Association of protease inhibitors and ergotamine causing systemic ergotism is well established 1,2,3 . Cerebral ergotism is poorly reported 4,5 . We describe the case of an HIV positive 49 yo man under protease inhibitors (ritonavir) presenting with total reversible left hemiparesis after the intake of 3 g of ergotamine. After 20 minutes he was spontaneously asymptomatic. TIA was diagnosed. Parenchymal MRI was normal, cervical doppler ultrasound showed symmetric narrowing in both internal carotid arteries, causes of cardiac embolism were properly excluded. Angio Magnetic Resonance Imaging (Figures 1 and 2) was performed in acute stage and evolution, as well as cerebral angiography, leading to the diagnosis of cerebral ergotism. Between both MRI showed, only aspirin 325 mg and bed rest was indicated.
Aim
. The aim of the study was to evaluate the clinical applicability of the 2017 ILAE classification of seizures and epilepsies through the analysis of a sample of 100 outpatients with a diagnosis of epilepsy.
Methods
. All clinical charts were reviewed applying both the 1981/1989 and 2017 classifications of seizures and epilepsies, respectively. For most focal seizures, descriptors were required to include all the relevant clinical information. The reclassification of complex partial seizures into focal seizures with impaired awareness with a motor / non‐motor onset allowed the inclusion of features of topographic value, although the chronological sequence of awareness impairment was lacking.
Results
. The use of the term “focal to bilateral tonic‐clonic” reduced the number of seizures classified as generalized tonic‐clonic seizures (GTCS) by 19%. A subset of GTCS (35%) and absence seizures (12.5%) were reclassified as seizures of unknown onset. Most focal symptomatic epilepsies (92%) were reclassified as focal structural epilepsies, while 27% of idiopathic generalized and 7% of focal cryptogenic epilepsies merged into the category of “epilepsies of unknown type”.
Conclusion
. Major strengths of the new classification are simplicity and the role of the category “unknown onset” to avoid forced categorization. A section assigned to uncertainty reinforces the need for further ancillary studies and periodic diagnostic re‐evaluation.
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