[Reflex triggers in juvenile myoclonic epilepsy]. / Los desencadenantes reflejos en la epilepsia mioclónica juvenil.

INTRODUCTION: Juvenile myoclonic epilepsy (JME) is an epileptic syndrome with onset in childhood and adolescence with myoclonus, absences, and generalized tonic-clonic seizures. Reflex stimuli such as sensitivity to light or photosensitivity, eyelid opening and closing, and praxis induction produce epileptiform discharges and seizures. These reflex triggers are not all systematically studied. OBJECTIVE: Examine reflex features in patients with JME. METHODS: One hundred adolescents and adults with JME who received different anti-seizure treatments were evaluated consecutively. A standard electroencephalogram was performed with an intermittent light stimulation (SLI) protocol and another for the evaluation of praxias through neurocognitive activity (CNA). The statistical analysis was descriptive and of correlation with a p > 0.05. RESULTS: Current age was 28±11 (14-67). The seizure began at 15 years ±3 (Range 8-25 years). They presented myoclonus and generalized tonic-clonic seizures in 58%. 50% received valproic acid and 31% continued with seizures. Epileptiform discharges at rest 20%; hyperventilation 30%; eyelid opening and closing 12%; photoparoxysmal response in SLI 40%; CNA 23%. Higher percentage of discharges and delay in performing CNA in those who presented seizures. Valproic acid compared to other drugs did not demonstrate superiority in seizure control. CONCLUSIONS: These findings confirm the importance of studying reflex traits for diagnosis, follow-up, and therapeutic control.

Introducción: La epilepsia mioclónica juvenil (EMJ) es un síndrome epiléptico de inicio en la infancia y adolescencia con mioclonías, convulsiones tónico-clónicas generalizadas y ausencias. Los estímulos reflejos como la sensibilidad a la luz o fotosensibilidad, la apertura y cierre palpebral y la inducción por praxias producen descargas epileptiformes y crisis. Estos desencadenantes reflejos no son todos sistemáticamente estudiados. OBJETIVO: Examinar los rasgos reflejos en pacientes con EMJ. Métodos: Se evaluaron en forma consecutiva 100 adolescentes y adultos con EMJ que recibían diferentes tratamientos anticrisis. Se realizó un electroencefalograma standard con un protocolo de estimulación luminosa intermitente (ELI) y otro para la evaluación de las praxias a través de una actividad neurocognitiva (ANC). El análisis estadístico fue descriptivo y de correlación. Se consideró significativa una p > 0.05. RESULTADOS: La edad actual fue de 28±11 (14-67). Las crisis comenzaron a los 15 años ±3 (Rango 8-25 años). EL 58% presentaron mioclonías y convulsiones tónico clónicas generalizadas. El 50% recibían ácido valproico y el 31% continuaban con crisis. Descargas epileptiformes en reposo 20%; hiperventilación 30%; apertura y cierre palpebral 12%; respuesta fotoparoxística en la ELI 40%; ANC 23%. Mayor porcentaje de descargas y demora en la realización de la ANC en los que presentaban crisis. El ácido valproico comparado con los otros fármacos no demostró superioridad en el control de las crisis. CONCLUSIONES: Estos hallazgos confirman la importancia del estudio de los rasgos reflejos para el diagnóstico, seguimiento y el control terapéutico.

Los desencadenantes reflejos en la epilepsia mioclónica juvenil / Reflex triggers in juvenile myoclonic epilepsy

