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Ordoño-Saiz MV, Púa-Torrejón RC, Justel-Rodríguez M, Arias-Vivas E, Heppe-Montero M, González-Alguacil E, Duat-Rodríguez A, Ruiz-Falcó-Rojas ML, García-Peñas JJ, Gutiérrez-Delicado E, Soto-Insuga V. Cerebral and cerebellar pseudoatrophy associated with valproic acid. Report of three pediatric cases. Rev Neurol 2023; 77:197-201. [PMID: 37807884 PMCID: PMC10831757 DOI: 10.33588/rn.7708.2023186] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Cerebral and cerebellar pseudoatrophy is a rare adverse effect of valproic acid (VPA) that we need to be aware of, due to its diagnostic and therapeutic implications. CASE REPORT We report three cases of children between 5 and 9 years old, with epilepsy and previous normal brain magnetic resonance imaging, who were taking the drug at correct doses. Pseudoatrophy manifests subacutely with symptoms and images of cerebral and/or cerebellar atrophy, reversible after drug withdrawal. DISCUSSION AND CONCLUSIONS This is a type of VPA-related encephalopathy, different from dose-dependent toxic encephalopathy, hyperammonaemic encephalopathy or encephalopathy related to liver failure. In children, it causes cognitive, motor, mood and behavioral deterioration, and may be accompanied by epileptic decompensation. Withdrawing the drug leads to complete clinical-radiological recovery, and reducing the dose leads to improvement.
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Affiliation(s)
- M V Ordoño-Saiz
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | - R C Púa-Torrejón
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - E Arias-Vivas
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | - M Heppe-Montero
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - A Duat-Rodríguez
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - J J García-Peñas
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - V Soto-Insuga
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
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Soto-Insuga V, González-Alguacil E, García-Peñas JJ. [The electroencephalogram: a complementary test that should not be forgotten to perform before a first seizure. Reply]. Rev Neurol 2023; 76:184. [PMID: 36843180 PMCID: PMC10364029 DOI: 10.33588/rn.7605.2023048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- V Soto-Insuga
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - J J García-Peñas
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
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Soto-Insuga V, González-Alguacil E, García-Peñas JJ. [Paediatric status epilepticus]. Rev Neurol 2022; 75:225-238. [PMID: 36218253 DOI: 10.33588/rn.7508.2022196] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Status epilepticus is defined as the situation resulting from the failure of the mechanisms responsible for terminating an epileptic seizure. In 2015, an operational concept was adopted internationally in which two times are identified: a first time, at which treatment must begin (five minutes for convulsive status, 10-15 minutes for focal and non-convulsive status); and a second time, after which there is considered to be a high risk of subsequent sequelae (30 minutes in the case of the convulsive). It occurs in 3-42/100,000 children per year, who are refractory or super-refractory in 10-40% of cases. DEVELOPMENT This article will review the different therapeutic options for status, from early treatment at home to the different first-line (benzodiazepines), second-line (phenobarbital, valproic acid, phenytoin, levetiracetam and lacosamide) or third-line treatments, which include both pharmacological (anaesthetics, propofol, ketamine, lidocaine, topiramate, brivaracetam or perampanel) and non-pharmacological (ketogenic diet, immunomodulatory treatments or epilepsy surgery) therapies. CONCLUSIONS Early identification and treatment of a prolonged crisis are essential to prevent progression to status. Although with fewer sequelae than in adults, status epilepticus in children represents a cause of mortality of up to 3-5%, while 25% of them will develop subsequent epilepsy, as well as a considerable percentage of neurological sequelae.
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Affiliation(s)
- V Soto-Insuga
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - J J García-Peñas
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
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Andina-Martínez D, Rodríguez-Palero S, Soto-Insuga V, Alonso-Cadenas JA, Bernardino-Cuesta B, Cartas-Carrión S, Cantarín-Extremera V. Peripheral facial nerve palsy in children during the COVID-19 pandemic. Rev Neurol 2022; 74:361-366. [PMID: 35635362 DOI: 10.33588/rn.7411.2022033] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, an increased frequency of peripheral facial nerve palsy has been described in adults and children. The etiology of the disease during this time remains unclear, since most cases occurred in patients who tested negative for SARS-CoV-2 infection. PATIENTS AND METHODS Retrospective study of pediatric cases of facial nerve palsy treated during the first year of the pandemic in the emergency department of a children´s hospital located in one of the areas with the highest prevalence of COVID-19 in Spain. Data from this period are compared with cases from the previous three years. RESULTS Twenty-nine patients with Bell's palsy were included. Over the previous three years combined, 24 patients presented with the same condition, a more than threefold increase. No clinical differences were found between the groups apart from the fact that fewer patients received corticosteroids during the pandemic (13.8% vs 41.6%; p = 0.022). Fourteen children underwent microbiologic testing for active SARS-CoV-2 infection (12 polymerase chain reaction, two rapid antigen test); all were negative. Thirteen patients received serologic testing, two with a positive IgG (15.3%). CONCLUSION A substantial increase in hospital presentations for facial nerve palsy was observed among children and adolescents during the first year of the pandemic, though findings of microbiologic testing cannot confirm a direct link with SARS-CoV-2 infection in most cases. Patient characteristics did not change between the two time periods. Difficulty accessing primary-care facilities during the pandemic in Spain may have played a role in this increase.
