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Estado actual de la Esclerosis Múltiple en Ecuador. Current Status of Multiple Sclerosis in Ecuador.
Trastorno del desarrollo de la coordinación en la infancia: Interacción con la condición física y estado nutricional. Developmental coordination disorder in childhood: Interaction with physical condition and nutritional status.
Dear Editor:
Developmental coordination disorder (DCD), or dyspraxis, is a challenge of interest to both clinical researchers and education professionals, particularly pre-service teachers. This disorder, as described by Castelluci et al., is characterized by impaired motor performance and difficulties learning motor skills in childhood.
Recent evidence suggests that infants with greater motor impairment are at increased risk of developing health problems, given that decreased levels of physical activity and participation in sports activities could aggravate this condition. In this case, infants with probable DCD have demonstrated lower levels of muscle strength, aerobic fitness, and endurance compared to their peers without DCD.
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Mejorando la Atención del Evento Cerebrovascular en Ecuador a través de una Red Articulada de Atención Improving Cerebrovascular Event Care in Ecuador through an Articulated Care Network
In the era of “big data” in health and healthcare, the need for high-quality information on population health has never been more critical. In the context of cerebrovascular events (CVD) in Ecuador, the increasing burden of the disease, the inequity in the distribution of neurologists, and the recent enactment of the Universal Health Care Law underscore the urgency of establishing effective networks between primary care and hospitals prepared to treat CVD. This article reviews the existing literature and evidence highlighting the role of primary care providers (PCPs) and specialists in the different stages of CVD management, as well as care transitions and the use of telemedicine/teleneurology.
The experience in Ecuador with the “Act with Speed” campaign launched by the Vice Presidency of the Republic in coordination with the Global Angels initiative provides a valuable model. This campaign has certified hospitals as Stroke Ready Centers, trained thousands of professionals, and raised awareness among the population about the importance of a rapid response to a CVD. Implementing a CVD referral network between primary care and specialized hospitals could significantly improve patient outcomes, especially in underserved areas.
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Ambientes Saludables en la Infancia Temprana. La clave para el desarrollo de Funciones Ejecutivas Healthy Environments in Early Childhood. The key to the development of Executive Functions.
We would like to complement the findings of the article “Daily Stress, Executive Functions, and Academic Performance in Elementary School Children” by Armstrong-Gallegos and Troncoso-Díaz, published in the Ecuadorian Journal of Neurology (Vol. 33, No. 1, 2024). Along these lines, we propose adding the perspective of the first two years of life, understanding that this is a critical stage in this process.
The brain development of children is rapid and crucial. Nutrition plays a fundamental role during these first years of life. Nutrients such as iron, omega-3 fatty acids, and B vitamins support important processes such as myelination and synaptogenesis. These processes, in turn, are key to executive function (EF) skills such as working memory, inhibitory control, and cognitive flexibility.1,2 Conversely, a lack of these nutrients can lead to long-term difficulties with self-regulation, impacting social and educational environments.3 Furthermore, glucose, as the brain’s primary energy source, when blood levels fluctuate too much, may make it harder for individuals to stay focused or control their impulses, which can affect their performance and interactions with others.
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Palabras clave: Funciones Ejecutivas,
infancia temprana,
Keywords: early childhood,
Executive function,
Características Clínicas de Pacientes Hipertensos hospitalizados con y sin Enfermedad Cerebrovascular de 60 a 90 años en Quito, Ecuador: Estudio de Casos y Controles. Clinical Characteristics of hospitalized Hypertensive Patients with and without Stroke aged 60 to 90 years in Quito, Ecuador: A Case-Control Study.
Background: Stroke is the world’s second leading cause of death from disease, and disability-adjusted life years. The investment in management of a hospitalized stroke patient generates a high healthcare cost. In Ecuador it is the third leading cause of death. Hypertension is one of the most important factors in the stroke development. Patients with high blood pressure and stroke have a higher risk of complications, mortality and poor prognosis.
Objective: The present study aimed to identify which variables differ between hypertensive patients with stroke versus hypertensive patients without stroke, hospitalized, during 2017- 2020.
Methods: In a population of 96 cases and 57 controls, a retrospective analytical cohort study between two groups of patients was conducted.