Resumen Introducción : La epilepsia mioclónica juvenil (EMJ) es un síndrome epiléptico de inicio en la infancia y ado lescencia con mioclonías, convulsiones tónico-clónicas generalizadas y ausencias. Los estímulos reflejos como la sensibilidad a la luz o fotosensibilidad, la apertura y cierre palpebral y la inducción por praxias producen descargas epileptiformes y crisis. Estos desencadenan tes reflejos no son todos sistemáticamente estudiados. Objetivo : Examinar los rasgos reflejos en pacientes con EMJ. Métodos : Se evaluaron en forma consecutiva 100 adolescentes y adultos con EMJ que recibían diferentes tratamientos anticrisis. Se realizó un electroencefalogra ma standard con un protocolo de estimulación luminosa intermitente (ELI) y otro para la evaluación de las pra xias a través de una actividad neurocognitiva (ANC). El análisis estadístico fue descriptivo y de correlación. Se consideró significativa una p > 0.05. Resultados : La edad actual fue de 28+/-11 (14-67). Las crisis comenzaron a los 15 años +/-3 (Rango 8-25 años). EL 58% presentaron mioclonías y convulsiones tónico clónicas generalizadas. El 50% recibían ácido valproico y el 31% continuaban con crisis. Descargas epileptiformes en reposo 20%; hiperventilación 30%; apertura y cierre palpebral 12%; respuesta fotoparoxística en la ELI 40%; ANC 23%. Mayor porcentaje de descargas y demora en la realización de la ANC en los que presentaban crisis. El ácido valproico comparado con los otros fármacos no demostró superioridad en el control de las crisis. Conclusiones : Estos hallazgos confirman la importan cia del estudio de los rasgos reflejos para el diagnóstico, seguimiento y el control terapéutico.

Abstract Introduction : Juvenile myoclonic epilepsy (JME) is an epileptic syndrome with onset in childhood and adolescence with myoclonus, absences, and generalized tonic-clonic seizures. Reflex stimuli such as sensitivity to light or photosensitivity, eyelid opening and closing, and praxis induction produce epileptiform discharges and seizures. These reflex triggers are not all system atically studied. Objective : Examine reflex features in patients with JME. Methods : One hundred adolescents and adults with JME who received different anti-seizure treatments were evaluated consecutively. A standard electroen cephalogram was performed with an intermittent light stimulation (SLI) protocol and another for the evaluation of praxias through neurocognitive activity (CNA). The statistical analysis was descriptive and of correlation with a p > 0.05. Results : Current age was 28+/-11 (14-67). The seizure began at 15 years +/-3 (Range 8-25 years). They pre sented myoclonus and generalized tonic-clonic seizures in 58%. 50% received valproic acid and 31% continued with seizures. Epileptiform discharges at rest 20%; hy perventilation 30%; eyelid opening and closing 12%; photoparoxysmal response in SLI 40%; CNA 23%. Higher percentage of discharges and delay in performing CNA in those who presented seizures. Valproic acid com pared to other drugs did not demonstrate superiority in seizure control. Conclusions : These findings confirm the importance of studying reflex traits for diagnosis, follow-up, and therapeutic control.

[Posterior reversible encephalopathy syndrome in transplanted patients. Clinical features and imaging follow up]. / Leucoencefalopatía posterior reversible en pacientes trasplantados. Presentación clínica, radiológica y evolución.

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological disorder characterized by headache, encephalopathy, seizures and visual disturbances, with reversible vasogenic edema in posterior brain areas. The aim of this research was to describe a case series of transplanted patients who developed PRES, characterize their presentation, treatment, clinical and imaging evolution. Electronic medical records were analyzed from January 2009 to January 2019. Demographic data, clinical backgrounds, causes of admission, hospital length of stay and time from transplantation to PRES were collected. Image improvement/resolution and annual survival were assessed. We identified 27 patients with PRES; 22 of 1647 total solid-organ transplant (1.3%) and 5 of 617 total bone marrow transplant (0.8%). The mean age at presentation was 38.2 years (SD 19.5), 62.9% female, 59.2% (16) before the year of transplantation. The most common comorbidities were kidney disease (14; 51%) and high blood pressure (11; 40%). Computed axial tomography (CT) was performed in 23 patients (85.1%), with pathological findings in 11 (47.8%). Magnetic resonance imaging (MRI) of 25 (92.6%), showed a characteristic pattern in 17 (62.9%) with improvement/resolution before the year in 20 (74%). Treatment was symptomatic, modifying immunosuppression. Five deaths were recorded during hospital stay and another 3 before the year of admission, with an annual survival of 70.3% (19 patients). Organ transplant trend is growing in our region. These patients are particularly susceptible to PRES, with a different imaging presentation and comorbidities from other populations.

