Impact of a rapid systemic guide on pediatric patients with suspicion of epilepsy

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Palau-Dávila, A. Camacho-Ortiz" "autores" => array:2 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Palau-Dávila" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Camacho-Ortiz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579616300539?idApp=UINPBA00004N" "url" => "/16655796/0000001800000071/v1_201608180032/S1665579616300539/v1_201608180032/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Impact of a rapid systemic guide on pediatric patients with suspicion of epilepsy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "63" "paginaFinal" => "72" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.R. Morales-Mancías, S. Vázquez-Fuentes, A.C. Cantú-Salinas, L. de León-Flores, B.E. Chávez-Luévanos, H. Villarreal-Velázquez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "L.R." "apellidos" => "Morales-Mancías" ] 1 => array:4 [ "nombre" => "S." "apellidos" => "Vázquez-Fuentes" "email" => array:1 [ 0 => "svfuentes03@yahoo.com.mx" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "A.C." "apellidos" => "Cantú-Salinas" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "de León-Flores" ] 4 => array:2 [ "nombre" => "B.E." "apellidos" => "Chávez-Luévanos" ] 5 => array:2 [ "nombre" => "H." "apellidos" => "Villarreal-Velázquez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pediatric Neurology Service at the “Dr. José Eleuterio González” University Hospital of at the Autonomous University of Nuevo León, Monterrey, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Servicio de Neurología Pediátrica del Hospital Universitario “Dr. José Eleuterio González” de la Universidad Autónoma de Nuevo León, Av. Francisco I. Madero pte y Ave. Gonzalitos s/n, Col. Mitras Centro, CP 64460 Monterrey, NL, Mexico." ] ] ] ] "textoCompleto" => "IntroductionSeizure, according to the International League Against Epilepsy (ILAE), is the transitory occurrence of signs and/or symptoms due to abnormal excessive synchronous neuronal activity in the brain.<a class="elsevierStyleCrossRef" href="#bib0060">1</a> Epilepsy is a disorder of the brain defined as the presence of hyper synchronous neuronal activity, which is clinically expressed by any of the following circumstances<a class="elsevierStyleCrossRef" href="#bib0065">2</a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•At least two unprovoked or reflex seizures occurring more than 24 hours apart.</li><li class="elsevierStyleListItem" id="lsti0010">•An unprovoked or reflex seizure, and a probability of presenting further seizures over the next 10 years, similar to the general recurrence risk (at least 60%) subsequent to the onset of two unprovoked seizures.</li><li class="elsevierStyleListItem" id="lsti0015">•As an integral part of an epileptic syndrome.</li></ul>An epilepsy syndrome is a group of signs and symptoms which define a unique epileptic condition, made up of convulsive crises with specific characteristics, onset age, gender predominance, etiology, cognitive or behavioral comorbidity, daily variation or its link to sleep and family history. Some triggering factors are: sleep deprivation, photic stimulation, hyperventilation, etc., which has direct implications in its management, evolution and prognosis within neurodevelopment and the result of the epilepsy, genetic tests and inheritance.<a class="elsevierStyleCrossRef" href="#bib0070">3</a>In Mexico, the prevalence in the Priority Programs for Epilepsy centers is 11–15/1000, thus this numbers suggest that in our country the number of patients with epilepsy is around 1.5 million.<a class="elsevierStyleCrossRef" href="#bib0075">4</a> In 2010, the ILAE redesigned the classification of seizures and epilepsy crises; dividing them into generalized, focal and unknown crisis (epileptic spasms).<a class="elsevierStyleCrossRef" href="#bib0080">5</a> Regarding to electro-clinical syndromes and other epilepsies, they were classified according to the age of onset and specific etiology as follows: genetic, structural/metabolic, of unknown causes, and in conditions which are not actual epilepsy.<a class="elsevierStyleCrossRef" href="#bib0080">5</a>The objective of this paper was to increase the percentage of epilepsies etiologic diagnoses in pediatric patients (according to the classification by the 2010 ILAE) using a systematic quick guide in pediatric patients with suspected epilepsy.Materials and methodsAn ambi-directional cohort study was conducted, with interventionism in the prospective group (with the application of the proposed systematic quick guide). The sample size was at convenience, all patients who arrived during one year in both groups.The first group studied was the prospective group, a systematic quick guide was used in this group (see <a class="elsevierStyleCrossRef" href="#sec0040">annex 1</a>). Inclusion criteria: patients under 16 years of age who attended the “Dr. José E. González” University Hospital in Monterrey, Nuevo León, México (at its hospital admission area or outpatient clinic) for the first time with suspicion of epilepsy, and who have been assessed by the Pediatric Neurology Service between June 18, 2014 and June 17, 2015. Exclusion criteria: Those patients who were 16 years old or older. Elimination criteria: Patients with an incomplete systematic quick guide, patients with an incomplete clinical file, patients who were ruled out of having epilepsy, and epileptic patients who did not complete the minimum studies (EEG and/or imaging studies) in order to classify them etiologically.After finishing the prospective group, the retrospective group began. We searched for the registries of every patient who attended the Pediatric Neurology Outpatient Clinic for the first time. All the files from those patients were reviewed, obtaining epidemiological data and etiological diagnoses of all patients with epilepsy. Inclusion criteria: Patients under 16 years of age, with suspicion of epilepsy. Exclusion criteria: Patients who were 16 years of age or older. Elimination criteria: Patients who were ruled out of having epilepsy and patients with incomplete clinical files.Databases for both groups were set up using Microsoft Excel 2010. Subsequently, a