Estudio observacional multicéntrico retrospectivo sobre el manejo clínico y terapéutico de los diferentes tipos de estatus epiléptico en la práctica clínica / Retrospective multicentre observational study on clinical management and treatment of different types of status epilepticus in clinical practice

Introducción: El estatus epiléptico es una urgencia neurológica asociada a una mortalidad y morbilidad significativa. Analizamos las características en nuestra población. Métodos: Se recogieron los datos de manera retrospectiva de la historia clínica electrónica de adultos con diagnóstico de estatus epiléptico en 5 centros hospitalarios durante 4 años. Resultados: Se obtuvieron datos de un total de 84 episodios en 77 pacientes, con edad media de 60,3 años. El 52,4% tenían historia previa de epilepsia. Clasificación según el tipo de estatus: 47,6% tónico-clónico; 21,4% parcial complejo; 17,9% parcial motor; 6% parcial simple; 3,6% mioclónico y 3,6% sutil. Si analizamos el momento que finalizó el estatus según las fases definidas para este estudio obtenemos: 13,1% precoz (hasta 30 min); 20,2% establecido (entre 30-120 min); 41,7% refractario (más de 120 min) y 13,1% superrefractario (continúan o recurren después de más de 24 h de anestesia). Diez casos (11,9%) fallecieron sin haberse controlado el estatus. El porcentaje acumulativo de éxito alcanzado con el primer tratamiento fue de 8,3%; segundo 27,3%; tercero 48,7%; cuarto 58,2%; quinto 70,1%; sexto 80,8%; séptimo 83,2% y octavo 84,4%. Conclusiones: En nuestro estudio encontramos que el estatus no se controló en las primeras 2 h en casi la mitad de los casos, y un 11,9% fallecieron sin controlarse, sin haber diferencias significativas entre el tipo de estatus. En casi la mitad se logró el control del estatus con el tercer tratamiento, pero en algún caso se precisó hasta 8. Son necesarios registros amplios que permitan analizar el manejo en los distintos tipos y fases (AU)

Introduction: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. Methods: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. Results: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy. Status classification: 47.6% tonic-clonic, 21.4% complex partial, 17.9% partial motor, 6% partial simple, 3.6% myoclonic, and 3.6% subtle SE. Based on the duration of the episode, SE was defined in this study as early stage (up to 30 min) in 13.1%, established (30-120 min) in 20.2%, refractory (more than 120 min) in 41.7%, and super-refractory (episodes continuing or recurring after more than 24h of anaesthesia) in 13.1%. Ten patients (11.9%) died when treatment failed to control SE. The cumulative percentage of success achieved was 8.3% with the first treatment, 27.3% for the second, 48.7% for the third, 58.2% for the fourth, 70.1% for the fifth, 80.8% for the sixth, 83.2% for the seventh, and 84.4% for the eighth. Conclusions: In our study, we found that SE did not respond to treatment within 2h in approximately half the cases and 11.9% of the patients died without achieving seizure control, regardless of the type of status. Half the patients responded by the third treatment but some patients needed as many as 8 treatments to resolve seizures. Using large registers permitting analysis of the different types and stages of SE is warranted (AU)

Retrospective multicentre observational study on clinical management and treatment of different types of status epilepticus in clinical practice. / Estudio observacional multicéntrico retrospectivo sobre el manejo clínico y terapéutico de los diferentes tipos de estatus epiléptico en la práctica clínica.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. METHODS: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. RESULTS: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy. Status classification: 47.6% tonic-clonic, 21.4% complex partial, 17.9% partial motor, 6% partial simple, 3.6% myoclonic, and 3.6% subtle SE. Based on the duration of the episode, SE was defined in this study as early stage (up to 30min) in 13.1%, established (30-120min) in 20.2%, refractory (more than 120min) in 41.7%, and super-refractory (episodes continuing or recurring after more than 24h of anaesthesia) in 13.1%. Ten patients (11.9%) died when treatment failed to control SE. The cumulative percentage of success achieved was 8.3% with the first treatment, 27.3% for the second, 48.7% for the third, 58.2% for the fourth, 70.1% for the fifth, 80.8% for the sixth, 83.2% for the seventh, and 84.4% for the eighth. CONCLUSIONS: In our study, we found that SE did not respond to treatment within 2h in approximately half the cases and 11.9% of the patients died without achieving seizure control, regardless of the type of status. Half the patients responded by the third treatment but some patients needed as many as 8 treatments to resolve seizures. Using large registers permitting analysis of the different types and stages of SE is warranted.

