Video-EEG in the first 24 hours after the first unprovoked seizure in patients with normal neurological examination and head CT scan.

PURPOSE: to determine the yield of Video-Electroencephalogram (VEEG) in the first 24 h in patients with a first unprovoked seizure and normal neurological examination, laboratory findings, and cranial CT scans. METHODS: we analyzed retrospectively the yield of VEEG performed in these patients in the emergency department. All the patients were subsequently seen in the Epilepsy Clinic, and the epilepsy diagnosis was confirmed. RESULTS: we included 19 patients who met the inclusion criteria; all of them underwent VEEG with the 10-20 system within the first 24 h after the seizure. The duration of the recordings averaged at 108.53 min and may or may not have included intermittent photic stimulation and sleep recording; 74% of the recordings were abnormal, with 26% being normal. Among the abnormal cases, epileptogenic activity was found in 47% and seizures in 26% of the patients; because both findings could be present in the same VEEG, 63% of all the VEEG showed epileptogenic alterations or seizures. The VEEG anomalies were recorded before the 20th minute (standard VEEG duration) in 58% of patients who exhibited epileptogenic activity and/or seizures, and after the 20th minute in 42%. CONCLUSION: conducting approximately 100-minute VEEGs within the first 24 h after a first unprovoked seizure can enhance the diagnostic yield in patients with epilepsy. However, the study has the limitations of its sample size and retrospective nature.

[Nutritional factors associated with migraine]. / Factores nutricionales asociados a la migraña.

Introduction: Migraine is a chronic, highly prevalent, multidimensional, and complex disorder, influenced by genetic and environmental factors, among which is the diet. Medical treatments are partially effective, and that makes necessary to complement them with other therapeutic strategies. The nutrition plays a prevalent role. We will review dietary factors that have been linked to migraine and therapeutic nutritional guidelines about it: elimination, integral, ketogenic, epigenetic and hypocaloric diets, as well as diets that interest fatty acids, sodium, vitamins, and the gut-brain axis. To date, the evidence of the efficacy of nutritional treatments for migraine is not widespread and it is necessary to advise our patients about patterns consistent with nutritional general recommendations.

Introducción: La migraña es un trastorno crónico, muy prevalente, multidimensional y complejo, influenciado por factores genéticos y ambientales, entre los que se encuentra la dieta. Los tratamientos médicos son parcialmente eficaces y se hace necesario complementarlos con otras estrategias terapéuticas, entre las que la nutrición juega un papel prevalente. Revisaremos los factores dietéticos que se han vinculado con la migraña y las pautas nutricionales terapéuticas más estudiadas: dietas de eliminación, integrales, cetogénicas, epigenéticas e hipocalóricas, así como dietas que implican a los ácidos grasos, el sodio, las vitaminas y el eje intestino-cerebro. A día de hoy la evidencia de la eficacia de los tratamientos nutricionales para la migraña no es amplia, de modo que aún en estos pacientes conviene aconsejar patrones dietéticos coherentes con las recomendaciones nutricionales generales.

Factores nutricionales asociados a la migraña / Nutritional factors associated with migraine

La migraña es un trastorno crónico, muy prevalente, multidimensional y complejo, influenciado por factores genéticos y ambientales, entre los que se encuentra la dieta. Los tratamientos médicos son parcialmente eficaces y se hace necesario complementarlos con otras estrategias terapéuticas, entre las que la nutrición juega un papel prevalente.Revisaremos los factores dietéticos que se han vinculado con la migraña y las pautas nutricionales terapéuticas más estudiadas: dietas de eliminación, integrales, cetogénicas, epigenéticas e hipocalóricas, así como dietas que implican a los ácidos grasos, el sodio, las vitaminas y el eje intestino-cerebro.A día de hoy la evidencia de la eficacia de los tratamientos nutricionales para la migraña no es amplia, de modo que aún en estos pacientes conviene aconsejar patrones dietéticos coherentes con las recomendaciones nutricionales generales. (AU)

