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.
Artículos Especiales
Requisitos Para que Proceda la Responsabilidad Civil por Mala Práctica Médica. Requirements For Civil Liability To Proceed Due To Medical Malpractice.
A physician is subject to civil liability in his professional practice. Under Ecuadorian law, civil liability arises when three requirements are met: fraud or negligence, harm and causation between the fraud or negligence and the harm. Once these requirements have been met, an obligation to compensate is born. Compensating means paying a sum of money equivalent to the patient’s harm.
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Demencia y Ley. El Papel Jurídico del Neurólogo
Dementia has several legal effects under ecuadorian law. These effects are produced once dementia has been judicially established. The judge decides that a person suffers dementia based on a neurological report. When a neurologist elaborates such report, he has to take into account that legal concept of dementia resembles the medical concept of dementia.
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Jerarquía de los diseños epidemiológicos. Revisión de las publicaciones de los 17 años de la Revista Ecuatoriana de Neurología.
There are several types of epidemiological designs and they can be organized in levels of evidence. These designs are divided in observational and experimental. The observational studies can be cohort, case control and cross sectional studies. The experimental studies are the clinical trials. Due to the importance of the meta-analysis they will also be mentioned. All the articles published in the Ecuadorian Journal of Neurology were gathered since its first edition in 1992. During these 17 years, 271 articles have been published from which 94 are original articles. Clinical trials represented 12.8% of all the original articles. A decrease in the number of series reports and an increase of cohort and cross sectional studies was observed. From 1992 to 2004 most of the articles were from national authors but then, foreign authors represented the higher percentage. We think it is very important to promote the national production especially of clinical trials because they would provide a better evidence and, more importantly, evidence that could be applied to the Ecuadorian population.
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Video filmación en Neurociencias: Informe técnico-clínico.
Near the end of the 19th century, cinematography developed and was immediately recognized as a new technique applicable to the field of the medicine and we owe Gheorghe Marinescu and Arthur Van Gehuchten their introduction in the field of the neurology. Between 1899 and 1914 Marinescu and Van Gehuchten perfected the use of the cinematography like a diagnostic method in neuroscience based mainly on the recording of several patients with the same dysfunctions to be able to appreciate the wide spectrum of oneself entity, or to value certain therapy filming the patients before and after certain treatment. This contribution to the medicine and in short to the clinical neurology it marked an important landmark that lasts and it is continued using after more than one century.
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Cirugía de Epilepsia en Ecuador 2010.
Epilepsy is one of the most common chronic neurological conditions in children and adults. The lifetime risk of developing epilepsy is 3.2%. In this review article we suggest how to apply a safety protocol for the surgical treatment of antiepileptic drugs resistant patients. We review who the ideal candidate for a pre-surgical evaluation is and when to do it; how to do it, using clinical, physiological, imaging and neuro-cognitive biomarkers in order to achieve medical benefit from epilepsy surgery; why patients should go and receive a surgical evaluation. Finally we review the current concepts of drug resistant epilepsy and the surgical intervention benefit/risk relationship.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria. RESUMEN.
Not Available.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 1: Introducción.
Not Available.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 2: Valoración prequirúrgica.
Not Available.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 3: Cirugía de la Epilepsia Farmacorresistente.
Not Available.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 4: Unidades Multidisciplinares de Epilepsia y Cirugía de la Epilepsia.
Not Available.
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Sobre Neurociencia y Proceso Judicial.
Neuroscience is a relatively new field of study that is introducing challenges in different fields of knowledge and has begun to generate interest in legal scholars and philosophers. The dialogue and debate between Law and neuroscience has become urgent. Neurociencia y proceso judicial [traducción libre: Neuroscience and judicial process], a work published in 2013, gives a good account of that. Its eight essays written by legal scholars and legal philosophers explores a wide spectrum of issues and suggestive connections between procedural law, philosophy of evidence, legal philosophy, scientific and technological advances on the study of the brain and its functioning, and some of the postulates from certain neuroscientific currents. This article contains a review of that work.
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Estimulación Cerebral Profunda y Enfermedad de Parkinson: Documento Instructivo para el Manejo Multidisciplinario en el Hospital Regional Dr. Teodoro Maldonado Carbo
Neuromodulation by deep brain stimulation (DBS) in the treatment of Parkinson’s disease has developed new research in its pathophysiology. By electrical stimulation of established surgical targets, clinical response can be modified and optimized, improving quality of life. Even though its efficacy, DBS is not indicated for all patients. Selection criteria must be considered and a multidisciplinary team -with roles and responsibilities clearly defined- must evaluate the patient.
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Medical Therapy for Cysticercosis: Indications, Risk, and Benefits
Neurocysticercosis is a pleomorphic disease that causes serveral neurological syndromes and pathological lesions. Therefore, a unique therapeutic shceme can not be useful in every patient. A proper characterizcion of the disease in terms of viability of cysts, degree of the host’s immune response to the parasites, and location of the lesions is of major importance for a rational therapy. Therapy include a combination of symptomatic drugs, cysticidal drugs, surgical resection of lesions, ana placement of ventricular shunts.
