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Background: The safety and effectiveness of lacosamide, an antiepileptic drug (AED) that selectively enhances the slow inactivation of voltage-gated sodium channels without affecting rapid inactivation, has been demonstrated in randomized, double-blind, placebo-controlled trials in adults with focal epileptic seizures. Although lacosamide is approved for use in patients over 16 years of age, limited clinical experience exists for younger patients., Objective: To assess the efficacy and tolerability of lacosamide in children with refractory epilepsy. DesignMethods: The trial was a prospective, open-label, observational, multicenter study. A total of 130 patients aged less than 16 years (range 6 months to 16 years) with refractory epilepsy who had initiated treatment with lacosamide were enrolled at 18 neuropediatric units in hospitals across Spain. Patients with a variety of etiologies were enrolled, including those with partial epilepsies and symptomatic, generalized epilepsy syndromes. Lacosamide (VIMPAT®; UCB Pharma SA, Brussels, Belgium) was primarily administered once every 12 hours as an oral solution or as an oral tablet, with an initial dose of 1-2 mg/kg/day in the majority of cases. The majority of patients were also receiving stable concomitant therapy with ≥1 other AED. Treatment response to lacosamide was determined by assessing the change in seizure frequency after 3 months of lacosamide therapy. Responders were defined as patients who achieved a seizure frequency reduction of >50%. Tolerability was assessed by the reporting of adverse effects, laboratory testing, and electroencephalography recordings., Results: Lacosamide was dosed at a mean of 6.80 ± 2.39 mg/kg/day. After 3 months of lacosamide therapy, 62.3% of patients achieved a >50% reduction in seizure frequency, with complete seizure suppression being reported in 13.8% of patients. Adverse effects occurred in 39 patients (30%), but no dose-response relationship was observed in terms of these events. In ten patients, instability, difficulty walking, an inability to relate to subjective elements, and blurred vision or dizziness were reported. A total of 13 patients discontinued treatment - in five of these patients, symptom intensity remained unchanged despite dose reduction, which led to treatment discontinuation. The symptoms were markedly different in each patient, preventing determination of a causal factor(s)., Conclusions: The results of this study provide preliminary evidence for the efficacy of lacosamide in children with refractory epilepsy. Further evaluation in a randomized, controlled trial is needed to validate the efficacy in this population and to fully investigate the adverse effects described here. We recommend an initial dose of 1-2 mg/kg/day, uptitrated to 6-9 mg/kg/day over 4-6 weeks.

Our review of the literature is basically focused on the primary prophylaxis of early seizures after surgery of cerebral supratentorial tumors, with the aim of suggesting several recommendations in medical antiepileptic treatment to avoid this kind of seizures which occur immediately after surgery. In conclusion, it is recommended to provide criteria for prophylaxis of early seizures after surgery of cerebral supratentorial tumors. It́s recommended a one week treatment with antiepileptic drugs in patients who didńt have seizures jet, starting immediately after the surgical treatment. If seizures appear during progress of the disease, a large period treatment will be needed. Preferred antiepileptic treatment is intravenous and with a low interactions profile. Levetiracetam, followed by valproic acid seem to be most appropriated drugs due to their properties and protective effects, particularly for our patients requirements. These recommendations are considered a general proposal to effective clinical management of early seizures after surgery, not taking into account the single circumstances of our patients. Always, clinical features of the patients could modify even significantly these guides in the benefit of each patient., (Copyright © 2011 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.)

Introduction: Evidence-based medicine establishes guidelines for clinical decision-making in which priority is given to processes that have the highest level of evidence. Although these guidelines provide valuable general guidance, the information is partial, because oftentimes obtaining evidence on antiepileptic drugs is promoted by commercial expectations and not by clinical priorities. Furthermore, the guidelines tend to classify different types of epilepsy into large groups, often without contemplating the different syndromes. Expert opinions are subject to criticism on the basis of methodology and their authoritarian aspect, although they can supplement medical literature and advice on specific clinical situations quickly and efficiently., Objectives: This review seeks to incorporate scientific evidence and expert opinion into drug treatment for epilepsy., Methods: To analyze this issue, a review of the literature was conducted by means of PubMed searches., Conclusion: We have found that in all types of epilepsy [except in focal epilepsy in children where a new drug (oxcarbamazepine) is considered to be the first choice for initial treatment], classic drugs (valproic acid in idiopathic generalized epilepsy and carbamazepine in focal epilepsy) are recommended as long as there are no contraindications due to adverse effects or concomitant use of other drugs that interact with the antiepileptics. However, despite the general recommendations, it can be deduced from the studies and reflections on the subject that the decision as to whether to start treatment or not, as well as the drug of choice, must be made on a case-by-case basis, taking into account the patient's personal and social circumstances.

