivos de consulta y diagnósticos de los 12.726 pacientes valorados en los 20 años, así como los resultados obtenidos del grupo 1 (2.046 pacientes) y del grupo 2 (4.488 pacientes), con sus intervalos de confianza, se presentan en diversas tablas. Conclusiones: Las variaciones experimentadas en los motivos de consulta, los diagnósticos y los exámenes complementarios a lo largo del tiempo reflejan los cambios determinados por los avances médicos, científicos y sociales, además de temas organizativos propios de cada hospital, lo que explica las dificultades para comparar diferentes series de pacientes en diferentes momentos y más aún entre diferentes hospitales

Objective: The purpose of this study is to determine the profile of the demand for paediatric neurology care in a Spanish tertiary hospital over the past 20 years. Method: We studied epidemiological data, reasons for consultation, diagnoses and complementary tests from all patients examined by our Paediatric Neurology Unit in its 20 years of service (from May 1990 to March 2010). We also reviewed data from patients whose first visit took place within the last five years (2005-2010) and compared them to data obtained from a prior study carried out in this Unit from 1990 to 1995. To compare the first 5 years (group 1) with the last 5 years (group 2), we calculated confidence intervals, P<.05, for the frequency distribution (%) in each category. Results: Main reasons for consultation and principal diagnoses for the 12726 patients evaluated in the 20-year period, as well as results from group 1 (2046 patients) and group 2 (4488 patients) corresponding to first and the last 5 years of activity respectively, are presented with their confidence intervals in a series of tables. Conclusions: Variations in the reasons for consultation, diagnoses and complementary tests over time reflect changes determined by medical, scientific and social progress, and organizational changes specific to each hospital. This explains the difficulty of comparing different patient series studied consecutively, which are even more pronounced between different hospitals

[Changes in the demand for paediatric neurology care in a spanish tertiary care hospital over a 20-year period]. / Evolución de la demanda asistencial neuropediátrica en un hospital español de tercer nivel a lo largo de 20 años.

OBJECTIVE: The purpose of this study is to determine the profile of the demand for paediatric neurology care in a Spanish tertiary hospital over the past 20 years. METHOD: We studied epidemiological data, reasons for consultation, diagnoses and complementary tests from all patients examined by our Paediatric Neurology Unit in its 20 years of service (from May 1990 to March 2010). We also reviewed data from patients whose first visit took place within the last five years (2005-2010) and compared them to data obtained from a prior study carried out in this Unit from 1990 to 1995. To compare the first 5 years (group 1) with the last 5 years (group 2), we calculated confidence intervals, P<.05, for the frequency distribution (%) in each category. RESULTS: Main reasons for consultation and principal diagnoses for the 12726 patients evaluated in the 20-year period, as well as results from group 1 (2046 patients) and group 2 (4488 patients) corresponding to first and the last 5 years of activity respectively, are presented with their confidence intervals in a series of tables. CONCLUSIONS: Variations in the reasons for consultation, diagnoses and complementary tests over time reflect changes determined by medical, scientific and social progress, and organisational changes specific to each hospital. This explains the difficulty of comparing different patient series studied consecutively, which are even more pronounced between different hospitals.

Accidentes cerebrovasculares isquémicos neonatales: revisión casuística de los últimos 20 años / Neonatal ischemic cerebrovascular strokes: review of patients in the last 20 years

Introducción: Los accidentes cerebrovasculares (ACV), aunque son una patología poco frecuente en los recién nacidos a término (RNT), constituyen una causa importante de morbimortalidad neonatal. La forma habitual de presentación son las convulsiones focales, con buena respuesta al tratamiento. Objetivos: Revisión de los ACV isquémicos en RNT, analizando los posibles factores causales y pronósticos. Pacientes y métodos: Estudio descriptivo retrospectivo de los RNT con diagnóstico de ACV isquémico ingresados en la Sección de Neonatología del Hospital «Miguel Servet» de Zaragoza en los últimos 20 años. De cada caso se recogen datos sobre antecedentes familiares y personales, antecedentes perinatales, presentación clínica, exámenes complementarios y evolución neurológica posterior. Resultados: Se recogen un total de 12 casos, todos con afectación de la arteria cerebral media, generalmente la izquierda. Excepto en un paciente, se manifestaron en forma de crisis focales con buena respuesta al tratamiento anticonvulsivo. La neuroimagen fue fundamental para el diagnóstico. La evolución no presentó secuelas en 7 casos; el déficit motor fue la secuela principal, de carácter leve en todos los casos excepto en uno, que asoció también un déficit cognitivo y epilepsia. Conclusiones: Los ACV son entidades poco frecuentes, y en la mayoría de los casos no se puede identificar su etiología. La convulsión focal precoz es la manifestación más común, con buena respuesta terapéutica. Las técnicas de neuroimagen son imprescindibles para su diagnóstico. La evolución a corto y largo plazo suele ser favorable, y la secuela más habitual es el déficit motor focal. No se suelen identificar los factores que permiten predecir su evolución y pronóstico(AU)

