Papel de la estimulación del nervio vago en el tratamiento de la epilepsia refractaria. Resultados clínicos e impacto en la calidad de vida / The role of vagus nerve stimulation in the treatment of refractory epilepsy: Clinical outcomes and impact on quality of life

Introducción: La estimulación del nervio vago (ENV) se ha mostrado como una terapia complementaria al tratamiento farmacológico en pacientes con epilepsia refractaria. Nuestro objetivo es evaluar la eficacia de la ENV en relación con la disminución del número, intensidad y duración de las crisis, con la reducción del número de fármacos antiepilépticos y con la mejoría de la calidad de vida. Material y métodos: Se analizó la evolución de 70 pacientes con epilepsia refractaria, tratados mediante ENV en el Hospital General Universitario de Alicante y en el Hospital Clínico de Valencia. Se recogieron variables pre- y postoperatorias. La diferencia en la frecuencia tras la estimulación vagal se clasificó mediante la escala de McHugh. También se recogieron los cambios en la duración e intensidad de las crisis y la disminución de la medicación junto con la modificación de la calidad de vida. Resultados: El 12,86% de los pacientes se clasificaron como McHugh I, el 44,29% como ii, el 40% como iii y el 2,86% como iv-v. Un 57,15% de los pacientes presentaron una reducción superior al 50% en la frecuencia de las crisis. Un 88% de los pacientes presentaron una mejoría en la duración de las crisis, en el 68% disminuyó la intensidad, un 66% toman menos fármacos y en el 93% mejoró la calidad de vida. Conclusiones: La ENV ha mostrado disminuir la frecuencia de las crisis, así como la duración, la intensidad y el consumo de fármacos, ofreciendo además una mejoría en la calidad de vida de nuestros pacientes. (AU)

Background: Vagus nerve stimulation (VNS) is used as a complementary therapy to pharmacological treatment in patients with refractory epilepsy. This study aims to evaluate the efficacy of VNS in reducing seizure frequency, severity, and duration; reducing the number of antiepileptic drugs administered; and improving patients’ quality of life. Material and methods: We analysed the clinical progression of 70 patients with refractory epilepsy treated with VNS at Hospital Universitario de Alicante and Hospital Clínico de Valencia. Data were collected before and after the procedure. The difference in seizure frequency pre- and post-VNS was classified using the McHugh scale. Data were also collected on seizure duration and severity, the number of drugs administered, and quality of life. Results: According to the McHugh classification, 12.86% of the patients were Class I, 44.29% were Class II, 40% were Class III, and the remaining 2.86% of patients were Class IV-V. A ≥ 50% reduction in seizure frequency was observed in 57.15% of patients. Improvements were observed in seizure duration in 88% of patients and in seizure severity in 68%; the number of drugs administered was reduced in 66% of patients, and 93% reported better quality of life. Conclusions: VNS is effective for reducing seizure frequency, duration, and severity and the number of antiepileptic drugs administered. It also enables an improvement in patients’ quality of life. (AU)

The role of vagus nerve stimulation in the treatment of refractory epilepsy: clinical outcomes and impact on quality of life.

BACKGROUND: Vagus nerve stimulation (VNS) is used as a complementary therapy to pharmacological treatment in patients with refractory epilepsy. This study aims to evaluate the efficacy of VNS in reducing seizure frequency, severity, and duration; reducing the number of antiepileptic drugs administered; and improving patients' quality of life. MATERIAL AND METHODS: We analysed the clinical progression of 70 patients with refractory epilepsy treated with VNS at Hospital Universitario de Alicante and Hospital Clínico de Valencia. Data were collected before and after the procedure. The difference in seizure frequency pre- and post-VNS was classified using the McHugh scale. Data were also collected on seizure duration and severity, the number of drugs administered, and quality of life. RESULTS: According to the McHugh classification, 12.86% of the patients were Class I, 44.29% were Class II, 40% were Class III, and the remaining 2.86% of patients were Class IV-V. A ≥ 50% reduction in seizure frequency was observed in 57.15% of patients. Improvements were observed in seizure duration in 88% of patients and in seizure severity in 68%; the number of drugs administered was reduced in 66% of patients, and 93% reported better quality of life. CONCLUSIONS: VNS is effective for reducing seizure frequency, duration, and severity and the number of antiepileptic drugs administered. It also enables an improvement in patients' quality of life.