El síndrome de leucoencefalopatía posterior reversible (PRES) es un desorden neurológico agudo caracterizado por cefalea, alteración de la conciencia, convulsiones y alteraciones visuales, con imágenes de edema vasogénico reversible en regiones cerebrales posteriores. Nos propusimos describir una serie de casos de pacientes trasplantados que desarrollaron PRES, caracterizando su presentación, evolución clínica, imágenes y terapéutica. Se analizaron historias clínicas informatizadas desde enero 2009 hasta enero 2019. Se recabaron datos demográficos, antecedentes clínicos, motivos y días de internación, tiempos desde el trasplante a la presentación clínica y diagnóstico. Se evaluó la mejoría/resolución en estudios por imágenes y la supervivencia anual. Se identificaron 27 pacientes con PRES; 22 trasplantados de órgano sólido de 1647 totales (1.3%) y 5 de médula ósea de 617 totales (0.8%). La media de edad fue de 38.2 años (DS 19.5), 62.9% de sexo femenino, 59.2% (16) antes del año del trasplante. Las comorbilidades más frecuentes enfermedad renal (14; 51%) e hipertensión arterial (11; 40%). Se realizó tomografía axial computarizada (TAC) a 23 pacientes (85.1%), siendo patológica en 11 (47.8%), y resonancia magnética nuclear (RMN) a 25 (92.6%), mostrando patrón característico en 17 (62.9%), con mejoría/resolución antes del año en 20 (74%). El tratamiento fue sintomático, modificando la inmunosupresión. Se registraron 5 óbitos durante la internación y otros 3 antes del año, con una supervivencia anual del 70.3% (19). La población de trasplantados, en crecimiento en nuestro medio, es particularmente susceptible al PRES. Tanto su presentación en estudios por imágenes, como su comorbilidad, difieren de otras poblaciones.

Leucoencefalopatía posterior reversible en pacientes trasplantados. Presentación clínica, radiológica y evolución / Posterior reversible encephalopathy syndrome in transplanted patients. Clinical features and imaging follow up

Resumen El síndrome de leucoencefalopatía posterior reversible (PRES) es un desorden neurológico agudo caracterizado por cefalea, alteración de la conciencia, convulsiones y alteraciones visuales, con imágenes de edema vasogénico reversible en regiones cerebrales posteriores. Nos propusimos describir una serie de casos de pacientes trasplantados que desarrollaron PRES, caracterizando su presentación, evolución clínica, imágenes y terapéutica. Se analizaron historias clínicas informatizadas desde enero 2009 hasta enero 2019. Se recabaron datos demográficos, antecedentes clínicos, motivos y días de internación, tiempos desde el trasplante a la presentación clínica y diagnóstico. Se evaluó la mejoría/resolución en estudios por imágenes y la supervivencia anual. Se identificaron 27 pacientes con PRES; 22 trasplantados de órgano sólido de 1647 totales (1.3%) y 5 de médula ósea de 617 totales (0.8%). La media de edad fue de 38.2 años (DS 19.5), 62.9% de sexo femenino, 59.2% (16) antes del año del trasplante. Las comorbilidades más frecuentes enfermedad renal (14; 51%) e hipertensión arterial (11; 40%). Se realizó tomografía axial computarizada (TAC) a 23 pacientes (85.1%), siendo patológica en 11 (47.8%), y resonancia magnética nuclear (RMN) a 25 (92.6%), mostrando patrón característico en 17 (62.9%), con mejoría/resolución antes del año en 20 (74%). El tratamiento fue sintomático, modificando la inmunosupresión. Se registraron 5 óbitos durante la internación y otros 3 antes del año, con una supervivencia anual del 70.3% (19). La población de trasplantados, en crecimiento en nuestro medio, es particularmente susceptible al PRES. Tanto su presentación en estudios por imágenes, como su comorbilidad, difieren de otras poblaciones.

