Seguridad y tolerabilidad de la gabapentina

To review the information available regarding the safety and tolerability of gabapentin (GBP) in the treatment of epilepsy. PATIENTS AND METHODS: We reviewed the reports in the literature on the safety, adverse effects and tolerance of GBP as treatment, used as monotherapy or associated with other drugs, in epilepsies in patients of all age groups, including children, adults and the elderly. RESULTS: All published studies confirm that GBP is a well tolerated drug when used for monotherapy or associated with other antiepileptic drugs. The commonest adverse effects seen were somnolence, fainting, ataxia, nystagmus, tremor and headache. However, their incidence was low and intensity mild. There was no clear relationship between the dose given and appearance of side effects, except for fainting and somnolence. CONCLUSIONS: GBP is a drug which is free of unwanted side effects. Its safety and tolerability profile is excellent for treatment of simple and complex partial crises, with or without generalization in epileptic patients of all ages

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

Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios. A propósito de un caso

We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic crises and treated with valproate for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EGG monitoring, where there was an episode that showed temporary right epileptiform activity, with a diagnosis established of focal epilepsy of unknown cause. At present, she remains asymptomatic with oxycarbazepine

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

Vídeo-electroencefalografía: una necesidad

El vídeo-EEG es una herramienta diagnóstica habitual. Los avances técnicos de la última década la han simplificado de tal modo que con poco más de un ordenador y una cámara de vídeo pueden conseguirse registros de calidad. Se requiere personal preparado para su ejecución e interpretación. Es muy útil para el diagnóstico de episodios paroxísticos, para la clasificación y caracterización de crisis epilépticas y para la cuantificación de crisis o grafoelementos epileptiformes. Dada la importancia de un diagnóstico exacto, certero, ante un episodio paroxístico, no cabe duda de que esta herramienta debe ser cada vez más asequible para evitar el mal trato a muchos enfermos neurológicos. A pesar del paso de los años, un 20-30% de pacientes diagnosticados de epilepsia no son realmente epilépticos, lo cual sigue siendo excesivo e inaceptable.The video-EEG is a common diagnostic tool nowadays. The technical achievements of the last decade have brought a simplification of the equipment required to obtain good quality recordings, with little more than a computer and a video camera being necessary. However, the medical and technical staff must be well trained to execute and interpret the study. It is very useful in the diagnosis of paroxysmal events, for the classification and characterization of epileptic seizures and to quantify epileptiform discharges. Due to the importance of a correct diagnosis to avoid mistreating many neurological patients, this tool should be accessible to clinicians. In spite of the advances of recent years, 20-30% of patients diagnosed with epilepsy are not really epileptic, a fact that it is excessive and unacceptabl

Epilepsia y sueño

La relación entre epilepsia y sueño se conoce desde hace más de un siglo. Al final del siglo XIX se observó una relación entre la aparición de las crisis epilépticas y el ciclo vigilia-sueño. Con la aparición de la electroencefalografía se comprobó cual era el efecto del sueño y de la privación del mismo sobre las descargas epileptiformes interictales y las crisis epilépticas. Existen una serie de síndromes epilépticos parciales y generalizados que se asocian con el sueño y que es importante reconocer para poder hacer un buen diagnóstico diferencial de los pacientes con trastornos motores y de comportamiento durante el sueño. En este artículo se revisan todos esThe relationship between sleep and epilepsy is known from more than a century ago. At the end of the XIXth century a temporal relationship between the onset of epileptic seizures and the wake-sleep cycle was observed. The introduction of the electroencephalogram allowed establishing the effect of sleep and sleeping deprivation on epileptiform interictal discharges and on epileptic seizures. The recognition of the variety of generalized and partial epileptic syndromes associated to sleep is important to make a correct differential diagnosis of patients presenting with motor and behavioural disturbances of sleep. This article reviews the different aspects of the relationship between epilepsy and sleep

Epilepsia y sueño

La relación entre epilepsia y sueño se conoce desde hace más de un siglo. Al final del siglo XIX se observó una relación entre la aparición de las crisis epilépticas y el ciclo vigilia-sueño. Con la aparición de la electroencefalografía se comprobó cual era el efecto del sueño y de la privación del mismo sobre las descargas epileptiformes interictales y las crisis epilépticas. Existen una serie de síndromes epilépticos parciales y generalizados que se asocian con el sueño y que es importante reconocer para poder hacer un buen diagnóstico diferencial de los pacientes con trastornos motores y de comportamiento durante el sueño. En este artículo se revisan todos esThe relationship between sleep and epilepsy is known from more than a century ago. At the end of the XIXth century a temporal relationship between the onset of epileptic seizures and the wake-sleep cycle was observed. The introduction of the electroencephalogram allowed establishing the effect of sleep and sleeping deprivation on epileptiform interictal discharges and on epileptic seizures. The recognition of the variety of generalized and partial epileptic syndromes associated to sleep is important to make a correct differential diagnosis of patients presenting with motor and behavioural disturbances of sleep. This article reviews the different aspects of the relationship between epilepsy and sleep

Seguridad y tolerabilidad de la gabapentina

To review the information available regarding the safety and tolerability of gabapentin (GBP) in the treatment of epilepsy. PATIENTS AND METHODS: We reviewed the reports in the literature on the safety, adverse effects and tolerance of GBP as treatment, used as monotherapy or associated with other drugs, in epilepsies in patients of all age groups, including children, adults and the elderly. RESULTS: All published studies confirm that GBP is a well tolerated drug when used for monotherapy or associated with other antiepileptic drugs. The commonest adverse effects seen were somnolence, fainting, ataxia, nystagmus, tremor and headache. However, their incidence was low and intensity mild. There was no clear relationship between the dose given and appearance of side effects, except for fainting and somnolence. CONCLUSIONS: GBP is a drug which is free of unwanted side effects. Its safety and tolerability profile is excellent for treatment of simple and complex partial crises, with or without generalization in epileptic patients of all ages

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