Vitamin D status and parathyroid hormone assessment in girls with central precocious puberty.

PURPOSE: The objective of this study was to analyze vitamin D status and PTH concentrations in 6- to 8-year-old girls with central precocious puberty. METHODS: A cross-sectional clinical and blood testing study (calcium, phosphorus, 25(OH)D and PTH) was carried out in 78 girls with central precocious puberty (CPP group), aged 6.1-7.9 years. A control group was recruited (137 prepubertal girls, aged 6.1-8.2 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: There were no significant differences in vitamin D status between both groups. There were no significant differences in 25(OH)D concentrations between CPP (25.4 ± 8.6 ng/mL) and control groups (28.2 ± 7.4 ng/mL). In contrast, PHT concentrations in CPP group (44.8 ± 16.3 pg/mL) were higher (p < 0.05) with respect to control group (31.0 ± 11.9 ng/mL). In CPP group, there was a positive correlation (p < 0.05) between PTH concentrations and growth rate, bone age, and basal estradiol, basal FSH, basal LH and LH peak concentrations. CONCLUSION: Vitamin D status in 6- to 8-year-old girls with CPP is similar to that in prepubertal girls. PTH concentrations were significantly higher in girls with CPP, and this could be considered as a physiological characteristic of puberty and, in this case, of pubertal precocity.

Hyper-androgenemia and obesity in early-pubertal girls.

PURPOSE: The aim of this study was to examine the hormonal profile in early-pubertal girls with obesity. We hypothesized that these patients might already present hormonal alterations with POCS-like features. METHODS: Cross-sectional study in a sample of 283 peri-pubertal girls (prepubertal and early-puberty subgroups), aged 6.1-12.0 years, diagnosed with obesity (BMI-SDS > 2.0, 97th percentile), so-called obesity group. They all underwent clinical examination and blood testing for hormonal measurements (leptin, TSH, FT4, IGF-1, IGFBP3, prolactin, insulin, FSH, LH, estradiol, ACTH, cortisol, 17-OH-P, DHE-S, androstenedione, testosterone and free testosterone). A control group was recruited: 243 healthy girls, aged 6.3-12.1 years, with normal BMI status. RESULTS: Prepubertal girls with obesity had significantly higher values (p < 0.05) for BMI-SDS, leptin, insulin and HOMA-IR levels than control group. Early-pubertal girls with obesity also had significantly higher values (p < 0.05) for BMI-SDS, leptin, IGF-1, IGFBP3, insulin and HOMA-IR, LH, ratio LH/FSH, ACTH, DHE-S, androstenedione, testosterone and free testosterone levels than control group. In early-pubertal girls with obesity (not prepubertal girls), there was a positive correlation (p < 0.01) between leptin levels with LH, androstenedione and testosterone, and HOMA-IR with LH and testosterone levels. There was also a positive correlation (p < 0.01) between IGF-1 levels with LH, androstenedione, DHE-S and testosterone; and LH levels with testosterone. CONCLUSION: The results obtained support our hypothesis that an abnormal hormonal profile with POCS-like features can already be detected (insulin resistance and hyperinsulinemia, increased secretion of LH and ACTH, and overproduction of ovarian and adrenal androgens) in early-pubertal girls with obesity.

Changes in body composition and cardiometabolic risk factors in relation to the reduction in body mass index in adolescents with obesity / Cambios en la composición corporal y factores de riesgo cardiometabólico en relación con la reducción del índice de masa corporal en adolescentes con obesidad

Introduction: there are controversial data in relation to the reduction in body mass index standard deviation score (BMI-SDS) needed to improve adiposity in the pediatric population with obesity. The aim of this work was to determine the minimum variation in BMI-SDS required to improve the values of adiposity markers and cardiometabolic risk factors in growing adolescents with obesity. Methods: a longitudinal study consisting of clinical evaluation (waist circumference, waist-to-height ratio, fat mass index, and blood pressure) and blood testing (insulin resistance and lipid profile) was conducted in 350 adolescents with obesity (152 boys and 198 girls) aged 10.2-14.3 years who went through a combined intervention (12 months). Results: a decrease in SDS-BMI ≤ 0.5 was not associated with any significant improvement in the clinical features and blood testing recorded. A decrease in BMI-SDS > 0.5, and especially if > 1.0, was linked to a significant improvement in adiposity markers. A decrease in BMI-SDS > 0.5 was associated with a significant improvement in insulin resistance, and a decrease in BMI-SDS > 1.0 was associated with a significant decrease in the percentage of patients who showed high values of systolic blood pressure, HOMA-IR, and lipid profile Conclusions: improvement in body composition, insulin resistance, and lipid profile can be observed with reductions in BMI-SDS ≥ 0.5 in obese adolescents, while extended benefits are obtained by losing at least 1.0 BMI-SDS (AU)

Introducción: los datos en relación con la reducción del índice de masa corporal (IMC-SDS) necesario para mejorar la adiposidad en la población pediátrica con obesidad son controvertidos. El objetivo de este trabajo es determinar la variación mínima del IMC-SDS necesaria para mejorar los valores de los marcadores de adiposidad y los factores de riesgo cardiometabólico en adolescentes obesos. Métodos: estudio longitudinal clínico (perímetro de cintura, índice cintura-estatura e índice de masa grasa y presión arterial) y analítico (HOMA-R y perfil lipídico) realizado en 350 adolescentes con obesidad (152 niños y 198 niñas) de entre 10,2 y 14,3 años de edad que completaron una intervención combinada (12 meses). Resultados: una disminución en el índice de masa corporal (SDS-BMI) ≤ 0,5 no se asoció con ninguna mejora significativa de las características clínicas y analíticas registradas. Una disminución del IMC-SDS > 0,5, y especialmente si > 1,0, se relacionó con una mejora significativa de los marcadores clínicos de adiposidad. Una disminución del IMC-SDS > 0,5 se asoció con una mejora significativa de la resistencia a la insulina y una disminución del BMI-SDS > 1,0 se asoció con una disminución significativa del porcentaje de pacientes que mostraban valores altos de presión arterial sistólica, HOMA-IR y perfil lipídico Conclusiones: con una reducción del IMC-SDS ≥ 0,5 se observa una mejoría tanto en la composición corporal como en los factores de riesgo cardiovascular en los adolescentes obesos; no obstante, estos beneficios son mayores si la reducción del IMC-SDS es superior a 1.0 (AU)

Vitamin D status and response to growth hormone treatment in prepubertal children with growth hormone deficiency.

