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AIM: Ketogenic dietary therapies (KDT) produce anticonvulsant and neuroprotective effects, reduce seizures and improve the cognitive state in patients with epilepsy. Our purpose was to evaluate the effects of KDT in children with refractory epilepsy (effectiveness, side effects, impact on nutritional status and growth). METHODS: A retrospective and prospective observational descriptive study was conducted in a Spanish tertiary hospital (January 2000 to December 2018). One hundred sixty pediatric patients with epilepsy were treated with KDT (82 males; mean age 5 years 9 months). Seizures, anti-epileptic drugs, anthropometric measures, side effects, and laboratory assessment were monitored baseline and at 3, 6, 12 and 24 months after the onset of KDT. RESULTS: In these time intervals, the seizure-free patients were: 13.7, 12.5, 14.4 and 10.6%, respectively, and a reduction of seizures ≥ 50% was achieved in 41.9, 37.5, 28.7 and 16.2%. Side effects were frequent, especially digestive disorders, hypercalciuria, hypoglycemia, hepatic dysfunction and dyslipidemia. Prealbumin, retinol binding protein, vitamin A and magnesium decreased significantly. Height was affected, especially in children below 2 years. CONCLUSIONS: KDT are effective for refractory epilepsy in children. However, adverse effects are frequent, and it may affect nutritional status and growth.

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Introducción: Las terapias dietéticas cetogénicas (TDC) tienen efecto neuroprotector y anticonvulsivante, reducen las crisis epilépticas y mejoran el estado cognitivo en pacientes epilépticos. Nuestro propósito fue evaluar los efectos de las TDC en niños con epilepsia refractaria (eficacia, efectos secundarios, impacto en el estado nutricional y crecimiento).Métodos: Se realizó un estudio observacional descriptivo retrospectivo y prospectivo en un hospital terciario español (enero de 2000-diciembre de 2018). Ciento sesenta pacientes pediátricos con epilepsia fueron tratados con TDC (82 varones; edad media 5 años 9 meses). Las convulsiones, los fármacos antiepilépticos, la antropometría, los efectos secundarios y los parámetros analíticos se controlaron al inicio del tratamiento y a los 3, 6, 12 y 24 meses.Resultados: En estos intervalos los pacientes libres de crisis fueron: 13,7%, 12,5%, 14,4% y 10,6%, respectivamente, lográndose una reducción de las convulsiones≥50% en el 41,9%, 37,5%, 28,7% y 16,2%. Los efectos secundarios fueron frecuentes, especialmente trastornos digestivos, hipercalciuria, hipoglucemia, disfunción hepática y dislipidemia. La prealbúmina, la proteína de unión al retinol, la vitamina A y el magnesio disminuyeron significativamente. La talla se vio afectada, especialmente en niños menores de 2 años.Conclusiones: Las TDC son efectivas para la epilepsia refractaria infantil. Sin embargo, los efectos adversos son frecuentes y pueden afectar al estado nutricional y al crecimiento. (AU)

Aim: Ketogenic dietary therapies (KDT) produce anticonvulsant and neuroprotective effects, reduce seizures and improve the cognitive state in patients with epilepsy. Our purpose was to evaluate the effects of KDT in children with refractory epilepsy (effectiveness, side effects, impact on nutritional status and growth).Methods: A retrospective and prospective observational descriptive study was conducted in a Spanish tertiary hospital (January 2000 to December 2018). One hundred sixty pediatric patients with epilepsy were treated with KDT (82 males; mean age 5 years 9 months). Seizures, anti-epileptic drugs, anthropometric measures, side effects, and laboratory assessment were monitored baseline and at 3, 6, 12 and 24 months after the onset of KDT.Results: In these time intervals, the seizure-free patients were: 13.7, 12.5, 14.4 and 10.6%, respectively, and a reduction of seizures≥50% was achieved in 41.9, 37.5, 28.7 and 16.2%. Side effects were frequent, especially digestive disorders, hypercalciuria, hypoglycemia, hepatic dysfunction and dyslipidemia. Prealbumin, retinol binding protein, vitamin A and magnesium decreased significantly. Height was affected, especially in children below 2 years.Conclusions: KDT are effective for refractory epilepsy in children. However, adverse effects are frequent, and it may affect nutritional status and growth.(AU)

