Mercè Falip

Resumen Entre el 0,3 y el 1% de las consultas en urgencias se deben a crisis epilépticas o sospecha de crisis epiléptica. Es el tercer motivo de consulta neurológica en urgencias tras el ictus y la cefalea. Por otro lado, la epilepsia es un trastorno neurológico que cursa con crisis epilépticas no provocadas. Existen diversos tipos de crisis epilépticas que se clasifican según la presencia o ausencia de manifestaciones motoras y la presencia o ausencia de alteración de la consciencia. Algunos tipos de crisis epilépticas pueden confundirse con otras enfermedades, siendo vital para su correcto diagnóstico una anamnesis dirigida, así como determinadas pruebas complementarias. Las crisis urgentes, que incluyen el estado epiléptico, las crisis agrupadas, las primeras crisis y las crisis de alto riesgo, requieren de atención y tratamiento urgentes dado su potencial riesgo vital y de daños cerebrales permanentes. Las crisis epilépticas se clasifican en provocadas y no provocadas. Las causas más frecuentes de crisis provocadas son: enfermedad cerebrovascular, traumatismo craneoencefálico, encefalitis infecciosas e inmunomediadas, tóxicos o fármacos y trastornos metabólicos. Las crisis epilépticas no provocadas aumentan el riesgo de desarrollar epilepsia.

Objective: The effectiveness of surgery in drug‐resistant epilepsies is often focused exclusively on seizure control. The Epilepsy Surgery Satisfaction Questionnaire‐19 (ESSQ_19), developed in 2020, is a reliable tool for assessing the level of satisfaction of patients undergoing surgery. We aimed to perform a Spanish translation, adaptation, and validation of the ESSQ_19 questionnaire. Methods: This was a prospective multicenter study (five Spanish‐speaking countries) including an international cohort of adult patients who underwent epilepsy surgery at least 1 year prior to participation. We followed a translation and back‐translation methodology to obtain the Spanish version of the questionnaire (ESP‐ESSQ_19). For validation, internal consistency (Cronbach alpha) and test–retest reliability at 6 months were assessed, and psychometric properties were measured by correlating them with parallel aspects using validated questionnaires. Results: One hundred fifty patients were included (59.3% women; mean age = 39.3 ± 13 years, interquartile range [IQR] = 28–49 years), of whom 94 completed the baseline and follow‐up questionnaires, with a median time since surgery of 3 (IQR = 1–7) years. Temporal lobe epilepsy was the most common ( n = 112, 77.8%), as was structural etiology ( n = 139, 95.2%). At inclusion, 101 patients (68.7%) had been seizure‐free for ≥1 year. The ESP‐ESSQ_19 questionnaire showed an internal consistency index of .88–.95 for all domains and a test–retest reliability of .91 (95% confidence interval = .87–.94). Significant correlation coefficients were observed between the ESP‐ESSQ_19 questionnaire and all validated questionnaires used. Significance: The ESP‐ESSQ_19 questionnaire is a Spanish‐language instrument useful for assessing patient satisfaction after epilepsy surgery, with adequate psychometric properties that allow its use in clinical practice and in research.

Lennox–Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy (DEE) characterized by multiple types of drug‐resistant seizures (which must include tonic seizures) with classical onset before 8 years (although some cases with later onset have also been described), abnormal electroencephalographic features, and cognitive and behavioral impairments. Management and treatment of LGS are challenging, due to associated comorbidities and the treatment resistance of seizures. A panel of five epileptologists reconvened to provide updated guidance and treatment algorithms for LGS, incorporating recent advancements in antiseizure medications (ASMs) and understanding of DEEs. The resulting consensus document is based on current evidence from clinical trials and clinical practice and the panel's expert opinion, focusing on new ASMs with novel mechanisms of action, such as highly purified cannabidiol and fenfluramine. For a patient presenting with newly diagnosed LGS or suspected LGS, the recommended first‐line treatment continues to be valproate. If this is ineffective as monotherapy, adjunctive therapy with, firstly, lamotrigine and secondly, rufinamide, is recommended. If seizure control remains suboptimal, subsequent adjunctive ASM treatment options include (alphabetically) cannabidiol, clobazam, felbamate, fenfluramine, and topiramate, although evidence for these is more limited. Whenever possible, no more than two ASMs should be used together. Nonpharmacological treatment approaches should be used in conjunction with ASM therapy and include ketogenic diet therapies, vagus nerve stimulation, and corpus callosotomy. Patients with LGS that has evolved from another type of epilepsy who are not already being treated with valproate should be transitioned to valproate and then managed using the same algorithm as for newly diagnosed LGS. Older patients with established LGS should be reviewed at least annually by a suitably experienced neurologist. The revised guidance aims to improve seizure control and quality of life for patients with LGS through personalized, evidence‐based treatment strategies while addressing the challenges of accurate diagnosis and management in a rapidly evolving therapeutic landscape.Plain Language Summary: Lennox–Gastaut syndrome (LGS) is a severe type of epilepsy that usually starts in childhood but continues into adulthood. It is characterized by a variety of different types of seizures (abnormal electrical activity in the brain), which are difficult to treat and often cause people with the condition to fall and injure themselves. Most people with LGS have learning difficulties and need a lot of support, often in residential care. The authors are experts in treating people with LGS and this article provides up‐to‐date guidance and advice on how best to care for those with the condition.

