Recommendations for the prevention of healthcare-associated infections in nursing homes.

Nursing homes (NH) conceptually should look as much like a home as possible. However NH have unquestionable similarities with a nosocomium as they are places where many patients with underlying diseases and comorbidities accumulate. There is evidence of transmission of microorganisms between residents and between residents and caregivers. We have not found any recommendations specifically aimed at the prevention of nosocomial infections in NH by the major Public Health Agencies and, therefore, the Health Sciences Foundation (Fundación de Ciencias de la Salud) has convened a series of experts and 14 Spanish scientific societies to discuss recommendations that could guide NH personnel in establishing written programs for the control and reduction of these infections. The present document is the result of these deliberations and contains suggestions for establishing such control programs on a voluntary and flexible basis in NH. We also hope that the document can help the health authorities to encourage this control activity in the different territorial areas of Spain. In our opinion, it is necessary to draw up a written plan and establish the figure of a coordinator or person responsible for implementing these projects. The document includes measures to be implemented and ways of quantifying the reality of different problems and of monitoring the impact of the measures established.

Estudio sobre el empleo de sistemas personalizados de reacondicionamiento para mejorar los valores de tensión arterial en pacientes hipertensos / Study on the use of multi-compartment compliance aids to improve blood pressure values in hypertensive patients

Objetivos: analizar la mejora de la adherencia en pacientes no adherentes con HTA no controlada, polimedicados y mayores de 55 años tras el empleo de sistemas personalizados de reacondicionamiento (SPD). Diseño: estudio longitudinal (6 meses). Se analizaron los niveles de adherencia al tratamiento mediante una adaptación del test de Morisky-Green, contaje de medicación devuelta (en el grupo SPD) y valores de presión arterial. Emplazamiento: estudio multicéntrico en 35 farmacias comunitarias de toda España. Participantes: 195 participantes (88 grupo SPD y 107 grupo control) mayores de 55 años, polimedicados, no adherentes a la medicación, con HTA no controlada y que empleaban receta médica electrónica. Intervenciones: el grupo SPD recibió su medicación en SPD mientras el grupo control recibía su medicación de manera rutinaria. Mediciones principales: a ambos grupos se les realizaron tomas periódicas de sus valores de PAS/PAD mediante tensiómetro digital.Resultados: el grupo SPD obtuvo un descenso significativo de los valores de PA frente al grupo control (la PAS disminuyó en 18,3 mmHg en el grupo SPD vs. 9,9 mmHg en el grupo control y la PAD en 9,9 mmHg vs. 8,9 mmHg). Ambos grupos aumentaron su adherencia hasta superar el 90 %.Conclusiones: el empleo de SPD permitió controlar los niveles de PA a casi un 50 % de los pacientes por lo que se postula como una buena herramienta (costo-efectiva, bien tolerada por los usuarios, de fácil uso…) para mejorar la adherencia de los pacientes y controlar la HTA de estos, aunque son necesarios más estudios. (AU)

Barrow holographic dark energy with Granda-Oliveros cutoff.

A study on the effects of implementing the Granda-Oliveros infrared cutoff in the recently introduced Barrow holographic dark energy model is presented, and its cosmological evolution is investigated. We find how the deformation parameter, Δ , affects the evolution of H(z) and that from this model it is possible to obtain an accelerated expansion regime of the universe at late times. We also observe that increasing Δ causes a transition of the EoS parameter from quintessence to phantom regimes. In addition, we show that the model can be used to describe the know eras of dominance. Finally, after studying the stability of the proposed model, a fit of the corresponding parameters is preformed, utilizing the measurements of the expansion rate of the universe, H(z). The best fit of the parameters is found to be ( α , ß , Δ ) = 1 . 00 - 0.02 + 0.02 , 0 . 69 - 0.02 + 0.03 , 0 . 000 - 0.000 + 0.004 at 1 σ C.L., for which the Bekenstein-Hawking relation is favored.

Dexmedetomidine metabolic clearance is not affected by fat mass in obese patients.

