Epilepsy in elderly patients: does age of onset make a difference?

INTRODUCTION: Epilepsy is most frequent in children and elderly people. Today's population is ageing and epilepsy prevalence is increasing. The type of epilepsy and its management change with age. METHODS: We performed a retrospective, observational study comparing patients aged ≥ 65 years with epilepsy diagnosed before and after the age of 65, and describing epilepsy characteristics and comorbidities in each group. RESULTS: The sample included 123 patients, of whom 61 were diagnosed at < 65 years of age (group A), 62 at ≥ 65 of age (group B). Sex distribution was similar in both groups, with 39 men (62.9%) in group A and 37 (60.7%) in group B. Mean age was 69.97 ±â€¯5.6 years in group A and 77.29 ±â€¯6.73 in group B. The most common aetiology was cryptogenic in group A (44.3%, n = 27) and vascular in group B (74.2%, n = 46). History of stroke was present in 12 patients from group A (19.7%) and 32 (51.6%) in group B. Antiepileptic drugs were prescribed at lower doses in group A. Statistically significant differences were found between groups for history of ischaemic stroke, cognitive impairment, psychiatric disorders, and diabetes mellitus; degree of dependence; and number of antiepileptic drugs. CONCLUSION: Age of onset ≥ 65 years is closely related to cardiovascular risk factors; these patients require fewer antiepileptic drugs and respond to lower doses. Some cases initially present as status epilepticus.

[Emergency department management of epileptic seizures in patients with epilepsy]. / Atención en el servicio de urgencias de las crisis epilépticas en pacientes con epilepsia.

AIM: To analyse the care of patients with epilepsy (PwE) who visit the hospital emergency department (ED) due to an epileptic seizure. MATERIALS AND METHODS: Single-centre retrospective observational study, based on the clinical history of the PwE seen in the ED for epileptic seizures between January 2016 and December 2018. Demographic, clinical and ED management variables were collected. Specifically, the results of a computed tomography (CT) brain scan and electroencephalogram and the presence of precipitating factors for epileptic seizures were analysed. RESULTS: A total of 232 PwE were identified, with a mean age of 49.8 years. The most frequent reason for the visit was focal epileptic seizures (50.4%). In 106 cases (45.6%) possible precipitating factors were found, of which poor therapy adherence was the most frequent. An urgent CT brain scan was performed in 67 cases (28.9%) and acute alterations were found in only one patient. An electroencephalogram was carried out in 16 of them (6.9%). Adjustments were made to the antiepileptic treatment in 135 patients (58.1%). A total of 195 were discharged without being hospitalised (84.1%). CONCLUSIONS: PwE accounted for a considerable proportion of the patients seen for epileptic seizures in the ED. The presence of a potentially controllable precipitating factor was identified in almost half of the cases, the most frequent being poor adherence to therapy. In addition, a high number of urgent complementary tests were performed, which in many cases may be unnecessary and avoidable.

TITLE: Atención en el servicio de urgencias de las crisis epilépticas en pacientes con epilepsia.Objetivo. Analizar la atención al paciente con epilepsia (PcE) que consulta en el servicio de urgencias hospitalarias (SUH) por una crisis epiléptica. Materiales y métodos. Estudio observacional retrospectivo unicéntrico, basado en la historia clínica de los PcE atendidos en el SUH por crisis epilépticas entre enero de 2016 y diciembre de 2018. Se recogieron variables demográficas, clínicas y de manejo en el SUH. De forma específica, se analizó la realización de una tomografía computarizada cerebral y un electroencefalograma, y la presencia de factores precipitantes de crisis epilépticas. Resultados. Se identificó a 232 PcE, con una edad media de 49,8 años. El motivo de atención más frecuente fueron las crisis epilépticas focales (50,4%). En 106 (45,6%) se encontraron posibles factores precipitantes, de entre los cuales, la mala adhesión terapéutica fue el más frecuente. En 67 casos (28,9%) se realizó una tomografía computarizada cerebral urgente, y se encontraron alteraciones agudas en un solo paciente. En 16 (6,9%) se realizó un electroencefalograma. Se realizó un ajuste del tratamiento antiepiléptico en 135 pacientes (58,1%). Fueron dados de alta sin hospitalización 195 (84,1%). Conclusiones. Los PcE representaron una proporción considerable de pacientes atendidos por crisis epilépticas en el SUH. Casi en la mitad de los casos se identificó la presencia de algún factor precipitante potencialmente controlable, y el más frecuente fue la mala adhesión terapéutica. Además, se observó una realización de pruebas complementarias urgentes elevada, que en muchos casos podrían ser prescindibles.

