The importance of timing in epilepsia partialis continua.

INTRODUCTION: Timing is one of the most important modifiable prognostic factors in the management of status epilepticus. Epilepsia partialis continua (EPC) is a status epilepticus subtype of highly variable, occasionally prolonged, duration. The aim of this study was to analyse the relationship between EPC duration and outcomes. METHODS: We performed an observational prospective study of all patients with EPC admitted to our tertiary hospital between 1 September 2017 and 1 September 2018. RESULTS: The sample included 10 patients, of whom 9 were women; median age was 74 years. The most frequent aetiology was cerebrovascular disease (n = 6). EPC onset occurred outside the hospital in 5 patients, with a median time to hospital admission of 4 hours. The median time to treatment onset (TT) for all patients was 12.3 hours. The median time from treatment onset to EPC control (TC) was 30 hours; TC showed a strong positive correlation with TT (Spearman's rho = 0.88). Six patients presented hyperglycaemia at onset; this was positively correlated with TC (rho = 0.71). All 6 patients with hyperglycaemia presented a brain injury explaining the EPC episode. CONCLUSIONS: Delays were observed in different phases of EPC management, which was related to longer duration of the episode. Glycaemia was also related to episode duration, probably acting as a triggering factor rather than as the aetiology.

The importance of timing in epilepsia partialis continua. / La relevancia del tiempo en la epilepsia parcial continua.

INTRODUCTION: Timing is one of the most important modifiable prognostic factors in the management of status epilepticus. Epilepsia partialis continua (EPC) is a status epilepticus subtype of highly variable, occasionally prolonged, duration. The aim of this study was to analyze the relationship between EPC duration and outcomes. METHODS: We performed an observational prospective study of all patients with EPC admitted to our tertiary hospital between 1 September 2017 and 1 September 2018. RESULTS: The sample included 10 patients, of whom 9 were women; median age was 74 years. The most frequent aetiology was cerebrovascular disease (n=6). EPC onset occurred outside the hospital in 5 patients, with a median time to hospital admission of 4hours. The median time to treatment onset for all patients was 12.3hours. The median time from treatment onset to EPC control was 30hours; time from treatment onset to EPC control showed a strong positive correlation with TT (Spearman's rho=0.88). Six patients presented hyperglycaemia at onset; this was positively correlated with time from treatment onset to EPC control (rho=0.71). All 6 patients with hyperglycaemia presented a brain injury explaining the EPC episode. CONCLUSIONS: Delays were observed in different phases of EPC management, which was related to longer duration of the episode. Glycaemia was also related to episode duration, probably acting as a triggering factor rather than as the aetiology.

Encefalitis de Rasmussen: diagnóstico y enfoque terapéutico / Rasmussen encephalitis: diagnostic and therapeutic approaches

Objetivo: describir el caso de una paciente escolar con diagnóstico de encefalitis de Rasmussen de presentación aguda y el enfoque terapéutico. Presentación: paciente femenina de 5 años y nueve meses que cursa con cuadro de evolución progresiva caracterizado por posturas distónicas que se inicia en pierna izquierda seguida de miembro superior ipsilateral asociadas con crisis focales con semiología de inicio opercular que la conducen a estatus epiléptico. La resonancia magnética cerebral evidencia cambios estructurales progresivos con atrofia hemisférica y del núcleo basal derechos, se inicia terapia antiepiléptica e inmunomoduladora con buena respuesta. Discusión: se realizó una revisión de la literatura sobre la presentación clínica, diagnóstico y mejores opciones terapéuticas. Conclusiones: se trata de una escolar con síndrome de Rasmussen en etapa aguda, con adecuada evolución clínica luego de inicio de inmunoterapia. En Colombia existen pocos reportes, nuestro propósito es realizar la presentación de un caso y revisar el enfoque diagnóstico y terapéutico.

