César Viteri - Academia.edu (original) (raw)
Papers by César Viteri
Revista de Medicina de la Universidad de Navarra
Las parasomnias son comportamientos o fenómenos anormales que aparecen en el sueño. Se clasifica... more Las parasomnias son comportamientos o fenómenos anormales que aparecen en el sueño. Se clasifican según la fase del sueño en la que aparecen y según su semiología. Las parasomnias suelen ocurrir en las transiciones entre unas fases y otras, por lo que tienden a clasificarse según se presenten predominantemente al despertar, al entrar en sueño o durante la fase REM. Si se confirma una causa se clasifican como secundarios a la patología correspondiente y se tratan en consecuencia, quedando como parasomnias propiamente aquellas que son puramente trastornos del sueño. En el presente capítulo presentamos una revisión de las distintas parasomnias incidiendo de modo especial en su diagnóstico diferencial y su tratamiento.
Revista de neurologia
ABSTRACT
Neurología (Barcelona, Spain), 2008
Epilepsy patients not only have to deal with the disease itself but also the side effects of some... more Epilepsy patients not only have to deal with the disease itself but also the side effects of some treatments, fear about sudden occurrence of seizures, stigmatization, and restrictions in activities of daily living. For this reason, it is accepted that seizure control is only one feature of the clinical management of epilepsy, since cognitive, physical and psychological deterioration also affects quality of life. It is essential to have measurement tools that rapidly and accurately evaluate the complex aspects included in the concept of quality of life in persons with epilepsy. This study has aimed to validate the specific Health-Related Quality of Life (HRQoL) questionnaire for epileptic patients, QOLIE-10 (Quality of Life in Epilepsy Inventory-10), a reduced version having easier clinical application than the QOLIE-31 in a Spanish population. Naturalistic, prospective, national and multicenter study, in which 21 Spanish neurologists took part. Patients with partial or generalized ...
Epileptic disorders : international epilepsy journal with videotape, 2006
We present a case of laryngospasm in a 12-year-old male who experienced sudden, nocturnal episode... more We present a case of laryngospasm in a 12-year-old male who experienced sudden, nocturnal episodes of breathing difficulties and agitation. Apart from laryngospasm, the main differential diagnoses included frontal seizures, sleep-related choking syndrome, sleep asthma, sleep apnoea and REM sleep behaviour disorder. The video and the EEG recordings supported the diagnosis of laryngospasm. The pH-metry confirmed the existence of reflux. Its treatment successfully controlled the episodes. This case illustrates, with a typical video recording, this infrequent type of paroxysmal event with an important differential diagnosis.[Published with video sequences].
Advances in neurology, 1986
Several toxins produce encephalopathies in which myoclonus can be a prominent feature. These incl... more Several toxins produce encephalopathies in which myoclonus can be a prominent feature. These include intoxications with bismuth, methyl bromide, cooking oil containing anilines, and tetraethyl lead. The clinical features in many cases resemble the action myoclonus syndrome of posthypoxic encephalopathy.
Revista clínica española, 1986
Seizure, 2014
To describe visual scanning pattern for facial identity recognition (FIR) and emotion recognition... more To describe visual scanning pattern for facial identity recognition (FIR) and emotion recognition (FER) in patients with idiopathic generalized (IGE) and mesial temporal lobe epilepsy (MTLE). Secondary endpoint was to correlate the results with cognitive function. Benton Facial Recognition Test (BFRT) and Ekman&Friesen series were performed for FIR and FER respectively in 23 controls, 20 IGE and 19 MTLE patients. Eye movements were recorded by a Hi-Speed eye-tracker system. Neuropsychological tools explored cognitive function. Correct FIR rate was 78% in controls, 70.7% in IGE and 67.4% (p=0.009) in MTLE patients. FER hits reached 82.7% in controls, 74.3% in IGE (p=0.006) and 73.4% in MTLE (p=0.002) groups. IGE patients failed in disgust (p=0.005) and MTLE ones in fear (p=0.009) and disgust (p=0.03). FER correlated with neuropsychological scores, particularly verbal fluency (r=0.542, p<0.001). Eye-tracking revealed that controls scanned faces more diffusely than IGE and MTLE pati...
