Biomedical subjects

J A Mauri-Llerda

Publications and source records attributed to J A Mauri-Llerda.

14 recordsLinked to original sources

PubMed1997

[Discontinuation of anti-epileptic drugs].

OBJECTIVE: It is well known that in the long term most patients achieve/gain control over their epileptic crises and the morbidity associated with chronic anti-epileptic drug treatment. We have tried to review the criteria for discontinuation of such treatment and evaluate drug toxicity and the risks of discontinuation. DEVELOPMENT: It is correctly accepted that 70-80% of all epileptic patients experience remission of the disorder, in most cases easily. The greatest risk of recurrence after discontinuation of treatment is during the first year (25-30%). The most important factors to consider with regard to the risk of recurrence are: the age at onset (in nearly all the series studied there was less risk of recurrence when onset occurred before the age of 12, aetiology (greater risk in symptomatic than in idiopathic crises) and EEG (there is a greater risk when focal slowing or bilateral paroxystic activity is seen). CONCLUSIONS: The ideal type of patient in whom to discontinue anti-epileptic drugs is a patient who has been free of crises for two years whilst being treated, only one type of crisis present which as always been well controlled, normal neurological examination and IQ, idiopathic epilepsy (except for juvenile myoclonic epilepsy) and with normalization of the EEG whilst on treatment. The decision to discontinue treatment should be made jointly with the patient, especially when adult, regarding fundamental aspects such as driving vehicles and the problem of work and/or loss of a job.

Adolescent↗

PubMedDate not supplied

[Epidemiology of various types of vascular epilepsy in adults].

From studies of the incidence of epilepsy, figures of between 40 and 70 per 100,000 inhabitants are obtained whilst in studies of prevalence, 5 to 7 cases per 1,000 are found. Cerebrovascular disease is the commonest cause of epileptic crises in the developed world, being more frequent in patients aged over 60, who make up 50% of all cases. Depending on the moment of presentation of crises in relation to the cerebrovascular disease, these may be classified as herald crises or precursors of vascular epilepsy, early crises if they occur during the first week and late crises if they occur after. Whilst early crises are usually due to metabolic or cytotoxic factors, the late crises occur in true vascular epilepsy. When these patients are assessed it is also important to consider increased hospital mortality in those with early crises and possible deterioration of neurological deficit as sequelae following late epileptic crises.

Adult↗

PubMedDate not supplied

[Acute symptomatic epilepsies].

OBJECTIVES: To review the differentiating characteristics of symptomatic acute epilepsies, epidemiology, aetiology and controversies over treatment, and describe our experience with symptomatic acute epilepsy in cerebrovascular disorders. DEVELOPMENT AND CONCLUSIONS: The so-called symptomatic acute epilepsies show clearly differentiated characteristics with regard to true epileptic disorders: 1. A clearly identified causal association; 2. Generally tend not to recur; 3. Usually long-term anti-epileptic treatment is not necessary. Therefore the most suitable term for them is symptomatic acute seizures. They make up a large proportion of all newly-diagnosed epilepsies around 40%. The highest incidence occurs during the first year of life (probably because of the high incidence of seizures due to encephalopathies, metabolic disorders and infections) and in elderly patients (especially in relations to cerebrovascular disorders). The commonest causes are: cerebrovascular disorders, head injury, infections of the central nervous system, alcohol and drugs. The risk of subsequent epilepsy is increased in a subgroup of these patients, especially in cases with associated cerebrovascular disorders, head injuries and central nervous system infection. Long-term preventive treatment is rarely indicated in these patients.

Acute Disease↗

PubMedDate not supplied

[Visual field changes secondary to vigabatrin treatment].

INTRODUCTION: Vigabatrin is an effective antiepileptic drug for treatment of partial crises with or without generalization. It acts by increasing GABA levels by irreversible inhibition of the enzyme GABA-transaminase. In recent years there have been several reports published on the appearance of alterations of the visual fields of patients treated with this drug. OBJECTIVE: To study the prevalence and characteristics of the visual field changes associated with vigabatrin treatment in an adult epilepsy clinic. PATIENTS AND METHODS: Ophthalmological examination, consisting of questions about eye symptoms, study of the fundus oculi, Humphrey-type campimetry, protocol 30-2, visual evoked potentials and electroretinogram were done on a group of 10 patients on long-term vigabatrin treatment. RESULTS: Six of the ten patients (60%) had campimetric alterations, which were serious in two cases (20%). Only the two patients with severe field defects complained of sight changes when questioned and their complaints were mainly of repeatedly bumping into things. In two patients (20%) there was pallor of the optic nerve. In both cases, the patients with severe field defects showed alterations on the electroretinogram. Visual evoked potentials were normal in all cases. CONCLUSIONS: There is a very high prevalence of visual field defects in patients on long-term treatment with vigabatrin. Clinical ophthalmological signs are not usually seen until advanced stages. Pallor of the optic nerve was seen in a group of patients. It is very important that serial campimetric studies are done for early detection of such alterations.