Atención en el servicio de urgencias de las crisis epilépticas en pacientes con epilepsia / Emergency department management of epileptic seizures in patients with epilepsy

Objetivo: Analizar la atención al paciente con epilepsia (PcE) que consulta en el servicio de urgencias hospitalarias (SUH) por una crisis epiléptica. Materiales y métodos: Estudio observacional retrospectivo unicéntrico, basado en la historia clínica de los PcE atendidos en el SUH por crisis epilépticas entre enero de 2016 y diciembre de 2018. Se recogieron variables demográficas, clínicas y de manejo en el SUH. De forma específica, se analizó la realización de una tomografía computarizada cerebral y un electroencefalograma, y la presencia de factores precipitantes de crisis epilépticas. Resultados: Se identificó a 232 PcE, con una edad media de 49,8 años. El motivo de atención más frecuente fueron las crisis epilépticas focales (50,4%). En 106 (45,6%) se encontraron posibles factores precipitantes, de entre los cuales, la mala adhesión terapéutica fue el más frecuente. En 67 casos (28,9%) se realizó una tomografía computarizada cerebral urgente, y se encontraron alteraciones agudas en un solo paciente. En 16 (6,9%) se realizó un electroencefalograma. Se realizó un ajuste del tratamiento antiepiléptico en 135 pacientes (58,1%). Fueron dados de alta sin hospitalización 195 (84,1%). Conclusiones: Los PcE representaron una proporción considerable de pacientes atendidos por crisis epilépticas en el SUH. Casi en la mitad de los casos se identificó la presencia de algún factor precipitante potencialmente controlable, y el más frecuente fue la mala adhesión terapéutica. Además, se observó una realización de pruebas complementarias urgentes elevada, que en muchos casos podrían ser prescindibles.(AU)

Aim: To analyse the care of patients with epilepsy (PwE) who visit the hospital emergency department (ED) due to an epileptic seizure. Materials and methods: Single-centre retrospective observational study, based on the clinical history of the PwE seen in the ED for epileptic seizures between January 2016 and December 2018. Demographic, clinical and ED management variables were collected. Specifically, the results of a computed tomography (CT) brain scan and electroencephalogram and the presence of precipitating factors for epileptic seizures were analysed. Results: A total of 232 PwE were identified, with a mean age of 49.8 years. The most frequent reason for the visit was focal epileptic seizures (50.4%). In 106 cases (45.6%) possible precipitating factors were found, of which poor therapy adherence was the most frequent. An urgent CT brain scan was performed in 67 cases (28.9%) and acute alterations were found in only one patient. An electroencephalogram was carried out in 16 of them (6.9%). Adjustments were made to the antiepileptic treatment in 135 patients (58.1%). A total of 195 were discharged without being hospitalised (84.1%). Conclusions: PwE accounted for a considerable proportion of the patients seen for epileptic seizures in the ED. The presence of a potentially controllable precipitating factor was identified in almost half of the cases, the most frequent being poor adherence to therapy. In addition, a high number of urgent complementary tests were performed, which in many cases may be unnecessary and avoidable.(AU)

[Juvenile myoclonic epilepsy: long-term prognosis and antiepileptic drug withdrawal]. / Epilepsia mioclónica juvenil: pronóstico a largo plazo y retirada de tratamiento.

BACKGROUND: Juvenile myoclonic epilepsy (JME) is a classic epileptic syndrome that lacks consensus on the possibility of suspending treatment with antiepileptic drugs (AD). METHOD: Retrospective observational study of a series of patients diagnosed with JME with 20 years or more of evolution, focusing on those with withdrawal from AD. RESULTS: The study involved twenty patients (average age 44.1 years, 55% men) with JME of 30 years average evolution and average age at its outset of 14.2 years. The most frequent type of motor crisis was the combination of myoclonic and tonic-clonic seizures (70%); 60% of the patients have been free of seizures for more than five years. Four patients (20%) were withdrawn from AD, two of them with an average age of 23 years and an average time free of seizures of 7.5 years, who relapsed, and the other two with an average age of 39 years and following 23.5 years free of seizures, who currently have been without seizures for two and nine years. CONCLUSIONS: The possibility of withdrawing AD in patients with JME who have been free of seizures over an extended time seems feasible. We suggest taking into account age at withdrawal and prior existence of a prolonged period of time free of seizures.