Influencia de la comorbilidad médica y neuropsiquiátrica en la evolución de la epilepsia infantil / Influence of medical and neuropsychiatric comorbidities on the course of childhood epilepsy

INTRODUCCIÓN: El creciente reconocimiento de la comorbilidad y su carga plantea la necesidad de incluir en el manejo de los pacientes con epilepsia su investigación, prevención y tratamiento. MATERIAL Y MÉTODOS: Estudio descriptivo de todos los pacientes con epilepsia, perteneciente a un área suburbana de la Comunidad de Madrid, seguidos en consulta al menos durante un año. Excluimos a menores de 2 años, las crisis febriles y sintomáticas agudas. RESULTADOS: Incluimos a 46 pacientes (54% varones y edad media 9,1 años). El 52,5% en monoterapia. El 45,7% «libre de crisis», el 23,9% epilepsia «farmacorresistente» y el 30,4% «indeterminada». El 28,3% tenía patología médica crónica asociada y un 41,3% neuropsiquiátrica. El 32,6% acudió de manera imprevista por crisis, con un riesgo de 15 y 8,3 veces mayor aquellos con comorbilidad médica crónica y neuropsiquiátrica respecto al de los pacientes sin comorbilidades. CONCLUSIONES: La comorbilidad puede desempeñar un papel importante en el curso de la epilepsia

INTRODUCTION: Comorbidity has a significant influence in the management of patients with epilepsy. MATERIAL AND METHODS: A descriptive study of all patients with epilepsy, from a suburban area in the Community of Madrid followed up for at least 1 year. Children under 2 years, those with symptomatic acute febrile seizures were excluded. RESULTS: Out of a total of 46 patients (54% male, age median 9.1 years), more than half (52.5%) were on monotherapy, 45.7% were ''free of seizures'', 23.9% had ''drug resistant epilepsy'', and 30.4% were ''undetermined''. As regards comorbidities, 28.3% had chronic medical conditions, and 41.3% associated neuropsychiatric disorders. In32.6%, the seizures were of sudden onset, and those with chronic medical and neuropsychiatric comorbidities had a risk of 15 and 8.3 times, respectively, than those patients without comorbidities. CONCLUSIONS: Comorbidities may have an important role in the course of epilepsy

[Influence of medical and neuropsychiatric comorbidities on the course of childhood epilepsy]. / Influencia de la comorbilidad médica y neuropsiquiátrica en la evolución de la epilepsia infantil.

INTRODUCTION: Comorbidity has a significant influence in the management of patients with epilepsy. MATERIAL AND METHODS: A descriptive study of all patients with epilepsy, from a suburban area in the Community of Madrid followed up for at least 1 year. Children under 2 years, those with symptomatic acute febrile seizures were excluded. RESULTS: Out of a total of 46 patients (54% male, age median 9.1 years), more than half (52.5%) were on monotherapy, 45.7% were "free of seizures", 23.9% had "drug resistant epilepsy", and 30.4% were "undetermined". As regards comorbidities, 28.3% had chronic medical conditions, and 41.3% associated neuropsychiatric disorders. In32.6%, the seizures were of sudden onset, and those with chronic medical and neuropsychiatric comorbidities had a risk of 15 and 8.3 times, respectively, than those patients without comorbidities. CONCLUSIONS: Comorbidities may have an important role in the course of epilepsy.

