Aspectos electroclínicos de la epilepsia temporal mesial / Neuropsychological risk in temporal lobe epilepsy

Introducción: La epilepsia del lóbulo temporal mesial se considera la más frecuente de las epilepsias focales, con signos y síntomas característicos que ayudan a definir su diagnóstico. Contenidos: Dentro de su historia natural, las crisis pueden iniciar en los primeros años de vida, usualmente como episodios febriles con un periodo de remisión, para reaparecer en la adolescencia o en el adulto joven. La presentación electroencefalográfica tiene un patrón característico, con aparición de puntas y ondas agudas interictales en la región temporal anterior, por lo general unilaterales, y con actividad ictal generalmente theta en la misma localización. La causa más frecuente es la esclerosis del hipocampo. El tratamiento con medicamentos anticrisis puede controlar la epilepsia, aunque algunos casos pueden evolucionar a la farmacorresistencia, en la cual la cirugía de epilepsia está indicada, y tiene buenos resultados. Conclusiones: Esta revisión se centra en la descripción de las características electroclínicas de la epilepsia temporal mesial, para hacer un diagnóstico temprano e iniciar un tratamiento adecuado, a efectos de lograr un mejor pronóstico y una mejor calidad de vida para los pacientes con epilepsia y sus familiares.

Introduction: Mesial temporal lobe epilepsy is considered the most common of the focal epilepsies, with characteristic signs and symptoms that help define its diagnosis. Contents: In the natural history of the disease, seizures can begin in the first years of life, usually as febrile seizures with a period of remission, to reappear in adolescence or in the young adult. The electroencephalographic presentation has a characteristic pattern with the appearance of interictal sharp waves and spikes in the anterior temporal region, usually unilateral, and with generally theta ictal activity in the same location. The most common cause is hippocampal sclerosis. Treatment with antiseizure medication can control epilepsy. However, in some cases evolution of drug resistance can occur, leading to epilepsy surgery as the most appropriate treatment, based on its good results. Conclusions: This review focuses on the description of the electroclinical characteristics of temporal mesial epilepsy, in order to make an early diagnosis and adequate treatment, thus providing a better prognosis and quality of life for patients with epilepsy and their families.

Encuesta nacional de telemedicina para neurólogos durante la pandemia del covid-19 en Colombia / National telemedicine survey for neurologists during the COVID-19 pandemic in Colombia

RESUMEN INTRODUCCIÓN: Durante la pandemia de covid-19, la telemedicina, inicialmente vista como inadecuada, ahora se muestra como una de las respuestas durante este tiempo exigente en la medicina. OBJETIVO: El objetivo de este estudio es evaluar el impacto de la atención médica en neurología con la telemedicina durante la pandemia del covid-19 en Colombia. MATERIALES Y MÉTODOS: Se realizó un estudio observacional descriptivo. La información fue obtenida a través de una encuesta anónima dirigida a neurólogos que laboraran en Colombia. RESULTADOS: Se obtuvieron 120 encuestas diligenciadas; 70 (58%) fueron del género femenino. La carga laboral por la atención médica a través de la telemedicina se percibió aumentada en 70 (58.3%) de los encuestados. 76 (63,9%) de los encuestados piensa que la telemedicina es una herramienta que se debería seguir utilizando en la práctica diaria de la neurología, pero con mejoras. Las enfermedades neuromusculares, desmielinizantes y trastornos de movimiento no se consideraron una buena opción para evaluar por telemedicina. Por otro lado, la epilepsia y la demencia se consideraron una buena opción para evaluar por primera vez. DISCUSIÓN: 76 (64%) de los encuestados está de acuerdo en que la telemedicina debe continuar después de la pandemia, pero deben realizarse mejoras para una atención de mejor calidad. Se recomienda realizar nuevos estudios para evaluar de forma sistemática la precisión de la teleneurología en comparación con las consultas en persona. CONCLUSIONES: La telemedicina es una herramienta útil en la práctica neurológica pero requiere mejoras en el proceso para aumentar su eficacia, seguridad y calidad.

