Validation of a short useful questionnaire in Spanish for the epidemiological screening of epilepsy in Spain. EPIBERIA Questionnaire.

INTRODUCTION: There is a major gap in knowledge about the epidemiology of epilepsy in Mediterranean countries. The EPIBERIA group was formed with the aim of promoting the conducting of epidemiological studies in this region in order to improve this situation. This paper deals with the validation of a brief questionnaire for screening patients with epilepsy in the general population. METHODS: We selected an English-language questionnaire previously validated by the Ottman group. It was translated, modified to suit the characteristics of the Spanish population, and administered to a sample of 200 patients (93 epileptics and 107 non-epileptic patient controls) sampled consecutively from 5 epilepsy units in different cities in Spain. Both groups were homogeneous in demographic variables and the control group was representative of the general population. RESULTS: We obtained a sensitivity of 100% and a specificity of 74.77% for the least rigorous correction model for the questionnaire, with a sensitivity of 94.62% and a specificity of 99.07% for the most stringent correction model. The PPV ranged from 7.48% for the first case to 69.49% in the second, assuming an epilepsy prevalence of 2%. CONCLUSIONS: The questionnaire EPIBERIA is a valid Spanish tool for epilepsy screening in the general population in Spain.

Epilepsia resistente a fármacos antiepilépticos: recomendaciones de actuación diagnóstica y terapéutica en España / Drug-resistant epilepsy: current recommendations for diagnosis and treatment in Spain

Introducción: La epilepsia resistente a fármacos antiepilépticos (ERF) constituye un problemasocio-sanitario de primer nivel, que debe ser individualizado precozmente por sus dramáticas repercusiones individuales y colectivas.Desarrollo: Recientemente, la Liga Internacional Contra la Epilepsia ha definido la ERF como aquella en la que no se controlen las crisis tras haber tomado de forma adecuada dos fármacos antiepilépticos apropiados y bien tolerados, entendiendo como falta de control la aparición de crisis en un año o en un tiempo inferior a tres veces el intervalo entre crisis que mostraba antesde iniciar el tratamiento. Esta sociedad internacional recomienda en todo paciente con ERF una evaluación rápida y detallada en una unidad de epilepsia. Se entiende como Unidad Clínica de Epilepsia (UCE) el conjunto de profesionales que actuando en colaboración tienen como objetivo primario el diagnóstico y tratamiento del paciente con epilepsia. Las UCE en España pueden ser estratificadas en distintos niveles, dependiendo de la actividad que se desarrolle en cada una de ellas. La consulta específica de epilepsia se considera como el germen de toda UCE, siendo necesaria la figura del experto en epilepsia. En las UCE médicas se realiza la monitorización vídeo-EEG prolongada. En las UCE médico-quirúrgicas además se realiza cirugía de epilepsia de dificultad diversa. Conclusiones: Todas las UCE deben cooperar con protocolos consensuados, debiendo existir un flujo bidireccional entre ellas. La estratificación de las UCE permite una alta eficacia y eficiencia, debiendo existir el suficiente número que garantice el fácil acceso de todos los pacientes con epilepsia (AU)

Introduction: Drug-resistant epilepsy (DRE) is a top-priority social health problem which requires early individual treatment due to its dramatic repercussions for the patient and society. Development: The International League Against Epilepsy (ILAE) has recently defined DRE as that in which the seizures are not controlled after having correctly taken two appropriate and well tolerated anti-epileptic drugs, with lack of control being understood as the appearance of seizures within one year or in a period less than three times the inter-seizure interval before starting treatment. This International Society recommends a rapid and detailed assessment of all patients in an Epilepsy Unit. A Clinical Epilepsy Unit (CEU) is understood as a group of professionals who, acting in collaboration, have the diagnosis and treatment of the patient with epilepsy as their primary objective. CEUs in Spain may be stratified into different levels depending on the activity carried out in each of them. The specific epilepsy clinic is considered the fundamental type of CEU and includes the necessary figure of an expert in epilepsy. Prolonged video-monitoring is performed in medical CEUs. In medical-surgical CEUs epilepsy surgery with varying degrees of difficulty is also performed. Conclusions: All CEUs must cooperate with consensus protocols, and there must be a two-way flow between them. Stratification of CEUs increases efficacy and efficiency, due to there being a sufficient number of them to ensure easy access by all patients with epilepsy (AU)

