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Caraballo R, Reyes G, Semprino M, Chacón S, Galichio S, Adi J, Gallo A, Gamboni B, Cachia P, Fortini S, Espeche A. Use of sulthiame as add-on therapy in children with non-self-limited focal epilepsies of childhood. Epilepsy Behav 2023; 143:109220. [PMID: 37119578 DOI: 10.1016/j.yebeh.2023.109220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE This retrospective study aimed to evaluate the efficacy and tolerability of sulthiame (STM) as an add-on treatment in 49 patients with non-self-limited focal epilepsies of childhood (non-SeLFE) resistant to other antiseizure medications (ASM) and/or non-pharmacological treatment. METHODS Patients with non-SeLFE who had failed to respond to at least five previous ASM, alone or in combination, were included in the study. All patients underwent neurological examination, brain magnetic resonance imaging repeated prolonged electroencephalography (EEG) or video-EEG studies, and neurometabolic studies. School achievements and/or performance on neuropsychological tests were also assessed. Sulthiame was added in doses ranging from 10 to 40 mg/kg/day. Efficacy was measured by comparing seizure frequency before and after initiating STM therapy. RESULTS Twenty-nine of 49 patients (59.1%) who received STM as add-on therapy had a greater than 50% decrease in seizures after a mean follow-up of 35 months. One patient (2%) became seizure-free. Fourteen patients (40%) had a 25-50% seizure reduction. The mean time of response was 5 months (range, 3.5 to 6 months). No differences were found either between patients with a response of more or less than 50% or between the response of the focal seizure types (motor or non-motor, with or without consciousness impairment). CONCLUSION In our study, STM was found to be effective and well-tolerated in children and adolescents with non-SeLFE. In the patients who responded, improvement in the EEG was seen.
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Affiliation(s)
| | | | | | - Santiago Chacón
- Centro de Neurología Infantil (CENI), Gualeguaychú, Argentina
| | | | - Javier Adi
- Hospital de Pediatría Humberto Notti, Mendoza, Argentina
| | - Adolfo Gallo
- Hospital de Niños Victor Vilela, Rosario, Argentina
| | | | - Pedro Cachia
- Hospital de Niños Jorge Vilela, Rosario, Argentina
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Semprino M, Galicchio S, Espeche A, Cersosimo R, Chacon S, Gamboni B, Adi J, Fasulo L, Fortini S, Cachia P, Gallo A, Caraballo RH. Panayiotopoulos syndrome: Unusual clinical manifestations. Epilepsy Behav 2022; 128:108552. [PMID: 35063695 DOI: 10.1016/j.yebeh.2022.108552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE We retrospectively analyzed the electroclinical features, treatment, and outcome of patients with Panayiotopoulos syndrome (PS) who presented with unusual clinical manifestations. METHOD A retrospective, descriptive, multicenter study was conducted evaluating 44 patients with PS who had seizures with an unusual semiology. Data from patients with PS seen at eight Argentine centers between April 2000 and April 2019 were collected. RESULTS Twelve patients (29.2%) had ictal syncope or syncope-like epileptic seizures. Three children (7.3%) had recurrent episodes of vomiting. Four patients (9.7%) presented with urinary incontinence associated with autonomic signs and consciousness impairment. One child had hiccups with autonomic manifestations followed by eye deviation. One boy had episodes of laughter with autonomic symptoms followed by loss of consciousness. Six patients (14.6%) had hyperthermia without acute febrile illness with autonomic symptoms as the first manifestation. Six others (14.6%) had focal motor seizures characterized by eye and head deviation in four and eyelid blinking in two. Four patients (9.7%) had ictal headache as the initial manifestation followed by nausea and vomiting. Two children (4.8%) had their first seizure while asleep associated with cardiorespiratory arrest. Two children (4.8%) had oral automatisms, such as sucking and chewing. In two children (4.8%) coughing was the initial manifestation followed by emetic symptoms. One patient (2.3%) had vertigo with a sensation of fear, with eye deviation and unresponsiveness. One child started with continuous spikes and waves during slow sleep, behavior disturbances, and emetic symptoms. CONCLUSION In this study, evidence of the existence of unusual clinical cases of PS with typical EEG patterns was found. Outcome was excellent.
