204 research outputs found
Manejo de la primera crisis epiléptica y del status en urgencias
First epileptic seizure is a common reason for
attending the emergency department. Its management
is focused on diagnosis of the episode and on
identification and treatment of the underlying cause.
Occasionally, anti-epileptic treatment will be required.
However, when the seizure is prolonged - a condition
known as status epilepticus - it becomes a life-threatening
process and requires immediate treatment. In this
article, general advice and guidelines for the
management of seizures and of sta
Estado epiléptico no convulsivo en el siglo XXI: clínica, diagnóstico, tratamiento y pronóstico
Non-convulsive status epilepticus is a significant issue for a neurologist
because, despite its low prevalence, it mimics other pathologies, with
therapeutics and prognostic outcomes. Diagnosis is based on clinical features,
mainly mental status or impaired consciousness and electroencephalographic
changes, so electroencephalogram is the first exploration we must perform with
clinical suspicion. There are three clinical forms: generalized or absence
status, with diffuse epileptiform discharges; focal, with epileptic discharges
located in a specific brain area and may not affect consciousness; and subtle,
with diffuse or local epileptic activity after a tonic-clonic seizure or
convulsive status and limited or no motor activity. Treatment are benzodiazepines
and antiepileptic drugs; anesthetic drugs are only recommended for patients with
subtle status and in some with partial complex status. Prognosis is mainly
determined by etiology and associated brain damage
Estimulación vagal en el tratamiento de la epilepsia
The vagal nerve stimulation is a new technique for the treatment of
drug resistant epilepsies. DEVELOPMENT: In 1997, it was approved in United States
by the FDA to be used in adults with refractory focal epilepsies not candidates
for epilepsy surgery. Its mechanism of action is unknown. The results in the
controlled studies indicated a decrease of 30 50% in the seizure frequency in
around 50% of the patients. Although more experience is needed to corroborate
these results, it seems reasonable as a treatment for patients with difficult
epilepsies, especially when the response to the antiepileptic drugs is poor or
they are producing secondary effects, and the resection of the focus is not
possible
Clasificación de los trastornos del sueño
Sleep disorders are frequent processes, both as a symptom associated with other diseases and as independent disorders. However, only in the last 4 decades has Sleep medicine gained its position among the medical specialties. In fact, it was only in these years that significant advances were obtained in the study of the etiology and treatment of these disorders. Similarly, the different classifications have been evolving over the years. First, they were based upon the clinical symptom; later on, more emphasis was given to the diseases. Finally, in 2005, the new classification was once again based on the symptoms. More than 90 disorders are listed in this latest classification, and an attempt is made to include the symptoms and the diseases of sleep, as well as those in which sleep disorders are fundamental. It is essential to have a clear idea of this complete classification of sleep disorders in order to deal with these patients appropriately
El camino hacia la sostenibilidad en el País Vasco. La Agenda 21 en Vitoria-Gasteiz
The article deals with actions carried out by the Department of Environment and Regional Planning for the Basque Government in order to suppost the introduction of Local Agenda 21 in Basque municipalities. Special emphasis is placed on networking via intermunicipal cooperation. By way of acase study, the municipal area of Vitoria-Gasteiz -pioneer in the region for implementing the said Local Agenda 21- has been chosen, providing an opportunityt o make an initial assessment of its achievements and failures.El artículo aborda las actuaciones llevadas a cabo por el Departanlento de Ordenación del Territorio y Medio Ambiente del Gobierno Vasco para impulsar la implantación de la Agenda 21 Local en los municipios vascos. Se hace especial hincapié en la promoción del trabajo en red a través de la cooperación intermunicipal. Como estudio de caso, se ha elegido el rnunicipio de Vitoria-Gasteiz, pionero en la región en la puesta en marcha de dicha Agenda 21 Local, lo que permite realizar una primera valoración de sus logros y fracasos
Continuous intraocular pressure monitoring in patients with obstructive sleep apnea syndrome using a contact lens sensor