statistical analysis was performed using SPSS version 20, where a descriptive statistical analysis of the prospective and retrospective groups was completed, then the comparison between both groups was conducted using Pearson's chi square test (for the variables: gender and etiological diagnosis of epilepsy) and the Student T-test (for the age variable). A p<0.05 value was determined as a statistically significant result. This work was approved by the Ethics Committee of the School of Medicine at the Autonomous University of Nuevo Leon on April 20th, 2015, with the registry code NR15-003.ResultsThe proposed systematic quick guide was conducted on 137 patients with suspicion of epilepsy. Eight patients were ruled out of having epilepsy, and thus were eliminated, and another 9 patients with epilepsy were eliminated as well because they did not comply with the minimum tests (EEG and/or imaging studies) in order to classify them etiologically. The prospective group included 120 patients, while the retrospective group included 71 patients.First, a description of the prospective group was done (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>), and the Denver II tool was used to evaluate the patients’ psychomotor capability. Subsequently, an age comparison between prospective groups (patients admitted plus outpatients, and only outpatients) and the retrospective group was conducted (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Lastly, a comparison of epilepsy diagnosis by etiological groups was done between prospective groups (patients admitted plus outpatients, and only outpatients) and the retrospective group (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionA total of 120 patients were included in the prospective group and 71 patients in the retrospective group. Average age was 6.3 years for the first group and 7.7 for the second group, compared to a study conducted in Spain where the average age was 5.2 years.<a class="elsevierStyleCrossRef" href="#bib0085">6</a> Gender distribution in the prospective group was 66.7% male and 33.3% female, whereas for the retrospective group the distribution was 66.2% male and 33.8% female, compared to a study conducted in Turkey where 59.3% of the patients were male and 40.7% were female.<a class="elsevierStyleCrossRef" href="#bib0090">7</a> In the prospective group, 26.7% had family history of epilepsy, compared to the 22.2% and 22.5% of studies conducted in Germany<a class="elsevierStyleCrossRef" href="#bib0095">8</a> and Turkey,<a class="elsevierStyleCrossRef" href="#bib0090">7</a> respectively. In the prospective group, 83% of patients presented a generalized seizure crisis, 14.2% presented a focal and 2.5% presented an unknown (epileptic spasms), in comparison to a study conducted in Iceland<a class="elsevierStyleCrossRef" href="#bib0100">9</a> where 58% of patients presented a generalized seizure crisis, 40% presented a focal and 2% presented an unknown; furthermore, a study conducted in the US<a class="elsevierStyleCrossRef" href="#bib0105">10</a> showed 40% of patients with a generalized seizure crisis, 57% with a focal and 3% with an unknown seizure crisis. This gap in percentages can be attributed to the difficulty to express clinical characteristics of the crisis by people who witness them (they might have started focally and later become generalized). Regarding the prospective group, 70.8% of patients presented some anomaly in the neurological physical examination, while a study in Turkey reported only a 25.8% of patients presenting neurological anomalies.<a class="elsevierStyleCrossRef" href="#bib0090">7</a> This could be due to the fact that any neurological abnormality, including abnormalities in the higher brain functions, were considered anomalies in this study. If we change the nomenclature of the epileptic etiology from the symptomatic epilepsy, idiopathic epilepsy and cryptogenic epilepsy of the old ILAE 1989 classification, to the structural/metabolic epilepsy, genetic epilepsy and epilepsy with an unknown cause, respectively, from the new classification from the ILAE 2010, the prospective group (inpatient and ambulatory) had 2.5% unknown cause, 31.7% genetic cause (electroclinical syndromes), 61.7% structural/metabolic causes, and 4.2% which were not epilepsy, strictly speaking. In the retrospective group, we found that 52.1% of the patients had epilepsy of an unknown origin, 11.3% had epilepsy of a genetic origin, 36.6% had epilepsy of a structural/metabolic origin, and 0% had conditions which were not epilepsy, strictly speaking. We can compare our results to those of a study in Iceland,<a class="elsevierStyleCrossRef" href="#bib0100">9</a> where 53% of the patients had epilepsy of an unknown origin, 14% had epilepsy of a genetic origin, 32% had epilepsy of a structural/metabolic origin, and 1% had conditions which were not epilepsy, strictly speaking. Another study in Switzerland<a class="elsevierStyleCrossRef" href="#bib0110">11</a> concluded that 35% of the patients had epilepsy of an unknown origin, 10.3% had epilepsy of a genetic origin, 54% had epilepsy of a structural/metabolic origin, and 1% had conditions which were not epilepsy, strictly speaking.The positive aspects of this study include the following: it is a cohort, ambi-perspective study in a third level hospital, which is a reference center for the northeast of Mexico. It includes an important number of patients with epilepsy in both groups (prospective and retrospective), and the genders and ages within both groups were homogenous and therefore comparable. Other points in favor of this study are: the inclusion of clinical, demographic, epidemiological and therapeutic characteristics, creating a database for these patients. With the systematic rapid guide proposed in this study for pediatric patients under suspicion of epilepsy, this study showed, with statistical importance, that this guide decreases the “unknown cause” diagnoses of epilepsy and it increases the diagnoses of genetic and structural/metabolic epilepsy for our pediatric patients.Both study groups were evaluated over the course of a year, and it would be important to extend the follow-up time for these patients. This study has aspects which could be improved: 2.5% of the patients in the prospective group did not recieved an electroencephalogram, due to death or surgical or medical complications, or they were discharged before an electroencephalogram could be performed. 