Seizure, 2010
Patients suffering from epilepsy have an impaired health related quality of life (HRQoL) because ... more Patients suffering from epilepsy have an impaired health related quality of life (HRQoL) because of seizures and treatment adverse events. Epilepsy affects differently both genders, due to hormonal influence in women. The aim of this study is to assess the impact on HRQoL and treatment satisfaction in epilepsy patients treated with stable doses of lamotrigine and valproic acid. Observational cohort prospective study was conducted in 18 Spanish neurology sites. Patients with clinically stable partial or generalized epilepsy, already receiving lamotrigine or valproic acid on monotherapy, were assessed in two visits: baseline and at 6 months. Socio-demographic and clinical variables were recorded at baseline; HRQoL (QOLIE-10) treatment satisfaction and women image self-perception were assessed at both visits. Impact on HRQoL was assessed in both treatment arms overall and in the women subgroup. A total of 107 patients were evaluated; 53 (14 men, 39 women) on lamotrigine and 54 (27 men, 27 women) on valproic acid. Mean (SD) age was 30.4 (9.1) years and mean (SD) time since epilepsy diagnosis was 8 (8.1) years. Mean (SD) QOLIE-10 score at baseline was 73.9 (15.7) points (76.6 and 71.4 for lamotrigine and valproic, respectively). At follow up, patients reported better HRQoL on both lamotrigine (78.8 points) (p&amp;amp;amp;amp;amp;amp;amp;lt;0.05) and on valproic (72.4 points) in comparison with baseline. Women&amp;amp;amp;amp;amp;amp;amp;#39;s HRQoL at follow up was better on the lamotrigine arm compared with valproic acid: 78.8 (12.8) vs. 70.3 (15.9) (p&amp;amp;amp;amp;amp;amp;amp;lt;0.05). Women on the lamotrigine arm declared higher satisfaction with treatment and higher disagreement with the different statements referred to a negative image self-perception. Chronic patients with epilepsy already treated with lamotrigine slightly improved HRQoL at 6 month follow up, whereas no significant changes were observed in the valproic acid group. Lamotrigine impact on patients&amp;amp;amp;amp;amp;amp;amp;#39; HRQoL seems to be even more positive in the subgroup of women.
Journal of Clinical Neurophysiology, 2009
Epilepsy & Behavior, 2011
Epilepsia, 2009
SummaryCardiac changes may occasionally occur during vagus nerve stimulation (VNS) used in epilep... more SummaryCardiac changes may occasionally occur during vagus nerve stimulation (VNS) used in epileptic patients. As they can be potentially life‐threatening, it is important to detect them, and this is why an intraoperative test is performed during the implantation. Few cases of asystole during this test have been described. Only one patient with late‐onset bradyarrythmia caused by VNS has been reported. This patient had been implanted 2 years and 4 months before the episode. We present another case of late asystole in a patient whose VNS had been implanted 9 years before the arrhythmia onset. In our patient, each run of stimulation produced bradyarrhythmias and very often severe asystolia due to atrium‐ventricular block.
