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

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Nueva clasificación de las epilepsias de la Liga Internacional contra la Epilepsia (ILAE): ¿un paso en dirección equivocada? / The new International League Against Epilepsy (ILAE) classification of epilepsies: a step in the wrong direction?

Introducción. La clasificación de las epilepsias de la Liga Internacional contra la Epilepsia (ILAE) de 1989 se ha usado en todo el mundo en numerosos estudios. En el año 2010 la ILAE propuso una nueva clasificación. Objetivo. Intentamos valorar la aportación de la clasificación de las epilepsias de 2010 comparándola con la versión previa y analizándola de acuerdo con los principios de una buena clasificación. Desarrollo. La clasificación de 2010 muestra cambios radicales, tanto en terminología como en criterios taxonómicos, respecto a la de 1989. La nueva versión carece de muchos atributos propios de una buena clasificación. El criterio mayor elegido para clasificar las epilepsias (mezcla de especificidad sindrómica y etiología) divide las epilepsias en cuatro grupos que no son mutuamente excluyentes. Por ejemplo, la epilepsia rolándica benigna sería incluida tanto entre los ‘síndromes electroclínicos’ como entre las ‘epilepsias de causa desconocida’. Además, el criterio elegido parece clínicamente menos relevante que los de la clasificación previa (localización y etiología). La ILAE propuso un ejemplo de ‘organización’ de las epilepsias, no una verdadera clasificación, y animó a crear otras clasificaciones para fines específicos. Si estas últimas no estuvieran conectadas con una clasificación principal previa, supondrían un verdadero riesgo. Varias autoridades internacionales en la materia han criticado ya las nuevas propuestas de la ILAE. Conclusiones. El lanzamiento de la nueva clasificación de las epilepsias no ha sido un éxito. Un debate internacional sobre el tema ayudaría a desarrollar una nueva clasificación con amplio respaldo universal (AU)

Introduction. The 1989 International League Against Epilepsy (ILAE) classification of epilepsies has been used in many studies world-wide. In 2010, the ILAE proposed a new classification. Aim. We evaluated the potential contribution of the 2010 classification of epilepsies compared to the previous one. We also analyzed the new version according to the principles of a good classification. Development. The 2010 classification of epilepsies shows radical changes, both in terminology and taxonomic criteria, when compared to the 1989 classification. The new version lacks many of the desirable principles of a good classification system. The main criterion selected to classify the epilepsies (a mixture of syndromic specificity and etiology) divides the epilepsies in four groups which are not mutually exclusive. For instance, benign rolandic epilepsy should be included both under ‘electroclinical syndromes’ and ‘epilepsies of unknown cause’. The division of clinical entities in ‘electroclinical syndromes’, ‘constellations’, and ‘ill-defined syndromes’ could have avoided such problem, although it appears to be clinically less relevant than 1989 classification criteria (localization and etiology). The ILAE has proposed an example of ‘organization’ of the epilepsies, instead of a true classification, and has encouraged the creation of different classifications for specific purposes. Should these ones were not linked to a previously established main classification they would represent a risk. Several international authorities have already disapproved the new proposals of the ILAE. Conclusions. The attempts to replace the 1989 ILAE classification of epilepsies have been far from successful. An international debate on the subject might help to develop a new classification supported world-wide (AU)

[The new International League Against Epilepsy (ILAE) classification of epilepsies: a step in the wrong direction?]. / Nueva clasificacion de las epilepsias de la Liga Internacional contra la Epilepsia (ILAE): un paso en direccion equivocada?