Purpose To analyse nocturnal intraocular pressure (IOP) fluctuations in patients with obstructive sleep apnea syndrome (OSAS) using a contact lens sensor (CLS) and to identify associations between the OSAS parameters determined by polysomnographic study (PSG) and IOP changes. Method Prospective, observational study. Twenty participants suspected of having OSAS were recruited. During PSG study, IOP was monitored using a CLS placed in the eye of the patient. The patients were classified according to the apnea-hypopnea index (AHI) in two categories, severe (>30) or mild/moderate (<30) OSAS. We evaluated several parameters determined by the IOP curves, including nocturnal elevations (acrophase) and plateau times in acrophase (PTs) defined by mathematical and visual methods. Results The IOP curves exhibited a nocturnal acrophase followed by PTs of varying extents at which the IOP remained higher than daytime measurement with small variations. We found significant differences in the length of the PTs in patients with severe OSAS compared to those with mild/moderate disease (P = 0.032/P = 0.028). We found a positive correlation between PTs and OSAS severity measured by the total number of apneic events (r = 0.681/ 0.751 P = 0.004/0.001) and AHI (r = 0.674/0.710, P = 0.004/0.002). Respiratory-related arousal and oxygen saturation also were associated significantly with the IOP PT length. Conclusions Periods of nocturnal IOP elevation lasted longer in severe OSAS patients than those with mild/moderate OSAS and correlate with the severity of the disease. The length of the nocturnal PT is also associated to respiratory parameters altered in patients with OSAS
Paresia poscrítica durante estudios de monitorización de vídeo-EEG
To know the frequency of Todd s paralysis during the video EEG
monitoring studies, to investigate in its pathophysiology, and to confirm its
value to localise the epileptic focus. PATIENTS AND METHODS: We reviewed 114
monitoring studies, in 102 patients. RESULTS: Sixty patients had epileptic
seizures. An obvious paresis was noted in four seizures of two patients (3 and 1,
respectively). Both patients had frontal epilepsy. During the paralysis, in the
first patient the EEG showed ictal discharges on the contralateral centrotemporal
area. In the second patient, the EEG demonstrated slow waves in the contralateral
frontal region. The ictal onset was contralateral to the paresis in all cases. No
patient with pseudoseizures had paralysis. CONCLUSIONS: Postconvulsive paralysis
are not frequent in video EEG monitoring studies. However, if present it points
out to a contralateral seizure onset. In our series it happened in patients with
frontal seizures. The EEG may help to clarify if it correspond to a true
postictal phenomenon or to a ictal paralysis
Acoustic evaluation of modular greenery noise barriers
Green noise barriers have become an alternative means of reducing urban traffic noise. In this paper, the acoustic performance of a modular greenery noise barrier is evaluated. In situ measurements of noise reflection were performed using an experimental prototype to estimate the sound absorption coefficients. These coefficients were found to have values of approximately 0.7, higher than those previously found in laboratory measurements for a similar system with a lower vegetation density. The obtained values were input into software for predicting environmental noise to analyse the expected performance of such barriers, particularly in the case of a pair of parallel barriers. A comparison with the results for reflective barriers indicates a significant improvement in sound attenuation of up to 4 dBA. The values are similar and even superior to results reported by other authors regarding the effectiveness of absorptive treatments applied to parallel barriers, and furthermore, the proposed barriers offer an aesthetic element for environmental integration.Peer ReviewedPostprint (published version
Changes in the heart rate variability in patients with obstructive sleep apnea and its response to acute CPAP treatment
Obstructive Sleep Apnea (OSA) is a major risk factor for
cardiovascular disease. The goal of this study was to demonstrate whether the use
of CPAP produces significant changes in the heart rate or in the heart rate
variability of patients with OSA in the first night of treatment and whether
gender and obesity play a role in these differences. METHODS: Single-center
transversal study including patients with severe OSA corrected with CPAP. Only
patients with total correction after CPAP were included. Patients underwent two
sleep studies on consecutive nights: the first night a basal study, and the
second with CPAP. We also analyzed the heart rate changes and their relationship
with CPAP treatment, sleep stages, sex and body mass index. Twenty-minute
segments of the ECG were selected from the sleep periods of REM, no-REM and
awake. Heart rate (HR) and heart rate variability (HRV) were studied by comparing
the R-R interval in the different conditions. We also compared samples from the
basal study and CPAP nights. RESULTS: 39 patients (15 females, 24 males) were
studied. The mean age was 50.67 years old, the mean AHI was 48.54, and mean body
mass index was 33.41 kg/m(2) (31.83 males, 35.95 females). Our results showed
that HRV (SDNN) decreased after the use of CPAP during the first night of
treatment, especially in non-REM sleep. Gender and obesity did not have any
influence on our results. CONCLUSIONS: These findings support that cardiac
variability improves as an acute effect, independently of gender or weight, in
the first night of CPAP use in severe OSA patients, supporting the idea of
continuous use and emphasizing that noncompliance of CPAP treatment should be
avoided even if it is just once
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