Anales del Sistema Sanitario de Navarra, 2007
Revista de Medicina de la Universidad de Navarra
Revista de Medicina de la Universidad de Navarra
Therapeutic drug monitoring, Feb 1, 2018
To evaluate the effect of concomitant antiepileptic therapy on levetiracetam (LEV) pharmacokineti... more To evaluate the effect of concomitant antiepileptic therapy on levetiracetam (LEV) pharmacokinetics. A 6-year retrospective observational study. Patients were grouped according to the antiepileptic drug used as concomitant medication: group A, LEV in monotherapy; group B, LEV + enzyme-inducing antiepileptic drugs (EIAEDs); and group C, LEV + non-enzyme-inducing antiepileptic drugs (NEIAEDs). Apparent oral levetiracetam clearance (LEV CL/F) and basal serum levetiracetam concentrations (LEV C0) were compared among the different groups by analysis of variance. A total of 330 LEV C0 corresponding to 205 patients (56% men) were identified. The mean (±SD) of LEV CL/F in group A (n = 180), B (n = 92), and C (n = 58) was 4.41 ± 2.06 L/h, 7.23 ± 3.72 L/h, and 4.87 ± 1.65 L/h, respectively. EIAEDs increased LEV CL/F (L/h) by 64% compared with the monotherapy group and by 48% compared with the NEIAEDs group. The greatest induction in LEV CL/F, compared with the LEV monotherapy group, was obser...
Purpose: To evaluate facial identity and emotion recognition in patients with mesial temporal lob... more Purpose: To evaluate facial identity and emotion recognition in patients with mesial temporal lobe epilepsy due to amygdalo-hippocampal sclerosis (MTLE-AHS). Method: We studied patients diagnosed with MTLE-AHS, idiopathic generalized epilepsy (IGE) and healthy controls. Baseline cognitive function was assessed through neuropsychological tests. Identity recognition was evaluated with computerized Benton Facial Recognition Test (BFRT) and recognition of basic emotions (anger, disgust, fear, happiness, sadness and surprise) with Ekman & Friesen test (E&FT). Time gap between presentation of emotion and response was measured. Result: Seven MTLE-AHS, 10 IGE patients and 20 healthy controls were analyzed. Median age was 35.6, 30.7 and 37.9 years respectively. Trail-Making-part B, Digit Span and word fluency tasks were significantly impaired in MTLE-AHS patients (p<0.05). MTLE-AHS patients scored lower than controls in BFRT (36.4 vs 41.9), but slightly higher than IGE individuals (36.4 v...
![Research paper thumbnail of [Video-EEG monitoring and simultaneous ECG for the differential diagnosis of transient consciousness disorders. A case report]](https://attachments.academia-assets.com/112153378/thumbnails/1.jpg)
](Anales del sistema sanitario de Navarra
We present the case of a 36 year-old woman, with history of transient consciousness disorders wit... more We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic crises and treated with valproate for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EGG monitoring, where there was an episode that showed temporary right epileptiform activity, with a diagnosis established of focal epilepsy of unknown cause. At present, she remains asymptomatic with oxycarbazepine.
Revista de neurologia, Jan 16, 2012
Non-convulsive status epilepticus is a significant issue for a neurologist because, despite its l... more Non-convulsive status epilepticus is a significant issue for a neurologist because, despite its low prevalence, it mimics other pathologies, with therapeutics and prognostic outcomes. Diagnosis is based on clinical features, mainly mental status or impaired consciousness and electroencephalographic changes, so electroencephalogram is the first exploration we must perform with clinical suspicion. There are three clinical forms: generalized or absence status, with diffuse epileptiform discharges; focal, with epileptic discharges located in a specific brain area and may not affect consciousness; and subtle, with diffuse or local epileptic activity after a tonic-clonic seizure or convulsive status and limited or no motor activity. Treatment are benzodiazepines and antiepileptic drugs; anesthetic drugs are only recommended for patients with subtle status and in some with partial complex status. Prognosis is mainly determined by etiology and associated brain damage.
Neurología (Barcelona, Spain)
Frequently, epileptic seizures are accompanied by changes in the heart rate. They are usually tra... more Frequently, epileptic seizures are accompanied by changes in the heart rate. They are usually transient and irrelevant for the patient's symptoms and the patient recorders his usually baseline rhythm in second or a few minutes. In this report we present a case of a patient diagnosed previously of epilepsy who presented episodes of dizziness and presyncope. During the video-EEG study we recorded one of these spells. The diagnosis of this spell was a focal seizure associated with asystole: the seizure was almost asymptomatic, and only when the asystole developed (40 seconds after the EEG ictal changes) the patient complained about dizziness. Recovery was fast, but treatment with pacemaker must be considered.
