Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

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Funciones Ejecutivas en Niños Preescolares con y sin Trastorno del Lenguaje. Executive Functions In Preschool Children With And Without Language Disorders.

The objectives of this study were to compare the executive functions (attention, flexibility, inhibitory control, planning and working memory) of preschool children with and without language disorder and to define a profile of executive functions. The design is non-experimental for descriptive/comparative purposes. The sample consisted of 105 children. The group with language disorder was composed of 31 children and 19 girls, average age 4.68 years, of Special Language Schools. The group without language disorder was composed of 15 children and 24 girls, average age 4.98 years, of Public Schools of the city of Concepcion in Chile.

The results show that there is statistically significant evidence to state that the scores obtained by children with language disorders are lower than their peers without language disorder in all the executive functions evaluated, which supports the current literature on the subject. Regarding the profile of executive functions, the function that could predict the presence of language disorder in a preschool is the executive planning function.

It is interesting to continue deepening the profile of executive functions in children with language disorder and their specific relationship with the linguistic problems that these children have.

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Palabras clave: Funciones Ejecutivas, funciones neuropsicológicas, Trastorno del lenguaje, trastornos de la comunicación,

Keywords: communication disorders, Disorders of language, Executive functions, neuropsychological functions,

Autismo en Ecuador: un Grupo Social en Espera de Atención. Autism In Ecuador: A Social Group Waiting For Attention.

Although increasing historical progresses have been achieved in defining the characteristics on a unusual behavior among people who could be on the autism spectrum disorder, unattended issues remain. Accuray is necessary for a correct diagnosis and urgent attention.

Ecuador is also part of this reality. This study is the first research that has been performed in the country, with 160 school-aged boys and girls coming from the mountains and the coast of Ecuador, 80 diagnosed with autism, and 80 neuro-typical kids. The results reveal the necessity to attend this matter. Surveys and confirmation cases including an innovative way of social insertion analysis show that the diagnostic processes demands important economical resources, and these economical resources could vary according to social insertion, and socio-spatial location; 26% of the children that were part of this study, received between 1 to 5 previous different diagnosis, 13,75% were mistakenly diagnosed; 46,2% of them, that were from the city of Guayaquil, and 23,7% from the city of Quito, spent more than one thousand dollars trying to get the diagnosis. This case-control study with children between ages of 2 and 12 years old, from Quito and Guayaquil, allows us to know the real situation of autism in Ecuador. It reveals major problems regarding on how to obtain a diagnosis, a therapeutic process, most of them related to the socio economical situation of the parents that were part of this study.

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Palabras clave: Autismo, diagnóstico, inclusión educativa, inserción social,

Keywords: Autism, diagnosis, educational inclusion, social insertion,

Regulación Emocional en Pacientes con Esquizofrenia: Un Estudio Piloto. Emotion Regulation In Schizophrenia Patients: A Pilot Study.

Background. It has been reported that schizophrenia patients display emotional processing impairments, specifically in the emotion perception domain. However, less is known about other domains of emotional processing, like emotion regulation. Objective. The aim of this study was to assess and compare emotion regulation abilities and neurocognition in schizophrenia patients and healthy controls, as well as to identify correlations between emotion regulation, neurocognition and demographic data. Methods. 9 patients (GE) and 9 controls (GC) were recruited. Demographic data was obtained. To assess emotion regulation, the Mayer-Salovey-Caruso Emotional Intelligence Test -Managing Emotions section- was administered. Finally, a brief neurocognitive assessment was conducted. Results. The GE showed significant poorer performance than the GC in the emotion regulation test as well as in the neurocognitive assessment (p < .05). No correlations were identified between emotion regulation, neurocognition, demographic and clinical data. Discussion and conclusion. Schizophrenia patients show emotion regulation impairment, as well as neurocognitive deficits. Our results are consistent with other studies.

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Palabras clave: Esquizofrenia, neurocognición, procesamiento emocional, regulación emocional,

Keywords: emotion regulation, emotional processing, neurocognition, Schizophrenia,

Tabaquismo y su Asociación con Mortalidad Intrahospitalaria en Pacientes con Ictus Hemorrágico. Cigarette Smoking And Its Association With In-Hospital Mortality In Hemorrhagic Stroke Patients.

Background: Smoking is a well-known reversible risk factor associated with acute ischemic stroke (AIS), however, some data showed that in-hospital mortality rates among smoker’s patients with hemorrhagic stroke is lower when compared with non-smokers patients. The objective of this analysis was to assess in-hospital patient mortality rate between smokers and non-smokers patients with confirmed diagnosis of hemorrhagic stroke. Methods and Results: We analyzed all the data from patients diagnosed with hemorrhagic stroke that were registered in the Florida Stroke database from 2008-2012. Among the 21,013 patients diagnosed with hemorrhagic stroke, 10.9% of patients were smokers. A Multivariable model was used to estimate the adjusted odds ratio of in-hospital mortality rate in smokers versus non-smokers. Smoking was associated with lower in-hospital mortality in hemorrhagic patients. (UOR= 0.71 vs. AOR= 0.75). Other risk factors like hypertension, BMI>40 and hyperlipidemia, remained significantly associated after modeling, and some others like gender, race, health insurance coverage, and diabetes became insignificant. The difference between unadjusted and adjusted odds ratios for smoking (0.71 versus 0.75) indicates no presence of substantial confounding by age and other control variables. Conclusions: Among patients hospitalized for hemorrhagic stroke, smoking is a risk factor for early age of onset, even among those with few vascular risk factors. The persistent association with lower in-hospital mortality after adjusted analyses probably represents other unmeasured confounding, although a biological effect of smoking cannot be excluded. Further clinical and prospective population-based studies are needed to explore variables that contribute to outcomes in these patients.