Results: The variable education (primary education) was the most affected among cases (χ²=13.298; p=0.039). Patients with atrial fibrillation were significantly higher in the case group (χ²=7.31 p=0.007). Other variables like: sex, age, provenance, years lived with hypertension, smoking, type 2 diabetes mellitus, heart failure, hypercholesterolemia and anticoagulant therapy, showed no significant difference between the two groups.
Conclusions: Patients with complete primary education and atrial fibrillation had significant presence in hypertensive patients with stroke.
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Factors related to swallowing prognosis in patients with acute ischemic stroke at a specialized institution in Medellín, Colombia. Factores asociados con el pronóstico deglutorio en pacientes con accidente cerebrovascular isquémico agudo en una institución especializada en Medellín, Colombia.
Objetive: To analyze the factors associated with swallowing prognosis among individuals with acute ischemic stroke who received treatment at a specialized neurology institution in Medellín, Colombia, in 2020.
Methods: This registry-based retrospective cohort study evaluated clinical factors influencing dysphagia, employing parametric survival models for interval-censored data.
Results: 270 patients were included, 52.2% female, with a mean age of 68.7 years (SD 14.4), with a mean follow-up of 4.91 days. The median survival time was 4.1 days (95% CI 3.7-4.6), with a cumulative seven-day survival rate of 22.72%. Main variables associated with dysphagia were TOAST small vessel occlusion (TR = 0.57, 95%CI 0.39-0.84) and large vessel atherosclerosis (TR=0.66, 95%CI 0.46-0.99), NIHSS severe (TR = 0.30, 95%CI 0.17-0.53), moderate (TR = 0.38, 95%CI 0.22-0.68), and mild to moderate scores (TR = 0.52, 95%CI 0.32-0.86), history of Parkinson’s disease (TR = 0.50, 95%CI 0.27-0.96) and older age (p = 0.043).
Conclusion: These findings have implications for developing a risk score to aid decision-making.
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Estado de las normas de las pruebas neuropsicológicas para niño/as y adolescentes en Ecuador. Status of neuropsychological testing standards for children and teenagers in Ecuador.
Using neuropsychological tests that have normative data from the population in which they are being applied has positive effects on the accuracy and validity of the diagnoses, which can influence the effectiveness of the interventions derived from them. In addition, it provides greater precision in the studies that use such tests. In Ecuador, there are no studies on the use of standardized tests, which is why the objective of this study was to identify the neuropsychological tests for children and adolescents that have been adapted, standardized and/or validated in Ecuador. A systematic review was conducted using the PRISMA model. There are 10 tests with normative data for the Ecuadorian population: Wisconsin Card Sorting Test Modified Version, Trail Making Test, Color and Word Test: STROOP, Peabody Picture Vocabulary Test, Symbol and Digit Test SDMT, Rey Complex Figure – Osterrieth, Learning and Verbal Memory Test (TAMV-I), Concentration Endurance Test (d2), Verbal Fluency Test and Token Test. The instruments allow the evaluation of 17 cognitive functions. Based on the results, it is recommended that the country’s professionals choose to use these tests and their Ecuadorian scales.
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Evaluación de la calidad de las guías de práctica clínica sobre encefalopatía hipóxico-isquémica en recién nacidos mediante la herramienta AGREE II: una revisión sistemática. Quality assessment of clinical practice guidelines on hypoxic-ischemic encephalopathy in newborns using the AGREE II tool: a systematic review.
Introduction: Hypoxic-ischemic encephalopathy (HIE) is a common cause of cerebral palsy and other severe neurological deficits in children. This study systematically evaluates the methodological quality of clinical practice guidelines (CPGs) on HIE using the AGREE II instrument.
Methodology: Ten CPGs were evaluated using the AGREE II instrument. Overall inter-rater agreement was calculated with the intraclass correlation coefficient (ICC).
Results: The “scope and purpose” domain received the highest score (78.33%, SD = 16.40, ICC 0.82), while the “applicability” domain received the lowest score (42.71%, SD = 38.86, ICC 0.85). Three guidelines were classified as “high quality” and seven as “low quality”. No significant differences were found in the quality of guidelines published between 2012-2017 and 2018-2023 (p = 0.20).