Revista de Medicina de la Universidad de Navarra
Las parasomnias son comportamientos o fenómenos anormales que aparecen en el sueño. Se clasifica... more Las parasomnias son comportamientos o fenómenos anormales que aparecen en el sueño. Se clasifican según la fase del sueño en la que aparecen y según su semiología. Las parasomnias suelen ocurrir en las transiciones entre unas fases y otras, por lo que tienden a clasificarse según se presenten predominantemente al despertar, al entrar en sueño o durante la fase REM. Si se confirma una causa se clasifican como secundarios a la patología correspondiente y se tratan en consecuencia, quedando como parasomnias propiamente aquellas que son puramente trastornos del sueño. En el presente capítulo presentamos una revisión de las distintas parasomnias incidiendo de modo especial en su diagnóstico diferencial y su tratamiento.
Revista de neurologia
ABSTRACT
Neurología (Barcelona, Spain), 2008
Epilepsy patients not only have to deal with the disease itself but also the side effects of some... more Epilepsy patients not only have to deal with the disease itself but also the side effects of some treatments, fear about sudden occurrence of seizures, stigmatization, and restrictions in activities of daily living. For this reason, it is accepted that seizure control is only one feature of the clinical management of epilepsy, since cognitive, physical and psychological deterioration also affects quality of life. It is essential to have measurement tools that rapidly and accurately evaluate the complex aspects included in the concept of quality of life in persons with epilepsy. This study has aimed to validate the specific Health-Related Quality of Life (HRQoL) questionnaire for epileptic patients, QOLIE-10 (Quality of Life in Epilepsy Inventory-10), a reduced version having easier clinical application than the QOLIE-31 in a Spanish population. Naturalistic, prospective, national and multicenter study, in which 21 Spanish neurologists took part. Patients with partial or generalized ...
Epileptic disorders : international epilepsy journal with videotape, 2006
We present a case of laryngospasm in a 12-year-old male who experienced sudden, nocturnal episode... more We present a case of laryngospasm in a 12-year-old male who experienced sudden, nocturnal episodes of breathing difficulties and agitation. Apart from laryngospasm, the main differential diagnoses included frontal seizures, sleep-related choking syndrome, sleep asthma, sleep apnoea and REM sleep behaviour disorder. The video and the EEG recordings supported the diagnosis of laryngospasm. The pH-metry confirmed the existence of reflux. Its treatment successfully controlled the episodes. This case illustrates, with a typical video recording, this infrequent type of paroxysmal event with an important differential diagnosis.[Published with video sequences].
Advances in neurology, 1986
Several toxins produce encephalopathies in which myoclonus can be a prominent feature. These incl... more Several toxins produce encephalopathies in which myoclonus can be a prominent feature. These include intoxications with bismuth, methyl bromide, cooking oil containing anilines, and tetraethyl lead. The clinical features in many cases resemble the action myoclonus syndrome of posthypoxic encephalopathy.
Revista clínica española, 1986
Seizure, 2014
To describe visual scanning pattern for facial identity recognition (FIR) and emotion recognition... more To describe visual scanning pattern for facial identity recognition (FIR) and emotion recognition (FER) in patients with idiopathic generalized (IGE) and mesial temporal lobe epilepsy (MTLE). Secondary endpoint was to correlate the results with cognitive function. Benton Facial Recognition Test (BFRT) and Ekman&Friesen series were performed for FIR and FER respectively in 23 controls, 20 IGE and 19 MTLE patients. Eye movements were recorded by a Hi-Speed eye-tracker system. Neuropsychological tools explored cognitive function. Correct FIR rate was 78% in controls, 70.7% in IGE and 67.4% (p=0.009) in MTLE patients. FER hits reached 82.7% in controls, 74.3% in IGE (p=0.006) and 73.4% in MTLE (p=0.002) groups. IGE patients failed in disgust (p=0.005) and MTLE ones in fear (p=0.009) and disgust (p=0.03). FER correlated with neuropsychological scores, particularly verbal fluency (r=0.542, p<0.001). Eye-tracking revealed that controls scanned faces more diffusely than IGE and MTLE pati...