20% of the patients did not recieved any brain imaging studies, some of them due to a lack of economic resources and some due to contraindications from the sedative drugs during the study, due to which some patients may have been subdiagnosed with epilepsy of a structural origin. The genetic studies were no performed on patients from both groups; it will be important for some patients to corroborate their epileptic diagnosis in the future, for which they will have to be cheaper, as they currently cost around 20,000 MXN, which is quite inaccessible for the population at our hospital. This study did not document the frequency of convulsive crises before and after the epilepsy diagnosis, and if there was some electric or clinical improvement after having made the etiological diagnosis using the proposed systematic quick guide, and treating them accordingly. Because of this, we recommend a follow-up study to corroborate clinical or electric improvement in these patients. Some patients in the genetic epilepsy category may also have been “over-diagnosed” when we used the guide to determine their etiology.Another negative aspect of this study is that we were unable to document all the variables in the retrospective group that we were able to do with the prospective group.In this study, we can conclude that the rapid systemic guide we used can be corroborated with statistical significance with the increase in the etiological definition of epilepsy in pediatric patients, both in-hospital and ambulatory. This guide can be used by first contact doctors or pediatric neurologists to create a proper diagnostic approach oriented toward all patients under suspicion of epilepsy, to find an etiology diagnosis in accordance with the 2010 ILAE classification. This determination of the specific etiology, as well as the electro-clinical syndromes, will allow us to provide a complete management, oriented on and recommended by the international guides for each patient, which will help us to predict the clinical prognosis of our patients with greater exactitude.FundingNo financial support was provided.Conflict of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres719228" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec724459" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-12-03" "fechaAceptado" => "2016-02-23" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec724459" "palabras" => array:4 [ 0 => "Epilepsy" 1 => "Pediatrics" 2 => "Guide" 3 => "ILAE" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesIncrease the percentage of etiological diagnosis of epilepsy (according to the classification by the 2010 ILAE) using a systematic quick guide for pediatric patients with suspected epilepsy. MethodsAmbispective cohort study. Patients under 16 years old with suspected epilepsy were studied, and a systematic quick guide was applied to the prospective group, and later the two groups were compared. It was a convenience sample, with a study period of one year for both groups. ResultsThe prospective group was 120 patients and the retrospective group 71 patients. Comparing the epileptic diagnosis by etiology groups, in the prospective group (only outpatient patients), 3.3% had epilepsy of an unknown cause, 55% had epilepsy of a genetic cause, 36.7% had epilepsy of a structural/metabolic cause, and 5% had conditions that are not epilepsy itself. Meanwhile in the retrospective group, 52.1% had epilepsy of an unknown cause, 11.3% had epilepsy of a genetic cause, and 36.6% had epilepsy of a structural/metabolic cause (p<0.001). ConclusionsCompared to other similar studies, the etiological percentages of epilepsy increased. Using the systematic quick guide proposed, the percentage of etiological definitions of epilepsy was increased in pediatric patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia>" "etiqueta" => "Appendix A" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:10 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variant \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Hereditary or family history of epilepsy</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Psychomotor development</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Presentation of seizures</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Awake \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asleep \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Awake and asleep \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Seizure type</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Generalized \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Focal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unknown (epileptic spasms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Type of generalized seizure</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tonic-clonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Absence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Myoclonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clonic+Myoclonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Type of focal seizure</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Motor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Autonomic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Psychic phenomena \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensitive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Performance of electroencephalogram</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">117 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Electroencephalogramresult</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Performance of imaging study</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Type of imaging study performed</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Computed axial tomography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Result of the imaging study</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Physical neurological examination</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1182406.