[Congenital hydrocephalus]. / Hidrocefalia congénita.

INTRODUCTION: Congenital hydrocephalus or ventriculomegaly is a disorder that now can be diagnosed in uterus with ultrasonography, this gives the chance of being able to give a treatment the earliest as possible. DEVELOPMENT: The clinical manifestations are reviewed, the diagnosis, the frequent treatment and causes of congenital hydrocephalus, being the first agenesis of the Sylvius' aqueduct, followed by Arnold-Chiari's malformations with mielomeningocele. CONCLUSIONS: In most of the cases the peritoneal-ventricle shunt is the best surgery treatment and now, the treatment with ventriculostomy of third ventricle by endoscopy has fewer complications apparently and in several cases it is the definitive treatment. The evolution of the diagnosis with the support of specific therapies is effective and the early treatment is good, of course taking into account the etiology.

Hidrocefalia congénita / Congenital hydrocephalus

Introducción. La hidrocefalia congénita o ventriculomegaliaes un trastorno que hoy día puede diagnosticarse in utero através de ecografía y esto da la oportunidad de aplicar un tratamientolo más tempranamente posible. Desarrollo. Se revisan lasmanifestaciones clínicas, el diagnóstico, el tratamiento y las causasmás frecuentes de la hidrocefalia congénita, la principal deellas la agenesia del acueducto de Silvio, seguida de la malformaciónde Arnold-Chiari con mielomeningocele. Conclusiones. En lamayoría de los casos, la derivación ventriculoperitoneal es el tratamientoquirúrgico de elección; en la actualidad, el tratamientocon la ventriculostomía del III ventrículo por endoscopia tiene enapariencia menos complicaciones y en varios casos es definitivo.El pronóstico cuando se diagnostica y se trata tempranamente, conel apoyo añadido de terapias específicas, es bueno, teniendo en cuentala etiología

Introduction. Congenital hydrocephalus or ventriculomegaly is a disorder that now can be diagnosed in uteruswith ultrasonography, this gives the chance of being able to give a treatment the earliest as possible. Development. Theclinical manifestations are reviewed, the diagnosis, the frequent treatment and causes of congenital hydrocephalus, being thefirst agenesis of the Sylvius’ aqueduct, followed by Arnold-Chiari’s malformations with mielomeningocele. Conclusions. Inmost of the cases the peritoneal-ventricle shunt is the best surgery treatment and now, the treatment with ventriculostomy ofthird ventricle by endoscopy has fewer complications apparently and in several cases it is the definitive treatment. Theevolution of the diagnosis with the support of specific therapies is effective and the early treatment is good, of course takinginto account the etiology

[The new antiepileptic drugs: their indications and side effects]. / Nuevos antiepilépticos: indicaciones y efectos colaterales.

INTRODUCTION: Although the significant progress in pharmacotherapy of epilepsy during last decade was achieved, about one third of patients are resistant to the current treatment. The introduction of numerous effective, well tolerated and safe new antiepileptic drugs (AEDs) in the last decade of the 20th century has widened the choice of treatment options in epilepsy and improved the tolerability and the ease of use of treating patients with epilepsy. Nevertheless, significant safety and efficacy deficits continue to exist. Severe idiosyncratic reactions and organ toxicity have hampered the wide use of some of the newer AEDs. As a decade before, about one third of patients with chronic epilepsy is resistant to current pharmacotherapy. Even in patients in whom pharmacotherapy is efficacious, current AEDs do not seem to affect the progression or the underlying natural history of epilepsy. DEVELOPMENT: The revision of newer AEDs are formulation, action, doses and side effects. CONCLUSION: Thus, there is an unmet need for safer and more effective drugs, especially for chronic, drug-resistant epilepsy. To stimulate the development of even better compounds, the demonstrated benefits and risks of current new AEDs are reviewed.

Nuevos antiepilépticos: indicaciones y efectos colaterales / The new antiepileptic drugs: their indications and side effects

Introducción. La aparición de varios fármacos antiepilépticos (FAE) seguros, bien tolerados y efectivos contra la epilepsia en la última década del siglo XX ha ampliado la posibilidad de elección de las opciones del tratamiento contra la misma, además de mejorar la tolerabilidad y la facilidad en el manejo del paciente epiléptico.Sin embargo, todavía persisten los problemas en cuanto a su seguridad y su eficacia. Las reacciones por idiosincrasia y toxicidad han limitado el uso de algunos de los nuevos FAE. Como hace una década, cerca de un tercio de los pacientes con epilepsia crónica generalizada son resistentes a la mayoría de los FAE comunes. Aun en los pacientes en los que la farmacoterapia es exitosa, los FAE comunes no parecen modificar la evolución de la epilepsia. Desarrollo. Se revisan los nuevos FAE, su fórmula, mecanismos de acción, dosis y reacciones de toxicidad y secundarias. Conclusión. Es necesario conocer medicamentos más seguros y más efectivos contra la epilepsia, especialmente para las formas resistentes. Algunos de los nuevos medicamentos presentan numerosas ventajas frente a los ya existentes, lo que puede ser de gran utilidad clínica, y se debe establecer una estrategia más racional en el manejo de las epilepsias y de los síndromes epilépticos, pues la mayoría son formas resistentes a los anticonvulsionantes actuales (AU)