Consenso de las Recomendaciones de Actuación diagnóstica y Terapéutica sobre Epilepsia resistente a fármacos antiepilépticos en España (Consenso RATE-España) / Consensus-recommended diagnostic and therapeutic guidelines for drug-resistant epilepsy in Spain (Consenso RATE-España)

Objetivo: Conocer la opinión de un colectivo de expertos en epilepsia y elaborar un consenso sobre la definición de epilepsia resistente a fármacos (ERF) según la Liga Internacional Contra la Epilepsia (ILAE) y los distintos niveles asistenciales al paciente con ERF en España. Material y métodos: El estudio fue realizado utilizando el método Delphi, mediante dos rondas sucesivas de cuestionarios. Un comité científico confeccionó un documento preliminar y catorce preguntas relacionadas y fueron remitidos por correo electrónico al panel de expertos. Se incluían ítems relacionados con el concepto de ERF, niveles asistenciales e itinerario entre dichos niveles de los pacientes con ERF. Resultados:Contestaron el cuestionario 41 expertos. Se alcanzó acuerdo sobre la necesidad y aplicabilidad de la definición de ERF según la ILAE, necesidad de la existencia del experto en epilepsia, consulta específica de epilepsia y unidades clínicas de epilepsia con diversa estratificación, según la graduación de actividades que se realicen. Existió moderado consenso con la dotación y actividad de las unidades clínicas de referencia y no hubo consenso sobre la remisión de pacientes que han presentado una crisis epiléptica a una consulta de epilepsia. Conclusiones: El panel de expertos estuvo de acuerdo con la definición de ERF según la ILAE y en remitir a todo paciente con ERF a un estudio pormenorizado a una consulta de epilepsia o unidad clínica de epilepsia. Se resalta la necesidad de la monitorización vídeo-EEG en el estudio del paciente con ERF y el proponer otras formas terapéuticas en pacientes seleccionados (AU)

Objective: To ascertain the opinions of an Epilepsy Expert Group and prepare a consensus document on the definition of drug-resistant epilepsy (DRE) according to the International League Against Epilepsy (ILAE) and the different healthcare levels for the patient with epilepsy in Spain. Material y methods: The study was conducted using the Delphi method, by means of successive rounds of questionnaires. A scientific committee prepared a preliminary document and fourteen associated questions, which were sent by e-mail to the panel of experts. They included items related to the concept of DRE, health care levels and the route between these levels for patients with DRE. Results: A total of 41 experts answered the questionnaire. They agreed regarding the necessity and applicability of the DRE definition according to the ILAE, the need for an expert panel on epilepsy, specialist epilepsy clinics, and clinical epilepsy units stratified depending on the level of activities they carried out. There was moderate consensus on the resources and activity of the clinical units of reference and there was no consensus on the referral of patients who have suffered an epileptic seizure to an epilepsy clinic. Conclusions: The expert panel agreed with the definition of DRE according to the ILAE and on referring patients with DRE for a detailed study in an epilepsy clinic or epilepsy clinical unit. They highlighted the need for video-EEG monitoring in the study of patients with DRE and the need to propose other forms of treatment in selected patients (AU)

Drug-resistant epilepsy: current recommendations for diagnosis and treatment in Spain.

INTRODUCTION: Drug-resistant epilepsy (DRE) is a top-priority social health problem which requires early individual treatment due to its dramatic repercussions for the patient and society. DEVELOPMENT: The International League Against Epilepsy (ILAE) has recently defined DRE as that in which the seizures are not controlled after having correctly taken two appropriate and well tolerated anti-epileptic drugs, with lack of control being understood as the appearance of seizures within one year or in a period less than three times the inter-seizure interval before starting treatment. This International Society recommends a rapid and detailed assessment of all patients in an Epilepsy Unit. A Clinical Epilepsy Unit (CEU) is understood as a group of professionals who, acting in collaboration, have the diagnosis and treatment of the patient with epilepsy as their primary objective. CEUs in Spain may be stratified into different levels depending on the activity carried out in each of them. The specific epilepsy clinic is considered the fundamental type of CEU and includes the necessary figure of an expert in epilepsy. Prolonged video-monitoring is performed in medical CEUs. In medical-surgical CEUs epilepsy surgery with varying degrees of difficulty is also performed. CONCLUSIONS: All CEUs must cooperate with consensus protocols, and there must be a two-way flow between them. Stratification of CEUs increases efficacy and efficiency, due to there being a sufficient number of them to ensure easy access by all patients with epilepsy.