Usefulness of electroencephalography for the management of epilepsy in emergency departments. / Utilidad del electroencefalograma en el manejo de la epilepsia en el Servicio de Urgencias.

INTRODUCTION: Electroencephalography (EEG) is an essential diagnostic tool in epilepsy. Its use in emergency departments (ED) is usually restricted to the diagnosis and management of non-convulsive status epilepticus (NCSE). However, EDs may also benefit from EEG in the context of other situations in epilepsy. METHODS: We conducted a retrospective observational study using the clinical histories of patients treated at our hospital's ED for epileptic seizures and suspicion of NCSE and undergoing EEG studies in 2015 and 2016. We collected a series of demographic and clinical variables. RESULTS: Our sample included 87 patients (mean age of 44 years). Epileptic seizures constituted the most common reason for consultation: 59.8% due to the first episode of epileptic seizures (FES), 27.6% due to recurrence, and 12.6% due to suspected NCSE. Interictal epileptiform discharges (IED) were observed in 38.4% of patients reporting FES and in 33.3% of those with a known diagnosis of epilepsy. NCSE was confirmed by EEG in 36.4% of all cases of suspected NCSE. Presence of IED led to administration of or changes in long-term treatment in 59.8% of the patients. CONCLUSIONS: EEG is a useful tool for seizure management in EDs, not only for severe, sudden-onset clinical situations such as NCSE but also for diagnosis in cases of non-affiliated epilepsy and in patients experiencing the first episode of epilepsy.

Epilepsy in elderly patients: does age of onset make a difference? / Epilepsia en el anciano: ¿la edad de inicio marca la diferencia?

INTRODUCTION: Epilepsy is most frequent in children and elderly people. Today's population is ageing and epilepsy prevalence is increasing. The type of epilepsy and its management change with age. METHODS: We performed a retrospective, observational study comparing patients aged ≥ 65 years with epilepsy diagnosed before and after the age of 65, and describing epilepsy characteristics and comorbidities in each group. RESULTS: The sample included 123 patients, of whom 61 were diagnosed at <65 years of age (group A), 62 at ≥ 65 of age (group B). Sex distribution was similar in both groups, with 39 men (62.9%) in group A and 37 (60.7%) in group B. Mean age was 69.97±5.6 years in group A and 77.29±6.73 in group B. The most common aetiology was unknown in group A (44.3%, n=27) and vascular in group B (74.2%, n=46). History of stroke was present in 12 patients from group A (19.7%) and 32 (51.6%) in group B. Antiepileptic drugs were prescribed at lower doses in group A. Statistically significant differences were found between groups for history of ischaemic stroke, cognitive impairment, psychiatric disorders, and diabetes mellitus; degree of dependence; and number of antiepileptic drugs. CONCLUSION: Age of onset ≥ 65 years is closely related to cardiovascular risk factors; these patients require fewer antiepileptic drugs and respond to lower doses. Some cases initially present as status epilepticus.

[Study of the diagnostic agreement on headaches between neurology and primary care]. / Estudio de concordancia diagnostica en cefalea entre neurologia y atencion primaria.

INTRODUCTION: Headache as a symptom is a very common disease and one of the main reasons for consultation in primary care. AIM: To analyze the characteristics of patients referred from primary care to general neurology whose chief complaint was headache and/or neuralgia and diagnostic agreement. PATIENTS AND METHODS: Cross-sectional study of all patients referred from primary care; demographic/clinical variables were collected and diagnostic hypothesis by primary care and general neurology were compared by determining their agreement. RESULTS: 2,514 were referred from primary care patients (588 of them on a preferential basis); in 378 cases the reason for consultation was headache and/or neuralgia (average 42.46 years; 77.8% female). In 139 patients it was established only a semiological diagnostic and other episodic migraine predominated (49.79%), chronic tension headache (18.41%) and trigeminal neuralgia (12.13%). Since general neurology, the most common diagnoses were, respectively, 33.86%, 24.05% and 18.67%. A compatible kappa coefficient of 0.543 (p < 0.05) with a moderate agreement when considering only those patients referred from primary care to a specific diagnosis was obtained. CONCLUSIONS: Headaches are a very common reason for consultation in primary care (15%). The diagnostic agreement is moderate in our health sector so it is necessary to design training programs to help outline the criteria for referral to specialists and improve care for our patients.