Introduction. Although the significant progress in pharmacotherapy of epilepsy during last decade was achieved, about one third of patients are resistant to the current treatment. The introduction of numerous effective, well tolerated and safe new antiepileptic drugs (AEDs) in the last decade of the 20th century has widened the choice of treatment options in epilepsy and improved the tolerability and the ease of use of treating patients with epilepsy. Nevertheless, significant safety and efficacy deficits continue to exist. Severe idiosyncratic reactions and organ toxicity have hampered the wide use of some of the newer AEDs. As a decade before, about one third of patients with chronic epilepsy is resistant to current pharmacotherapy. Even in patients in whom pharmacotherapy is efficacious, current AEDs do not seem to affect the progression or the underlying natural history of epilepsy. Development. The revision of newer AEDs are formulation, action, doses and side effects. Conclusion. Thus, there is an unmet need for safer and more effective drugs, especially for chronic, drug-resistant epilepsy. To stimulate the development of even better compounds, the demonstrated benefits and risks of current new AEDs are reviewed (AU)

[A randomised open trial comparing monotherapy with topiramate versus carbamazepine in the treatment of paediatric patients with recently diagnosed epilepsy]. / Estudio abierto aleatorio y comparativo de monoterapia con topiramato frente a carbamacepina en el tratamiento de pacientes pediátricos con epilepsia de reciente diagnóstico.

INTRODUCTION: In some studies in children, topiramate showed efficacy. AIM: To evaluate efficacy, tolerability and safety of topiramate in monotherapy in newly diagnosed epilepsy vs carbamazepine in children. PATIENTS AND METHODS: In a multicentre, open-label, comparative and randomized study patients with partial epilepsy, were randomized to received topiramate or carbamazepine treatment. Patients with degenerative disease were excluded. Data were analysed by SPSS statistical program v. 11.0, and non parametric test. Comparisons between groups were made with chi square test and t Student's test. RESULTS: In total were included 88 patients, 33 in group 1 (topiramate), 32 group 2 (carbamazepine), 23 were drop-outs because adverse events and lost in follow-up (13 in group 1 y 10 group 2). In both groups were observed good efficacy, in month 6 and 9 of follow-up, the average of seizures in group 1 were better than group 2 (p = 0.01, t Student's test). The percentage of free seizure patients was greater in group 1 than group 2 (statistical significance p = 0.02 chi square test). The adverse events were similar in both groups and mild, somnolence 9%, weight loss 6% in group 1 and somnolence 19%, dizziness 3% and seizure discontrol 3% in group 2. CONCLUSIONS: Good efficacy in both groups, and topiramate in good treatment choice in newly diagnosed epilepsy in children because it's the efficacy and tolerability in comparison with the gold standard carbamazepine.

[Cognitive effects of antiepileptic drugs]. / Efectos cognitivos de los fármacos antiepilépticos.

DEVELOPMENT: Traditionally it has been shown that anti epileptic drugs have side effects which cause alterations particularly in behaviour and cognition, independently from that due to the epilepsy itself. This has caused great controversy. Some studies have informed that many of these drug effects are caused by the epilepsy rather than the drugs themselves. It is possible that the drugs may cause changes in behaviour and cognition, but these also improve when the seizures are brought under control. The main problem therefore is to determine the methodology which would take these variables into account, since many studies do not follow a standard methodology: the various drugs and neuropsychological aspects are compared using a large variety of tests. CONCLUSIONS: At the present time, using suitable methodology, and double blind randomized controlled trials, it has been found that the secondary effects on cognition and behaviour are not as severe as had been thought. The drug causing most alterations is phenobarbitone and some benzodiazepines, such as clonazepam, alter cognitive function to a greater degree. With the newer anti epileptic drugs improvement in cognition has been observed due to its mechanism of action and to control of the epilepsy.