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Affiliation(s)
| | | | - V Soto-Insuga
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | | | - S Cartas-Carrión
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | - V Cantarín-Extremera
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER). ISCIII, Madrid, España
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Martinez-Cayuelas E, Moreno-Vinues B, Pozo RD, Rodrigo-Moreno M, Soto-Insuga V, Pérez-Villena A. Sleep, chronotype, and behavior in adolescents with attention-deficit/hyperactivity disorder. Arch Pediatr 2022; 29:277-280. [DOI: 10.1016/j.arcped.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/09/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
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Púa-Torrejón RC, González-Alguacil E, Soto-Insuga V, Moreno-Cantero T, Ortiz-Cabrera NV, Pérez-Poyato MS, Ruiz Falcó-Rojas ML, García-Peñas JJ. [Variability of the clinical expression of KCNB1 encephalopathy]. Rev Neurol 2021; 73:403-408. [PMID: 34877642 DOI: 10.33588/rn.7312.2021267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The KCNB1 gene encodes a voltage-dependent potassium channel that regulates transmembrane currents in pyramidal neurons. Heterozygous variants have recently been associated with early-onset epileptic encephalopathies and intellectual disability, but their clinical characterisation has not yet been fully defined. AIM To describe the clinical spectrum associated with variants of KCNB1 in paediatric patients. PATIENTS AND METHODS Retrospective study of four patients from three families with KCNB1 encephalopathy, including an analysis of the clinical and electroencephalographic features of epilepsy, associated neurological manifestations and neurodevelopmental pattern. RESULTS In two of them, the mutation in KCNB1 was de novo; the other two, who were sisters, inherited the variant from a parent with germline mosaicism. All had mild-to-moderate intellectual disability, two patients had autistic spectrum disorder and two had attention deficit hyperactivity disorder. Only case 2 displayed alterations in the MRI brain scan: progressive cortical atrophy. Three of them developed epilepsy (cases 1-3). Case 1: onset at 9.5 months with West syndrome that was well controlled with vigabatrine and zonisamide. Case 2: onset at 13 months with West syndrome, evolutionary development of polymorphic seizures (atonic, hypermotor, dysautonomic and tonic) that were refractory to 10 antiepileptic drugs and corticosteroids. Accompanied by a movement disorder characterised by ataxia, dyskinesias and tremor. Case 3: onset at 14.5 years with atonic seizures, multifocal EEG pattern and adequate control with levetiracetam. CONCLUSIONS KCNB1 encephalopathy has a heterogeneous natural history, mainly with respect to epilepsy, ranging from patients with refractory epilepsy to patients without any epileptic seizures. All had neurodevelopmental disorders, such as intellectual disability or autism spectrum disorder, independent of epilepsy.
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Affiliation(s)
- R C Púa-Torrejón
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - V Soto-Insuga
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | - T Moreno-Cantero
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | | | | | - J J García-Peñas
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
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Soto-Insuga V. [How must we manage epileptic encephalopathies in infants? Conclusions]. Rev Neurol 2017; 64:S77-S80. [PMID: 28524225] [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: 06/07/2023]
Abstract
Epileptic encephalopathies are defined as epileptic syndromes in which the epileptic activity per se (in the form of frequent seizures or the presence of interictal epileptiform activity) contributes to a cognitive and behavioural disorder that is more important than could be expected from the causation of the disorder. Their aetiological diagnosis is fundamental to allow an early treatment to be established. We propose a diagnostic algorithm for patients with epileptic encephalopathy with onset during the first year of life, which includes management coordinated with electroencephalographic studies, neuroimaging, and screening for metabolic and genetic disorders.