[Alzemon: a prospective follow-up study of eslicarbazepine acetate monotherapy in patients with newly diagnosed epilepsy]. / Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente.

INTRODUCTION: Eslicarbazepine acetate is a novel sodium channel blocker for use in the treatment of focal onset seizures. Prospective studies on its effectiveness in monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice are scarce. AIM: To evaluate the effectiveness of eslicarbazepine as initial monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice. PATIENTS AND METHODS: A prospective, multicentre, post-authorisation study. Patients with newly diagnosed partial epilepsy aged 18 years or older without previous treatment were included. The efficacy variables were: percentage of seizure-free patients, responders and reduction in monthly frequency of seizures. The safety variables analyse the 12-month retention rate and the occurrence of adverse effects. RESULTS: Fifty-three patients were included. The retention rate was 77.4%. At the end of the observation period, 83% of patients were seizure-free and 92.5% had reduced their baseline frequency by 50% or more. In addition, 68% of the patients reported some adverse effect and 7.5% of them dropped out of the study for this reason. The effectiveness analysis of the subgroup of patients aged 65 years or more showed no differences with respect to the overall population. CONCLUSION: Eslicarbazepine monotherapy in patients with newly diagnosed partial epilepsy, both in the general population and in the population over 65 years old, is effective and safe in routine clinical practice.

TITLE: Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente.Introducción. El acetato de eslicarbacepina es un nuevo bloqueante de los canales de sodio en el tratamiento de las crisis de inicio focal. Los estudios prospectivos sobre su efectividad en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual son escasos. Objetivo. Evaluar la efectividad de la eslicarbacepina en monoterapia de inicio en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual. Pacientes y métodos. Estudio postautorización prospectivo y multicéntrico. Se incluyó a pacientes con epilepsia parcial de reciente diagnóstico de 18 años o más sin tratamiento previo. Las variables de eficacia fueron: porcentaje de pacientes libres de crisis, respondedores y reducción en la frecuencia mensual de crisis. Las variables de seguridad analizan la tasa de retención a los 12 meses y la aparición de efectos adversos. Resultados. Se incluyó a 53 pacientes. La tasa de retención fue del 77,4%. Al final del período de observación, el 83% de los pacientes se encontraba libre de crisis y el 92,5% había reducido en un 50% o más su frecuencia basal. El 68% de los pacientes notificó algún efecto adverso y el 7,5% de ellos abandonó el estudio por este motivo. El análisis de efectividad del subgrupo de 65 años o más no mostró diferencias respecto a la población global. Conclusión. La eslicarbacepina en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico, tanto en la población general como en la población de más de 65 años, es eficaz y segura en la práctica clínica habitual.

Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente / Alzemon: a prospective follow-up study of eslicarbazepine acetate monotherapy in patients with newly diagnosed epilepsy

Introducción: El acetato de eslicarbacepina es un nuevo bloqueante de los canales de sodio en el tratamiento de las crisis de inicio focal. Los estudios prospectivos sobre su efectividad en monoterapia en pacientes con epilepsia parcia l de reciente diagnóstico en la práctica clínica habitual son escasos.Objetivo: Evaluar la efectividad de la eslicarbacepina en monoterapia de inicio en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual.Pacientes y métodos: Estudio postautorización prospectivo y multicéntrico. Se incluyó a pacientes con epilepsia parcial de reciente diagnóstico de 18 años o más sin tratamiento previo. Las variables de eficacia fueron: porcentaje de pacientes libres de crisis, respondedores y reducción en la frecuencia mensual de crisis. Las variables de seguridad analizan la tasa de retención a los 12 meses y la aparición de efectos adversos.Resultados: Se incluyó a 53 pacientes. La tasa de retención fue del 77,4%. Al final del período de observación, el 83% de los pacientes se encontraba libre de crisis y el 92,5% había reducido en un 50% o más su frecuencia basal. El 68% de los pacientes notificó algún efecto adverso y el 7,5% de ellos abandonó el estudio por este motivo. El análisis de efectividad del subgrupo de 65 años o más no mostró diferencias respecto a la población global.Conclusión: La eslicarbacepina en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico, tanto en la población general como en la población de más de 65 años, es eficaz y segura en la práctica clínica habitual.(AU)