Conclusions: Most guidelines were rated as having low methodological quality, with the applicability domain receiving the lowest scores. Gaps were identified in the development of HIE guidelines between high-income and low/middle-income countries, and there was limited user involvement in formulating recommendations.
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Relación de las funciones ejecutivas y la conducta delictiva: Una revisión sistemática cuantitativa. Relationship of executive functions and criminal behavior: A quantitative systematic review.
Executive functions can be contextualized as the higher cognitive processes that allow a person to plan, make decisions, regulate behavior and solve problems, while criminal behaviors are actions or behaviors that violate the norms established in society. The aim of the article is to report the results of a quantitative systematic review that sought to analyze the relationship described in previous research between executive functions and criminal behavior. The databases reviewed for this work were Scopus and Pubmed. A total of 101 articles were identified and by applying inclusion and exclusion criteria, 11 eligible studies were selected. The research variables were examined in these studies. The results suggest that, impairments in executive functions are associated with an increased risk of engaging in delinquent behaviors. These impairments may be caused by genetic factors, brain injury, exposure to addictive substances, or dysfunctional family environment. The results are discussed in relation to previous research, highlighting the importance of further progress in conducting studies that expand and strengthen the current understanding of executive functions in criminal behavior.
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Palabras clave: conducta delictiva,
criminalidad,
Funciones Ejecutivas,
psicología forense,
toma de decisiones,
Funciones ejecutivas y género. Una revisión sistemática. Executive functions and gender. A systematic review.
Executive functions are a set of higher-order skills involved in the generation, regulation, and effective execution of behaviors to perform goal-directed activities. Given the importance of gender, it is essential to explore how executive functioning contributes to the adaptive behavior of women and men. Therefore, the aim of this study was to evaluate the existing evidence on executive functions in relation to gender. A systematic review of articles published in scientific journals was conducted using the PRISMA method. Selection criteria for the databases, inclusion and exclusion criteria for the studies, and search descriptors were established. Initially, 9277 records were identified, which, after being evaluated for eligibility, were reduced to 24 studies that were included for analysis. Four categories of analysis were established: women<men, women>men, women≠men, women=men. The analysis revealed that, although there is no consensus among the studies, the discrepancy decreases in those reporting that the brain areas and circuits activated in executive functioning differ between genders. The findings are discussed.
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Palabras clave: áreas cerebrales,
desempeño,
edad,
estimulación formal e informal,
Funciones Ejecutivas,
género,
Keywords: age,
brain areas,
Executive functions,
formal and informal stimulation,
Gender,
performance,
Encefalopatía Posterior Reversible asociada a hipercalcemia maligna: una presentación poco usual. Posterior Reversible Encephalopathy associated with malignant hypercalcemia: an unusual presentation
Posterior reversible encephalopathy syndrome (PRES) is a transient clinical condition associated with a loss of cerebral vascular regulation. We present the case of a patient diagnosed with abdominal diffuse large B-cell lymphoma who presented to the emergency department with visual impairment, headache, and seizures. A brain magnetic resonance imaging showed T2 bilateral occipital hyperintensity and on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) showed hyperintense signal, consistent with vasogenic edema compatible with PRES, with no additional findings on images or in cerebrospinal fluid. The only abnormal metabolic finding was hypercalcemia. Metastatic involvement of the central nervous system was ruled out. Medical management of the hypercalcemia was performed, achieving complete resolution of the patient’s symptoms with reversibility of the imaging alterations 6 weeks after the episode.
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Palabras clave: hipercalcemia,
leucoencefalopatía posterior reversible,
Linfoma,
Linfoma No Hodgkin,
PRES,
Epilepsia del lóbulo temporal de inicio tardío en etapa post-Covid. Post-Covid Late onset temporal lobe epilepsy.
Introduction: Temporal lobe epilepsy (TLE) of is the most frequent form of adult epilepsy, temporal mesial sclerosis (TMS) is a common abnormality associated. It could appear at the end of second decades in life.
Case report: We report a male patient, 67 years old, who suffered moderated Covid 19. Six months, he started with seizures which characterized by gastric disturbances, hand and oral automatisms, teeth snapping, upper extremities rigidity and change of hands coloration. EEG showed interictal paroxystic activity over left frontal and central-temporal regions and also abnormalities in quantitative measures. MRI described frontal, parietal, occipital and temporal mesial atrophy with hyperintensity on mesial and hippocampal areas. The volumetric value was diminished on middle frontal and temporal gyrus, pre-central gyrus, parietal lobe, insular cortex and operculum, the value of cortical thickness was diminished on pre-central gyrus.
Conclusions: This is a case with unusual beginning of TLE due to TME post-Covid.
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Palabras clave: COVID-19,
EEG,
Epilepsia del Lóbulo temporal,
esclerosis temporal mesial,
IRM,
volumetría,
Síndrome de encefalopatía posterior reversible atípico en paciente gestante. Atypical posterior reversible encephalopathy syndrome in a pregnant patient.
Introduction: Posterior reversible encephalopathy syndrome (PRES) was first described by Hinchey in 1996, when he observed that some patients presented with an acute reversible picture comprising mental alterations, loss of vision and headache.
Objective: To present the clinical case of a patient with atypical posterior reversible encephalopathy syndrome.
Clinical case: A 19-year-old woman, 36.5 weeks of gestation, presented with a clinical picture of 4 hours of evolution with high intensity stabbing pain in the epigastrium associated with moderate intensity global headache, accompanied by a self-resolved convulsive episode. Magnetic resonance imaging (MRI) showed bilateral intensity changes in the frontoparietal cortico-subcortical regions, lenticular nuclei and brain stem region with restrictive pattern in some lesions, and diffusion was indicative of ischemic vascular involvement with diffuse edema, in addition, parietooccipital paramedial hemorrhagic foci were observed bilaterally, suggesting a possible PRES.
Conclusions: PRES should be considered as a diagnosis in a previously healthy pregnant woman who has sudden convulsive episodes during labor. The exact etiology of PRES during pregnancy is not entirely clear and remains controversial. Clinical presentation and MRI are used for diagnosis. Immediate treatment should be focused on controlling the underlying cause or pathology, the main one being hypertension.
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Palabras clave: Convulsiones,
Eclampsia,
embarazo,
Síndrome de encefalopatía posterior reversible atípico,
Síndrome de Guillain Barré asociado a infección por SARS-CoV-2. Guillain-Barré Syndrome Associated with SARS-CoV-2 infection.
Guillain-Barré Syndrome (GBS) is an uncommon but potentially serious clinical entity characterized by symmetric, rapidly progressive limb weakness, reduced or absent deep tendon reflexes, and paresthesias. This case report discusses a 23-year-old male with a history of SARS-CoV-2 infection, presenting with paresthesias, weakness in the thighs, and walking difficulty.
Physical examination exhibited asymmetric facial diplegia, right sixth cranial nerve palsy, flaccid quadriparesis with predominant crural involvement, and generalized areflexia.
Electrophysiological studies, practiced within the first week, revealed absent H reflex and delayed distal motor latencies. Additionally, concentric needle examination showed no abnormal activity at rest, with a pattern of poor recruitment of motor units with normal morphology. The cerebrospinal fluid analysis showed albumin-cytological dissociation. Intravenous immunoglobulin therapy was initiated, resulting in gradual neurological stabilization, and the patient was discharged with a Rankin score of 4/5.
Follow-up evaluations showed improvement in motor symptoms, and after six months, the patient fully reintegrated into normal life. This case emphasizes the association between GBS and prior COVID-19 infection, highlighting the importance of neurological monitoring during convalescence.
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Paresia velopalatina unilateral aguda. Unilateral acute velopalatine paresis.
A 13-year-old male patient presented with acute symptoms of rhinolalia and nasal regurgitation. He reported no trauma, recent infections, or other relevant personal history. Examination revealed unilateral left-sided velopalatine hemiparesis (HPH), with hypomotility of the left soft palate and a right-sided deviation of the uvula (see Figure 1). He had no sensory or motor disturbances at other levels.
A cranial MRI was performed, which ruled out central nervous system disorders, including cranial nerves. A complete blood count and biochemical analysis were normal, and serologic tests (Borrelia, Mycoplasma, Chlamydia, VZV, HSV, parvovirus B19, EBV, CMV, toxoplasmosis, poliomyelitis, rubella, mumps) were negative.
Empirical corticosteroid treatment with prednisone was initiated for 5 days, followed by tapering. Follow-up revealed complete resolution of the symptoms (see Figure 2).
Given negative complementary studies and a favorable clinical course, the diagnosis is compatible with idiopathic PVH. This is a rare entity with sudden onset, mostly unilateral, transient, and benign. It occurs predominantly in boys aged 5–15 years. The typical triad consists of rhinolalia, nasal regurgitation, and uvular deviation. The diagnosis is based on exclusion, ruling out other causes such as surgery, tumors, or neuromuscular pathology. Recovery is usually complete.
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Mortalidad y pronóstico funcional en pacientes con infarto cerebral en una ciudad a gran altitud (Cusco, 3300m) durante la pandemia por COVID-19. Mortality and functional prognosis in patients with ischemic stroke residing in a high-altitude city (Cusco, 3300 m) during the covid-19 pandemic.
Introduction: Information on stroke mortality in people residing at high altitudes is controversial, and during the coronavirus disease 2019 (COVID-19) pandemic, there was a decrease in in-person care. Our objective is to evaluate mortality and functional prognosis after 3 months in stroke patients residing at high altitude during the COVID-19 pandemic. Methods: An analytical longitudinal study was conducted from January 2020 to January 2022 in a hospital in Cusco (3300 m above sea level), including adult patients diagnosed with stroke but without COVID-19 diagnosis, who were followed up for 90 days, evaluating mortality and functional disability (modified Rankin scale ≥ 3). Clinical and laboratory risk factors were evaluated, obtaining crude and adjusted hazard ratios (HR) through Cox regression models with 95% confidence intervals (CI95%). Results: One hundred twenty-three stroke patients were evaluated. After 90 days of follow-up, 28 patients (22.7%) died and 80 patients (65.0%) were diagnosed with functional disability. In models adjusted for gender, age, Alberta stroke program early CT (ASPECTS) score, and hypertension background, the only variable with increased risk was National Institutes of Health Stroke Scale (NIHSS) score at admission, both for mortality (HR 1.14, CI95% 1.09–1.20) and functional disability (HR 1.07, CI95% 1.04–1.11). Conclusions: Regarding stroke patients cared for in a high-altitude city during the COVID-19 pandemic, NIHSS score at admission is the most important risk factor for determining the 90-day mortality or functional disability, with a risk increase of approximately 10% for both outcomes for each additional point on the scale.
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Demanda asistencial en consulta de neurología en la provincia de Sucumbíos, Ecuador. Care demand in neurology consultation in Sucumbios province, Ecuador.
Objective: To characterize the care activity in the neurology outpatient clinic of the Marcos Vinicio Iza Hospital in the province of Sucumbíos, Ecuador. Patients and methods: Cross-sectional descriptive observational study, which included patients seen in a first general neurology consultation, between the months of June to November 2022. The variables analyzed included demographic data, related to healthcare activity and clinics. Results were compared between sexes and are shown by age group. Results: 733 patients were included in the study; the mean age was 35 years (SD ± 25.27) with a predominance of males (p 0.008). Most of the patients were of Ecuadorian nationality, followed by Colombians. 84% patients were referred from the primary level of care by family physicians, followed by internal medicine (7%) and pediatrics (6%) from the hospital. The main diagnostic categories treated were epilepsy (24.8%), headache (22.2%) and neurodevelopmental disorders (21.1%). Conclusion: The population we assist has specific characteristics. In our case we function as a consultant to other specialties, mainly Family Medicine. The greater frequency of patients with epilepsy and neuropediatric diseases requires changes in the provision of human resources and diagnosis to demand from the health authorities.
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Consenso de expertos para el tratamiento de los pacientes con Esclerosis Múltiple en Ecuador. Experts recommendations on the management of Multiple Sclerosis patients in Ecuador.