TITLE: Estudio de concordancia diagnostica en cefalea entre neurologia y atencion primaria.Introduccion. La cefalea como sintoma es una patologia frecuente y uno de los principales motivos de consulta por parte de atencion primaria. Objetivo. Analizar las caracteristicas de los pacientes derivados desde atencion primaria a la consulta de neurologia general con cefalea o neuralgia como motivo de consulta, y la concordancia diagnostica. Pacientes y metodos. Estudio descriptivo transversal de todos los pacientes remitidos desde atencion primaria; se recogieron variables demograficas/clinicas y se compararon las hipotesis diagnosticas de atencion primaria y neurologia, determinando su concordancia. Resultados. Se remitieron desde atencion primaria 2.514 pacientes (588 de ellos con caracter preferente); en 378 casos el motivo de la consulta fue cefalea o neuralgia (42,46 años de media; el 77,8%, mujeres). En 139 pacientes se establecio tan solo un diagnostico semiologico y en el resto predominaron la migraña episodica (49,79%), la cefalea tensional cronica (18,41%) y la neuralgia del trigemino (12,13%). Desde neurologia, los diagnosticos mas frecuentes fueron, respectivamente, 33,86%, 24,05% y 18,67%. Se obtuvo un coeficiente kappa de 0,543 (p < 0,05), compatible con una concordancia moderada al considerar solo los pacientes remitidos desde atencion primaria con un diagnostico concreto. Conclusiones. Las cefaleas constituyen un motivo de consulta desde atencion primaria muy frecuente (15%). La concordancia diagnostica es moderada en nuestro sector sanitario, por lo que es necesario diseñar programas de formacion que ayuden a perfilar los criterios de derivacion al especialista y mejorar la atencion a nuestros pacientes.

[Treatment adherence with levetiracetam: a non-interventionist retrospective observation-based study]. / Adhesion al tratamiento con levetiracetam: estudio observacional retrospectivo no intervencionista.

INTRODUCTION: Treatment adherence is a factor that is affecting the effectiveness of antiepileptic drugs. Levetiracetam is a drug whose effectiveness and safety is well established and is available in different oral formulations (granulates in sachets, tablets, oral solution), but information on treatment adherence/compliance with these oral formulations is limited. AIM: To determine treatment adherence with levetiracetam formulations (granulates in sachets, tablets) in adult and elderly people. PATIENTS AND METHODS: Retrospective observational non-interventionist study. During the three months before the study patients should be treated with levetiracetam (granulates in sachets or tablets), either alone or in combination. Compliance tests (Green-Morisky modified test) as well as a satisfaction questionnaire investigator and patient/caregiver is assessed. Data were analyzed using SPSS v. 21.0 program. RESULTS: A total of 466 patients completed the study. The average age was 52.75 ± 19.17 years old and the average over 65 years of 72.79 ± 6.15. 55.4% were men. Compliance is related to the variable 'pharmaceutical formulation' and with age (p = 0.031). The risk of non-compliance was 86.4% higher among those taking tablets versus granulates in sachets of levetiracetam (odds ratio: 1.864). Likewise, the non-compliance was greater among patients over 65 years. The non-compliance was related to attributing of memory failures. CONCLUSIONS: Patients older are more difficult to compliance. The granulates levetiracetam in sachets improves compliance.