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MESH Headings
- Anticonvulsants/therapeutic use
- Brain Diseases, Metabolic, Inborn/complications
- Brain Diseases, Metabolic, Inborn/diagnosis
- Brain Diseases, Metabolic, Inborn/genetics
- Brain Diseases, Metabolic, Inborn/therapy
- Child
- Child Behavior Disorders/etiology
- Child Behavior Disorders/prevention & control
- Child, Preschool
- Cognition Disorders/etiology
- Cognition Disorders/prevention & control
- Combined Modality Therapy
- Diagnosis, Differential
- Diagnostic Techniques, Neurological
- Disease Management
- Drug Resistant Epilepsy/therapy
- Electroencephalography
- Epileptic Syndromes/complications
- Epileptic Syndromes/diagnosis
- Epileptic Syndromes/genetics
- Epileptic Syndromes/therapy
- Humans
- Infant
- Malformations of Cortical Development/complications
- Malformations of Cortical Development/diagnosis
- Malformations of Cortical Development/genetics
- Malformations of Cortical Development/therapy
- Neuroimaging
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Castano-De la Mota C, Moreno-Acero N, Losada-Del Pozo R, Soto-Insuga V, Perez-Villena A, Rodriguez-Fernandez C, Martin-Del Valle F, Pons-Rodriguez M. [Restless legs syndrome in patients diagnosed with attention deficit hyperactivity disorder]. Rev Neurol 2017; 64:299-304. [PMID: 28345734] [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: 06/06/2023]
Abstract
INTRODUCTION Restless legs syndrome (RLS) is a common neurological disease. RLS has been linked to various psychiatric disorders, especially with attention deficit hyperactivity disorder (ADHD). AIMS The main objective was to describe the frequency of RLS in pediatric patients diagnosed with ADHD. Secondary objectives of the study were describe other sleep disorders in ADHD patients. PATIENTS AND METHODS A multicentre prospective study was conducted in nine Spanish centers. We included children aged 6-18 years diagnosed with ADHD between January and June 2015. Data were collected by 13 researchers doctors through an interview with the parent/caregiver and with the child. To assess the degree of functioning of patients with ADHD we used the Children's Global Assessment Scale. The Sleep Disturbance Scale for Children was applied to screening sleep disorders in childhood. RESULTS A sample of 73 patients was collected. Five patients (6.8%) met diagnostic criteria for RLS: four of them definitive and one probable. CONCLUSIONS RLS is a frequent condition in adulthood but also in adolescence and childhood. ADHD patients have an increased risk of an RLS.
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Losada-Del Pozo R, Soto-Insuga V, Martínez González M, Soriano Guillén L. Neuropsychiatric manifestations of Graves' disease in paediatric patients. Neurologia 2015; 32:196-197. [PMID: 26096670 DOI: 10.1016/j.nrl.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- R Losada-Del Pozo
- Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - V Soto-Insuga
- Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M Martínez González
- Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - L Soriano Guillén
- Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
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Soto-Insuga V, López-Villanueva L, Rodrigo M, Aroyo IM, Losada R, Soriano-Guillén L. Confusion as a presentation symptom of pseudomigraine with pleocytosis in a paediatric patient. Anales de Pediatría (English Edition) 2014. [DOI: 10.1016/j.anpede.2013.10.004] [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: 10/25/2022] Open
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Soto-Insuga V, López-Villanueva L, Rodrigo M, Mois Aroyo I, Losada R, Soriano-Guillén L. [Confusion as a presentation symptom of pseudomigraine with pleocytosis in a paediatric patient]. An Pediatr (Barc) 2013; 80:394-8. [PMID: 24286871 DOI: 10.1016/j.anpedi.2013.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 04/23/2013] [Revised: 10/11/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022] Open
Abstract
Transient headache and neurological deficits with cerebrospinal fluid lymphocytic pleocytosis (Handl) syndrome is a rare condition of unknown origin that is characterized by episodes of severe headache, transient neurological deficits that recur over less than 3 months, and lymphocytic pleocytosis in CSF. We report the case of a 14 year-old girl who presented with headache and vomiting that lasted 4 days, later combined with a clinical presentation of confusion, with a decrease in the level of consciousness, aphasia, peripheral facial paralysis, ataxia and fever for 24 hours. CSF analysis showed pleocytosis (110 cells/ml) and proteinorrachia (87 mg/dl). Electroencephalogram in the acute time showed generalized slowing, and later a focal slowing in the left hemisphere. She suffered 7 episodes of migraine (severe headache and vomiting) in the following two months, remaining asymptomatic thereafter. This is the first pediatric case published in the literature that presents with an agitated and/or confused state. This condition must be considered in the differential diagnosis of patients with headache and acute altered level of consciousness, in order to avoid prolonged treatments or unnecessary invasive testing.
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Affiliation(s)
- V Soto-Insuga
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, España.
| | | | - M Rodrigo
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, España
| | - I Mois Aroyo
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, España
| | - R Losada
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, España
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Soto-Insuga V, Calleja M, Prados M, Castaño C, Losada R, Ruiz-Falcó M. Utilidad del hierro en el tratamiento del trastorno por déficit de atención e hiperactividad. An Pediatr (Barc) 2013; 79:230-5. [DOI: 10.1016/j.anpedi.2013.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 10/26/2022] Open
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13
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Soto-Insuga V, Alvarez González B, Rubio Gribble B, Ramos Amador JT. [Clinical case: sulphur colloid scintigraphy, a diagnostic tool to differentiate between an infarction and osteomyelitis in a patient with drepanocytic anaemia]. An Pediatr (Barc) 2010; 72:224-5. [PMID: 20138599 DOI: 10.1016/j.anpedi.2009.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 09/25/2009] [Accepted: 11/06/2009] [Indexed: 11/28/2022] Open
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