4-Aminobutyrate Transaminase↗

PubMedDate not supplied

[Lamotrigine in refractory partial and general epilepsies].

INTRODUCTION: Lamotrigine (LTG) is a new antiepileptic drug that it has proved to be efficacious in treating patients with partial and generalized tonic-clonic seizures in adjunctive and monotherapy. It has similar efficacy in comparison with carbamazepine and phenytoin with a minor number of adverse experiences. PATIENTS AND METHODS: We report the use of LTG in adjunctive therapy in 106 adults patients with refractory epilepsy (efficacy and safety) with partial and generalized seizures, with follow-up to 3.4 years. The LTG mean doses used was 273 mg/day. RESULTS: 66% of patients experienced a > or = 50% reduction in seizure frequency, with 30% in remission. Both partial, secondarily generalized and generalized seizures showed significant reductions with LTG treatment. LTG was well tolerated in our patients. Side effects were minor. No case of rash was seen. CONCLUSION: LTG is a excellent agent for adjunctive therapy in refractory epilepsy.

Adolescent↗

PubMedDate not supplied

[Neuropsychological changes in epilepsy].

OBJECTIVE: The neuropsychological assessment of the epileptic patient is a very important aspect of diagnosis and treatment. It may be used to contribute to localization of the hemisphere involved in the seizures, differentiate situations of anxiety or depression or when planning treatment for rehabilitation. We review the different aspects of neuropsychological changes in patients with epilepsy. DEVELOPMENT: Firstly we review the different tests used in the neuropsychological assessment of epilepsy. Dodrill's neuropsychological battery of tests, in which the patients score less than the controls, is the most commonly used. We then evaluate and study the so-called 'transient cognitive disorder'. We also study memory problems in epilepsy. There may be episodes of seizures with amnesic features ('amnesic epileptic seizures'). Finally, the possibility of neuropsychological dysfunction secondary to antiepileptic drugs should always be considered. CONCLUSIONS: Epileptic patients have lower scores than persons taken as controls for the results of various neuropsychological tests, although there is less difference between the two groups when the patient group is made up of persons with a normal intelligence quotient. Transient cognitive involvement is common in epileptics and may cause underachievement at school or psychological problems. Memory disorders, particularly subjective, are common in epileptics, although neuropsychological tests other than those generally used may be necessary to evaluate this. It is possible that such memory disorders, if occurring as seizures, may be due to amnesic partial crises, which should always be differentiated from the diagnosis of transient global amnesia. Almost all antiepileptic drugs can cause negative neuropsychological effects, especially the benzodiazepines and barbiturates.

Acute Disease↗

PubMedDate not supplied

[Use of lamotrigine in the treatment of absence epilepsy crises].

OBJECTIVE: To review the current treatment and usefulness of lamotrigine in absence seizures. DEVELOPMENT: Absence seizures are classified amongst the generalized epilepsies. They are defined as a transient loss of consciousness of sudden onset and recovery characteristically associated with generalized spike-and-wave discharges on the EEG. In recent years, the epileptic syndromes associated with this type of seizure have been better defined, basically by means of video-EEG studies. The International League Against Epilepsy has recognized four epileptic syndromes with typical absences: absence-epilepsy of childhood, juvenile absence-epilepsy, juvenile myoclonic epilepsy and epilepsy with myoclonic absences. The classical treatment for this type of seizure was based on ethosuximide, or more often, sodium valproate. Sometimes both drugs together were necessary. Other useful drugs are the benzodiazepines such as clobazam. CONCLUSIONS: We review studies of the efficacy and tolerance of lamotrigine in the treatment of absence seizures, one of the groups of seizures in which this drug has been shown to be most effective. Although studies comparing lamotrigine, valproate and ethosuximide are necessary, we emphasize the possibility that lamotrigine may be a drug of choice in absence seizures.

Anticonvulsants↗

PubMedDate not supplied

[Depression and epilepsy].