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Palabras clave: enfermedad cerebrovascular, Ictus, Mortalidad, Tabaquismo,

Keywords: cerbrovascular disease, Mortality, Smoking, stroke,

Estimación de la Función Cognitiva Premórbida con el Test de Acentuación de Palabras. Estimation Of Premorbid Cognitive Function With The Word Accentuation Test.

Objectives: Premorbid estimation of cognitive function is essential for the interpretation of the presence and severity of actual cognitive impairment. The most reliable method in Spanish speaking countries is with the Word Accentuation Test (WAT) / Test de Acentuación de Palabras (TAP). This is used to predict intelligence test scores by linear regression. Results: In an Ecuadorian sample the TAP was found to have good internal consistency and test-retest reliability. The correlation of the TAP with WAIS-IV full IQ scores was high (r= .827), allowing the development of a regression equation to estimate IQ scores from TAP performance. Furthermore, a sample of dementia patients was found to perform normally on the WAT compared to a matched control group. This suggests that WAT performance holds in the presence of neurological illness with associated cognitive impairment. Conclusions: The WAT has good psychometric properties and can be used to rapidly estimate actual intelligence test scores in healthy participants. It can also estimate premorbid intelligence scores in patients with neurological or psychiatric illnesses, allowing a clearer interpretation of the severity of impairment. This simple assessment could be used in various research and clinical contexts.

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Palabras clave: Cognición, neuropsicología, premórbida, test de palabras,

Keywords: Cognition, neurophsycology, premorbid, word test,

Uso de Toxina Botulínica Tipo A en Pacientes con Espasmo Hemifacial en Cuba. Botulinum Toxin A In Hemifacial Spasm In Cuba.

Objective: To evaluate botulinum toxin A therapy in patients with hemifacial spasm attended in a Neurology Service in Cuba. Patients and methods: 35 patients with hemifacial spasm were treated with botulinum toxin A during 15 months. Some parameters of botulinum toxin were collected including doses, latency, maximum duration and total duration of improvement. Clinical data were determined, such as functional status, gravity, frequency and adverse events. Results: There was a high percentage of female with hemifacial spasm. Most patients showed a latency of 48 hs, maximum duration until 60 days and total duration of improvement of 3 months. Functional status decreased through time, independently of hemifacial spasm onset and its origin. Parameters related to functional status, as gravity and frequency also diminished significantly their categories. Botulinum toxin doses were statistically increased over this treatment, independently of any patient conditions. Only eight patients showed adverse events (facial muscle weakness and ptosis). Conclusions: Recovery of functional status, and low rate of adverse events observed during botulinum toxin treatment might suggest that this therapy seems to be effective and low-risk under our conditions.

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Palabras clave: distonía, espasmo hemifacial, Toxina botulínica,

Keywords: Botulinum toxin, dystonia, hemifacial spasm,

Características Clínicas y Epidemiológicas de los Tumores de Fosa Posterior en Pacientes Pediátricos. Experiencia en un Centro de Referencia Nacional. Clinical And Epidemiological Features Of Posterior Fossa Tumors In Pediatric Patients. Experience Of A National Reference Center.

Objective: To perform a descriptive study of posterior fossa tumors from a sample of patients from a national reference center in Ecuador.

Materials and methods: a descriptive, retrospective, cross-sectional study was performed. Socio-demographic and clinical-epidemiological variables were established for 24 patients under the age of 14, whose clinical records reported a diagnosis of posterior fossa tumor, and who were hospitalized in Baca Ortiz Pediatric Hospital between 2014 and 2016.

Results: There was a 1:1 relationship between males and females, an age distribution of 20,8% of patients younger than 3 years, 33,3% between 3 and 6 years, and 45,8% of patients older than 6 years of age. The most frequent histopathological diagnosis was medulloblastoma with 45,8%, followed by ependymoma with 29,2%, and astrocytoma with 12,5%. 12,5% of patients did not have a biopsy performed. Intracranial hypertension was the most frequent clinical presentation syndrome with 87,5% followed by far less frequent symptoms in our sample.

Conclusions: Scientific evidence about posterior fossa tumors is limited in Ecuador. This study states the need to perform similar and more complete studies of this frequent pediatric brain tumor.

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Palabras clave: epidemiología, Fosa posterior, Presentación clínica, Tumor cerebral,

Keywords: Brain tumor, Clinical presentation, epidemiology, Posterior fossa,

Atahualpa, Una Población Rural Ideal Para la Práctica de Estudios Epidemiológicos. Atahualpa, An Optimal Rural Setting For The Practice Of Epidemiological Studies

Atahualpa is a rural village located in coastal Ecuador that achieve a number of requisites to be considered as an optimal setting for the practice of epidemiological studies. Atahualpa is an isolated village with a very low index of migration rate. Inhabitants are fairly homogeneous regarding race, lifestyles and diet, which is rich in oily fish. From the racial point of view, inhabitants are Ecuadorian natives with little evidence of cross-breading. Most men are artisan carpenters and most women are homemakers. These coincidences reduce the risk of the presence of unexpected confounders at the time of data analyses. However, this may also cause that data obtained might not be extrapolated to other regions. The practice of studies in neighboring villages, using similar protocols, is needed to validate generality of data obtained in Atahualpa.

