Guía oficial de la Sociedad Española de Neurología de práctica clínica en epilepsia. Epilepsia en situaciones especiales: comorbilidades, mujer y anciano / The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients

Introducción: En el tratamiento de la epilepsia existen una serie de comorbilidades y grupos poblacionales (mujeres en edad fértil y ancianos) para los cuales podemos encontrar limitaciones en el manejo y precisar ajustes del tratamiento. Desarrollo: Búsqueda de artículos en Pubmed y recomendaciones de las Guías de práctica clínica en epilepsia y sociedades científicas más relevantes referentes la epilepsia en situaciones especiales (comorbilidades, mujeres en edad fértil, ancianos). Se clasifican las evidencias y recomendaciones según los criterios pronósticos del Oxford Center of Evidence-Based Medicine (2001) y de la European Federation of Neurological Societies (2004) para las actuaciones terapéuticas. Conclusiones: En las diversas comorbilidades, es necesaria una adecuada selección del tratamiento para mejorar la eficacia con el menor número de efectos secundarios. En la epilepsia catamenial es necesario un ajuste de la medicación antiepiléptica y/u hormonal, para poder controlar correctamente las crisis. La exposición a fármacos antiepilépticos durante la gestación aumenta el riesgo de malformaciones congénitas (MC) y puede afectar al crecimiento fetal y/o al desarrollo cognitivo. En el puerperio se aconseja la lactancia materna, vigilando los efectos adversos si se usan fármacos sedantes. Finalmente, los ancianos son una población muy susceptible de presentar epilepsia y que tiene unas características diferenciales con respecto a otros grupos de edad para el diagnóstico y el tratamiento. Estos pacientes pueden presentar con mayor frecuencia limitaciones terapéuticas por sus comorbilidades, pero suelen responder mejor al tratamiento y a dosis más bajas que en el resto de grupos de edad

Introduction: The characteristics of some population groups (patients with comorbidities, women of childbearing age, the elderly) may limit epilepsy management. Antiepileptic treatment in these patients may require adjustments. Development: We searched articles in Pubmed, clinical practice guidelines for epilepsy, and recommendations by the most relevant medical societies regarding epilepsy in special situations (patients with comorbidities, women of childbearing age, the elderly). Evidence and recommendations are classified according to the prognostic criteria of Oxford Centre of Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic interventions. Conclusions: Epilepsy treatment in special cases of comorbidities must be selected properly to improve efficacy with the fewest side effects. Adjusting antiepileptic medication and/or hormone therapy is necessary for proper seizure management in catamenial epilepsy. Exposure to antiepileptic drugs (AED) during pregnancy increases the risk of birth defects and may affect fetal growth and/or cognitive development. Postpartum breastfeeding is recommended, with monitoring for adverse effects if sedative AEDs are used. Finally, the elderly are prone to epilepsy, and diagnostic and treatment characteristics in this group differ from those of other age groups. Although therapeutic limitations may be more frequent in older patients due to comorbidities, they usually respond better to lower doses of AEDs than do other age groups

The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients.

INTRODUCTION: The characteristics of some population groups (patients with comorbidities, women of childbearing age, the elderly) may limit epilepsy management. Antiepileptic treatment in these patients may require adjustments. DEVELOPMENT: We searched articles in Pubmed, clinical practice guidelines for epilepsy, and recommendations by the most relevant medical societies regarding epilepsy in special situations (patients with comorbidities, women of childbearing age, the elderly). Evidence and recommendations are classified according to the prognostic criteria of Oxford Centre of Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic interventions. CONCLUSIONS: Epilepsy treatment in special cases of comorbidities must be selected properly to improve efficacy with the fewest side effects. Adjusting antiepileptic medication and/or hormone therapy is necessary for proper seizure management in catamenial epilepsy. Exposure to antiepileptic drugs (AED) during pregnancy increases the risk of birth defects and may affect fetal growth and/or cognitive development. Postpartum breastfeeding is recommended, with monitoring for adverse effects if sedative AEDs are used. Finally, the elderly are prone to epilepsy, and diagnostic and treatment characteristics in this group differ from those of other age groups. Although therapeutic limitations may be more frequent in older patients due to comorbidities, they usually respond better to lower doses of AEDs than do other age groups.

Epilepsia: una nueva definición para una vieja enfermedad / Epilepsy: a new definition for an old disease

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La rabia: ¿una historia de nunca acabar? / Rabies, a never ending story

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Pancreatitis asociada a la combinación de valproato y olanzapina / Pancreatitis coincident with valproate and olazapine use

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Tomografía por emisión de positrones corporal: ¿urge un cambio de tutela? / Whole-body positron emission tomography: should official regulations be urgently changed?

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[Clinical experiences with pregabalin in the treatment of focal epilepsies]. / Experiencia clínica de la pregabalina en el tratamiento de las epilepsias focales.

INTRODUCTION: Pregabalin is an antiepileptic drug recently approved in the European Union for add-on therapy of focal epilepsy. A review of its clinical and pharmacological characteristics is, therefore, appropriate. DEVELOPMENT: This drug, which binds to a subunit of voltage-dependent calcium channels in neuronal membranes, has a favourable pharmacokinetic profile. Pregabalin administered in two or three divided doses was compared to placebo in three double-blind randomised multicenter clinical trials, including 1,052 patients with focal epilepsy not controlled with other antiepileptic drugs. Results of these studies showed efficacy at doses of 150 mg per day, and a dose-response relationship up to doses of 600 mg per day. At the highest dose, mean seizure reduction for pregabalin was 44.3 to 54%, a significant reduction compared to placebo (p < or =0.0001), and a response rate of 43.5 to 51% (p < or =0.001). In one of these studies 12% of patients treated with pregabalin at 600 mg per day were seizure free for the last month of therapy while another study demonstrated its efficacy when used on a twice daily schedule. Subsequent open studies demonstrated a sustained efficacy of the drug. The most common adverse events were dizziness, somnolence, ataxia, asthenia, and weight gain. Withdrawal from controlled studies due to adverse effects was 15.3% in patients treated with pregabalin, compared with 6.15% in those receiving placebo. CONCLUSION: Pregabalin favourable pharmacokinetic profile, in addition to its good tolerability and remarkable efficacy make this new antiepileptic drug an attractive option for the treatment of focal epilepsies.