BACKGROUND: Obesity has been associated with reduced dexmedetomidine clearance, suggesting impaired hepatic function or reduced hepatic blood flow. The aim of this study was to clarify the effect of obesity in dexmedetomidine metabolic clearance. METHODS: Forty patients, ASA I-III, 18-60 yr old, weighing 47-126 kg, scheduled for abdominal laparoscopic surgery, were enrolled. Anaesthetic agents (propofol, remifentanil, and dexmedetomidine) were dosed based on lean body weight measured by dual X-ray absorptiometry. Serial venous samples were drawn during and after dexmedetomidine infusion. A pharmacokinetic analysis was undertaken using non-linear mixed-effect models. In the modelling approach, the total body weight, lean body weight, and adjusted body weight were first tested as size descriptors for volumes and clearances. Hepatic blood flow, liver histopathology, liver enzymes, and gene expression of metabolic enzymes (UGT2B10 and UGT1A4) were tested as covariates of dexmedetomidine metabolic clearance. A decrease in NONMEM objective function value (ΔOFV) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. RESULTS: A total of 637 dexmedetomidine serum samples were obtained. A two-compartmental model scaled to measured lean weight adequately described the dexmedetomidine pharmacokinetics. Liver blood flow was a covariate for dexmedetomidine clearance (ΔOFV=-5.878). Other factors, including fat mass, histopathological damage, and differential expression of enzymes, did not affect the dexmedetomidine clearance in the population studied (ΔOFV<3.84). CONCLUSIONS: We did not find a negative influence of obesity in dexmedetomidine clearance when doses were adjusted to lean body weight. Liver blood flow showed a significant effect on dexmedetomidine clearance. CLINICAL TRIAL REGISTRATION: NCT02557867.

LPS-induced cortical kynurenic acid and neurogranin-NFAT signaling is associated with deficits in stimulus processing during Pavlovian conditioning.

The N-Methyl-d-Aspartate receptor (NMDAR) antagonist kynurenic acid (KYNA) and the post-synaptic calmodulin binding protein neurogranin (Nrgn) have been implicated in neurological and neuropsychiatric conditions including Alzheimer's disease and schizophrenia. This study indicates that systemic dual-lipopolysaccharide (LPS) injections increases KYNA in the medial prefrontal cortex (mPFC), which is accompanied with increased phosphorylation of nuclear factor kappa chain of activated B cells (NFκB) and activation of the nuclear factor of activated T- cells (NFAT). Our results also indicate that dual-LPS increases Nrgn phosphorylation and concomitantly reduces phosphorylation of calmodulin kinase-II (CaMKII). We confirmed that systemic blockade of kynurenine-3 monooxygenase in conjunction with kynurenine administration results in significant increases in Nrgn phosphorylation and a significant reduction of CaMKII phosphorylation in the mPFC. Consequently, dual-LPS administration induced significant impairments in stimulus processing during Pavlovian conditioning. Taken together, our study indicates that elevations in KYNA in the mPFC can directly regulate NMDA-Nrgn-CaMKII signaling, suggesting that neuroinflammatory conditions affecting this pathway may be associated with cognitive dysfunction.

Adenosine A2A receptor and ERK-driven impulsivity potentiates hippocampal neuroblast proliferation.

Dampened adenosine A2A receptor (A2AR) function has been implicated in addiction through enhancement of goal-directed behaviors. However, the contribution of the A2AR to the control of impulsive reward seeking remains unknown. Using mice that were exposed to differential reward of low rate (DRL) schedules during Pavlovian-conditioning, second-order schedule discrimination, and the 5-choice serial reaction time task (5-CSRTT), we demonstrate that deficits of A2AR function promote impulsive responses. Antagonism of the A2AR lowered ERK1 and ERK2 phosphorylation in the dorsal hippocampus (dHip) and potentiated impulsivity during Pavlovian-conditioning and the 5-CSRTT. Remarkably, inhibition of ERK1 and ERK2 phosphorylation by U0126 in the dHip prior to Pavlovian-conditioning exacerbated impulsive reward seeking. Moreover, we found decreased A2AR expression, and reduced ERK1 and ERK2 phosphorylation in the dHip of equilibrative nucleoside transporter type 1 (ENT1-/-) null mice, which displayed exacerbated impulsivity. To determine whether impulsive response behavior is associated with hippocampal neuroblast development, we investigated expression of BrdU+ and doublecortin (DCX+) following 5-CSRTT testing. These studies revealed that impulsive behavior driven by inhibition of the A2AR is accompanied by increased neuroblast proliferation in the hippocampus.

Repeated LPS Injection Induces Distinct Changes in the Kynurenine Pathway in Mice.