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Palabras clave: áreas rurales, Atahualpa, Ecuador, epidemiología, estudio poblacional,

Keywords: Atahualpa, Ecuador, epidemiology, population-based study, rural settings,

El Proyecto Atahualpa, Protocolo, Definiciones Operacionales y Diseño Inicial. The Atahualpa Project: Protocol, Operational Definitions, And Initial Study Design

Non-communicable diseases are the new health epidemics in developing countries due to increased life expectancy, and changes in lifestyle and dietary habits of the population. The Atahualpa Project was designed as a multi-step population-based cohort study designed to reduce the increasing burden of these conditions in rural Ecuador. The first step of the study followed a 3-Phase design, aimed to get information on demographics and cardiovascular risk factors of Atahualpa residents aged ≥40 years, as well as to assess the prevalence of stroke and ischemic heart disease. During Phase I, participants were screened with standardized questionnaires to evaluate their cardiovascular health and to identify those with suspected stroke or ischemic heart disease. In Phase II, neurologists and cardiologists examined suspected cases of stroke or ischemic heart disease, as well as a random sample of matched negative individuals, to assess prevalence of these conditions. In Phase III, patients with diagnosis of stroke and ischemic heart disease underwent complementary tests for achieving more specific diagnosis. Implementation of public health strategies directed to improve the cardiovascular health status of a given population must be based on studies evaluating specific risk factors at regional levels. Epidemiologic surveys such as the Atahualpa Project may prove cost-effective for improving the cardiovascular health status of people living in Latin American rural villages by increasing the knowledge on the particular needs of these populations.

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Palabras clave: Atahualpa, cardiopatía isquémica, Ecuador, enfermedad cerebrovascular, epidemiología, estudio poblacional, salud cardiovascular,

Keywords: Atahualpa, cardiovascular health, Cerebrovascular disease, Ecuador, epidemiology, ischemic heart disease, population-based study,

Salud Cardiovascular en Habitantes de Atahualpa: Características y Correlatos. Cardiovascular Health Status In Atahualpa Residents: Characteristics And Correlates

Stroke and cardiovascular diseases will be the next epidemics in Latin America due to changes in lifestyle and increased life expectancy. Knowledge of cardiovascular health (CVH) status of the population is mandatory to implement cost-effective strategies directed to reduce the burden of vascular diseases in the region. In the Atahualpa Project, we assessed the CVH status of participants using the metrics proposed by the American Heart Association. The basal study included 616 subjects free of stroke and ischemic heart disease aged ≥40 years. Of these, 2.1% had ideal, 28.1% had intermediate and 69.8% had poor CVH status. Poorest metrics were blood pressure, fasting glucose, and BMI. The odds for having a poor CVH status were increased in persons aged ≥ 60 years and in those with only primary school education. Then, we compared our results with the Hispanic population of the Northern Manhattan Stroke Study (NOMAS), and found that Atahualpa residents had significantly better metrics than those enrolled in the NOMAS, with the exception of fasting glucose levels. Likewise, the odds for having 5 to 7 ideal metrics were also better in Atahualpa residents, irrespective of age. We also conducted a case-control study to assess the CVH status of Atahualpa residents according to their living arrangements, and found that social isolation was associated with a worse CVH status in this population. A couple of studies showed correlation between some sleep related disorders and poor CVH status. We have also started an ongoing program called “known your numbers”, which, together with community talks, is directed to improve the CVH status and to reduce the burden of vascular diseases in the region.

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Palabras clave: apoyo comunitario, Atahualpa, Ecuador, epidemiología, estudio poblacional, salud cardiovascular, síndrome metabólico, trastornos de sueño,

Keywords: Atahualpa, cardiovascular health, community support, Ecuador, epidemiology, metabolic syndrome, population-based study, sleep disorders,

Sub-estudio de Neuroimagen del Proyecto Atahualpa. Neuroimaging Substudy Of The Atahualpa Project

The Atahualpa Project includes a Neuroimaging sub-study, which consists in the practice of MRIs and MRAs to all participants aged ≥60 years, as well as those presenting with specific neurological complains. Likewise, all participants aged ≥20 years have been invited for the practice of a head CT. MRIs and MRAs have been performed with the use of a Philips Intera 1.5T MRI machine, and TCs with the use of a Philips Brilliance 64 CT scanner, following established protocols. All exams have been independently reviewed by a neurologist and a neuroradiologist, with adequate kappa coefficients for inter-rater agreement. MRIs studies have been focused on the evaluation of global cortical atrophy, posterior parietal atrophy, bicaudate index, Evans index, hippocampal atrophy, signatures of cerebral small vessel disease, and lesions consistent with ischemic or hemorrhagic strokes. By the use of MRI, we have assessed the prevalence of intracranial artery stenosis, intracranial dolichoectasia and variations in the configuration of the circle of Willis. Using CT, we have focused on the diagnosis of neurocysticercosis, pineal gland calcifications, as well as in variations and characteristics of skull bones, cerebellar atrophy, and severity of carotid siphon calcifications. In the present study, we focused on the description of basic protocols used for assessment of previously mentioned lesions of interest.

