Coste-efectividad de una solución bucal de midazolam en el tratamiento de las crisis convulsivas prolongadas en el entorno ambulatorio en España / Cost-effectiveness of buccal midazolam in the treatment of prolonged convulsive seizures in the outpatient setting in Spain

Introducción. El tratamiento de las crisis epilépticas prolongadas requiere disponer de una medicación de rescate cómoda, segura y efectiva. Actualmente, el tratamiento estándar en la comunidad es el diacepam rectal. La introducción de una solución bucal de midazolam abre una perspectiva nueva en el tratamiento. Objetivo. Evaluar el coste-efectividad del midazolam bucal respecto al diacepam rectal para los niños con un diagnóstico de epilepsia que presentan crisis convulsivas prolongadas en la comunidad en España. Materiales y métodos. Modelo coste-efectividad desde la perspectiva del Sistema Nacional de Salud (SNS) español, con resultados presentados en términos de costes y años de vida ajustados por calidad. Los datos se obtuvieron de varias fuentes, incluidas las estimaciones de efectividad clínica de un ensayo clínico, de un panel Delphi en España y de una encuesta nacional a padres de niños con epilepsia para determinar las prácticas actuales. Resultados. El tratamiento con midazolam bucal produce un ahorro de costes en comparación con el diacepam rectal. El ahorro para el SNS español es de 5.484 euros por paciente al año. El tratamiento con midazolam bucal ofrece una mejora en la calidad de vida relacionada con la salud. Esto, unido al ahorro de costes, hace que el midazolam bucal sea dominante frente al diacepam rectal en todos los escenarios examinados. Conclusión. Los resultados del modelo muestran que el midazolam bucal es más coste-efectivo que el diacepam rectal debido a una reducción en la necesidad de llamadas a la ambulancia y estancias en el hospital, así como a una mejora en la calidad de vida relacionada con la salud (AU)

Introduction. To be able to treat prolonged epileptic crises practical, safe and effective rescue medication is needed. Today, the standard treatment in community healthcare is rectal diazepam. The introduction of a buccal solution of midazolam opens up a new perspective in their treatment. Aims. To evaluate the cost-effectiveness of buccal midazolam with respect to rectal diazepam for children diagnosed with epilepsy who present prolonged convulsive seizures in the community setting in Spain. Materials and methods. The study produces a model of its cost-effectiveness from the perspective of the Spanish National Health System (SNS), with the outcomes presented in terms of cost-quality adjusted life years. Data were collected from different sources, including estimations regarding the clinical effectiveness from a clinical trial, from a Delphi panel in Spain and from a national survey carried out on parents of children with epilepsy in order to determine the current practices. Results. Treatment with buccal midazolam produces a saving in costs in comparison to rectal diazepam. The amount saved by the Spanish SNS comes to 5,484 euros per patient per year. Treatment with buccal midazolam offers an improved health-related quality of life. This, together with the savings in costs, means that there is a dominance of buccal midazolam over rectal diazepam in all the settings that have been examined. Conclusions. The results obtained with the model show that buccal midazolam is more cost-effective than rectal diazepam due to a reduction in the need to call out ambulances and for stays in hospital, as well as an improved health-related quality of life (AU)

[Cost-effectiveness of buccal midazolam in the treatment of prolonged convulsive seizures in the outpatient setting in Spain]. / Coste-efectividad de una solucion bucal de midazolam en el tratamiento de las crisis convulsivas prolongadas en el entorno ambulatorio en España.