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Affiliation(s)
| | | | | | - Ricardo Cersosimo
- Centro Integral de Neurociencias (CINEU), Lomas de Zamora, Provincia de Buenos Aires, Argentina
| | - Santiago Chacon
- Centro de Neurología Infantil (CENI), Gualeguaychu, Entre Ríos, Argentina
| | | | - Javier Adi
- Hospital Pediátrico Humberto H Notti, Mendoza, Argentina
| | | | | | - Pedro Cachia
- Hospital de Niños Victor J Vilela. Rosario, Santa Fé, Argentina
| | - Adolfo Gallo
- Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
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Caraballo R, Semprino M, Fasulo L, Reyes G, Chacón S, Gallo A, Buompadre C. Status of epileptic spasms: A study of 21 children. Epilepsy Behav 2022; 126:108451. [PMID: 34864379 DOI: 10.1016/j.yebeh.2021.108451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/06/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We studied cases with long-lasting epileptic spasms (ES) considered as a spasm status analyzing type of epilepsy, epileptic syndrome, etiology, treatment, and outcome in 21 patients. METHODS We evaluated the charts of 21 patients seen between June 2006 and July 2017 who met the electroclinical diagnostic criteria of a spasm status. The spasm status was defined as continuous ES lasting 30 min or longer. RESULTS The type of ES was mixed in nine patients, flexion in seven, and extension in five. Epileptic spasms were asymmetric in three patients and unilateral in two. They occurred on awakening in all patients, while during sleep they decreased in all and disappeared in three cases. The duration of the spasm status ranged from 40 min to 15 days according to the seizure diaries of patients and video-EEG recordings. Two well-defined subgroups of patients were recognized; the first included patients with West syndrome (WS) and the second other types of severe non-West epilepsy syndromes. The spasm status responded well to oral vigabatrin (VGB) in four patients, oral topiramate (TPM) in three, oral corticosteroids in one, and cannabidiol in another patient. A good response was observed with benzodiazepines in six patients, with phenytoin (PH) in two, and with phenobarbital (PB) in one. Adrenocorticotropic hormone (ACTH) was effective in one patient and the ketogenic diet in two. Prognosis depends on the etiology. CONCLUSION In this study we identified patients with WS and other types of severe non-West epilepsy syndromes who had a particular type of long-lasting ES that, in spite of its long duration does not strictly meet the criteria of the International League against Epilepsy (ILAE) classification of status epilepticus, may be considered a spasm status.
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Affiliation(s)
- Roberto Caraballo
- Department of Neurology, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina.
| | - Marcos Semprino
- Department of Neurology, Clinica San Lucas, Neuquen, Argentina
| | - Lorena Fasulo
- Department of Neurology, Clinica San Lucas, Neuquen, Argentina
| | - Gabriela Reyes
- Department of Neurology, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Adolfo Gallo
- Department of Neurology, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Celeste Buompadre
- Department of Neurology, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
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Fortini S, Espeche A, Galicchio S, Cersósimo R, Chacon S, Gallo A, Gamboni B, Adi J, Fasulo L, Semprino M, Cachia P, Caraballo RH. More than one self-limited epilepsy of childhood in the same patient: A multicenter study. Epilepsy Res 2021; 177:106768. [PMID: 34547632 DOI: 10.1016/j.eplepsyres.2021.106768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/29/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We describe the evolution of the electroclinical picture of patients with different types of self-limited epilepsy of childhood (SLEC) occurring at the same or at different times with or without atypical evolutions as well as patients with SLEC associated with childhood absence epilepsy (CAE). MATERIAL AND METHODS A multicenter, retrospective, descriptive study was conducted evaluating patients with SLEC who had focal seizures of different types of SLEC including atypical evolutions as well as SLEC associated with