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Palabras clave: angio-resonancia, Atahualpa, Ecuador, epidemiología, estudio poblacional, resonancia magnética, tomografía computada,

Keywords: Atahualpa, computed tomography, Ecuador, epidemiology, magnetic resonance angiography, magnetic resonance imaging, population-based study,

Búsqueda de Substitutos Para Estudios de Neuroimagen con Propósitos de Investigación: Experiencia del Proyecto Atahualpa. The Search Of Surrogates For Neuroimaging Studies For Research Purposes: The Atahualpa Project Experience

Diagnosis of many non-communicable neurological diseases require the use of MRI, which is not readily available in remote rural populations. Efforts should be directed to find portable screening diagnostic tools that may help identify candidates for MRI screening. In the Atahualpa Project, all participants aged ≥60 years have been invited for the practice of MRI, and about 80% of them have underwent the procedure. Therefore, we have the unique opportunity to test the accuracy of non-invasive exams to be used as surrogates to MRI for identifying candidates for the practice of this exam. To date, we have assessed the value of the ankle-brachial index (ABI), the reliability of the neutrophil-to-lymphocyte ratio (NLR), the accuracy of hypertensive retinopathy, and the value of transcranial Doppler (TCD) to detect individuals with cerebral small vessel disease. Individuals with an abnormal ABI have 4 times de odds of having a silent lacunar infarct than those with a normal ABI. A high NLR has a poor sensitivity but is highly specific for detecting persons with at least one imaging signature of small vessel disease. Individuals with hypertensive retinopathy Grades 2-3 are almost four times more likely to have moderate-to-severe white matter hyperintensities than those with no- or only Grade 1 retinopathy. Finally, the correlation between the pulsatility indexes of major cerebral arteries with imaging markers of small vessel disease, as assessed by TCD, was poor. We are still in the search of some non-expensive and readily available biomarker that allow the identification of apparently healthy persons at risk of suffering a catastrophic cerebrovascular event.

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Palabras clave: Atahualpa, Doppler transcraneal, Ecuador, epidemiología, estudio poblacional, índice tobillo-brazo, relación neutrófilos-linfocitos, Retinopatía,

Keywords: ankle-brachial index, Atahualpa, Ecuador, epidemiology, neutrophil-to-lymphocyte ratio, population-based study, Retinopathy, Transcranial Doppler,

Trastornos de Sueño en Residentes de Atahualpa. Sleep Disorders In Atahualpa Residents.

Health problems related to sleep disorders are likely on the rise in rural areas of Latin America, partly related to changes in life style, shift work, and other factors. However, little is known on the burden of these conditions in remote rural settings. In the Atahualpa Project, we have investigated sleep disorders using standardized field instruments associated with sophisticated technology such as polysomnography. A poor sleep quality has been associated with frailty and with the presence of neuroimaging markers of cerebral small vessel disease and global cortical atrophy. On the contrary, dietary intake of oily fish was associated with a better sleep quality. We have also investigated the prevalence and some correlates of the restless legs syndrome (Willis-Ekbom disease), and found a prevalence relatively higher than that described in most other tropical regions, as well as the association of this condition with psychological stress. Finally, a preliminary report shows a high prevalence of moderate-to-severe obstructive sleep apnea in Atahualpa residents aged ≥60 years (27%) and its correlation with diffuse subcortical damage of vascular origin. Further studies are needed to better understand consequences of sleep-related symptoms in underserved populations.

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Palabras clave: apnea de sueño, Atahualpa, calidad de sueño, Ecuador, enfermedad de Willis-Ekbom, epidemiología, estudio poblacional, somnolencia diurna,

Keywords: Atahualpa, daytime somnolence, Ecuador, epidemiology, population-based study, Sleep apnea, sleep quality, Willis-Ekbom disease,

Alcohol: Consumo, Consecuencias y Complicaciones Neurológicas. Resultados del Proyecto Atahualpa. Alcohol: Intake, Consequences and Neurological Complications. Results From The Atahualpa Project.

Information about the burden and consequences of alcohol intake in rural communities of Latin America is scarce. This study aims to assess the magnitude of alcohol intake in Atahualpa as well as its consequences and prevalence of neurological complications. Male residents aged ≥40 years (n=277) were interviewed with a structured questionnaire designed to evaluate prevalence, drinking patterns and consequences of chronic alcohol intake. Most of them were current drinkers and 40% started drinking below the legal age (18 years). Weekly binge drinking were admitted by 81% individuals, 58% referred physical consequences related to alcohol intake, 59% had social consequences, and 51% recognized alcohol intake as a major economic burden. Individuals who started drinking below the legal age were more often involved in binge drinking and consumed more alcohol than those aged ≥18 years at first regular drink. The relationship between alcohol intake and alcoholic cerebellar degeneration was evaluated by the use of the BARS scale, with 14.6% of individuals having clinically relevant alcoholic cerebellar degeneration. Predictive models showed significant relationships between BARS score margins and years of drinking and the amount of alcohol intake. Our study also provided robust evidence favoring an independent and synergistic effect of age and years of drinking in the relationship between ACD and cognitive decline. This study shows a high prevalence of chronic alcohol intake in community-dwelling men living in Atahualpa.