Consensus-recommended diagnostic and therapeutic guidelines for drug-resistant epilepsy in Spain (Consenso RATE-España).

OBJECTIVE: To ascertain the opinions of an Epilepsy Expert Group and prepare a consensus document on the definition of drug-resistant epilepsy (DRE) according to the International League Against Epilepsy (ILAE) and the different healthcare levels for the patient with epilepsy in Spain. MATERIAL AND METHODS: The study was conducted using the Delphi method, by means of successive rounds of questionnaires. A scientific committee prepared a preliminary document and fourteen associated questions, which were sent by e-mail to the panel of experts. They included items related to the concept of DRE, health care levels and the route between these levels for patients with DRE. RESULTS: A total of 41 experts answered the questionnaire. They agreed regarding the necessity and applicability of the DRE definition according to the ILAE, the need for an expert panel on epilepsy, specialist epilepsy clinics, and clinical epilepsy units stratified depending on the level of activities they carried out. There was moderate consensus on the resources and activity of the clinical units of reference and there was no consensus on the referral of patients who have suffered an epileptic seizure to an epilepsy clinic. CONCLUSIONS: The expert panel agreed with the definition of DRE according to the ILAE and on referring patients with DRE for a detailed study in an epilepsy clinic or epilepsy clinical unit. They highlighted the need for video-EEG monitoring in the study of patients with DRE and the need to propose other forms of treatment in selected patients.

Treatment initiation in epilepsy: an expert consensus in Spain.

OBJECTIVE: The goals of this study were to explore the diverse criteria surrounding indications for antiepileptic therapy and to establish a consensus on drug selection for initial monotherapy in adult patients with epilepsy. METHODS: The study was performed using the modified Delphi method, which aims to achieve professional consensus by means of a series of questionnaires. Three different groups of items were evaluated: the beginning of antiepileptic treatment, the drug selected for initial monotherapy with respect to the type of epilepsy, and the drug selected for initial monotherapy with respect to comorbidity. RESULTS: Sixty experts completed two rounds of a questionnaire. In the first round, consensus was reached on 135 of the 194 questions analyzed. After the second round, consensus was reached on 148 items. The main findings of the survey revealed a consensus on beginning treatment after the first seizure when the EEG showed abnormalities such as generalized spike-wave discharges, when MRI demonstrated an epileptogenic brain lesion, and in elderly patients. Regarding to the antiepileptic drug selected for initial monotherapy with respect to type of epilepsy, levetiracetam and lamotrigine were recommended for generalized tonic-clonic seizures regardless of sex or age; levetiracetam was recommended for myoclonic epilepsy regardless of sex; valproic acid, ethosuximide, levetiracetam, and lamotrigine were chosen for absence epilepsy; and carbamazepine, levetiracetam, lamotrigine, and oxcarbazepine were recommended for partial epilepsy regardless of age or sex. Finally, in the evaluation of drug selection with respect to comorbidity, first-generation drugs were less recommended than second-generation drugs, which were clearly preferable. The drugs on which there was a greater consensus were levetiracetam, lamotrigine, valproic acid, and topiramate. CONCLUSIONS: There is a tendency to begin treatment after the first seizure, depending on the results of additional testing. In general, first-generation drugs are less recommended for different types of epilepsy, especially in the presence of a comorbid condition. However, the authors are conveying perceptions and opinions, the effect of which on treatment outcomes has not been evaluated.

Antiepileptic treatment in patients with epilepsy and other comorbidities.

