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Introduction: This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. Methods: We performed a retrospective, observational study including patients with a first seizure attended at our centre’s emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. Results: We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63). Conclusions: Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test. Resumen: Introducción: Determinar si la administración de fármacos antiepilépticos (FAE) puede alterar la probabilidad de encontrar anomalías epileptiformes en EEG realizados de forma precoz tras una primera crisis epiléptica (CE). Método: Estudio observacional retrospectivo en el que se incluyeron los pacientes atendidos en urgencias de nuestro centro por una primera CE entre julio de 2014 y noviembre de 2019. Se recogieron los datos clínicos, las características técnicas de adquisición e interpretación de los EEG efectuados durante las primeras 72 horas tras la CE y los factores relacionados con la recurrencia. Resultados: Se recogieron 155 pacientes; edad media 48,6 ± 22,5 años; 61,3% hombres. El 51% presentaron crisis tónico-clónicas (TC) de inicio desconocido y el 12 % focales con progresión a tónico-clónica bilateral. El 25,2% (39/155) recibieron tratamiento con FAE antes de la realización del EEG; en 33 pacientes se administró un FAE no benzodiacepínico y en 6 una benzodiacepina. Se observaron anomalías epileptiformes en 29,7% de los pacientes. La administración previa de FAE no se asoció de forma significativa ni con la probabilidad de detectar anomalías epileptiformes (p = 0,25) ni con el riesgo de recurrencia a los 6 meses (p = 0,63). Conclusiones: La administración de un FAE previo a la realización del EEG precoz tras una primera CE no disminuye la probabilidad de detectar anomalías epileptiformes. Estos hallazgos sugieren que iniciar un FAE de forma inmediata en aquellos pacientes con alto riesgo de recurrencia precoz no implica un menor rendimiento diagnóstico de dicha prueba.

La epilepsia es una condición neurológica que afecta a millones de personas en el mundo. Los estudios sobre frecuencia de epilepsia en Venezuela y en Latinoamérica son escasos, y se basan en clasificaciones desactualizadas. El objetivo de esta investigación fue determinar la casuística de epilepsia y del tipo de crisis, en pacientes de Barinas, Venezuela, durante los años 2021 - 2023. Se realizó un estudio descriptivo, transversal, en una muestra de 213 pacientes. Los resultados evidenciaron que 74 pacientes (34,7%) presentaron crisis de inicio focal; hubo preservación de la conciencia en el 91,9% de los casos y afectación de la misma en el 8,1%. De los pacientes que presentaron crisis de inicio focal, el 33,8% evolucionó a bilateral tónico-clónica. Las manifestaciones exclusivas motoras se presentaron en el 27% de los pacientes, y las no motoras en el 66,2%; mientras que el resto presentó crisis con ambos tipos de manifestaciones. Por otra parte, 134 (62,9%) pacientes presentaron crisis de inicio generalizado; 97,8% presentó manifestaciones motoras puras, siendo más frecuentes las crisis motoras tónico-clónicas (92,5%), y solo el 1,5% cursó con manifestaciones no motoras puras. El fármaco antiepiléptico más empleado fue la carbamazepina (41,8%) seguido del ácido valproico (12,7%), mientras que la terapia combinada representó el 17,8%. Los resultados demuestran una mayor proporción de pacientes con epilepsia de inicio generalizado, por encima del inicio focal. Las manifestaciones motoras fueron más frecuentes en las crisis generalizadas, contrario a lo observado en las crisis de inicio focal.

Introduction: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. Methods: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. Results: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P

La epilepsia refractaria o farmacorresistente es una condición frecuente en nuestra práctica neurológica cotidiana. Se considera que aproximadamente el 30% de pacientes con epilepsia de cualquier tipo van a persistir con crisis epilépticas a pesar de la terapia farmacológica. La definición de epilepsia farmacorresistente ha sido motivo de controversia entre los grupos de investigación a lo largo de las últimas décadas. La nueva propuesta de la Liga Internacional contra la Epilepsia (ILAE) para definir la falla del tratamiento médico y facilitar la selección de pacientes candidatos a procedimientos quirúrgicos es un gran avance hacia un mejor tratamiento para esta población. El objetivo del presente artículo es dar pautas que le permitan al neurólogo clínico identificar a los pacientes con epilepsia refractaria y dirigir los estudios diagnósticos que permitan seleccionar aquellos candidatos a un procedimiento quirúrgico curativo o paliativo. El éxito de dichos procedimientos está condicionado por la precisión diagnóstica en el protocolo prequirúrgico, donde el neurólogo desempeña un papel fundamental.

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From an epidemiological point of view, worldwide epilepsy has a bimodal increase in incidence, both in children and in the elderly. The epilepsy that begins in people over 65 is estimated to be of the order of 80 to 150 per 100,000 people and should be considered a different age group. Epileptic seizures in the elderly represent a clinical challenge for differential diagnosis, as well as to determine the type of crisis. The etiology is mostly structural, predominantly vascular pathology, particularly ischemic, followed by craniocerebral trauma and hippocampal sclerosis. Monotherapy with antiepileptic drugs (AEDs) is the gold standard. Considering the comorbidities of the elderly, the pharmacokinetics of AEDs, interactions with other drugs and tolerance, there are only class II and III studies for lamotrigine and levetiracetam for the treatment of epileptic seizures in the elderly. [ABSTRACT FROM AUTHOR]

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Cutaneous adverse drug reactions include maculopapular exanthema, Stevens-Johnson syndrome, and toxic epidermal necrolysis and are a global public health problem associated with the use of antiepileptic drugs (AEDs). Lamotrigine (LTG) stands out among AEDs because it does not cause sedation and does not affect cognition. Cutaneous adverse reactions (cADRs) to LTG occur in patients carrying certain allele variants of the human leukocyte antigen (HLA) system; although infrequent, they are alarming because they put the life at risk and force discontinuation of the treatment. The fear of neurologists to cADRs to LTG decreases its prescription despite its therapeutic advantages. Here, we review the allele variants of the HLA system that have been associated with cADRs to LTG in Mexican mestizos and other ethnic groups; identification of these variants would serve to select the patients that may be treated with LTG. [ABSTRACT FROM AUTHOR]

Trigeminal neuralgia (TN) is a syndrome characterized by recurrent paroxysms of neuropathic pain in the area of somatosensitive innervation of the trigeminal nerve. TN is notorious for its complex treatment, where therapeutic failure and resistance are frequent. Approximately 2% of patients fail to improve in their first pharmacotherapeutic trial. Moreover, up to 50% of the patients display poor control of the pain with carbamazepine--the pharmacological gold standard for TN--after 5-10 years of treatment, and approximately 27% interrupt their treatment earlier due to intolerable adverse effects. Other pharmacological alternatives, much like surgical management, are not exempt from this tendency towards therapeutic failure, with high frequency of recurrence or only partial symptom improvement. These implications have propelled the development and research of new options for the treatment for TN. Assessment of these new pharmacoterapeutic tools may be especially important, as drug treatment is often the first step in the management of this condition. The pharmacological armamentarium for TN includes various antiepileptic drugs such as lamotrigine, topiramate, levetiracetam, gabapentin, and pregabalin; as well as several neuromodulators from different pharmacological classes, such as pimozide, baclofen, tizanidine, tocainide, ropivacaine, lidocaine, sumatriptan, vixotrigine, botulinum toxin, and carbon dioxide. Nevertheless, there is yet abundant territory to be explored in this field of clinical research. Furthermore, this represents a valuable opportunity for enriching knowledge on the pathophysiology and pharmacology of pain, which may be extrapolated to the clinical management of other pain disorders with difficult treatment. This review discusses emergent alternatives in the pharmacotherapy of TN. [ABSTRACT FROM AUTHOR]

Las crisis convulsivas son una complicación ampliamente descrita de la lesión cerebral aguda y de las patologías que requieren de intervención neuroquirúrgica. Los fármacos antiepilépticos se utilizan con frecuencia en la profilaxis y tratamiento anticonvulsivo en pacientes neurocríticos, siendo la primera una práctica controversial, ya que sus potenciales efectos adversos podrían afectar la evolución del paciente. La incidencia de las convulsiones varía en función de la extensión de la lesión neurológica, de su localización y de las intervenciones realizadas. Es por esto que el uso de fármacos antiepilépticos, ya sea en tratamiento o en profilaxis anticonvulsiva, debe también considerar a los nuevos fármacos incorporados al mercado, que en función de sus características farmacocinéticas, pueden representar una alternativa de similar eficacia y mayor seguridad. El propósito de este artículo es revisar la literatura y directrices actuales, con el fin de delinear el uso adecuado de los fármacos antiepilépticos en el ámbito del cuidado neurocrítico.

Introduction: This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure., Methods: We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence., Results: We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63)., Conclusions: Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test., (Copyright © 2021 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Ha habido debates importantes sobre bioequivalencia y sustitución de ciertos medicamentos de índice terapéutico estrecho, tales como los fármacos antiepilépticos. En este artículo revisamos los conceptos por detrás del tratamiento de la epilepsia, haciendo hincapié en las características específicas de estos medicamentos, así como los datos relacionados con las crisis epilépticas y el umbral epiléptico individual. Estas condiciones pueden volver vulnerables a los pacientes con epilepsia cuando se cambia sus fórmulas farmacéuticas, ya sea entre las de marca a los productos genéricos o similares y viceversa, así como entre los genéricos entre sí.

Casi 40% de los pacientes con epilepsia no responde a nuestra primera elección de fármacos antiepilépticos, (FAEs). Esto debería ser justificación suficiente para la búsqueda de nuevos compuestos. La mejora en eficacia de los 16 nuevos FAEs comercializados en los últimos 20 años parece modesta, si bien su tolerabilidad y comodidad de uso ha aumentado el número de combinaciones útiles potenciales, dentro de la corriente de la politerapia racional. El metabolismo de la mayoría de ellos, independiente de la inducción de sistemas enzimáticos hepáticos, es posiblemente la mejor ventaja competitiva frente a los FAEs más veteranos, lo que puede favorecer su situación en los estudios fármaco-económicos de coste-beneficio. La evidencia disponible hasta el momento es incompleta, especialmente a largo plazo, y se necesitan estudios más amplios para clarificar estas cuestiones.

Hay muchos aspectos por abordar en el manejo de las mujeres con epilepsia, relacionados con su rol en la reproducción. Algunos de éstos necesitan ser considerados en la adolescencia, otros están relacionados con el embarazo, afectando tanto a la madre como a su hijo, y algunos con el ciclo menstrual y la menopausia. Esta revisión considera la epilepsia catamenial, contracepción, fertilidad, teratogenicidad y menopausia. También se discuten los efectos del embarazo en el control de las crisis y los efectos de las crisis sobre el feto.

Objective To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively). Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients). At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4–7.7). Conclusion The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system.

Actually it is known that the alteration in the metabolism of vitamin D has been growing in importance becoming a public health issue and it is increasingly common the etiologies related to hormone deficiency and its consequences in the long term, for this reason it is necessary to conduct a detailed description ranging from the molecular basis of metabolism of vitamin D giving special attention to the participation of the family enzymes that carry out its metabolism belonging to the cytochrome P450, as well as the description of the metabolic pathways, interaction with the specific receptor, the genomic and non-genomic actions of vitamin D and describe its effects in bone metabolism and extra- skeletal role. Later it is described the model by which medications and especially antiepileptic drugs (AED) affect directly the cytochrome P450 enzymes and have a negative effect on the levels of vitamin D, bone metabolism and thus extrapolate this concepts to the clinical practice and help the clinician to identify patients at risk of vitamin D deficiency and establish the risk to carry out a consistent therapeutic approach. It should be remembered that at the present time there isn't a universal protocol about the clinical monitoring of these patients even with the improvement in access to diagnostic resources. [ABSTRACT FROM AUTHOR]

Introduction: Status epilepticus (SE) is a neurological emergency associated with high morbidity and mortality. One prognostic factor is the type of SE. The purpose of this review is to analyse the most recent recommendations of different scientific societies and expert groups on the treatment of SE, and the latest studies, to assess the literature on the management of focal SE., Methods: We searched PubMed for studies published between 1 August 2008 and 1 August 2018 on the pharmacological treatment of focal SE and its different types in adults., Results: We identified 29 publications among reviews, treatment guidelines, meta-analyses, clinical trials, and case series on the treatment of SE. Only 3 of them accounted for whether SE was focal or generalised; 4 focused exclusively on focal SE, and 7 differentiated between convulsive and non-convulsive SE and also record the presence of focal seizures. Treatment recommendations for focal SE do not differ from those of generalised SE in stages I and II: initially intravenous lorazepam or diazepam, if the intravenous route is available, and otherwise intramuscular midazolam, followed by intravenous phenytoin, valproate, levetiracetam, or lacosamide if seizures persist. Use of anaesthetic drugs should be delayed for as long as possible in patients with refractory focal SE., Conclusions: The available scientific evidence is insufficient to claim that pharmacological treatment of focal SE should be different from treatment for generalised SE. More studies with a greater number of patients are needed., (Copyright © 2019 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols., Methods: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE., Results: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <  .05)., Conclusions: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications)., (Copyright © 2019 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Vagus nerve stimulation (VNS) is used as a complementary therapy to pharmacological treatment in patients with refractory epilepsy. This study aims to evaluate the efficacy of VNS in reducing seizure frequency, severity, and duration; reducing the number of antiepileptic drugs administered; and improving patients' quality of life., Material and Methods: We analysed the clinical progression of 70 patients with refractory epilepsy treated with VNS at Hospital Universitario de Alicante and Hospital Clínico de Valencia. Data were collected before and after the procedure. The difference in seizure frequency pre- and post-VNS was classified using the McHugh scale. Data were also collected on seizure duration and severity, the number of drugs administered, and quality of life., Results: According to the McHugh classification, 12.86% of the patients were Class I, 44.29% were Class II, 40% were Class III, and the remaining 2.86% of patients were Class IV-V. A ≥ 50% reduction in seizure frequency was observed in 57.15% of patients. Improvements were observed in seizure duration in 88% of patients and in seizure severity in 68%; the number of drugs administered was reduced in 66% of patients, and 93% reported better quality of life., Conclusions: VNS is effective for reducing seizure frequency, duration, and severity and the number of antiepileptic drugs administered. It also enables an improvement in patients' quality of life., (Copyright © 2019 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Epilepsy, a serious problem of public health in Mexico, is linked to psychiatric co-morbidity, whose sexual expression is wrongly interpreted in society, and not well attended. The neural response and the epileptic mechanisms of affectation are described, as well as the processes derived from the use of anti-epileptic drugs and other ethiopathogenic factors to be considered in this problem. The timely clinical identification of the incapacity that implies feminine sexual dysfunction, remains blocked by myths and prejudices, or is simply ignored. The double social moral and the wrong interpretation of feminine sexual behavior, even when it is healthy, causes direct/indirect damages in different ways" Psychopathologic (self-devaluation, infant-juvenile sexual abuse, etc.), socio-familiar, neuro-physiopathologic, and by effect of illegal/legal substances. The approaches to these problems are recommend, and the frequent sexual alterations described, in order to promote the accomplishment of a better semiologic-propedeutic methodology in which treatment f the primary upheaval and its co-morbidity are simultaneously built. The appropriate reference of the patient is an unsustainable clinical need that reinforces comprehensive treatment. It is necessary to improve emotional aspects of the patients within themselves, in first instance, to increase quality in their conjugal, familiar and communitarian life. The restriction of social opportunities and the limitation of access to formal and occupational educative experiences to his and nay other stigmatized population is inadmissible. It is the responsibility of the health personnel to work specifically in eliminating both stigmas: sexual and epileptic, when trying to consolidate the humanistic paradigm of our profession [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure., Method: We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72hours after the seizure, and the factors related with seizure recurrence., Results: We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63)., Conclusions: Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test., (Copyright © 2021 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The study aims to quantify the types of antiepileptic drugs (AED) prescribed in neurology consultations., Material and Method: This descriptive, observational study included a sample of 559 patients older than 14 years, diagnosed with epilepsy, and receiving pharmacological treatment. Data were collected at outpatient consultations by 47 Spanish neurologists in May 2016. Epilepsy was defined based on the International League Against Epilepsy classification. According to the year of marketing, AEDs were categorised as classic (before 1990) or new (after 1990). We performed a descriptive analysis of qualitative and quantitative variables., Results: Female patients accounted for 54.6% of the sample. Mean age was 42.7 years; mean age of onset was 22.4. Regarding epilepsy type, 75.7% of patients experienced partial