Epilepsia y embarazo

Epilepsy is the most frequent neurological condition in pregnancy that requires continuous treatment during it to avoid adverse results in both the mother and the fetus. Pregnant women with epilepsy are a risk group during pregnancy, despite the fact that more than 90% have favorable results during it; its treatment is aimed at achieving the best possible control of seizures with the least adverse effects for both the mother and the fetus in terms of maternal and perinatal obstetric complications; Hence the importance of informing the doctors and health personnel who care for the obstetric patient about the risk factors and preconception treatment, during pregnancy, and at the time of delivery.La epilepsia es una condición frecuente en el embarazo afectando 0,3-0,8% de mujeres embarazadas y su inadecuado tratamiento puede derivar en complicaciones graves para la madre y el feto siendo las más relevantes el abrupcio de placenta, parto pretérmino y cesárea en la madre incluidas las caídas; y en el feto aborto, RCIU, hipoxia y las malformaciones congénitas; adicionalmente los cambios fisiológicos durante el embarazo afectan la distribución y efectividad de los medicamentos, el objetivo del tratamiento es lograr el mejor control de las convulsiones con menores efectos adversos para el binomio. Síntomas y signos de la epilepsia en el embarazo no difieren de los encontrados en mujeres no embarazadas, la historia clínica es importante para orientar el diagnóstico etiológico y de esta forma solicitar las ayudas diagnósticas pertinentes que incluyen electroencefalograma, tomografía axial computarizada o resonancia magnética nuclear del cerebro y química sanguínea, las imágenes diagnósticas están supeditadas al riesgo – beneficio por irradiación y por el uso del medio de contraste para el feto. El tratamiento de la epilepsia en contexto del embarazo debe iniciarse en el ámbito preconcepcional, del control prenatal, monitoreo intraparto y atención postparto. En casos de crisis epiléptica el manejo se orienta a la estabilización materna y control rápido de la crisis para prevenir hipoxia materna y fetal, es importante definir que el nacimiento inmediato por cesárea se reservará a los casos refractarios al manejo inicial o estatus epiléptico, en los demás casos la vía de parto se definirá por indicación obstétrica

Performance of Screening Strategies for Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease: Results from the ENEIDA Registry of GETECCU

(1) Aims: Patients receiving antitumor necrosis factor (anti-TNF) therapy are at risk of developing tuberculosis (TB), usually due to the reactivation of a latent TB infection (LTBI). LTBI screening and treatment decreases the risk of TB. This study evaluated the diagnostic performance of different LTBI screening strategies in patients with inflammatory bowel disease (IBD). (2) Methods: Patients in the Spanish ENEIDA registry with IBD screened for LTBI between January 2003 and January 2018 were included. The diagnostic yield of different strategies (dual screening with tuberculin skin test [TST] and interferon-gamma-release assay [IGRA], two-step TST, and early screening performed at least 12 months before starting biological treatment) was analyzed. (3) Results: Out of 7594 screened patients, 1445 (19%; 95% CI 18-20%) had LTBI. Immunomodulator (IMM) treatment at screening decreased the probability of detecting LTBI (20% vs. 17%, p = 0.001). Regarding screening strategies, LTBI was more frequently diagnosed by dual screening than by a single screening strategy (IGRA, OR 0.60; 95% CI 0.50-0.73, p < 0.001; TST, OR 0.76; 95% CI 0.66-0.88, p < 0.001). Two-step TST increased the diagnostic yield of a single TST by 24%. More cases of LTBI were diagnosed by early screening than by routine screening before starting anti-TNF agents (21% [95% CI 20-22%] vs. 14% [95% CI 13-16%], p < 0.001). The highest diagnostic performance for LTBI (29%) was obtained by combining early and TST/IGRA dual screening strategies in patients without IMM. (4): Conclusions: Both early screening and TST/IGRA dual screening strategies significantly increased diagnostic performance for LTBI in patients with IBD, with optimal performance achieved when they are used together in the absence of IMM

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case–Control Study (COVID-19-EII)

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case-control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March-July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3-5.9), occupational risk (OR: 2.9; 95%CI: 1.8-4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2-2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09-0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution

Síndrome de piernas inquietas o enfermedad de Willis Ekbom

El síndrome de piernas inquietas (SPI) es un trastorno sensitivo y motor en el que el paciente refiere un deseo incontenible de mover las extremidades, que puede estar acompañado por una sensación desagradable, mal definida, y hasta en el 50 % de los casos con dolor, difícil de ubicar en un punto específico, y que inicialmente se manifiesta en las piernas. Se presenta principalmente en las noches impidiendo el sueño y subsecuentemente afectando la calidad de vida del paciente. Clásicamente se divide en síndrome de piernas inquietas primario y secundario, por la presencia o no de enfermedades concomitantes relacionadas con el tratamiento y pronóstico del SPI. Esta enfermedad tiene una incidencia en la población general de 9 a 22 pacientes por cada 1.000 personas al año (equivalente a 1,7 % por año); con una prevalencia de 5-13 % de la población general. El diagnóstico del SPI se realiza mediante el uso de los criterios establecidos por el Grupo Internacional de Estudio de SPI, divididos en esenciales y de soporte. Su tratamiento tiene como piedra angular a los agonistas dopaminérgicos, y otros medicamentos como el gabapentin enacarbil que han ganado terreno en los últimos años. La importancia del conocimiento de la enfermedad radica en el impacto negativo que ejerce sobre la calidad de vida de los pacientes afectados en general, y el aumento de la mortalidad en los pacientes con comorbilidad de enfermedad renal terminal en particular. Su diagnóstico es clínico y debe buscarse como causa de insomnio