BACKGROUND: A high number of patients with epilepsy have comorbidities. The type of comorbidity is an important factor in deciding on the most suitable treatment, including that for acute epileptic seizures and chronic antiepileptic treatment. Evidence-based criteria should guide the selection of the appropriate antiepileptic drugs given specific comorbidities. METHODS: We performed a comprehensive search of the scientific literature on epilepsy treatment in patients with the following comorbidities: heart disease, lung disease, liver disease, kidney disease, porphyria, organ transplantation, thyroid disease, metabolic disorder, infection, mental disability, psychiatric disorder, cognitive impairment, stroke, and brain tumour. RESULTS: Most of the studies were case series and retrospective analyses. No randomised controlled trials specifically designed for this type of clinical situation were identified. The level of scientific evidence to guide clinical decisions is therefore low. CONCLUSIONS: In this review we make recommendations based on the best scientific evidence available for treating epilepsy in patients with other comorbidities, including the treatment of epileptic seizures in acute situations as well as chronic antiepileptic treatment. When no scientific evidence is available, our recommendations are based on pharmacokinetic criteria and tolerability of antiepileptic drugs, using accumulated experience and the consensus of the members of the Andalusian Epilepsy Society.

Guía de práctica clínica de la Sociedad Andaluza de Epilepsia sobre profilaxis y tratamiento de las crisis epilépticas sintomáticas agudas / Clinical practice guidelines of the Andalusian epilepsy society on prophylaxis and treatment of acute symptomatic epileptic seizures

Introducción y objetivo. Los fármacos antiepilépticos (FAE) se han utilizado tradicionalmente de forma empírica para prevenir la presentación de crisis epilépticas en pacientes con afecciones cerebrales agudas durante la fase precoz o tardía. Sin embargo, los FAE no están exentos de serios inconvenientes, por lo que su empleo debería sustentarse en bases racionales y científicas. Nos proponemos la realización de una guía de práctica basada en evidencias explícitas acerca de cuándo está indicado el tratamiento profiláctico con FAE y su duración en las crisis sintomáticas agudas (CSA). Desarrollo. Realizamos una búsqueda selectiva de la información científica de calidad relacionada con el tema propuesto en PubMed-Medline, Tripdatabase y Biblioteca Cochrane Plus. Los autores analizaron y discutieron las referencias seleccionadas y se extrajeron las recomendaciones de ellas derivadas. Se identificaron 14 documentos primarios y ocho guías de práctica, protocolos o recomendaciones de expertos. Nuestras recomendaciones se recogieron al final del documento de manera explícita. Conclusiones. La Sociedad Andaluza de Epilepsia recomienda: a) emplear FAE sólo para la prevención primaria de CSA en los traumatismos craneoencefálicos graves y como prevención secundaria de nuevas CSA por otras causas de afectación cerebral aguda; b) la duración del tratamiento de las CSA no deberá superar el tiempo de resolución de la causa que las ha provocado; y c) las benzodiacepinas son los fármacos de elección para en el tratamiento de las CSA por abstinencia de alcohol y el sulfatode magnesio para las CSA de la eclampsia (AU)

Introduction and aims. Antiepileptic drugs (AED) have traditionally been used empirically to prevent the presentation of epileptic seizures in patients with acute brain disorders during the early or late phase. However, AED are not free of serious drawbacks, which means that their use should be based on solid scientific foundations. Our aim is to produce a set of practice guidelines based on explicit evidence about when prophylactic treatment with AED is indicated and the length of time it should be continued in acute symptomatic seizures (ASS). Development. A selective search for quality scientific information on the subject was conducted on PubMed-Medline, Tripdatabase and the Biblioteca Cochrane Plus. The authors discussed and analysed the references that were selected and any recommendations that could be drawn from them were collected. A total of 14 primary documents and eight practice guidelines, protocols or experts’ recommendations were identified. Our recommendations were explicitly included at the end of the document. Conclusions. The Andalusian Epilepsy Society makes the following recommendations: a) AED must only be used for the primary prevention of ASS in severe traumatic brain injury and as secondary prevention of new ASS due to other causes of acute brain damage; b) duration of treatment of ASS must not exceed the time needed to resolve the cause that gave rise to them; and c) benzodiazepines are the preferred drugs for use in the treatment of ASS due to alcohol withdrawal and magnesium sulphate for the ASS of eclampsia (AU)

[Clinical practice guidelines of the Andalusian Epilepsy Society on prophylaxis and treatment of acute symptomatic epileptic seizures]. / Guía de práctica clínica de la Sociedad Andaluza de Epilepsia sobre profilaxis y tratamiento de las crisis epilépticas sintomáticas agudas.