PURPOSE: To analyze whether vitamin D deficiency could condition the growth response to GH therapy, as well as to analyze if GH treatment modifies both seasonal variations and vitamin D levels in these patients. METHODS: Retrospective study in 98 prepubertal children with GH deficiency (GHD), aged 4.1-8.9 years treated with GH. Growth rate and blood testing (calcium, phosphorus, IGF-I, 25(0H)D and PTH) were monitored at diagnostic and every six months until 24 months of treatment. A control group was recruited (247 healthy children, aged 3.8-9.7 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: There were no significant differences in vitamin D deficiency among control (12.5%) and GHD groups (15.3%) before starting treatment. Growth rate and IGF-1 and PTH increased (p < 0.05) during GH treatment, but there were no significant differences in calcium, phosphorus and 25(OH)D. There were no significant differences in growth rate and IGF-1, calcium and phosphorus levels in relation to the seasons along GH treatment. There was no correlation between 25(OH)D and IGF-1 during GH therapy. In every programmed control, patients with vitamin D deficiency showed lower growth rate (p < 0.05) compared to patients with vitamin D insufficiency or sufficiency. CONCLUSION: GH treatment, at least during the first two years, does not modify the vitamin D levels. Vitamin D deficiency could condition the response to GH therapy so vitamin D monitoring should be considered as part of the routine evaluation of children with GH treatment.

Prevalence of hypovitaminosis D and associated factors in obese Spanish children.

BACKGROUND/OBJECTIVES: Vitamin D deficiency may contribute to endocrine health and disease (diabetes, autoimmune thyroid diseases, polycystic ovarian syndrome, etc.). The aim of this study was to determine the prevalence and specific factors for hypovitaminosis D among children stratified by body mass index (BMI) in Northern Spain. SUBJECTS/METHODS: A cross-sectional clinical (sex, age, season of study visit, place of residence and BMI) and blood testing (calcium, phosphorous, calcidiol and parathyroid hormone (PTH)) were accomplished in 546 Caucasian individuals (aged 3.2-15.8 years). The BMI (Z-score) allowed establishing four groups: normal, overweight, obesity and severe obesity. The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: Calcidiol levels were significantly higher in normal and overweight groups (P=0.001), whereas PTH levels were significantly higher in obesity and severe obesity groups (P=0.001). Hypovitaminosis D prevalence was significantly higher in severe obesity (81.1%) and obesity (68.2%) groups, whereas was lowest in overweight (55%) and normal (58.1%) groups (P=0.001). There was a negative correlation between calcidiol and PTH levels (P<0.01). Female (90.9%), adolescent group (88,2%), winter (100%) and autumn (82.4%) time and urban residence (94.1%) imply a higher prevalence of hypovitaminosis D in subjects with severe obesity (P<0.001). Female, puberal age, autumn, winter and spring time, urban residence and severe obesity were found to be independent predictors for hypovitaminosis D. CONCLUSIONS: Severe obesity could be considered as an associated factor for vitamin D deficiency, and, owing to its high prevalence, the implementation of systematic screening and hypovitaminosis treatment programs would be particularly useful.

[Anthropometric secular changes among two cohorts of healthy infants aged 0-2 years born in 1993 and 2009]. / Cambios seculares antropométricos entre dos cohortes de niños sanos de 0 a 2 años de edad nacidos en 1993 y 2009.

OBJECTIVE: To accomplish a longitudinal anthropometric study in two different cohorts of healthy children (from birth to 2 years of age) who were born in 1993 and 2009. The possible appearance of secular changes within this period is analyzed. MATERIAL AND METHODS: Weight, height and body mass index (BMI) at birth and ages 3, 6, 9, 12, 15, 18 and 24 months in two different cohorts of healthy children born in 1993 (459 males and 425 females) and 2009 (460 males and 481 females) have been registered and analyzed. RESULTS: Average values for weight and BMI in 1993 cohort were significantly higher (p < 0.05) than those in 2009 cohort beyond 6 months of age in females and 9 months of age in males, up to 24 months of age. There were no statistically significant differences among average values of registered height in every period of age within both cohorts. CONCLUSIONS: The comparison of anthropometric data among two different cohorts of healthy children born in 1993 and 2009 in similar social and health conditions shows a "secular change" in a negative sense regarding weight and BMI, without affecting height.

Objetivo: Realizar un estudio antropométrico longitudinal en dos cohortes de niños sanos, desde el nacimiento hasta los 2 años de edad, nacidos en los años 1993 y 2009; analizándose los cambios seculares que pudieran haberse dado durante este intervalo de tiempo. Material y métodos: Se han registrado retrospectivamente y comparado los pesos, tallas e índice de masa corporal (IMC) al nacimiento y a las edades de 3, 6, 9, 12, 15, 18 y 24 meses, de dos cohortes de niños sanos nacidos en los años 1993 (459 varones y 425 mujeres) y 2009 (460 varones y 481 mujeres). Resultados: Los valores medios de los pesos e IMC de la cohorte del año 1993 eran significativamente superiores (p < 0,05) respecto a los de la cohorte del año 2009 a partir de los 6 meses de edad en las mujeres y de los 9 meses de edad en los varones y hasta los 24 meses de edad. En ambos sexos, no existían diferencias estadísticamente significativas entre los valores medios de las tallas registradas en cada una de las edades consideradas entre ambas cohortes. Conclusiones: Al comparar los datos antropométricos entre dos cohortes de niños sanos nacidos en los años 1993 y 2009 en condiciones socio-sanitarias similares se ha advertido un "cambio secular" con sentido negativo en lo que respecta al peso e IMC, sin afectarse la talla.

