Focal status epilepticus: a review of pharmacological treatment.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency associated with high morbidity and mortality. One prognostic factor is the type of SE. The purpose of this review is to analyse the most recent recommendations of different scientific societies and expert groups on the treatment of SE, and the latest studies, to assess the literature on the management of focal SE. METHODS: We searched PubMed for studies published between 1 August 2008 and 1 August 2018 on the pharmacological treatment of focal SE and its different types in adults. RESULTS: We identified 29 publications among reviews, treatment guidelines, meta-analyses, clinical trials, and case series on the treatment of SE. Only 3 of them accounted for whether SE was focal or generalised; 4 focused exclusively on focal SE, and 7 differentiated between convulsive and non-convulsive SE and also record the presence of focal seizures. Treatment recommendations for focal SE do not differ from those of generalised SE in stages I and II: initially intravenous lorazepam or diazepam, if the intravenous route is available, and otherwise intramuscular midazolam, followed by intravenous phenytoin, valproate, levetiracetam, or lacosamide if seizures persist. Use of anaesthetic drugs should be delayed for as long as possible in patients with refractory focal SE. CONCLUSIONS: The available scientific evidence is insufficient to claim that pharmacological treatment of focal SE should be different from treatment for generalised SE. More studies with a greater number of patients are needed.

Estatus epiléptico focal: revisión del tratamiento farmacológico / Focal status epilepticus: a review of pharmacological treatment

Introducción: El estatus epiléptico (EE) es una urgencia neurológica asociada a una elevada mortalidad y morbilidad. Uno de los factores pronósticos es el tipo de EE. El objetivo de este trabajo es analizar las últimas recomendaciones de las distintas sociedades científicas y grupos de expertos sobre el tratamiento del EE, así como los estudios más recientes, para evaluar las referencias sobre el manejo del EE de tipo focal.MétodosSe realizó una búsqueda en PubMed entre el 01/08/2008 y el 01/08/2018 sobre el tratamiento farmacológico del EE focal y sus distintos tipos en adultos.ResultadosSe encontraron 29 publicaciones entre revisiones, guías terapéuticas, metaanálisis, ensayos clínicos y estudios de casos sobre el tratamiento del EE. De estas, solamente 3 tienen en cuenta si el EE es focal o generalizado, 4 se centran exclusivamente en EE focales y 7 diferencian entre EE convulsivo o no convulsivo especificando si incluyen crisis focales. Las recomendaciones terapéuticas para un EE focal no difieren de las de un EE generalizado en las fases I y II: inicialmente lorazepam o diazepam intravenoso si hay acceso venoso o midazolam intramuscular en caso contrario, seguido de fenitoína, valproato, levetiracetam o lacosamida intravenosos si persisten las crisis. En EE focales refractarios se recomienda retrasar en lo posible el inicio de fármacos anestésicos.ConclusionesActualmente no disponemos de suficiente evidencia científica para afirmar que el tratamiento farmacológico del EE focal debe ser distinto al del EE generalizado. Son necesarios más registros con un amplio número de pacientes. (AU)

Introduction: Status epilepticus (SE) is a neurological emergency associated with high morbidity and mortality. One prognostic factor is the type of SE. The purpose of this review is to analyse the most recent recommendations of different scientific societies and expert groups on the treatment of SE, and the latest studies, to assess the literature on the management of focal SE.MethodsWe searched PubMed for studies published between 1 August 2008 and 1 August 2018 on the pharmacological treatment of focal SE and its different types in adults.ResultsWe identified 29 publications among reviews, treatment guidelines, meta-analyses, clinical trials, and case series on the treatment of SE. Only 3 of them accounted for whether SE was focal or generalised; 4 focused exclusively on focal SE, and 7 differentiated between convulsive and non-convulsive SE and also record the presence of focal seizures. Treatment recommendations for focal SE do not differ from those of generalised SE in stages I and II: initially intravenous lorazepam or diazepam, if the intravenous route is available, and otherwise intramuscular midazolam, followed by intravenous phenytoin, valproate, levetiracetam, or lacosamide if seizures persist. Use of anaesthetic drugs should be delayed for as long as possible in patients with refractory focal SE.ConclusionsThe available scientific evidence is insufficient to claim that pharmacological treatment of focal SE should be different from treatment for generalised SE. More studies with a greater number of patients are needed. (AU)