The immune system has been recognized as a potential contributor to psychiatric disorders. In animals, lipopolysaccharide (LPS) is used to induce inflammation and behaviors analogous to some of the symptoms in these disorders. Recent data indicate that the kynurenine pathway contributes to LPS-induced aberrant behaviors. However, data are inconclusive regarding optimal LPS dose and treatment strategy. Here, we therefore aimed to evaluate the effects of single versus repeated administration of LPS on the kynurenine pathway. Adult C57BL6 mice were given 0.83 mg/kg LPS as a single or a repeated injection (LPS + LPS) and sacrificed after 24, 48, 72, or 120 h. Mice receiving LPS + LPS had significantly elevated brain kynurenine levels at 24 and 48 h, and elevated serum kynurenine at 24, 48 and 72 h. Brain kynurenic acid and quinolinic acid were significantly increased at 24 and 48 h in mice receiving LPS + LPS, whereas serum kynurenic acid levels were significantly decreased at 24 h. The increase of brain kynurenic acid by LPS + LPS was likely unrelated to the higher total dose as a separate group of mice receiving 1.66 mg/kg LPS as single injection 24 h prior to sacrifice did not show increased brain kynurenic acid. Serum quinolinic acid levels were not affected by LPS + LPS compared to vehicle. Animals given repeated injections of LPS showed a more robust induction of the kynurenine pathway in contrast to animals receiving a single injection. These results may be valuable in light of data showing the importance of the kynurenine pathway in psychiatric disorders.

Purinergic signaling and energy homeostasis in psychiatric disorders.

Purinergic signaling regulates numerous vital biological processes in the central nervous system (CNS). The two principle purines, ATP and adenosine act as excitatory and inhibitory neurotransmitters, respectively. Compared to other classical neurotransmitters, the role of purinergic signaling in psychiatric disorders is not well understood or appreciated. Because ATP exerts its main effect on energy homeostasis, neuronal function of ATP has been underestimated. Similarly, adenosine is primarily appreciated as a precursor of nucleotide synthesis during active cell growth and division. However, recent findings suggest that purinergic signaling may explain how neuronal activity is associated neuronal energy charge and energy homeostasis, especially in mental disorders. In this review, we provide an overview of the synaptic function of mitochondria and purines in neuromodulation, synaptic plasticity, and neuron-glia interactions. We summarize how mitochondrial and purinergic dysfunction contribute to mental illnesses such as schizophrenia, bipolar disorder, autism spectrum disorder (ASD), depression, and addiction. Finally, we discuss future implications regarding the pharmacological targeting of mitochondrial and purinergic function for the treatment of psychiatric disorders.

Genome-wide association study of bipolar disorder accounting for effect of body mass index identifies a new risk allele in TCF7L2.

Bipolar disorder (BD) is associated with higher body mass index (BMI) and increased metabolic comorbidity. Considering the associated phenotypic traits in genetic studies of complex diseases, either by adjusting for covariates or by investigating interactions between genetic variants and covariates, may help to uncover the missing heritability. However, obesity-related traits have not been incorporated in prior genome-wide analyses of BD as covariates or potential interacting factors. To investigate the genetic factors underlying BD while considering BMI, we conducted genome-wide analyses using data from the Genetic Association Information Network BD study. We analyzed 729,454 genotyped single-nucleotide polymorphism (SNP) markers on 388 European-American BD cases and 1020 healthy controls with available data for maximum BMI. We performed genome-wide association analyses of the genetic effects while accounting for the effect of maximum BMI, and also evaluated SNP-BMI interactions. A joint test of main and interaction effects demonstrated significant evidence of association at the genome-wide level with rs12772424 in an intron of TCF7L2 (P=2.85E-8). This SNP exhibited interaction effects, indicating that the bipolar susceptibility risk of this SNP is dependent on BMI. TCF7L2 codes for the transcription factor TCF/LF, part of the Wnt canonical pathway, and is one of the strongest genetic risk variants for type 2 diabetes (T2D). This is consistent with BD pathophysiology, as the Wnt pathway has crucial implications in neurodevelopment, neurogenesis and neuroplasticity, and is involved in the mechanisms of action of BD and depression treatments. We hypothesize that genetic risk for BD is BMI dependent, possibly related to common genetic risk with T2D.

Protein immobilization on 3C-SiC (100) as a substrate for detecting the onset of acute myocardial infarction (AMI).

Silicon Carbide (SiC), has been shown to be a bio- and hema-compatible substrate that could potentially be used in biosensor applications. The development of a viable biorecognition interface using SiC as the substrate material for bio-detection is described. Surface modification with 3-aminopropyltriethoxysilane (APTES) and immobilization via covalent conjugation of antimyoglobin (anti-Myo) on the modified surfaces is achieved, which are initial steps for immunosensing based devices. Successful formation of APTES layers and antibody immobilization were identified with surface water contact angle (SWCA), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM).