INTRODUCTION: To be able to treat prolonged epileptic crises practical, safe and effective rescue medication is needed. Today, the standard treatment in community healthcare is rectal diazepam. The introduction of a buccal solution of midazolam opens up a new perspective in their treatment. AIMS: To evaluate the cost-effectiveness of buccal midazolam with respect to rectal diazepam for children diagnosed with epilepsy who present prolonged convulsive seizures in the community setting in Spain. MATERIALS AND METHODS: The study produces a model of its cost-effectiveness from the perspective of the Spanish National Health System (SNS), with the outcomes presented in terms of cost-quality adjusted life years. Data were collected from different sources, including estimations regarding the clinical effectiveness from a clinical trial, from a Delphi panel in Spain and from a national survey carried out on parents of children with epilepsy in order to determine the current practices. RESULTS: Treatment with buccal midazolam produces a saving in costs in comparison to rectal diazepam. The amount saved by the Spanish SNS comes to 5,484 euros per patient per year. Treatment with buccal midazolam offers an improved health-related quality of life. This, together with the savings in costs, means that there is a dominance of buccal midazolam over rectal diazepam in all the settings that have been examined. CONCLUSIONS: The results obtained with the model show that buccal midazolam is more cost-effective than rectal diazepam due to a reduction in the need to call out ambulances and for stays in hospital, as well as an improved health-related quality of life.

TITLE: Coste-efectividad de una solucion bucal de midazolam en el tratamiento de las crisis convulsivas prolongadas en el entorno ambulatorio en España.Introduccion. El tratamiento de las crisis epilepticas prolongadas requiere disponer de una medicacion de rescate comoda, segura y efectiva. Actualmente, el tratamiento estandar en la comunidad es el diacepam rectal. La introduccion de una solucion bucal de midazolam abre una perspectiva nueva en el tratamiento. Objetivo. Evaluar el coste-efectividad del midazolam bucal respecto al diacepam rectal para los niños con un diagnostico de epilepsia que presentan crisis convulsivas prolongadas en la comunidad en España. Materiales y metodos. Modelo coste-efectividad desde la perspectiva del Sistema Nacional de Salud (SNS) español, con resultados presentados en terminos de costes y años de vida ajustados por calidad. Los datos se obtuvieron de varias fuentes, incluidas las estimaciones de efectividad clinica de un ensayo clinico, de un panel Delphi en España y de una encuesta nacional a padres de niños con epilepsia para determinar las practicas actuales. Resultados. El tratamiento con midazolam bucal produce un ahorro de costes en comparacion con el diacepam rectal. El ahorro para el SNS español es de 5.484 euros por paciente al año. El tratamiento con midazolam bucal ofrece una mejora en la calidad de vida relacionada con la salud. Esto, unido al ahorro de costes, hace que el midazolam bucal sea dominante frente al diacepam rectal en todos los escenarios examinados. Conclusion. Los resultados del modelo muestran que el midazolam bucal es mas coste-efectivo que el diacepam rectal debido a una reduccion en la necesidad de llamadas a la ambulancia y estancias en el hospital, asi como a una mejora en la calidad de vida relacionada con la salud.

Documento de consenso del síndrome de apneas-hipopneas durante el sueño en niños (versión completa) / Consensus document on sleep apnea-hypopnea syndrome in children (full version)

No disponible

[Five years' experience in a paediatric epilepsy unit]. / Experiencia de cinco años en una unidad de epilepsia pediátrica.

INTRODUCTION AND AIMS: The epilepsy monitoring unit is a space inside a hospital, which objective is to reproduce epileptic seizures in order to better study of an epileptic patient. We have analysed data from all the patients admitted to our pediatric epilepsy unit in the last 5 years. PATIENTS AND METHODS: 191 patients have been admitted in our unit, and we have obtained seizures in 186 admissions (monitoring efficacy, 85.9%). In this report we summarize characteristics of these children, type of seizures and treatment. RESULTS: The most frequent cause of epilepsy in our series is cortical development malformation. Patients are often late in their admission, with a median time of 3 to 4 years from epileptic onset to admission in the epilepsy unit. After the study, 22 patients underwent functional epilepsy surgery, all of them with excellent results, 9 patients underwent vagal nerve stimulator implantation and in 66 patients their previous pharmacological treatment was modified. CONCLUSIONS: The efficacy of our monitoring unit is similar to previously published, 85.9%. After the admission, we have changed diagnose in 57% of the patients and pharmacological treatment in 29%. We recommend the study in a monitoring epilepsy unit of every patient with refractory epilepsy, meaning an epilepsy that does not respond to 2-3 different appropriate treatments.