Impacto de la alimentación en la lucha contra el insomnio / Nutrition impact on insomnia treatment

INTRODUCCIÓN: el insomnio representa un creciente problema de salud, con repercusiones importantes si es mantenido a largo plazo, ya que puede impactar en la salud del individuo. Actualmente se dispone de técnicas de registro del sueño y cuestionarios de análisis que facilitan la realización de estudios de calidad del sueño. OBJETIVOS: demostrar el impacto de la nutrición en los trastornos del sueño. MÉTODOS: revisión bibliográfica con selección de los artículos más relevantes relacionados con la nutrición y el insomnio. RESULTADOS: existe una relación directa entre ciertos alimentos o suplementos y la calidad y cantidad del sueño, de esta manera se identifican actuaciones nutricionales que pueden ayudar a resolver o a prevenir ciertos trastornos del sueño. Parece clara la relación del triptófano y la melatonina con la inducción y el mantenimiento del sueño, pero las vitaminas, los minerales, los macronutrientes y ciertos hábitos dietéticos pueden influir también de forma directa. CONCLUSIONES: la nutrición parece tener un papel relevante en la prevención y resolución del insomnio, si bien futuros estudios dirigidos han de aportar más evidencia al respecto

INTRODUCTION: insomnia represents a growing and important health problem. If it persists, it could have a negative impact in people's welfare. Nowadays we have a wide range of techniques to measure and analyze sleep quality and quantity. OBJECTIVES: to demonstrate the impact of nutrition in sleep disorders. METHODS: bibliographic review selecting the most relevant papers related to nutrition and its impact on sleep. RESULTS: there is a direct correlation between some food or supplements and sleep quality and quantity. In addition, there exist some nutritional maneuvers that can help to prevent or solve some sleep disorders. The relationship between tryptophan and melatonin with the induction and maintenance of the sleep is clear, but vitamins, minerals, macronutrients and some dietetic habits can also have an impact. CONCLUSIONS: nutrition can have a relevant effect in the prevention and resolution of sleep disorders. Further studies are necessary to assess the real impact of nutritional treatments in insomnia

Patología neurológica por desequilibrio de vitaminas liposolubles / Neurological pathology by liposoluble vitamin-related disorders

INTRODUCCIÓN: en la práctica clínica hospitalaria nos enfrentamos a algunas patologías que tienen origen nutricional. Aunque rara vez, las alteraciones vitamínicas pueden desencadenar trastornos neurológicos graves. OBJETIVOS: mostrar los síntomas neurológicos que pueden darse por alteraciones en los niveles de las vitaminas liposolubles, centrándonos en las vitaminas E y A, mediante la exposición de dos casos clínicos. CONCLUSIONES: es importante tener en mente las alteraciones de vitaminas liposolubles como origen de un trastorno neurológico, a pesar de su escasa frecuencia, habiendo descartado primero las causas más probables

BACKGROUND: the clinicians rarely have to cope with diseases of nutritional origin and scarcely, although possible, vitamins alterations produce neurological symptoms. OBJECTIVES: to show, based on two clinical cases, the neurological symptoms due to liposoluble vitamins alterations, focusing on vitamins E and A. CONCLUSIONS: it is important to consider liposoluble vitamin alterations as a cause of neurological symptoms, despite their rarity, after rolling out the most probable entities