Introduction: Although cerebrovascular stroke is a rare disease in full-term newborns but is an important cause of neonatal morbidity and mortality. Focal seizures are the most common form of presentation with a good response to therapy. Objectives: Review of ischemic stroke in full-term newborns and analyze of the possible causal and prognosis factors. Patients and methods: A retrospective study of full-term newborn diagnosed with ischemic stroke admitted to the Neonatology Section of Hospital «Miguel Servet» in Zaragoza in the last 20 years. In each case we collect personal and family history, perinatal history, clinical presentation, complementary tests and neurological. Results: We report a total of 12 cases. All the cases are strokes of the middle cerebral artery, most left. All but one appeared as focal seizures with good response to anticonvulsant therapy. Neuroimaging was essential for diagnosis. Evolution without sequelae was observed in 7 cases. The motor deficit was the main sequelae, mild in all but one case, which also teamed cognitive impairment and epilepsy. Conclusions: These are rare entities, unable to identify the etiology in most cases. The early focal seizure is the most common with good therapeutic response. Neuroimaging techniques are essential for diagnosis. The short-and long-term evolution is usually favorable. The most common sequelae is focal motor deficit. There are usually no prognostic factors(AU)

Lesiones cerebrales focales isquémicas y hemorrágicas en el recién nacido a término. Revisión casuística / Focal ischemic and hemorragic brain lesions in the full term new born: A casuistic review

Introducción. Las afecciones cerebrovasculares tienen un gran interés en los recién nacidos a término (RNT), siendo poco frecuentes en relación con los pretérmino por ser causa importante de morbimortalidad neonatal, debiéndose considerar ante la aparición de síntomas neurológicos, principalmente convulsiones. Objetivo. Revisar los accidentes cerebrovasculares focales isquémicos o hemorrágicos en RNT par aun mejor conocimiento de estas afecciones en nuestro medio, tratando de identificar posibles factores cáusales y pronósticos. Pacientes y métodos. Se han estudiado retrospectivamente los RNT con diagnóstico de accidente cerebrovascular focal isquémico o hemorrágico y clínica neurológica precoz, ingresados en la dos últimas décadas (enero 1990 a julio 2009) en la sección de Neonatología del Hospital Universitario Miguel Servet de Zaragoza y controlados posteriormente en la policlínica de seguimiento. De cada caso se recogieron antecedentes familiares y personales, gestación, parto, clínica, exploración, estudios complementarios, así como su evolución neurológica. Resultados. De los 21 casos recogidos, 12 fueron infartos de la arteria cerebral media (la mayoría izquierdos) y 9 hemorragias. En 4 casos de hemorragia existía antecedente de traumatismo intraparto y en los restantes no se encontró una causa que los justificara. La mayoría se manifestaron como convulsiones focales asociadas a movimientos sutiles. La neuroimagen fue esencial para el diagnóstico. El déficit motor es la secuela principal, en dos de ellos asociada a déficit cognitivo y epilepsia, siendo en 8 casos el desarrollo psicomotor normal. Conclusiones. Son entidades poco frecuente, desconociéndose su etiología en la mayoría de los casos. La convulsión focal precoz asociada a movimientos sutiles es la manifestación principal y los estudios de neuroimagen son esenciales para el diagnóstico. La evolución neurológica suele ser favorable en la mayoría y las secuelas más importantes son las motoras. No suele existir factores pronósticos (AU)