Medidas de calidad en la atención a pacientes con epilepsia en la consulta de neurología / Quality measures in neurology consult care for epileptic patients

Introducción: La epilepsia es una de las afecciones que con más frecuencia atendemos en las consultas externas de neurología. Métodos: Analizamos la aplicación en nuestro centro de las 8 medidas sobre calidad en el cuidado de pacientes con epilepsia propuestas por la Academia Americana de Neurología: tipo de crisis y frecuencia de crisis, etiología de la epilepsia o síndrome epiléptico, resultados electroencefalograma, neuroimagen, aconsejar sobre efectos adversos de los fármacos antiepilépticos, remisión de los casos de epilepsia refractaria, consejos sobre cuestiones de seguridad y a mujeres en edad fértil. Resultados: En la mayoría de los casos estaba documentado adecuadamente las 4 primeras medidas de calidad. En el 66% se había preguntado sobre efectos adversos de los fármacos en todas las visitas. En casi todas las epilepsias intratables se había propuesto o remitido aun centro de referencia quirúrgico para la valoración en algún momento de la enfermedad, aunque generalmente hacía más de 3 a˜nos de la propuesta. Un 37% de los pacientes habían sido aconsejados sobre cuestiones de seguridad y menos de la mitad de las mujeres con epilepsia en edad fértil habían recibido consejos relativos a anticonceptivos y embarazo al menos una vez al año. Conclusiones: Realizamos una atención adecuada de acuerdo con las medidas de calidad en muchos de los aspectos clínicos, pero debemos mejorar la administración de consejos e información necesaria para el cuidado del paciente con epilepsia en las diferentes etapas de la vida

Introduction: Epilepsy is one of the most frequently observed diseases in neurology outpatient care. Methods: We analysed our hospital’s implementation of the 8 epilepsy quality measures proposed by the American Academy of Neurology: documented seizure types and seizure frequency, aetiology of epilepsy or the epilepsy syndrome, review of EEG, MRI, or CT results, counselling about antiepileptic drug side effects, surgical therapy referral for intractable epilepsy, and counselling about epilepsy-specific safety issues and for women of childbearing age. Results: In most cases, the first four quality measures were documented correctly. In 66% of the cases, doctors had asked about any adverse drug effects during every visit. Almost all patients with intractable epilepsy had been informed about surgical options or referred to a surgical centre of reference for an evaluation at some point, although referrals usually took place more than 3 years after the initial proposal. Safety issues had been explained to 37% of the patients and less than half of women of childbearing age with epilepsy had received counselling regardingcontraception and pregnancy at least once a year. Conclusions: The care we provide is appropriate according to many of the quality measures, but we must deliver more counselling and information necessary for the care of epileptic patients in different stages of life

Quality measures in neurology consult care for epileptic patients.

INTRODUCTION: Epilepsy is one of the most frequently observed diseases in neurology outpatient care. METHODS: We analysed our hospital's implementation of the 8 epilepsy quality measures proposed by the American Academy of Neurology: documented seizure types and seizure frequency, aetiology of epilepsy or the epilepsy syndrome, review of EEG, MRI, or CT results, counselling about antiepileptic drug side effects, surgical therapy referral for intractable epilepsy, and counselling about epilepsy-specific safety issues and for women of childbearing age. RESULTS: In most cases, the first four quality measures were documented correctly. In 66% of the cases, doctors had asked about any adverse drug effects during every visit. Almost all patients with intractable epilepsy had been informed about surgical options or referred to a surgical centre of reference for an evaluation at some point, although referrals usually took place more than 3 years after the initial proposal. Safety issues had been explained to 37% of the patients and less than half of women of childbearing age with epilepsy had received counselling regarding contraception and pregnancy at least once a year. CONCLUSIONS: The care we provide is appropriate according to many of the quality measures, but we must deliver more counselling and information necessary for the care of epileptic patients in different stages of life.