Objective: to describe the case of a school-age patient aged 5 years 9 months diagnosed with acute Rasmussen encephalitis (RE), and its therapeutic approach. Case presentation: a girl aged 5 years 9 months presenting with progressive dystonic postures starting in the left lower limb with spread to the ipsilateral upper limb associated with focal seizures characterized by opercular epilepsy semiology which lead to status epilepticus. Cerebral magnetic resonance imaging revealed progressive structural changes with atrophy of the right cerebral hemisphere and basal nuclei. Anti-epileptic and immunmodulator therapy was initiated obtaining good response. Discussion: a review of the literature on RE clinical presentation, diagnosis and best treatment options was conducted. Conclusions: this is the case of a young girl with Rasmussen syndrome in the acute stage evidencing proper clinical progression after receiving immunotherapy. Few reports exist on this topic in Colombia. Our purpose was to present a case and review RE diagnostic and therapeutic approaches.

Prevalência dos fatores instrínsecos e extrínsecos do processo de aprendizagem em crianças com epilepsia / Prevalence of intrinsic and extrinsic factors of the learning process in children with epilepsy

Objetivo levantar a prevalência dos fatores intrínsecos e extrínsecos que podem interferir no processo de aprendizagem em crianças com epilepsia. Métodos este estudo descritivo foi realizado no Ambulatório de Neurologia Infantil do Hospital de Pediatria Professor Heriberto Bezerra (HOSPED) da UFRN. A obtenção dos dados ocorreu durante setembro/2009 a março/2010 por meio da aplicação de um questionário com pais e cuidadores de crianças com epilepsia. A amostra foi constituída por 41 crianças, seguindo os seguintes critérios de inclusão: a) pais ou cuidadores de crianças com diagnóstico inequívoco de epilepsia atendidas no ambulatório do HOSPED; b) crianças com idades entre 3 e 12 anos; e c) pais ou responsáveis assinarem o termo de consentimento livre e esclarecido. Resultados 61% das crianças apresentaram diagnóstico de epilepsia pura. 59% tiveram sua primeira crise antes dos 03 anos de idade. 34% apresentavam crises do tipo generalizada. 51% apresentavam crises no período da pesquisa. 98% estavam em tratamento medicamentoso para controle das crises, sendo 55% monoterapia e 45% politerapia. 76% estavam inseridas na escola, sendo 50% em escolas públicas. 66% nunca repetiram o ano. 49% das crianças tiveram assiduidade escolar prejudicada em virtude das crises. 64% nunca foram excluídas da escola pelos professores devido a epilepsia e 85% dos pais afirmaram superproteger os filhos. Conclusão o estudo concluiu que, além da epilepsia, as crianças com essa patologia são também expostas a outros fatores, decorrentes da doença, que podem influenciar negativamente no processo de aprendizagem dessas crianças. .

Purpose to raise the prevalence of intrinsic and extrinsic factors of the learning process in children with epilepsy. Methods this descriptive study was conducted at the Clinic of Neurology Children’s Hospital of Pediatrics Professor Heriberto Bezerra, HOSPED – UFRN. Data collection occurred during the September/2009 to March/2010 through a questionnaire with parents and carers of children with epilepsy. The sample comprised 41 children, according to the following inclusion criteria: a) parents or caregivers of children with an unequivocal diagnosis of epilepsy seen at the outpatient clinic of HOSPED; b) children aged between 3 and 12 years; and c) parents or guardian sign the consent form free and clear. Results 61% of children were diagnosed with pure epilepsy. 59% had their first crisis before the age of 03. 34% presented generalized crisis type. 51% presented crisis during the survey period. 98% were on medications to control crisis, and from these children, 55% monotherapy and 45% polytherapy. 76% were at school, 50% inserted in public school. 66% never repeated the school year. 49% of children had school attendance affected because of the crisis. 64% have never been excluded from school by teachers because of epilepsy and 85% of parents affirmed to overprotect their children. Conclusion the study concluded that, in addition epilepsy, children with that pathology are also exposed to other factors, resulting from the disease, which may negatively affect these children learning process. .