SEMIOLOGÍA DE CRISIS EN PROBABLE EPILEPSIA DEL LÓBULO FRONTAL

Antecedentes: La epilepsia del lóbulo frontal es la segunda más frecuente entre las epilepsias focales. En ésta puede haber mayor dificultad en la interpretación del electroencefalograma de superficie y la resonancia ser normal. Por esto, los estudios más recientes buscan evaluar la semiología de las crisis para mejorar la localización del foco. Objetivo: describir la frecuencia y secuencia de aparición de las manifestaciones ictales de pacientes con probable epilepsia del lóbulo frontal, en el laboratorio de electroencefalografía CEC-LAB, entre enero 2009 y mayo 2016. Método: Estudio descriptivo, retrospectivo, de los videoelectroencefalogramas de pacientes con probable epilepsia del lóbulo frontal. Se incluyeron 28 videoelectroencefalogramas de igual número de pacientes. Se hizo recolección de la información por dos evaluadores independientes y entrenados previamente. Resultados: El grupo estuvo conformado en su mayoría por mujeres (53,6%), habitantes del área urbana (92,6%), con una media de edad de 27.75 años, y de edad de inicio de la epilepsia de 12.13 años. En el 50% de los casos había predominio nocturno de las crisis. Las manifestaciones ictales más frecuentes en primer orden de aparición fueron el alertamiento ictal, la crisis hipermotora tipo 2, la expresión facial de miedo y el giro cefálico a la izquierda. Conclusiones: El alertamiento ictal, las crisis hipermotoras tipo 2, la expresión facial de miedo y el giro cefálico a la izquierda fueron los hallazgos clínicos más frecuentes al inicio de las crisis de los pacientes con probable epilepsia del lóbulo frontal; coincidiendo con otras series de epilepsia del lóbulo frontal

Trends in Targeted Therapy Usage in Inflammatory Bowel Disease : TRENDY Study of ENEIDA

Markers that allow for the selection of tailored treatments for individual patients with inflammatory bowel diseases (IBD) are yet to be identified. Our aim was to describe trends in real-life treatment usage. For this purpose, patients from the ENEIDA registry who received their first targeted IBD treatment (biologics or tofacitinib) between 2015 and 2021 were included. A subsequent analysis with Machine Learning models was performed. The study included 10,009 patients [71% with Crohn's disease (CD) and 29% with ulcerative colitis (UC)]. In CD, anti-TNF (predominantly adalimumab) were the main agents in the 1st line of treatment (LoT), although their use declined over time. In UC, anti-TNF (mainly infliximab) use was predominant in 1st LoT, remaining stable over time. Ustekinumab and vedolizumab were the most prescribed drugs in 2nd and 3rd LoT in CD and UC, respectively. Overall, the use of biosimilars increased over time. Machine Learning failed to identify a model capable of predicting treatment patterns. In conclusion, drug positioning is different in CD and UC. Anti-TNF were the most used drugs in IBD 1st LoT, being adalimumab predominant in CD and infliximab in UC. Ustekinumab and vedolizumab have gained importance in CD and UC, respectively. The approval of biosimilars had a significant impact on treatment

Effectiveness and safety of ustekinumab in ulcerative colitis: Real-world evidence from the ENEIDA registry

Abstract Background: The development program (UNIFI) has shown promising results of ustekinumab in ulcerative colitis (UC) treatment that should be confirmed in clinical practice. Aims: To evaluate the durability, effectiveness and safety of ustekinumab in UC in real-life. Methods: Patients included in the prospectively maintained ENEIDA registry who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score (PMS) >2] were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at week 16. Results: A total of 95 patients were included. At week 16, 53% of patients had response (including 35% of patients in remission). In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at weeks 24 and 52, respectively. Thirty-six percent of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at week 16, 63% at week 56, and 59% at week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. Conclusions: Ustekinumab is effective both in the short and the long-term in real-life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinuma

Nationwide COVID-19-EII Study : Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry

We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March-July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged ≥ 60 years (OR 7.1, 95% CI: 1.8-27 and 4.5, 95% CI: 1.3-15.9), while having ≥2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3-11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case&ndash;Control Study (COVID-19-EII)

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case&ndash;control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March&ndash;July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p &lt; 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p &lt; 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3&ndash;5.9), occupational risk (OR: 2.9; 95%CI: 1.8&ndash;4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2&ndash;2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09&ndash;0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution