The Ketogenic Diet (KD) is a modality of treatment used since the 1920s as a treatment for intractable epilepsy. It has been proposed as a dietary treatment that would produce similar benefits to fasting, which is already recorded in the Hippocratic collection. The KD has a high fat content (90%) and low protein and carbohydrate. Evidence shows that KD and its variants are a good alternative for non-surgical pharmacoresistant patients with epilepsy of any age, taking into account that the type of diet should be designed individually and that less-restrictive and more-palatable diets are usually better options for adults and adolescents. This review discusses the KD, including the possible mechanisms of action, applicability, side effects, and evidence for its efficacy, and for the more-palatable diets such as the Modified Atkins Diet (MAD) and the Low Glycemic Index Diet (LGID) in children and adults.

No abstract

Pilocarpine is a cholinergic agonist that increases salivary flow and has been used to treat xerostomia. Oral intake is the most frequent route of administration. Adverse effects are dose-dependent and include sudoresis, facial blushing and increased urinary frequency. The objective of the present study was to evaluate the effects of topical pilocarpine solutions as mouthwashes on salivary flow and their adverse effects on healthy subjects. Forty volunteers received 10 ml 0.5, 1 and 2% pilocarpine solutions or 0.9% saline in a randomized, double-blind, placebo-controlled manner. Salivation was measured before and 45, 60 and 75 min after mouth rinsing for 1 min with 10 ml of saline or pilocarpine solutions. Vital signs were measured and ocular, gastrointestinal and cardiovascular symptoms, anxiety and flushing were estimated using visual analog scales. There was a dosedependent increase in salivation. Salivation measured after 1 and 2% pilocarpine (1.4 ± 0.36 and 2.22 ± 0.42 g, respectively) was significantly (P<0.001) higher than before (0.70 ± 0.15 and 0.64 ± 0.1 g), with a plateau between 45 and 75 min. Cardiovascular, visual, gastrointestinal and behavioral symptoms and signs were not changed by topical pilocarpine. Mouth rinsing with pilocarpine solutions at concentrations of 1 to 2% induced a significant objective and subjective dose-dependent increase in salivary flow, similar to the results reported by others studying the effect of oral 5 mg pilocarpine. The present study revealed the efficacy of pilocarpine mouthwash solutions in increasing salivary flow in healthy volunteers, with no adverse effects. Additional studies on patients with xerostomia are needed.

Background Lacosamide (LCM) is a third-generation anti-seizure drug approved in Europe and the United States, either as a monotherapy or adjunctive therapy, to treat partial-onset seizures in adults, adolescents, and children. In Brazil, LCM is licensed for treatment only in patients older than 16 years of age. Objective To evaluate a cohort of children presenting with refractory epilepsy who received LCM as an add-on therapy and observe the response and tolerability to the LCM treatment. Methods A retrospective cohort study conducted in a tertiary health care facility, which included 26 children, aged up to 16 years, who presented with refractory epilepsy and received LCM as an add-on treatment. The follow-up visits were scheduled every 3 months until 9 months of treatment with LCM. Results After 3 months of LCM administration, in 73.1% of the children, there was a reduction of > 50% in the frequency of seizures, and this clinical improvement was maintained in most patients (73.9%) for the following 9 months. Mild (such as, somnolence and behavioral changes) or severe (seizure worsening) adverse effects were observed in two and three children respectively. Among responders to LCM, there was a higher prevalence of males, fewer concomitant anti-seizure drugs, and lower percentage of patients using sodium channel blockers. Conclusions Lacosamide should be considered as an early treatment option in pediatric patients with refractory epilepsy, mainly focal seizures.

-This article describes a 76 years old man that, after lung cancer surgery, showed left extrinsic oculomotor paralysis and contralateral paralysis of the superior rectus muscle associated with bilateral ptosis. Magnetic resonance imaging confirmed a rare situation characterized by an isolated metastasis in the region of the left third cranial nerve nucleus, probably compromising the superior rectus subnucleus and the central caudal nucleus, therefore justifying the bilateral oculomotor involvement.KEY WORDS: Cranial third nerve nucleus, metastasis, ophthalmoplegia.Metástase para o complexo nuclear oculomotor unilateral: relato de caso RESUMO -O presente relato descreve um homem de 76 anos que, após ciru rgia de câncer de pulmão apresentou paralisia oculomotora extrínseca à esquerda e paralisia contralateral do músculo reto superior, além de ptose palpebral bilateral. O exame de ressonância magnética evidenciou uma rara situação caracterizada por metástase isolada na região do núcleo do terc e i ro nervo craniano esquerdo provavelmente comp rometendo o sub-núcleo do reto superior e o núcleo central caudal, justificando assim o envolvimento óculo motor bilateral. PALAVRAS-CHAVE: Núcleo do III nervo cranial, metástase, oftalmoplegia. c a rcinoma in the right lung. A right inferior lobectomy with mediastinal linfadenectomy was done without interc u rrences. Based on the TNM international staging system, his lung cancer was classified as T III N 0 M 0. Ten days later, he had a rapidly pro g ressive bilateral ptosis. Examination revealed a lucid, oriented, and concerned patient, with cranial nerve III extrinsic palsy in the left eye and right ptosis associated with up gaze palsy (Fig 1). His pupils were of medium caliber, symmetric, and responded to light. He could forcefully close his eyes. The fundus oculis was irrem a rcable, and the remainder of the examination was unrevealing. He had no headaches, fever, or signs of intracranial hypertension. Eletro n e u romiography examination was n o rmal and the brain MRI demonstrated a lesion in the midbrain adjacent to the cerebral aqueduct, in the re g i o n of the left oculom otor nucleus (Fig 2). Radiotherapy w as done, and after that, the patient phy sically deteriorated without changes in the oculomotor aspects, until his death one month later. Post Mortem, the patient's daughter has f o rmally given authorization for the publication of this case report.D i ff e rent kinds of lesions can compromise the t h i rdnerve nucleus 1 , 2 . Solitary metastasis to the brainstem is uncommon; isolated metastasis concern i n g the nucleus of the third cranial nerve is even rare r. Ve rtical eye movements are organized in the midbrain, with ipsilateral oculomotor paralysis and contralateral paralysis of the superior rectus muscle, when the third nerve nucleus is unilaterally damaged, associated with bilateral ptosis, when the lesion also affects the central caudal nucleus 3 .The aim of this article is to re p o rt a rare case of bilateral oculomotor signs and magnetic re s ...