Introduction: Eslicarbazepine acetate is a novel sodium channel blocker for use in the treatment of focal onset seizures. Prospective studies on its effectiveness in monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice are scarce. Aim: To evaluate the effectiveness of eslicarbazepine as initial monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice. Patients and methods: A prospective, multicentre, post-authorisation study. Patients with newly diagnosed partial epilepsy aged 18 years or older without previous treatment were included. The efficacy variables were: percentage of seizure-free patients, responders and reduction in monthly frequency of seizures. The safety variables analyse the 12-month retention rate and the occurrence of adverse effects. Results: Fifty-three patients were included. The retention rate was 77.4%. At the end of the observation period, 83% of patients were seizure-free and 92.5% had reduced their baseline frequency by 50% or more. In addition, 68% of the patients reported some adverse effect and 7.5% of them dropped out of the study for this reason. The effectiveness analysis of the subgroup of patients aged 65 years or more showed no differences with respect to the overall population. Conclusion: Eslicarbazepine monotherapy in patients with newly diagnosed partial epilepsy, both in the general population and in the population over 65 years old, is effective and safe in routine clinical practice.(AU)

The role of vagus nerve stimulation in the treatment of refractory epilepsy: Clinical outcomes and impact on quality of life. / Papel de la estimulación del nervio vago en el tratamiento de la epilepsia refractaria. Resultados clínicos e impacto en la calidad de vida.

BACKGROUND: Vagus nerve stimulation (VNS) is used as a complementary therapy to pharmacological treatment in patients with refractory epilepsy. This study aims to evaluate the efficacy of VNS in reducing seizure frequency, severity, and duration; reducing the number of antiepileptic drugs administered; and improving patients' quality of life. MATERIAL AND METHODS: We analysed the clinical progression of 70 patients with refractory epilepsy treated with VNS at Hospital Universitario de Alicante and Hospital Clínico de Valencia. Data were collected before and after the procedure. The difference in seizure frequency pre- and post-VNS was classified using the McHugh scale. Data were also collected on seizure duration and severity, the number of drugs administered, and quality of life. RESULTS: According to the McHugh classification, 12.86% of the patients were Class I, 44.29% were Class II, 40% were Class III, and the remaining 2.86% of patients were Class IV-V. A≥50% reduction in seizure frequency was observed in 57.15% of patients. Improvements were observed in seizure duration in 88% of patients and in seizure severity in 68%; the number of drugs administered was reduced in 66% of patients, and 93% reported better quality of life. CONCLUSIONS: VNS is effective for reducing seizure frequency, duration, and severity and the number of antiepileptic drugs administered. It also enables an improvement in patients' quality of life.

Utilización de levetiracetam intravenoso en un hospital general / The Use of intravenous levetiracetam in a general hospital

Introducción y objetivos. Aunque la vía oral es la forma habitual de administración de los fármacos antiepilépticos, en ciertas ocasiones se requiere la vía parenteral. El levetiracetam es el único de los nuevos fármacos antiepilépticos con posibilidad de administración por vía intravenosa. Se presenta un estudio de utilización de levetiracetam intravenoso en un hospital general, con evaluación de su eficacia y seguridad. Pacientes y métodos. Se analizaron de forma retrospectiva las historias clínicas de todos los pacientes ingresados en el hospital que fueron tratados con levetiracetam intravenoso durante el período de tiempo comprendido entre julio de 2007 y mayo de 2008. Resultados. Un total de 53 pacientes fue tratado con levetiracetam intravenoso. Aproximadamente la mitad de los pacientes (47%) había estado ingresada a cargo del servicio de neurología, seguido del servicio de neurocirugía (21%) y oncología (9%). La edad media fue de 52,2 años (rango: 9-87 años) y el 40% eran mujeres. Las crisis fueron sintomáticas en el 81%, y las etiologías más frecuentes fueron los ictus (40%) y los tumores cerebrales (33%). La presentación clínica más frecuente fueron las crisis epilépticas repetidas (47,2%) y el estado epiléptico (26,4%). Globalmente, el control de las crisis se consiguió en el 87% de los pacientes. No se detectaron efectos adversos graves atribuibles al tratamiento con levetiracetam. Conclusiones. El levetiracetam intravenoso parece ser un fármaco antiepiléptico eficaz y seguro en pacientes hospitalizados, especialmente en aquéllos que presentan comorbilidad asociada y/o plurimedicación (AU)

