Browsing by Author "Manterola, Carla"
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Item Behavioral alterations associated with levetiracetam in pediatric epilepsy(2020) Cortes, Camila; Manterola, CarlaLevetiracetam (LEV) has an improved pharmacological profile and is one of the most commonly used antiepileptic drugs (AEDs). However, associations between this pharmacological profile and behavioral side effects have been extensively reported in pediatric populations. We assessed behavioral changes after initiation of LEV, prescribed by the treating neurologist, in Chilean patients with epilepsy aged 4–15 years. A behavioral questionnaire was applied at baseline and at two, four, and twelve weeks of treatment. Thirty patients were enrolled: 16 males, 14 females, average age 8 years (range: 4–14). By week four, 23.3% of patients showed significant behavioral alterations that persisted throughout the observation period. No significant alterations emerged after four weeks in the remaining patients. Family history of psychiatric disease and prior behavioral difficulties were predisposing factors for adverse behavioral effects. Although previous studies associated adverse behavioral effects with LEV in pediatric patients with epilepsy, we believe that this is the first study to use a prospective methodology and standardized tools to quantify the symptomatology. Adverse behavioral effects may significantly affect quality of life for patients and families, diminishing the tolerability of treatment. To ensure successful therapy and improve medical decision-making, it is essential to consider predisposing factors for drug-related adverse effects and to regularly assess for behavioral alterations during treatment.Publication How the characteristics of pediatric neurologists in Latin America influence the communication of sudden unexpected death in epilepsy to patients and caregivers(2022) Venegas, Viviana; Manterola, Carla; De Pablo, José; Garcia, Mariano; Ponce de León, Sonia; Cavada, GabrielObjective: This study aimed to describe the characteristics of pediatric neurologists (PNs) in Latin America (LA) who attend to children and adolescents with epilepsy and convey to them the risk of sudden unexpected death in epilepsy (SUDEP). Methods: Personal data and details of discussion of SUDEP with families, including relevance of SUDEP disclosure, frequency of such communication, perceived benefits and risks of disclosure, extent of training received on such disclosure, and professional experience with SUDEP, were collected through an online survey of PNs from LA. Their personal experience in carrying out this conversation was obtained through responses to an open question, further used to identify the main barriers. Results: Of the 442 surveys received, 367 (83%) were analyzed. Most participants (73.8%) responded that the communication of SUDEP risk was relevant or very relevant; however, only 17.9% reported communicating it always or very frequently. Factors that increased the frequency of SUDEP communication included patients with higher levels of complexity (OR = 2.18, P = .003) and the physician's personal experience with SUDEP (OR = 2.305, P < .001). Direct questions from the family and avoiding scaring them about a rare outcome were the main motivations behind discussing and not discussing SUDEP, respectively. In the open question, respondents identified worries about the patient's ability to understand the information and cultural gaps as barriers. "Informing with the intention of improving adherence to treatment" and "establishing an empathic relationship" were significantly related. Further, the concept of "do not scare" was significantly related to "personal difficulties in discussing SUDEP." Significance: Although most PNs agree that communication about SUDEP is relevant, only a minority actually engages in it. Participants identified a lack of appropriate training in such communication as a barrier. A better understanding of communication expectations, education of health professionals, and communication techniques have a strong relevance in diminishing the gap between guidelines and practice.Item Morphometric analysis program: Detection of epileptic foci in young children using an adult normative database: Initial experience(2021) Stecher, Ximena; Schonstedt, Valeria; Manterola, Carla; Velásquez, Álvaro; Zamorano, Francisco; Carreño, Fernando; Castillo, MauricioObjective: To report our initial experience using an adult-template MAP in drugresistant focal epilepsy in five children with apparently normal MRI. Methods: Patients selected were highly suspicious of harboring focal structural lesions and had negative brain MRI studies. MAP was performed using a locally obtained adult database as a template. Results were reviewed by two neuroradiologists. Pertinence of MAP-positive areas was confirmed by the focal epileptic hypothesis or by pathology when possible (J Neuroradiol, 39, 2012, 87). Visual analysis was performed using Mango Software. MRI studies were reanalyzed at the workstation with knowledge of the clinical suspicion to confirm or discard the possibility of FCD. Results: Five patients aged 19-48 months were studied, all with initial 3T MRI studies interpreted as normal. All had focal epileptic hypothesis