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Predictores del nivel de somnolencia en pacientes con Apnea Obstructiva del Sueño.

Excessive daytime sleepiness (EDS) is the obstructive sleep apnea syndrome (OSAS) most frequent symptom. The relationship between the level of daytime sleepiness and standard polysomnographic variables (i.e., apnea/hypopnea index [AHI] and oxygen saturation SaO2) has been the subject of a number of studies. To date, the results have been inconsistent. The goal of this study is to assess the variables significantly related with daytime sleepiness severity. The variables chosen were: AHI, percentage of total time that the subject remains with arterial oxygen saturation level below 90% (SaO2<90%), minimum oxygen saturation (SaO2 m), body mass index (BMI), and age. The study sample was composed of 51 obstructive sleep apnea patients selected from a medical centre.

Subjects completed using the Epworth Sleepiness Scale (ESS) to determine daytime sleepiness. The OSAS was diagnosed by conventional polysomnography.

The results indicated significant correlations between level of daytime sleepiness and age (r=.302; p<.05), BMI (r=.339, p<.05), SaO2 m (r=-.393, p<.01) and SaO2 < 90% (r=.492, p<.01). Significant correlations were also found between AHI and SaO2<90% (r=.314, p<.05), BMI and SaO2<90% (r=.387; p<.05), and SaO2 m and SaO2<90% (r=- .746; p<. 01). No significant correlation was detected between AHI and level of daytime sleepiness. According to the results, the percentage of total time that the subject remains with arterial oxygen saturation level below 90% (SaO2< 90%) is the best predictor of daytime sleepiness severity.

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Palabras clave: Apnea, Índice de apnea-hipopnea, Índice de masa corporal, Saturación de oxígeno, Somnolencia,

Keywords: Apnea, Apnea-hypopnea index, Body mass index, Oxygen saturation, Sleepiness,

Descripción y Valoración Pronóstica de la Hemorragia Cerebelosa no Traumática.

Spontaneous cerebellar hematomas (CH) represent 5%–10% of intracranial hemorrhages The purpose of this study was to describe CH characteristics in patients admitted to the critical care unit, to determine the prevalence of risk factors, to describe the clinical presentation, the treatment and the clinical situation at discharge. Thirty four consecutive patients were included. The mean age was 67±15 years. In the univariant analysis, only Glasgow Coma Score was associated with high mortality. An hematoma diameter > 3 cm., intraventricular hemorrhage and hydrocephalus were associated with mortality, but without statistical significance.

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Palabras clave: Hemorragia cerebelosa espontánea, Pronóstico,

Keywords: Prognosis, Spontaneous cerebellar hematoma,

The incongruities of the NPI−Q score obtained by the caregiver versus that obtained directly from the non−demented patient with Parkinson’s disease.

Background: Neuropsychiatric symptomatology frequently accompanies Parkinson’s disease. Purpose: In this work (a one point time analytical study), we wished to explorer the Neuropsychiatric Inventory in its shorter format (NPI–Q) in seventy consecutive patients. To find out in what way information obtained from the caregiver (CG) is correlated with that which the patients provide. If this tool, designed to evaluate patients with dementia, can be applied to non-demented subjects with Parkinson’s disease (NDP).

Method: The study, the NPI–Q Spanish version was employed, first with the CG alone and subsequently, with the individual patient alone by a researcher with no knowledge of the previous result from the CG. The weighted kappa correlation coefficient was measured to evaluate the CG–NDP consistency rate (Test–retest reliability; obtained by judging the reproductibility or stability of a instrument over time; two or more observers; or two or more times); a value of 0.7 or higher was accepted as significant. Because the correlation results were found to be insignificant, a post–hoc analysis was performed. We study the convergent validity (Validity–Construct–related, include examining the logical relations that should exist with other measures, know too as convergent validity) analyzed using the Spearman rank correlation statistic values greater than (r <0.29 are weak correlations; r <0.3– .58 are moderate correlations and; r < 0.59 are high correlations the convergent validity).

Results: The consistency inter-rater (CG–NDP), were without any significant agreement; in the inter- tems correlations the best values were for the patients; and in the Spearman’s correlations (a measure of converging validity), the values obtained on the NDP were more significant.

Conclusions: We can assume that the patient’s NDP is the best source of information, and hence for these patients, we consider that the NPI–Q (reported by the CG) is not the best tool to evaluate the Neuropsychiatric symptomatology of NDP sufferers.