SUMMARY INTRODUCTION: During the COVID-19 pandemic, telemedicine, initially viewed as inadequate, can now be considered as one of the solutions during this demanding time in medicine. OBJECTIVES: The main objective of this study is to evaluate the impact of medical attention in neurology with telemedicine during the COVID-19 pandemic. MATERIALS AND METHODS: This is an observational descriptive study. Data was obtained by an anonymous survey aimed at working Neurologists in Colombia. RESULTS: Of the 120 questionnaires collected, 70 (58%) were answered by women. The data shows that 70 (58.3%) of participating doctors in this study perceived their patient workload volume increased. Data collected reveals seventy-six (63,9%) of the doctors in this study felt that outpatient telemedicine, with some improvements, can continue to be a useful tool in the daily practice of Neurology. Neuromuscular and demyelinating diseases, and movement disorders were not considered a good option to assess via telemedicine. However, Epilepsy and Dementia were considered a good option for first-time evaluation. DISCUSSION: 76 (64%) of the doctors agreed the practice of telemedicine should continue, even when the pandemic is no longer a factor, however, improvements should be made for a better quality of attention. Additional studies are required to evaluate accuracy of teleneurology in comparison to face-to-face outpatient consultation. CONCLUSION: Telemedicine is a useful tool in Neurology outpatient evaluation, but improvement is needed to assure quality and safety.

Covid-19 y epilepsia / COVID-19 and epilepsy

RESUMEN La encefalopatía es una manifestación neurológica frecuente en los pacientes en UCI con Covid-19. Es importante realizar un adecuado diagnóstico diferencial con el estado epiléptico no convulsivo, para poder optimizar su cuidado y pronóstico. El uso del video-electroencefalograma (VEEG) bajo adecuadas normas de bioseguridad, permite realizar un adecuado diagnóstico del estado epiléptico, disminuyendo el numero de ingresos innecesarios a la Unidad de Cuidado Intensivo, y el tiempo de sedación con anestésicos. La telemedicina para los pacientes con epilepsia ha demostrado ser una herramienta útil, al no mostrar inferioridad en comparación con las visitas cara a cara habituales en términos de diferencia significativa en el número de las crisis, hospitalizaciones, visitas a la sala de emergencias o cumplimiento de medicamentos.

SUMMARY: Encephalopathy is a frequent neurological manifestation in ICU patients with COVID-19. It is important to make an accurate differential diagnosis with non-convulsive epileptic status, in order to optimize the management and prognosis. The use of Video-EEG monitoring assuring biosecurity standards, allows an adequate diagnosis of epileptic status, reducing the number of unnecessary admissions to the intensive care unit, sedation time and anesthetics use. The use of telemedicine in patients with epilepsy has proven to be a useful tool, compared to standard outpatient visits in terms of number of seizures, admissions, emergency visits, or adherence to the medication.

Clinical Benefit of 3 Tesla Magnetic Resonance Imaging Rescanning in Patients With Focal Epilepsy and Negative 1.5 Tesla Magnetic Resonance Imaging.

BACKGROUND: Magnetic resonance imaging is an essential tool in the pre-surgical evaluation of patients with drug-resistant epilepsy. OBJECTIVE: Our aim was to assess the value of re-imaging patients with focal drug-resistant epilepsy. METHODS: Thirty patients with negative or non-conclusive 1.5 Tesla magnetic resonance imaging were rescanned with 1.5T and 3T. All of them had previous 1.5 scans with no seizure protocol in a non-specialized center. Two neuroradiologists who were blinded to prior imaging results randomly reviewed the magnetic resonance images. Kappa score was used to assess the reliability. RESULTS: Mean age of patients was 30 (SD ± 11) years. The intra-observer agreement for the first radiologist was 0.74 for 1.5T and 0.71 for 3T. In the second radiologist it was 0.82 and 0.66, respectively. Three lesions (10%) were identified by general radiologists in non-specialized centers using a 1.5T standard protocol. In our center a consensus between two neuroradiologists using epilepsy protocol identified seven lesions (23%) using 1.5T and 10 (33%) using 3T (p < 0.01). In 28% of patients this additional information resulted in a change in clinical management. CONCLUSIONS: 3T magnetic resonance imaging rescanning improves the diagnostic yield in patients with focal epilepsy and previous negative 1.5T magnetic resonance imaging. Use of 3T magnetic resonance imaging, epilepsy protocols, and interpretation by experienced neuroradiologists is highly recommended.

Epilepsia muy refractaria en una muestra escasamente definida. Réplica / Highly refractory epilepsy in a poorly defined sample. Reply

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Severity of anxiety and depression are related to a higher perception of adverse effects of antiepileptic drugs.