Experiencia de cinco años en una unidad de epilepsia pediátrica / Five years’ experience in a paediatric epilepsy unit

Introducción y objetivos. La unidad de monitorización continua videoelectroencefalográfica (video-EEG) es una zona dentro del ámbito hospitalario cuyo objetivo es intentar reproducir el mayor número de crisis en un paciente para su estudio. Hemos realizado un análisis de los datos de los pacientes ingresados en los últimos cinco años en nuestra unidad de epilepsia pediátrica. Pacientes y métodos. En total han ingresado 191 pacientes, obteniéndose crisis en 186 (eficacia de la monitorización del 85,9%). En este estudio se resumen las características de estos niños, del tipo de crisis que presentaron y de su tratamiento. Resultados. La causa más frecuente de epilepsia en nuestros niños han sido las malformaciones del desarrollo cortical. Los pacientes tardaron un promedio de 3-4 años desde el inicio de la epilepsia hasta el ingreso en la unidad. Tras el ingreso, 22 pacientes fueron sometidos a cirugía funcional de la epilepsia, con resultados excelentes, a nueve niños se les implantó un estimulador del nervio vago y a 66 se les modificó el tratamiento médico previo, con mejoría significativa de su clínica y su calidad de vida. Conclusiones. La eficacia de la monitorización en nuestra unidad es similar a estudios previos publicados, del 85,9%. Tras el ingreso, hemos modificado el diagnóstico en un 57% y el tratamiento médico en un 29%. Aún tardamos mucho tiempo en ingresar a un paciente en la unidad de monitorización. Recomendamos el estudio en una unidad de monitorización continua video-EEG a todo paciente con epilepsia farmacorresistente, considerada como aquélla que no responde tras dos o tres tratamientos antiepilépticos adecuados (AU)

Introduction and aims. The epilepsy monitoring unit is a space inside a hospital, which objective is to reproduce epileptic seizures in order to better study of an epileptic patient. We have analysed data from all the patients admitted to our pediatric epilepsy unit in the last 5 years. Patients and methods. 191 patients have been admitted in our unit, and we have obtained seizures in 186 admissions (monitoring efficacy, 85.9%). In this report we summarize characteristics of these children, type of seizures and treatment. Results. The most frequent cause of epilepsy in our series is cortical development malformation. Patients are often late in their admission, with a median time of 3 to 4 years from epileptic onset to admission in the epilepsy unit. After the study,22 patients underwent functional epilepsy surgery, all of them with excellent results, 9 patients underwent vagal nerve stimulator implantation and in 66 patients their previous pharmacological treatment was modified. Conclusions. The efficacy of our monitoring unit is similar to previously published, 85.9%. After the admission, we have changed diagnose in 57% of the patients and pharmacological treatment in 29%. We recommend the study in a monitoring epilepsy unit of every patient with refractory epilepsy, meaning an epilepsy that does not respond to 2-3 different appropriate treatment (AU)

Variables predictoras de retraso mental en una unidad de monitorización videoelectroencefalográfica pediátrica. Evaluación neuropsicológica / Predictive variables for mental retardation in a Pediatric Epilepsy Monitoring Unit