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Palabras clave: enfermedad de Parkinson, Inventario neuropsiquiátrico, Sintomatología neuropsiquiátrica, Validez convergente,

Keywords: Consistence inter–rater, Convergent validity, Neuropsichiatric Inventory short Format, Neuropsychiatric symptomatology, Parkinson’s disease,

Valor del Potencial Evocado Auditivo de Latencia Media en el estudio de personas con Esclerosis Múltiple Forma Brote–Remisión.

A prospective study was carried out to establish the utility of Auditory Middle Latency Response (AMLR) in the evaluation of patients with relapsing- remitting multiple sclerosis. Twenty subjects were evaluated with the multimodal battery of auditory, visual and somatosensory evoked potentials, AMLR, and motor evoked potential by transcraneal magnetic stimulation. The results showed the following abnormalities: 60 % in the AMLR, (only 50 % of them with clinical symptoms), 25% in the auditory brainstem response, 85 % in the visual response and 90 % in somatosensorial and motor potentials. We found significant differences between the auditory tests and the rest of the electrophysiological techniques (rate comparison, p<.05). Those differences disappeared when auditory tests were considered together. There was a significant association between anatomical and functional tests in the evaluation of the auditory pathway, and a positive correlation between the absolute latency of Na, Pa, and Pb components and the temporal course of the disease. The results suggest the convenience of including AMLR in the battery of evoked potentials for the study of relapsing- remitting multiple sclerosis patients.

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Palabras clave: esclerosis múltiple, Estimulación magnética transcraneal, Potencial evocado auditivo de latencia media, Potencial evocado auditivo de tallo cerebral, Potencial evocado motor, Potencial evocado somatosensorial, Potencial evocado visual, Resonancia magnética nuclear,

Keywords: Auditory brainstem evoked potential, magnetic resonance imaging, Middle latency auditory evoked response, Motor evoked potential, multiple sclerosis, Somatosensory evoked potential, Transcraneal magnetic stimulation, Visual evoked potential,

Subtipos de Enfermedad Cerebrovascular: Análisis del registro de la Unidad de Ictus del Hospital Clínica Kennedy.

The main goal of this study was to determine the relative incidence of the different subtypes of stroke in a group of people from Guayaquil, considered of a relatively high socioeconomic stratus, to establish a relationship that was previously proposed as a probable cause of the etiologic stroke subtype variation found in our city. We conducted a retrospective study, in which were identified 100 consecutive patients with acute first-ever stroke admitted to the stroke unit of Hospital-Clínica Kennedy. The results were: male prevalence (57% vs 43%), mean age of onset 70 years for infarcts and 54 years for hemorrhages. Sixtythree patients had a cerebral infarction and 37 had an intracranial hemorrhage. As conclusion, we found that this relatively high prevalence of hemorrhages were related to rupture of intracranial aneurysms, and that most infarcts were related to hypertensive vasculopathy. We also found that the main risk factors were arterial hypertension and cardiopathies (p<0.05). Is important to resolve the controversies that were provoke in the last years about onset variability in types and subtypes of stroke, for which more studies and further are required.

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Palabras clave: hemorragia, Ictus, variación de subtipos, vasculopatía hipertensiva,

Keywords: hemorrhages, hypertensive vasculopathy, stroke, subtype variation,

Cadena de supervivencia del Ictus: Un desafío de la medicina actual.

A quasi experimental study was carried out in patients with cerebrovascular disease, through the stroke survival chain at the Municipality Holguín, in order to characterize the access getting of these patients to the secondary care unit at the Hospital Provincial Docente V. I. Lenin, from May to October 2006. Neurological evaluation and cerebrovascular risk scales were applied, obtaining the following results: ages from 60 to 74 years were the more affected, predominantly in male. Atherotrombotic cerebral infarcts were the more frequent. Only 8 patients (23,5%) arrived to the hospital during the first three hours of the event. High blood pressure, history of cerebrovascular disease and cardiopathies were the more frequent risk factors. Glasgow coma scale above 11 points was observed in all the cases. We conclude that, in order to reestablish cerebral blood flow after stroke, it is necessary to participate in a whole performance survival chain.

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Palabras clave: cadena de supervivencia, enfermedad cerebrovascular, infarto cerebral,

Keywords: Cerebrovascular disease, stroke, survival chain,

Efectos de la Terapia con Campos Magnéticos en los Niveles de Fatiga de las personas con Esclerosis Múltiple.