Focal status epilepticus: a review of pharmacological treatment. / Estatus epiléptico focal: revisión del tratamiento farmacológico.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency associated with high morbidity and mortality. One prognostic factor is the type of SE. The purpose of this review is to analyse the most recent recommendations of different scientific societies and expert groups on the treatment of SE, and the latest studies, to assess the literature on the management of focal SE. METHODS: We searched PubMed for studies published between 1 August 2008 and 1 August 2018 on the pharmacological treatment of focal SE and its different types in adults. RESULTS: We identified 29 publications among reviews, treatment guidelines, meta-analyses, clinical trials, and case series on the treatment of SE. Only 3 of them accounted for whether SE was focal or generalised; 4 focused exclusively on focal SE, and 7 differentiated between convulsive and non-convulsive SE and also record the presence of focal seizures. Treatment recommendations for focal SE do not differ from those of generalised SE in stages I and II: initially intravenous lorazepam or diazepam, if the intravenous route is available, and otherwise intramuscular midazolam, followed by intravenous phenytoin, valproate, levetiracetam, or lacosamide if seizures persist. Use of anaesthetic drugs should be delayed for as long as possible in patients with refractory focal SE. CONCLUSIONS: The available scientific evidence is insufficient to claim that pharmacological treatment of focal SE should be different from treatment for generalised SE. More studies with a greater number of patients are needed.

[Epilepsy, Mozart and his sonata K.448: is the «Mozart effect¼ therapeutic?] / Epilepsia, Mozart y su sonata K.448: es terapeutico el «efecto Mozart¼?

AIMS: To present a review of the so-called «Mozart effect¼, to explain why Mozart and his sonata K.448 were chosen, and to review the available literature on the treatment of epilepsy with that sonata. DEVELOPMENT: Profuse literature exists on the cerebral mechanisms that allow us to perceive, process and respond to the musical stimulus. Cerebral plasticity, especially in people with musical training, has also been demonstrated. The «Mozart effect¼ arose from the finding that hearing the sonata K.448 improved cognitive abilities, but the fact that these results may be due not to the music itself but to the listener increasing arousal or enjoyment generated controversy. In this context of debate, a large number of papers about the «Mozart effect¼ in the field of epilepsy were published, and are reviewed in this work. CONCLUSIONS: The «Mozart effect¼ has a scientific basis but its nature limits the methodological quality of the research. The music of Mozart, chosen for its exquisite structure, has been able to increase even more the controversy because also it is of the taste of a great majority. It is still far from being consolidated as a non-pharmacological antiepileptic treatment, but it could increase the scientific evidence with studies whose design minimizes the cited confounding factors.

TITLE: Epilepsia, Mozart y su sonata K.448: es terapeutico el «efecto Mozart¼?Objetivos. Presentar una revision del denominado «efecto Mozart¼, explicar por que se eligio a Mozart y su sonata K.448, y repasar la bibliografia disponible sobre el tratamiento de la epilepsia con la citada sonata. Desarrollo. Existe abundante bibliografia sobre los mecanismos cerebrales que nos permiten percibir, procesar y responder al estimulo musical. Tambien se ha demostrado la plasticidad cerebral que, en especial el adiestramiento musical, desencadena. El «efecto Mozart¼ se planteo a raiz de la comprobacion de que la audicion de la sonata K.448 mejoraba habilidades cognitivas, pero el hecho de que esos resultados se puedan deber no a la musica en si, sino a que el oyente aumente su nivel de alerta o disfrute con ella, genero controversia. En este contexto de debate se publico un volumen importante de estudios sobre el «efecto Mozart¼ en el campo de la epilepsia, que se repasan en este trabajo. Conclusiones. El «efecto Mozart¼ tiene base cientifica, pero su propia naturaleza limita la calidad metodologica de los estudios. La musica de Mozart, elegida por su exquisita estructura, ha podido aumentar aun mas la polemica porque tambien resulta del gusto de una gran mayoria. Aun esta lejos de consolidarse como tratamiento antiepileptico no farmacologico, pero podria aumentar la evidencia cientifica con estudios cuyo diseño minimice los factores de confusion citados.

[Voltage sources in mesial temporal area induced by etomidate]. / Fuentes de voltaje en la region temporal mesial inducidas por etomidato.