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of the prospective group (in-hospital and ambulatory patients)." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD: Standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variant \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Average \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">±SD \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age at first seizure (in years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of seizures (in min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of postictal period (in min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1182408.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prospective group (in-hospital and ambulatory patients)." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD: Standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Average (in years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">±SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Age</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prospective (in-hospital and ambulatory patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="middle">0.076</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prospective (ambulatory patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="middle">0.509</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1182405.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Age comparison between the prospective groups (in-hospital and ambulatory patients, and only ambulatory patients) and the retrospective group." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis of epilepsy by etiological group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="center" valign="middle">Prospective (in-hospital and ambulatory patients)</td><td class="td" title="table-entry " align="left" valign="top">Epilepsy of an unknown cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="8" align="char" valign="middle"><0.001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a genetic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a structural/metabolic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conditions that are not epilepsy, strictly speaking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="center" valign="middle">Retrospective</td><td class="td" title="table-entry " align="left" valign="top">Epilepsy of an unknown cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a genetic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a structural/metabolic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conditions that are not epilepsy, strictly speaking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="center" valign="middle">Prospective (ambulatory patients)</td><td class="td" title="table-entry " align="left" valign="top">Epilepsy of an unknown cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="8" align="char" valign="middle"><0.001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a genetic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a structural/metabolic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conditions that are not epilepsy, strictly speaking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="center" valign="middle">Retrospective</td><td class="td" title="table-entry " align="left" valign="top">Epilepsy of an unknown cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a genetic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a structural/metabolic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conditions that are not epilepsy, strictly speaking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1182407.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of the epilepsy diagnosis by etiological groups between the prospective groups (in-hospital and ambulatory patients, and only ambulatory patients) and the retrospective group." ] ] 4 => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 2729 "Ancho" => 2508 "Tamanyo" => 319321 ] ] ] 5 => array:5 [ "identificador" => "fig0010" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx2.jpeg" "Alto" => 3366 "Ancho" => 2500 "Tamanyo" => 378829 ] ] ] 6 => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx3.jpeg" "Alto" => 3218 "Ancho" => 2500 "Tamanyo" => 408636 ] ] ] 7 => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx4.jpeg" "Alto" => 3547 "Ancho" => 2512 "Tamanyo" => 458868 ] ] ] 8 => array:5 [ "identificador" => "fig0025" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx5.jpeg" "Alto" => 3187 "Ancho" => 2501 "Tamanyo" => 405001 ] ] ] 9 => array:5 [ "identificador" => "fig0030" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx6.jpeg" "Alto" => 1384 "Ancho" => 2507 "Tamanyo" => 120776 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.S. 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Kurland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Epilepsia" "fecha" => "1993" "volumen" => "34" "paginaInicial" => "453" "paginaFinal" => "468" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8504780" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of first epileptic seizures in the canton of Geneva, Switzerland" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Jallon" 1 => "M. Goumaz" 2 => "C. Haenggeli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Epilepsia" "fecha" => "1997" "volumen" => "38" "paginaInicial" => "547" "paginaFinal" => "552" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9184600" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16655796/0000001800000071/v1_201608180032/S1665579616300564/v1_201608180032/en/main.assets" "Apartado" => array:4 [ "identificador" => "55396" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/16655796/0000001800000071/v1_201608180032/S1665579616300564/v1_201608180032/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579616300564?idApp=UINPBA00004N"]

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L.R. Morales-Mancías, S. Vázquez-Fuentes

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svfuentes03@yahoo.com.mx

Corresponding author at: Servicio de Neurología Pediátrica del Hospital Universitario “Dr. José Eleuterio González” de la Universidad Autónoma de Nuevo León, Av. Francisco I. Madero pte y Ave. Gonzalitos s/n, Col. Mitras Centro, CP 64460 Monterrey, NL, Mexico.