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Palabras clave: alcohol, Atahualpa, degeneración cerebelosa alcohólica, Ecuador, epidemiología, estudio poblacional,

Keywords: alcohol, alcoholic cerebellar degeneration, Atahualpa, Ecuador, epidemiology, population-based study,

Enfermedad Cerebrovascular en Atahualpa: Prevalencia e Incidencia. Cerebrovascular Disease In Atahualpa: Prevalence And Incidence

Stroke burden is on the rise in rural regions of South America. We evaluated prevalence, pattern of subtypes and pathogenetic mechanisms underlying stroke in Atahualpa. In a three-phase epidemiologic study, suspected cases were detected by a door-to-door survey. Then, neurologists evaluated suspected cases and randomly selected negative persons, and confirmed patients underwent complementary exams. We found 20 stroke patients among 642 persons aged ≥ 40 years. Stroke prevalence was 31.15‰ that increased with age. Hypertensive arteriolopathy was the most likely mechanism underlying strokes (55% patients). Extracranial atherosclerotic lesions or cardiac sources of emboli were not found in any case. Comparison of our findings with a previous survey performed in the same village showed an alarming increase in stroke prevalence (from 14.08‰ in 2003 to 31.15‰ in 2012, p=0.03). Thereafter, we conducted an incidence study. For this, first-ever strokes occurring over four years were identified from yearly door-to-door surveys and other overlapping sources. Of 807 stroke-free individuals prospectively enrolled in the Atahualpa Project, follow-up was achieved in 718 (89%), contributing 2,499 years of follow-up (average 3.48±0.95 years). Stroke incidence rate was 2.97 per 100 person-years of follow-up (95% C.I.: 1.73–4.2), which increased to 4.77 (95% C.I.: 1.61–14.1) when only persons aged ≥57 years were considered. Poisson regression models, adjusted for relevant confounders, showed that high blood pressure (IRR: 5.24; 95% C.I.: 2.55–7.93) and severe edentulism (IRR: 5.06; 95% C.I.: 2.28–7.85) were the factors independently increasing stroke incidence. Stroke incidence in Atahualpa is comparable to that reported from the developed world. Besides age and high blood pressure, severe edentulism is a major factor independently predicting incident strokes.

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Palabras clave: Atahualpa, Ecuador, epidemiología, estudio poblacional, infarto cerebral hemorragia intracraneal,

Keywords: Atahualpa, Cerebral infarction, Ecuador, epidemiology, intracranial hemorrhage, population-based study,

Deterioro Cognitivo: Prevalencia y Correlatos en una Comunidad Rural Ecuatoriana. Lecciones del Proyecto Atahualpa. Cognitive Decline: Prevalence And Correlates In A Rural Ecuadorian Community. Lessons From The Atahualpa Project.

Assessment of cognitive impairment in rural areas of developing countries is complicated by illiteracy and cross-cultural factors. The Montreal Cognitive Assessment (MoCA) was used to estimate cognitive performance in individuals enrolled in the Atahualpa Project. Some problems were noticed with the use of this test, including issues related to naming animals, as well as the need to adjust a different cutoff for diagnosing mild cognitive decline than that used in highly educated individuals living in developed countries. After correlating MoCA scores with neuroimaging signatures of cortical and subcortical atrophy, a cutoff of 19-20 points would better define cognitive impaired individuals in rural areas. We also noticed that severe edentulism as well as psychological distress were associated with poor cognitive performance in older adults living in Atahualpa. In contrast, our study showed a linear, and dose-dependent, direct relationship between dietary oily fish intake and cognitive performance. We also aimed to assess the independent contribution and the interaction of age, the stroke itself and diffuse subcortical damage in the poor cognitive performance observed in patients with stroke, and noticed that interaction of age and diffuse subcortical damage are major determinants for poor cognitive performance among stroke patients. The total cerebral small vessel disease score can be used as a reliable predictor of poor cognitive performance, although its predictive power is not better than that of isolated neuroimaging signatures of cerebral small vessel disease. Finally, we noticed an inverse relationship between calcium content in the carotid siphon – used as a surrogate of intracranial atherosclerosis – and cognitive performance in our population.

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Palabras clave: Atahualpa, deterioro cognitivo, Ecuador, epidemiología, estudio poblacional, prueba de evaluación cognitiva de Montreal, Test de Leganés,

Keywords: Atahualpa, cardiovascular health, Cerebrovascular disease, Ecuador, epidemiology, ischemic heart disease, population-based study,

Estatus Epiléptico en Colombia: Análisis Descriptivo de Serie de Casos. Status Epilepticus In Colombia: A Case Series Descriptive Analysis.

Status Epilepticus (SE) is a neurological emergency that is by itself a syndrome defined according its clinical presentation and electroencephalographical manifestations, both highly variable. There aren’t any case series about this relatively common neurological emergency in Colombian indexed journals, for which a search for cases was performed in two neurological critical care institutions in the Colombian capital city in the period between 2011-2015. We describe demographical, diagnostic and therapeutic characteristics emphasizing in its clinical and paraclinical presentation, as the treatment applied according international guidelines. We found convulsive SE was three times more common that the non-convulsing time, 1.4 times more common in females that in males, more common in the pediatric group and less common in the geriatric group, the majority of this cases presented SE secondary to a congenital structural injury while adult and elder patients presented SE as a consequence of non-voluntary discontinuation of the therapy, and in 66% of the cases the SE described was not the first of its kind. The therapeutic regime applied corresponded to the stipulated in international guidelines in only 41.67%.

