Biomedical subjects

M Rufo-Campos

Publications and source records attributed to M Rufo-Campos.

13 recordsLinked to original sources

PubMed2002

[Melatonin and epilepsy].

OBJECTIVE: This review has been prepared in response to the increasing interest shown in understanding the part played by melatonin in the body, which has led to the search for new uses of it in cerebral disorders, such as sleep disorders including insomnia, irritability, depression, behaviour disorders and even the treatment of autism, since sleep disorders also occur in this condition. We pay particular attention to studies involving epilepsy. DEVELOPMENT: We show that interest in melatonin is rapidly increasing and new discoveries are being made of the part it plays in the biological regulation of circadian rhythm, sleep, mood, ageing, tumour growth and reproduction. Perhaps these processes between them have led to its use in the treatment of many current problems such as neuroprotection, migraine and the control of epileptic seizures. CONCLUSIONS: It has been shown that in both children and adults melatonin is of low toxicity and may be used in high risk persons. In this paper we make a careful analysis of recent publications in the medical literature dealing with the use of melatonin in the control of epileptic seizures and discuss its advantages and disadvantages. However, as with other types of treatment, further study, both experimental and otherwise, is necessary for confirmation.

Anticonvulsants↗

PubMed2002

[Characteristics and indications of lamotrigine].

OBJECTIVE: In this paper we make an extensive review of the most recent and important studies which have been published on lamotrigine, a phenyltriazinic compound unrelated to the other known anti epileptic drugs, which is available on the market in many countries and is currently considered to be a first line anti epileptic drug. DEVELOPMENT: It is known that its anti epileptic effect is mainly due to blocking the voltage sensitive sodium channels most effectively in depolarized cells, resulting in the presynaptic inhibition of excessive release of excitatory amino acids, particularly glutamate and aspartate. In this review, we fully discuss their different mechanisms of action and compare various experimental animal studies with the use of these drugs in humans and the results obtained in everyday clinical practice. Amongst the metabolic aspects we analyze the reasons why children are more prone to develop enzyme induction than adults are. It has been shown that in infancy patients who take inductors and inhibitors show figures for the half life of lamotrigine which are between those of patients who take inductors only and those taking inhibitors only, causing a so called mixed effect . Adverse effects include skin eruptions which may lead to withdrawal of the drug. However, it should be remembered that the proportion of persons with this side effect is much reduced when the correct dosage is used, and the sliding scale of dosage starts with sufficiently low doses. CONCLUSIONS: After extensive analysis of the results, we point out the new possibilities now available for the treatment of other disorders besides epilepsy. We show the positive aspects of this treatment, its use in epileptic seizures and interactions in disorders besides epilepsy now that the mechanism of action is better understood.

Adult↗

PubMed2000

[Inter-relationships of the epileptic encephalopathies of infancy].

INTRODUCTION: The epilepsies of childhood are much more variable in expression and outcome than those of adults: the clinical and EEG features of epilepsy can change considerably with age. DEVELOPMENT: The neonatal epileptic encephalopathy, West and Lennox syndromes are present at different age, and each one shows a stereotyped association of seizures and EEG findings that are essentially pathognomonic for each syndrome. It is possible that these syndromes represent successive stages in maturation of an epileptic process, although there are differences between the disorders that may not be explained by the concept of age-dependent encephalopathy. Clinically it is very important to differentiate signs, symptoms and EEG findings in the West syndrome from the Lennox syndrome transition. CONCLUSION: The study of the age-dependent epileptic encephalopathies will contribute to the understanding of the pathophysiology of epilepsy.

Adult↗

PubMed2000

[Mortality in epilepsies].

INTRODUCTION: The overall mortality associated with epilepsy has been estimated to be two or three times that of the general population. Data from contemporary studies show excess mortality in the first decade of life and the first few years after diagnosis. DEVELOPMENT: The underlying disease of which epilepsy is a symptom is the main cause of death in new cases, while the epilepsy itself is a major cause in chronic epilepsy. Sudden unexpected death in epilepsy is probably the most common category of epilepsy-related deaths and is likely to be seizure-related in the great majority of cases. The mechanisms involved in sudden unexpected death in epileptics may include autonomically mediated cardiac arrhythmia and neurogenic pulmonary edema. Other causes of death are status epilepticus, trauma, burns or drowning secondary to a seizure, severe aspiration, food bolus, and the presence of significant cardiorespiratory disease.

Adolescent↗

PubMed1999

[Epileptic signs of neonatal hypoxia-ischemia].