INTRODUCTION: It has been recently shown that activation of the EEG by etomidate is a specific and safe technique during the evaluation of patients for epilepsy surgery. AIM: To analyze the pathophysiological properties of interictal activity induced by etomidate and compare with the interictal spontaneous activity. PATIENTS AND METHODS: We studied 13 patients by video-EEG with foramen ovale electrodes. Etomidate (0.1 mg/kg) was injected to activate the epileptogenic region. The activity of foramen ovale electrodes was adjusted to a monopolar voltage source. RESULTS: Interictal activity mediated by etomidate fits well to a monopolar model, in the same way that the basal interictal activity. The voltage sources distribution recorded during the interictal activity and distribution of voltage sources recorded in presence of etomidate have similar topographical properties. The equivalent charge induced by etomidate was higher than the basal one. CONCLUSIONS: The basal and etomidate induced activity have similar electrophysiological properties, suggesting that the same or similar structures are responsible of both. So, etomidate can be used as an specific inductor of EEG activity during presurgical evaluation.

Factores genéticos asociados a la epilepsia del lóbulo temporal / Genetics components in patients with temporal lobe epilepsy

Introducción. La epilepsia es uno de los mayores trastornos neurológicos y afecta a alrededor del 0,5-2% de la población mundial. Se caracteriza por la aparición de crisis espontáneas y recurrentes. Se considera a la epilepsia del lóbulo temporal (ELT) como un síndrome adquirido multifactorial, que aparece como un efecto secundario a diferentes lesiones. Los avances realizados en biología molecular han facilitado la detección de numerosas alteraciones en genética molecular que pueden tener un efecto patógeno en las ELT. Recientemente, numerosos autores muestran evidencias de la existencia de componentes genéticos como origen de algunos tipos de ELT. Desarrollo. Se plantea como objetivo revisar las mutaciones y los polimorfismos relacionados con la epilepsia del lóbulo temporal que se han descrito en la literatura científica y su contribución a la fisiopatología de la epileptogénesis. Se revisan los genes LGI1, de la interleucina-1beta, de la prodinorfina, PRNP, el que codifica para el receptor GABAB tipo 1, SCN1A, SCN1B, KCNA1, KCND2 y ApoE. Conclusión. La ELT es una enfermedad compleja que puede depender tanto de la predisposición genética como de otros factores que contribuyen a su desarrollo. Es necesario realizar estudios funcionales para poder correlacionar su base molecular y su desarrollo (AU)

Introduction. Epilepsy is one of the major neurological disorders characterized by spontaneous and recurrent seizures. Traditionally temporal lobe epilepsy (TLE) was considered as a multifactorial syndrome due to environmental factors. Advances in molecular biology have facilitated the detection of many genetic alterations that may have a pathogenic effect in ELT. Recently, many authors show evidence about the existence of genetic components as the source of some types of ELT. Development. This review aims to provide an overview of mutations and polymorphisms associated with temporal lobe epilepsy, which have been described in scientific literature and its contribution to the pathophysiology of epileptogenesis. We have reviewed the following genes; LGI1, PDYN (prodynorphin), interleucine 1beta, PRPN (prion protein), ApoE (apolipoprotein E), GABBR1, SCN1A, SCN1B, KCNA1, KCND2. Conclusion. The ELT is a complex disease and its development could depend on either genetics factors or other factors. Functional studies are necessary in order to correlate its molecular basis and their development (AU)

[Genetics components in patients with temporal lobe epilepsy]. / Factores genéticos asociados a la epilepsia del lóbulo temporal.

INTRODUCTION: Epilepsy is one of the major neurological disorders characterized by spontaneous and recurrent seizures. Traditionally temporal lobe epilepsy (TLE) was considered as a multifactorial syndrome due to environmental factors. Advances in molecular biology have facilitated the detection of many genetic alterations that may have a pathogenic effect in ELT. Recently, many authors show evidence about the existence of genetic components as the source of some types of ELT. DEVELOPMENT: This review aims to provide an overview of mutations and polymorphisms associated with temporal lobe epilepsy, which have been described in scientific literature and its contribution to the pathophysiology of epileptogenesis. We have reviewed the following genes; LGI1, PDYN (prodynorphin), interleucine 1beta, PRPN (prion protein), ApoE (apolipoprotein E), GABBR1, SCN1A, SCN1B, KCNA1, KCND2. CONCLUSION: The ELT is a complex disease and its development could depend on either genetics factors or other factors. Functional studies are necessary in order to correlate its molecular basis and their development.