Background: Despite the correct use of antiepileptic drugs, control of seizures is not possible in 20% to 30% of people with epilepsy. This group of patients is considered to suffer from drug-resistant epilepsy, a clinical situation that can be caused by certain syndromes in which surgery can be used to bring the seizures under control., Review Summary: Determining the suitability of the surgical treatment and the best approach always requires a full assessment, which includes video-electroencephalogram (EEG) monitoring, neuropsychological examination, and structural magnetic resonance imaging. In some patients it may be necessary to perform functional imaging tests and intracranial electrode recordings. These tests make it possible to confirm that the patient does indeed have epilepsy, identify the type of epilepsy, determine the severity of the seizures, and locate the epileptogenic zone. The best surgical results are obtained in patients with small epileptogenic lesions which can be totally resected. Nevertheless, in many patients in whom complete control is not achieved after surgery, the improvement in control of the seizures also has a positive impact on their quality of life. Some surgical techniques (partial resections, corpus callosotomy, subpial transection, electrical stimulation of the vagus nerve, and deep brain stimulation) have a palliative effect., Conclusion: The aim of this review is to update knowledge on the indications for surgery and electrical stimulation in the management of epilepsy.

Trisomy 9p is a chromosome abnormality caused by duplication of the short arm of chromosome 9. Clinically it is characterized by psychomotor retardation, malformations that can affect various organs and sometimes epilepsy. Trisomy 9p may be the fourth most common autosomal trisomy, after trisomies 21, 13 and 18. Two new cases of trisomy 9p are described. Previous cases reported in Spain, associated clinical features, and the diagnostic and therapeutic approach to these patients are revised.

Relationship between steady-state plasma concentrations of phenobarbitone (PB), phenytoin (PHT), primidone (PRM), carbamazepine (CBZ) and sodium valproate (VPA) and their efficacy and toxicity, were studied in 392 pediatric outpatients, long-term treated in monotherapy for epileptic seizures or febrile convulsions, in order to establish "target" values which may be used, as reference, in clinical practice. The concentration-efficacy and toxicity curves suggest target values of 20, 15, 9, 10, 6 and 70 mg/l for PB, PB derived from PRM, PRM, PHT, CBZ and VPA respectively. Above 25 mg/l of PB, 20 of PHT and 100 of VPA, markedly decreased the probability of response in refractory patients, and a clear increase in toxicity was shown. Above 7 mg/l of CBZ a decrease in the percentage of seizure-free patients was observed, without an increase of toxicity. For PRM no efficacy "ceiling" was found but side effects increased. The target values proposed may be helpful as a reference for the initial dosage of antiepileptic drugs in children, during monotherapy. Nevertheless, final doses should be adjusted according to clinical response of each patient.

Thanks to a survey sent the 4,099 teachers of Cantabria, we value their knowledge and attitudes about the epileptic child. After analyses the 1,283 surveys were sent back (31.3%), 28% of teachers had had an epileptic pupil, although the 89% never had received specialized information about epilepsy, whose etiology was unknown by 30%. A quarter thinks necessary special school or complementary help for the schoolhood of these children, and the 23% thinks the epileptic child is less intelligent than his fellows.

Progressive muscular dystrophy is an hereditary disease with a sex-linked recessive transmission. It is remarkable that in a 33% of the patients the disease is due to a spontaneous mutation. The great deal of methods described for the detection of carriers, reflects their poor reliability. The gemellus muscles of 11 women belonging to 3 different families with children affected by progressive muscular dystrophy were explored by means of ultrasounds. Comparison was made with healthy controls. Since our findings are in concordance with those of the literature, we recommend the use of muscular ultrasounds in the detection of Duchenne muscular dystrophy carriers, specially considering the accessibility, innocuousness and quickness of this method.

The influence of risk factors predisposing to recurrences was assessed in 103 children with febrile convulsions who were given prophylactic treatment with phenobarbitone, primidone or sodium valproate at adequate doses and whose compliance with treatment was monitored. There was a greater risk of recurrence among girls. Increasing risk was observed with decreasing age at which children suffered the first febrile convulsion. Neither a family history of epilepsy, failure of previous treatment, history of perinatal incidents, focal or prolonged febrile convulsions, recognition of neurological disease nor the number of previous febrile convulsions led to any significantly greater risk in these children. There was an increased tendency for recurrence with increasing interval between the first febrile convulsion and the start of prophylactic treatment.

The case of an eight year old boy affected by a meningoradiculitis in the prodromic phase of an acute hepatitis A is described. The diagnostic was confirmed (ac. anti-HAV-IgM). We point out the finding of this association which hasn't been described up to now.

The clinical and neuroradiological findings in a case of semilobar holoprosencephaly associated to hypernatremia behaving like diabetes insipidus are described. The differential diagnosis with a neurogenic hypernatremia is discussed. The advantages of ultrasounds in the diagnosis of this malformation are pointed out. So are the characteristics which differentiate it from other neurological malformations and the importance of a dorsal sac to delimitate the more serous clinical forms.