INTRODUCTION: Neonatal convulsions are usually symptomatic and originate mainly from a hypoxic-ischemic (H-I) lesion. The high incidence of crises and their serious sequelas have led us to carry out this retrospective study. PATIENTS AND METHODS: We studied 54 histories of neonatal H-I and epileptic crises, analyzing 45 variables and evaluating their diagnostic concordance. RESULTS: In 20 children meconium was detected during gestation and, to a lesser extent, infection and hemorrhage. Birth was dystonic on 48 occasions, 37 at term and 12 preterm. In most cases (27) birth weight was in accordance with gestational age. Apgar scores were always less than 5. The crises, occasional or daily in most cases, were of subtle semiology in 29 children, followed by generalized tonic (23), focal clonic (13), general clonic (11), multifocal clonic (7), focal tonic and multifocal myoclonic (6), focal myoclonic (4) and generalized myoclonic (2) crises. Only 7 EEGs were done during crises (1 normal, 3 with anomalies and 3 with slow basal activity). Paroxystic anomalies were only found on 10 EEGs done between crises. Cerebral echography was the method most used and most useful. Very frequently changes were observed in other organs as the expression of a multisystemic disorder. Most children had abnormalities on neurological examination. In most cases, classical anti-epileptic drugs were used intravenously, and new generation drugs were given if the crises persisted. After an average of 16-19 months of follow-up, 13 children had died and 34 no longer had crises. However, only 20 of the surviving children were considered to be normal, 14 had severe mental retardation, 6 moderate and one slight retardation. CONCLUSIONS: Neonatal H-I is the main cause of epileptic crises in the RN period, with a high percentage mortality and severe neurological sequelas. The crises are usually well-controlled by classical anti-epileptic drugs, and are an excellent marker, together with the Apgar score and gestational and placental changes. The appearance of normal EEGs during periods of crises should make us doubt the authenticity of subtle crises, perhaps corroborated by a good therapeutic response.

Brain↗

PubMed1998

[Follow-up of partial seizure progression in an infant].

UNLABELLED: OBJECTIVE AND MATERIAL: We are carried out a retrospective study of 43 patients, 21 males and 22 women entered during the period of infancy in the Service of Neurology of our hospital and with diagnostic of any type of partial seizure, in an intent to correlate a series of clinical parameters, electroneurophysiologics and initial therapeutics with their factors follow-up periods. RESULTS: They are a half age of 7.11 months (1-19), consecutive being controlled for a period of time of 40 months (6-96). We have settled down a relationship between the drugs utilized in the first seizure and that other that they remained in their last revision, the current state of the critical manifestations, and the existence or not of an agreement between the e diagnosis emitted to the discharge and the development of the illness. CONCLUSION: After the present study, we thought that the current classification of the epileptic seizures is insufficient in the age of the infant, with presages much more complexes.

Anticonvulsants↗

PubMed1997

Utility of high doses of melatonin as adjunctive anticonvulsant therapy in a child with severe myoclonic epilepsy: two years' experience.

Recent data indicate that melatonin inhibits brain glutamate receptors and nitric oxide production, thus suggesting that it may exert a neuroprotective and antiexcitotoxic effect. Melatonin has been seen to prevent seizures in several animal models and to decrease epileptic manifestations in humans. The lack of response to conventional anticonvulsants in an epileptic child led us to use melatonin in this case. A female child who began to have convulsive seizures at the age of 1.5 months and was diagnosed as having severe myoclonic epilepsy was unsuccessfully treated with different combinations of anticonvulsants, including valproic acid, phenobarbital, clonazepam, vigabatrin, lamotrigin, and clobazam. Melatonin was thus added to the treatment. Imaging studies (CT, SPECT, and MNR), EEG recordings, blood biochemical, and hematological analyses, including measures of the circadian rhythm of melatonin, were made. The child was initially treated with various anticonvulsants. Severe neurological and psychomotor deterioration combined with increased seizure activity showed a lack of response to the treatment. At the age of 29 mon the patient was in a pre-comatose stage at which time melatonin was added to treatment. After 1 month of melatonin plus phenobarbital therapy and for a year thereafter, the child's seizures were under control. On reducing the melatonin dose after this time, however, seizures resumed and the patient's condition was re-stabilized after restoring melatonin. Prior to our attempts to reduce melatonin, all analyses, including EEG recordings and SPECT, were normal. As far as the results of neurological examination are concerned, only mild hypotony without focalization remained. Changes in the therapeutic schedules during the second year of melatonin treatment, including the withdrawal of phenobarbital, did not result in the same degree of seizure control, although progressively the child became satisfactorily controlled. At the present moment the child continues to have mild hypotony and shows attention disorder and irritability. Melatonin has proven to be useful as adjunctive therapy in the clinical control of this case of severe infantile myoclonic epilepsy. The results suggest that melatonin may have a useful role in mechanisms of neuroprotection and also indicate its use in other cases of untreatable epilepsy. Further studies using more patients and placebo-treatment would be beneficial in understanding the potential use of melatonin as a co-therapy in some cases of seizures.

Anticonvulsants↗

PubMedDate not supplied

[Paroxysmal disorders and episodic non-epileptic symptoms related to sleep].

INTRODUCTION: The paroxystical disorders and episodic symptoms not epileptics related to the sleep, constitute a great preoccupation motive for the parents as well as for all the professionals related to the Pediatrics, and defer in a way substantial of those which are gone to find in subsequent ages of the life. Development. A great number of they are bound to the development and have their maximum or exclusive incidence in the infantile age; and those which also occur in the adult age, have some special connotations in the infancy, with a thoroughly different therapeutic boarding to that of other ages therefore it is necessary an exhaustive knowledge of the same for their correct identification, by having a high incidence, and especially by the frequent mistakes that generate, since frequently they can carry to diagnostic of epilepsy those processes that it be not, with the social connotations that this implies, the countless complementary exams accomplishment and the possibility of certain drugs administration potentially toxic. CONCLUSIONS: It is discussed the need of a classification of the disorders of the sleep in the child and is accomplished a detailed description of the same emphasizing the important differential characteristics with other processes, taking into account to of the problems of the sleep that interests to consider in the pediatric age, the most important are found between those incidents associated with the stages of the sleep or the awake partial, recognized as parasomnias. Specific disorders are discussed.

Child↗

PubMedDate not supplied

[Cerebral seizures in neonatal period: semiology, evolution and factors of influence].

INTRODUCTION: In spite of their incidence being much greater than at any other period during life, seizures occurring during the neonatal period are difficult to identify, since their patterns are not well organized on account of insufficient anatomical, physiological and/or biochemical development. OBJECTIVE: To analyse the semiology of seizures during the neonatal period, their classification and subsequent evolution. PATIENTS AND METHODS: We made a retrospective study of 60 patients who had convulsions during the neonatal period, selected from amongst the children admitted to the Neonatology Department of the Hospital Infantil Universitario Virgen de Rocio in Sevilla, between 1990 and 1998. We investigated 22 medical variables related to the clinical history, neurological examination, neuroimaging studies, EEG and drugs used. RESULTS: Anomalies were found on the initial examination in 83.3% of the cases. The hypoxic-ischemic syndrome was the commonest etiology, followed by hemorrhages, metabolic disorders, cardiopathies, malformations and infectious diseases. From the semiological angle, the seizures were seen as partial or generalised increase in muscle tone, followed by clonias, hypotonias and subtle seizures. Cerebral angiography was the most commonly used diagnostic imaging technique. There was a statistically significant relationship between the appearance of sequelae and the earliness of the occurrence of the seizures, but not with the duration, semiology or frequency. CONCLUSIONS: Seizures in the newborn are habitually seen in the hypoxic-ischemic syndrome, and usually present as alterations in muscle tone. Phenobarbitone is still the drug of choice for the treatment of seizures in the neonatal period.

Anticonvulsants↗

PubMedDate not supplied

[Hypoxic-ischemic encephalopathy in the full-term newborn infant. Recent advances, markers of hypoxia and therapeutic options].

INTRODUCTION: Hypoxic-ischemic encephalopathy is the neurological consequence of a nonprogressive encephalopathic clinical picture of the hypoxic-ischemic syndrome, caused by a mixture of reduced oxygenation of the blood with increased carbon dioxide (asphyxia) and a lack of tissue perfusion (ischemia). It is the chief cause of death during the perinatal period, and of nonprogressive neurological deficits in childhood. DEVELOPMENT AND CONCLUSIONS: Regarding neurophysiological factors, we emphasise the importance of re-perfusion and reoxygenation in hypoxia-ischemia, with increased oxidative stress, accumulation of oxygen and of hydroxyl radicles which lead to reduced local blood flow and changes in the DNA, enzyme systems and cell membranes. Most of the brain damage in the hypoxic-ischemic syndrome is due to activation of the inflammatory response itself occurring in the central nervous system. In this article we discuss the most important neuropathological lesions, their relation to the clinical findings, and neurological course in hypoxic-ischemic encephalopathy. Finally, we analyze current prognostic markers which have a clearly shown scientific basis to confirm their usefulness, and the most important aspects of treatment which may be used in full-term newborn babies with hypoxic-ischemic encephalopathy.

Biomarkers↗

PubMedDate not supplied

[Partial seizures in childhood].