INTRODUCTION AND AIMS: Antiepileptic drugs (AED) have traditionally been used empirically to prevent the presentation of epileptic seizures in patients with acute brain disorders during the early or late phase. However, AED are not free of serious drawbacks, which means that their use should be based on solid scientific foundations. Our aim is to produce a set of practice guidelines based on explicit evidence about when prophylactic treatment with AED is indicated and the length of time it should be continued in acute symptomatic seizures (ASS). DEVELOPMENT: A selective search for quality scientific information on the subject was conducted on PubMed-Medline, Tripdatabase and the Biblioteca Cochrane Plus. The authors discussed and analysed the references that were selected and any recommendations that could be drawn from them were collected. A total of 14 primary documents and eight practice guidelines, protocols or experts' recommendations were identified. Our recommendations were explicitly included at the end of the document. CONCLUSIONS: The Andalusian Epilepsy Society makes the following recommendations: a) AED must only be used for the primary prevention of ASS in severe traumatic brain injury and as secondary prevention of new ASS due to other causes of acute brain damage; b) duration of treatment of ASS must not exceed the time needed to resolve the cause that gave rise to them; and c) benzodiazepines are the preferred drugs for use in the treatment of ASS due to alcohol withdrawal and magnesium sulphate for the ASS of eclampsia.

Guía de práctica clínica de consenso de la Sociedad Andaluza de Epilepsia sobre prescripción de fármacos antiepilépticos genéricos / Consensus clinical practice guidelines of the andalusian epilepsy society on prescibing generic antiepileptic drugs

Resumen. Introducción. El consumo farmacéutico en España supone el 1,2-1,4% del producto interior bruto y aumenta anualmente un 5-12%. Entre las medidas estatales adoptadas para moderar este gasto está la posibilidad de sustituir el fármaco original prescrito por su genérico. En el caso de los fármacos antiepilépticos (FAE), caracterizados por un escaso margen terapéutico, dicha medida ha generado un debate científico acerca de su repercusión sobre el control del enfermo epiléptico. Nos proponemos la elaboración de una guía de práctica de consenso basada en evidencias implícitas acerca de cuestiones relacionadas con este tema. Desarrollo. Realizamos una búsqueda selectiva de la información científica de calidad vinculada con el objetivo propuesto en Pubmed-Medline, Tripdatabase y Biblioteca Cochrane Plus. Las referencias seleccionadas fueron analizadas y discutidas por los autores y se extrajeron las recomendaciones de ellas derivadas. Se identificaron 21 documentos primarios y 16 guías de práctica, protocolos o recomendaciones de expertos. Nuestras recomendaciones se recogieron al final del documento de manera explícita. Conclusiones. La Sociedad Andaluza de Epilepsia recomienda: 1) no sustituir un FAE innovador por su genérico en un epiléptico controlado; 2) es admisible iniciar un tratamiento con un FAE genérico en monoterapia o en asociación; 3) no intercambiar FAE genéricos de distintas empresas farmacéuticas; 4) explicar al paciente las normas de autorización de los genéricos y la importancia de evitar intercambios entre diferentes FAE genéricos; y 5) en caso de empeoramiento clínico o efectos adversos tras la introducción de un genérico, investigar las razones y comunicarlos a los órganos de farmacovigilancia (AU)

Summary. Introduction. Pharmaceutical spending in Spain accounts for 1.2-1.4% of the gross domestic product and is increasing by 5-12% per year. One of the measures adopted by the government to cut this spending is the possible substitution of original prescribed drugs by generics. In the case of antiepileptic drugs (AED), which are characterised by a scant therapeutic margin, these steps have sparked a scientific debate about their repercussion on the control of epileptic patients. We propose to draw up a set of implicit evidence-based consensus practice guidelines concerning issues related with this topic. Development. A selective search for quality scientific information on the subject was conducted on PubMed-Medline, Tripdatabase and the Biblioteca Cochrane Plus. The selected references were analysed and discussed by the authors, and the recommendations deriving from them were collected. A total of 21 primary documents and 16 practice guidelines, protocols or experts’ recommendations were identified. Our recommendations were explicitly included at the end of the text. Conclusions. The Andalusian Epilepsy Society makes the following recommendations: 1) not replacing an innovative AED by its generic in a controlled patient; 2) beginning treatment with a generic AED in monotherapy or in association is acceptable; 3) not exchanging generic AED from different pharmaceutical companies; 4) explaining to the patient the rules governing the authorisation of generics and the importance of avoiding exchanges between different generic AED; and 5) if there is some worsening of the clinical condition or side effects appear following the introduction of a generic, the causes must be investigated and communicated to the bodies responsible for pharmacovigilance (AU)