Atomic force microscopy analysis of central nervous system cell morphology on silicon carbide and diamond substrates.

Brain machine interface (BMI) devices offer a platform that can be used to assist people with extreme disabilities, such as amyotrophic lateral sclerosis (ALS) and Parkinson's disease. Silicon (Si) has been the material of choice used for the manufacture of BMI devices due to its mechanical strength, its electrical properties and multiple fabrication techniques; however, chronically implanted BMI devices have usually failed within months of implantation due to biocompatibility issues and the fact that Si does not withstand the harsh environment of the body. Single crystal cubic silicon carbide (3C-SiC) and nanocrystalline diamond (NCD) are semiconductor materials that have previously shown good biocompatibility with skin and bone cells. Like Si, these materials have excellent physical characteristics, good electrical properties, but unlike Si, they are chemically inert. We have performed a study to evaluate the general biocompatibility levels of all of these materials through the use of in vitro techniques. H4 human neuroglioma and PC12 rat pheochromocytoma cell lines were used for the study, and polystyrene (PSt) and amorphous glass were used as controls or for morphological comparison. MTT [3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide] assays were performed to determine general cell viability with each substrate and atomic force microscopy (AFM) was used to quantify the general cell morphology on the substrate surface along with the substrate permissiveness to lamellipodia extension. 3C-SiC was the only substrate tested to have good viability and superior lamellipodia permissiveness with both cell lines, while NCD showed a good level of viability with the neural H4 line but a poor viability with the PC12 line and lower permissiveness than 3C-SiC. Explanations pertaining to the performance of each substrate with both cell lines are presented and discussed along with future work that must be performed to further evaluate specific cell reactions on these substrates.

[Peripheral neuropathy in systemic lupus erythematosus]. / Neuropatía periférica en el lupus eritematoso sistémico.

INTRODUCTION: Systemic lupus erythematosus (SLE) is the connective tissue disorder in which neuropsychiatric complications are most often seen. The prevalence of peripheral neuropathy varies from 5 to 27% depending on the series of cases described, with subclinical forms being most frequent. OBJECTIVES: To determine the prevalence of subclinical peripheral neuropathy in a group of patients with SLE, define their characteristics, and investigate any possible associations with clinico analytical parameters of the disease. PATIENTS AND METHODS. 32 patients with SLE were diagnosed in an Internal Medicine Outpatient Clinic and followed up for at least a year. They were studied prospectively and consecutively by clinical examination, laboratory test and neurophysiological studies (electroneurogram). RESULTS: Neurophysiological study showed peripheral neuropathy to be present in 50% of the patients, who were mainly asymptomatic (75%) and found to be normal on neurological examination (81.2%). The most frequent type of neuropathy was polyneuropathy (37.5%) which was predominantly axonal symmetrical and sensomotor followed by isolated mono neuropathy (6.2%) and multiple mononeuritis (6.2%). No clinical or analytical parameter was significantly associated with the development of peripheral neuropathy. CONCLUSIONS: The considerable frequency of subclinical peripheral neuropathy in patients with SLE and the absence of associated clinical or analytical parameters makes it necessary to carry out neurophysiological studies in these patients to detect its presence and establish the precise extent of the disorder.

Neuropatía periférica en el lupus eritematoso sistémico / Peripheral neuropathy in systemic lupus erythematosus

El lupus eritematoso sistémico (LES) es la enfermedad del tejido conectivo que con mayor frecuencia presenta complicaciones neuropsiquiátricas. La prevalencia de neuropatía periférica varía de un 5 a un 27 por ciento según las series, siendo más frecuentes las formas subclínicas. Objetivos. Determinar la prevalencia de neuropatía periférica subclínica en un grupo de pacientes con LES, definir sus características e investigar las posibles asociaciones existentes con parámetros clinicoanalíticos de la enfermedad. Pacientes y métodos. Se han diagnosticado 32 pacientes con LES en una consulta externa del Servicio de Medicina Interna, con seguimiento en la misma durante al menos un año; fueron estudiados de forma prospectiva y consecutiva mediante examen clínico, test de laboratorio y estudio neurofisiológico (electroneurograma). Resultados. El estudio neurofisiológico demostró neuropatía periférica en un 50 por ciento de los pacientes, en su mayoría asintomáticos (75 por ciento) y con exploración neurológica normal (81,2 por ciento). El tipo de neuropatía más frecuente fue la polineuropatía (37,5 por ciento) de predominio sensitivomotor simétrica axonal, seguida de la mononeuropatía aislada (6,2 por ciento) y la mononeuritis múltiple (6,2 por ciento). Ningún parámetro clínico o analítico se asoció significativamente con el desarrollo de neuropatía periférica. Conclusiones. La elevada frecuencia de neuropatía periférica subclínica en los pacientes con LES y la ausencia de parámetros clínicos o analíticos asociados a la misma hace necesaria la práctica de un estudio neurofisiológico en estos pacientes para detectar su presencia, y establecer con exactitud la extensión de la enfermedad (AU)

