RESUMO
INTRODUCTION: Some epileptic syndromes are characterised by seizures that are difficult to control and are associated to delayed neuropsychomotor development, which results in a deterioration in the patient's quality of life as well as in that of his or her family. AIM: To evaluate the use of cannabidiol as adjuvant therapy in patients with refractory epilepsies. PATIENTS AND METHODS: An observational study was conducted by means of a survey addressed to the patient's caregiver. Data collected included information about the patient and the caregiver, changes observed in the seizures, neuropsychological effects, side effects and the family's overall perception following the use of cannabidiol. RESULTS: The evaluation examined 15 patients with refractory epilepsies, who received cannabidiol over a period ranging from one month to one year. The frequency of seizures decreased in 40% of the patients, 60% of the patients were seen to have control over 50% of their seizures and in 27% of them the seizures disappeared completely. Neurocognitive changes were also reported: behaviour improved in 73%; 60% reported an improvement in language; in 50% sleep improved; 43% reported improvements in eating habits; and 100% said their mood had improved. The overall perception of the illness was that there had been improvements in 73% of respondents. The most common side effects were drowsiness and fatigue. CONCLUSIONS: These results suggest a possible beneficial effect of cannabidiol on the control of seizures and on the improvement of certain neurocognitive aspects in patients with refractory epilepsies.
TITLE: Cannabidiol: uso en epilepsias refractarias.Introduccion. Algunos sindromes epilepticos se caracterizan por crisis de dificil control y asocian un retraso en el desarrollo neuropsicomotor, lo que conlleva un deterioro en la calidad de vida del paciente y su familia. Objetivo. Evaluar el uso del cannabidiol como tratamiento adyuvante en pacientes con epilepsias refractarias. Pacientes y metodos. Se realizo un estudio observacional por medio de una encuesta dirigida a la persona cuidadora del paciente. Se valoro la informacion sobre el paciente y el cuidador, cambios observados sobre las crisis, efectos neuropsicologicos, efectos adversos y percepcion global de la familia tras el uso del cannabidiol. Resultados. Se evaluo a 15 pacientes con epilepsias refractarias, quienes recibieron cannabidiol durante un periodo de un mes a un año. En el 40% de los pacientes hubo una disminucion en la frecuencia de las crisis, en el 60% de los pacientes se observo un control de mas del 50% de las crisis y en el 27% las crisis desaparecieron totalmente. Tambien se comunicaron cambios neurocognitivos: en el 73% hubo una mejoria del comportamiento; el 60% notifico una mejoria en el lenguaje; el 50%, en el sueño; el 43%, en la alimentacion; y el 100%, en el estado de animo. La percepcion global sobre la enfermedad notifico una mejoria en el 73%. Los efectos adversos mas frecuentes fueron somnolencia y fatiga. Conclusiones. Estos resultados sugieren un posible efecto beneficioso del cannabidiol sobre el control de las crisis y en la mejoria de ciertos aspectos neurocognitivos en pacientes con epilepsias refractarias.
Assuntos
Canabidiol/uso terapêutico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto JovemRESUMO
INTRODUCTION: The ability to draw is a complex perception and cognition function, which is acquired in infancy and is not usually investigated in the neuropaediatric clinic. OBJECTIVE: To validate the Pascual graphomotor test (PGT) in 5 to 11 year-old Cuban school children. PATIENTS AND METHODS: The PGT was performed on a total of 172 children from the city of Havana Círculo Infantil del Municipio Plaza nursery school and from the 1st to 5th year of a primary school in the same area. The sample was systematic. The test was repeated the following day. All the drawings were scored blind by a neurologist and neurology resident. RESULTS: For the validation of the test the differentiation with age and school year was taken as a validation criterion. A high correlation was obtained between the ages of the children and the scores obtained. The Spearman coefficient was -0.78 (P=0.01), and a there was a similar inverse correlation between the school year and the test scores (Spearman coefficient=-0.79, P=0.01). The test was very reliable, with an intraclass correlation coefficient (ICC) of 0.99 for inter-observer agreement and 0.97 for the test-retest. CONCLUSIONS: The test was valid according to the criterion employed, differentiation with age and school year. The PGT demonstrated good temporal and inter-observer stability. We believe that it is a very useful tool in the neurological examination of Cuban school children.
Assuntos
Testes Neuropsicológicos/normas , Desempenho Psicomotor/fisiologia , Instituições Acadêmicas , Criança , Pré-Escolar , Cuba , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
AIMS: To present nine cases of unilateral cerebellar hypoplasia and to show the clinical alterations and the possible etiology. CASE REPORTS: A retrospective analysis of the clinical, radiological and perinatal features of a series of nine infantile cases with unilateral cerebellar hypoplasia was made. The unilateral cerebellar hypoplasia was demonstrated in all patients after computarized tomography or magnetic resonance (MR) studies. Angiographic study was performed in six patients, in most of them by MR arteriography, with demonstration of vascular anomalies in the cerebellar and/or vertebral arteries in most of the patients. However, other types of malformations of the posterior fossa were also observed: retrocerebellar cyst associated with obstruction of the aqueduct (two cases), cutaneous hemangioma or vascular malformation (two cases), and psychomotor retardation (five cases), being this last disturbance the most frequent clinical alteration. CONCLUSIONS: The unilateral cerebellar hypoplasia is a relatively rare malformation and it is more frequently associated with psychomotor retardation than with cerebellar symptomatology. Hypoplasia or aplasia of the cerebellar arteries, of probable early intrauterine origin, would be the cause of this malformation.