Seizure, 2010
Patients suffering from epilepsy have an impaired health related quality of life (HRQoL) because ... more Patients suffering from epilepsy have an impaired health related quality of life (HRQoL) because of seizures and treatment adverse events. Epilepsy affects differently both genders, due to hormonal influence in women. The aim of this study is to assess the impact on HRQoL and treatment satisfaction in epilepsy patients treated with stable doses of lamotrigine and valproic acid. Observational cohort prospective study was conducted in 18 Spanish neurology sites. Patients with clinically stable partial or generalized epilepsy, already receiving lamotrigine or valproic acid on monotherapy, were assessed in two visits: baseline and at 6 months. Socio-demographic and clinical variables were recorded at baseline; HRQoL (QOLIE-10) treatment satisfaction and women image self-perception were assessed at both visits. Impact on HRQoL was assessed in both treatment arms overall and in the women subgroup. A total of 107 patients were evaluated; 53 (14 men, 39 women) on lamotrigine and 54 (27 men, 27 women) on valproic acid. Mean (SD) age was 30.4 (9.1) years and mean (SD) time since epilepsy diagnosis was 8 (8.1) years. Mean (SD) QOLIE-10 score at baseline was 73.9 (15.7) points (76.6 and 71.4 for lamotrigine and valproic, respectively). At follow up, patients reported better HRQoL on both lamotrigine (78.8 points) (p&amp;amp;amp;amp;amp;amp;amp;lt;0.05) and on valproic (72.4 points) in comparison with baseline. Women&amp;amp;amp;amp;amp;amp;amp;#39;s HRQoL at follow up was better on the lamotrigine arm compared with valproic acid: 78.8 (12.8) vs. 70.3 (15.9) (p&amp;amp;amp;amp;amp;amp;amp;lt;0.05). Women on the lamotrigine arm declared higher satisfaction with treatment and higher disagreement with the different statements referred to a negative image self-perception. Chronic patients with epilepsy already treated with lamotrigine slightly improved HRQoL at 6 month follow up, whereas no significant changes were observed in the valproic acid group. Lamotrigine impact on patients&amp;amp;amp;amp;amp;amp;amp;#39; HRQoL seems to be even more positive in the subgroup of women.
Journal of Clinical Neurophysiology, 2009
Epilepsy & Behavior, 2011
Epilepsia, 2009
SummaryCardiac changes may occasionally occur during vagus nerve stimulation (VNS) used in epilep... more SummaryCardiac changes may occasionally occur during vagus nerve stimulation (VNS) used in epileptic patients. As they can be potentially life‐threatening, it is important to detect them, and this is why an intraoperative test is performed during the implantation. Few cases of asystole during this test have been described. Only one patient with late‐onset bradyarrythmia caused by VNS has been reported. This patient had been implanted 2 years and 4 months before the episode. We present another case of late asystole in a patient whose VNS had been implanted 9 years before the arrhythmia onset. In our patient, each run of stimulation produced bradyarrhythmias and very often severe asystolia due to atrium‐ventricular block.