[Sensory ganglionopathy as a manifestation of celiac disease]. / Ganglionopatia sensitiva como manifestacion de enfermedad celiaca.

INTRODUCTION: The neurological manifestations of celiac disease (CD) may be caused by the disease itself, by associated autoimmune diseases or by complications from the tumours that may develop in the long term. We report a case of sensory ganglionopathy associated to CD. CASE REPORT: A 59-year-old female with chronic diarrhoea and loss of weight, who visited because of a clinical picture of gait disorders that progressed to the point where she was barely able to walk. Having been diagnosed with CD, finding a sensory ganglionopathy with dysautonomia (an atypical manifestation of this disease) led to a diagnosis of associated Sjogren's syndrome (SS). CONCLUSIONS: The neurological manifestations of CD are very varied, but in the presence of a sensory ganglionopathy, a neurological picture that is atypical in this disease, it becomes necessary to suspect SS, which is an infrequent but well established association. Likewise, all patients with SS must be screened for CD, which (albeit subclinically) can be complicated in the long term by the development of tumours. The differential diagnosis of the neurological manifestations of CD and of sensory ganglionopathy, as well as the association between celiac disease and SS, is also discussed.

Ganglionopatía sensitiva como manifestación de enfermedad celiaca / Sensory ganglionopathy as a manifestation of celica disease

Introducción. Las manifestaciones neurológicas de la enfermedad celiaca (EC) pueden deberse a la propia enfermedad, a las enfermedades autoinmunes asociadas o a complicaciones de los tumores que pueden desarrollar a largo plazo. Presentamos un caso de ganglionopatía sensitiva asociada a una EC. Caso clínico. Mujer de 59 años con diarrea crónica y pérdida de peso, que acude por un cuadro de trastorno de la marcha, que progresa hasta llegar a impedirla. Diagnosticada como EC, el hallazgo de una ganglionopatía sensitiva con disautonomía, manifestación atípica para esta enfermedad, llevó al diagnóstico de un síndrome de Sjögren (SS) asociado. Conclusiones. Las manifestaciones neurológicas de la EC son muy variadas, pero ante la presencia de una ganglionopatía sensitiva, cuadro neurológico atípico en esta enfermedad, es obligado sospechar un SS, asociación infrecuente, pero bien establecida. De igual manera, en todo paciente con SS debe realizarse un cribado de EC, que, aunque subclínica, puede complicarse a largo plazo con el desarrollo de tumores. Discutimos el diagnóstico diferencial de las manifestaciones neurológicas de la EC y de la ganglionopatía sensitiva, así como la asociación entre la celiaquía y el SS

Introduction. The neurological manifestations of celiac disease (CD) may be caused by the disease itself, by associated autoimmune diseases or by complications from the tumours that may develop in the long term. We report a case of sensory ganglionopathy associated to CD. Case report. A 59-year-old female with chronic diarrhoea and loss of weight, who visited because of a clinical picture of gait disorders that progressed to the point where she was barely able to walk. Having been diagnosed with CD, finding a sensory ganglionopathy with dysautonomia (an atypical manifestation of this disease) led to a diagnosis of associated Sjogren’s syndrome (SS). Conclusions. The neurological manifestations of CD are very varied, but in the presence of a sensory ganglionopathy, a neurological picture that is atypical in this disease, it becomes necessary to suspect SS, which is an infrequent but well established association. Likewise, all patients with SS must be screened for CD, which (albeit subclinically) can be complicated in the long term by the development of tumours. The differential diagnosis of the neurological manifestations of CD and of sensory ganglionopathy, as well as the association between celiac disease and SS, is also discussed

Nistagmo vertical secundario a la administración de morfina epidural / Vertical nystagmus secondary to the epidural administration of morphine

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