[Unilateral subthalamic stimulation in the treatment of advanced Parkinson's disease]. / Estimulación subtalámica unilateral en el tratamientode la enfermedad de Parkinson avanzada.

INTRODUCTION: The use of unilateral subthalamic stimulation (USTS) in the treatment of advanced Parkinson's disease can be effective and offer a series of advantages on comparing this technique with bilateral subthalamic stimulation (BSTS). PATIENTS AND METHODS: We studied 35 consecutive patients: 22 with BSTS and 13 with USTS (six left and seven right). The epidemiological features and the scores on the functional assessment scales -Hoehn and Yahr, Schwab and England, and the Unified Parkinson's Disease Rating Scale (UPDRS) I to IV- were not significantly different in the two groups, except for the Hoehn and Yahr in off (USTS: 3.3 +/- 0.3; BSTS: 4.1 +/- 0.2; p = 0.004). RESULTS: The overall percentages of improvement six months after surgery were UPDRS I: 12%; II: 21.6%; III-medication off/stimulator on: 30.6% (with respect to the baseline off state); III-on/on: 8.8% (with respect to the baseline on state); IV: 48.9%. Reduction in the levodopa equivalent dose: USTS: 26.3%; BSTS: 17%. These percentages of improvement were not significantly different in the two groups. If we consider the motor scale in medication-off and stimulator-on in the sixth month and we compare it with the same in the off state before surgery, the axial motor symptoms improved by 17.1% (USTS) and 25% (BSTS); in the extremities, USTS: 39.1% in the limbs contralateral to the implanted electrode, and 14.5% in the ipsilaterals; BSTS: right extremities, 32.6%; left extremities, 31.5%. No significant differences were found on comparing the electrical power consumed by the electrodes in the two groups of patients in the sixth month of treatment. CONCLUSIONS: USTS was effective in improving the axial symptoms. In our series, the reduction in medication following surgery was similar to that of the patients with BSTS.

La experiencia en la práctica médica. Réplica / Experience in medical practice. Reply

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[Impact of experience on improving the surgical outcome in temporal lobe epilepsy]. / Impacto de la experiencia sobre los resultados quirúrgicos en la epilepsia del lóbulo temporal.

INTRODUCTION: Recently, we have published the results of a first surgical series of patients with temporal lobe epilepsy (TLE). We describe a posterior series of patients intervened of TLE, we compare the functional results with the previous series and we finally analyze the causes of changes. PATIENTS AND METHODS: We studied the first 22 consecutive patients surgically intervened of TLE with a minimum post-surgery follow-up of 2 years. Patients showing I and II Engel's grade were used as gold standard for evaluation of pre-surgical complementary studies. RESULTS: We have obtained better functional results: 91% patients showing Engel's grade I, 9% showing grade II and neither III nor IV grades were obtained. Pre-surgical studies changed in comparison with the previous report. The most improving change was observed in video-EEG with foramen-ovale electrodes (FOE) (37%), scalp EEG (26.6%), interictal SPECT (11.7%) and MRI (11.7%). Video-EEG with FOE was the study than showed greater concordance with epileptic focus (95.5%), followed by EEG (86.4%). In 35% of cases, MRI was normal or without valid data for correct localization of focus. CONCLUSIONS: Video-EEG with FOE and TLE surgery are safety methods, which results improve with the experience. Normal or not informative MRI do not should a priori reject those patients with drug-resistant TLE from surgery.

Impacto de la experiencia sobre los resultados quirúrgicos en la epilepsia del lóbulo temporal / Impact of experience on improving the surgical outcome in temporal lobe epilepsy