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Palabras clave: Electroencefalografía, Epilepsia, Estatus epiléptico, serie de casos,

Keywords: Case series, Electroencephalography, Epilepsy, Status Epilepticus,

Estudio Poblacional de Prevalencia de Cisticercosis Porcina en Atahualpa, Ecuador. Metodología y Definiciones Operacionales. Population-Based Study Of Porcine Cysticercosis Prevalence In Atahualpa, Ecuador. Methodology And Operational Definitions.

Objective: To assess sero-prevalence of porcine cysticercosis in Atahualpa, a rural Ecuadorian village endemic for human neurocysticercosis.

Design: We aim to collect at least 600 blood samples of local pigs, to quantify the number of positive bands in the EITB, and to estimate crude prevalence rates of porcine cysticercosis in the village. Sampling will only include pigs older than 2 months of age. Only healthy pigs will be sampled, to avoid risks inherent to manipulation of sick animals. There will be no risk for pigs as the result of the procedure. According to the estimated endemicity of human cysticercosis, we expect to find about 25% of infected pigs in this study. In the event of prevalence rates above or below the expected percentage, we will attempt to assess the causes of such discrepancies. All pig positive to 3 bands of more in the EITB will receive treatment with oxfendazole at a single dose of 30 mg/kg.

Comment: The importance of defining the prevalence of porcine cysticercosis in a village endemic for human neurocysticercosis is to confirm the existence of active transmission. If this is true, treatment of infected pigs will help to interrupt the life cycle of Taenia solium, thus reducing the prevalence of this disease in humans.

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Palabras clave: Atahualpa, cisticercosis, cisticercosis porcina, estudio poblacional, Inmunoblot, neurocisticercosis, Western Blot,

Keywords: Atahualpa, Cysticercosis, Immunoblot, neurocysticercosis, population-based study, Porcine cysticercosis, Western Blot,

Prevalencia de la Enfermedad de Parkinson: Estudio Puerta-Puerta en la Provincia de Manabí-Ecuador. Prevalence of Parkinson’s Disease: Door-to-door Study in Manabi-Ecuador.

Parkinson’s disease (PD) is one of the most frequent neurodegenerative disorders after dementias, with a worldwide prevalence of more than 1% in patients older than 65 years. In Ecuador, there are not direct statistical data on this disease. The aim of our research lies in establishing for the first time, the prevalence of Parkinson’s disease in the province of Manabi. For that, a door-to-door study was designed in two phases. They were selected 116,983 people, over forty years old. During the first phase, they were evaluated by survey, according to the London Brain Bank criteria for diagnosis. In the second phase, patients who met the criteria were referred to a neurologist for a definitive diagnosis. A total of 285 people (0.24%) were positive for Parkinson’s disease, predominating those aged over 61 years (33.33%), and with a slightly higher prevalence among males (56.14%) than in women (43.86%).

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Palabras clave: Ecuador, enfermedad de Parkinson, epidemiología, estudio puerta a puerta, Prevalencia,

Keywords: door-to-door study, Ecuador, epidemiology, Parkinson’s disease, Prevalence,

Evaluación Neuropsicológica del Control Inhibitorio y el Control de la Interferencia: Validación de Tareas Experimentales en el Contexto Ecuatoriano. Neuropsychological Evaluation Of Inhibitory Control And Interference Control: Validation Of Experimental Tasks In The Ecuadorian Context.

In this article we report a study in which three experimental tasks (SIMON, Go / No-Go and Stroop Victoria) were adapted and validated to evaluate the inhibitory control and interference control in a sample of Ecuadorian students. The sample consisted of 100 students between 6 and 15 years old (M = 10.13 years, SD = 2.48) belonging to the public education system of Ecuador. The process followed in the adaptation and validation was through the linguistic translation of the experiments, followed by an expert judgment and a pilot study. In the results it was found that there are no statistically significant differences in the measures that assess the inhibitory control and the interference considering the sociodemographic variables of the participants as comparison factors. In the correlation analysis we found a statistically significant association between the measurements of the experiments. We conclude by analyzing the associations found and underlining the need to continue providing evidence in the research line of adaptation and validation of test for using in neuropsychological evaluation.

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Palabras clave: control inhibitorio, evaluación neuropsicológica, GO/NO-GO, SIMON, STROOP,

Keywords: GO / NO-GO, inhibitory control, Neuropsychological Evaluation, SIMON, STROOP,

Funcionamiento de los Comités de Ética de Investigación en Seres Humanos en Ecuador, 2015

Research Ethics Committees play an important role in securing the quality of interventional studies in humans; in Ecuador, they are in process of becoming stronger. The aim of this observational study was to describe the evolution of Ecuadorian legislation, training processes implemented by the health authority in the period of 2006-2015 and the performance of six committees (Quito and Guayaquil) during 2015. A self-assessment survey and a questionnaire to determine training needs were applied. Each committee was visited to evaluate its performance. The average member number was 10 and, although there was no gender equity, all members had the profile required for membership. The average response time was 26 days and the average quorum at meetings was of six members. Among the weaknesses are, little training in biostatistics and clinical research methodology and a poor follow-up of the studies; concerning strengths, we highlight the willingness of the members to improve the performance of the committees, and the willingness of Ministry of Public Health to support them. This study reports for the first time, the evolution of Ecuadorian legislation regarding ethics committee, its basic characteristics, weakness and strengths.