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AIM: Ketogenic dietary therapies (KDT) produce anticonvulsant and neuroprotective effects, reduce seizures and improve the cognitive state in patients with epilepsy. Our purpose was to evaluate the effects of KDT in children with refractory epilepsy (effectiveness, side effects, impact on nutritional status and growth). METHODS: A retrospective and prospective observational descriptive study was conducted in a Spanish tertiary hospital (January 2000 to December 2018). One hundred sixty pediatric patients with epilepsy were treated with KDT (82 males; mean age 5 years 9 months). Seizures, anti-epileptic drugs, anthropometric measures, side effects, and laboratory assessment were monitored baseline and at 3, 6, 12 and 24 months after the onset of KDT. RESULTS: In these time intervals, the seizure-free patients were: 13.7, 12.5, 14.4 and 10.6%, respectively, and a reduction of seizures≥50% was achieved in 41.9, 37.5, 28.7 and 16.2%. Side effects were frequent, especially digestive disorders, hypercalciuria, hypoglycemia, hepatic dysfunction and dyslipidemia. Prealbumin, retinol binding protein, vitamin A and magnesium decreased significantly. Height was affected, especially in children below 2 years. CONCLUSIONS: KDT are effective for refractory epilepsy in children. However, adverse effects are frequent, and it may affect nutritional status and growth.

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Resumen: Antecedentes: la epilepsia y el trastorno por déficit de atención e hiperactividad (TDAH) son frecuentes de la infancia; se han reportado como comorbilidades. Se estima que aproximadamente 40% de los pacientes con epilepsia pueden presentar TDAH; sin embargo, hay pocas evidencias de si es acompañante o producto de la actividad epiléptica anormal, efectos secundarios de los fármacos o un proceso multigenético asociado. Objetivos: describir qué factores neurobiológicos tiene mayor relevancia en la aparición del trastorno por déficit de atención e hiperactividad en pacientes con epilepsia infantil de reciente diagnóstico. Materiales y métodos: se evaluó pacientes con epilepsia recién diagnosticada, entre los 4 y 16 años de edad durante el período comprendido entre octubre de 2011 y abril de 2012 con un seguimiento prospectivo de 6 meses, estableciendo desde el inicio si existían criterios de TDAH y midiendo factores tanto biológicos como asociados para el desarrollo de TDAH. Se completó los estudios para el abordaje de epilepsia. Resultados: se evaluaron 32 pacientes en los que se observó que el 40% tenía criterios de TDAH del subtipo inatento; además, se determinó que en el sexo masculino las epilepsias parciales representan el 63.2%, y en el femenino las epilepsias generalizadas el 53.8%. Los fármacos utilizados más frecuentes fueron el AVP (72%) y CBZ (28%). Conclusiones: consideramos que es muy frecuente el subtipo de TDAH inatento, lo que sustenta la idea de que sus síntomas son una disfunción neurológica causada por la epilepsia que por un trastorno biológico asociado. Esto realza la importancia de diagnosticar y tratar la epilepsia en sí, y evaluar después de un tiempo, la necesidad de complementar los tratamientos que controlen el TDAH. Palabras claves: factores neurobiológicos, epilepsia infantil de reciente diagnóstico, trastorno de déficit de atención e hiperactividad (TDAH).

Background: Epilepsy and ADHD are neurological disorders frequently seen in childhood, and have been reported as comorbidities. It is estimated that about 40% of patients with epilepsy may have ADHD, however, there is little evidence that if this disorder is or companion product of the abnormal epileptic activity, drug side effects or process associated multigenic. Objective: Describe which of the neurobiological factors have greater relevance in the development of attention deficit disorder and hyperactivity in patients with newly diagnosed childhood epilepsy. Materials and methods: We evaluated patients with newly diagnosed epilepsy, between 4 and 16 years of age in the period between October 2011 and April 2012 with a prospective monitoring six months from start setting if were no criteria for ADHD and measuring both biological factors associated with development of ADHD. Were completed relevant studies for addressing epilepsy. Results: We evaluated more than 32 patients, where it was observed that 40% of the sample had ADHD criteria for inattentive subtype, also was determined that in males partial epilepsies represent 63.2% and in women the epilepsy represents 53,8% overall. Among the most common drugs used were VPA by 72% and 28% CBZ. Conclusions: We believe it is very common subtype of ADHD is found the inattentive, so supports the idea that many of the symptoms of ADHD represent a more neurological dysfunction that epilepsy associated with a biological disorder, This enhances the importance of a diagnosis and treatment of epilepsy itself and to assess after a while, the need to supplement with control treatments for ADHD.