TITLE: Adhesion al tratamiento con levetiracetam: estudio observacional retrospectivo no intervencionista.Introduccion. La adhesion al tratamiento es un factor que esta repercutiendo en la eficacia de los farmacos antiepilepticos. El levetiracetam es un principio activo cuya eficacia y seguridad estan ampliamente demostradas y que esta disponible en diferentes formulaciones orales (sobres, comprimidos y solucion oral), pero la informacion sobre la adhesion/cumplimiento del tratamiento con estas formulaciones orales es escasa. Objetivo. Conocer la adhesion al tratamiento con formulaciones de levetiracetam (granulado en sobre y comprimidos) en adultos y ancianos. Pacientes y metodos. Estudio observacional retrospectivo no intervencionista. Durante los tres meses previos al estudio debia estar en tratamiento con levetiracetam (granulado en sobre o comprimidos), bien en monoterapia o en combinacion. Se valoraron los tests de cumplimiento (cuestionario de Morisky-Green modificado), asi como un cuestionario de satisfaccion del investigador y del paciente/cuidador. Los datos se analizaron con el programa SPSS v. 21.0. Resultados. Un total de 466 pacientes completaron el estudio. La edad media fue de 52,75 ± 19,17 años, y la media en los mayores de 65 años fue de 72,79 ± 6,15 años. Un 55,4% eran hombres. El cumplimiento se relaciona con la variable 'formulacion galenica' y con la edad (p = 0,031). El riesgo de incumplimiento es un 86,4% mayor entre los que toman comprimidos frente a granulado de levetiracetam (odds ratio: 1,864). Asimismo, el incumplimiento es mayor entre los pacientes mayores de 65 años. El incumplimiento se relaciona con la atribucion de fallos de memoria. Conclusiones. Los pacientes mas mayores presentan mas dificultades en el cumplimiento. El granulado de levetiracetam en sobres favorece el cumplimiento.

The Spanish Neurological Society official clinical practice guidelines in epilepsy.

Previous Official Clinical Practice Guidelines (CPGs) in Epilepsy were based on expert opinions and developed by the Epilepsy Study Group of the Spanish Neurological Society (GE-SEN). The current CPG in epilepsy is based on the scientific method, which extracts recommendations from published scientific evidence. A reduction in the variability in clinical practice through standardization of medical practice has become its main function. SCOPE AND OBJECTIVES: This CPG is focused on comprehensive care for individuals affected by epilepsy as a primary and predominant symptom, regardless of the age of onset and medical policy. METHODOLOGY: 1. Creation of GE-SEN neurologists working group, in collaboration with Neuropediatricians, Neurophysiologists and Neuroradiologists. 2. Identification of clinical areas to be covered: diagnosis, prognosis and treatment. 3. Search and selection of the relevant scientific evidence. 4. Formulation of recommendations based on the classification of the available scientific evidence. RESULTS: It contains 161 recommendations of which 57% are consensus between authors and publishers, due to an important lack of awareness in many fields of this pathology. CONCLUSIONS: This Epilepsy CPG formulates recommendations based on explicit scientific evidence as a result of a formal and rigorous methodology, according to the current knowledge in the pre-selected areas. This paper includes the CPG chapter dedicated to emergency situations in seizures and epilepsy, which may present as a first seizure, an unfavorable outcome in a patient with known epilepsy, or status epilepticus as the most severe manifestation.

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.

Prognosis in epilepsy: initiating long-term drug therapy.

INTRODUCTION: Prognosis in epilepsy refers to the probability of either achieving seizure remission (SR), whether spontaneously or using antiepileptic drugs (AED), or failing to achieve control of epileptic seizures (ES) despite appropriate treatment. Use of AED is recommended after a second unprovoked ES. For a first episode, the decision of whether or not to start drug treatment depends on the risk of recurrence and the advantages or disadvantages of the antiepileptic drug. The main goal of treatment is achieving absence of ES without adverse effects (AE). AED is selected according to epilepsy type and the demographic and clinical characteristics of the patient. DEVELOPMENT: A PubMed search located articles and recommendations by the most relevant scientific societies and clinical practice guidelines concerning epilepsy prognosis and treatment. Evidence and recommendations are classified according to the prognostic criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions. CONCLUSIONS: Most newly diagnosed epileptic patients achieve good control over their ES. The majority of the AEDs available at present provide effective control over all types of ES, and choice therefore depends on the patient's individual characteristics. Treatment should be initiated as monotherapy at the lowest effective dose, which in half of all patients provides ES control and is well tolerated. In cases in which the first AED is not effective, alternative therapy should be started, and monotherapy should be employed before combination therapy where possible. The probability of achieving good control over ES decreases with each successive treatment failure.

[Does medication abuse in patients with chronic migraine influence the effectiveness of preventive treatment with topiramate?]. / ¿El abuso de farmacos en pacientes con migraña cronica influye en la efectividad del tratamiento preventivo con topiramato?