Abstract Posterior reversible encephalopathy syndrome (PRES) is an acute neurological disorder characterized by headache, encephalopathy, seizures and visual disturbances, with reversible vasogenic edema in posterior brain areas. The aim of this research was to describe a case series of transplanted patients who developed PRES, characterize their presentation, treatment, clinical and imaging evolution. Electronic medi cal records were analyzed from January 2009 to January 2019. Demographic data, clinical backgrounds, causes of admission, hospital length of stay and time from transplantation to PRES were collected. Image improvement/ resolution and annual survival were assessed. We identified 27 patients with PRES; 22 of 1647 total solid-organ transplant (1.3%) and 5 of 617 total bone marrow transplant (0.8%). The mean age at presentation was 38.2 years (SD 19.5), 62.9% female, 59.2% (16) before the year of transplantation. The most common comorbidities were kidney disease (14; 51%) and high blood pressure (11; 40%). Computed axial tomography (CT) was per formed in 23 patients (85.1%), with pathological findings in 11 (47.8%). Magnetic resonance imaging (MRI) of 25 (92.6%), showed a characteristic pattern in 17 (62.9%) with improvement/resolution before the year in 20 (74%). Treatment was symptomatic, modifying immunosuppression. Five deaths were recorded during hospital stay and another 3 before the year of admission, with an annual survival of 70.3% (19 patients). Organ transplant trend is growing in our region. These patients are particularly susceptible to PRES, with a different imaging presentation and comorbidities from other populations.

Educational needs of epileptologists regarding psychiatric comorbidities of the epilepsies: a descriptive quantitative survey.

Psychiatric disorders are relatively frequent comorbidities in epilepsy and they have an impact on morbidity, mortality, and quality of life. This is a report from the Task Force on Education of the ILAE Commission on Neuropsychiatry based on a survey about educational needs of epileptologists regarding management of the psychiatric comorbidities of epilepsy. The Task Force designed a quantitative questionnaire to survey the self-perceived confidence of child and adult epileptologists and psychiatrists in managing major psychiatric comorbidities of epilepsy to identify: (1) critical areas of improvement from a list of skills that are usually considered necessary for effective management of these conditions, and (2) the preferred educational format for improving these skills. A total of 211 respondents from 36 different countries participated in the survey. Confidence and usefulness scores suggest that responders would most value education and training in the management of specific clinical scenarios. Child neurologists identified major Axis I disorders, such as mood and anxiety disorders, while adult neurologists identified attention deficit hyperactivity disorder, intellectual disabilities, and autistic spectrum disorder as key areas. Both adult and child neurologists identified screening skills as the priority. Psychiatrists mainly valued specific training in the management of psychiatric complications of epilepsy surgery or psychiatric adverse events of antiepileptic drugs. Sessions during congresses and face-to-face meetings represent the preferred educational format, while e-learning modules and review papers were chosen by a minority of respondents. Results of this survey identify key areas for improvement in managing the psychiatric comorbidities of epilepsy and suggest specific strategies to develop better training for clinicians involved in epilepsy care.

Screening of major depression in epilepsy: the Neurologic Depression Disorders Inventory in Epilepsy-Spanish version (Argentina).

OBJECTIVES: To validate and translate the English version of the Neurologic Depression Disorders Inventory in Epilepsy (NDDI-E) into Spanish as a screening instrument for major depressive episodes (MDE) for patients with epilepsy from Argentina and Uruguay. METHODS: One hundred fifty-five consecutive outpatients with epilepsy participated in this study. The module of MDE of the MINI International Neuropsychiatric Instrument (MINI Plus version) was used as the gold standard against which the translated version of the NDDI-E was validated. RESULTS: Among the 155 patients, 25 (16%) met Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria for MDE according to the MINI. With a total score of >15, The NDDI-E identified MDE with an 80% sensitivity, 90% specificity, 60% positive predictive value, and 95.5% negative predictive value. SIGNIFICANCE: These data indicate that the Spanish version of the NDDI-E can reliably identify MDE in patients with epilepsy from Argentina and Uruguay.

[Psychiatric disorders in epilepsy: an update]. / Actualización de los trastornos psiquiátricos específicos de las epilepsias.