[Consensus clinical practice guidelines of the Andalusian Epilepsy Society on prescribing generic antiepileptic drugs]. / Guía de práctica clínica de consenso de la Sociedad Andaluza de Epilepsia sobre prescripción de fármacos antiepilépticos genéricos.

INTRODUCTION: Pharmaceutical spending in Spain accounts for 1.2-1.4% of the gross domestic product and is increasing by 5-12% per year. One of the measures adopted by the government to cut this spending is the possible substitution of original prescribed drugs by generics. In the case of antiepileptic drugs (AED), which are characterised by a scant therapeutic margin, these steps have sparked a scientific debate about their repercussion on the control of epileptic patients. We propose to draw up a set of implicit evidence-based consensus practice guidelines concerning issues related with this topic. DEVELOPMENT: A selective search for quality scientific information on the subject was conducted on PubMed-Medline, Tripdatabase and the Biblioteca Cochrane Plus. The selected references were analysed and discussed by the authors, and the recommendations deriving from them were collected. A total of 21 primary documents and 16 practice guidelines, protocols or experts' recommendations were identified. Our recommendations were explicitly included at the end of the text. CONCLUSIONS: The Andalusian Epilepsy Society makes the following recommendations: 1) not replacing an innovative AED by its generic in a controlled patient; 2) beginning treatment with a generic AED in monotherapy or in association is acceptable; 3) not exchanging generic AED from different pharmaceutical companies; 4) explaining to the patient the rules governing the authorization of generics and the importance of avoiding exchanges between different generic AED; and 5) if there is some worsening of the clinical condition or side effects appear following the introduction of a generic, the causes must be investigated and communicated to the bodies responsible for pharmacovigilance.

Self-reported memory problems in everyday activities in patients with epilepsy treated with antiepileptic drugs.

OBJECTIVE: The goal of this study was to assess everyday memory complaints in a large cohort of patients with epilepsy treated with antiepileptic drugs and to determine demographic, clinical, and emotional state factors associated with patients' self-perception of memory disturbances. METHODS: This cross-sectional epidemiological study was carried out in routine clinical practice using the Questionnaire of Memory Efficiency (QME) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Six hundred sixty-one patients were recruited. The time since epilepsy diagnosis was 17.3 years (SD=12.5); the number of seizures in the past year 13.8 (SD=4.8); the proportion of patients free of seizures in the last year 42.5%; the proportion of patients with partial seizures 73.2%; and the proportion of patients on monotherapy 56.3%. Total QME score was 110.0 (SD=18.6). Depression and anxiety scores and polytherapy explained 38.7% of the QME variance. CONCLUSIONS: Subjective memory functioning in this cohort of patients with epilepsy was relatively good. Complaints expressed by these patients are explained mainly by the presence of depressive and anxiety symptoms.

Guía de práctica clínica de consenso de la Sociedad Andaluza de Epilepsia: recomendaciones terapéuticas ante una crisis epiléptica y en el estado epiléptico / Consensus clinical practice guidelines of the andalusian epilepsy society: Therapeutic recommendations when dealing with a first epileptic seizure and in epileptic status