Introduction and aims. Although antiepileptic drugs are usually administered orally, sometimes they must be given intravenously. Levetiracetam is the only one of the new antiepileptic drugs that can be administered intravenously. In this study we report on the use of intravenous levetiracetam in a general hospital, while also evaluating its effectiveness and safety. Patients and methods. A retrospective analysis was conducted of the medical records of all hospital admissions that were treated with intravenous levetiracetam between July 2007 and May 2008. Results. A total of 53 patients were treated with intravenous levetiracetam. Approximately half the patients (47%) had been admitted to neurology, followed by neurosurgery (21%) and oncology (9%). The mean age was 52.2 years (range: 9-87 years) and 40% were females. Seizures were symptomatic in 81% of cases and the most common aetiologies were strokes (40%) and brain tumours (33%). The most frequent presenting symptoms were repeated epileptic seizures (47.2%) and epileptic status (26.4%). Overall, control of seizures was achieved in 87% of patients. No severe side-effects that could be attributed to levetiracetam therapy were detected. Conclusions. Intravenous levetiracetam seems to be an effective, safe antiepileptic drug in hospitalised patients, and especially so in those who present an associated comorbidity and/or who are on multiple drug therapy (AU)

[The use of intravenous levetiracetam in a general hospital]. / Utilización de levetiracetam intravenoso en un hospital general.

INTRODUCTION AND AIMS: Although antiepileptic drugs are usually administered orally, sometimes they must be given intravenously. Levetiracetam is the only one of the new antiepileptic drugs that can be administered intravenously. In this study we report on the use of intravenous levetiracetam in a general hospital, while also evaluating its effectiveness and safety. PATIENTS AND METHODS: A retrospective analysis was conducted of the medical records of all hospital admissions that were treated with intravenous levetiracetam between July 2007 and May 2008. RESULTS: A total of 53 patients were treated with intravenous levetiracetam. Approximately half the patients (47%) had been admitted to neurology, followed by neurosurgery (21%) and oncology (9%). The mean age was 52.2 years (range: 9-87 years) and 40% were females. Seizures were symptomatic in 81% of cases and the most common aetiologies were strokes (40%) and brain tumours (33%). The most frequent presenting symptoms were repeated epileptic seizures (47.2%) and epileptic status (26.4%). Overall, control of seizures was achieved in 87% of patients. No severe side-effects that could be attributed to levetiracetam therapy were detected. CONCLUSIONS: Intravenous levetiracetam seems to be an effective, safe antiepileptic drug in hospitalised patients, and especially so in those who present an associated comorbidity and/or who are on multiple drug therapy.

[Health care activity in a headache-specific clinic]. / Actividad asistencial en una consulta específica de cefalea.

INTRODUCTION: It is reckoned that headaches affect, at least once a year, around 90% of the population. The socioeconomic repercussion occasioned by this malady justifies the appearance in recent years of headache units. AIM: To conduct a descriptive epidemiological and health care study of the activity carried out in a headache-specific clinic. PATIENTS AND METHODS: All the relevant points from the histories of patients who visited our surgery over a period of two years were collected prospectively and consecutively. The different types of headaches were classified according to the 1988 IHS criteria. Both the symptomatic and the preventive treatment were analysed. RESULTS: In all, a total of 866 patients were found; 691 (79.8%) were females and the mean age was 39.8 +/- 15.9 years (range: 6-90 years); 208 (24%) had a history of migraine in the family; 399 (49.9%) were diagnosed as suffering from migraine: 256 (64.2%) had migraine without aura, 152 (19%) were diagnosed as having tension-type headache, and 218 (27.3%) presented chronic daily headache (CDH). The most frequently used symptomatic treatments were NSAI drugs (36.7%) and triptanes (28.4%). Amitriptyline (47.7%), beta-blockers (14.5%) and calcium antagonists (11.3%) were the main drugs used as preventive treatment. DISCUSSION: After several years' operation of our Headache Unit, we thought there was a need to analyse the population seen in the visits. The fact that the majority of our patients were middle-aged females matched our expectations. Although most of the patients were diagnosed as suffering from M, we also want to highlight the high proportion of cases of CDH, above all associated with the abuse of analgesics.

