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Resumen: Introducción: La epilepsia ausencia juvenil (EAJ) es un tipo de epilepsia generalizada idiopática que se caracteriza por la presencia de crisis de ausencia (CA) que comienzan en la adolescencia, con un EEG típico de punta-onda generalizada, y que puede acompañarse de mioclonías y crisis tónico-clónicas generalizadas (CTCG). El pronóstico a largo plazo es incierto. Material y métodos: Seleccionamos de manera retrospectiva todos los pacientes que cumplían los criterios diagnósticos de EAJ de la ILAE 1989, analizamos las variables clínicas, el tratamiento farmacológico, el estar libre de crisis y la posibilidad de retirar el tratamiento. Resultados: Encontramos 21 pacientes, 17 mujeres y 4 varones, el 86% presentó también CTCG y el 14% mioclonías. La edad de inicio de las CA fue de 17 años (rango: 10-44). Cuatro pacientes comenzaron con CA en la edad adulta. El seguimiento medio fue de 25 años (intervalo: 10-43). El 90% recibió tratamiento con valproato y el 62% requirió politerapia. El 43% de los pacientes están actualmente libres de crisis, aunque todos ellos en tratamiento farmacológico. Todos los intentos de retirar la medicación fracasaron, pese a largos períodos sin crisis. Conclusiones: Menos de la mitad de los pacientes con EAJ están libres de crisis. El tratamiento antiepiléptico es necesario durante toda la vida a pesar de largos períodos de remisiones. Abstract: Introduction: Juvenile absence epilepsy (JAE) is a generalized form of epilepsy, characterized by absence seizures (AS) initiated in adolescence, with a typical EEG showing generalized spike-wave discharges. Apart from absences, other seizure types may be observed such as myoclonia and generalized tonic-clonic seizures (GTCS). Its long-term prognosis is uncertain. Material and methods: We retrospectively selected all patients who met the 1989 ILAE diagnostic criteria for JAE. We analysed clinical variables, pharmacological treatment, and seizure remission with medical treatment and seizure relapse after stopping medical treatment. Results: We identified 21 patients, 17 women and 4 men, 86% of whom had suffered GTCS and 14% myoclonias. Mean age at AS onset was 17 years old (range 10-44), 4 patients debuted with AS in adulthood. Mean follow up duration was 25 years (range 10-43). Ninety per cent of the patients were treated with valproate and 62% needed polytherapy. Currently 43% have achieved seizure freedom under medical treatment. All attempts to stop treatment failed, in some cases after long periods of seizure remission. Conclusions: Less than fifty per cent of patients with JAE achieve remission, antiepileptic treatment is mandatory during all life, despite having long periods of remission. Palabras clave: Epilepsia ausencia juvenil, Ausencias, Pronóstico, Tratamiento, Edad adulta, Keywords: Juvenile absence epilepsy, Absences, Prognostic, Treatment, Adulthood

Introduction: Juvenile absence epilepsy (JAE) is a generalized form of epilepsy, characterized by absence seizures (AS) initiated in adolescence, with a typical EEG showing generalized spike-wave discharges. Apart from absences, other seizure types may be observed such as myoclonia and generalized tonic-clonic seizures (GTCS). Its long-term prognosis is uncertain. Material and methods: We retrospectively selected all patients who met the 1989 ILAE diagnostic criteria for JAE. We analysed clinical variables, pharmacological treatment, and seizure remission with medical treatment and seizure relapse after stopping medical treatment. Results: We identified 21 patients, 17 women and 4 men, 86% of whom had suffered GTCS and 14% myoclonias. Mean age at AS onset was 17 years old (range 10–44), 4 patients debuted with AS in adulthood. Mean follow up duration was 25 years (range 10–43). Ninety per cent of the patients were treated with valproate and 62% needed polytherapy. Currently 43% have achieved seizure freedom under medical treatment. All attempts to stop treatment failed, in some cases after long periods of seizure remission. Conclusions: Less than fifty per cent of patients with JAE achieve remission, antiepileptic treatment is mandatory during all life, despite having long periods of remission. Resumen: Introducción: La epilepsia ausencia juvenil (EAJ) es un tipo de epilepsia generalizada idiopática que se caracteriza por la presencia de crisis de ausencia (CA) que comienzan en la adolescencia, con un EEG típico de punta-onda generalizada, y que puede acompañarse de mioclonías y crisis tónico-clónicas generalizadas (CTCG). El pronóstico a largo plazo es incierto. Material y métodos: Seleccionamos de manera retrospectiva todos los pacientes que cumplían los criterios diagnósticos de EAJ de la ILAE 1989, analizamos las variables clínicas, el tratamiento farmacológico, el estar libre de crisis y la posibilidad de retirar el tratamiento. Resultados: Encontramos 21 pacientes, 17 mujeres y 4 varones, el 86% presentó también CTCG y el 14% mioclonías. La edad de inicio de las CA fue de 17 años (rango: 10–44). Cuatro pacientes comenzaron con CA en la edad adulta. El seguimiento medio fue de 25 años (intervalo: 10–43). El 90% recibió tratamiento con valproato y el 62% requirió politerapia. El 43% de los pacientes están actualmente libres de crisis, aunque todos ellos en tratamiento farmacológico. Todos los intentos de retirar la medicación fracasaron, pese a largos períodos sin crisis. Conclusiones: Menos de la mitad de los pacientes con EAJ están libres de crisis. El tratamiento antiepiléptico es necesario durante toda la vida a pesar de largos períodos de remisiones. Keywords: Juvenile absence epilepsy, Absences, Prognostic, Treatment, Adulthood, Palabras clave: Epilepsia ausencia juvenil, Ausencias, Pronóstico, Tratamiento, Edad adulta