, A.C. Cantú-Salinas, L. de León-Flores, B.E. Chávez-Luévanos, H. Villarreal-Velázquez

Pediatric Neurology Service at the “Dr. José Eleuterio González” University Hospital of at the Autonomous University of Nuevo León, Monterrey, Mexico

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Seizure&#44; according to the International League Against Epilepsy &#40;ILAE&#41;&#44; is the transitory occurrence of signs and&#47;or symptoms due to abnormal excessive synchronous neuronal activity in the brain&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Epilepsy is a disorder of the brain defined as the presence of hyper synchronous neuronal activity&#44; which is clinically expressed by any of the following circumstances<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0010" class="elsevierStylePara elsevierViewall">At least two unprovoked or reflex seizures occurring more than 24 hours apart&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">An unprovoked or reflex seizure&#44; and a probability of presenting further seizures over the next 10 years&#44; similar to the general recurrence risk &#40;at least 60&#37;&#41; subsequent to the onset of two unprovoked seizures&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">As an integral part of an epileptic syndrome&#46;</p></li></ul></p><p id="par0025" class="elsevierStylePara elsevierViewall">An epilepsy syndrome is a group of signs and symptoms which define a unique epileptic condition&#44; made up of convulsive crises with specific characteristics&#44; onset age&#44; gender predominance&#44; etiology&#44; cognitive or behavioral comorbidity&#44; daily variation or its link to sleep and family history&#46; Some triggering factors are&#58; sleep deprivation&#44; photic stimulation&#44; hyperventilation&#44; etc&#46;&#44; which has direct implications in its management&#44; evolution and prognosis within neurodevelopment and the result of the epilepsy&#44; genetic tests and inheritance&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In Mexico&#44; the prevalence in the Priority Programs for Epilepsy centers is 11&#8211;15&#47;1000&#44; thus this numbers suggest that in our country the number of patients with epilepsy is around 1&#46;5 million&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> In 2010&#44; the ILAE redesigned the classification of seizures and epilepsy crises&#59; dividing them into generalized&#44; focal and unknown crisis &#40;epileptic spasms&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Regarding to electro-clinical syndromes and other epilepsies&#44; they were classified according to the age of onset and specific etiology as follows&#58; genetic&#44; structural&#47;metabolic&#44; of unknown causes&#44; and in conditions which are not actual epilepsy&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The objective of this paper was to increase the percentage of epilepsies etiologic diagnoses in pediatric patients &#40;according to the classification by the 2010 ILAE&#41; using a systematic quick guide in pediatric patients with suspected epilepsy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">An ambi-directional cohort study was conducted&#44; with interventionism in the prospective group &#40;with the application of the proposed systematic quick guide&#41;&#46; The sample size was at convenience&#44; all patients who arrived during one year in both groups&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The first group studied was the prospective group&#44; a systematic quick guide was used in this group &#40;see <a class="elsevierStyleCrossRef" href="#sec0040">annex 1</a>&#41;&#46; <span class="elsevierStyleItalic">Inclusion criteria</span>&#58; patients under 16 years of age who attended the &#8220;Dr&#46; Jos&#233; E&#46; Gonz&#225;lez&#8221; University Hospital in Monterrey&#44; Nuevo Le&#243;n&#44; M&#233;xico &#40;at its hospital admission area or outpatient clinic&#41; for the first time with suspicion of epilepsy&#44; and who have been assessed by the Pediatric Neurology Service between June 18&#44; 2014 and June 17&#44; 2015&#46; <span class="elsevierStyleItalic">Exclusion criteria</span>&#58; Those patients who were 16 years old or older&#46; <span class="elsevierStyleItalic">Elimination criteria</span>&#58; Patients with an incomplete systematic quick guide&#44; patients with an incomplete clinical file&#44; patients who were ruled out of having epilepsy&#44; and epileptic patients who did not complete the minimum studies &#40;EEG and&#47;or imaging studies&#41; in order to classify them etiologically&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">After finishing the prospective group&#44; the retrospective group began&#46; We searched for the registries of every patient who attended the Pediatric Neurology Outpatient Clinic for the first time&#46; All the files from those patients were reviewed&#44; obtaining epidemiological data and etiological diagnoses of all patients with epilepsy&#46; <span class="elsevierStyleItalic">Inclusion criteria</span>&#58; Patients under 16 years of age&#44; with suspicion of epilepsy&#46; <span class="elsevierStyleItalic">Exclusion criteria</span>&#58; Patients who were 16 years of age or older&#46; <span class="elsevierStyleItalic">Elimination criteria</span>&#58; Patients who were ruled out of having epilepsy and patients with incomplete clinical files&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Databases for both groups were set up using Microsoft Excel 2010&#46; Subsequently&#44; a statistical analysis was performed using SPSS version 20&#44; where a descriptive statistical analysis of the prospective and retrospective groups was completed&#44; then the comparison between both groups was conducted using Pearson&#39;s chi square test &#40;for the variables&#58; gender and etiological diagnosis of epilepsy&#41; and the Student <span class="elsevierStyleItalic">T</span>-test &#40;for the age variable&#41;&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 value was determined as a statistically significant result&#46; This work was approved by the Ethics Committee of the School of Medicine at the Autonomous University of Nuevo Leon on April 20th&#44; 2015&#44; with the registry code NR15-003&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The proposed systematic quick guide was conducted on 137 patients with suspicion of epilepsy&#46; Eight