absence epilepsy seen at eight Argentinian centers between April 2000 and April 2019. Of 7705 patients with SLEC, aged between 2 and 14 years (mean, 7.5 years), of whom 2013 were female and 5692 male (ratio, 1:2.8), 5068 patients had SLECTS, 2260 patients had self-limited childhood occipital epilepsy Panayiotopoulos type (SLE-P), 356 had self-limited childhood occipital epilepsy Gastaut type (SLE-G), and 21 had self-limited epilepsy with affective seizures (SLEAS). Electroclinical features typical of more than one SLEC syndrome were recognized in 998 (13 %) children. RESULTS We recognized three well-defined groups of patients. The most frequent association was SLE-P and SLECTS, the paradigmatic type, but associations of SLE-P and SLE-G, SLECTS and SLE-G, and SLEAS and SLE-P or SLECTS were also recognized. The second-most-common association was SLEC and an atypical evolution. In this group, the most frequent combination was SLECTS with its atypical evolution, opercular status epilepticus, epileptic encephalopathy with continuous spike-and-waves during slow sleep, or Landau-Kleffner syndrome. SLE-P and SLE-G associated with an atypical evolution were also identified. The third, less-frequent group had SLECTS, SLE-P, or SLE-G associated with CAE. These cases support the concept that the different types of SLEC are part of a self-limited childhood seizure susceptibility syndrome. CONCLUSION Our study demonstrated that 13 % of our patients with SLEC have with different types of SLEC occurring at the same or at different times with or without atypical evolutions - i.e. CSWSS - as well as patients with SLEC associated with CAE, supporting the concept of the self-limited childhood seizure susceptibility syndrome.
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Affiliation(s)
| | | | | | - Ricardo Cersósimo
- Centro Integral de Neurociencias (CINEU), Lomas de Zamora, Provincia de Buenos Aires, Argentina
| | - Santiago Chacon
- Centro de Neurología Infantil (CENI) de Gualeguaychu, Entre Ríos, Argentina
| | - Adolfo Gallo
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Javier Adi
- Hospital Pediátrico Humberto H Notti de Mendoza, Argentina
| | | | | | - Pedro Cachia
- Hospital de Niños Victor J Vilela de Rosario, Santa Fé, Argentina
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Espeche A, Galicchio S, Cersósimo R, Chacon S, Gamboni B, Adi J, Fasulo L, Semprino M, Fortini S, Cachia P, Caraballo RH. Self-limited epilepsy of childhood with affective seizures: A well-defined epileptic syndrome? Epilepsy Behav 2021; 117:107885. [PMID: 33714932 DOI: 10.1016/j.yebeh.2021.107885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Here we present cases of focal epilepsy with affective symptoms analyzing seizure characteristics, EEG pattern, treatment, and outcome. METHODS A multicenter, descriptive, retrospective study was conducted evaluating 18 patients with self-limited epilepsy who presented with seizures with affective symptoms seen between April 2000 and April 2018 at eight Argentinian centers. RESULTS Eighteen patients had focal seizures with affective symptoms; all of them had affective symptoms characterized by sudden fright or terror and screaming. Seizures started with manifestations of sudden fright or terror manifested by a facial expression of fear; consciousness was mildly impaired in 15/18 patients. Eleven of the patients also had autonomic manifestations, such as pallor, sweating, and abdominal pain. In addition, four of these 11 patients had ictus emeticus and one also presented with unilateral deviation of the eyes and head. Speech arrest, salivation, glottal noises, and chewing or swallowing movements were observed in 2/18 patients at the onset of the affective seizures. Two others also had mild asymmetric dystonic seizures involving both hands and arms. Three patients had tonic deviation of the mouth involving the lips and tongue as well pharyngeal and laryngeal muscles, resulting in anarthria and drooling. Two patients had brief hemifacial focal clonic seizures. CONCLUSION Affective manifestations associated or not with motor and/or autonomic manifestations and associated with typical EEG features of the idiopathic focal epilepsies of childhood is a particular presentation of self-limited focal epilepsy in childhood.