AIMS: To review the literature on the frequency, aetiology, risk factors, diagnosis and treatment of depression in epileptic illness with a view to clarifying certain controversial issues in a clinically relevant subject. METHOD: Work published on this subject over the last three years was analysed and the data combined in order to achieve a scientific approach to the clinical handling of these patients. We analyse papers, especially reviews of literature on the subject, we compare postures and attempt to highlight the most popular. We point out the aspects that are still in need of study and the gaps to be filled in handling protocols, and we propose characteristics required for future research. CONCLUSIONS: Interictal depression is frequent, and appears in some moment in the evolution in one out of every three epileptics, especially in cases of severe epilepsy with frequent seizures. There are aetiological factors and risk indicators, both of a biological and a psychosocial nature, that point to a more likely appearance of depression. Treatment includes the control of epileptic seizures with a reappraisal of the established pharmacological antiepileptic treatment; the use of antidepressants is, however, nearly always necessary. Choice of the antidepressant must be based on knowledge of pharmacological interactions, the side effects, possible effects on the convulsion threshold and efficiency. Among all the antidepressants, the new ones, especially citalopram and some other SSRIs, seem to offer less convulsant risk and maprotiline, amoxapine and bupropion are clearly unadvisable. Electroconvulsive therapy can be a good therapeutic option.

Anticonvulsants↗

PubMedDate not supplied

[Non epileptic psychogenic seizures].

INTRODUCTION: Non epileptic psychogenic seizures (NEPS) is a pathological condition that arouses the interest of many specialists due to the fact that, every day, it gives rise to problems in different fields especially in diagnosis and therapeutics. This means that sometimes the right diagnosis is reached after a period of explorations and treatment which later turn out to be unnecessary, and have important repercussions on the patient s family and social life, and, financially, on the health care system. METHOD: We review the literature on the subject that has been published over the last five years, with the aim of contrasting and integrating the different positions that are currently held. We draw attention to the better known aspects, on which there is a more general agreement, and others that are still subject to controversy and debate; we also attempt to lay down a set of guidelines, bearing in mind the gaps that are still to be filled, to aid future research. CONCLUSIONS: 1. NEPS is very difficult to diagnose. It is important to have a good clinical history to be able to identify possible stressors. Video EEG can be of great help, although it is very expensive and not available to all Neurology services. 2. Before deciding on the final diagnosis, frontal, frontomesial and temporal lobe seizures must be taken into account since they sometimes present symptoms that are similar to those of NEPS. 3. The association with different psychiatric pathologies has been shown to exist, and more than one psychopathogenic mechanism may be involved as a mediator in the appearance of NEPS. 4. Therapy begins with the presentation of the diagnosis, which must be performed with due care and attention, and is aided by a multidisciplinary treatment.

Humans↗

PubMedDate not supplied

[Evaluation of patients who do not visit neurology units].

AIMS: Our aim was to study the relation between non-attendance at neurology units and the delay that exists, as well as the demographic factors that may come to bear on non-attendance. PATIENTS AND METHODS: Data on neurology outpatients over the period between November and December 2002 were collected prospectively. Both patients who were referred for evaluation and those on their first programmed visit were included in the study. RESULTS: The total number of subjects was 1,035, with an average age of 55.31 +/- 19.84 (14-96). Of these, 605 were females and 430 were males, with no significant differences in the age of the two groups. 40% of the cases came from rural areas. 237 (22.9%) did not attend the visit. We found a statistically significant relation between age and non-attendance (t=2.67; p=0.008, Student's t). There was also a relation between not going to the visit and the delay that existed (t=5.84; p=0.000, Student's t). Patients who were referred from the Casualty department missed their visit more often those who were sent by their GP (Pi2=2.4; p=0.07, chi2). The date on which they received the appointment was also related to non-attendance (t=2.55; p=0.011, Student's t). CONCLUSIONS: Non-attendance was associated, above all, with the delay, with youth, being sent from casualty and with the length of time since they received notice of the visit.

Adolescent↗

PubMedDate not supplied

[Treatment of the epileptic patient in special situations].

AIMS: It is known that epileptic seizures can present not only in neurological diseases but also in a number of different medical diseases, and are important in the prognosis and treatment of the primary disease. The purpose of this study is to review a series of patients with epilepsy whose therapy involves a series of peculiarities. DEVELOPMENT: We reviewed the treatment of epilepsy in groups of patients with the following characteristics: mental disability, cardiovascular disease, respiratory disease, liver failure, hepatic porphyrias, liver transplant, kidney failure, haemodialysis, kidney transplant, infectious diseases, acquired immunodeficiency syndrome, diseases of the digestive tract, endocrine diseases, preventive antiepileptic therapy, and surgical diseases. CONCLUSIONS: The increase in life expectancy, together with the ensuing growth in the number of medical diseases, surgical procedures and pharmacological treatments, means that we often have to deal with epileptic seizures in these groups of patients. Many of the epileptic seizures presented in these patients are generally of the acute symptomatic type; they therefore require no long-term antiepileptic treatment and have a good prognosis, once the situation or disease that triggers them is righted or treated. When it comes to choosing a possible antiepileptic drug for these patients, basically all the pharmacological treatments for these medical diseases must be considered. This is because of the possible interactions that may reciprocally alter the effectiveness of the two types of drugs and, similarly, their pharmacokinetics, pharmacodynamic behaviour and preferred choice of pathways.