Cambios seculares antropométricos entre dos cohortes de niños sanos de 0 a 2 años de edad nacidos en 1993 y 2009 / Anthropometric secular changes among two cohorts of healthy infants aged 0-2 years born in 1993 and 2009

Objetivo: Realizar un estudio antropométrico longitudinal en dos cohortes de niños sanos, desde el nacimiento hasta los 2 años de edad, nacidos en los años 1993 y 2009; analizándose los cambios seculares que pudieran haberse dado durante este intervalo de tiempo. Material y métodos: Se han registrado retrospectivamente y comparado los pesos, tallas e índice de masa corporal (IMC) al nacimiento y a las edades de 3, 6, 9, 12, 15, 18 y 24 meses, de dos cohortes de niños sanos nacidos en los años 1993 (459 varones y 425 mujeres) y 2009 (460 varones y 481 mujeres). Resultados: Los valores medios de los pesos e IMC de la cohorte del año 1993 eran significativamente superiores (p < 0,05) respecto a los de la cohorte del año 2009 a partir de los 6 meses de edad en las mujeres y de los 9 meses de edad en los varones y hasta los 24 meses de edad. En ambos sexos, no existían diferencias estadísticamente significativas entre los valores medios de las tallas registradas en cada una de las edades consideradas entre ambas cohortes. Conclusiones: Al comparar los datos antropométricos entre dos cohortes de niños sanos nacidos en los años 1993 y 2009 en condiciones socio-sanitarias similares se ha advertido un "cambio secular" con sentido negativo en lo que respecta al peso e IMC, sin afectarse la talla (AU)

Objective: To accomplish a longitudinal anthropometric study in two different cohorts of healthy children (from birth to 2 years of age) who were born in 1993 and 2009. The possible appearance of secular changes within this period is analyzed. Material and methods: Weight, height and body mass index (BMI) at birth and ages 3, 6, 9, 12, 15, 18 and 24 months in two different cohorts of healthy children born in 1993 (459 males and 425 females) and 2009 (460 males and 481 females) have been registered and analyzed. Results: Average values for weight and BMI in 1993 cohort were significantly higher (p < 0.05) than those in 2009 cohort beyond 6 months of age in females and 9 months of age in males, up to 24 months of age. There were no statistically significant differences among average values of registered height in every period of age within both cohorts. Conclusions: The comparison of anthropometric data among two different cohorts of healthy children born in 1993 and 2009 in similar social and health conditions shows a "secular change" in a negative sense regarding weight and BMI, without affecting height (AU)

Evolución natural del exceso de peso corporal (sobrepeso y obesidad) / Natural evolution of excess body weight (overweight and obesity) in children

Objetivo: Analizar la evolución cronológica del exceso de peso corporal (sobrepeso y obesidad) para sensibilizar a los diferentes ámbitos de intervención (familiar, escolar, empresarial y sanitario) a adoptar las medidas oportunas. Material y métodos: Se han registrado retrospectivamente pesos, tallas e índice de masa corporal (IMC) de 604 sujetos sanos (307 varones y 297 mujeres) al nacimiento y a las edades de 1, 2, 3, 4, 6, 8, 10, 12 y 14 años. Se ha calculado el exceso de peso corporal con las referencias nacionales de Ferrández et al. Resultados: La prevalencia del exceso de peso corporal a los 14 años de edad era significativamente superior (p < 0,05) en los varones (29%) respecto a las mujeres (12,8%). En ambos sexos, el IMC (kg/m2) era significativamente superior (p < 0,05) en cada una de las edades consideradas, salvo al nacimiento y al año de edad, en los pacientes con exceso de peso corporal a los 14 años de edad respecto al grupo normonutrido a la misma edad. En los grupos que a los 14 años tenían exceso de peso corporal, el IMC (Z-score) ya alcanzaba rango de sobrepeso u obesidad a los 4 años de edad, que se iría incrementando progresivamente. Conclusiones: El exceso de peso corporal comenzaría en edades tempranas de la vida, cuando la dieta del niño depende casi exclusivamente de los hábitos familiares, que luego se agravaría con la escolarización y, por último, en la adolescencia tendría lugar un desproporcionado incremento ponderal probablemente relacionado con unos hábitos alimentarios y estilos de vida adquiridos poco saludables (AU)

Objective: To analyze the chronological evolution of excess body weight (overweight and obesity)in order to raise public awareness within the different areas of intervention (family, school, business environment, health services) and to take effective actions. Material and methods: Weight, height and body mass index (BMI) of 604 healthy subjects (307males and 297 females) have been recorded at birth and at the age of 1, 2, 3, 4, 6, 8, 10, 12 and14 years. The excess body weight has been calculated according to national references from Ferrández et al. Results: Prevalence of excess body weight at age 14 years was significantly higher (P<.05) in males (29%) than in females (12.8%). BMI (kg/m2) was significantly higher (P<.05) for both sexes in every age period, except for birth and age 1 year, in those patients with excess body weight at age 14, with respect to patients with normal nutritional status of the same age. Those groups with excess body weight at age 14 showed a BMI (Z-score) reaching overweight or obesity levels at age 4, and progressively increasing. Conclusions: Excess body weight probably starts at early stages in life, when dietary habits of the child depends almost exclusively on family habits, and may be aggravated during school attendance. Finally, a disproportionate weight increase occurs in adolescence that is probably related to unhealthy dietary habits and way of life (AU)

[Natural evolution of excess body weight (overweight and obesity) in children]. / Evolución natural del exceso de peso corporal (sobrepeso y obesidad).