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Affiliation(s)
| | | | - Ricardo Cersósimo
- Centro Integral de Neurociencias (CINEU), Lomas de Zamora, Provincia de Buenos Aires, Argentina
| | - Santiago Chacon
- Centro de Neurología Infantil (CENI) de Gualeguaychu, Entre Ríos, Argentina
| | | | - Javier Adi
- Hospital Pediátrico Humberto H Notti de Mendoza, Argentina
| | | | | | | | - Pedro Cachia
- Hospital de Niños Victor J Vilela de Rosario, Santa Fé, Argentina
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Semprino M, Fasulo L, Fortini S, Martorell Molina CI, González L, Ramos PA, Martínez C, Caraballo R. Telemedicine, drug-resistant epilepsy, and ketogenic dietary therapies: A patient survey of a pediatric remote-care program during the COVID-19 pandemic. Epilepsy Behav 2020; 112:107493. [PMID: 33181913 PMCID: PMC7532773 DOI: 10.1016/j.yebeh.2020.107493] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study was to assess parent satisfaction with the management of ketogenic diet therapies (KDTs) through telemedicine using WhatsApp as the main tool. METHODS Parent satisfaction was longitudinally evaluated through questionnaires. The survey was developed with Google Questionnaire forms and sent via WhatsApp. The questionnaire consisted of 13 items concerning the management of KDTs using telemedicine in the context of the coronavirus disease 2019 (COVID-19) pandemic. Our population of patients has limited financial resources and low levels of education. Given that many families did not have either computers or WIFI, or any other access to information or communication technology, WhatsApp was chosen as a tool as it was available on the cell phones of all families and the professionals. RESULTS Our survey showed that 96.3% of the parents were satisfied with the management of KDTs through telemedicine. The main benefits observed were the possibility of continuing treatment during the COVID-19 pandemic and the ease of accessing the professional team from the comfort of their home. Overall, 72.2% of the families would recommend using telemedicine for KDTs in any situation regardless of the pandemic. None of the families reported that they would recommend against treatment by telemedicine. The availability of a social support network (parents WhatsApp group) coordinated by professionals from the KDT team was considered to be useful by most respondents (90%). CONCLUSIONS Our study suggests that management of children with DRE on KDTs through telemedicine is feasible, well accepted by the families, and probably as safe as conventional medicine. WhatsApp may be an interesting telemedicine tool to start and maintain KDTs.
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Affiliation(s)
- Marcos Semprino
- Department of Neurology, Clínica San Lucas, Neuquén, Argentina,Department of Nutrition, Clínica San Lucas, Neuquén, Argentina
| | - Lorena Fasulo
- Department of Neurology, Clínica San Lucas, Neuquén, Argentina,Department of Nutrition, Clínica San Lucas, Neuquén, Argentina
| | - Sebastian Fortini
- Department of Neurology, Hospital de Pediatría Niño Jesús, Tucumán, Argentina
| | | | - Lara González
- Department of Neurology, Hospital de Pediatría Niño Jesús, Tucumán, Argentina
| | | | - Carolina Martínez
- Department of Nutrition, Hospital de Pediatría Niño Jesús, Tucumán, Argentina
| | - Roberto Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina.
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Caraballo RH, Pociecha J, Reyes G, Espeche A, Galichio S, Fasulo L, Semprino M. Rufinamide as add-on therapy in children with epileptic encephalopathies other than Lennox-Gastaut syndrome: A study of 34 patients. Epilepsy Behav 2020; 108:107074. [PMID: 32334364 DOI: 10.1016/j.yebeh.2020.107074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/15/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Here, we present a multicenter series of patients with developmental and epileptic encephalopathies (DEE) and related electroclinical patterns (REP) other than Lennox-Gastaut syndrome (LGS) who were treated with rufinamide as add-on therapy. METHODS Medical records of 34 patients with DEE and REP other than LGS treated with add-on rufinamide seen at four pediatric neurology centers in Argentina between May 2014 and March 2019 were retrospectively analyzed. RESULTS We evaluated 34 patients (18 males, 16 females), aged between 2 and 15 years with a mean and median age of 6 and 8 years, respectively. The children had different types of childhood-onset refractory DEE and REP other than LGS and were treated with rufinamide for a mean period of 20 months (range, 12-60 months). Twenty-two of 34 patients (64.5%) who received rufinamide as add-on therapy had a greater than 50% decrease in seizures, and two patients (5.8%) became seizure-free. Four patients (11.7%) had a 25-50% seizure reduction, while seizure frequency remained unchanged in four others (11.7%) and increased in two patients (5.8%). The final mean dosage of rufinamide was 31.5 ± 15.5 mg/kg per day (range, 19-75.4 mg/kg) if combined with valproic acid and of 35.4 ± 11.5 mg/kg per day (range, 8-60.5 mg/kg) without valproic acid. Adverse effects were recorded in nine patients (26.4%). A seizure increase was reported in two of 24 patients (7.3%). CONCLUSION Rufinamide may be used as a treatment option in DEE and REP other than LGS.