UNLABELLED: After reviewing the negative effects of antiepileptic drugs (AEDs) on general health and quality of life, the Commission on Outcome Measurement from the International League Against Epilepsy (ILAE) recommended incorporating reliable and valid tools in clinical essays in order to achieve a more accurate assessment of the subjective adverse effects rate and disease severity when using AEDs. PURPOSE: The aim of this study was to correlate the severity of adverse effects of AEDs, with the presence of anxiety and depression in patients with epilepsy. METHODS: The Spanish version of the Liverpool Adverse Events Profile (LAEP) and the hospital anxiety and depression scale (HADS) were applied on 130 consecutive outpatients with epilepsy from the epilepsy clinic at the Mexico's National Institute of Neurology and Neurosurgery. A correlation analysis was carried out to determine if the presence of depression and anxiety was related to the adverse effects of AEDs. The relation between LAEP scores with other epidemiological variables was also assessed. RESULTS: Our study found a positive correlation between the LAEP and the HADS scores (p < or = 0.01). The most common adverse effects were drowsiness (81.5% [n=106]), difficulty in concentrating (76% [n=99]), and nervousness and/or agitation (75% [n=97]). Female gender, a history of febrile seizures, persistent seizures and polytherapy were associated with a higher toxicity on LAEP. In our study, age at epilepsy onset, duration of epilepsy, type of epilepsy and patients' age were not related to higher LAEP scores. CONCLUSION: Adverse effects to AEDs can be related with the presence of psychiatric disorders such as anxiety and depression in patients with epilepsy.

Epilepsia farmacorresistente: uso de la nueva definición y factores de riesgo relacionados. Estudio en población mexicana de un centro de tercer nivel / Refractory epilepsy: use of the new definition and related risk factors. A study in the Mexican population of a third-level centre

Introducción. Recientemente, la Liga Internacional contra la Epilepsia (ILAE) ha propuesto un consenso para definir la epilepsiafarmacorresistente. Pacientes y métodos. Estudio retrospectivo, analítico y descriptivo. Se incluyeron 206 pacientes atendidos en la clínica de epilepsia de un centro de tercer nivel en México. Se utilizó la nueva definición de la ILAE de farmacorresistencia paraclasificar a los pacientes. Se describieron la frecuencia y factores de riesgo involucrados en la refractariedad. Se analizó deforma secundaria la tendencia de prescripción de fármacos antiepilépticos (FAE) en esta población. Resultados. De los 206 pacientes analizados, 57 (28%) se encontraban libres de crisis, 115 (56%) persistían con crisis, 17(8%) fueron clasificados como no determinados y 17 (8%) fueron pseudorrefractarios. Los factores estadísticamente significativosasociados a farmacorresistencia encontrados en nuestra población fueron: epilepsia focal frente a generalizada (p = 0,02), epilepsia catamenial (p = 0,02), desarrollo psicomotor anormal (p = 0,02), historia familiar de epilepsia (p =0,025), examen neurológico con anormalidad focal (p = 0,04), hipoxia perinatal (p = 0,06) y enfermedad psiquiátricaprevia (p = 0,03). Los FAE más prescritos en mono y politerapia fueron valproato y carbamacepina. Del total de los pacienteslibres de crisis, el 47% utilizaba monoterapia. Conclusiones. La frecuencia de farmacorresistencia en la población analizada se estimó en un 56%. La identificación delos factores asociados a farmacorresistencia permite considerar el tratamiento quirúrgico o bien optimizar el tratamientocon FAE. Hay una tendencia en el uso de nuevos FAE, sobre todo en politerapia. Nuestros hallazgos son concordantes con lo descrito en la bibliografía (AU)

Introduction. The International League against Epilepsy (ILAE) has recently proposed a consensus to define refractory epilepsy.Patients and methods. A retrospective, analytical, descriptive study was conducted involving 206 patients who wereattended at the epilepsy clinic of a third-level centre in Mexico. The ILAE’s new definition of pharmacoresistance wasused to classify the patients. The frequency and risk factors involved in the refractoriness were reported. The tendency to prescribe antiepileptic drugs (AED) in this population was analysed using secondary data. Results. Of the 206 patients analysed, 57 (28%) were free of seizures, 115 (56%) continued to have seizures, 17 (8%) were classified as undetermined and 17 (8%) were pseudo-refractory. The statistically significant factors associated to pharmacoresistancethat were found in our population were: focal versus generalised epilepsy (p = 0.02), catamenial epilepsy (p = 0.02), abnormal psychomotor development (p = 0.02), history of epilepsy in the family (p = 0.025), neurological examination with focal abnormality (p = 0.04), perinatal hypoxia (p = 0.06) and prior psychiatric illness (p = 0.03). The mostly frequently AED used in mono- and polytherapy were valproate and carbamazepine. Of all the patients who were free ofseizures, 47% were treated using monotherapy. Conclusions. The frequency of pharmacoresistance in the population analysed was estimated to be 56%. Identificationof the factors associated with pharmacoresistance makes it possible to consider surgical treatment or to optimise thetreatment with AED. There is a tendency to use the new AED, above all in combination therapy. Our findings are consistent with those described in the literature (AU)

[Refractory epilepsy: use of the new definition and related risk factors. A study in the Mexican population of a third-level centre]. / Epilepsia farmacorresistente: uso de la nueva definición y factores de riesgo relacionados. Estudio en poblacion mexicana de un centro de tercer nivel.

