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

Epilepsia refractaria

 

Perfil de efectividad y seguridad de preparaciones orales de cannabis para el tratamiento de epilepsias refractarias en la población infantojuvenil. Una revisión de alcance. Effectiveness and safety profile of oral cannabis preparations for the treatment of refractory epilepsies in infant-young population: A Scoping Review

Introduction: Refractory epilepsies (RE) are a common neurological condition expressed in childhood and adulthood, highlighting the current use of cannabis as an alternative treatment. Oral Cannabis Preparations (OCP) have demonstrated effectiveness in the adult population; however, knowledge is limited in the infant-young population.

Aim: To synthesize the available evidence on the efficacy and safety of OCP for the treatment of refractory epilepsies in the infant-young population.

Methods: The present study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and included studies from January 2013 until December 2020 from electronic databases, including SciELO, ScienceDirect, PubMed, and Web of Science.

Results: 7 articles were included in this scoping review for critical analysis. The results indicate that pharmaceutical and artisanal origin OCP has 41.3% effectiveness in reducing seizures and low safety after administration (≤ 27.4%). Likewise, after administration, the most frequent adverse symptoms were somnolence/fatigue, weight loss/decreased appetite, and irritability/aggressiveness.

Conclusion: The low levels of effectiveness and safety of OCP suggest that they should be administered with caution and as a complementary treatment and not as the first choice for managing RE in the infant-young population.

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Palabras clave: Cannabidiol, Cannabis, Crisis convulsiva, Epilepsia refractaria, Revisión de Alcance,

Keywords: Cannabidiol, Cannabis, Refractory epilepsy, Scoping Review, Seizures,

Abordaje prequirúrgico en epilepsia de difícil control. Presurgical approach in drug-resistant epilepsy

Epilepsy is one of the main reasons for consultation in general neurology. It is a highly prevalent pathology, with a high impact on the quality of life of these patients. There is a percentage of drug resistance between 30% and 40% of epilepsy cases, and therefore it is very important to know the surgical alternative, as well as the importance of a timely and prompt referral to a specialized surgery center of epilepsy given the high possibility of seizure remission or improvement towards less disabling seizures, with a notable improvement in quality of life. The evaluation process of a patient with drug-resistant focal epilepsy who is a candidate for epilepsy surgery is based on a set of non-invasive diagnostic techniques. The evaluation process is based on the seizure locating semiology, an adequate protocol for the imaging study, electroencephalogram, and interictal and ictal video-monitoring, and neuropsychological evaluation in all cases, and in other functional studies such as computed tomography are necessary, ictal and interictal single-photon emission, positron emission tomography, and also invasive monitoring techniques, through which it is possible to proceed to surgery. A review of the literature is made.

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Palabras clave: Cirugía de epilepsia, Epilepsia, Epilepsia refractaria,

Keywords: drug-resistant epilepsy, Epilepsy, Epilepsy Surgery,

Experiencia Quirúrgica de Dos Años en el Manejo de la Epilepsia Refractaria Multifocal

Objective: To describe the series of patients with multifocal refractory epilepsy who have undergone surgery in our center.

Methods: A prospective analysis of patients with multifocal refractory epilepsy treated in our hospital during the last two years was performed.

Results: In this period we studied 25 patients with multifocal refractory epilepsy who have completed > or =1 year postoperative follow-up after callosotomy. The ages of the patients were between 3.8 and 18.8 years (mean 11, SD 4.46). The most common cause of refractory epilepsy in our series was Lennox Gastaut syndrome (ten patients). We perform 14 callosotomy in 13 patients. Of these, 10 were of the above callosotomías 2/3 and four complete. Overall there was a 66.5% reduction in seizures; in the case of total callosotomías this reduction was 90%. We report two minor complications and death from a pneumonic process.

Conclusion: The surgical management of multifocal refractory epilepsy is a safe procedure that provides good results in controlling the crisis. The complete callosotomy is the most efficient procedure in this population.

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Palabras clave: Callosotomía, Cirugía de la epilepsia, Epilepsia refractaria, Neuronavegación, Planificación quirúrgica,

Keywords: Callosotomy, Epilepsy Surgery, Neuronavigation, Refractory epilepsy, Surgical planning,
 
 
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