Introduction: Multiple Sclerosis (MS) is a demyelinating and neurodegenerative disease of the Central Nervous System. It is the major cause of neurological disability in the young adult. One of the most frequent and refractory symptoms to treatment is fatigue. Objective: To evaluate the efficacy of treatment with Magnetic Fields for fatigue produced by MS.

Material and Method: An almost experimental-type intervention study was performed in 14 patients evaluated at the Psychomotor Evaluation Lab and diagnosed with MS (Mc Donald et al) who presented fatigue. The Impact Fatigue Scale (IFS) was applied before and after the treatment with 1750-l magnetic bed was conducted for 4 weeks and 20 minutes, 50 Gauss. Statistics tests used were Spearman and ANOVA within the statistics program. The level of significance was p<0.05.

Results: The sample was composed by women (86%). The most frequent clinical form of MS was the Secondary Progressive (64.3%). Fatigue was found in 92.9% of cases, with an evolution period of 6 months or more. This is one of the symptoms that produced greater disability in these patients. After treatment with magnetic fields there was fatigue improvement in 92.9% of cases according to the evaluation of the fatigue impact scale. Tolerance to treatment was excellent.

Conclusion: Therapy with magnetic fields produced improvement of fatigue symptom in this group of patients with MS, especially in the progressive type.

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Palabras clave: Campos magnéticos de baja frecuencia, esclerosis múltiple, Fatiga,

Keywords: Fatigue, Low frequency magnetic fields, multiple sclerosis,

La Creatinfosfokinasa tiene utilidad en la Evaluación Pronóstica Temprana de Discapacidad en el Infarto Cerebral.

Introduction: Cerebral infarction is the third cause of morbidity and mortality in the occidental world. The diagnosis is usually based on clinical and imaging studies, like computerized axial tomography. However, the prognostic value is limited especially in the first 48 h after the event. Currently, creatinphosphokinase tests are not known as a prognostic tool.

Objective: To study the creatinphosphokinase serum levels in patients with cerebral infarction in the first hours after the event, to determinate prognosis and establish a relation with disability.

Patients and methods: Forty hospitalized patients with cerebral infarction were studied. Levels of creatinphosphokinase in serum were measured at 12, 24 and 48 hours after infarction and were associated with disability using the Rankin modified scale.

Results: The creatinphosphokinase concentration increased during the first 12 hours after infarction, was higher at 24 hours and, at 48 hours, it began to decrease. The levels of creatinphosphokinase are correlated with disability results in the Rankin scale.

Conclusions: The creatinphosphokinase can be a useful tool in the prognostic evaluation of disability in patients suffering brain infarction, in the first hours after the event takes place, and preceding tomographic alterations.

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Palabras clave: Creatinfosfokinasa, Discapacidad, infarto cerebral, Marcador biológico, Pronóstico, Rankin,

Keywords: Biological marker, Cerebral infarction, Creatinphosphokinase, Disability, Prognosis, Rankin,

Mielitis Crónica por HTLV-1: Resultados en 45 Casos Estudiados.

ntroduction: HTLV-I myelitis is a chronic disease, endemic in several countries, with well-established clinical and diagnostic criteria.

Methods: Etiology and immunology are reviewed based on 45 patients diagnosed and followed up in our neurology service since 1992. We evaluate the inclusion criteria , assessment scale (Osame`s motor disability scale) and blood, CSF, radiological (specially MRI) and neurophysiological studies for the diagnosis.

Results: Motor, sensory and long tract signs predominated. Patients resulted positive for HTLV1 by ELISA and Western Blot in blood and CSF. These results were similar as those previously reported.

Conclusions: We confirm the existence of chronic HTLV-1- associated myelitis in Ecuador, with an endemic focus in Esmeraldas region. It is necessary to perform new neuroepidemiological studies in order to obtain a better prevention and control of this disease in medical centers, blood banks and to monitor infected nursing mothers.

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Palabras clave: escala de Osame, estudios neuroepidemiológicos, Mielitis crónica por HTLV-1,

Keywords: HTLV-1 chronic myelitis, neuroepidemiological studies, Osame´s scale,

Concurrent Validity of the Hamilton Depression Rating Scale and the Beck Depression Inventory versus the ICD-10 Diagnostic Criteria among Patients with Parkinson’s Disease.