Neuralgia esencial del trigémino y otros nervios craneales / No disponible

Revisión de la clínica, diagnóstico y tratamiento de la neuralgia del trigémino, con especial atención a las nuevas opciones terapéuticas. De aparición menos frecuente, pero no de menor trascendencia clínica, son las neuralgias del glosofaríngeo, nervio intermediario, occipital y laríngeo superior (AU)

Review of clinical signs, diagnosis and treatment of trigeminal neuralgia, with special attention to new therapeutic options. Less frequent, but without less clinical relevance, are the neuralgias of glossopharyngeal, intermediate nerve, occipital and upper laryngeal nerves (AU)

Tetracycline and novobiocin in the treatment of amoebic dysentery in children

A study is made on the use of tetracycline-novobiocin combination (Albamycin-T) on 52 children suffering from acute amoebic dysentery. All patients received the medication at a dose of 30 mgs. per kilogram body weight per day of each of the tetracycline and novobiocin components of the drug. The dose was divided and given three times a day for ten daysEvaluation of the results of the study was based on the criteria for success of treatment suggested by the Council on Pharmacy and Chemistry; 1. improvement of the patient subjectively. 2. elimination of cysts and/or trophozoites from the stools. 3. healing of ulcers in the colonAll of the 52 patients had dramatic clinical improvement between the first and fifth day of treatment, about 90% of whom showed such therapeutic response during the first three days. All the 21 patients who were treated for ten days became asymptomatic during the course of therapy as did 22 (95.7%) of the 23 patients who were treated for a period of from 5 to 8 days; and 4 (50%) of the eight patients who received the medication for a period of only 2 to 4 daysOnly the 21 patients who were treated for 10 days had adequate number of repeat stool examinations necessary for analysis. All patients became negative for E. histolytica during the period of therapy. In two patients who had sigmoidoscopic examinations before and after treatment, the amoebic ulcers completely disappeared during the repeat examinationTwo patients (3.8%) had side effects of the drug in the form of generalized urticarial rashes. No cases of jaundice or moniliasis were clinically apparent among the 52 patientsThe combination of tetracycline-novobiocin (Albamycin-T), indeed, is an effective armamentarium in the treatment of acute amoebic dysentery in children. The recommended dose is 30 mgs. of tetracycline and novobiocin each per kilogram body weight per day for a period of five to ten days. (Summary and Conclusion)

[Electro-clinical and neuroimaging studies in epilepsy in elderly patients]. / Estudio electroclínico y de neuroimagen en epilepsia en el anciano.

INTRODUCTION: Due to the aging population in developed countries, epidemiological studies show an increasing tendency to the prevalence of epilepsy in the elderly. PATIENTS AND METHODS: During 54 months, we have studied the electroclinical and neuroimaging features in outpatients older than 60, with active epilepsy. Every patient was interviewed by one of the authors. Then, we have reviewed the medical records about the clinical features, EEG and neuroimaging (NI) studies and seizures frequency (SF) outcome. Differences in crude proportions were assessed by chi 2 test for independence by 2 x 2 tables. RESULTS: The study was been performed in 78 patients with 70.3 +/- 7.3 years of mean age at review. Partial seizures were significantly related with an higher SF at onset and, in the series of complex partial seizures was more frequent a temporal EEG topography. There was predominance of men, NI abnormal, symptomatic etiology and SF at onset > or = 1 by day in that patients who started their epilepsy after 60 years. A 51.3% was seizures-free in the last year and in 80% the SF was improved a 50% or more from the beginning. CONCLUSION: A significantly greater percentage of patients remained with seizures in four cases: in those with a SF at onset greater than 1 every day, in those suffering complex partial seizures, in women and in patients with temporal EEG topography.