Introduction. Cerebrovascular diseases are very important in full-term newborns, being rare compared to preterm and it is an important cause of neonatal morbidity, and it must be consider with the appearance before of neurological symptoms, mainly seizures. Objective. The review focal ischemic or hemorrhagic stroke in term newborn to a better understanding of these conditions in our country, trying to identify possible causal factors and prognosis. Patients and Methods. Term newborns with a diagnosis of focal ischemic or hemorrhagic stroke an early neurological symptoms admitted during the last two decades (January 1990 to July 2009) in the section of Neonatology of the University Hospital Miguel Servet in Zaragoza and controlled later in the follow-up clinical have been studied. In each case we collected personal and family history, pregnancy, childbirth, clinical examination, complementary studies and their neurological development. Results. Of the 21 cases reported, 12 were strokes of the middle cerebral artery (most left) and 9 bleeding. In 4 cases there was history of trauma hemorrhage intrapartum and in the raining we did not find a cause. Most appeared as focal seizures associated with subtle movements. The neuroimaging was essential for diagnosis. The motor deficit is the main sequelae, two of them associated with cognitive impairment and epilepsy. With 8 cases having normal psychomotor development. Conclusions. These are rare entities of unknown etiology in most cases. The early focal seizure associated with subtle movements is the main manifestation and neuroimaging studies are essential for diagnosis. The neurological outcome is usually favourable in the majority and the most important sequelaes are motor deficit. There are usually no prognostic factors (AU)

Trastornos paroxísticos no epilépticos en niños de 0 a 15 meses: Revisión de dos años / Non epileptic paroxismal disorders in children from 0 to 15 months. A two-year review

Introducción. Los trastornos paroxísticos no epilépticos son manifestaciones de origen brusco y breve duración. Se originan por una disfunción cerebral y tiene en común el carácter excluyente de no ser epilépticas. Objetivo. Analizar los datos epidemiológicos, clínica y evolución de estos episodios en nuestra serie. Material y métodos. Se revisaron las historias de 139 pacientes de 0 a 15 meses valorados en nuestro Servicio de Pediatría en 2007 y 2008 que presentaron al menos un episodio paroxístico y se registraron las características epidemiológicas, clínicas, actitud diagnóstico-terapéutica y evolución. Resultados. El 94,3% de los pacientes con trastornos paroxísticos fueron no epilépticos. El 67% fueron crisis febriles y el 28% afebriles. Este último grupo se clasificó en: crisis anóxicas (59%), trastornos motores (8%), trastornos secundarios a tóxicos (7,7%) o relacionados con el sueño (2,6%). El desarrollo psicomotor fue normal en todos excepto en uno. Precisaron tratamiento farmacológico (2 síndrome de Sandifer y 1 síndrome de abstinencia). Conclusiones. Los trastornos paroxísticos no epilépticos son 10 veces más frecuentes que los epilépticos, no precisan tratamiento farmacológico, pero sí normas de actuación ante las crisis, ya que a pesar de su naturaleza benigna y mejor pronóstico, causan gran angustia familiar y generan consultas frecuentes (AU)

Introduction. Non epileptic paroxismal events are clinical disorders with sudden appearance, short duration and caused by a cerebral dysfunction with the common feature to be not epileptic. Objective. Our aim was to analyze the epidemiological, clinical and evolution of these events in our series. Methods. We included 139 patients from 0 to 15 months studied in our department in 2007 and 2008 who had at least one paroxysmal event and registered the epidemiological, clinical, diagnostic, therapeutic and developmental data. Results. 94.3% of patients were non-epileptic paroxysmal events. Of these, 67% were febrile seizures and 28% were afebrile. The latter group was classified as: Anoxic events (59%), motor disorders (8%), toxic secondry disorders (7.7%) or sleep-related (2.6%), among others. Psychomotro development was normal in all cases except one. Only three patients were treated 82 Sandifer Syndrome and 1 withdrawal). Conclusion. It is estimated that non-epileptic paroxysmal disorders are 10 times more common that epilepsy, not usually require drug treatment, but a proper performance is needed because despite its benign nature and better prognosis cause great distress and generate family frequent consultations (AU)