Introducción. La gran mayoría de crisis epilépticas son breves y autolimitadas, pero, en ocasiones, su duración puede ser mayor de la esperada, lo que, en el caso de las crisis convulsivas generalizadas, comporta un alto riesgo de morbimortalidad, que aumenta con su duración. Esta gravedad justifica la realización de una guía de práctica clínica de consenso, basada en evidencias implícitas sobre aspectos relacionados con el manejo terapéutico recomendado a un paciente con una crisis prolongada asistido en los servicios de urgencias. Materiales y métodos. Se ha realizado una búsqueda selectiva de la información científica relacionada con el tema propuesto en Pubmed-Medline, utilizando filtros de evidencia científica. Dicha búsqueda se completó en otros buscadores de evidencia científica, como Tripdatabase, Biblioteca Cochrane Plus o DARE. Las referencias seleccionadas se analizaron y discutieron por los autores y se extrajeron las evidencias disponibles y las recomendaciones de ellas derivadas. Resultados. Se identificaron 33 documentos primarios y seis guías de práctica o protocolos relacionados con el tema propuesto. Las recomendaciones se insertaron en el texto de manera explícita. Conclusiones. El protocolo terapéutico debe iniciarse ante cualquier crisis convulsiva con una duración superior a cinco minutos, asegurando, en primer lugar, la correcta función respiratoria y cardiocirculatoria, y administrando fármacos antiepilépticos por vía intravenosa de acción rápida y con dosis altas, mantenidos hasta que se identifica y controla la causa. Las crisis no convulsivas prolongadas, por su menor morbimortalidad, no precisan generalmente de una terapia tan enérgica y con riesgo de complicaciones (AU)

Introduction. Most epileptic seizures are brief and self-limiting, but sometimes they can last longer than expected and this entails (in the case of generalised seizures) a high risk of morbidity and mortality, which increases as they get longer. This severity justifies the need to draw up a set of consensus-based practice guidelines based on implicit evidence, to use Liberati’s nomenclature, concerning aspects related to the recommended therapeutic management of a patient with prolonged seizures who is being attended in an emergency department. Materials and methods. A selective search was conducted on PubMed-Medline for scientific information related to the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. Results. The search revealed the existence of 33 primary documents and six practice guidelines or protocols related with the topic under study. The recommendations were inserted in the text explicitly. Conclusions. The therapeutic protocol must be started when faced with any seizures that last more than five minutes. First, steps must be taken to ensure proper respiratory and cardiocirculatory functioning, and then fast-acting antiepileptic drugs are administered intravenously and in high doses until the cause is identified and controlled. Due to their lower level of morbidity and mortality, prolonged non-convulsive seizures do not generally require therapy that is so vigorous and with such a high risk of complications (AU)

[Consensus clinical practice guidelines of the Andalusian Epilepsy Society: therapeutic recommendations when dealing with a first epileptic seizure and in epileptic status]. / Guia de practica clinica de consenso de la Sociedad Andaluza de Epilepsia: recomendaciones terapeuticas ante una crisis epileptica y en el estado epileptico.

INTRODUCTION: Most epileptic seizures are brief and self-limiting, but sometimes they can last longer than expected and this entails (in the case of generalised seizures) a high risk of morbidity and mortality, which increases as they get longer. This severity justifies the need to draw up a set of consensus-based practice guidelines based on implicit evidence, to use Liberati's nomenclature, concerning aspects related to the recommended therapeutic management of a patient with prolonged seizures who is being attended in an emergency department. MATERIALS AND METHODS: A selective search was conducted on PubMed-Medline for scientific information related to the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. RESULTS: The search revealed the existence of 33 primary documents and six practice guidelines or protocols related with the topic under study. The recommendations were inserted in the text explicitly. CONCLUSIONS: The therapeutic protocol must be started when faced with any seizures that last more than five minutes. First, steps must be taken to ensure proper respiratory and cardiocirculatory functioning, and then fast-acting antiepileptic drugs are administered intravenously and in high doses until the cause is identified and controlled. Due to their lower level of morbidity and mortality, prolonged non-convulsive seizures do not generally require therapy that is so vigorous and with such a high risk of complications.

[Consensus clinical practice guidelines of the Sociedad Andaluza de Epilepsia for the diagnosis and treatment of patients with their first epileptic seizure in emergencies]. / Guía de práctica clínica de consenso de la Sociedad Andaluza de Epilepsia para el diagnóstico y tratamiento del paciente con una primera crisis epiléptica en situaciones de urgencia.