Although there is good clinical evidence suggesting that the psychiatric disorders of epilepsy are clinically distinct, they do not find a place in the current classification systems. To develop a useful classification of the psychopathology of epilepsy, it is important to embrace not only the spectrum of psychiatric diagnoses as given by current psychiatric terminology, as in ICD-10 and DSM-IV, but also those diagnoses related to the classification of seizures and epilepsy. This should be combined with considerable clinical experience in understanding these associations. The Commission on Psychobiology of The International League Against Epilepsy (ILAE) has developed a classification which is shown in this revision. We also describe the bidirectionality between epilepsy and depression and its consequences. A special issue is the overlap between depressive epilepsy-related symptoms and bipolar symptomatology. The psychoses of epilepsy, in the way the ILAE classification considers them, are also reviewed. Finally, we include case reports that illustrate what we understand as the complexity for the clinical diagnosis and therapeutics. Key words.

Actualización de los trastornos psiquiátricos específicos de las epilepsias / [Psychiatric disorders in epilepsy: an update].

Although there is good clinical evidence suggesting that the psychiatric disorders of epilepsy are clinically distinct, they do not find a place in the current classification systems. To develop a useful classification of the psychopathology of epilepsy, it is important to embrace not only the spectrum of psychiatric diagnoses as given by current psychiatric terminology, as in ICD-10 and DSM-IV, but also those diagnoses related to the classification of seizures and epilepsy. This should be combined with considerable clinical experience in understanding these associations. The Commission on Psychobiology of The International League Against Epilepsy (ILAE) has developed a classification which is shown in this revision. We also describe the bidirectionality between epilepsy and depression and its consequences. A special issue is the overlap between depressive epilepsy-related symptoms and bipolar symptomatology. The psychoses of epilepsy, in the way the ILAE classification considers them, are also reviewed. Finally, we include case reports that illustrate what we understand as the complexity for the clinical diagnosis and therapeutics. Key words.

Actualización de los trastornos psiquiátricos específicos de las epilepsias. / [Psychiatric disorders in epilepsy: an update].

Although there is good clinical evidence suggesting that the psychiatric disorders of epilepsy are clinically distinct, they do not find a place in the current classification systems. To develop a useful classification of the psychopathology of epilepsy, it is important to embrace not only the spectrum of psychiatric diagnoses as given by current psychiatric terminology, as in ICD-10 and DSM-IV, but also those diagnoses related to the classification of seizures and epilepsy. This should be combined with considerable clinical experience in understanding these associations. The Commission on Psychobiology of The International League Against Epilepsy (ILAE) has developed a classification which is shown in this revision. We also describe the bidirectionality between epilepsy and depression and its consequences. A special issue is the overlap between depressive epilepsy-related symptoms and bipolar symptomatology. The psychoses of epilepsy, in the way the ILAE classification considers them, are also reviewed. Finally, we include case reports that illustrate what we understand as the complexity for the clinical diagnosis and therapeutics. Key words.

[Prophylactic treatment with antiepileptic drugs in neurological conditions]. / Profilaxis con drogas antiepilepticas en enfermedades neurologicas.

Prophylactic use of antiepileptic drugs in neurological conditions such as ischemic and hemorrhagic stroke, subarachnoid hemorrhage, head injury, and brain tumors has been matter of debate for many years. These drugs are used for reducing secondary neurological damage caused by epileptic seizures. However, the evidence supporting this indication is scarce. Potential drug interactions, side effects, and even neurotoxicity related to these drugs have raised concern about this therapeutic approach. In this review, we examine the evidence on the prophylactic use of antiepileptic drugs in the neurological disorders above mentioned.

Profilaxis con drogas antiepilépticas en enfermedades neurológicas / Prophylactic treatment with antiepileptic drugs in neurological conditions

El uso profiláctico de drogas antiepilépticas en enfermedades neurológicas como el accidente cerebrovascular isquémico y hemorrágico, la hemorragia subaracnoidea, el traumatismo de cráneo y los tumores cerebrales ha sido motivo de controversia durante muchos años. Estas drogas son indicadas con el fin de disminuir el daño neurológico secundario a las crisis epilépticas. Sin embargo, la escasa evidencia científica disponible para avalar esta hipótesis, las potenciales interacciones farmacológicas, los efectos adversos y algunos informes sobre neurotoxicidad generan dudas en cuanto a esta conducta terapéutica. En esta revisión, analizamos la evidencia acerca del uso profiláctico de drogas epilépticas en las enfermedades neurológicas arriba mencionadas.