OBJECTIVE: To analyze the chronological evolution of excess body weight (overweight and obesity) in order to raise public awareness within the different areas of intervention (family, school, business environment, health services) and to take effective actions. MATERIAL AND METHODS: Weight, height and body mass index (BMI) of 604 healthy subjects (307 males and 297 females) have been recorded at birth and at the age of 1, 2, 3, 4, 6, 8, 10, 12 and 14 years. The excess body weight has been calculated according to national references from Ferrández et al. RESULTS: Prevalence of excess body weight at age 14 years was significantly higher (P<.05) in males (29%) than in females (12.8%). BMI (kg/m2) was significantly higher (P<.05) for both sexes in every age period, except for birth and age 1 year, in those patients with excess body weight at age 14, with respect to patients with normal nutritional status of the same age. Those groups with excess body weight at age 14 showed a BMI (Z-score) reaching overweight or obesity levels at age 4, and progressively increasing. CONCLUSIONS: Excess body weight probably starts at early stages in life, when dietary habits of the child depends almost exclusively on family habits, and may be aggravated during school attendance. Finally, a disproportionate weight increase occurs in adolescence that is probably related to unhealthy dietary habits and way of life.

Magnetic resonance imaging abnormalities in children with epilepsy.

BACKGROUND AND PURPOSE: The aim of this study is to analyze the proportional distribution of epilepsy and epileptic syndromes in children and to describe the magnetic resonance imaging (MRI) abnormalities found in these patients. METHODS: Data from 457 children aged 1 month to 15 years at the time of diagnosis of epilepsy were recorded. A routine MRI has been requested in all patients with epilepsy at diagnosis according to a standardized pediatric seizure protocol. Abnormalities on MRI were classified as either significant or non-significant (standardized scoring system). International League Against Epilepsy criteria were used for diagnoses. RESULTS: The prevalence of significant MRI abnormalities was 21.9% (in infants 42.3%, in childhood 18.2%, and in adolescents 15.9%). The most common abnormalities included white-matter lesions (27.6%), volume loss (19.6%), gray-matter lesions (19.6%), and ventricular enlargement (12%). CONCLUSIONS: The use of MRI and a reliable standardized scoring system at diagnosis of epilepsy in children identified a high rate of significant abnormalities findings. This may have important implications for practice guidelines in this population.

Infantile convulsions with mild gastroenteritis: a retrospective study of 25 patients.

BACKGROUND: The aim of this study was to analyze the epidemiologic, clinical, and evolutional characteristics in patients who presented convulsions with mild gastroenteritis (CwG) to facilitate the diagnosis in daily clinical practice. METHODS: Twenty-five medical records of patients diagnosed with CwG were reviewed, and the epidemiological and clinical features, results of complementary studies, and evolutional data were collected. RESULTS: Age of onset ranged between 12 and 24 months in 76% of patients. Female/male ratio was 2.6 (18 women and seven men). Seizures were mostly brief (<5 min) and apparently generalized, and often repetitive occurring in cluster (2.2 seizures per episode). One patient with status epilepticus was recorded. The average interval between the onset of gastroenteritis and seizures was 3.8 days, even though seizure preceded diarrhea in three cases. Mean rectal temperature at the moment of seizure was 37.1°C. Rotavirus antigen was positive in stool in 17 episodes (55.8%). There were no abnormalities in serum biochemistry tests and cerebrospinal fluid studies. Four patients showed anomalies in the interictal electroencephalogram. The period of follow-up was 4.2 years. Five patients (20%) experienced recurrences when suffering a new gastroenteritis episode. One patient developed epilepsy during the follow-up period. CONCLUSIONS: CwG would constitute a well-differentiated convulsive syndrome. Prognosis is excellent, but a relatively important percentage of patients relapse when suffering a new diarrhea episode.

[Rolandic epilepsy: epidemiological and clinical characteristics and outcome]. / Epilepsia rolándica: características epidemiológicas, clínicas y evolutivas.

OBJECTIVE: To analyse the epidemiological, clinical and developmental characteristics of Rolandic epilepsy as an aid to its suspected diagnosis in daily clinical practice. PATIENTS AND METHODS: The medical records of 56 patients with Rolandic epilepsy were reviewed in order to collect epidemiological and clinical features, results of complementary examinations and developmental data. The criteria defined by the International League Against Epilepsy (ILAE) were used in the diagnosis. RESULTS: Mean age at diagnosis was 7.7 years. In all, 62.5 % were diagnosed at school age, with a higher prevalence of males (58.9 %). Seizures occurred during sleep in 84.4 % of patients, and they were mainly characterised by hemifacial seizures with eye deviation and/or headaches (76.8 %), hypersalivation (44.6 %), guttural sounds (30.6 %), secondary generalised tonic-clonic (35.7 %) and/or unilateral clonic or tonic seizures (26.8 %), dysarthria (17.9 %) and unilateral paresthesias (16.1 %). Inter-ictal EEG showed paroxysms in the centrotemporal regions, frequently unilateral (78.6 %). Of all recurrences, 50.7 % occurred during the first 12 months after diagnosis, 24.6 % between 12 and 24 months after diagnosis, and 24.6 % between 2 and 4 years of follow up. Two patients with atypical progression were recorded: a case with epilepsy with continuous spikes and waves during slow-wave sleep, and another case with a Landau-Kleffner syndrome. CONCLUSIONS: Rolandic epilepsy is a common type of epilepsy in the pediatric age group and generally begins at school-aged children. Its semiological sequence is fairly characteristic, and finding centrotemporal spikes is considered as necessary for the syndromic diagnosis. The prognosis is excellent; however, as a few patients may progress to atypical outcomes and/or neuropsychological deficits, a rigorous developmental control of these patients should be of the highest priority.

