Tabla I. Características demográficas y clínicas. |
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Porcentaje |
n |
||
Género |
Masculino |
56,5% |
131 |
Femenino |
43,5% |
101 |
|
Etiología de la epilepsia |
Estructural |
45,3% |
105 |
Genética |
11,2% |
26 |
|
Metabólica |
0,4% |
1 |
|
Infecciosa |
0,4% |
1 |
|
Autoinmunitaria |
0,4% |
1 |
|
Desconocida |
42,2% |
98 |
|
Tratamiento antiepiléptico |
Sin tratamiento |
10,3% |
24 |
Monoterapia |
56,5% |
131 |
|
Politerapia |
33,2% |
77 |
|
Farmacorresistencia |
17,2% |
40 |
Tabla II. Fármacos antiepilépticos empleados en monoterapia y politerapia como tratamiento previo a la atención en el servicio de urgencias hospitalarias. |
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Monoterapia |
Politerapia |
|
Ácido valproico |
12,2% (16) |
23,4% (18) |
Brivaracetam |
0 |
10,4% (8) |
Carbamacepina |
3,8% (5) |
16,9% (13) |
Clobazam |
0,8% (1) |
19,5% (15) |
Clonacepam |
0 |
6,5% (5) |
Eslicarbacepina |
6,9% (9) |
1,3% (1) |
Fenobarbital |
0,8% (1) |
11,7% (9) |
Gabapentina |
0 |
1,3% (1) |
Lacosamida |
0,8% (1) |
23,4% (18) |
Lamotrigina |
2,3% (3) |
22,1% (17) |
Levetiracetam |
67,2% (88) |
55,8% (43) |
Oxcarbacepina |
1,5% (2) |
2,4% (2) |
Perampanel |
0,8% (1) |
11,7% (9) |
Primidona |
0,8% (1) |
0 |
Topiramato |
1,5% (2) |
6,5% (5) |
Zonisamida |
0,8% (1) |
10,4% (8) |
Figura. Factores precipitantes de crisis epilépticas identificados en el estudio (n = 34).
Tabla III. Características de los pacientes en los que se identificó mala adhesión terapéutica como factor precipitante de la crisis epiléptica (n = 34). |
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Edad (media, DE) |
46,4 (17,5) |
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Porcentaje |
n |
|||
Género Femenino |
Masculino |
73,5% |
25 |
|
26,5% |
9 |
|||
Etiología de la epilepsia |
Estructural |
32,4% |
11 |
|
Genética |
14,7% |
5 |
||
Desconocida |
52,9% |
18 |
||
Tratamiento antiepiléptico Politerapia |
Monoterapia |
76,5% |
26 |
|
23,5% |
8 |
|||
Farmacorresistencia |
8,8% |
3 |
||
Monoterapia |
Politerapia |
|||
FAE empleado |
Levetiracetam |
57,7% (15) |
50% (4) |
|
Zonisamida |
0 |
12,5% (1) |
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Brivaracetam |
0 |
12,5% (1) |
||
Valproato |
19,2% (5) |
25% (2) |
||
Fenobarbital |
0 |
12,5% (1) |
||
Lamotrigina |
0 |
37,5% (3) |
||
Eslicarbacepina |
15,4% (4) |
25% (2) |
||
Clobazam |
0 |
25% (2) |
||
Carbamacepina |
3,8% (1) |
12,5% (1) |
||
Lacosamida |
0 |
25% (2) |
||
Oxcarbacepina |
3,8% (1) |
0 |
||
Perampanel |
0 |
12,5% (1) |
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DE: desviación estándar; FAE: fármaco antiepiléptico. |
Tabla IV. Destino al alta del servicio de urgencias hospitalarias y motivo de ingreso de los pacientes con epilepsia que fueron hospitalizados. |
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Destino al alta |
n (porcentaje) |
|
Alta a domicilio |
195 (84,1%) |
|
Alta voluntaria |
3 (1,3%) |
|
Ingreso hospitalario |
34 (14,6%) |
Motivo de ingreso |
Neurología |
22 (9,5%) |
Serie de crisis (n = 6) Estado epiléptico (n = 10) Completar estudio (n = 6) |
Medicina interna |
4 (1,7%) |
Sepsis (n = 2) Neumonía (n = 2) |
Medicina intensiva |
2 (0,8%) |
Estado epiléptico refractario (n = 1) Parada cardiorrespiratoria (n = 1) |
Cirugía general |
1 (0,4%) |
Apendicitis aguda |
Oncología médica |
2 (0,8%) |
No especificado |
Neurocirugía |
2 (0,8%) |
Recidiva tumoral (n = 1) No especificado (n = 1) |
Enfermedades infecciosas |
1 (0,4%) |
Neumonía |
Emergency department management of epileptic seizures in patients with epilepsy Aim. To analyse the care of patients with epilepsy (PwE) who visit the hospital emergency department (ED) due to an epileptic seizure. Materials and methods. Single-centre retrospective observational study, based on the clinical history of the PwE seen in the ED for epileptic seizures between January 2016 and December 2018. Demographic, clinical and ED management variables were collected. Specifically, the results of a computed tomography (CT) brain scan and electroencephalogram and the presence of precipitating factors for epileptic seizures were analysed. Results. A total of 232 PwE were identified, with a mean age of 49.8 years. The most frequent reason for the visit was focal epileptic seizures (50.4%). In 106 cases (45.6%) possible precipitating factors were found, of which poor therapy adherence was the most frequent. An urgent CT brain scan was performed in 67 cases (28.9%) and acute alterations were found in only one patient. An electroencephalogram was carried out in 16 of them (6.9%). Adjustments were made to the antiepileptic treatment in 135 patients (58.1%). A total of 195 were discharged without being hospitalised (84.1%). Conclusions. PwE accounted for a considerable proportion of the patients seen for epileptic seizures in the ED. The presence of a potentially controllable precipitating factor was identified in almost half of the cases, the most frequent being poor adherence to therapy. In addition, a high number of urgent complementary tests were performed, which in many cases may be unnecessary and avoidable. Key words. Antiepileptic drugs. Antiseizure drugs. Epilepsy. Epileptic seizure. Lack of adhesion. Status epilepticus. |