Efectos cognitivos de los fármacos antiepilépticos / Cognitive effects of antiepileptic drugs

Desarrollo. Tradicionalmente se ha determinado que los medicamentos antiepilépticos tienen efectos secundarios que alteran en especial la conducta y la cognición, independientemente de la enfermedad. Esto ha provocado una gran controversia; diversos estudios han informado que la epilepsia, más que los fármacos, ocasiona muchos de los efectos secundarios atribuidos a los medicamentos.Es posible que los medicamentos puedan provocar alteraciones en la conducta y en la cognición, pero también la mejoran, al lograr el control de las crisis. El problema mayor, por tanto, es determinar una metodología en la cual se tengan en cuenta estas variables, ya que muchos estudios no siguen un estándar metodológico: se comparan diversos medicamentos y se califica también el aspecto neuropsicológico con una gran variedad de pruebas. Conclusiones. En la actualidad, con una metodología adecuada y en estudios doble ciego, al azar y con control, se ha determinado que los efectos secundarios sobre la cognición y la conducta no son tan graves como se había sospechado. Incluso con los nuevos antiepilépticos se ha observado una mejoría en la cognición (AU)

Development. Traditionally it has been shown that anti-epileptic drugs have side-effects which cause alterations particularly in behaviour and cognition, independently from that due to the epilepsy itself. This has caused great controversy. Some studies have informed that many of these drug effects are caused by the epilepsy rather than the drugs themselves. It is possible that the drugs may cause changes in behaviour and cognition, but these also improve when the seizures are brought under control. The main problem therefore is to determine the methodology which would take these variables into account, since many studies do not follow a standard methodology: the various drugs and neuropsychological aspects are compared using a large variety of tests. Conclusions. At the present time, using suitable methodology, and double-blind randomized controlled trials, it has been found that the secondary effects on cognition and behaviour are not as severe as had been thought. The drug causing most alterations is phenobarbitone and some benzodiazepines, such as clonazepam, alter cognitive function to a greater degree. With the newer anti-epileptic drugs improvement in cognition has been observed due to its mechanism of action and to control of the epilepsy (AU)

[Neurocysticercosis in pediatrics. Prognosis, treatment and prevention]. / Neurocisticercosis en pediatría. Pronóstico, tratamiento y prevención.

INTRODUCTION: Neurocysticercosis is an endemic disease caused by the larva of Taenia solium, which accidentally finds its way into the central nervous system of human beings. It is not found in any zone in particular and this leads to clinical pleomorphism. This makes treatment in paediatric patients even more difficult than in adults, because of their growth and development. DEVELOPMENT: There is controversy over the use of cestocide drugs, which should not be used in general except in specific cases such as cysticercosic meningitis and when there is intracranial hypertension. In other cases symptomatic treatment is recommended. In few cases is surgery worthwhile. Prognosis is good in most patients. CONCLUSION: Prevention by hygienic-dietetic measures is the basis for control and eradication.

[Neurologic disorders in children with chronic terminal renal insufficiency]. / Alteraciones neurológicas en niños con insuficiencia renal crónica terminal.

Neurological alterations are very frequent in children with end stage renal disease (ESRD). In order to assess the type of these complications, a neurological study was undertaken in 30 children with ESRD. Three of the patients had convulsions and hyperreflexia was the only clinical sign found in all the patients. Low serum levels of hemoglobin and calcium and high concentrations of phosphates, aluminum and parathyroid hormone were found in all cases, but correlations with any neurological alteration were not made. Abnormal EEG with slow waves in the occipital region were obtained in 23 patients. Sensorial hypoacusia was registered in 6 children who were previously treated with aminoglucosides. The cerebral tomography showed calcifications in three instances, but only in one patient were of clinical significance. In five, out of the 30 patients, cerebral atrophy was detected. In conclusion, assessment of the neurological condition is mandatory in children with ESRD before renal transplantation is performed, since the complication itself or the therapy may interfere with rehabilitation.

Status epilepticus within the Lennox-Gastaut syndrome: clinical characteristics and management.

This report describes 2 cases, 7 and 8 years of age, with the Lennox-Gastaut Syndrome and status epilepticus. Both cases responded favorably, clinically and in their EEGs, to continuous therapeutic control with clonazepam, and remained under control with valproic acid.

Neonatal status epilepticus II: Electroencephalographic aspects.

A prospective study of 15 newborns were identified with NSE. In 11 cases the findings were electrical only without clinical manifestations (ENSE), and the other four presented simultaneously clinical seizures and electrical discharges (ECNSE).

Neonatal status epilepticus I: Clinical aspects.

Fifteen newborns with neonatal status epilepticus were prospectively identified from a protocol of convulsion in the newborn, at the neonatal intensive care unit. The mean postnatal age was 7.1 days, with fourteen full term babies and one premature. Previous complications during childbirth existed in twelve infants. The principal etiology associated was hypoxic-ischemic-encephalopathy, and four patients died. In thirteen cases the antecedent of subtle seizures existed; only in four cases was status epilepticus suspected. Difficulty in clinical recognition makes it necessary to perform an EEG on each newborn with risk factors, abnormal neurological manifestations, or with prolonged and or repeated hypoxic perinatal antecedents.