patients were ruled out of having epilepsy&#44; and thus were eliminated&#44; and another 9 patients with epilepsy were eliminated as well because they did not comply with the minimum tests &#40;EEG and&#47;or imaging studies&#41; in order to classify them etiologically&#46; The prospective group included 120 patients&#44; while the retrospective group included 71 patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">First&#44; a description of the prospective group was done &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#41;&#44; and the Denver II tool was used to evaluate the patients&#8217; psychomotor capability&#46; Subsequently&#44; an age comparison between prospective groups &#40;patients admitted plus outpatients&#44; and only outpatients&#41; and the retrospective group was conducted &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Lastly&#44; a comparison of epilepsy diagnosis by etiological groups was done between prospective groups &#40;patients admitted plus outpatients&#44; and only outpatients&#41; and the retrospective group &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 120 patients were included in the prospective group and 71 patients in the retrospective group&#46; Average age was 6&#46;3 years for the first group and 7&#46;7 for the second group&#44; compared to a study conducted in Spain where the average age was 5&#46;2 years&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Gender distribution in the prospective group was 66&#46;7&#37; male and 33&#46;3&#37; female&#44; whereas for the retrospective group the distribution was 66&#46;2&#37; male and 33&#46;8&#37; female&#44; compared to a study conducted in Turkey where 59&#46;3&#37; of the patients were male and 40&#46;7&#37; were female&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> In the prospective group&#44; 26&#46;7&#37; had family history of epilepsy&#44; compared to the 22&#46;2&#37; and 22&#46;5&#37; of studies conducted in Germany<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> and Turkey&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> respectively&#46; In the prospective group&#44; 83&#37; of patients presented a generalized seizure crisis&#44; 14&#46;2&#37; presented a focal and 2&#46;5&#37; presented an unknown &#40;epileptic spasms&#41;&#44; in comparison to a study conducted in Iceland<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> where 58&#37; of patients presented a generalized seizure crisis&#44; 40&#37; presented a focal and 2&#37; presented an unknown&#59; furthermore&#44; a study conducted in the US<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> showed 40&#37; of patients with a generalized seizure crisis&#44; 57&#37; with a focal and 3&#37; with an unknown seizure crisis&#46; This gap in percentages can be attributed to the difficulty to express clinical characteristics of the crisis by people who witness them &#40;they might have started focally and later become generalized&#41;&#46; Regarding the prospective group&#44; 70&#46;8&#37; of patients presented some anomaly in the neurological physical examination&#44; while a study in Turkey reported only a 25&#46;8&#37; of patients presenting neurological anomalies&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> This could be due to the fact that any neurological abnormality&#44; including abnormalities in the higher brain functions&#44; were considered anomalies in this study&#46; If we change the nomenclature of the epileptic etiology from the symptomatic epilepsy&#44; idiopathic epilepsy and cryptogenic epilepsy of the old ILAE 1989 classification&#44; to the structural&#47;metabolic epilepsy&#44; genetic epilepsy and epilepsy with an unknown cause&#44; respectively&#44; from the new classification from the ILAE 2010&#44; the prospective group &#40;inpatient and ambulatory&#41; had 2&#46;5&#37; unknown cause&#44; 31&#46;7&#37; genetic cause &#40;electroclinical syndromes&#41;&#44; 61&#46;7&#37; structural&#47;metabolic causes&#44; and 4&#46;2&#37; which were not epilepsy&#44; strictly speaking&#46; In the retrospective group&#44; we found that 52&#46;1&#37; of the patients had epilepsy of an unknown origin&#44; 11&#46;3&#37; had epilepsy of a genetic origin&#44; 36&#46;6&#37; had epilepsy of a structural&#47;metabolic origin&#44; and 0&#37; had conditions which were not epilepsy&#44; strictly speaking&#46; We can compare our results to those of a study in Iceland&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> where 53&#37; of the patients had epilepsy of an unknown origin&#44; 14&#37; had epilepsy of a genetic origin&#44; 32&#37; had epilepsy of a structural&#47;metabolic origin&#44; and 1&#37; had conditions which were not epilepsy&#44; strictly speaking&#46; Another study in Switzerland<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> concluded that 35&#37; of the patients had epilepsy of an unknown origin&#44; 10&#46;3&#37; had epilepsy of a genetic origin&#44; 54&#37; had epilepsy of a structural&#47;metabolic origin&#44; and 1&#37; had conditions which were not epilepsy&#44; strictly speaking&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The positive aspects of this study include the following&#58; it is a cohort&#44; ambi-perspective study in a third level hospital&#44; which is a reference center for the northeast of Mexico&#46; It includes an important number of patients with epilepsy in both groups &#40;prospective and retrospective&#41;&#44; and the genders and ages within both groups were homogenous and therefore comparable&#46; Other points in favor of this study are&#58; the inclusion of clinical&#44; demographic&#44; epidemiological and therapeutic characteristics&#44; creating a database for these patients&#46; With the systematic rapid guide proposed in this study for pediatric patients under suspicion of epilepsy&#44; this study showed&#44; with statistical importance&#44; that this guide decreases the &#8220;unknown cause&#8221; diagnoses of epilepsy and it increases the diagnoses of genetic and structural&#47;metabolic epilepsy for our pediatric patients&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Both study groups were evaluated over the course of a year&#44; and it would be important to extend the follow-up time for these patients&#46; This study has aspects which could be improved&#58; 2&#46;5&#37; of the patients in the prospective