Guerrero PCA, García GRJ, Reyes CT, Valdivia MR, Bonet QE, Marrero MP, Macías PL, Luis LC

Language: Spanish
References: 21
Page: 1-14
PDF size: 213.43 Kb.

ABSTRACT

Objective: To describe the main clinical and evolutionary characteristics of a series of patients with difficult control epilepsy treated with high doses of intravenous dexamethasone.
Methods: A descriptive study was conducted with a series of 12 cases treated for difficult control epilepsy in the Neuropediatric Service at Juan Manuel Márquez Pediatric Teaching Hospital from January 2010 to September 2018. They received intravenous dexamethasone at high doses on 3 consecutive days each month (cycle) and for five months, in addition to the antiepileptic drugs they had indicated. This study analyzed the ages at epilepsy onset and at diagnosis, at the beginning of treatment, the type of seizures and epilepsy, the time between the epilepsy onset and treatment and, in addition, the cause. The fisher exact test was used to determine the association between these last two variables and the clinical evolution.
Results: Male patients predominated, those who started clinical manifestations in the first year of life, those who presented several types of seizures, those who used polytherapy and had a known cause of epilepsy (symptomatic). After five treatment cycles, a satisfactory evolution was detected. The frequency of seizures decreased by at least 50 % in 8 of 12 patients. Only in two cases showed adverse reactions to the treatment (arterial hypertension), which did not require the withdrawal of the therapy.
Conclusions: There was a predominance of patients with several types of epileptic seizures and of those that the cause of epilepsy was recognized as structural. In them, the use of intravenous dexamethasone at high doses, added to other antiepileptic drugs, was an effective alternative to reduce the frequency of epileptic seizures.

REFERENCES

1. Burneo JG, Téllez-Zenteno J, Wiebe S. Understanding the burden of epilepsy in Latin America: a systematic review of its prevalence and incidence. Epilepsy Res. 2005;66:63-74.

2. Garcia-Martin G, Serrano-Castro PJ. Epidemiology of epilepsy in Spain and Latin America. Rev Neurol. 2018 Oct 1;67(7):249-62.

3. Pascual-López MA, Pascual-Gispert J, Rodríguez-Rivera L, Rojas-Ochoa F, Tejeiros A. Epilepsy: epidemiological study in a child population. Bol Med Hosp Infant Mex. 1980;37:811-21.

4. Colectivo de autores. Enfermedades neurológicas. En: Pediatría. Diagnóstico y tratamiento. La Habana: Editorial Ciencias Médicas; 2016. p. 272-308.

5. Sillanpää M, Schmidt D. Long-term outcome of medically treated epilepsy. Seizure. 2017;44:211-6.

6. Kwan P, Schachter SC, Brodie MJ. Drug-Resistant Epilepsy. N Engl J Med. 2011;369:919-26.

7. Niriayo L, Mamo A, Kassa T, Asgedom S, Atey T, Gidey K, et al. Treatment outcome and associated factors among patients with epilepsy. Scientific Reports. 2018;8:17354. DOI: 10.1038/s41598-018-35906-2

8. Bakaki PM, Horace A, Dawson N, Winterstein A, Waldron J, Staley J, et al. Defining pediatric polypharmacy: A scoping review. PLoS ONE [Internet]. 2018 [citado: 16/11/2018];13(11):e0208047. Disponible en: https://doi.org/ 10.1371/journal.pone.0208047

9. Jones R, Butler J, Thomas V, Peveler R, Prevett M. Adherence to treatment in patients with epilepsy: Associations with seizure control and illness beliefs. Seizure. 2006;15:504-8.

10. Mbuba C, Ngugi A, Newton C, Carter J. The epilepsy treatment gap in developing countries: A systematic review of the magnitude, causes, and intervention strategies. Epilepsia. 2008;49:1491-503.

11. Englot DJ, Chang EF. Rates and predictors of seizure freedom in resective epilepsy surgery: an update. Neurosurg Rev. 2014;37(3):389-405. DOI:10.1007/s10143-014-0527-9

12. Haberlandt E, Weger C, Baumgartner S, Rauchenzauner M, Scholl-Burgi S, Rostasy K, et al. Adrenocorticotropic Hormone versus Pulsatile Dexamethasone in the Treatment of Infantile Epilepsy Syndromes. Pediatr Neurol. 2010;42:21-7.

13. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981;22:489-501.

14. Gaily E, Lommi M, Lapatto R, Lehesjoki A. Incidence and outcome of epilepsy syndromes with onset in the first year of life: A retrospective population-based study. Epilepsia. 2016;57(10):1594-601. DOI: 10.1111/epi.13514

15. Sadr S, Javanbakht J, Javidan J, Ghaffarpour M, Khamse S, Naghshband Z. Descriptive epidemiology: prevalence, incidence, sociodemographic factors, socioeconomic domains, and quality of life of epilepsy: an update and systematic review. Arch Med Sci. 2018;14(4):717-24. DOI: https://doi.org/10.5114/aoms.2016.60377

16. International League Against Epilepsy, Commission on Classification and Terminology. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia. 1989;30:389-99.

17. Nariai H, Duberstein S, Shinnar S. Treatment of epileptic encephalopathies: Current state of the art. J Child Neurol. 2018 January;33(1):41-54. DOI:10.1177/0883073817690290

18. Gupta R, Appleton R. Corticosteroids in the management of the paediatric epilepsies. Arch Dis Child. 2005;90:379-84.

19. Gedalia A, Shetty A. Chronic steroid and immunosuppressant therapy in children. Pediatr Rev. 2004;25:425-34.

20. Mehta V, Ferrie CD, Cross JH, Vadlamani G. Corticosteroids including ACTH for childhood epilepsy other than epileptic spasms. Cochrane Database of Syst Rev. 2015 Jun 18;(6):CD005222. DOI: 10.1002/14651858.CD005222.pub3.

21. Laxer KD, Trinka E, Hirsch LJ, Cendes F, Langfitt J, Delanty N, et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav. 2014;37:59-70.