Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Treatment

 

Tratamiento de migraña en embarazo. Treatment of migraine in pregnancy.

Introduction: Migraine is the most disabling primary headache. In pregnancy, its treatment is controversial due to possible side effects.

Objective: Conduct an updated literature search on migraine treatment during pregnancy.

Method: A search was carried out in PubMed, Scopus and Web of Science. Search terms were “pregnancy”, “migraine” and “treatment”. Search date ranged from 2018 to 2023. 315 articles were found; duplicates were eliminated with Rayyan QCRI (Rayyan Systems Inc ©) where selection was carried out by title and summaries, and full text. Finally, 21 articles were selected that included clinical trials, systematic reviews and narratives.

Development: Acute and preventive therapy exists for migraine during pregnancy; non-pharmacological treatment is the first choice in both. For acute treatment, paracetamol, non-steroidal anti-inflammatory drugs only in the second trimester, triptans, metoclopramide and nerve blocks can be used. If the intensity is moderate and is not controlled with acute treatment, prevention is carried out with propranolol; Other drugs do not show safe evidence for use during pregnancy

Conclusion: An appropriate choice of treatment, prioritizing non-pharmacological treatment and taking into account drug associations, is necessary in pregnant women whose migraine attacks do not subside.

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Palabras clave: embarazo, Migraña, paracetamol, Propranolol, Tratamiento,

Keywords: Migraine, paracetamol, pregnancy, propranolol, Treatment,

Estado Epiléptico Refractario de Aparición Reciente (NORSE): Revisión y actualización. New-Onset Refractory Status Epilepticus (NORSE): Review and Update

The New-Onset Refractory Status Epilepticus (NORSE) is a rare entity that is defined as a clinical presentation, in a patient without active epilepsy or other relevant neurological disorder, who presents a refractory status epilepticus (RSE) without an acute or active structural, toxic, or metabolic cause. NORSE constitutes a diagnostic challenge that implies high morbidity and mortality in the short and long term. Clinically, NORSE is characterized by a prodromal phase, an acute phase, where seizures with diverse semiology that evolve to an RSE occur, and a chronic phase, with neurological deterioration and drug-resistant epilepsy. After an extensive work-up, the cause of NORSE is identified in only half of the cases. The initial treatment is based on the use of conventional anti-seizure drugs, requiring most of patients the use of anesthetics and mechanical ventilation. Better results have been observed with immunotherapy, more recently with anti-cytokine drugs, such as tocilizumab and anakinra, consistent with the immunological/inflammatory mechanisms proposed for the pathophysiology of NORSE.

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Palabras clave: diagnóstico, estado epiléptico, Estado epiléptico refractario de aparición reciente, fisiopatología, Tratamiento,

Keywords: diagnosis, New-onset refractory status epilepticus, physiopathology, Status Epilepticus, Treatment,

Music therapy intervention for memory, attention, and language in children with dyslalia. Intervención musicoterapéutica para mejorar la memoria, atención y lenguaje in niños con dislalia

Dyslalia is a language disorder that is present in a wide percentage of children. This work proposes an intervention protocol in music therapy to improve attention, memory, and language for children with the dyslalia disorder. A confirmatory mixed-method design composed of two studies was conducted: the first included a quantitative and pre-experimental design with a sample of 20 children aged between 5 and 8 years (Mage=6.45, SD=1.23) diagnosed with dyslalia. The second study used a qualitative confirmatory methodology, where participants’ parents and therapists participated. Wepman’s and the initial Luria pre- and post-tests measurements were applied. The results of the pre-experiment found statistically significant improvements in verbal regulation t(19)=-5.03, p=<.001, d=.76, attention t(19)=-5.05, p=<.001, d=.76, and memory t(19)=-2.88, p=.009, d=.55. In the qualitative phase, narratives were found that affirmed the positive results of the pre-experiment. Moreover, data surrounding the benefits of the music therapy intervention protocol in the improvement of cognitive processes and the relationship with previous literature that found positive results with this type of intervention are discussed.

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Palabras clave: Atención, dislalia, intervención, Lenguaje, Memoria, musicoterapia, Tratamiento,

Keywords: Attention, dyslalia, intervention, Language, Memory, music therapy, Treatment,

Parálisis Cerebral en Pediatría: Problemas Asociados. Cerebral Palsy In Pediatrics: Associated Problems

Introduction: Cerebral palsy is the most frequent cause of childhood disability. Children with CP will associate, in addition to neurological problems, other non-neurological disorders that will be more frequent with a greater degree of CP involvement.

Objective: To address the clinical manifestations of children with cerebral palsy and their diagnostic and therapeutic management in order to provide a comprehensive approach to these patients in a single document.

Development: A review is made of the clinical manifestations of the child with cerebral palsy including neurological disorders, orthopedic problems, digestive disorders, respiratory problems, bone health, visual and hearing problems, urological and sexual disorders, oral health, hypersalivation, sleep disorder and pain.

Conclusions: The approach to the patient with CP has changed in recent years. Care provided by an specialized multidisciplinary team is essential. However, from our experience, the role of a pediatrician who knows all the associated problems seems essential to coordinate all the follow-up.

