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Introduccion. La encefalitis autoinmune contra receptores N-metil-D-aspartato (NMDA) se diagnostica cada vez con mayor frecuencia en la edad pediatrica. Debe sospecharse en ninos con sintomatologia psiquiatrica, encefalopatia, movimientos anormales o crisis epilepticas. Los casos paraneoplasicos son menos frecuentes que en adultos. Caso clinico. Nino de 2,5 anos con cuadro encefalopatico subagudo que comenzo con crisis epilepticas seguidas de alteraciones del comportamiento, regresion neurologica, discinesias e insomnio. El estudio del liquido cefalorraquideo fue normal, en la resonancia magnetica craneal existia una lesion periventricular focal y captacion leptomeningea difusa y los electroencefalogramas seriados revelaron una actividad delta de gran amplitud intercalada con actividad epileptiforme intercritica generalizada. Recibio tratamiento empirico con altas dosis de corticoides e inmunoglobulinas intravenosas sin respuesta. Tras demostrarse la positividad de anticuerpos contra el receptor NMDA se inicio la plasmaferesis, con la que experimento una mejoria rapida y espectacular. Tras mas de 18 meses de seguimiento, sus secuelas se limitan a leves alteraciones conductuales y del lenguaje. No ha presentado recaidas ni ha precisado ningun tratamiento de mantenimiento. Conclusiones. La encefalitis anti-NMDA es un trastorno tratable y, ocasionalmente, el primer indicio de una neoplasia subyacente, por lo que su reconocimiento y tratamiento precoz es fundamental. El tratamiento de las formas no paraneoplasicas se basa en la inmunoterapia: glucocorticoides, inmunoglobulinas intravenosas, plasmaferesis e inmunosupresores. La plasmaferesis puede inducir una mejoria rapida y espectacular.

INTRODUCTION Epilepsy is a chronic disorder. The prognosis of one particular subtype, that of children with generalized spike and wave discharges (P-O) on the electroencephalogram (EEG), is unknown. OBJECTIVE To determine the prognosis of children with epilepsy with P-O on EEG and the factors which affect this. PATIENTS AND METHODS All EEGs done over ten years (39,322) were reviewed, and the epileptic patients under 14 years old identified. Absence and recurrence of crises were evaluated and the factors influencing them analyzed. Minimum significance was p < 0.05. The chi square test, Student's t test and Kaplan-Meier method were used. Logistic regression models were devised. RESULTS Of the children studied, 78% became crisis-free. After monovariant and multivariant analysis the only conditions which fitted the regression models were: abnormal pregnancy; West syndrome or learning difficulties; having certain types of crises, myoclonic, clonic-tonic, partial simple or complex crises; a normal EEG with hypsarrhythmia, slow or fast P-O and requiring multiple medication. When medication ceased, 31.4% had recurrence of the episodes. On monovariant and multivariant analysis, protective factors were absence of attacks and risk factors were a family history of epilepsy or an EEG with rapid P-O. CONCLUSIONS The overall prognosis for epileptic children with P-O is good. There are factors which improve or worsen the pronosis, but these cannot be modified.