seizures, 51.5% were symptomatic,32.4% had refractory epilepsy, 35.6% had been seizure-free for the previous year, and 59.2% had associated comorbidities.A total of 1103 AED prescriptions were made; 64.6% of prescriptions were for new AEDs; 85.4% of patients received new AEDs. Patients received a mean of 2 AEDs (range, 1-5). A total of 59.6% of patients received polytherapy.The most frequently prescribed AEDs were levetiracetam (42.6%), valproic acid (25.4%), lamotrigine (19.5%), carbamazepine (17.9%), and lacosamide (17.5%). No AED was employed exclusively as monotherapy. The most frequently prescribed AEDs for generalised and partial seizures were valproic acid (48.2%) and levetiracetam (43.2%), respectively. Valproic acid was less frequently prescribed to female patients. Patients with refractory epilepsy or with associated comorbidities were more frequently prescribed a combination of new and classic AEDs (48.7% and 45.6%, respectively) than only one type of AED., Conclusions: The majority of patients received new AEDs. The combination of classic and new AEDs was more frequently prescribed to patients with refractory epilepsy or with associated comorbidities., (Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Status epilepticus (SE) is a neurological emergency that requires urgent antiepileptic therapies, and a rapid treatment of its cause. In recent years, its definition has been updated to adapt it to all types of SE; this update helps to standardise the treatment. The new definition is based on two times: point t1, after which the event will not spontaneously cease, and period t2, after which neuronal damage may appear. There are three lines of treatment: first, benzodiazepines; second, antiepileptic drugs; and third, intravenous anaesthetics. The application of the different lines of treatment raises still unanswered questions, since the prognosis also depends on the aetiology, age and duration. For this reason, different prognostic scales are being developed to help us to assess its evolution and in turn, adapt the aggressiveness of the treatment to each patient., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Introduction: Status epilepticus (SE) is a neurological emergency associated with high morbidity and mortality. One prognostic factor is the type of SE. The purpose of this review is to analyse the most recent recommendations of different scientific societies and expert groups on the treatment of SE, and the latest studies, to assess the literature on the management of focal SE., Methods: We searched PubMed for studies published between 1 August 2008 and 1 August 2018 on the pharmacological treatment of focal SE and its different types in adults., Results: We identified 29 publications among reviews, treatment guidelines, meta-analyses, clinical trials, and case series on the treatment of SE. Only 3 of them accounted for whether SE was focal or generalised; 4 focused exclusively on focal SE, and 7 differentiated between convulsive and non-convulsive SE and also record the presence of focal seizures. Treatment recommendations for focal SE do not differ from those of generalised SE in stages I and II: initially intravenous lorazepam or diazepam, if the intravenous route is available, and otherwise intramuscular midazolam, followed by intravenous phenytoin, valproate, levetiracetam, or lacosamide if seizures persist. Use of anaesthetic drugs should be delayed for as long as possible in patients with refractory focal SE., Conclusions: The available scientific evidence is insufficient to claim that pharmacological treatment of focal SE should be different from treatment for generalised SE. More studies with a greater number of patients are needed., (Copyright © 2019 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Extended-release vinpocetine is effective to control focal onset epileptic seizures with a low rate of adverse events. A clinical study was performed to evaluate the efficacy and tolerability of vinpocetine as an adjuvant treatment in patients with this condition., Methods: A double-blind clinical study of parallel groups was conducted, in which 87 patients with a diagnosis of focal epilepsy treated with one to three antiepileptic drugs were recruited. Patients were randomized to receive vinpocetine (n = 41) or placebo (n = 46) adjuvant to their treatment. Patients entered the baseline phase (4 weeks), the titration phase (4 weeks) and the evaluation phase (8 weeks), maintaining stable doses of vinpocetine and their respective antiepileptic drug treatment., Results: Vinpocetine was more effective than placebo in reducing seizures at the end of the evaluation phase (p < 0.0001). Sixty-nine percent of the vinpocetine-treated patients had a 50% reduction in seizures compared to 13% of placebo-treated patients. No significant differences in the presence of adverse effects in patients treated with vinpocetine compared to those treated with placebo were observed. The most frequent adverse events observed with vinpocetine were headache (7.9%) and diplopia (5.2%)., Conclusions: As an adjuvant treatment, vinpocetine (2 mg/kg/day) effectively reduced the frequency of epileptic seizures and proved to be well tolerated. Vinpocetine has a wide safety profile and well-known adverse events, which are transient and with no sequelae., (Copyright: © 2019 Permanyer.)

Las infecciones por parásitos intestinales presentan altas tasas de prevalencia y amplia distribución mundial, principalmente en las regiones tropicales y subtropicales. Por otro lado, se estima que unos 50 millones de personas en el mundo padecen epilepsia, y de ellas el 85 % viven en regiones tropicales o en vías de desarrollo. La prevalencia de epilepsia en Cuba fluctúa entre 3,3 y 9 por cada mil habitantes y, de acuerdo con estas cifras, se calcula que deben existir aproximadamente 60 mil epilépticos. La presencia de parásitos intestinales pudiera contribuir a que la epilepsia sea refractaria a los fármacos antiepilépticos, a partir de la hipótesis fisiopatológica de que algunos de ellos pueden tener la capacidad biológica de interferir en la absorción de los medicamentos. El conocimiento cada vez más profundo del papel de los parásitos intestinales y su relación en el control de la epilepsia, pudiera convertirse en una de las herramientas importantes en el enfoque de este desorden neurológico, sobre todo en países en desarrollo, donde el parasitismo intestinal es endémico.