INTRODUCTION: Patients with chronic migraine (CM) and medication abuse are difficult to treat, and have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. AIM: To evaluate whether the presence of medication abuse lowers the effectiveness of topiramate. PATIENTS AND METHODS: A series of patients with CM were grouped according to whether they met abuse criteria or not. They were advised to stop taking the drug that they were abusing. Treatment was adjusted to match their crises and preventive treatment with topiramate was established from the beginning. The number of days with headache and intense migraine in the previous month and at four months of treatment was evaluated. RESULTS: In all, 262 patients with CM criteria were selected and 167 (63.7%) of them fulfilled abuse criteria. In both groups there was a significant reduction in the number of days with headache/month and number of migraine attacks/month at the fourth month of treatment with topiramate. The percentage of reduction in the number of days with headache/month in CM without abuse was 59.3 ± 36.1%, and with abuse, 48.7 ± 41.7% (p = 0.0574). The percentage of reduction in the number of days with intense migraine/month in CM without abuse was 61.2%, and with abuse, 50% (p = 0.0224). Response rate according to the number of days with headache/month in CM without abuse was 69%, and with abuse, 57%. Response rate according to the number of intense migraines/month in CM without abuse was 76.8%, and in CM with abuse, 61% (p = 0.0097). CONCLUSIONS: Topiramate was effective in patients with CM with and without medication abuse, although effectiveness is lower in the latter case.

TITLE: El abuso de farmacos en pacientes con migraña cronica influye en la efectividad del tratamiento preventivo con topiramato?Introduccion. Los pacientes con migraña cronica (MC) y abuso de medicacion son dificiles de tratar y tienen peor calidad de vida que otros pacientes con migrañas. Objetivo. Valorar si la presencia de abuso de farmacos disminuye la efectividad del topiramato. Pacientes y metodos. Una serie de pacientes con MC fueron agrupados segun presentasen criterios de abuso o no abuso de farmacos. Se les aconsejo la supresion del farmaco del cual abusaban. Se ajusto el tratamiento de sus crisis y se inicio tratamiento preventivo desde el principio con topiramato. Se valoro el numero dias con cefalea y migrañas intensas en el mes previo y al cuarto mes de tratamiento. Resultados. Fueron seleccionados 262 pacientes con criterios de MC, y de ellos 167 (63,7%) cumplieron criterios de abuso. En ambos grupos hubo una reduccion significativa del numero de dias con cefalea/mes y numero de crisis de migraña/mes al cuarto mes de tratamiento con topiramato. Porcentaje de reduccion de dias con cefalea/mes en MC sin abuso, 59,3 ± 36,1%; y con abuso, 48,7 ± 41,7% (p = 0,0574). Porcentaje de reduccion de migrañas intensas/mes en MC sin abuso, 61,2%; y con abuso, 50% (p = 0,0224). Tasa de respondedores segun numero de dias con cefalea/mes en MC sin abuso, 69%; y con abuso, 57%. Tasa de respondedores segun numero de migrañas intensas/mes en MC sin abuso, 76,8%; y en MC con abuso, 61% (p = 0,0097). Conclusiones. El topiramato fue efectivo en pacientes con MC sin y con abuso de farmacos, aunque con menor efectividad en estos ultimos.

Psicosis epiléptica periictal, una causa de psicosis reversible / Epileptic peri-ictal psychosis, a reversible cause of psychosis

Introducción: Las psicosis epilépticas se dividen respecto de su relación con las crisis en periictales e interictales. Las psicosis periictales tienen una estrecha relación temporal con las crisis epilépticas y ocurren antes (preictales), durante (ictales) o después de las mismas (postictales). Generalmente, tienen un inicio y final agudo, corta duración y una remisión completa, con riesgo de recurrencia. Las psicosis interictales o crónicas no guardan relación temporal con las crisis epilépticas. Existe otro tipo de psicosis epilépticas que se relaciona con la respuesta al tratamiento de la epilepsia: psicosis epiléptica por fenómeno de normalización forzada (psicosis alternativa) y dentro de esta se encuentra la psicosis epiléptica secundaria a cirugía de la epilepsia. Aunque se ha generalizado la combinación de antiepilépticos y neurolépticos para su manejo, no existen unas pautas estandarizadas de tratamiento en las psicosis epilépticas. Casos clínicos: Presentamos 5 casos de psicosis epilépticas periictales y remarcamos la excelente respuesta al tratamiento con levetiracetam. Consiguiendo un buen control tanto de las crisis como de los episodios psicóticos. Este fármaco resultó inocuo al asociarlo con neurolépticos en nuestros pacientes y no se precisaron dosis elevadas de estos últimos. Conclusiones: La diferenciación de los estados psicóticos asociados con la epilepsia según la relación temporal con las crisis epilépticas tiene utilidad clínica y pronóstica, dado que aporta aspectos importantes respecto al tratamiento y a la evolución de la enfermedad. El tratamiento de los trastornos mentales periictales o agudos se basa en el control de las crisis epilépticas, mientras que el tratamiento de los interictales o crónicos guarda más similitud con el de los trastornos de origen puramente psiquiátrico. El control estricto de las crisis puede, además de mejorar la calidad de vida del paciente y su discapacidad, prevenir el desarrollo de una psicosis interictal, por lo que consideramos que sería necesario establecer un protocolo de tratamiento para estos casos (AU)