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Affiliation(s)
| | - Juan Pociecha
- Department of Neurology, Juan P Garrahan Hospital, Buenos Aires, Argentina
| | - Gabriela Reyes
- Department of Neurology, Juan P Garrahan Hospital, Buenos Aires, Argentina
| | - Alberto Espeche
- Department of Neurology, Hospital Materno-infantil, Salta, Argentina
| | - Santiago Galichio
- Department of Neurology, Hospital de Niños Victor J. Vilela, Rosario, Argentina
| | - Lorena Fasulo
- Department of Neurology, Clínica San Lucas, Neuquen, Argentina
| | - Marcos Semprino
- Department of Neurology, Clínica San Lucas, Neuquen, Argentina
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Fasulo L, Semprino M, Caraballo R. [Multidisciplinary teamwork in the clinical application of the ketogenic diet]. Medicina (B Aires) 2019; 79:225-231. [PMID: 31284260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
The ketogenic diet is an established, effective and well-tolerated treatment in refractory epilepsy. This paper provides practical information on the administration of ketogenic diet. It goes over the standardized protocols and the new ones that allow to broaden the scope regarding the clinical management of the ketogenic diet. It addresses issues such as the implementation, counseling and follow-up as well as the application and how to proceed in special situations such as anesthesia or acute illness. Finally, the aim of this paper is to highlight the relevance of the multidisciplinary teamwork and the family support throughout this laborious but interesting treatment.
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Affiliation(s)
| | | | - Roberto Caraballo
- Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Vaccarezza M, Agustinho A, Alberti MJ, Argumedo L, Armeno M, Blanco V, Bouquet C, Cabrera A, Caraballo R, Caramuta L, Cresta A, de Grandis ES, DeMartini MG, Diez C, Diz M, Dlugoszewski C, Escobal N, Ferrero H, Galicchio S, Gambarini V, Gamboni B, Gonzalez L, Guisande S, Hassan A, Matarrese P, Mestre G, Pesce L, Rios V, Semprino M, Sosa P, Toma M, Viollaz R, Panico L. [National consensus on the modified Atkins diet]. Rev Neurol 2016; 62:371-376. [PMID: 27064917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Epilepsy is a chronic disease that affects 0.5-1% of the population. One third of the patients become refractory to antiepileptic drugs. Among the non-pharmacological treatments available, the modified Atkins diet is an effective treatment used since 2003 as another alternative for children and adults with refractory epilepsy. DEVELOPMENT The Ketogenic Diet National Committee, which depends on the Argentine Society of Pediatric Neurology, elaborated this consensus on the modified Atkins diet, basing itself on a review of the literature and on their clinical experience. This consensus in Spanish explains the different aspects to be taken into account regarding the modified Atkins diet, patient selection, implementation, different controls and adverse effects. Unlike the classic ketogenic diet, the modified Atkins diet is initiated without fasting or hospital stay, nor does it require protein, calorie or fluid restriction, thus improving patient palatability and consequently patient tolerability. CONCLUSIONS The modified Atkins diet is a useful treatment for patients with intractable epilepsy. The publication of this consensus offers the possibility for new centers to get oriented regarding this diet implementation.