Prophylactic use of antiepileptic drugs in neurological conditions such as ischemic and hemorrhagic stroke, subarachnoid hemorrhage, head injury, and brain tumors has been matter of debate for many years. These drugs are used for reducing secondary neurological damage caused by epileptic seizures. However, the evidence supporting this indication is scarce. Potential drug interactions, side effects, and even neurotoxicity related to these drugs have raised concern about this therapeutic approach. In this review, we examine the evidence on the prophylactic use of antiepileptic drugs in the neurological disorders above mentioned.

[Psychogenic non epileptic events and frontal lobe seizures]. / Eventos no epilépticos psicogénicos y la clínica de la epilepsia del lóbulo frontal.

The distinction between epilepsy and psychogenic non epileptic events or seizures (PNES) has been made since the middle of the first millennium (B.C.) Psychogenic non epileptic seizures (PNES) resemble epileptic seizures presenting as paroxysmal, involuntary, time-limited alterations in behaviour, motor activity, autonomic function, consciousness, or sensation. However, unlike epilepsy, NES do not result from epileptogenic pathology and are not accompanied by an epileptiform pattern during an ictal electroencephalogram (EEG). This article reviews the concept of psychogenic non epileptic events, its contemporary assessment including diagnostic and therapeutic issues, as well as the complexity related to various nosological topics. The PNES are a hallmark of an ancient illness, hysteria, which wanders between the somatoform and the dissociative disorders in the contemporary classification systems. With the availability of video electroencephalography (video-EEG), it has been possible to define more strictly the limits between epileptic and non epileptic disorders, avoiding unnecessary and even iatrogenic and invasive treatments. We also describe the clinical presentation and diagnosis of frontal lobe seizures, especially those that might be mistakenly diagnosed as psychogenic events. The frontal lobes are the largest cortical region from which seizures can arise; complex and/ or bizarre behavioural clinical presentations are frequent. In addition, some patients with epilepsy can also present non epileptic events.

[Psychiatric aspects of Epilepsy]. / Aspectos psiquiátricos de las epilepsias.

The classification of epileptic seizures is reviewed, emphasizing the clinical features of partial seizures with psychic symptoms. Psychiatric issues in epilepsy are also assessed, particularly affective disorders and psychosis. Although there currently is no internationally accepted syndromic classification for them, we expose recently proposed definitions. The concept of "epileptic personality" is reviewed, and the matter of aggression as well. Finally we include a case report that illustrates what we understand as the complexity for the clinical diagnosis.

Genotype-phenotype correlations for EPM2A mutations in Lafora's progressive myoclonus epilepsy: exon 1 mutations associate with an early-onset cognitive deficit subphenotype.

Mutations in the EPM2A gene encoding a dual-specificity phosphatase (laforin) cause an autosomal recessive fatal disorder called Lafora's disease (LD) classically described as an adolescent-onset stimulus-sensitive myoclonus, epilepsy and neurologic deterioration. Here we related mutations in EPM2A with phenotypes of 22 patients (14 families) and identified two subsyndromes: (i) classical LD with adolescent-onset stimulus-sensitive grand mal, absence and myoclonic seizures followed by dementia and neurologic deterioration, and associated mainly with mutations in exon 4 (P = 0.0007); (ii) atypical LD with childhood-onset dyslexia and learning disorder followed by epilepsy and neurologic deterioration, and associated mainly with mutations in exon 1 (P = 0.0015). To understand the two subsyndromes better, we investigated the effect of five missense mutations in the carbohydrate-binding domain (CBD-4; coded by exon 1) and three missense mutations in the dual phosphatase domain (DSPD; coded by exons 3 and 4) on laforin's intracellular localization in HeLa cells. Expression of three mutant proteins (T194I, G279S and Y294N) in DSPD formed ubiquitin-positive cytoplasmic aggregates, suggesting that they were folding mutants set for degradation. In contrast, none of the three CBD-4 mutants showed cytoplasmic clumping. However, CBD-4 mutants W32G and R108C targeted both cytoplasm and nucleus, suggesting that laforin had diminished its usual affinity for polysomes. Our data, thus, represent the first report of a novel childhood syndrome for LD. Our results also provide clues for distinct roles for the CBD-4 and DSP domains of laforin in the etiology of two subsyndromes of LD.