Migraine is a chronic, highly prevalent, multidimensional, and complex disorder, influenced by genetic and environmental factors, among which is the diet. Medical treatments are partially effective, and that makes necessary to complement them with other therapeutic strategies. The nutrition plays a prevalent role.We will review dietary factors that have been linked to migraine and therapeutic nutritional guidelines about it: elimination, integral, ketogenic, epigenetic and hypocaloric diets, as well as diets that interest fatty acids, sodium, vitamins, and the gut-brain axis.To date, the evidence of the efficacy of nutritional treatments for migraine is not widespread and it is necessary to advise our patients about patterns consistent with nutritional general recommendations. (AU)

Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: Experience from a national multicenter registry.

OBJECTIVE: To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic-clonic seizures (GTCS). METHODS: This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure-free rate after 3, 6, and 12 months and tolerability throughout the follow-up. RESULTS: A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of 14 months (range = 1-57) with a median dose of 4 mg (range = 2-10). The retention rates at 3, 6, and 12 months and last follow-up were 93.8%, 89.3%, 80.9%, and 71.4%, respectively. The retention rates according to the type of monotherapy (primary vs conversion) did not differ (log-rank P value = .57). Among the 98 patients, 61.2% patients had seizures throughout the baseline period, with a median seizure frequency of 0.6 seizures per month (range = 0.3-26). Responder rates at 3, 6, and 12 months were 79.6%, 70.1%, and 52.8%, respectively, and seizure freedom rates at the same points were 62.7%, 56.1%, and 41.5%. Regarding the 33 patients who had GTCS in the baseline period, 87.8% were seizure-free at 3 months, 78.1% at 6 months, and 55.1% at 12 months. Over the entire follow-up, PER monotherapy was generally well tolerated, and only 16% of patients discontinued PER due to adverse events (AEs). Female patients were found to be at a higher risk of psychiatric AEs (female vs male odds ratio = 2.85, 95% confidence interval = 1-8.33, P = .046). SIGNIFICANCE: PER demonstrated good effectiveness and a good safety profile when used as primary therapy or conversion to monotherapy at relatively low doses, in a clinical setting with patients with focal seizures and GTCS.

Consulta de epilepsia durante la pandemia de Covid-19: papel de la telemedicina y efectos del confinamiento en pacientes epilépticos / The epilepsy unit during the COVID-19 epidemic: the role of telemedicine and the effects of confinement on patients with epilepsy

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Wernicke's Encephalopathy, Wet Beriberi, and Polyneuropathy in a Patient with Folate and Thiamine Deficiency Related to Gastric Phytobezoar.

Background. Wernicke's encephalopathy (WE) is an acute neurological disorder resulting from thiamine deficiency. It is mainly related to alcohol abuse but it can be associated with other conditions such as gastrointestinal disorders. This vitamin deficiency can also present with cardiovascular symptoms, called "wet beriberi." Association with folate deficit worsens the clinical picture. Subject. A 70-year-old man with gastric phytobezoar presented with gait instability, dyspnoea, chest pain associated with right heart failure and pericarditis, and folate deficiency. Furosemide was administered and cardiac symptoms improved but he soon developed vertiginous syndrome, nystagmus, diplopia, dysmetria, and sensitive and motor deficit in all four limbs with areflexia. Results. A cerebral magnetic resonance imaging (MRI) showed typical findings of WE. He was immediately treated with thiamine. Neurological symptoms improved in a few days and abnormal signals disappeared in a follow-up MRI two weeks later. Conclusion. Patients with malabsorption due to gastrointestinal disorders have an increased risk of thiamine deficiency, and folate deficiency can make this vitamin malabsorption worse. An established deficiency mainly shows neurological symptoms, WE, or rarely cardiovascular symptoms, wet beriberi. Early vitamin treatment in symptomatic patients improves prognosis. We recommend administration of prophylactic multivitamins supplements in patients at risk as routine clinical practice.