with coherence of clinical seizure characterization and electroencephalographic findings. In two patients, histology showed type 1 FCD. Due to the age of our subjects, the junction map always highlighted the subcortical white matter in relationship to maturity differences. FCD was identified as asymmetric U-shaped highlighted regions in the junction map. Significance: FCD is the most frequent pathology reported in pediatric epilepsy surgery series (Epileptic Disord, 18, 2016, 240). Significant number of FCDs may be overlooked on MRIs, reducing the odds of seizure freedom after surgery (Epilepsy Res, 89, 2010, 310). MAP is an image postprocessing method for enhanced visualization of FCD; however, when using an adult template in developing brains, normal subcortical regions may be highlighted as pathological. Creating a pediatric template is difficult, due to the need for general anesthesia to acquire the MRI database. Here, we were able to show that MAP identified FCDs as asymmetric “U-” shaped highlighted regions in the junction maps of all five patients, which may indicate that obtaining childhood databases for this purpose may not be necessary and that adult ones suffice for diagnosis of FCD.Publication Patients recovering from COVID-19 who presented with anosmia during their acute episode have behavioral, functional, and structural brain alterations(2024) Kausel, Leonie; Figueroa-Vargas, Alejandra; Zamorano, Francisco; Stecher, Ximena; Aspé-Sánchez, Mauricio; Carvajal-Paredes, Patricio; Márquez-Rodríguez, Víctor; Martínez-Molina, María Paz; Román, Claudio; Soto-Fernández, Patricio; Valdebenito-Oyarzo, Gabriela; Manterola, Carla; Uribe-San-Martín, Reinaldo; Silva, Claudio; Henríquez-Ch, Rodrigo; Aboitiz, Francisco; Polania, Rafael; Guevara, Pamela; Muñoz-Venturelli, Paula; Soto-Icaza, Patricia; Billeke, PabloPatients recovering from COVID-19 commonly exhibit cognitive and brain alterations, yet the specific neuropathological mechanisms and risk factors underlying these alterations remain elusive. Given the significant global incidence of COVID-19, identifying factors that can distinguish individuals at risk of developing brain alterations is crucial for prioritizing follow-up care. Here, we report findings from a sample of patients consisting of 73 adults with a mild to moderate SARS-CoV-2 infection without signs of respiratory failure and 27 with infections attributed to other agents and no history of COVID-19. The participants underwent cognitive screening, a decision-making task, and MRI evaluations. We assessed for the presence of anosmia and the requirement for hospitalization. Groups did not differ in age or cognitive performance. Patients who presented with anosmia exhibited more impulsive alternative changes after a shift in probabilities (r = − 0.26, p = 0.001), while patients who required hospitalization showed more perseverative choices (r = 0.25, p = 0.003). Anosmia correlated with brain measures, including decreased functional activity during the decision-making task, thinning of cortical thickness in parietal regions, and loss of white matter integrity. Hence, anosmia could be a factor to be considered when identifying at-risk populations for follow-upPublication Radiología en el estudio de la macrocefalia. ¿Por qué?, ¿cuándo?, ¿cómo?(2022) Schonstedt, V.; Stecher, Ximena; Manterola, Carla; Roviraf, À.Macrocephaly is a clinical term defined as an occipitofrontal circumference more than two standard deviations above the mean. It is present in 5% of children and is a common indication for imaging studies. There are multiple causes of macrocephaly; most of them are benign. Nevertheless, in some cases, macrocephaly is the clinical manifestation of a condition that requires timely medical and/or surgical treatment. The importance of imaging studies lies in identifying the patients who would benefit from treatment. Children with macrocephaly associated with neurologic alterations, neurocutaneous stigmata, delayed development, or rapid increase of the circumference have a greater risk of having disease. By contrast, parental macrocephaly is predictive of a benign condition. Limiting imaging studies to patients with increased risk makes it possible to optimize resources and reduce unnecessary exposure to tests. Macrocefalia es un término clínico definido como el incremento de la circunferencia occipitofrontal por encima de dos desviaciones estándar. Se presenta en el 5% de los niños y es una indicación frecuente de estudios radiológicos. Existen múltiples causas de macrocefalia, que corresponden mayoritariamente a condiciones benignas. Sin embargo, en algunos casos es la manifestación clínica de una patología que requiere una oportuna intervención médico-quirúrgica. La relevancia del estudio radiológico radica en la identificación de estos pacientes. Aquellos niños que se presentan con macrocefalia asociada a alteraciones neurológicas, estigmas neurocutáneos, retraso del desarrollo o rápido aumento de la circunferencia craneal poseen un riesgo aumentado de presentar patología. Por el contrario, el antecedente de macrocefalia parenteral es predictivo de una condición benigna. Acotar el estudio radiológico a los pacientes de mayor riesgo permite optimizar recursos y disminuir la exposición innecesaria a exámenes.