INTRODUCTION AND OBJECTIVE: Partial seizures make up 49.3% of the epilepsies of school-age children and adolescents, and is the most prevalent type of epilepsy. Patients with complex partial seizures have more recurrences than other patients who have generalized seizures. We analyze the factors which worsen the prognosis in refractory partial epilepsies, their cost in childhood, the characteristics of the new drugs, and the few comparative studies of combinations of these drugs in resistant partial crises of childhood. DEVELOPMENT: The essential factors for prediction are previous brain damage, early onset of the seizures and presence on the EEG recording of marked paroxystic anomalies. Convincing studies on the economic aspects of the epilepsies should not be limited to the cost of the disease, but be descriptive studies which measure all the costs caused by epilepsy. It has been shown that the economic impact of the disorder on children with refractory epilepsy is 2.7 times the average cost of children whose seizures are well-controlled. There are no marked differences between the new antiepileptic drugs in the treatment of seizures of this type. Their appearance has led to reconsideration of what is rational bitherapy and what benefit may be obtained with it. CONCLUSIONS: When possible associations of antiepileptic drugs are considered, one should take into account criteria of efficacy and toxicity, the pharmacodynamic characteristics of the drugs to be used together and their pharmacokinetic interactions. It is necessary to avoid drugs with a low therapeutic index to which tolerance may develop or which interact frequently, and antiepileptic drugs with a broad spectrum, high therapeutic index and few pharmacokinetic interactions should be preferred. The association of valproate and viagabatrin may be very beneficial, since it has been suggested that there is a synergistic reaction in patients with partial seizures that are resistant to other drugs. The efficacy of the association of valproate and viagabatrin has been shown in patients with refractory partial seizures, since they have different modes of action and different spectrums, different profiles of toxicity and no pharmacokinetic interactions. Finally, we describe the basic principles of treatment of refractory partial seizures of childhood.

Anticonvulsants↗

PubMedDate not supplied

[Prophylactic treatment of headache].

INTRODUCTION: Headache continues to be the commonest neurological disorder of childhood. There are few studies of prophylactic treatment for headache at this age, perhaps because of the difficulty in measuring intensity of pain and response to treatment in children. Before headache can be treated prophylactically, it is necessary to know its exact site and main trigger mechanisms. Therefore, treatment has to be adapted to the individual, bearing in mind the age of the patient, frequency of headaches, presence or absence of aura, intensity of pain and attitude of the family. Behavior therapy, psychological support and relaxation exercises may be necessary to reduce the frequency and intensity of the headache. DEVELOPMENT: The first prophylactic treatment for chronic headache should be identification of any underlying trigger factor. Tension type headache may be a simple somatic reaction to stress. Prophylactic drugs should be given according to the frequency of headaches, their duration and intensity whenever drug treatment for the acute phase has not eased the pain completely. The tricyclic antidepressants are the initial drug of choice for use in tension headache. It should be remembered that in children drugs should only be used when other measures of pain control have proved useless. In general prophylactic treatment of migraine should be started as monotherapy, maintained for at least one month (approximately between 3 and 6 months) before gradually stopping the drug. The drugs usually used in children are adrenergic beta blockers, calcium antagonists, seretoninergenic antagonists, antidepressants, non steroid anti inflammatory drugs, and the anti convulsant drugs currently being developed.

Adolescent↗

PubMedDate not supplied

[Dysmorphology, genetics and infantile neurology].

INTRODUCTION: Dysmorphology is a relatively modern science which is very wide, continuously advancing and inevitably related to infantile neurology and genetics. DEVELOPMENT: A neuropaediatrician, before making indiscriminate use of such major complementary investigations as neurogenetics and imaging techniques to diagnose a dysmorphic syndrome, should obtain a detailed clinical history and, particularly, a very careful physical examination, including adequate neurological examination. Thus in neuropaediatrics the final diagnosis and early determination of normality or abnormality is based on two things: the clinical semiology derived from the clinical history and neurological examination, and complementary investigations (sophisticated or not) which make us relate these findings to clinical data. RESULTS: A large proportion of neurological disorders, especially those involving the intellect, are found in patients with some type of chromosome anomaly, which cause less than 6% of all malformations of the central nervous system. At the present time a wide range of dysmorphic syndromes are recognized, with or without accompanying chromosome anomalies. Many of these are also associated with mental deficiency or signs of neurological deficiency. Genetic studies should be requested when monogenetic disorders or mitochondrial disorders are suspected, and in multifactorial disorders. It has been shown that the presence of minor dysmorphic defects in children with epileptic seizures is associated with a much worse prognosis, possibly because it is also associated with cerebral malformations. Often these minor anomalies are seen in similar form in close relations of the children involved. It is therefore necessary to take care in evaluation of these defects.

Congenital Abnormalities↗