Neurologist Asier Gómez answers questions about his epilepsy talk last March in NeuronUP Academy from NeuronUP
Doubts and Questions for Asier Gomez’s Epilepsy presentation
Gema Diaz Blancat: What do you think of the use of cannabidiol as a pharmacological tool in these patients?
Cannabidiol is approved for the treatment of epilepsy in the context of Dravet syndrome and Lennox-Gastaut syndrome, so we can use it perfectly, and I have some patients, in those cases. There are also studies on patients with tuberous sclerosis, but, as far as I know, it’s not approved yet. In the rest of epilepsies there is not enough evidence yet, so the recommendation, at the moment, is not to use it.
2. Gema Diaz Blancat: I understand that the neuropsychological evaluation of the patient is done within your neurology service, but do you also attend to cognitive rehabilitation? If not, how is the referral made from your CUN consultation to the cognitive rehabilitation centers?
In fact, we also do cognitive rehabilitation, and this is done by the same neuropsychologist as the evaluations, Dr. Teresa Rognoni.
3. Sandra Martinez, early care neuropsychologist I find quite a few cases of children, with undiagnosed nocturnal epilepsies because the EG protocols are not primarily nocturnal with sleep deprivation. I mainly observe (in these cases) language and memory difficulties that in most of these cases are altered. Is it possible to detect any nocturnal alteration in a half-hour daytime EEg?
In an ambulatory EEG in vigil you can detect alterations, but to evaluate sleep, which as you say is very important because during sleep we detect epileptiform activity or subclinical crises (for example children with continuous wave-tip in sleep) that can explain or favor those language and memory difficulties that you mention, it is fundamental to make a record of EEG that includes sleep. Ideally, a MVEEG of at least one admitted night should be done, but if the center does not have this, a sleep-deprived EEG should be done for all children with the difficulties you mention.
4. What can I do as a neuropsychologist to send more objective data to neurologists to administer a sleep test?
I would recommend it in cases where you find that the cognitive or language alterations are more important than you would expect because of the structural damage, the evolution of the epilepsy during the day (objective seizures) or the amount of antiepileptic drugs the patient is taking. In these cases, as I said before, we must rule out a continuous wave-point epilepsy during sleep or that the patient is having seizures during sleep.
All the best,
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