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The prevalence of obstructive sleep apnea-hypopnea syndrome in the general childhood population is 1-2% and the most common cause is adenotonsillar hypertrophy. However, beyond adenotonsillar hypertrophy, there are other highly prevalent causes of this syndrome in children. The causes are often multifactorial and include muscular hypotonia, dentofacial abnormalities, soft tissue hypertrophy of the airway, and neurological disorders). Collaboration between different specialties involved in the care of these children is essential, given the wide variability of conditions and how frequently different factors are involved in their genesis, as well as the different treatments to be applied. We carried out a wide literature review of other causes of obstructive sleep apnea-hypopnea syndrome in children, beyond adenotonsillar hypertrophy. We organised the prevalence of this syndrome in each pathology and the reasons that cause it, as well as their interactions and management, in a consistent manner.

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La epilepsia es sin duda una dolencia de las más antiguas y enigmáticas en la historia de la medicina, encontrándose relatos de su existencia desde tiempos remotos. Del oscurantismo ancestral hasta el presente se ha ido avanzando de forma importante en el diagnóstico y el tratamiento científico de la epilepsia. El manejo de un niño con epilepsia debe desarrollarse en el marco de un protocolo que incluya una evaluación clínica y de laboratorio detallada. Toda enfermedad crónica, incluida la epilepsia, es vivida como una doble agresión: 1) Interna, ligada a las alteraciones que ella determina, y 2) Externa, en relación con las exploraciones, las medicinas, las prohibiciones, los cuidados excesivos y todas las reglas y apremios que de ella se derivan. El médico (pediatra, neuropediatra o epileptólogo), al iniciar la relación con el niño con epilepsia, va a dotarle de un nuevo estatuto, frecuentemente duro de asumir, interviniendo por lo general ya lejos de la crisis, o poco después de que ella se produjo, en un ambiente todavía cargado de una gran angustia familiar. Sin duda la epilepsia es difícil para el niño, pero igualmente lo es para los padres, los responsables de un cuidado diferente, quienes se van a preocupar todos los días porque su hijo tome regularmente el tratamiento y van a tener que afrontar la espera tensa de nuevas crisis. Más que cualquier otra enfermedad infantil, la epilepsia implica una gran inquietud por su carácter espectacular, por la aparatosidad de su presentación y por todas las creencias ancestrales que todavía hoy se le atribuyen. Por dichas razones, frecuentemente el diagnóstico de epilepsia produce tres reacciones de gran relevancia en la familia: ansiedad, culpabilidad y agresividad. La intervención del médico en el tratamiento de la epilepsia infantil debe ser "integral". Actuando con mística y devoción el médico debe abrazar el verdadero concepto hipocrático del cuidado del paciente.

Epilepsy is without a doubt one of the most ancient and enigmatic conditions in the history of medicine, as it was already described in remote times. From the ancestral obscure understanding of epilepsy to the present, there have been important scientific advances in the knowledge of its diagnosis and treatment. The management of a child with epilepsy requires following a protocol that includes a detailed clinical and laboratory evaluation. All chronic diseases, and also epilepsy, are felt as a double aggression: 1) Internal, related to the changes that the disease causes, and 2) external, related to the tests, medications, excessive protection, and all the rules and prohibitions that are applied. The doctor (pediatrician, pediatric neurologist or epileptologist), when initiating a relationship with the child with epilepsy, is going to propose "a new code", often hard to accept. He is going to intervene far away from the crisis, or soon after it happened, in an environment characterized by significant anguish for the family. There is no question that the disease is difficult for the child, as it is also for the parents, who become responsible for a different type of care, are preoccupied daily about their son taking the medication regularly, and suffer awaiting for another crisis to happen. Epilepsy, more than other conditions, creates a high level of restlessness because of the spectacular, dramatic nature of its presentation and for the ancestral myths still attributed to it. For all these reasons, the diagnosis of epilepsy is frequently accompanied by three relevant reactions in the family: anxiety, guilt and aggressiveness. The intervention of the doctor in the treatment of childhood epilepsy must be "global". With mystic devotion, the doctor must embrace the true Hippocratic concept of patient care.

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