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Palabras clave: bioética en el Ecuador, comités de ética, investigación en seres humanos,

Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones

Background. Cerebrovascular disease is the second cause of death and occupies the third place as a factor causing disability worldwide. At present, despite the recognition of its importance, the available data about Ecuador is scarce and there are not published analysis of its behavior. Methods. Retrospective longitudinal analysis of available public data on cerebrovascular disease in Ecuador, from 1991 to 2015. Results Cerebrovascular disease was the leading cause of mortality by 77 897 (6.70%) deaths and it is the only one with a constant trend pattern in the last 25 years. Conclusions. Cerebrovascular disease is the number one cause of death in Ecuador and its mortality is steadily increasing. Government policies must be implemented to reduce their mortality.

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Palabras clave: Ecuador, enfermedad cerebrovascular, Ictus, Mortalidad,

Keywords: Cerebrovascular diseases, Ecuador, Mortality, stroke,

Prevalencia de Enfermedades Neurológicas no Transmisibles en una Población Rural del Estado de Chiapas, México: Protocolo y Resultados Basales. Estudio Pro-Mas (Proyecto Comunitario La Soledad)

Objective: We aimed to assess cardiovascular health and neurological status of community-dwelling adults living in “La Soledad,” Chiapas, México, to calculate prevalence and incidence of cerebrovascular diseases, epilepsy and cognitive decline. Among others, these conditions are currently considered as the new epidemics in rural.
Design: Following a protocol similar to that used for the Atahualpa Project, we conducted a two-phase epidemiological study. During phase I, La Soledad residents were interviewed with validated field instruments to assess cardiovascular health status and well as to detect suspected stroke, epilepsy and cognitive impairment patients. During phase II, trained physicians examined suspected individuals as well as a random sample of non-suspected individuals to assess prevalence of diseases of interest.
Comment: Public health strategies must be based on the study of region-specific risk factors. Studies such the Atahualpa Project were proven to be effective for the assessment of public health problems in a rural Ecuadorian village. PROMAS will likely be cost effective to increase current knowledge on these conditions in Mexican rural villages and to promote a better cardiovascular health status among their inhabitants.

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Palabras clave: deterioro cognitivo, enfermedad cerebrovascular, Epilepsia, estudio poblacional, PROMAS, salud cardiovascular,

Keywords: cardiovascular health, Cerebrovascular disease, cognitive impairment, Epilepsy, population-based study, PROMAS,

Características Pre y Perinatales de Niños que Viven en Sectores de Alto Riesgo Ambiental por Exposición a Solventes Orgánicos en el Municipio de Sampués-Sucre

The purpose of this study is to characterize -through the Maternal and Perinatal Risk Questionnaire CMRP – the pre and perinatal aspects of children whose mothers had frequent exposure to organic solvents during pregnancy.
The results demonstrates that exposed mothers had a higher number of urinary infections both before and during pregnancy, pre term deliveries, motor decline and cesarean deliveries, which are potential causes of developmental disorders, cerebral palsy, decreased growth of the baby and impaired psychomotor development. A significant data was the number of children who suffered hypoxia and anoxia during delivery, with subsequent risk of brain damage, learning disabilities, reduced IQ and potential behavior problems.

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Palabras clave: características pre y perinatales, conducta, desarrollo cognitivo, desarrollo físico, neurotoxicidad, Solventes orgánicos,

Keywords: behavior, cognitive development, neurotoxicity, Organic solvents, physical development, pre and perinatal characteristics,

Sistemas de Atención Focalizada, Sostenida y Selectiva en Universitarios de Quito-Ecuador

Introduction. Attention is a neuropsychological function that has threads of targeting, selectivity, sustainability, division and alternation, which enable human beings identify a particular stimulus for cognitive and brain processing. Objective. To analyze the performance of college students in a focused, sustained and selective attention test, considering age group, gender and academic level comparing factors. Method. A quantitative, non experimental, transectional and based on the comparison group research design was used. The sample size was 246 college students (50.8% men and 49.2% women), within17 and 29 years (M = 21.01, SD = 2.35) Results. It was found that targeting attentional processes, sustainability and selectivity are similar between the different age groups, educational level and gender. Conclusions. The basic attentional processes are fully developed in college students. Data are discussed around previous research and theoretical postulates of cognitive neuroscience.

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Palabras clave: atención selectiva, atención sostenida, Ecuador, estudiantes universitarios, focalización, neuropsicología,

Keywords: college students, Ecuador, focusing, neuropsychology, selective attention, sustained attention.,

Uso del Electroencefalograma en un Hospital de Tercer Nivel

Objective: To describe the EEG indications in Baca Ortiz Children Hospital and how they are related to the EEG results. Materials and Methods: This is a descriptive study with a sample of 659 pediatric EEG records from March to June 2016. Data of variables related to EEG indications and EEG results were obtained, and it was done a descriptive statistics analysis. Results: Fifty-six percent of the patients were male. The mean age was 6.46 years. Seventy percent of EEG requests came from the Outpatient Area and 88.16% from Neurology as specialty. Fifty-six percent of indications were related to Epilepsy. Fifty-one percent of requests were inadequate, where Epilepsy had again the highest percentage, 24.13% of all indications or 47,04% or all inadequate indications. Eighty-one percent of the EEG results were abnormal. Conclusions: These results reflect that EEG was misused as a routine diagnostic method, even in Epilepsy.