Epilepsy↗

PubMedDate not supplied

[Differential diagnosis of intracranial calcifications].

INTRODUCTION: Intracranial calcifications are a frequent chance finding in many neuroimaging tests. We report two clinical cases with intracranial calcifications as a common feature, but which had very different aetiologies and presenting symptoms. CASE REPORTS: The first case involved a 51-year-old male with a single tonic-clonic convulsive seizure associated to hypocalcemia secondary to hypoparathyroidism who presented extensive brain calcifications affecting the dentate nuclei, pons, periependymal and basal ganglia, and whose convulsive attacks remitted once normal Ca2+ values were restored. The second case was a 25-year-old female patient whose convulsive seizures were yet another symptom of Fahr's syndrome, which was associated to spastic paralysis, athetosis, mental retardation and occasionally hypoplasia of the optic nerve; the calcifications were located in the grey nuclei of the cerebrum and cerebellum. CONCLUSIONS: A correct history and physical and neurological examination must be carried out, and a detailed study of Ca2+/ P+ and hormonal metabolism is also required. A CAT scan is the preferred neuroimaging technique to achieve a proper differential diagnosis and to decide on the therapeutic approach that is best suited to the pathophysiological mechanisms that lead to the formation of these calcium deposits.

Adult↗

PubMedDate not supplied

[A study of the risk factors in transient global amnesia and its differentiation from a transient ischemic attack].

INTRODUCTION: Transient global amnesia (TGA) is a clinical condition that has been described in many studies, but its pathophysiology is not fully understood. In recent years the theory of valvular insufficiency in the jugular vein has been added to the classical hypotheses that link it to migraine, to epilepsy and -the most widely accepted- to transient ischemic attacks (TIA), although the real origin of the condition has still not been determined. PATIENTS AND METHODS: In a retrospective study we compared 131 patients diagnosed with TGA between 1993 and 2004 with 262 patients who were diagnosed as having TIA over the same period. RESULTS: Mean age was 65.94 years in TGA versus 71.11 years in the case of TIA. There was a higher rate of arterial hypertension among the patients with TGA and diabetes mellitus was more frequent among those with TIA (p<0.05 in both cases). Emboligenic heart disease was scarce among patients with TGA. The number of patients with a history of ischaemic heart disease and a history and the development of cerebrovascular diseases was greater among those with TIA than in cases of TGA (p<0.05). The TGA recurrence rate was 12%. The percentage of pathological findings in the CAT brain scan was higher in patients with TIA (p<0.05). There are no significant differences between patients with TGA and TIA as far as treatment on hospital discharge is concerned. CONCLUSIONS: TGA does not seem to be a symptom of an arteriosclerotic pathology nor does it appear to offer a higher risk of heart or cerebrovascular disease and, therefore, antiaggregating therapy would not be indicated in such cases.

Aged↗

PubMedDate not supplied

[Neuronal migration disorders: a cause of curable medication resistant epilepsy].

INTRODUCTION: Focal cortical dysplasia is a neuronal migration disorder that appears with bouts of epileptic seizures that are usually medication resistant. The improvements introduced into neuroimaging techniques in recent years have made it possible to diagnose and offer surgical treatment to certain patients who have been under polytherapy for many years with poor control over their seizures. CASE REPORT: We report the case of a 22-year-old male with epileptic fits since the age of 18 months, who was refractory to multiple combinations of oral antiepileptic drugs (AEDs) with electroencephalograms that displayed frontal, fast spike-wave discharges, with greater expression on the left side and findings from neuroimaging techniques that were repeatedly normal. After being readmitted to hospital because his seizures had got worse, the neuroimaging study was repeated and left frontal focal cortical dysplasia was observed, which led us to start considering neurosurgery. At present, six months after the intervention, the patient has had no further convulsive fits and therapy with oral AEDs is being reduced. CONCLUSIONS: Neuroimaging studies must be repeated in patients that have already been examined because in this way it may be possible to save a group of patients (who would otherwise have to resign to poor control over their seizures as well as the side effects of many AEDs) from becoming medication resistant.

Adult↗