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Affiliation(s)
| | - Ariela Agustinho
- Hospital Nacional de Pediatria J. P. Garrahan, 1818 Buenos Aires, Argentina
| | | | - Laura Argumedo
- Hospital de Ninos Santisima Trinidad, Cordoba, Argentina
| | - Marisa Armeno
- Hospital Nacional de Pediatria J. P. Garrahan, 1818 Buenos Aires, Argentina
| | | | - Cecilia Bouquet
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Roberto Caraballo
- Hospital Nacional de Pediatria J. P. Garrahan, 1818 Buenos Aires, Argentina
| | - Luciana Caramuta
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Araceli Cresta
- Hospital Nacional de Pediatria J. P. Garrahan, 1818 Buenos Aires, Argentina
| | | | | | - Cecilia Diez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Diz
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Nidia Escobal
- Hospital Nacional de Pediatria J. P. Garrahan, 1818 Buenos Aires, Argentina
| | - Hilario Ferrero
- Hospital Privado de Comunidad, 7600 Mar de Plata (Buenos Aires), Argentina
| | | | - Victoria Gambarini
- Hospital Privado de Comunidad, 7600 Mar de Plata (Buenos Aires), Argentina
| | - Beatriz Gamboni
- Hospital Pediatrico Doctor Humberto J. Notti, Mendoza, Argentina
| | | | - Silvina Guisande
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Amal Hassan
- Hospital Pediatrico Doctor Humberto J. Notti, Mendoza, Argentina
| | | | - Graciela Mestre
- Hospital Nacional de Pediatria J. P. Garrahan, 1818 Buenos Aires, Argentina
| | - Laura Pesce
- Hospital de Ninos Sor Maria Ludovica, La Plata, Argentina
- Hospital Pediatrico Doctor Humberto J. Notti, Mendoza, Argentina
| | - Viviana Rios
- Hospital de Ninos Doctor Orlando Alassia, Santa Fe, Argentina
| | | | - Patricia Sosa
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Marisol Toma
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rocío Viollaz
- Hospital de Ninos Sor Maria Ludovica, La Plata, Argentina
| | - Luis Panico
- Hospital de Ninos Doctor Orlando Alassia, Santa Fe, Argentina
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Vaccarezza Ferrari M, Agustinho A, Alberti MJ, Argumedo L, Armeno M, Blanco V, Bouquet C, Cabrera A, Caraballo RH, Caramuta L, Cresta A, De Grandis ES, Demartini MG, Díez C, Diz M, Dlugoszewski C, Escobal N, Ferrero H, Galicchio S, Gambarini V, Gamboni B, González L, Guisande S, Hassan A, Matarrese P, Mestre G, Pesce L, Ríos V, Semprino M, Sosa P, Toma M, Viollaz R, Panico LR. Consenso nacional de dieta Atkins modificada. Rev Neurol 2016. [DOI: 10.33588/rn.6208.2015447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Caraballo RH, Pozo AN, Gomez M, Semprino M. PEHO syndrome: a study of five Argentinian patients. Pediatr Neurol 2011; 44:259-64. [PMID: 21397166 DOI: 10.1016/j.pediatrneurol.2010.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/05/2010] [Accepted: 11/08/2010] [Indexed: 11/15/2022]
Abstract
We describe two familial and three nonfamilial cases from Argentina, examined between February 1, 1990-July 31, 2008, who met the diagnostic criteria of progressive encephalopathy, peripheral edema, hypsarrhythmia, and optic atrophy syndrome. All five children were products of normal gestation, although one was premature. Birth was uneventful in all patients. Two patients were twin brothers. During their first neurologic examination, between ages 2-6 months, patients presented with facial dysmorphia, poor visual contact, and generalized hypotonia with poor head control. Microcephaly and swelling of the dorsum of the hands and feet were evident. Hypsarrhythmia was observed in all patients (associated with epileptic spasms in four). Optic atrophy was evident in four cases. Magnetic resonance imaging indicated progressive cerebellum and brainstem atrophy in all cases. Toxoplasmosis, others, rubella, cytomegalovirus, herpes (TORCH), neurometabolic investigations, and karyotype studies produced normal results in all patients. Progressive encephalopathy, peripheral edema, hypsarrhythmia, and optic atrophy syndrome should be considered in infants with neonatal hypotonia, early onset of seizures (especially epileptic spasms), hypsarrhythmia, early loss of visual fixation, profound psychomotor retardation, typical dysmorphy, and progressive cerebellar and brainstem atrophy without a clear etiology. Autosomal recessive inheritance is suspected. Early diagnosis is important for adequate genetic counseling.