group did not recieved an electroencephalogram&#44; due to death or surgical or medical complications&#44; or they were discharged before an electroencephalogram could be performed&#46; 20&#37; of the patients did not recieved any brain imaging studies&#44; some of them due to a lack of economic resources and some due to contraindications from the sedative drugs during the study&#44; due to which some patients may have been subdiagnosed with epilepsy of a structural origin&#46; The genetic studies were no performed on patients from both groups&#59; it will be important for some patients to corroborate their epileptic diagnosis in the future&#44; for which they will have to be cheaper&#44; as they currently cost around 20&#44;000 MXN&#44; which is quite inaccessible for the population at our hospital&#46; This study did not document the frequency of convulsive crises before and after the epilepsy diagnosis&#44; and if there was some electric or clinical improvement after having made the etiological diagnosis using the proposed systematic quick guide&#44; and treating them accordingly&#46; Because of this&#44; we recommend a follow-up study to corroborate clinical or electric improvement in these patients&#46; Some patients in the genetic epilepsy category may also have been &#8220;over-diagnosed&#8221; when we used the guide to determine their etiology&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Another negative aspect of this study is that we were unable to document all the variables in the retrospective group that we were able to do with the prospective group&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In this study&#44; we can conclude that the rapid systemic guide we used can be corroborated with statistical significance with the increase in the etiological definition of epilepsy in pediatric patients&#44; both in-hospital and ambulatory&#46; This guide can be used by first contact doctors or pediatric neurologists to create a proper diagnostic approach oriented toward all patients under suspicion of epilepsy&#44; to find an etiology diagnosis in accordance with the 2010 ILAE classification&#46; This determination of the specific etiology&#44; as well as the electro-clinical syndromes&#44; will allow us to provide a complete management&#44; oriented on and recommended by the international guides for each patient&#44; which will help us to predict the clinical prognosis of our patients with greater exactitude&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0095" class="elsevierStylePara elsevierViewall">No financial support was provided&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "xres719228"
          "titulo" => "Abstract"
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          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
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        4 => array:2 [
          "identificador" => "sec0015"
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        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
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        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Funding"
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        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflict of interest"
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        8 => array:1 [
          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-12-03"
    "fechaAceptado" => "2016-02-23"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec724459"
          "palabras" => array:4 [
            0 => "Epilepsy"
            1 => "Pediatrics"
            2 => "Guide"
            3 => "ILAE"
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    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Increase the percentage of etiological diagnosis of epilepsy &#40;according to the classification by the 2010 ILAE&#41; using a systematic quick guide for pediatric patients with suspected epilepsy&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ambispective cohort study&#46; Patients under 16 years old with suspected epilepsy were studied&#44; and a systematic quick guide was applied to the prospective group&#44; and later the two groups were compared&#46; It was a convenience sample&#44; with a study period of one year for both groups&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The prospective group was 120 patients and the retrospective group 71 patients&#46; Comparing the epileptic diagnosis by etiology groups&#44; in the prospective group &#40;only outpatient patients&#41;&#44; 3&#46;3&#37; had epilepsy of an unknown cause&#44; 55&#37; had epilepsy of a genetic cause&#44; 36&#46;7&#37; had epilepsy of a structural&#47;metabolic cause&#44; and 5&#37; had conditions that are not epilepsy itself&#46; Meanwhile in the retrospective group&#44; 52&#46;1&#37; had epilepsy of an unknown cause&#44; 11&#46;3&#37; had epilepsy of a genetic cause&#44; and 36&#46;6&#37; had epilepsy of a structural&#47;metabolic cause &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Compared to other similar studies&#44; the etiological percentages of epilepsy increased&#46; Using the systematic quick guide proposed&#44; the percentage of etiological definitions of epilepsy was increased in pediatric patients&#46;</p></span>"
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            "identificador" => "abst0005"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "apendice" => "<p id="par0110" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "identificador" => "sec0040"
          ]
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      ]