Epilepsia rolándica: características epidemiológicas, clínicas y evolutivas / Rolandic epilepsy: Epidemiological and clinical characteristics and outcome

Objetivo: Analizar las características epidemiológicas, clínicas y evolutivas de la epilepsia rolándica para facilitar su sospecha diagnóstica en la práctica clínica diaria. Pacientes y métodos: Se han revisado 56 historias clínicas de pacientes con epilepsia rolándica y se han registrado características epidemiológicas y clínicas, exploraciones complementarias y datos evolutivos. Los criterios diagnósticos aplicados fueron los de la International League Against Epilepsy. Resultados: La edad media al diagnóstico era de 7,7 años. El 62,5 % fueron diagnosticados en edad escolar, con mayor prevalencia del sexo masculino (58,9 %). El 80,4 % de los pacientes tuvieron crisis exclusivamente durante el sueño caracterizadas por contracciones hemifaciales con desviación ocular y/o cefálica (76,8 %), sialorrea (44,6 %), sonidos guturales (30,6 %), crisis motoras secundariamente generalizadas (35,7 %) y/o hemicorporales (26,8 %), disartria (17,9 %) y parestesias unilaterales (16,1 %). Se constataron paroxismos de localización centrotemporal, preferentemente unilaterales (78,6 %). El 50,7 % de las recurrencias se dieron en los primeros 12 meses tras el diagnóstico, el 24,6 % entre los 12 y 24 meses, y el 24,6 % restante entre los 2 y 4 años. Se objetivaron 2 casos de evolución atípica: uno de actividad continua de punta-onda en sueño lento, y otro de afasia adquirida (síndrome de Landau-Kleffner). Conclusiones: La epilepsia rolándica constituye un síndrome epiléptico específicamente pediátrico que afecta preferentemente a varones en edad escolar. Su secuencia semiológica es bastante característica, y es imprescindible documentar paroxismos centrotemporales para su diagnóstico. Su pronóstico es excelente; sin embargo, dado que algunos pacientes cursan una evolución atípica y/o una afectación cognitiva transitoria sería conveniente mantener un riguroso control evolutivo (AU)

Objective: To analyse the epidemiological, clinical and developmental characteristics of Rolandic epilepsy as an aid to its suspected diagnosis in daily clinical practice. Patients and methods: The medical records of 56 patients with Rolandic epilepsy were reviewed in order to collect epidemiological and clinical features, results of complementary examinations and developmental data. The criteria defined by the International League Against Epilepsy (ILAE) were used in the diagnosis. Results: Mean age at diagnosis was 7.7 years. In all, 62.5 % were diagnosed at school age, with a higher prevalence of males (58.9 %). Seizures occurred during sleep in 84.4 % of patients, and they were mainly characterised by hemifacial seizures with eye deviation and/or headaches (76.8 %), hypersalivation (44.6 %), guttural sounds (30.6 %), secondary generalised tonic-clonic (35.7 %) and/or unilateral clonic or tonic seizures (26.8 %), dysarthria (17.9 %) and unilateral paresthesias (16.1 %). Inter-ictal EEG showed paroxysms in the centrotemporal regions, frequently unilateral (78.6 %). Of all recurrences, 50.7 % occurred during the first 12 months after diagnosis, 24.6 % between 12 and 24 months after diagnosis, and 24.6 % between 2 and 4 years of follow up. Two patients with atypical progression were recorded: a case with epilepsy with continuous spikes and waves during slow-wave sleep, and another case with a Landau-Kleffner syndrome. Conclusions: Rolandic epilepsy is a common type of epilepsy in the pediatric age group and generally begins at school-aged children. Its semiological sequence is fairly characteristic, and finding centrotemporal spikes is considered as necessary for the syndromic diagnosis. The prognosis is excellent; however, as a few patients may progress to atypical outcomes and/or neuropsychological deficits, a rigorous developmental control of these patients should be of the highest priority (AU)

Cefaleas agudas recurrentes en la infancia y adolescencia: análisis crítico de los criterios diagnósticos de la migraña / Acute recurrent headaches in childhood and adolescence: a critical study of the diagnostic criteria for migraine

Objetivo: Estudiar las características epidemiológicas y clínicas de la migraña y la cefalea tensional en la edad pediátrica y analizar la validez de los criterios utilizados en el diagnóstico de la migraña. Pacientes y métodos: Se han revisado 300 historias de pacientes con cefaleas agudas recurrentes, recogiéndose datos epidemiológicos y clínicos y, en su caso, exámenes complementarios. Los criterios diagnósticos aplicados fueron los de la International Headache Society (IHS). Se han calculado la sensibilidad, la especificidad y el cociente de verosimilitud de los criterios de Vahlquist, Prensky y de la IHS para la migraña. Resultados: El 98,3% de los casos eran cefaleas primarias: migraña (50%) o cefalea tensional (48,3%). El 32,7% de las migrañas tenían aura. La edad de inicio de la migraña era de8,7 años, y de la cefalea tensional 9,7 años (p <0,05), sin diferencias entre sexos. No obstante, en la migraña con aura la edad de comienza (9,8 años) y la prevalencia del sexo femenino (63,3%) eran significativamente mayores (p <0,05). En la cefalea tensional había una mayor prevalencia (p <0,05) de sexo femenino, procedencia urbana y rendimiento escolar excelente; y en la migraña había mayor prevalencia (p <0,05) de antecedentes familiares. En la migraña el dolor era unilateral (44,4%) o bilateral (55,9%), pulsátil (87,5%), empeoraba con el ejercicio (68,8%), interrumpía la actividad diaria (65,3%), y se acompañaba de vómitos (71%) y fotofobia/sonofobia (67%). En la cefalea tensional era bilateral (81,8%), opresivo (85,3%),apenas empeoraba con el ejercicio (22,3%) o interrumpía la actividad diaria (12,1%) y, ocasionalmente, se acompañaba de vómitos (7,3%) o fotofobia/sonofobia (18,9%). El carácter pulsátil, los vómitos, la unilateralidad y la intensidad moderada severa eran los ítems de mayor capacidad discriminatoria; los criterios de la IHS eran los de mayor validez diagnóstica. Los exámenes complementarios no modificaron el diagnóstico. Conclusiones: La migraña y la cefalea tensional son las causas más frecuentes de cefaleas agudas recurrentes en la edad pediátrica, de inicio preferentemente en la edad escolar. Aunque los criterios de la IHS permiten su diagnóstico diferencial, el control evolutivo sería la prueba de referencia para validarlos criterios diagnósticos(AU)