Introducción. Hemos publicado recientemente los resultados de una primera serie quirúrgica de pacientes con epilepsia del lóbulo temporal (ELT). Se presenta una serie inmediatamente posterior, y se analizan y comparan los resultados. Pacientes y métodos. Se estudian 22 pacientes nuevos intervenidos consecutivamente de ELT, con igual metodología que en la publicación previa y con un control clínico mínimo de dos años. Para evaluar la capacidad para localizar el foco de las pruebas complementarias se utilizó como estándar de oro los pacientes con grados I o II de Engel. Resultados. Se han obtenido mejores resultados funcionales: 91% de pacientes en grado I y 9% en grado II de Engel. No se han obtenido pacientes en grados III o IV. Los estudios prequirúrgicos que, comparativamente, han incrementado más su capacidad de localización fueron: videoelectroencefalograma (vídeo-EEG) con electrodos del foramen oval (EFO) (37,0%), EEG de scalp (26,6%), tomografía computarizada por emisión de fotón único (SPECT) interictal (11,7%) y la resonancia magnética (RM) (7,3%). La prueba con mayor grado de concordancia con el foco epileptógeno fue el vídeo-EEG con EFO (95,5%), seguido del EEG (86,4%). En un 35% de los estudios, la RM fue normal o sin datos válidos para la localización del foco epileptógeno. Conclusiones. La exploración con EFO y el tratamiento quirúrgico de la ELT es una metodología segura, cuyos resultados mejoran con la experiencia. La RM normal o no claramente informativa no tiene por qué excluir a priori a los pacientes con ELT farmacorresistente de esta alternativa terapéutica

Introduction. Recently, we have published the results of a first surgical series of patients with temporal lobe epilepsy (TLE). We describe a posterior series of patients intervened of TLE, we compare the functional results with the previous series and we finally analyze the causes of changes. Patients and methods.We studied the first 22 consecutive patients surgically intervened of TLE with a minimum post-surgery follow-up of 2 years. Patients showing I and II Engel’s grade were used as gold standard for evaluation of pre-surgical complementary studies. Results. We have obtained better functional results: 91% patients showing Engel’s grade I, 9% showing grade II and neither III nor IV grades were obtained. Pre-surgical studies changed in comparison with the previous report. The most improving change was observed in video-EEG with foramen-ovale electrodes (FOE) (37%), scalp EEG (26.6%), interictal SPECT (11.7%) and MRI (11.7%). Video-EEG with FOE was the study than showed greater concordance with epileptic focus (95.5%), followed by EEG (86.4%). In 35% of cases, MRI was normal or without valid data for correct localization of focus. Conclusions. Video-EEG with FOE and TLE surgery are safety methods, which results improve with the experience. Normal or not informative MRI do not should a priori reject those patients with drug-resistant TLE from surgery

[Pharmacoresistant temporal-lobe epilepsy. Exploration with foramen ovale electrodes and surgical outcomes]. / Epilepsia farmacorresistente del lóbulo temporal. Exploración con electrodos del foramen oval y resultados quirúrgicos.

AIM: To report our experience in the surgical treatment of temporal-lobe epilepsy. PATIENTS AND METHODS: An analysis was performed of the outcomes of 137 patients submitted to surgery between 1990 and 2001, with a follow-up of more than two years. A study was conducted of the percentages of successful detection by the different complementary tests--MRI, EEG, interictal SPECT, video-EEG with foramen ovale electrodes (FOE), neuropsychological study (NPS)--and the precision with which they reported the epileptogenic focus. RESULTS AND CONCLUSIONS: Successful surgical outcomes (Engel grades I-II): 73.4%. No surgical mortality occurred, although some mild, reversible morbidity was observed. Surgical outcomes were not affected by sex, age, age of onset and the length of time the patient had had the disease, or the frequency of the seizures. No association was found between seizures in the immediate post-operative period and a poorer long term control of the epilepsy. MR images were normal in 25% of patients; in these cases the surgical outcomes (Engel grades I-II at two years: 62%) were significantly poorer than in cases of tumours/cavernomas (86%); RMI studies of other types of lesions gave intermediate results (72%). With respect to the capacity of the different tests to lateralise/locate the epileptogenic focus, video-EEG-FOE proved to be the best, followed by MRI, SPECT, EEG and NPS.