During the last 25 years, multiple sclerosis (MS) has seen major changes with new diagnostic criteria, a better identification of disease, individualization of disease prognosis and the appearance of new therapeutic options. As a result, the management of MS patients has become more complex and challenging. The objective of these consensus recommendations was to review how the disease should be managed in Ecuador to improve short, mid and long-term outcomes in affected patients. Methods: A panel of experts in neurology from Ecuador, dedicated to the diagnosis and care of MS patients, gathered virtually during 2023 and 2024 to carry out consensus recommendations on the management of MS patients. To achieve consensus, the methodology of “formal consensus-RAND/UCLA method” was used. Results: Recommendations were established based on published evidence and expert opinion. Recommendations focused on diagnosis, disease prognosis and tailored treatment, treatment failure identification and the pharmacovigilance process. Conclusions: The recommendations of these consensus guidelines attempt to optimize the health care and management of patients with MS in Ecuador.
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Crisis focales como síntoma de presentación del síndrome HaNDL (cefalea transitoria y déficits neurológicos con pleocitosis linfocitaria). Focal seizures revealing HaNDL syndrome (Transient headache and neurological deficits with lymphocytic pleocytosis).
A 38-year-old woman with a history of migraine presented with two tonic-clonic seizures confined to the left size of the body, which occurred one hour apart. The second seizure was followed by severe headache and hemiplegia ipsilateral to the seizures, which persisted for 24 hours, reversing completely thereafter. Brain MRI and a 21-channel EEG were normal. A lumbar puncture revealed CSF under normal opening pressure, discrete lymphocyte pleocytosis, and normal glucose and protein levels. This patient meets the diagnostic criteria for HaNDL syndrome, a rare condition of unknown cause, whose prognosis is usually favorable, with complete reversal of symptoms within a few weeks. Its diagnosis must be taken into account to avoid the practice of invasive tests or complex treatments that are not devoid of adverse effects.
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Palabras clave: Cefalea,
crisis convulsivas,
hemiplejía transitoria,
pleocitosis linfocitaria,
Síndrome HaNDL,
Absceso cerebral: una entidad poco común en pediatría. Brain abscess: an uncommon entity in pediatrics.
Brain abscess rarely occurs in children. It is a neurosurgical emergency with a potentially catastrophic outcome, with a high risk of permanent neurological deficit. With the introduction of modern imaging, antibiotics, and stereotactic surgical techniques, mortality has decreased markedly. Symptoms are nonspecific and may vary depending on the child’s age, location, size, number, and stage of the abscess, and the primary source of infection. Despite the decline in mortality, brain abscess remains a serious disease that can lead to serious morbidity or even death if diagnosed late, incorrectly diagnosed, or inadequately treated.
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Parkinsonismo y deterioro cognitivo rápidamente progresivo en un paciente con lupus eritematoso sistémico y síndrome antifosfolípido triple positivo. Parkinsonism and rapidly progressive cognitive decline in a patient with systemic lupus erythematosus and triple-positive antiphospholipid syndrome.
Background: The association between parkinsonism and systemic lupus erythematosus is inadequately described, and to date, the underlying pathophysiological mechanisms are not fully established, ranging from vascular impairments to immunomediated phenomena. Literature analysis identified only 28 cases of parkinsonism in patients with systemic lupus erythematosus, underscoring the limited attention to these associations and their respective therapeutic approaches.
Case Report: We present a case of a patient with an atypical presentation of systemic lupus erythematosus and a diagnosis of triple-positive antiphospholipid syndrome. Despite the absence of lupus activity, the patient developed symptoms of parkinsonism and rapidly progressive cognitive decline. No other underlying causes or thrombotic events in brain imaging were found to explain the atypical clinical presentation. Simultaneous administration of immunosuppressive therapy and levodopa/carbidopa resulted in symptom improvement.
Conclusion: Insufficient research has been conducted on the correlation between systemic lupus erythematosus and parkinsonism, primarily due to its seemingly low incidence in the medical literature. Consequently, this case report offers additional insights into this association, potentially laying the groundwork for future structured and well-designed studies. The efficacy of levodopa and immunosuppressive therapy in treating these patients remains uncertain and necessitates further investigation.
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Palabras clave: autoinmunidad,
lupus eritematoso sistémico,
parkinsonismo,
Síndrome antifosfolípido,