Actividad asistencial en una consulta específica de cefalea / Health care activity in a headache-specific clinic

Introducción. Se calcula que la cefalea afecta, al menos una vez al año, a cerca del 90 por ciento de la población. La repercusión socioeconómica que comporta justifica la aparición en los últimos años de unidades de cefalea. Objetivo. Realizar un estudio descriptivo epidemiológico y asistencial de la actividad realizada en una consulta específica de cefalea. Pacientes y métodos. Durante dos años, se recogieron de forma prospectiva y consecutiva todos los antecedentes de interés de los pacientes vistos en nuestra consulta. Se realizó una clasificación de los distintos tipos de cefalea según la de la IHS de 1988. Se analizó tanto el tratamiento sintomático como el preventivo. Resultados. Se recogieron 866 pacientes; 691 (79,8 por ciento) fueron mujeres y la edad media fue de 39,8 ñ 15,9 años (intervalo: 6-90 años); 208 (24 por ciento) tenían antecedentes familiares de migraña; 399 (49,9 por ciento) se diagnosticaron de migraña -256 (64,2 por ciento) migraña sin aura-, 152 (19 por ciento) se diagnosticaron de cefalea de tensión; 218 (27,3 por ciento) presentaron cefalea crónica diaria (CCD). Los tratamientos sintomáticos más usados fueron los AINE (36,7 por ciento) y los triptanes (28,4 por ciento). Como tratamiento preventivo se usó la amitriptilina (47,7 por ciento), betabloqueadores (14,5 por ciento) y calcioantagonistas (11,3 por ciento), principalmente. Discusión. Tras varios años de funcionamiento de nuestra Unidad de Cefalea, creímos necesario analizar a la población atendida en la consulta. La presencia de una mayoría de mujeres en edades medias de la vida se ajusta a lo esperado. A pesar de que la mayoría de los pacientes se diagnosticaron de migraña, se reseña la alta proporción de enfermos con CCD, sobre todo asociada al abuso de analgésicos (AU)

Introduction. It is reckoned that headaches affect, at least once a year, around 90% of the population. The socioeconomic repercussion occasioned by this malady justifies the appearance in recent years of headache units. Aim. To conduct a descriptive epidemiological and health care study of the activity carried out in a headache-specific clinic. Patients and methods. All the relevant points from the histories of patients who visited our surgery over a period of two years were collected prospectively and consecutively. The different types of headaches were classified according to the 1988 IHS criteria. Both the symptomatic and the preventive treatment were analysed. Results. In all, a total of 866 patients were found; 691 (79.8%) were females and the mean age was 39.8 ± 15.9 years (range: 6-90 years); 208 (24%) had a history of migraine in the family; 399 (49.9%) were diagnosed as suffering from migraine: 256 (64.2%) had migraine without aura, 152 (19%) were diagnosed as having tensiontype headache, and 218 (27.3%) presented chronic daily headache (CDH). The most frequently used symptomatic treatments were NSAI drugs (36.7%) and triptanes (28.4%). Amitriptyline (47.7%), beta-blockers (14.5%) and calcium antagonists (11.3%) were the main drugs used as preventive treatment. Discussion. After several years’operation of our Headache Unit, we thought there was a need to analyse the population seen in the visits. The fact that the majority of our patients were middle-aged females matched our expectations. Although most of the patients were diagnosed as suffering from M, we also want to highlight the high proportion of cases of CDH, above all associated with the abuse of analgesics (AU)

[Lamotrigine in refractory epilepsy]. / Lamotrigina en epilepsia refractaria.

INTRODUCTION: Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment. AIMS: We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures. PATIENTS AND METHODS: We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction>50% of the seizures), inefficacy (reduction<50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout). RESULTS: In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 +/- 13.7 years; mean follow up time: 27.6 +/- 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 56.4%:23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance. CONCLUSION: Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate.