Objective: Epilepsy has a significant impact on quality of life. Many studies have observed higher unemployment rates among patients with epilepsy. However, unemployment rates vary according to the clinical conditions, country, and group studied., Methods: Between October 2007 and February 2008, we performed a cross-sectional multicenter epidemiological study to evaluate the socio-occupational and employment profiles of 872 adult patients with epilepsy followed in outpatient epilepsy clinics in Spain., Results: Fifty-eight percent of the patients were employed at the time of the survey, 10.9% of the patients were unemployed, and 12.5% were occupationally incapacitated., Conclusion: Patients with epilepsy had employment rates similar to those of the general population, and slightly higher levels of unemployment. The main factors associated with unemployment and incapacity were the presence of refractory epilepsy, the occurrence of a seizure in the last 12 months, level of education, and polytherapy., (Copyright © 2011. Published by Elsevier Inc.)

Objective: The goal of this study was to investigate clinical findings, ictal semiology, and results of video/electroencephalography (video/EEG), and magnetoencephalography (MEG) in patients with startle epilepsy and normal brain MRI., Methods: Four patients (mean age 12.5 years) with startle epilepsy were investigated with MRI, video/EEG, and MEG., Results: Epilepsy diagnosis was established in childhood, and all had spontaneous and reflex seizures. Reflex seizures were triggered by sudden, unexpected sounds and tactile stimuli. The neurological examinations and MRIs were normal. MEG recordings showed focal epileptiform activity. An ictal MEG was obtained in one patient. Source modeling yielded dipole sources in right central frontal region., Conclusion: The present study demonstrates that the origin of epileptiform activity in startle epilepsy can be localized in brain areas associated with supplementary motor seizures, even in patients with normal brain MRI. MEG adds complementary information to the localization of epileptiform activity and can be useful in planning invasive studies in cases evaluated for epilepsy surgery.

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.

Objective: The goal of the study described here was to obtain psychometric validation of the Spanish version of the 38-item Side Effects and Life Satisfaction (SEALS) Inventory., Methods: A cross-cultural adaptation of the inventory was performed. A total of 595 patients with epilepsy were included in a multicenter cross-sectional study. The SEALS Inventory was completed, together with the Hospital Anxiety and Depression Scale and SF-12 Health Survey., Results: The mean SEALS score was 60.7. SEALS presented high internal consistency, with a Cronbach alpha coefficient of 0.93, and good test-retest reliability, with an intraclass correlation coefficient of 0.92. The pattern of correlations with the Hospital Anxiety and Depression Scale and SF-12 Health Survey indicated good convergent and divergent validity. SEALS scores discriminated patients according to epilepsy-related factors, emotional disturbances, and the generic quality of life., Conclusion: The Spanish version of the SEALS Inventory is a valid psychometric instrument. It may be used in routine clinical practice and in clinical trials in patients with epilepsy to capture the cognitive and behavioral aspects of quality of life.

Introduction: Comorbidity between epilepsy and cancer is elevated. As a life-time condition, it is not impossible for a patient with epilepsy to have a cancer at some point. Besides, at least 30% of patients with primary brain tumors have epileptic seizures, but also in patients with metastatic infiltrating lesions of the central nervous system and with extracerebral tumors, epilepsy can be related. Seizures may also appear associated with paraneoplastic syndromes, such as limbic encephalitis and metabolic and infectious complications of chemotherapy and radiotherapy., Results: The precise mechanisms by which brain tumors and the other conditions mentioned above produce seizures are not fully understood, but are reviewed in this article, as well as the many different therapeutic options that may be used in the treatment of epileptic seizures. Pharmacological treatment poses various controversies, such as the utility of prophylactic treatment, interactions between antiepileptic drugs (AEDs) and chemotherapeutic drugs and the complications derived from the adverse effects of AEDs in this population. Finally, other treatments are proposed such as chemotherapy, radiotherapy and surgery, the rational application of which allows for an improvement in the patients' quality of life., Conclusion: In order to arrive at a diagnosis, the different causes that could condition the appearance of epileptic seizures in cancer patients must be known. After this, the most adequate treatment should be chosen, thus ensuring the comprehensive treatment of cancer and epilepsy.