Introduction: Epileptic psychoses are categorised as peri-ictal and interictal according to their relationship with the occurrence of seizures. There is a close temporal relationship between peri-ictal psychosis and seizures, and psychosis may present before (preictal), during (ictal) or after seizures (postictal). Epileptic psychoses usually have acute initial and final phases, with a short symptom duration and complete remission with a risk of recurrence. There is no temporal relationship between interictal or chronic psychosis and epileptic seizures. Another type of epileptic psychosis is related to the response to epilepsy treatment: epileptic psychosis caused by the phenomenon of forced normalisation (alternative psychosis), which includes epileptic psychosis secondary to epilepsy surgery. Although combination treatment with antiepileptic and neuroleptic drugs is now widely used to manage this condition, there are no standard treatment guidelines for epileptic psychosis. Clinical cases: We present 5 cases of peri-ictal epileptic psychosis in which we observed an excellent response to treatment with levetiracetam. Good control was achieved over both seizures and psychotic episodes. Levetiracetam was used in association with neuroleptic drugs with no adverse effects, and our patients did not require high doses of the latter. Conclusions: Categorising psychotic states associated with epilepsy according to their temporal relationship with seizures is clinically and prognostically useful because it provides important information regarding disease treatment and progression. The treatment of peri-ictal or acute mental disorders is based on epileptic seizure control, while the treatment of interictal or chronic disorders has more in common with managing disorders which are purely psychiatric in origin. In addition to improving the patient’s quality of life and reducing disability, achieving strict control over seizures may also prevent the development of interictal psychosis. For this reason, we believe that establishing a treatment protocol for such cases is necessary (AU)

Validation of a short useful questionnaire in Spanish for the epidemiological screening of epilepsy in Spain. EPIBERIA Questionnaire.

INTRODUCTION: There is a major gap in knowledge about the epidemiology of epilepsy in Mediterranean countries. The EPIBERIA group was formed with the aim of promoting the conducting of epidemiological studies in this region in order to improve this situation. This paper deals with the validation of a brief questionnaire for screening patients with epilepsy in the general population. METHODS: We selected an English-language questionnaire previously validated by the Ottman group. It was translated, modified to suit the characteristics of the Spanish population, and administered to a sample of 200 patients (93 epileptics and 107 non-epileptic patient controls) sampled consecutively from 5 epilepsy units in different cities in Spain. Both groups were homogeneous in demographic variables and the control group was representative of the general population. RESULTS: We obtained a sensitivity of 100% and a specificity of 74.77% for the least rigorous correction model for the questionnaire, with a sensitivity of 94.62% and a specificity of 99.07% for the most stringent correction model. The PPV ranged from 7.48% for the first case to 69.49% in the second, assuming an epilepsy prevalence of 2%. CONCLUSIONS: The questionnaire EPIBERIA is a valid Spanish tool for epilepsy screening in the general population in Spain.

Epileptic peri-ictal psychosis, a reversible cause of psychosis.