Anales del Sistema Sanitario de Navarra, 2007
Revista de Medicina de la Universidad de Navarra
Revista de Medicina de la Universidad de Navarra
Therapeutic drug monitoring, Feb 1, 2018
To evaluate the effect of concomitant antiepileptic therapy on levetiracetam (LEV) pharmacokineti... more To evaluate the effect of concomitant antiepileptic therapy on levetiracetam (LEV) pharmacokinetics. A 6-year retrospective observational study. Patients were grouped according to the antiepileptic drug used as concomitant medication: group A, LEV in monotherapy; group B, LEV + enzyme-inducing antiepileptic drugs (EIAEDs); and group C, LEV + non-enzyme-inducing antiepileptic drugs (NEIAEDs). Apparent oral levetiracetam clearance (LEV CL/F) and basal serum levetiracetam concentrations (LEV C0) were compared among the different groups by analysis of variance. A total of 330 LEV C0 corresponding to 205 patients (56% men) were identified. The mean (±SD) of LEV CL/F in group A (n = 180), B (n = 92), and C (n = 58) was 4.41 ± 2.06 L/h, 7.23 ± 3.72 L/h, and 4.87 ± 1.65 L/h, respectively. EIAEDs increased LEV CL/F (L/h) by 64% compared with the monotherapy group and by 48% compared with the NEIAEDs group. The greatest induction in LEV CL/F, compared with the LEV monotherapy group, was obser...
Purpose: To evaluate facial identity and emotion recognition in patients with mesial temporal lob... more Purpose: To evaluate facial identity and emotion recognition in patients with mesial temporal lobe epilepsy due to amygdalo-hippocampal sclerosis (MTLE-AHS). Method: We studied patients diagnosed with MTLE-AHS, idiopathic generalized epilepsy (IGE) and healthy controls. Baseline cognitive function was assessed through neuropsychological tests. Identity recognition was evaluated with computerized Benton Facial Recognition Test (BFRT) and recognition of basic emotions (anger, disgust, fear, happiness, sadness and surprise) with Ekman & Friesen test (E&FT). Time gap between presentation of emotion and response was measured. Result: Seven MTLE-AHS, 10 IGE patients and 20 healthy controls were analyzed. Median age was 35.6, 30.7 and 37.9 years respectively. Trail-Making-part B, Digit Span and word fluency tasks were significantly impaired in MTLE-AHS patients (p<0.05). MTLE-AHS patients scored lower than controls in BFRT (36.4 vs 41.9), but slightly higher than IGE individuals (36.4 v...
Anales del sistema sanitario de Navarra
We present the case of a 36 year-old woman, with history of transient consciousness disorders wit... more We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic crises and treated with valproate for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EGG monitoring, where there was an episode that showed temporary right epileptiform activity, with a diagnosis established of focal epilepsy of unknown cause. At present, she remains asymptomatic with oxycarbazepine.
Revista de neurologia, Jan 16, 2012
Non-convulsive status epilepticus is a significant issue for a neurologist because, despite its l... more Non-convulsive status epilepticus is a significant issue for a neurologist because, despite its low prevalence, it mimics other pathologies, with therapeutics and prognostic outcomes. Diagnosis is based on clinical features, mainly mental status or impaired consciousness and electroencephalographic changes, so electroencephalogram is the first exploration we must perform with clinical suspicion. There are three clinical forms: generalized or absence status, with diffuse epileptiform discharges; focal, with epileptic discharges located in a specific brain area and may not affect consciousness; and subtle, with diffuse or local epileptic activity after a tonic-clonic seizure or convulsive status and limited or no motor activity. Treatment are benzodiazepines and antiepileptic drugs; anesthetic drugs are only recommended for patients with subtle status and in some with partial complex status. Prognosis is mainly determined by etiology and associated brain damage.
Neurología (Barcelona, Spain)
Frequently, epileptic seizures are accompanied by changes in the heart rate. They are usually tra... more Frequently, epileptic seizures are accompanied by changes in the heart rate. They are usually transient and irrelevant for the patient's symptoms and the patient recorders his usually baseline rhythm in second or a few minutes. In this report we present a case of a patient diagnosed previously of epilepsy who presented episodes of dizziness and presyncope. During the video-EEG study we recorded one of these spells. The diagnosis of this spell was a focal seizure associated with asystole: the seizure was almost asymptomatic, and only when the asystole developed (40 seconds after the EEG ictal changes) the patient complained about dizziness. Recovery was fast, but treatment with pacemaker must be considered.