Lamotrigina en epilepsia refractaria / Lamotrigine in refractory epilepsy

Introducción. La lamotrigina (LTG) es un nuevo antiepiléptico indicado para todo tipo de crisis parciales y tonicoclónicas generalizadas, tanto en monoterapia como politerapia. El 20-30 por ciento de los pacientes epilépticos tienen un mal control de las crisis, pese a un tratamiento adecuado. Objetivo. Presentamos nuestra experiencia en cuanto a eficacia y tolerabilidad a largo plazo de la LTG en crisis refractarias. Pacientes y métodos. Estudiamos consecutivamente durante 10 años a los pacientes que iniciaron tratamiento con LTG tras un mal control de sus crisis, pese al tratamiento con dos o más fármacos antiepilépticos en monoterapia o en combinación. Recogimos sus datos epidemiológicos y clínicos. Estudiamos la eficacia del tratamiento, diferenciando entre remisión (ausencia de crisis), mejoría (reducción mayor o igual al 50 por ciento de las crisis), ineficacia (reducción menor del 50 por ciento), agravamiento (aumento de las crisis), y su tolerabilidad (efectos secundarios y abandono del tratamiento).Resultados. Se recogieron 39 pacientes -18 hombres (46,2 por ciento), edad media de 30,9 ñ 13,7 años-; el seguimiento medio fue de 27,6 ñ 23,4 meses. El 43,7 por ciento presentaba epilepsia criptogénica, el 28,5 por ciento, sintomática, y el 28,5 por ciento, idiopática. El EEG fue patológico en el 53,8 por ciento de los pacientes y la neuroimagen, en el 43,6 por ciento. Tras la introducción de la LTG, el 33 por ciento de los pacientes quedó libre de crisis, el 43,6 por ciento mejoró, en el 18,3 por ciento de ellos fue ineficaz y el 5,1 por ciento empeoró. El 56,4 por ciento abandonó el tratamiento: el 23,1 por ciento por control insuficiente de las crisis, el 17,9 por ciento por efectos secundarios y el 15,4 por ciento por incumplimiento terapéutico. Conclusión. El tratamiento con LTG logra una alta eficacia en el control de las crisis en los pacientes con epilepsia refractaria, si bien está limitado por una elevada tasa de abandonos terapéuticos (AU)

Introduction. Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment. Aims. We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures. Patients and methods. We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction > 50% of the seizures), inefficacy (reduction < 50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout). Results. In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 ± 13.7 years; mean follow-up time: 27.6 ± 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 56.4%: 23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance. Conclusion. Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate (AU)

[Peripheral and optical myeloneuropathy in a folic acid deficient alcoholic patient]. / Mieloneuropatía periférica y óptica en un paciente alcohólico deficiente en ácido fólico.

INTRODUCTION: In Western countries, neurological disorders secondary to toxic nutritional problems usually present as isolated cases that are generally associated to identifiable causes (alcoholism, eating disorders, absorption disorders, use of medicines) that reduce the availability of basic nutrients, especially B group vitamins, but also folic acid (FA). The optic nerves and the peripheral axons are frequent target organs in this type of pathology, but leukoencephalopathy and spinal cord involvement may also appear, often in combination. CASE REPORT: We describe the case of a 38-year-old female smoker with a heavy alcohol habit, who developed a subacute clinical pattern of, predominantly axonal, sensitive peripheral polyneuropathy, with vegetative fibre involvement. She also presented involvement of the posterior spinal cord, which gave rise to an ataxic disorder in the gait, as well as a severe bilateral retrobulbar optic neuropathy. Likewise, she presented macrocytosis (MCV: 118) due to megaloblastosis. She was also found to have a FA deficit but a normal vitamin B12 metabolism. With the help of supplementary vitamins, stopping drinking and the regularisation of her diet, the patient presented progressive clinical improvement, and was able to walk without support at 3 months and almost completely recovered her sight, which was corroborated by an improvement in the studies of both visual and somatosensorial evoked potentials. CONCLUSIONS: In our community, alcoholism is a frequent cause of nutritional deficiencies, which lead to neurological problems. FA is one of the nutrients that become deficient in alcoholics. More and more descriptions are being reported of peripheral polyneuropathy, retrobulbular optic neuropathy, myelopathy or leukoencephalopathy associated to FA deficiency, above all in patients with a history of alcoholism.