Objective: To study the epidemiological and clinical characteristics of migraine and tension-type headache in paediatrics, and to analyze the validity of criteria used to diagnose migraine. Patients and methods: Information on epidemiological and clinical characteristics, physical examination and complementary examinations, when performed, were collected from medical records of 300 children with acute recurrent headache. The criteria defined by the International Headache Society (IHS) were used in the diagnostic. The sensitivity, specificity and likelihood ratio of the Vahlquist, Prensky and IHS criteria for migraine were all calculated. Results: A total of 98.3% of the patients had primary headache: migraine (50%) and tensional-type headache (48.3%). Thirty two percent of those with migraine had migraine with aura. The mean age at onset was 8.7 years in migraine and 9.7 years in tensional type headache (p <0.05), with no differences between sexes. Nevertheless , in migraine aura the age of onset (9.8 years) and prevalence of females (63.3%) were significantly higher (p <0.05). Children with tensional-type headache showed a higher prevalence (p <0.05) of female sex, urban origin and excellent academic performance. Children with migraine had a higher prevalence (p<0.05) of positive family history. In migraine, the pain was unilateral (44.4%) or bilateral (55.9%), pulsatile (87.5%), aggravated by physical activity (68.8%), caused lost days at school (65.3%) and were usually accompanied by vomiting (71%) and photophobia/phonophobia (67%). In the tension-type headaches were bilateral (81.8%) and oppressive (85.3%), they were less frequently aggravated by physical activity (22.3%) or inhibited activities (12.1%)and occasionally accompanied by vomiting (7.3%) and photophobia/phonophobia (18.9%). The pulsating quality, vomiting, one-sidedness and moderate to severe intensity were the items that displayed the greatest discriminating capacity and the IHS criteria were those with the highest diagnostic validity. Diagnosis was not altered by the complementary examinations. Conclusions: Migraine and tension-type headache are a common cause of recurrent headache in paediatric age. Onset usually occurs in school-age children. The IHS criteria for the differential diagnosis of headache in children are useful, although monitoring its progress would be the gold standard to validate diagnostic criteria(AU)

Panayiotopoulos syndrome: epidemiological and clinical characteristics and outcome.

The aim of this study was to analyse the epidemiological, clinical and evolutional characteristics of Panayiotopoulos syndrome (PS) in order to facilitate the diagnosis in daily clinical practice. Thirty-seven medical records of patients diagnosed with PS were reviewed and the epidemiological and clinical features, results of complementary studies and evolutional data were collected. Mean age at diagnosis was 5.4 years. Female/male ratio was 2.1. The majority of seizures occurred during sleep (67.2%). They usually begin with autonomic manifestations or vomiting (70.1%). Ictal eye and/or cephalic deviation and progression to partial or generalized convulsions were also quite frequent. EEG showed occipital spikes in 28 patients (75.7%). Besides, 71.3% of recurrences were observed in the first 6 months after diagnosis, and 82.9% of the patients had no seizures beyond 2 years from diagnosis. One patient with an atypical development was recorded. The PS is a relatively frequent epileptic syndrome in paediatric age, especially in pre-school children. Although its semiological sequence is fairly typical, the unspecific clinical and neurological characteristics complicate the diagnostic suspicion. Prognosis is excellent; however, it would be convenient to keep a strict evolutional follow-up in these patients as an atypical evolution might occur.

[Incidence of epilepsy in 0-15 year-olds]. / Incidencia de la epilepsia infantil.

OBJECTIVE: To calculate the annual incidence rate of epilepsy, as well as the relative distribution of the different forms of epilepsy and epileptic syndromes in infants and children. PATIENTS AND METHODS: All incident cases in infants and children aged less than 15 years living in Navarre (Spain) with newly diagnosed epilepsy (2002 to 2005) were prospectively registered. Epidemiological and clinical data and the results of complementary investigations were recorded. The criteria for epileptic seizures and epileptic syndromes of the International League Against Epilepsy (ILAE) and the ILAE guidelines for epidemiological studies were applied. RESULTS: One hundred ninety-nine patients were diagnosed with childhood epilepsy (22 infants, 66 young children, 54 school children and 49 adolescents). The annual incidence rate was 62.6 cases per 100,000 (95 % CI: 62.3-62.9). The incidence rate was highest during the first year of life (95.3 per 100,000) and gradually decreased until adolescence (48.7/100,000). Focal epilepsy was found in 55 %, generalized epilepsy in 42.9 %, and undetermined epilepsy in 2.1 %. In infants, the most prevalent epileptic syndromes were West syndrome (45.5 %), epilepsies associated with specific syndromes (27.5 %), and focal symptomatic epileptic syndromes (13.6 %). In early childhood, the main syndromes were focal symptomatic epilepsy (22.7 %), cryptogenic epilepsy (21.2 %), and Doose syndrome (13.6 %). In schoolchildren, the most frequent syndromes were focal benign epilepsies (27.8 %), cryptogenic epilepsy (18.5 %), and absence epilepsy (18.5 %). In adolescents, the most frequent syndromes were focal cryptogenic epilepsies (27.6 %) and benign epilepsies (18.4 %). CONCLUSIONS: The annual incidence rate of epilepsy in infants and children in Navarre is similar the rates described for other western countries, with the highest incidence rate being found during the first year of life and gradually diminishing until adolescence. Published data concerning the relative frequency of epilepsy and epileptic syndromes are discordant. These discrepancies highlight the difficulty of establishing a syndromic diagnosis in this age group and the need to apply uniform criteria in order to obtain valid and comparable epidemiological data.

