Patient 17 years of age who come referred by her neurologist to assess possible OSAS in connection with epileptic seizures (grand mal) not responsive to medication ant. 9 / 09
Background:
- Seizures Generalized every 3 weeks in the last two years. (a dozen income UVI)
- Diagnosis 2007 of epilepsy with tonic-clonic in tto with Depakine
- 5 / 08 is changed medication for slowing and weight gain Kepros
- 3 / 09 back with the Kepros Depakine
- 5 / 09 is added to lamotrigine and Depakote Kepros.
- 4 / 09 MR 4 / 09 asymmetry of temporal horns right hippocampal atrophy and incipient.
- 7 / 09 Video 24 hours sleep EEG Ruber Clinic. Study shows abnormal slowing and epileptiform activity right. Decreased deep sleep periods are REM
15 months later
Results:
- Since 10/09 the patient has not had any more epileptic seizures
- He is currently under treatment with Kepra 1500 mg/12 h, Lamotrigine Stada 100 mg/8 h and Magnesium
- The patient has stopped snoring and having apnea pauses.
- Currently with an Epworth 3, the family is declining to pursue a new sleep study.
Discussion:
- Controlling apnea reduces repeated awakenings and improves sleep architecture, thereby improving seizure control.
- Other authors consider that respiratory acidosis associated with OSAS protects the CNS from seizures, which is why they give this disease a protective value against epilepsy.
- The prevalence of epilepsy in the population is between 0.5% and 1%, with grand mal epilepsy accounting for 6% of these. Osasuna epilepsy is 5% in the general population. The coexistence of both diseases is 1 case per 5 million inhabitants.
- In this case, the drastic elimination of epileptic seizures after the intervention and the clinical resolution of the apnea demonstrate that OSAS can be a factor that makes it difficult to control this disease in patients who suffer from it.
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