Epilepsia farmacorresistente del lóbulo temporal. Exploración con electrodos del foramen oval y resultados quirúrgicos / Pharmacoresistant temporal-lobe epilepsy. Exploration with foramen ovale electrodes and surgical outcomes

Objetivo. Presentar nuestra experiencia en el tratamiento quirúrgico de la epilepsia del lóbulo temporal. Pacientes y métodos. Se analizan resultados en 137 pacientes, intervenidos quirúrgicamente entre 1990 y 2001, con seguimiento mayor de dos años. Se estudia el porcentaje de aciertos de las pruebas complementarias-RM, EEG, SPECT interictal, vídeo-EEG con electrodos del foramen oval (EFO), estudio neuropsicológico (NPS)- y la precisión con que informaron del foco epileptógeno. Resultados y conclusiones. Éxitos quirúrgicos (grados I-II de Engel): 73,4%. No hubo mortalidad quirúrgica, aunque sí escasa morbilidad, leve yreversible. No modificaron los resultados quirúrgicos ni el sexo, edad, edad de comienzo y tiempo de desarrollo de la enfermedad, ni la frecuencia de las crisis. No encontramos asociación entre crisis en el postoperatorio inmediato y peor control de la epilepsia alargo plazo. La RM fue normal en el 25% de los pacientes; en ellos, los resultados quirúrgicos (grados I-II de Engel a los dos años: 62%) fueron significativamente peores que en los casos detumor/cavernoma (86%); ante otras lesiones en la RM, el resultado fue intermedio (72%). En relación a la capacidad lateralizadora/localizadora del foco epileptógeno de las diferentes pruebas, destaca el vídeo-EEG-EFO, seguido de la RM, SPECT, EEG y NPS

Aim. To report our experience in the surgical treatment of temporal-lobe epilepsy. Patients and methods. Ananalysis was performed of the outcomes of 137 patients submitted to surgery between 1990 and 2001, with a follow-up of more than two years. A study was conducted of the percentages of successful detection by the different complementary tests - MRI,EEG, interictal SPECT, video-EEG with foramen ovale electrodes (FOE), neuropsychological study (NPS) - and the precision with which they reported the epileptogenic focus. Results and conclusions. Successful surgical outcomes (Engel grades I-II):73.4%. No surgical mortality occurred, although some mild, reversible morbidity was observed. Surgical outcomes were not affected by sex, age, age of onset and the length of time the patient had had the disease, or the frequency of the seizures. No association was found between seizures in the immediate post-operative period and a poorer long term control of the epilepsy.MR images were normal in 25% of patients; in these cases the surgical outcomes (Engel grades I-II at two years: 62%) were significantly poorer than in cases of tumours/cavernomas (86%); RMI studies of other types of lesions gave intermediate results (72%). With respect to the capacity of the different tests to lateralise/locate the epileptogenic focus, video-EEG-FOE proved to be the best, followed by MRI, SPECT, EEG and NPS

[Psychosurgery and the neurosurgical treatment of pain: a systematic review of the experience gained in these kinds of treatment]. / Psicocirugía y tratamiento neuroquirúrgico del dolor: revisión sistemática de la experiencia alcanzada en estos tipos de tratamiento.

INTRODUCTION: Psychosurgery and the neurochemical treatment of pain (NTP) are therapeutic options restricted to patients who show resistance to medical treatments. Surgical techniques have been perfected over the last few decades. AIMS: Our aim was to conduct a systematic review of the studies dealing with psychosurgery and NTP reported in the literature, based on the standards of quality used in evidence-based medicine. DEVELOPMENT: Following screening and selection, nine of the 178 papers found (MEDLINE, 1990-2002) were selected for the study: three referring to the treatment of neuropathic pain and six about the treatment of obsessive-compulsive disorder (OCD). The objectives were the therapeutic results in all cases, the study of the anatomical-functional bases in three of them and the description of side effects in five. After adapting the standards of quality used in evidence-based medicine (there are no standards for papers about surgery), one was classified in group B, six in group C and two as C-D. The three papers about the treatment of pain reported a significant improvement in the pain scales in 40-77% of patients. As regards the treatment of OCD, results showed an overall improvement of the scales in 20.4-70% of the patients with an improvement above 50%. The side effects are also described. CONCLUSIONS: Data published support the indication of psychosurgery and NTP for selected patients with neuropathic pain and OCD. The methodological limitations of the papers prevent us from drawing conclusions about the other diseases for which these techniques have been indicated.