[An epidemiological, clinical and developmental study of 37 patients with early-onset benign occipital epilepsy of childhood]. / Estudio epidemiológico, clínico y evolutivo de 37 pacientes con epilepsia occipital benigna infantil de comienzo precoz.

AIM: To analyse the epidemiological, clinical and developmental characteristics of early-onset benign occipital epilepsy of childhood in order to facilitate its diagnostic suspicion in daily clinical practice. PATIENTS AND METHODS: The medical records of 37 patients with early-onset benign occipital epilepsy of childhood were reviewed in order to collect epidemiological and clinical features, results of complementary examinations and developmental data. The diagnostic criteria applied were those of the ILAE (International League Against Epilepsy). RESULTS: The mean age at diagnosis was 5.4 years. In all, 64.9% were diagnosed at a pre-school age, with a greater prevalence of females (67.6%). The mean number of seizures per patient was 3.3 and they were mainly characterised by impaired consciousness (90.3%), vomiting (70.1%), eye deviation and/or headaches (30.6%), and generalised (32.8%) or partial (11.2%) motor crises. Seizures occurred during sleep in 67.2% of cases. In 28 cases (75.7%) occipital paroxysms were observed that coexisted with generalised and/or multifocal paroxysms. Of all recurrences, 71.3% occurred during the first 6 months, and from 2 years onwards 82.9% of the patients had no seizures; no developmental differences were found between treated and non-treated patients. One patient with an atypical development was recorded. CONCLUSIONS: Early-onset benign occipital epilepsy of childhood is relatively frequent at the paediatric age, especially in the pre-school years. Although its semiological sequence is quite characteristic, the fact that it lacks clinical and neurological specificity makes diagnostic suspicion more difficult. Its prognosis is especially favourable; however, since their progress may develop in an atypical manner, a rigorous developmental control of these patients would be of the highest priority.

Incidencia de la epilepsia infantil / Incidence of epilepsy in 0-15 year-olds

Objetivo. Calcular la incidencia anual de la epilepsia, así como la distribución relativa de los distintos tipos de epilepsias y síndromes epilépticos en la población infantil. Pacientes y métodos. Se han registrado de manera prospectiva todos los pacientes menores de 15 años diagnosticados de epilepsia y residentes en Navarra entre enero de 2002 y diciembre de 2005. De cada paciente se recogieron datos epidemiológicos, clínicos y exámenes complementarios. Los criterios diagnósticos aplicados fueron los de la International League Againts Epilepsy (ILAE). Resultados. Fueron diagnosticados 191 casos nuevos de epilepsia infantil (22 lactantes, 66 preescolares, 54 escolares y 49 adolescentes). La incidencia anual fue de 62,6 casos por 100.000 (IC 95 %: 62,3-62,9), con una máxima incidencia en el primer año de vida (95,3/100.000) para luego ir disminuyendo gradualmente hasta la adolescencia (48,7/ 100.000). El 55 % de los pacientes presentaban epilepsias focales, el 42,9 % generalizadas y el 2,1 % de localización indeterminada. En los lactantes, el síndrome de West (45,5 %), las epilepsias asociadas a síndromes específicos (27,3 %) y las epilepsias focales sintomáticas (13,6 %) fueron los síndromes epilépticos más prevalentes. En los preescolares, las epilepsias focales sintomáticas (22,7 %) o criptogénicas (21,2 %) y el síndrome de Doose (13,6 %). En los escolares, las epilepsias focales benignas (27,8 %) y criptogénicas (18,5 %) y las ausencias (18,5 %). Y en los adolescentes, las epilepsias focales criptogénicas (27,6 %) y benignas (18,4 %). Conclusiones. La incidencia anual de la epilepsia infantil en nuestro medio coincide con la descrita en los países occidentales, con una incidencia máxima en el primer año de vida que luego disminuye gradualmente hasta la adolescencia. Los datos publicados respecto a la frecuencia relativa de las epilepsias y síndromes epilépticos son muy discordantes, lo que advierte de la complejidad del diagnóstico sindrómico en la infancia y necesidad de aplicar criterios uniformes en orden a disponer datos epidemiológicos válidos y comparables

Objective. To calculate the annual incidence rate of epilepsy, as well as the relative distribution of the different forms of epilepsy and epileptic syndromes in infants and children. Patients and methods. All incident cases in infants and children aged less than 15 years living in Navarre (Spain) with newly diagnosed epilepsy (2002 to 2005) were prospectively registered. Epidemiological and clinical data and the results of complementary investigations were recorded. The criteria for epileptic seizures and epileptic syndromes of the International League Against Epilepsy (ILAE) and the ILAE guidelines for epidemiological studies were applied. Results. One hundred ninety-nine patients were diagnosed with childhood epilepsy (22 infants, 66 young children, 54 school children and 49 adolescents). The annual incidence rate was 62.6 cases per 100,000 (95 % CI: 62.3-62.9). The incidence rate was highest during the first year of life (95.3 per 100,000) and gradually decreased until adolescence (48.7/100,000). Focal epilepsy was found in 55 %, generalized epilepsy in 42.9 %, and undetermined epilepsy in 2.1 %. In infants, the most prevalent epileptic syndromes were West syndrome (45.5 %), epilepsies associated with specific syndromes (27.5 %), and focal symptomatic epileptic syndromes (13.6 %). In early childhood, the main syndromes were focal symptomatic epilepsy (22.7 %), cryptogenic epilepsy (21.2 %), and Doose syndrome (13.6 %). In schoolchildren, the most frequent syndromes were focal benign epilepsies (27.8 %), cryptogenic epilepsy (18.5 %), and absence epilepsy (18.5 %). In adolescents, the most frequent syndromes were focal cryptogenic epilepsies (27.6 %) and benign epilepsies (18.4 %). Conclusions. The annual incidence rate of epilepsy in infants and children in Navarre is similar the rates described for other western countries, with the highest incidence rate being found during the first year of life and gradually diminishing until adolescence. Published data concerning the relative frequency of epilepsy and epileptic syndromes are discordant. These discrepancies highlight the difficulty of establishing a syndromic diagnosis in this age group and the need to apply uniform criteria in order to obtain valid and comparable epidemiological data