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Palabras clave: diagnóstico, Discapacidad, parálisis cerebral, trastornos neurológicos, Tratamiento,

Keywords: cerebral palsy, diagnosis, Disability, neurological disorders, Treatment,

Actualización en Neuropatía Óptica Isquémica No Arterítica. Nonarteritic Ischemic Optic Neuropathy: An Updated Review

Introduction: Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury is the second most common optic neuropathy after glaucoma.

Development: Patients are over the age of 50 years with vascular risk factors. This condition typically presents with acute, painless, monocular loss of vision associated with a variable visual field defect and optic disc edema. NAION is produced by inadequate perfusion of the optic nerved head, supposedly because of nocturnal hypotension and small cup/disk ratio. Diagnosis is mainly clinical and prognosis is generally guarded.

Conclusion: There is no treatment for this condition despite numerous medical and surgical attempts. This article reviews the literature and summarizes current data of proposed treatments.

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Palabras clave: fisiopatología, neuropatía óptica isquémica anterior no arterítica, Tratamiento,

Keywords: nonarteritic anterior ischemic optic neuropathy, physiopathology, Treatment,

Adherencia al Tratamiento Antiepiléptico en Pacientes Pediátricos del Hospital Roberto Gilbert Elizalde en el Año 2014. Adherence To Antiepileptic Treatment In Pediatric Patients At Hospital Roberto Gilbert Elizalde During 2014.

Introduction: Epilepsy in the pediatric population is an entity that mostly affects underdeveloped countries. In Ecuador, hospital admissions due to poor control are increasing and the main cause is poor adherence to antiepileptic treatment.

Objective: To demonstrate the incidence of nonadherence to the antiepileptic regimen and determine the factors that contributes to it.

Materials and methods: A cross-sectional study was conducted in which 119 patients were included with ages between 6 months and 17 years. The parents or legal guardians were questioned regarding the degree of adherence to antiepileptic treatment using the Morisky questionnaire. A logistic regression model was used to measure the strength of association between variables.

Results: An incidence of non-adherence to antiepileptic treatment of 36.97% was found. The significantly associated variables were the mother’s schooling (x2=11.83, IC= 10.13 – 13.53, p=0.018), previous medical information (x2=9.35, IC= 7.95 – 10.75, p=0.02) and the failure to obtain medication due to lack of money (x2=5.98, IC= 5.29 – 6.67, p=0.01).

Conclusion: The incidence of nonadherence in this study was high; control over sociodemographic factors and related to treatment can have a great impact on these patients.

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Palabras clave: adherencia, Epilepsia, pediatría, Tratamiento,

Keywords: adherence, Epilepsy, pediatrics, Treatment,

Epilepsia Occipital Benigna de la Niñez tipo Panayiotopoulos Presentación de cinco casos clínicos y revisión de la literatura.

Occipital Benign Epilepsy of Childhood, Panayiotopoulus Type (OBECP) is the more frecuent idiopathic epilepsy following the Benign Epilepsy Childhood with Centrotemporal Spikes. We present five cases with this diagnosis analyzing its clinical, electroencephalografics, therapeuthics and evolutives characteristics. This study remarks our low incidence, perhaps due to of poor knowledge and the most cases are underdiagnosted in the paediatric population. Our objetive is alert about this type of Epilepsy, its early diagnosis, adecuated treatment and the respective family assessment because this pathology had a favourable evolution.

 

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Palabras clave: diagnóstico, Epilepsia Occipital, Tipo Panayiotopoulos, Tratamiento,

Keywords: assessment, diagnosis, Occipital Epilepsy, Panayiotopoulus type, Treatment,

Estudio piloto de tratamiento de pacientes con Esclerosis Múltiple con el uso de una formulación homeopática de la Biomodulina T.

25 patients with defined exacerbating-remitting Multiple Sclerosis (MS), with a score between 1 and 5.5 according to Kurtzke’s disability scale, were treated with Biomoduline T at 6 ch during 15 months. After concluding this treatment 83% of the patients were clinically stable according to the disability score. Due to the immunoregulating and anti-inflammatory effects of this product, the possibility of employing this homeopathic variant for the treatment of MS is suggested, considering its low cost of production and the fact that no adverse reactions were referred.

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Palabras clave: Biomodulina T variante homeopática, esclerosis múltiple, Tratamiento,

Keywords: Biomoduline T homeopathic variant, multiple sclerosis, Treatment,

Aspectos Históricos del Tratamiento Farmacológico de la Epilepsia

In the present work, we make an historical revision on the different treatments that had been employed for epilepsy since ancient times through the present. This article reviews different periods such as: the believe between the Incas and the Aztecas that the cause of epilepsy was the action of malignant spirits and the basements of the treatments in magical and religious methods; the starting of pharmacological treatment in the XIX century with the use of bromides, the discovery of the antiepileptic drug phenobarbital by Alfred Hauptmann in 1912, phenytoin by H. Houston Merrit and Tracy Jackson Putnam in 1937, through the introduction of new antiepileptic drugs such as lamotrigine, tiagabine, vigabatrine, levetiracetam, etc. in the nineties.

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Palabras clave: Epilepsia, Tratamiento,

Keywords: Epilepsy, Treatment,
 
 
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