INTRODUCTION AND AIMS: Epileptic seizures are the cause of between 0.3 and 1.2% of all visits to hospital emergency departments. Twenty-five per cent of patients visit after having their first seizure. Such an impact seems to justify the development of a health care protocol. Our proposal is to draw up a set of implicit evidence-based consensus practice guidelines, to use Liberati's nomenclature, concerning aspects related to the diagnostic procedure and recommended therapeutic management of patients with a first seizure who are being attended in an emergency department. MATERIALS AND METHODS: A selective search was conducted on PubMed-Medline for quality scientific information on the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. RESULTS: A total of 47 primary documents and 10 practice guidelines or protocols related with the proposed topic were identified. The recommendations were inserted in the text explicitly. CONCLUSIONS: The diagnostic and therapeutic protocol for all paroxysmal phenomena in emergencies consists of three successive phases: diagnosis of the cause of the epilepsy, integration of the significance of the seizure within the clinical context, and designing the therapeutic scheme. Each phase will depend on the outcomes of the previous one as a decision algorithm. The fundamental tools in each phase are: patient record and examination (phase 1), and complementary tests (phase 2). They are then used to produce a therapeutic decision scheme.

[Neuropsychological intervention in patients with epilepsy]. / Intervención neuropsicológica en la clinica de la epilepsia.

INTRODUCTION: Neuropsychological evaluation is part of the protocols that are performed in epilepsy surgery units with the aim of selecting suitable candidates for the surgical intervention. DEVELOPMENT: Yet, neuropsychology can be useful for a wider range of purposes in patients with epilepsy. Identifying the cognitive, emotional and behavioural impairments that cause both the epileptic seizures and the possible underlying neuropathologies that trigger them can provide further knowledge of the functional deterioration suffered by epilepsy patients, whether they are candidates for surgery or not, and help guide their possible rehabilitation. The results of this evaluation can also make it easier to carry out the differential diagnosis to distinguish epileptic seizures from other non-epileptic episodes, such as psychogenic seizures. CONCLUSIONS: Neuropsychological evaluation in epileptic patients has increased our knowledge of the higher processes, the brain circuits involved in them and the repercussions that brain injury has on them.

Intervención neuropsicológica en la clínica de la epilepsia / Neuropsychological intervention in patients with epilepsy

Introducción. La evaluación neuropsicológica formaparte de los protocolos que se realizan en las unidades de cirugíade la epilepsia con el objetivo de seleccionar a los candidatos idóneospara la intervención quirúrgica. Desarrollo. Sin embargo, laslíneas de actuación de la neuropsicología dentro de la clínica de laepilepsia son más amplias. Identificar los déficit cognitivos, emocionalesy conductuales que causan tanto las crisis epilépticascomo los posibles sustratos neuropatológicos que las inducen puedecontribuir al conocimiento del deterioro funcional que sufre unpaciente con epilepsia, sea éste o no candidato a cirugía, y a orientarsu posible rehabilitación. Los resultados de esta evaluaciónpueden, asimismo, facilitar el diagnóstico diferencial de las crisisepilépticas con otros episodios no epilépticos, como las crisis psicógenas.Conclusión. La investigación neuropsicológica en pacientesepilépticos ha permitido ampliar el conocimiento de losprocesos superiores, de los circuitos cerebrales que los median y delas repercusiones que sobre ellos ocasiona el daño cerebral

Introduction. Neuropsychological evaluation is part of the protocols that are performed in epilepsy surgery unitswith the aim of selecting suitable candidates for the surgical intervention. Development. Yet, neuropsychology can be usefulfor a wider range of purposes in patients with epilepsy. Identifying the cognitive, emotional and behavioural impairments thatcause both the epileptic seizures and the possible underlying neuropathologies that trigger them can provide furtherknowledge of the functional deterioration suffered by epilepsy patients, whether they are candidates for surgery or not, andhelp guide their possible rehabilitation. The results of this evaluation can also make it easier to carry out the differentialdiagnosis to distinguish epileptic seizures from other non-epileptic episodes, such as psychogenic seizures. Conclusions.Neuropsychological evaluation in epileptic patients has increased our knowledge of the higher processes, the brain circuitsinvolved in them and the repercussions that brain injury has on them

[The Andalusia Epilepsy Society's Guide to Epilepsy Therapy 2005: II. Chronic therapy with antiepileptic drugs in adults and in children]. / Guia terapéutica en epilepsia de la Sociedad Andaluza de Epilepsia 2005: II. Terapéutica antiepiléptica crónica en el adulto y en el nino.

AIMS: The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy. DEVELOPMENT: A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines. CONCLUSIONS: The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.