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Affiliation(s)
- Roberto Horacio Caraballo
- Department of Neuropediatrics, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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Caraballo RH, Bongiorni L, Cersósimo R, Semprino M, Espeche A, Fejerman N. Epileptic encephalopathy with continuous spikes and waves during sleep in children with shunted hydrocephalus: a study of nine cases. Epilepsia 2008; 49:1520-7. [PMID: 18410359 DOI: 10.1111/j.1528-1167.2008.01608.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We present a series of nine patients with early-onset hydrocephalus who had seizures and continuous spikes and waves during slow sleep (CSWS) associated with neurocognitive and motor deterioration. METHODS Six boys and three girls aged 9-16 years (mean 11.3 years) were studied. [Correction added after online publication 12-Apr-2008: Number of girls and boys has been updated.] All patients underwent clinical examinations, electroencephalographic evaluations, neuroradiological imaging and neuropsychological assessment at first examination. Antiepileptic drugs (AEDs) were given in all cases and changed according to clinical and EEG evolution. RESULTS Onset of epilepsy occurred from age 8 to 60 months (mean 19.6 months and median 14 months) with focal seizures with or without secondary generalized tonic-clonic seizures. Between ages 6 and 13 years (mean 10.4 years and median 8 years), hyperkinesia, aggressiveness, and poor socialization appeared in all nine cases. Reduced attention span, deterioration of language, and temporospatial disorientation were found in three of them. Negative myoclonus was found in two patients. The EEG showed CSWS. Response to change in treatment was good in all patients. None of the patients had relapses, seven of them have remained seizure free, and two continued having sporadic focal motor seizures during 2-5 years (mean 3 years) of follow-up. CONCLUSION In children with early-onset hydrocephalus, particularly with behavioral and language disturbances and/or motor deterioration, CSWS should be considered. Periodic EEG recordings during sleep should be done in these children. The early identification of this particular electroclinical picture is crucial to start adequate treatment to avoid progressive cognitive deterioration.
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Caraballo R, Semprino M, Cersósimo R, Sologuestua A, Arroyo HA, Fejerman N. [Hemiparetic cerebral palsy and startle epilepsy]. Rev Neurol 2004; 38:123-7. [PMID: 14752709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES We analyzed electroclinical features and evolution in nine patients with hemiparetic cerebral palsy associated with SE. PATIENTS AND METHODS Nine patients with mean age 12.3 years and a follow up from 1 to 11 years were studied, analyzing etiology, neurological examination, psychometric evaluation, age at onset and semiology of epileptic seizures, EEGs and neuro-radiological findings, response to treatment and evolution. RESULTS Etiologies were: porencephaly in 4 cases, hypoxic-ischemic encephalopathy in 2, bacterial meningitis in 1, herpetic encephalitis in 1 and meningo-encephalitis in the last. All cases had mental retardation. Mean age at onset of epileptic seizures was 4 years. Mean age at onset of startle seizures was 6. The startle seizures were characterized by sudden tonic contractions of the paretic hemibody, provoked by auditory stimulus in 6, somatosensory in 2 and both types of stimulus in 1. Falls were observed in 6 patients. Seizures were daily and always when awake. Unprovoked focal seizures with or without secondary generalization were found in 8 cases, and in 6 they presented previously to the startle seizures. Interictal EEGs showed unilateral spikes in 3, bilateral spikes in 3 and generalized polyspike-wave paroxysms in the other three cases. Ictal EEGs were obtained in 8 of the 9 patients and showed diffuse paroxysms of rhythms 6-11 Hz. Cerebral CT scan and/or MRI revealed extensive unilateral encephalomalacia in 5 and porencephaly in 4. The different antiepileptic schedules were unsuccessful in all cases. Surgery was performed in two patients. They are free of seizures after 1 to 4 years of follow up. CONCLUSION SE should be considered as a distinctive epileptic syndrome or a particular electro-clinical evolution in patients with a large unilateral brain lesion associated with provoked reflex seizures usually refractory to antiepileptic drugs. Epileptic surgery should be considered.
