[Idiopathic generalised epilepsy. The value of semiology and EEG scanning in its classification]. / Epilepsia generalizada idiopática. Utilidad de la semiología y del electroencefalograma para su clasificación.

INTRODUCTION: The different syndromes included in the idiopathic generalized epilepsies present an important overlapping of their electroclinical characteristics. AIM: To compare the two actual classifications (International classification of epileptic syndromes: ILAE of 1989 and of 2001) in a sample of patients with idiopathic generalised epilepsy (IGE) and to evaluate which electro-clinical factors were more useful in order to classify a patient into a syndrome. PATIENTS AND METHODS: 70 patients (44 women/26 men). Neurological examination and neuro-radiological examination were normal in all cases. The EEG (standard or sleep deprived) showed generalised epileptiform discharges in all patients. Clinical findings included a median age of onset 12.3 years. Most frequent first type of seizure was tonic-clonic (71%). Seizures during awakening were the most frequent (37%) and lack of sleep was the most important precipitating factor (44.7%). Generalized epileptiform discharges were present in 62.9% of the basal sleep deprived EEG, on the other hand, only 22.3% of the basal standard EEG showed epileptiform discharges, p = 0.048. 28% of patients were unclassifiable according to the 1989 ILAE classification, 7% were unclassifiable according to the 2001 ILAE classification. EEG during intermittent photic stimulation (p = 0.007), at awakening (p = 0.015) and the timetable of the seizures (seizures generalised at awakening) (p = 0.053) differentiated between idiopathic generalised syndromes of adolescence. CONCLUSION: The 2001 ILAE classification is more useful in order to classify patients with IGE because includes patients previously considered unclassifiable in the syndrome of generalised epilepsy with different phenotypes.

Epilepsia generalizada idiopática. Utilidad de la semiología y del electroencefalograma para su clasificación / Idiopathic generalised epilepsy. The value of semiology and EEG scanning in its classification

Introducción. Los síndromes que conforman las epilepsias generalizadas idiopáticas (EGI) presentan un importante solapamiento de características electroclínicas. Objetivo. Valorar la capacidad diagnóstica para la EGI de la clasificación de la Liga Internacional contra la Epilepsia (ILAE) de 1989 y la del 2001, y determinar qué características clínicas y electroencefalográficas (EEG) permiten discriminar entre los síndromes. Pacientes y métodos. Participaron 70 pacientes (44 mujeres y 26 hombres). Todos presentaban descargas epileptiformes generalizadas en el EEG estándar o de privación de sueño (PS). Se aplicaron las clasificaciones de la ILAE de 1989 y del 2001. Resultados. Edad media de la primera crisis: 12,3 años; primera crisis más frecuente: tonicoclónica generalizada (71 por ciento); horario más frecuente de presentación de crisis: al despertar (37 por ciento); factor desencadenante más frecuente: privación de sueño (44,7 por ciento). Se observaron descargas generalizadas paroxísticas en el 62,9 por ciento de los EEG de PS basales, respecto a un 22,3 por ciento de los EEG estándares basales (p = 0,048). El 28 por ciento de los pacientes era inclasificable, según la clasificación de 1989, frente a sólo el 7 por ciento según la clasificación del 2001. Tanto las características del EEG (aparición de paroxismos durante la EGI, p = 0,007, y EEG en el momento del despertar, p = 0,015) como las clínicas (horario de las crisis, p = 0,053) diferenciaban los síndromes que conforman las EGI de la adolescencia. Conclusión. La clasificación de la ILAE del 2001 tiene un mayor porcentaje de pacientes, debido a que los pacientes considerados inclasificables en la clasificación del 1989 se incluyen dentro del síndrome de epilepsia generalizada con fenotipos variables (AU)