Mieloneuropatía periférica y óptica en un paciente alcohólico deficiente en ácido fólico / Peripheral and optical myeloneuropathy in a folic acid deficient alcoholic patient

Introducción. En los países occidentales, los trastornos neurológicos secundarios a problemas toxiconutricionales suelen presentarse como casos aislados, generalmente asociados a causas identificables (alcoholismo, aberraciones dietéticas, trastornos de la absorción, uso de fármacos), que disminuyen la disponibilidad de algunos nutrientes básicos, fundamentalmente vitaminas del grupo B, pero también de ácido fólico (AF). Los nervios ópticos y los axones periféricos son dianas frecuentes en este tipo de patologías, pero también pueden aparecer, frecuentemente en combinación, leucoencefalopatía y afectación medular. Caso clínico. Mujer de 38 años, fumadora y con hábito alcohólico importante, que desarrolló un cuadro subagudo de polineuropatía periférica, sensitiva, con afectación de las fibras vegetativas, y de predominio axonal, junto a afectación cordonal posterior, que provocó trastorno atáxico de la marcha, así como neuropatía óptica retrobulbar bilateral grave. Igualmente presentaba macrocitosis (VCM: 118) debida a megaloblastosis. Se halló deficiencia de AF con un metabolismo de la vitamina B12 normal. Con suplementos vitamínicos, el abandono del hábito alcohólico y la normalización de la dieta, la paciente presentó una mejoría clínica progresiva, y fue capaz de deambular sin apoyo a los tres meses, con una recuperación casi completa de la función visual, todo ello corroborado por una mejoría en los resultados de los estudios de potenciales evocados, tanto visuales como somatosensoriales. Conclusiones. En nuestro medio, el alcoholismo es una causa frecuente de deficiencias nutricionales, que ocasionan problemas neurológicos. El AF es uno de los nutrientes que se hace deficitario en el alcoholismo. Cada vez aparecen más descripciones de polineuropatía periférica, neuropatía óptica retrobulbar, mielopatía o leucoencefalopatía asociadas a una deficiencia de AF, sobre todo en pacientes con abuso de alcohol (AU)

Introduction. In Western countries, neurological disorders secondary to toxic-nutritional problems usually present as isolated cases that are generally associated to identifiable causes (alcoholism, eating disorders, absorption disorders, use of medicines) that reduce the availability of basic nutrients, especially B group vitamins, but also folic acid (FA). The optic nerves and the peripheral axons are frequent target organs in this type of pathology, but leukoencephalopathy and spinal cord involvement may also appear, often in combination. Case report. We describe the case of a 38-year-old female smoker with a heavy alcohol habit, who developed a subacute clinical pattern of, predominantly axonal, sensitive peripheral polyneuropathy, with vegetative fibre involvement. She also presented involvement of the posterior spinal cord, which gave rise to an ataxic disorder in the gait, as well as a severe bilateral retrobulbar optic neuropathy. Likewise, she presented macrocytosis (MCV: 118) due to megaloblastosis. She was also found to have a FA deficit but a normal vitamin B12 metabolism. With the help of supplementary vitamins, stopping drinking and the regularisation of her diet, the patient presented progressive clinical improvement, and was able to walk without support at 3 months and almost completely recovered her sight, which was corroborated by an improvement in the studies of both visual and somatosensorial evoked potentials. Conclusions. In our community, alcoholism is a frequent cause of nutritional deficiencies, which lead to neurological problems. FA is one of the nutrients that become deficient in alcoholics. More and more descriptions are being reported of peripheral polyneuropathy, retrobulbular optic neuropathy, myelopathy or leukoencephalopathy associated to FA deficiency, above all in patients with a history of alcoholism (AU)

[Meningeal carcinomatosis in giant cell lung cancer]. / Meningitis carcinomatosa en neoplasia pulmonar de células grandes.

A case of patient with symptoms of L3-L4 roots affliction and IV cranial nerve lesion, caused by meningeal carcinomatosis secondary to giant cell lung cancer, is presented. The clinical features, diagnosis methods, and therapeutic possibilities in this case are commented on.