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Affiliation(s)
- R Caraballo
- Servicio de Neurología, Hospital de Niños Prof Dr JP Garrahan, Buenos Aires, Argentina.
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Caraballo RH, Semprino M, Cersósimo R, Sologuestua A, Arroyo HA, Fejerman N. Parálisis cerebral hemiparética y epilepsia del sobresalto. Rev Neurol 2004. [DOI: 10.33588/rn.3802.2003372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Roubertie A, Semprino M, Chaze AM, Rivier F, Humbertclaude V, Cheminal R, Lefort G, Echenne B. Neurological presentation of three patients with 22q11 deletion (CATCH 22 syndrome). Brain Dev 2001; 23:810-4. [PMID: 11720799 DOI: 10.1016/s0387-7604(01)00258-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Chromosome 22q11 deletion (CATCH 22 syndrome or velocardiofacial syndrome) is one of the most frequent chromosomal syndromes. Neurological features other than cognitive disorders are probably the least-described part of the expanding phenotype of the 22q11 deletion. We report the neurological features of three unrelated children with a de novo deletion: one patient with an autistic disorder, a second patient with hypocalcaemic neonatal seizures and unusual persistent epileptic focus at electroencephalographic follow-up, and a third patient with atypical absence epilepsy. These observations enlarge the clinical and neurological spectrum of the 22q11 deletion. Awareness of such cases is necessary, and a diagnosis of the 22q11 deletion should be suspected in children with common neurological features associated with severe or mild dysmorphism. Diagnosis of the 22q11 deletion should be confirmed by fluorescence in situ hybridization analysis associated with standard chromosomal analysis.
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Affiliation(s)
- A Roubertie
- Pediatric Neurology, Saint Eloi Hospital, 2 Avenue Bertin Sans, 34295 Montpellier Cedex 5, France.
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Humbertclaude V, Tourtet S, Semprino M, Roubertie A, Rivier F, Leboucq N, Astruc J, Echenne B. [Acute myelitis of an unusual cause in a child: the lymphocytic choriomeningitis virus]. Arch Pediatr 2001; 8:282-5. [PMID: 11270252 DOI: 10.1016/s0929-693x(00)00196-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Acute transverse myelitis is a rare disorder in childhood. It usually occurs as a post-infectious disease, but a precise infectious agent is identified in only 20% of cases. OBSERVATION The diagnosis of acute transverse myelitis was made in a 5.5-year-old girl who initially presented with left Claude-Bernard-Horner syndrome and meningitis. A few days later, motor and sensory tetraparesia with bladder dysfunction was observed. Magnetic resonance imaging showed a diffuse lesion in the medulla, with a hypersignal in the T2 and a hyposignal in the T1 sequences. Serum analysis showed the presence of a viral infection due to the lymphocytic choriomeningitis (LCM) virus. The outcome was marked by complete recovery of the sensorimotor deficit, but a persistence of the left Claude-Bernard-Horner syndrome. CONCLUSION In rare cases, the LCM virus is responsible for myelitis. In the present case, the Claude-Bernard-Horner syndrome was secondary to the cervico-medullary lesion. Recent reports in the literature have been discussed, in particular as regards the use of immunomodulatory therapy, which clearly improves patient prognosis.
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Affiliation(s)
- V Humbertclaude
- Service de neuropédiatrie, centre hospitalier universitaire Saint-Eloi, avenue Bertin-Sans, 34295 Montpellier, France
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