Introduction. The different syndromes included in the idiopathic generalized epilepsies present an important overlapping of their electroclinical characteristics. Aim. To compare the two actual classifications (International classification of epileptic syndromes: ILAE of 1989 and of 2001) in a sample of patients with idiopathic generalised epilepsy (IGE) and to evaluate which electro-clinical factors were more useful in order to classify a patient into a syndrome. Patients and methods. 70 patients (44 women/26 men). Neurological examination and neuro-radiological examination were normal in all cases. The EEG (standard or sleep deprived) showed generalised epileptiform discharges in all patients. Clinical findings included a median age of onset 12.3 years. Most frequent first type of seizure was tonic-clonic (71%). Seizures during awakening were the most frequent (37%) and lack of sleep was the most important precipitating factor (44.7%). Generalized epileptiform discharges were present in 62.9% of the basal sleep deprived EEG, on the other hand, only 22.3% of the basal standard EEG showed epileptiform discharges, p = 0.048. 28% of patients were unclassifiable according to the 1989 ILAE classification, 7% were unclassifiable according to the 2001 ILAE classification. EEG during intermittent photic stimulation (p = 0.007), at awakening (p = 0.015) and the timetable of the seizures (seizures generalised at awakening) (p = 0.053) differentiated between idiopathic generalised syndromes of adolescence. Conclusion. The 2001 ILAE classification is more useful in order to classify patients with IGE because includes patients previously considered unclassifiable in the syndrome of generalised epilepsy with different phenotypes (AU)

[Prognostic factor for medical control for seizures in patients with radiologic evidence for mesial temporal lobe sclerosis]. / Factores pronósticos asociados al control médico en pacientes con evidencia radiológica de esclerosis mesial temporal.

INTRODUCTION: Patients with mesial temporal lobe sclerosis (MTS) usually have suffered a brain insult during early childhood, a febrile convulsion in most cases. Complex partial seizures start after a seizure free period of variable duration. These complex partial seizures have an stereotypic semiology. Often, these seizure are not controlled with medical therapy, previous studies shows a rate of control not superior of 30%. AIM. To know the prognosis for medical control of patients with MTS and to find related factors. PATIENTS AND METHODS: The clinical characteristics of 51 patients with temporal lobe epilepsy and radiologic evidence of MTS (hippocampus atrophy or increased signal on T2 or Flair magnetic resonance sequences). RESULTS: 51 patients, of them 17 (34%) were men. 17 (34%) presented right MTS, 30 (60%) left MTS and 2 (4.3%) bilateral MTS. 16 patients (34.8%) referred autonomic aura, 14 (27.5%) psychic aura, 4 (7.8%) dysphasia and 13 (25.5%) no aura, in 2 (3.9%) aura were mixed: autonomic psychic. The aura was associated to the lesion laterality (p= 0.023) and to the reference of some antecedent of cerebral aggression during early childhood (p= 0.011). Concerning to the seizure control, 15 patients (29.2%) were seizure free in the last 6 month and 36 (70.6%) remaining uncontrolled. The associated factors to the medical control were the age of onset (p= 0.024) and the duration of the epilepsy (p= 0.018). CONCLUSIONS: Around 29% of patients with MTS can be controlled with medical therapy. Seizure control is related with later age of onset and short duration of the epilepsy

[Gabapentin and women]. / Gabapentina y mujer.

OBJECTIVE: In the management of epilepsy, as a chronic disorder, one should remember the factors which differentiate the patients so that they may be classified into groups with common characteristics. Using gender as a differentiating criterion, we tried to systematize the factors which should be considered when studying and treating a female patient with epilepsy. DEVELOPMENT: The factors to be taken into account are biological such as the sex hormones or of psychosocial type such those related to the stigma, which may have special characteristics depending on gender. Once these factors had been systematized, we reviewed the clinical use of gabapentin from the point of view of the group considered. CONCLUSIONS: We suggest that special guidelines should be used according to the patient s gender. This review considers the female gender. The rational use of gabapentin, as monotherapy or polytherapy plays an important part in fulfilling the requirements described.

Gabapentina y mujer / Gabapentin and women

Objetivo. En el manejo de la epilepsia, en cuanto condición crónica, hay que tener en cuenta los factores diferenciadores que permiten agrupar pacientes según características compartidas. Si aplicamos el género como criterio diferenciador, tratamos de sistematizar los factores que deben considerarse cuando estudiamos y tratamos una persona con epilepsia, del género femenino. Desarrollo. Los factores a tener en cuenta son de tipo biológico, como las hormonas sexuales, o bien de tipo psicosocial, como los relacionados con el estigma, en el aspecto que pueden tener características especiales según el género. Sistematizados estos factores, revisamos el uso clínico de gabapentina desde el punto de vista de la adecuación a las características del colectivo considerado. Conclusiones. Proponemos la utilización de protocolos especiales según el género de cada paciente; esta revisión se dedica al género femenino; el uso racional de gabapentina, en monoterapia o politerapia, ocupa un lugar destacado en la satisfacción de los requerimientos descritos (AU)