Aspectos psiquiátricos de las epilepsias. / [Psychiatric aspects of Epilepsy]

The classification of epileptic seizures is reviewed, emphasizing the clinical features of partial seizures with psychic symptoms. Psychiatric issues in epilepsy are also assessed, particularly affective disorders and psychosis. Although there currently is no internationally accepted syndromic classification for them, we expose recently proposed definitions. The concept of [quot ]epileptic personality[quot ] is reviewed, and the matter of aggression as well. Finally we include a case report that illustrates what we understand as the complexity for the clinical diagnosis.

Aspectos psiquiátricos de las epilepsias / [Psychiatric aspects of Epilepsy]

The classification of epileptic seizures is reviewed, emphasizing the clinical features of partial seizures with psychic symptoms. Psychiatric issues in epilepsy are also assessed, particularly affective disorders and psychosis. Although there currently is no internationally accepted syndromic classification for them, we expose recently proposed definitions. The concept of [quot ]epileptic personality[quot ] is reviewed, and the matter of aggression as well. Finally we include a case report that illustrates what we understand as the complexity for the clinical diagnosis.

Status epiléptico: análisis de 102 casos en un hospital de comunidad / Status epilepticus: analysis of 102 cases in a community hospital

El Status Epiléptico (SE) es una emergencia neurológica con una significativa morbimortalidad, debiéndose conocer sus características clínicas y epidemiológicas para optimizar el diagnóstico y tratamiento. El objetivo de este trabajo es comunicar los resultados de un análisis retrospectivo de pacientes con SE admitidos entre 1993 y 1998

Status epiléptico: análisis de 102 casos en un hospital de comunidad / Status epilepticus: analysis of 102 cases in a community hospital

El Status Epiléptico (SE) es una emergencia neurológica con una significativa morbimortalidad, debiéndose conocer sus características clínicas y epidemiológicas para optimizar el diagnóstico y tratamiento. El objetivo de este trabajo es comunicar los resultados de un análisis retrospectivo de pacientes con SE admitidos entre 1993 y 1998

Alteracion cognitiva ejecutiva de tipo prefrontal en pacientes con epilepsia del lobulo temporal mesial / Executive cognitive alteration of prefrontal type in patients with mesial temporal lobe epilepsy

Este trabajo examina el desempeño interictal en la función ejecutiva (clásicamente comandada por el lóbulo frontal) en pacientes con epilepsia del lóbulo temporal. Para tal fin se evaluaron dos grupos de pacientes: un grupo con crisis parciales complejas de origen en el lóbulo temporal (ELT) (n = 16) y un grupo de pacientes con epilepsia generalizada primaria (EGP) (n = 12), tomado como grupo control. Como medida de la función ejecutiva se utilizó el test de la selección de cartas de Wisconsin (TSCW). Los resultados mostraron que el desempeño en el TSCW se halló notoriamente más comprometido en el grupo de ELT, observándose un comportamiento sugestivo de disfunción ejecutiva tipo frontal en un 75 por ciento de estos pacientes, contrastando con el 17 por ciento del grupo control (p < 0.001). El déficit en el desempeño se manifestó en el número de categorías resueltas (p < 0.05), los errores perseverativos (p < 0.001) y las respuestas perseverativas (p < 0.001). Estos hallazgos demuestran un patrón disejecutivo en estos pacientes que reflejaría la intervención de la estructura temporal en el circuito ejecutivo prefrontal.