Objective: The aim was to study the frequency and types of adverse effects (AEs) in patients treated with antiepileptic drugs (AEDs) according to the strategies used by the neurologist to detect them., Method: This cross-sectional epidemiological study was carried out in standard clinical practice. Two strategies were used to detect AEs: spontaneous reporting by the patient, and a checklist of possible treatment-related adverse reactions completed by the patient., Results: A total of 579 patients were recruited for the study. Roughly a third (33.7%) reported AEs spontaneously, and 65.2% did so when administered the checklist. The main reason for changing medication was lack of efficacy, but significant side effects were also an important reason for modifying treatment in those patients who reported higher levels of discomfort., Conclusions: The use of an active approach is recommended for detection of AEs of AED treatment. AEs appear to have a key effect on the decision to change treatment.

Introduction: Patients with drug resistant epilepsy are potential candidates for surgery. The pre surgical study of these patients involves a multidisciplinary approach., Patients and Methods: We included patients who had been submitted to EEG video monitoring in our centre (a tertiary university hospital) between April 1995 and May 2000. The evaluation protocol included magnetic resonance (MR) brain scan (according to a specific protocol), neuropsychological and psychiatric evaluation, and ictal/interictal SPECT, when possible. Patients who underwent surgery were followed up at regular intervals until at least two years after surgery., Results: Of the 299 patients with EEG video monitoring, 87 had been submitted to surgery up to June 2000. Nine of these patients required invasive subdural studies or studies of the foramen ovale using electrodes. Of the patients who underwent surgery, 44.8% had sclerosis of the hippocampus in the MR and in 10% it was found to be normal. The results of pathological anatomy revealed: 49.3% with sclerosis of the hippocampus, 15.1% with benign tumours, 13.7% with gliosis, 4.1% heterotopias and 4.1% cavernomas. Just one patient has been submitted to surgery again because of badly controlled seizures. Eight patients have presented post surgical complications (four with permanent morbidity). Of the 73 patients who were followed up for at least a year, 83.6% are in Engel class I, 9.6% in class II, 2.7% in class III and 4.1% in class IV. Among patients who underwent a temporal resection, 88.7% were in class I and 0% in class IV., Conclusions: Epilepsy surgery, in selected patients, has a very low morbidity/mortality rate and the chances that seizures will disappear or greatly improve are high.

Objectives: Approximately one third of the patients with epilepsy are drug resistant. For decades it has been speculated whether repetition of the seizures might potentially lead to progression of the disorder., Development: In recent years four levels of evidence (experimental, imaging, epidemiological and neuropsychological) suggest that in at least some types of epilepsy the disorder may progress. In various experimental models of epilepsy it has been shown that the persistence of seizures led to biochemical, structural and cellular changes which are persistent and progressive. However, it is difficult to extrapolate these results to human epilepsy. Studies using magnetic resonance volume measurements and spectroscopy have shown that in temporal lobe epilepsy the lesion seems to progress over the years. However, epidemiological and clinical studies do not consistently show a worsening pattern of seizures over the years of epilepsy duration. In fact, recent evidence has shown that drug resistance may occur from the beginning of the disorder., Conclusions: Neuropsychological studies in patients with drug resistant epilepsy, especially in those with mesial temporal lobe epilepsy, show deterioration of certain cognitive aspects (mainly memory) in relation to the duration and frequency of the partial and secondarily generalized seizures. In case progression of a epilepsy syndrome might be anticipated, this would undoubtedly lead to relevant consequences. If this is so, the therapeutic approach should be more aggressive than at present and might offer early curative treatment, such as epilepsy surgery or neuroprotective drugs, which might halt the progress of the disorder.

Introduction: Epilepsy affects 6.6 of every 1,000 inhabitants of the developed world. A third of these patients do not achieve satisfactory control of their condition with currently available antiepileptic drugs. Medical treatment of drug resistant epilepsy is complicated owing to the need to evaluate the clinical progress of the different types of epilepsy and to deal with many antiepileptic drugs., Development and Conclusions: We review the basic principles of satisfactory treatment of a patient with drug resistant epilepsy. We particularly emphasize the use of the new antiepileptic drugs, and evaluation of their efficacy and side effects. We also analyze the use of additional treatment of these patients and assess the pharmacokinetic and pharmacodynamic interactions of the drugs which are essential to determine which is the drug of choice in a particular patient. Finally, we consider the most suitable strategies for correct treatment of a patient with epilepsy which is difficult to control.

Purpose: To examine how cognitive, personality, and seizure outcome variables influence the subjective cognitive functioning of patients with refractory temporal lobe seizures after epilepsy surgery., Methods: Thirty-three consecutive patients with drug-resistant partial epilepsy who underwent surgical treatment at a tertiary referral university epilepsy center were tested before surgery and 1 year after surgery. Objective cognitive and subjective cognitive functioning tests were used, and personality was assessed. Seizure control was operationalized as a dichotomous variable., Results: A significant inverse relationship was found between neuroticism and subjective cognitive functioning. None of the other pre- and postoperative cognitive and surgery outcome variables were significant predictors of subjective cognitive functioning, even after controlling for the effect of neuroticism., Conclusions: Subjective and objective memory functioning are independent in patients with epilepsy after surgical treatment. Subjective memory functioning appears to be related not to seizure relief but to neuroticism. These data suggest that psychological factors such as personality traits predisposing to emotional distress should be taken into consideration in the clinical management and counseling of patients undergoing epilepsy surgery.