Clinical Case 1
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 after
Results:
- From 10/09 the patient has not had any seizures
- Currently being treated with Kepros 1500 mg/12 h, Stada Lamotrigine 100 mg / 8 h and Magnesium
- The patient has stopped snoring and apnea pauses
- Currently a 3 family Epworth withdraws a new sleep study
Discussion::
- Control of apnea decreases repeated awakenings and improved sleep architecture and thus the control of seizures
- Other authors consider that the respiratory acidosis associated with OSAS protects the CNS from the crisis so give this disease a protective value of epilepsy
- The prevalence of epilepsy in the population is between 0.5% and 1% being the great evil of 6% of these. Being the dare of 5% in the general population. The coexistence of both diseases is 1 case per 5 million
- In this case the drastic elimination of seizures after surgery, and clinical resolution of their apnea show that OSAS may be a factor that hinders the control of this disease in patients who suffer
Clinical Case 2
09/12/2009, 43 years old male patient. Hypertension, hyperuricemia, smoking and drinking, type 1 diabetes with suspected OSAS. Is referred for evaluation and possible ENT surgical evaluation with the Department of Pneumology
Treatment:
- apnea hypopnea index 99 x hours
- 95% SAT o2media
- SAT < 90% 1%
- You are informed of the different surgical options and if withdrawn the need for a CPAP. It alerts you that you will have problems in their use as septal deviation septoplasty is recommended. The patient refused any surgery initially
- control is indicated apnea CPAP pressure of 7 cm and a ramp hA20 15 minutes
- After that has been raised gradually to 15 mm / hg for lack of clinical efficacy
- The patient after 15 months of intermittent use of CPAP not tolerated concerns as indicated by lateral pharyngoplasty and septoplasty without tamponade (12/02/10)
- As of 3 days postoperatively stop using the cpap.
- New control IAH 3 (12/02/11)
- Currently no incidents
Conclusions:
- Performing surgery without tamponade septoplasty technique combined with lateral pharyngoplasty is a definitive cure for apnea in selected patients.