Objective: Our aim was to assess seizure development as a complication of pneumococcal meningitis and its possible prevention with antiseizure medication prophylaxis.Methods: Antiseizure medication (ASM) prophylaxis has been practiced for a long time at our center. We assessed all cases of community‐acquired pneumococcal meningitis admitted from January 2010 to April 2021 recorded in our prospective database and conducted further retrospective studies.Results: Of the 86 cases recorded, 21 (24.4%) developed acute symptomatic seizures, more than half of which (11/21; 52.4%) before admission. Seizure development increased the need for orotracheal intubation and intensive care unit admission, while also lengthening hospital stays and suggesting more risk of death and disability at discharge [adjusted odds ratio (aOR), 3.13; 95% confidence interval (CI): 1–9.8]. Of the 74 patients eligible for ASM prophylaxis, 64 received it and 10 did not. ASM prophylaxis seemed effective in preventing seizure development, as only six seizure events were recorded in 64 patients with ASM prophylaxis (9.4%) compared with four in the 10 patients without prophylaxis (40%). Its preventive capacity was especially notable when administered within 4 h of admission. Differences in mortality did not reach statistical significance. Adverse effects were rare.Significance: Seizure development is a common complication in pneumococcal meningitis and is associated with increased risks of Intensive Care Unit admission, orotracheal intubation, and longer hospital stays. ASM prophylaxis may be effective in blocking seizure development in patients with preventable seizures and may be associated with better prognosis. Further studies are now warranted.Plain Language Summary: Infection of the meninges (the covering of the brain) due to the common bacteria S pneumoniae, used to be a fatal disease before the introduction of antibiotics and corticoids. Thanks to these drugs, more people survive this disease but, due to the frequent complications, they may have several sequelae. Seizures are a common complication. Our study suggests that they might be prevented by using antiseizure drugs which may reduce both severity and hospital stay.

The electroencephalogram (EEG) is a cornerstone tool for the diagnosis, management, and prognosis of selected patient populations. EEGs offer significant advantages such as high temporal resolution, real-time cortical function assessment, and bedside usability. The quantitative EEG (qEEG) added the possibility of long recordings being processed in a compressive manner, making EEG revision more efficient for experienced users, and more friendly for new ones. Recent advancements in commercially available software, such as Persyst, have significantly expanded and facilitated the use of qEEGs, marking the beginning of a new era in its application. As a result, there has been a notable increase in the practical, real-world utilization of qEEGs in recent years. This paper aims to provide an overview of the current applications of qEEGs in daily neurological emergencies and ICU practice, and some elementary principles of qEEGs using Persyst software in clinical settings. This article illustrates basic qEEG patterns encountered in critical care and adopts the new terminology proposed for spectrogram reporting.

The association between epilepsy and myasthenia gravis has rarely been reported, and when it has been reported, it has only been in a small case series. The aim of the present study was to report the frequency of epilepsy and myasthenia gravis and to describe a case series of patients with myasthenia gravis and epilepsy, focusing on their clinical characteristics and searching for a possible physiopathological mechanism. A retrospective, observational, adult center study was conducted in 2022. Patients were recruited from the database of the outpatient clinic of the Myasthenia Gravis and Epilepsy Unit of the Neurology Service, Hospital Universitari de Bellvitge. Five patients were included. The frequency of epilepsy in the myasthenia gravis cohort was 5/469 (1.1%), and the frequency of myasthenia gravis in the epilepsy cohort was 5/1432 (0.35%). All patients suffered from focal epilepsy, mainly temporo-central, which was drug-resistant in 3/5 Myasthenia gravis, which was generalized and with exacerbations in 3/5. Three patients were thymectomized (anatomopathology: thymic hyperplasia). Other autoimmune diseases were found in two (40%). Epilepsy onset preceded myasthenia gravis onset in all patients. Both diseases were considered autoimmune-related in 3/5, related to genetic predisposition due to altered innate immune system in 1/5, and due to chance or to treatment in 1/5. Epilepsy and myasthenia gravis are only infrequently associated. In adult patients, epilepsy onset precedes myasthenia onset in most cases. In some cases, epilepsy has an autoimmune etiology and coexists with other autoimmune conditions.

Introduction: The association between epilepsy and myasthenia gravis has rarely been reported, and only in small case series. Objective: To report the frequency of epilepsy and myasthenia gravis and to describe a case series of patients with myasthenia gravis and epilepsy, focusing on their clinical characteristics and searching for a possible physiopathological mechanism. Methods: A retrospective, observational, adult center study was conducted in 2022. Patients were recruited from the database of the outpatient clinic of the Myasthenia Gravis unit and Epilepsy unit. Results: Five patients were included. Frequency of epilepsy in the myasthenia gravis cohort was 5/469 (1.1%), and of myasthenia gravis in the epilepsy cohort was 5/1432 (0.35%). All patients suffered focal epilepsy, mainly fronto-central, and drug-resistant in half of them. Myasthenia gravis was generalized and with exacerbations in half of them. Three patients were thymectomized. Other autoimmune diseases were found in 2 (40%). Epilepsy onset preceded myasthenia gravis onset in all patients. Both diseases were considered autoimmune-related in 3/5 (60%). Conclusion: Epilepsy and myasthenia gravis are only infrequently associated. In adult patients, epilepsy onset precedes myasthenia onset in most cases. In some cases, epilepsy has an autoimmune aetiology and coexists with other autoimmune conditions.