[Cerebral ischemia and epilepsy]. / Enfermedad cerebral isquémica y epilepsia.

INTRODUCTION: We review the characteristics and evolution of epileptic crises (EC) related to non-hemorrhagic ictus. Patients and methods. Since June 1994 we have studied patients with EC both at the time of the ictus (acute symptomatic crises, ASC) and later (remote symptomatic crises RSC). One hundred and fifteen fulfilled the criteria and were followed-up until recurrence of EC, death or the end of the study (30.06.98). There were 66 men and 49 women (average age at the time of ictus = 67.4 +/- 12 years). RESULTS: Ninety one patients had RSC; reversible ischemic neurological deficit (DNIR) (50%), atherothrombotic pathology (58.5%) and anterior territory (70%) predominated. There was a similar proportion of partial and generalized crises (51.5% compared with 48.5%). Fifteen patients had presented with ASC. Thirty-nine patients presented with ASC, with predominance of established ictus (48.5%), atherothrombotic pathology (56.5%), anterior territory (82%) and generalized crises (59%). There was recurrence in 50.5% of those with RSC (follow-up 18.5 +/- 24 months). STATISTICAL ANALYSIS: there was a predominance of ASC in patients with established ictus and RSC in the case of DNIR. In cases of abnormal EEG there was a greater proportion of patients with a history of ASC. In patients over 60 years old, CSR was commoner. In those with atherothrombosis there was a predominance of one crisis and in patients with embolisms two or more crises. There were more recurrences in patients with no previous history of ASC (p = 0.001), those with all the anterior territory affected (p = 0.002), those < 59 years old (p = 0.01), those previously untreated (p = 0.04) and those with abnormal EEG (p = 0.03). There was an increased RR in the abnormal EEG, involvement of the entire anterior territory and age < 59 years. Multivariate analysis showed that the probability of recurrence increased 1.23 times when there was a previous history of ASC; 14.73 times if the EEG was abnormal, and 18.12 times when both these factors were present.

[Early presentation of crises and the development of epilepsy in cerebral intra-parenchymatous hemorrhage]. / Presentación precoz de crisis y evolución de la epilepsia en la hemorragia intraparenquimatosa cerebral.

PATIENTS AND METHODS: Of a total of 283 patients with spontaneous or hypertensive cerebral intraparenchymatous hemorrhage, 18 (6.3%), with no previous epilepsy, had crises whilst being followed-up for a period of between 2 and 7 years. In 14 cases the hematoma was lobar and 4 involved the basal ganglia or thalamus. In 8 cases (2.8% of all hemorrhage), these crises occurred during the first 24 hours, or as a first symptom of intraparenchymatous hemorrhage. One patient presented with status epilepticus with generalized crises and two had subentrant secondarily generalized partial crises at the time of the ictus. Treatment with anti-epileptic drugs was started in 13 patients. Twelve patients (4.2% of the hemorrhages) developed symptomatic epilepsy with partial crises with or without secondary generalization. RESULTS AND CONCLUSIONS: The maximum rate of recurrence was four crises per year. However, in one patient, reduction of the dose of medication led to the appearance of status epilepticus. Patients with crises of late onset developed epilepsy more often than those who had early crises. In those with crises there was a predominance of bilobular involvement with participation of the parietal lobe and extension of the hematoma or oedema to the cerebral cortex.

[Overall treatment of vascular epilepsy]. / Tratamiento global de la epilepsia vascular.

Cerebrovascular disease has different acute, ischemic and hemorrhagic presentations and may be associated with epileptic crises during the acute phase, or a later epileptic syndrome may develop. Status epilepticus is an infrequent complication which may appear at any time during the course of the illness, sometimes as the first and only sign of epilepsy. The risk of acute crises or of an epileptic syndrome varies depending on the nature of the vascular accident: its occurrence is more likely in hemorrhagic lesions and in those involving the cerebral cortex. The acute crises may be treated with benzodiazepines or with fast acting antiepileptic drugs; parenteral administration may sometimes be necessary. The need for prolonged prophylactic antiepileptic treatment is still under discussion, since there is no evidence that this prevents later development of an epileptic syndrome. The management of status epilepticus is the same whatever the etiology, although one has to take account of the risk of side-effects related to the age and general health of the patient. When deciding on treatment for vascular epilepsy consideration should be given not only to which drugs are to be used, but also their pharmacokinetic characteristics and interactions with any treatment required by the patient for coexisting conditions such as arterial hypertension, heart failure, anticoagulation, diabetes, etc.