de Monitorización Videoelectroencefalográfica del Hospital Sant Joan de Déu de Barcelona, y determinar los factores de riesgo para presentar retraso mental. Pacientes y métodos. Se analizan retrospectivamente las historias de los pacientes ingresados desde el inicio de la Unidad de la Epilepsia (marzo de 2005) hasta diciembre de 2008. De los 158 pacientes (edad media: 8,8 ± 5,2 años; 55,1%, sexo masculino), se analizan los datos de los pacientes con un valor de cociente intelectual (CI) estimado, mayores de 3 años y con actividad epiléptica objetivada por electroencefalograma (EEG). Se agrupan en CI menor de 70 y CI mayor o igual a 70 (63 y 47 niños, respectivamente). Todos los sujetos presentaban una epilepsia farmacorresistente. Resultados. El porcentaje de pacientes con retraso mental es significativamente más alto en pacientes que inician la epilepsia antes de los 24 meses (68,3%) que en los que la inician más tarde (27,7%). Las variables que representan un riesgo mayor para presentar retraso mental son la edad de inicio de las crisis, los hallazgos del EEG y la etiología de la epilepsia. Conclusión. Haber iniciado las crisis de forma precoz, tener una epilepsia multifocal y una etiología criptogénica son factores de mal pronóstico para el desarrollo normal de las funciones cognitivas en pacientes pediátricos con epilepsias (AU)

Aim. We sought to describe the epidemiological and clinical data from our patients in the Pediatric Epilepsy Monitoring Unit (PEMU) of the Sant Joan de Déu Hospital of Barcelona, and determine the variables of risk for mental retardation. Patients and methods. A retrospective review of PEMU reports and hospital discharge summaries from March 2005 to December 2008 was conducted. The data from patients with intelligence quotient (IQ) estimated, older than 3 years of age and with epileptic electroencephalography (EEG) activity was analyzed in 158 patients (8.8 ± 5.2 years; 55.1% boys). Of those pediatric patients, 63 had IQ less than 70 and 47 an IQ greater than or equal to 70. Intractable epilepsy was present in all of them. Results. The percentage of the patients with mental retardation is significantly higher in patients with onset of epilepsy before 24 months (68.3%) than patients with later onset (27.7%). Onset of seizures, EEG findings and epilepsy etiology are significant risk factors for mental retardation. Conclusions. Early age at seizure, multifocal epilepsy and cryptogenic etiology are factors of worse prognosis to normal development of cognitive functions in pediatric intractable epilepsy (AU)

Seizures versus dystonia in encephalopathic crisis of glutaric aciduria type I.

In more than two thirds of cases, glutaric aciduria type I begins in the first 3 years of life with an acute encephalopathic crisis with hypotonia or generalized rigidity, neurologic depression, irritability, seizures, and dystonia. The clinical histories were reviewed for 13 glutaric aciduria type I patients (9 male, 4 female; mean age, 8.7 months; range, 3-15 months) with encephalopathic crisis seen at Sant Joan de Déu Hospital, to describe the clinical features and the initial electroencephalographic (EEG) findings. Twelve of the patients (92%) had paroxysmal episodes at onset. Other clinical features included irritability (12/13), neurologic depression (11/13), and hypotonia (7/13). All patients evolved to dystonic tetraparesis. Thirty-five EEGs were recorded in the acute stage and during the first year of follow-up. Spike discharges on EEG were observed in only 2 of the 13 patients, and 8 had slow background activity. No patient developed seizures during follow-up. Seizures may be part of the symptomatology at the onset of glutaric aciduria type I, but most paroxysmal movements appear to be dystonic episodes. This hypothesis is supported by four facts: seizures do not occur after dystonic tetraparesis is noticed, EEG paroxysms are infrequent in the acute stage, antiepileptic drugs are not needed in the long term, and epilepsy is rare in the follow-up.

Two cases of painful gynecomastia and lower extremity pain in association with pregabalin therapy.

We report two patients with refractory epilepsy who developed unilateral painful gynecomastia and lower extremity pain (one of them localized and the other one diffuse), shortly after receiving Pregabalin (PGB). Neither of them had previous endocrinologic problems or complaints about pain on their medical history. PGB was stopped in one patient and reduced in the other one, with complete disparition of the symptoms in the following weeks in both patients. This supports the hypothesis that gynecomastia could be a drug-induced and easy to manage secondary effect of PGB, with a higher incidence than observed on previous clinical trials.