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Hereditary or family history of epilepsy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Psychomotor development</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abnormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Presentation of seizures</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Awake&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asleep&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Awake and asleep&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Seizure type</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Generalized&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Focal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown &#40;epileptic spasms&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Type of generalized seizure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tonic-clonic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tonic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Absence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clonic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Atonic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Myoclonic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clonic<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Myoclonic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Type of focal seizure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Motor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Autonomic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psychic phenomena&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sensitive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Performance of electroencephalogram</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Electroencephalogramresult</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abnormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Performance of imaging study</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Type of imaging study performed</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Computed axial tomography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Result of the imaging study</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abnormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Physical neurological examination</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abnormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variant&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age at first seizure &#40;in years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of seizures &#40;in min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of postictal period &#40;in min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prospective &#40;ambulatory patients&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis of epilepsy by etiological group&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="center" valign="middle">Prospective &#40;in-hospital and ambulatory patients&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Epilepsy of an unknown cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="8" align="char" valign="middle">&#60;0&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a genetic cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a structural&#47;metabolic cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conditions that are not epilepsy&#44; strictly speaking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="center" valign="middle">Retrospective</td><td class="td" title="table-entry  " align="left" valign="top">Epilepsy of an unknown cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a genetic cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a structural&#47;metabolic cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conditions that are not epilepsy&#44; strictly speaking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="center" valign="middle">Prospective &#40;ambulatory patients&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Epilepsy of an unknown cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="8" align="char" valign="middle">&#60;0&#46;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a genetic cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a structural&#47;metabolic cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conditions that are not epilepsy&#44; strictly speaking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="center" valign="middle">Retrospective</td><td class="td" title="table-entry  " align="left" valign="top">Epilepsy of an unknown cause&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a genetic cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epilepsy of a structural&#47;metabolic cause&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conditions that are not epilepsy&#44; strictly speaking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 16655796
Original language: English

DOI:10.1016/j.rmu.2016.02.001

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Year/Month	Html	Pdf	Total

2024 November	4	0	4
2024 October	12	2	14
2024 September	31	4	35
2024 August	23	3	26
2024 July	23	7	30
2024 June	18	1	19
2024 May	8	9	17
2024 April	7	7	14
2024 March	9	7	16
2024 February	7	3	10
2024 January	16	10	26
2023 December	9	8	17
2023 November	13	5	18
2023 October	11	9	20
2023 September	13	1	14
2023 August	7	5	12
2023 July	6	5	11
2023 June	8	2	10
2023 May	8	13	21
2023 April	9	4	13
2023 March	10	4	14
2023 February	12	6	18
2023 January	10	8	18
2022 December	16	22	38
2022 November	15	21	36
2022 October	16	6	22
2022 September	10	8	18
2022 August	16	10	26
2022 July	10	8	18
2022 June	10	11	21
2022 May	7	9	16
2022 April	14	8	22
2022 March	9	9	18
2022 February	12	6	18
2022 January	18	5	23
2021 December	11	11	22
2021 November	16	9	25
2021 October	28	10	38
2021 September	24	10	34
2021 August	21	9	30
2021 July	11	8	19
2021 June	10	8	18
2021 May	24	6	30
2021 April	37	20	57
2021 March	22	5	27
2021 February	8	4	12
2021 January	14	8	22
2020 December	12	8	20
2020 November	12	2	14
2020 October	11	10	21
2020 September	14	9	23
2020 August	14	3	17
2020 July	6	2	8
2020 June	15	9	24
2020 May	42	15	57
2020 April	8	3	11
2020 March	16	5	21
2020 February	13	8	21
2020 January	14	4	18
2019 December	14	10	24
2019 November	7	7	14
2019 October	6	5	11
2019 September	9	4	13
2019 August	6	4	10
2019 July	16	9	25
2019 June	34	29	63
2019 May	103	48	151
2019 April	49	9	58
2019 March	10	11	21
2019 February	11	2	13
2019 January	12	6	18
2018 December	5	7	12
2018 November	18	2	20
2018 October	11	2	13
2018 September	27	6	33
2018 August	0	3	3
2018 July	2	2	4
2018 June	5	3	8
2018 May	2	2	4
2018 April	2	4	6
2018 March	2	1	3
2018 February	5	2	7
2018 January	1	2	3
2017 December	5	1	6
2017 November	6	4	10
2017 October	5	0	5
2017 September	10	2	12
2017 August	12	12	24
2017 July	14	2	16
2017 June	18	12	30
2017 May	19	14	33
2017 April	18	4	22
2017 March	21	30	51
2017 February	19	4	23
2017 January	16	2	18
2016 December	34	9	43
2016 November	39	9	48
2016 October	37	11	48
2016 September	41	9	50
2016 August	33	12	45
2016 July	2	4	6

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