Symptomatic epilepsy: a review of 208 patients
Summary. Objective. To determine the main etiological mechanisms of symptomatic epilepsy and its frequency according to age. Patients and methods. We made a retrospective analysis of 208 patients admitted during a period of four and a half years, studying the variables: age, sex and type of seizures: simple partial, secondarily generalized partial, complex partial, tonic-clonic, generalized tonic, and also EEG and neuroimaging. Results. The main etiological mechanisms found were: vascular (31.25%), alcoholic (12.01%), intracranial disorders (9.61%), traumatic (5.28%), degenerative (5.28%), infectious (2.88%) and cryptogenic (33.65%). In the last group there was an outstandingly large proportion of patients with silent infarcts. When considering vascular epilepsy, those seizures occurring during the acute phase of the stroke (24/65) are differentiated from those of late onset (41/65). In the latter there was a marked predominance of ischemic etiology (48.78% corresponded to extensive infarcts in the territory of the middle cerebral artery; 36.58% were associated with partial infarcts) probably because of the greater frequency of ischemic stroke as compared with hemorrhagic stroke. After the acute phase, the latency was of 10.68 ± 0.43 months and the most frequent seizures were tonic-clonic (48.78%). Conclusion. In persons under 30 years of age, etiology is multifactorial; between 30 and 50 years of age alcoholic epilepsy (39.53%) and traumatic epilepsy (11.62%) predominate; over the age of 50 years the cause was vascular in 43.5%. In the latter age group there was a high proportion of patients with heraldic seizures
Pacientes y métodos Se analizaron de forma retrospectiva 208 pacientes ingresados durante un período de 4 años y medio, y se estudiaron las variables edad, sexo y tipo de crisis: parcial simple, parcial secundariamente generalizada, parcial compleja, tonicoclónica, tónica generalizada, EEG y neuroimagen.
Resultados Los principales mecanismos etiológicos encontrados fueron: vascular (31,25%), enólica (12,01%), proceso intracraneal (9,61%), traumática (5,28%), degenerativa (5,28%), infecciosa (2,88%) y criptogénica (33,65%); destaca en este último grupo una elevada proporción de pacientes con infarto silente. Considerando la epilepsia vascular diferenciamos aquellas crisis acontecidas en la fase aguda del ictus (24/65) y las de aparición tardía (41/65). En estas últimas se observa un claro predominio de la etiología isquémica (48,78% corresponden a infartos extensos en el territorio de la arteria cerebral media; 36,58% se asocian a infartos parciales) probablemente por la mayor frecuencia del ictus isquémico frente al hemorrágico. Superada la fase aguda, la latencia es de 10,68 ± 0,43 meses y el tipo de crisis más frecuente es la tonicoclónica (48,78%).
Conclusiones En menores de 30 años la etiología es multifactorial; en el período comprendido entre los 30 y 50 años predomina la epilepsia enólica (39,53%) y traumática (11,62%), y en mayores de 50 años la causa vascular (43,5%). En este último grupo de edad destaca un elevado porcentaje de pacientes con crisis heráldicas