INTRODUCTION: The International League against Epilepsy (ILAE) has recently proposed a consensus to define refractory epilepsy. PATIENTS AND METHODS: A retrospective, analytical, descriptive study was conducted involving 206 patients who were attended at the epilepsy clinic of a third-level centre in Mexico. The ILAE's new definition of pharmacoresistance was used to classify the patients. The frequency and risk factors involved in the refractoriness were reported. The tendency to prescribe antiepileptic drugs (AED) in this population was analysed using secondary data. RESULTS: Of the 206 patients analysed, 57 (28%) were free of seizures, 115 (56%) continued to have seizures, 17 (8%) were classified as undetermined and 17 (8%) were pseudo-refractory. The statistically significant factors associated to pharmaco-resistance that were found in our population were: focal versus generalised epilepsy (p = 0.02), catamenial epilepsy (p = 0.02), abnormal psychomotor development (p = 0.02), history of epilepsy in the family (p = 0.025), neurological examination with focal abnormality (p = 0.04), perinatal hypoxia (p = 0.06) and prior psychiatric illness (p = 0.03). The mostly frequently AED used in mono- and polytherapy were valproate and carbamazepine. Of all the patients who were free of seizures, 47% were treated using monotherapy. CONCLUSIONS: The frequency of pharmacoresistance in the population analysed was estimated to be 56%. Identification of the factors associated with pharmacoresistance makes it possible to consider surgical treatment or to optimise the treatment with AED. There is a tendency to use the new AED, above all in combination therapy. Our findings are consistent with those described in the literature.

Tuberculomas cerebrales / Cerebral tuberculoma: a case report

El compromiso del sistema nervioso central por tuberculosis, continúa siendo una causa importante de morbi-mortalidad en los países en vías de desarrollo. Presentamos el caso de una paciente con meningitis y tuberculomas en el sistema nervioso central y discutimos los métodos diagnósticos disponibles en la actualidad para esta patología.

The central nervous system (CNS) involvement due to tuberculosis has been an important cause of morbid-mortality in third world countries. We present a clinical case of a patient with meningitis and CNS tuberculomas, and discuss the diagnostic tests available for this pathology actually.

La psicosis en epilepsia / Psychosis in epilepsy

Introducción: Los síndromes psicóticos pueden presentarse de forma frecuente durante el curso de la epilepsia, tanto en las crisis como en el período inmediatamente posterior o libre de estas; asociado con su pobre control sintomático, por refractariedad, cambio o abandono del tratamiento anticonvulsivo. También se han descrito luego del tratamiento quirúrgico de epilepsia especialmente en lobectomía temporal. Objetivo: Describir los aspectos generales, clasificación, clínica y tratamiento de las psicosis asociadas a la epilepsia. Método: Búsqueda de información relevante en diferentes bases de datos. Resultados y conclusiones: Las psicosis epilépticas ocasionan una mayor morbilidad en los pacientes epilépticos, pueden generar hospitalizaciones psiquiátricas, prolongar el tiempo de internación neurológica y hacer complejo el manejo farmacológico. Dentro de estas se encuentran la psicosis ictal, interictal y postictal, además de la normalización forzada y posquirúrgica; las últimas menos prevalentes. En su clínica pueden compartir aspectos con otros trastornos psiquiátricos como la manía y la misma esquizofrenia, situación que debe conducir al clínico a entender mejor sus hallazgos semiológicos y lo que representan en relación con las convulsiones, para asegurar un diagnóstico y manejo adecuados, que deberían de requerir el trabajo interdisciplinario entre psiquiatría y neurología...

Introduction: Psychotic syndromes are frequently seen in the course of epilepsy, either during the seizures or during the period following them. This is especially associated with poor symptomatic control, refractivity, and change or discontinuation of the anticonvulsive treatment. It has also been described after temporal lobectomy prescribed to control it. Objective: To describe general aspects, classification, clinical features, and treatment of psychosis associated with epilepsy. Method: Relevant data research in several data bases. Results and Conclusions: Epileptic psychosis produces greater morbidity in epileptic patients that might lead to psychiatric hospitalizations, lengthening the time of neurological internment and a more complex use of the pharmacological treatment. There are ictal, interictal and postictal psychosis, along with forced normalization and post-surgery psychosis, the latter two with a lower prevalence. Epileptic psychosis might share some aspects of psychiatric disorders such as mania and schizophrenia. In this case, the clinician must make a better assessment of the findings in relation to the seizures to ensure an adequate diagnosis and treatment that generally requires the intervention of both the fields of psychiatry and neurology...