La clasificación de las epilepsias: una invitación al desorden / Classification of epilepsies: a chaos invitation

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¿Hemorragia intraparenquimatosa occipital bilateral? / Bilateral occipital intraparenchymatous blleding?

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[Topiramate therapy in patients with refractory epilepsy]. / Tratamiento con topiramato en pacientes con epilepsia refractaria.

AIMS: The purpose of this study was to examine the result of administrating topiramate (TPM) to patients with epilepsy that is refractory to treatment with two or more antiepileptic agents. PATIENTS AND METHODS: A total of 50 patients were evaluated, 90% of which had partial seizures (simple partial, complex partial and partial with secondary generalisation) and the remaining 10% suffered from generalised seizures. The most frequent aetiology was that which corresponded to the symptoms (52% of the cases). 98% of the patients were treated with two or three drugs. TPM was added with a dosage interval between 75 and 550 mg and follow-up visits were carried out throughout a period of nine months. RESULTS: 12 patients remained seizure-free for at least the first three months of the study; in 20 patients the number of seizures decreased by 50% or more; in 14 patients no changes were observed, and in the other four there was an increase in the number of seizures. The best results were obtained in cases of seizures with an idiopathic aetiology, while complex partial seizures offered the worst results. We also analysed the factors that might exert an influence on the different degrees of response. CONCLUSIONS: TPM was effective in all kinds of seizures. 24% of the patients became seizure free, and the total percentage of respondents rose to 64%. No patients dropped out of the study because of intolerance to the drugs.

Tratamiento con topiramato en pacientes con epilepsia refractaria / Topiramate therapy in patients with refractory epilepsy

Objetivo. Estudiar el resultado de la administración de topiramato (TPM) a pacientes con epilepsia refractaria al tratamiento con dos o más fármacos antiepilépticos. Pacientes y métodos. Se evaluó un total de 50 pacientes. El 90 por ciento tenía crisis parciales (parciales simples, parciales complejas y parciales con generalización secundaria) y el 10 por ciento crisis generalizadas. La etiología más frecuente fue la sintomática (52 por ciento de los casos). El 98 por ciento de los pacientes se trataba con dos o tres fármacos. Se añadió TPM, con un intervalo de dosis entre 75 y 550 mg, y se hicieron visitas de seguimiento durante nueve meses. Resultados. 12 pacientes permanecieron libres de crisis, al menos durante los tres últimos meses del estudio; en 20 pacientes hubo una reducción del 50 por ciento o más en su número de crisis; en 14 pacientes no se observaron cambios, y en los cuatro restantes aumentó el número de crisis. Las crisis de etiología idiopática tienen mejor resultado, y las crisis parciales complejas, peor. Se analizan los factores que pudieron influir en los distintos grados de respuesta. Conclusiones. El TPM fue eficaz en todos los tipos de crisis. El 24 por ciento de los pacientes se libró de las crisis, y se elevó el porcentaje total de respondedores al 64 por ciento. Ningún paciente abandonó el estudio por intolerancia a la medicación (AU)

Aims. The purpose of this study was to examine the result of administrating topiramate (TPM) to patients with epilepsy that is refractory to treatment with two or more antiepileptic agents. Patients and methods. A total of 50 patients were evaluated, 90% of which had partial seizures (simple partial, complex partial and partial with secondary generalisation) and the remaining 10% suffered from generalised seizures. The most frequent aetiology was that which corresponded to the symptoms (52% of the cases). 98% of the patients were treated with two or three drugs. TPM was added with a dosage interval between 75 and 550 mg and follow-up visits were carried out throughout a period of nine months. Results. 12 patients remained seizure-free for at least the first three months of the study; in 20 patients the number of seizures decreased by 50% or more; in 14 patients no changes were observed, and in the other four there was an increase in the number of seizures. The best results were obtained in cases of seizures with an idiopathic aetiology, while complex partial seizures offered the worst results. We also analysed the factors that might exert an influence on the different degrees of response. Conclusions. TPM was effective in all kinds of seizures. 24% of the patients became seizure-free, and the total percentage of respondents rose to 64%. No patients dropped out of the study because of intolerance to the drugs (AU)

[Encephalopathy with focal lesions due to Mycoplasma pneumoniae]. / Encefalopatía con lesiones focales por Mycoplasma pneumoniae.

Mycoplasma pneumoniae infections usually produce respiratory symptoms, that only exceptionally involve the nervous system. In this case, the infection generally causes an encephalitic picture characterized by impaired consciousness and seizures, and by normal or non-specific neuroradiological findings. However, four cases of M. pneumoniae infection associated with symmetrical lesions in the putamen and its external surrounding areas, and with extrapiramidal symptoms, have been recently published. We present the case of a patient with a clinical picture characterized by confusion, fever, and seizures, associated with a M. pneumoniae infection. The MRI study showed two symmetrical lesions that involved the areas just outside the putamen and disappeared coinciding with her clinical improvement. The present case would support that the encephalopathy associated with the M. pneumoniae infection shows a tendency to involve a particular region of the brain. Our case might represent the minimal expression of these characteristic lesions, which in the most benign cases would involve the areas immediately outside the putamen, and in other instances the putamen as well.