Clarisa Maxit

Long-term follow-up of the ketogenic diet for refractory epilepsy: multicenter Argentinean experience in 216 pediatric patients.

PURPOSE In this Argentinean retrospective, collaborative, multicenter study, we examine the efficacy and tolerability of the ketogenic diet (KD) for different epilepsy syndromes. MATERIALS AND METHODS we evaluated the clinical records of 216 patients started on the KD between March 1, 1990 and December 31, 2010. RESULTS One hundred forty of the initial patients (65%) remained on the diet at the end of the study period. Twenty-nine patients (20.5%) became seizure free and 50 children (36%) had a 75-99% decrease in seizures. Thus, 56.5% of the patients had a seizure control of more than 75%. The best results were found in patients with epilepsy with myoclonic-astatic seizures, Lennox-Gastaut syndrome, and West syndrome. Good results were also found in patients with Dravet syndrome, in those with symptomatic focal epilepsy secondary to malformations of cortical development, and in patients with tuberous sclerosis. Seizures were significantly reduced in four patients with fever-induced refractory epileptic encephalopathy in school-age children and in two patients with epileptic encephalopathy with continuous spikes and waves during slow sleep. The median period of follow-up after discontinuation of the diet was 6 years. Twenty patients who had become seizure free discontinued the diet, but seizures recurred in five (25%). Of 40 patients with a seizure reduction of more than 50% who discontinued the diet, 10 presented with recurrent seizures. CONCLUSION The ketogenic diet is a good option in the treatment of refractory epilepsy. After discontinuing the diet, seizures recurrence occurred in few patients.

Epilepsia partialis continua associated with levamisole.

Epilepsia partialis continua is defined as a spontaneous regular or irregular clonic muscular twitching affecting a limited part of the body, occurring for a minimum of 1 hour and recurring at intervals of less than 10 seconds. Levamisole is used as an immunomodulating medication in patients with recurrent aphthous ulcers. Evidence suggests that it can induce multifocal inflammatory leukoencephalopathy. We describe the clinical neuroimaging and ictal electroencephalographic findings in an adolescent with epilepsia partialis continua caused by the administration of levamisole with cortical and subcortical lesions. To our knowledge, this is the first report that describes the association of epilepsia partialis continua cortical lesions detected by magnetic resonance imaging and levamisole that were not previously described.

Prevalencia de estereotipias en pacientes sin enfermedades crónicas

Introduccion: Las estereotipias han sido descritas en ninos con trastornos del desarrollo pero su prevalencia y caracteristicas en ninos con desarrollo madurativo normal no es conocida. Objetivo: Estimar la prevalencia de estereotipias en ninos sin enfermedades cronicas y describir sus caracteristicas clinicas y epidemiologicas Pacientes y Metodos: Estudio de corte transversal. Se aplico una encuesta a madres de ninos recien nacidos hasta ninos de 12 anos que concurrieron a los consultorios externos con muestreo consecutivo y no aleatorizado. La encuesta fue analizada previamente en un subgrupo de madres. Resultados: Se completaron 406 encuestas, en el 57% se refirieron estereotipias y las mas frecuentes fueron chuparse los dedos (21,8%) y comerse las unas (20%). El analisis multivariado identifico mayor probabilidad de presentar estereotipias en ninos con antecedentes de esterotipia en los padres, situaciones de estres y madres mayores de 35 anos. Conclusion: Las estereotipias tienen una elevada prevalencia en los ninos y son mas frecuentes en ninos con antecedentes familiares de estereotipias, situaciones de estres y en ninos con madres de mayor edad.