Estudio epidemiológico, clínico y evolutivo de 37 pacientes con epilepsia occipital benigna infantil de comienzo precoz / An epidemiological, clinical and developmental study of 37 patients with early-onset benign occipital epilepsy of childhood

Objetivo. Analizar las características epidemiológicas, clínicas y evolutivas de la epilepsia occipital benigna infantil de comienzo precoz para facilitar su sospecha diagnóstica en la práctica clínica diaria. Pacientes y métodos. Se han revisado 37 historias clínicas de pacientes con epilepsia occipital benigna infantil de comienzo precoz, recogiéndose características epidemiológicas y clínicas, exploraciones complementarias y datos evolutivos. Los criterios diagnósticos aplicados fueron los de la ILAE (International League Against Epilepsy). Resultados. La edad media al diagnóstico era de 5,4 años. El 64,9% fueron diagnosticados en edad preescolar, con mayor prevalencia del sexo femenino (67,6%). El número medio de crisis por paciente era de 3,3, y se caracterizaban preferentemente por alteración de la conciencia (90,3%), vómitos (70,1%), desviación ocular y/o cefálica (30,6%), y crisis motoras generalizadas (32,8%) o parciales (11,2%). El 67,2% de las crisis fueron durante el sueño. En 28 casos (75,7%) se objetivaron paroxismos occipitales que coexistían con paroxismos generalizados y/o multifocales. El 71,3% de las recurrencias se dieron en los primeros 6 meses, y a partir de los 2 años el 82,9% de los pacientes no tuvieron crisis, no encontrándose diferencias evolutivas entre pacientes tratados y no tratados. Se registró un paciente con evolución atípica. Conclusiones. La epilepsia occipital benigna infantil de aparición precoz es relativamente frecuente en la edad pediátrica, especialmente en edad preescolar. Aunque su secuencia semiológica es bastante característica, su inespecificidad clínica y neurofisiológica dificulta la sospecha diagnóstica. Su pronóstico es excelente; sin embargo, dado que podrían cursar de forma atípica, sería prioritario un riguroso control evolutivo de estos pacientes (AU)

Aim. To analyse the epidemiological, clinical and developmental characteristics of early-onset benign occipital epilepsy of childhood in order to facilitate its diagnostic suspicion in daily clinical practice. Patients and methods. The medical records of 37 patients with early-onset benign occipital epilepsy of childhood were reviewed in order to collect epidemiological and clinical features, results of complementary examinations and developmental data. The diagnostic criteria applied were those of the ILAE (International League Against Epilepsy). Results. The mean age at diagnosis was 5.4 years. In all, 64.9% were diagnosed at a pre-school age, with a greater prevalence of females (67.6%). The mean number of seizures per patient was 3.3 and they were mainly characterised by impaired consciousness (90.3%), vomiting (70.1%), eye deviation and/or headaches (30.6%), and generalised (32.8%) or partial (11.2%) motor crises. Seizures occurred during sleep in 67.2% of cases. In 28 cases (75.7%) occipital paroxysms were observed that coexisted with generalised and/or multifocal paroxysms. Of all recurrences, 71.3% occurred during the first 6 months, and from 2 years onwards 82.9% of the patients had no seizures; no developmental differences were found between treated and non-treated patients. One patient with an atypical development was recorded. Conclusions. Early-onset benign occipital epilepsy of childhood is relatively frequent at the paediatric age, especially in the pre-school years. Although its semiological sequence is quite characteristic, the fact that it lacks clinical and neurological specificity makes diagnostic suspicion more difficult. Its prognosis is especially favourable; however, since their progress may develop in an atypical manner, a rigorous developmental control of these patients would be of the highest priority (AU)

[A descriptive study of childhood epilepsy]. / Estudio descriptivo de la epilepsia infantil.

AIM: To analyse the epidemiological characteristics and the relative distribution of the different types of epilepsy and epileptic syndromes in the childhood population. PATIENTS AND METHODS: We reviewed the medical histories of 365 patients (192 males and 173 females) with epilepsy. Epidemiological and clinical data were collected, together with information from complementary examinations. The diagnostic criteria applied were those of the International League Against Epilepsy (ILAE). RESULTS: The mean age at diagnosis was 5.9 years and the mean follow-up time was 4.6 years. A personal and/or familial history of febrile convulsions was reported in 13.4% of cases and 23.5% had a history of epilepsy in the family. The aetiology was idiopathic in 166 cases (45.5%), cryptogenic in 106 (29%) and symptomatic in 93 (25.5%). Of the total number of patients, 52.9% reported having focal epilepsies, they were generalised in 43.6% and 3.5% had epilepsies with an undetermined localisation. In each age group the most common epileptic syndromes were: in infants, West's syndrome (34.1%) and symptomatic focal epilepsies (24.4%); in preschoolers, idiopathic focal (21.3%) or cryptogenic (17.7%) and myoclonic-astatic epilepsies (12.8%); in school-age children, idiopathic focal epilepsies (27.3%) and absences (24.5%); and in teenagers, cryptogenic (26.6%) and idiopathic focal epilepsies (23.4%). CONCLUSIONS: The initial distinction between epileptic syndromes is usually difficult to establish and developmental monitoring is essential for reaching a definitive diagnosis and a classification of their syndromes. Age appears to be a determining factor in the clinical expression of the different types of childhood epilepsy, and the relative distribution of the epileptic syndromes is different in each age group.