INTRODUCTION: The 1989 International League Against Epilepsy (ILAE) classification of epilepsies has been used in many studies world-wide. In 2010, the ILAE proposed a new classification. AIM: We evaluated the potential contribution of the 2010 classification of epilepsies compared to the previous one. We also analyzed the new version according to the principles of a good classification. DEVELOPMENT: The 2010 classification of epilepsies shows radical changes, both in terminology and taxonomic criteria, when compared to the 1989 classification. The new version lacks many of the desirable principles of a good classification system. The main criterion selected to classify the epilepsies (a mixture of syndromic specificity and etiology) divides the epilepsies in four groups which are not mutually exclusive. For instance, benign rolandic epilepsy should be included both under 'electroclinical syndromes' and 'epilepsies of unknown cause'. The division of clinical entities in 'electroclinical syndromes', 'constellations', and 'ill-defined syndromes' could have avoided such problem, although it appears to be clinically less relevant than 1989 classification criteria (localization and etiology). The ILAE has proposed an example of 'organization' of the epilepsies, instead of a true classification, and has encouraged the creation of different classifications for specific purposes. Should these ones were not linked to a previously established main classification they would represent a risk. Several international authorities have already disapproved the new proposals of the ILAE. CONCLUSIONS: The attempts to replace the 1989 ILAE classification of epilepsies have been far from successful. An international debate on the subject might help to develop a new classification supported world-wide.

Epilepsia focal refractaria: ¿tratamiento médico o quirúrgico? / Focal refractory epilepsy: medical or surgical treatment?

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Risks and benefits of generic antiepileptic drugs.

INTRODUCTION: In most therapeutic areas, prescribing generic drugs seems to lower costs without sacrificing efficacy. The use of generic drugs for treating epilepsy may, however, be more controversial. MATERIALS AND METHODS: A systematic review of the literature on generic antiepileptic drugs has been carried out based primarily on a bibliographical search in the Medline database. RESULTS: Published studies are usually of a descriptive nature and are sometimes based on generic drugs that were approved in times when regulatory agency requirements were not as strict as they are now. Experts claim that a change in pharmaceutical formulations could cause seizure recurrence in cases that had been successfully controlled in the past, with severe effects on patients. Meanwhile, several health organizations have provided inconsistent recommendations on the use of generic antiepileptic drugs. CONCLUSION: In order to obtain scientific evidence on the potential risks and benefits of interchanging branded and generic antiepileptic drugs, high methodological comparative studies are necessary. These studies could bring consensus about the role of generic drugs for treating epilepsy.

Diagnosis of epilepsy over the course of the disease.

BACKGROUND: At the onset of the disease, differential diagnosis should be established between an epileptic seizure and a series of paroxysmal phenomena, such as syncope, pseudoseizure, or migraine aura, which may manifest with similar symptoms. But even when the initial differential diagnosis is established rigorously, we will see that it is often necessary to reconsider the diagnosis of epilepsy during the course of the disease. REVIEW SUMMARY: Prospective studies analyzing initial recognition of epilepsy found that on half of occasions the diagnosis was reached late, when the patient had already suffered repeated seizures. On other occasions, it is noted that, although the diagnosis of epilepsy was correct, the epileptic syndrome of the patient was classified erroneously, which can lead to inappropriate management. There are a number of reasons that can explain these delays or errors in diagnosis, and we will devote this entire article to their discussion. CONCLUSIONS: Based on a detailed medical history and with the aid of the electroencephalogram and magnetic resonance imaging, the diagnosis of epilepsy can be made and the specific epileptic syndrome identified in many patients from the time of the first seizure. However, various studies show that it is often necessary to modify the initial diagnosis during the follow-up of a patient because of progression of the disease itself (infantile stage), a previous diagnostic error, or because of diagnostic difficulties or inadequate interpretation of tests such as the electroencephalogram or magnetic resonance imaging.

Diagnostic problems in the initial assessment of epilepsy.

BACKGROUND: On most occasions, the diagnosis of seizures and epilepsy is considered in cases of temporary disturbance of neurologic function. In this clinical situation, the physician in charge (neurologist, emergency physician, general practitioner, intensivist, cardiologist, psychiatrist, etc.) should establish the differential diagnosis with other pathologies that can also cause transient neurologic disturbances. REVIEW SUMMARY: We will review the relevant literature about the diagnostic process and the differential diagnosis of epileptic seizures and epilepsy at the onset of the disease, and the medical consequences of an incorrect diagnosis. CONCLUSION: Neurologists and non-neurologists often diagnose epilepsy. The diagnostic challenge consists of correctly interpreting the medical history, characteristics of the episodes and physical and neurologic examination, and properly using and interpreting supplemental paraclinical tests.

Tabaco y enfermedad de Parkinson: ¿un pacto con el diablo? / Tobacco and PArkinson: a pact with the devil?

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