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Palabras clave: Electrodiagnóstico, Electroencefalografía, Electrofisiología, neurofisiología, Técnicas de Diagnóstico Neurológico, Técnicas y Procedimientos Diagnósticos (DeCS),

Keywords: Diagnostic Techniques, Electrodiagnosis, Electroencephalography, Electrophysiology, Neurological Diagnostic Techniques and Procedures (MeSH), neurophysiology,

Trombectomía Mecánica: Técnica de Primera Elección en el Tratamiento del Ictus Isquémico Agudo. Análisis de Beneficios y Resultados

The main objective of this article is to portrait mechanical thrombectomy as the modality of choice for interventional stroke treatment.

Methods and materials: Nine patients with acute ischemic stroke were diagnosed. Mechanical thrombectomy was perfomed in all of them with a solitaire type device associated with intraarterial rTPA. Eight patients (89%) had anterior vascular occlusion and only one (11%) had posterior vascular compromise. Treatment efficacy was assesed using a modified Rankin scale (mRs).

Results: Five patients (55%) had complete recovery while three of them (33%) had partial recovery. Only one patient (11%) showed no recovery at all.

Discussion: Although more data is needed, mechanical thrombectomy prooved to be effective and shows promising outcomes in patients with acute ischemic stroke.

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Palabras clave: ictus isquémico agudo, trombectomía mecánica,

Keywords: acute ischemic stroke, mechanical thrombectomy,

Experiencia Quirúrgica de Dos Años en el Manejo de la Epilepsia Refractaria Multifocal

Objective: To describe the series of patients with multifocal refractory epilepsy who have undergone surgery in our center.

Methods: A prospective analysis of patients with multifocal refractory epilepsy treated in our hospital during the last two years was performed.

Results: In this period we studied 25 patients with multifocal refractory epilepsy who have completed > or =1 year postoperative follow-up after callosotomy. The ages of the patients were between 3.8 and 18.8 years (mean 11, SD 4.46). The most common cause of refractory epilepsy in our series was Lennox Gastaut syndrome (ten patients). We perform 14 callosotomy in 13 patients. Of these, 10 were of the above callosotomías 2/3 and four complete. Overall there was a 66.5% reduction in seizures; in the case of total callosotomías this reduction was 90%. We report two minor complications and death from a pneumonic process.

Conclusion: The surgical management of multifocal refractory epilepsy is a safe procedure that provides good results in controlling the crisis. The complete callosotomy is the most efficient procedure in this population.

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Palabras clave: Callosotomía, Cirugía de la epilepsia, Epilepsia refractaria, Neuronavegación, Planificación quirúrgica,

Keywords: Callosotomy, Epilepsy Surgery, Neuronavigation, Refractory epilepsy, Surgical planning,

Impacto del Aprendizaje del Inglés Sobre los Procesos Cognitivos en Adultos Mayores. Un Estudio Preliminar en Cuenca

A descriptive exploratory study, before and after a six-month english learning course for seniors is conducted to evaluate the cognitive effect of learning another language in this age group in the city of Cuenca.

Materials and Methods: 80 adults of average age 70.48 ± 4.9 years (31 men, 19 women) were included; who underwent neurological and neuropsychological evaluation at baseline, six and twelve months after the course; including tests for executive function (working memory and attention processes).

Results: Data show significant statistical association between impaired olfactory perception related to age. Neuropsychological tests show interesting data relating cognitive maintenance and even improvement in the Performance Testing Direct and inverse series (Wais III) and Symbol Digital Modality Test (SMDT) six and twelve months after initiating a learning course of English.

Conclusion: The study suggests that learning English, even without functional objective of a new language, may have protective effect on the executive functions and neuronal brain networks are claimed the first findings in patients with cognitive impairment. We suggest perform this follow up long term in time to find strongest evidence, related to international bibliography.

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Palabras clave: demencia, deterioro cognitivo, inglés, Neuroprotección,

Keywords: Cognitive decline, dementia, english, Neuroprotection,

Validación de la Escala de Impulsividad Bis 11-C para su Aplicación en Adolescentes Ecuatorianos

Barratt scale (BIS) is an assessment tool often used to evaluate impulsivity. In this study, an analysis of the psychometric properties of the BIS 11 c scale Ecuadorian adolescent students (N = 245) is performed. Internal consistency through Cronbach’s alpha coefficient and homogeneity of the items were evaluated. For assessing the construct validity we perform a confirmatory factor analysis. The results obtained were acceptable parameters of valid and reliability to use the BIS 11 c scale in Ecuadorian adolescents. Finally, a discriminant analysis in a clinical sample of 18 students with ADHD was conducted.

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Palabras clave: adolescentes, Déficit atencional, Escala BIS, Hiperactividad, impulsividad,

Keywords: adolescents, Attentional Deficit Hyperactivity Disorder, BIS Scale, impulsivity,

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