INTRODUCTION: Epileptic psychoses are categorised as peri-ictal and interictal according to their relationship with the occurrence of seizures. There is a close temporal relationship between peri-ictal psychosis and seizures, and psychosis may present before (preictal), during (ictal) or after seizures (postictal). Epileptic psychoses usually have acute initial and final phases, with a short symptom duration and complete remission with a risk of recurrence. There is no temporal relationship between interictal or chronic psychosis and epileptic seizures. Another type of epileptic psychosis is related to the response to epilepsy treatment: epileptic psychosis caused by the phenomenon of forced normalisation (alternative psychosis), which includes epileptic psychosis secondary to epilepsy surgery. Although combination treatment with antiepileptic and neuroleptic drugs is now widely used to manage this condition, there are no standard treatment guidelines for epileptic psychosis. CLINICAL CASES: We present 5 cases of peri-ictal epileptic psychosis in which we observed an excellent response to treatment with levetiracetam. Good control was achieved over both seizures and psychotic episodes. Levetiracetam was used in association with neuroleptic drugs with no adverse effects, and our patients did not require high doses of the latter. CONCLUSIONS: Categorising psychotic states associated with epilepsy according to their temporal relationship with seizures is clinically and prognostically useful because it provides important information regarding disease treatment and progression. The treatment of peri-ictal or acute mental disorders is based on epileptic seizure control, while the treatment of interictal or chronic disorders has more in common with managing disorders which are purely psychiatric in origin. In addition to improving the patient's quality of life and reducing disability, achieving strict control over seizures may also prevent the development of interictal psychosis. For this reason, we believe that establishing a treatment protocol for such cases is necessary.

Epilepsia resistente a fármacos antiepilépticos: recomendaciones de actuación diagnóstica y terapéutica en España / Drug-resistant epilepsy: current recommendations for diagnosis and treatment in Spain

Introducción: La epilepsia resistente a fármacos antiepilépticos (ERF) constituye un problemasocio-sanitario de primer nivel, que debe ser individualizado precozmente por sus dramáticas repercusiones individuales y colectivas.Desarrollo: Recientemente, la Liga Internacional Contra la Epilepsia ha definido la ERF como aquella en la que no se controlen las crisis tras haber tomado de forma adecuada dos fármacos antiepilépticos apropiados y bien tolerados, entendiendo como falta de control la aparición de crisis en un año o en un tiempo inferior a tres veces el intervalo entre crisis que mostraba antesde iniciar el tratamiento. Esta sociedad internacional recomienda en todo paciente con ERF una evaluación rápida y detallada en una unidad de epilepsia. Se entiende como Unidad Clínica de Epilepsia (UCE) el conjunto de profesionales que actuando en colaboración tienen como objetivo primario el diagnóstico y tratamiento del paciente con epilepsia. Las UCE en España pueden ser estratificadas en distintos niveles, dependiendo de la actividad que se desarrolle en cada una de ellas. La consulta específica de epilepsia se considera como el germen de toda UCE, siendo necesaria la figura del experto en epilepsia. En las UCE médicas se realiza la monitorización vídeo-EEG prolongada. En las UCE médico-quirúrgicas además se realiza cirugía de epilepsia de dificultad diversa. Conclusiones: Todas las UCE deben cooperar con protocolos consensuados, debiendo existir un flujo bidireccional entre ellas. La estratificación de las UCE permite una alta eficacia y eficiencia, debiendo existir el suficiente número que garantice el fácil acceso de todos los pacientes con epilepsia (AU)

Introduction: Drug-resistant epilepsy (DRE) is a top-priority social health problem which requires early individual treatment due to its dramatic repercussions for the patient and society. Development: The International League Against Epilepsy (ILAE) has recently defined DRE as that in which the seizures are not controlled after having correctly taken two appropriate and well tolerated anti-epileptic drugs, with lack of control being understood as the appearance of seizures within one year or in a period less than three times the inter-seizure interval before starting treatment. This International Society recommends a rapid and detailed assessment of all patients in an Epilepsy Unit. A Clinical Epilepsy Unit (CEU) is understood as a group of professionals who, acting in collaboration, have the diagnosis and treatment of the patient with epilepsy as their primary objective. CEUs in Spain may be stratified into different levels depending on the activity carried out in each of them. The specific epilepsy clinic is considered the fundamental type of CEU and includes the necessary figure of an expert in epilepsy. Prolonged video-monitoring is performed in medical CEUs. In medical-surgical CEUs epilepsy surgery with varying degrees of difficulty is also performed. Conclusions: All CEUs must cooperate with consensus protocols, and there must be a two-way flow between them. Stratification of CEUs increases efficacy and efficiency, due to there being a sufficient number of them to ensure easy access by all patients with epilepsy (AU)