Objective: To examine the concurrent validity of the Hamilton Depression Rating Scale and the Beck Depression Inventory for quantifying depression in patients with Parkinson’s disease, using the ICD-10 Diagnostic Criteria as the gold standard, and to determine if the somatization items considered are pertinent.

Methods: The study involved one hundred and forty consecutive PD patients –102 men and 38 women– with a mean age of 68.7 years and mean disease duration of 6.7 years. Sensitivity, specificity, positive and negative predictive values and likelihood ratios were obtained with a 95% CI. ROC Curves (AUC) were also performed.

Results: Based on ROC measurement of discriminative ability, our results suggest that both scales were poor at recognizing mild depression, somewhat better at recognizing moderate depression and adequate for distinguishing severe depression, though with poor specificity. Comparisons of HDRS-21, HDRS-12, BDI-21 and BDI-16 to determine concurrent validity all gave similar results for each depression level and no important differences between the complete scales (all 21 items) and abbreviated forms (without somatic items) were noted.

Conclusions: We conclude that both scales possess similar psychometric properties, but our results cannot be compared with those of other studies that used DSM-IV criteria as their gold standard. These observations led to the following conclusions: (1) the evaluation scales and criteria that comprise them were not designed for PD; (2) the somatic items observed in our patients were a product of PD; and (3) as the severity of the illness increased, so did the number of items that were confused as elements of depression.

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Keywords: Beck Depression Inventory, depression, Hamilton Depression Rating Scale, Parkinson’s disease, Sensitiviy, Somatic items in depression, Specificity,

Tratamiento del Blefaroespasmo y Síndrome de Meige con toxina botulínica. Experiencia y seguimiento en 18 casos.

Treatment with botulinum toxin (BT) is a good therapeutic alternative for patients with blepharospasm and Meige’s syndrome. We report follow up results of 18 patients with blepharospasm and Meige’s syndrome treated with botulinum toxin, to asses therapy response. 67 injection sessions were performed with a mean dose of 40.2 ± 26.5 UI. The duration of effect was 120 ± 50 days and the global assessment of the results on a scale from 0 to 4 (0 no results to 4 very good results) was an average of 3.1 ± 0.72. We can say that botulinum toxin therapy was good or very good in 14 (77.7%) patients with blepharospasm and Meige’s Syndrome. Only 3 cases (16.6%) had significative complications, reversible in all cases.

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Palabras clave: Blefaroespasmo, Síndrome de Meige, Toxina botulínica,

Keywords: Blepharospasm, Botulinum toxin, Meige’s syndrome,

Estudio piloto de tratamiento de pacientes con Esclerosis Múltiple con el uso de una formulación homeopática de la Biomodulina T.

25 patients with defined exacerbating-remitting Multiple Sclerosis (MS), with a score between 1 and 5.5 according to Kurtzke’s disability scale, were treated with Biomoduline T at 6 ch during 15 months. After concluding this treatment 83% of the patients were clinically stable according to the disability score. Due to the immunoregulating and anti-inflammatory effects of this product, the possibility of employing this homeopathic variant for the treatment of MS is suggested, considering its low cost of production and the fact that no adverse reactions were referred.

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Palabras clave: Biomodulina T variante homeopática, esclerosis múltiple, Tratamiento,

Keywords: Biomoduline T homeopathic variant, multiple sclerosis, Treatment,

Pathological changes induced by ototoxicity on spiral ganglion neurons and its peripheral processes.

Deafness is one of the most widespread disabilities in the world. Its most frequent cause is death of cochlear hair cells (located in the organ of Corti), which induces degeneration of spiral ganglion neurons and their peripheral processes innervating the organ of Corti. In a previous light microscopy study using a rat model of ototoxicity, a loss of spiral ganglion neurons was observed since the eighth week of deafness and peripheral processes degeneration since the fourth week. In order to determine the onset of ultrastructural degenerative changes, a transmission electron microscopy study of spiral ganglion neurons and their peripheral processes was undertaken. Rat cochleae sampled after 2, 4, 8 and 16 weeks of deafness and healthy controls were analyzed. Since the fourth week of deafness, Type I spiral ganglion neurons and the myelin sheaths of their peripheral processes showed progressive degenerative changes. Most of the remaining neurons exhibited complete demyelination at sixteen weeks of deafness, resulting in the pathological type III spiral ganglion neurons. These results show ultrastructural degenerative changes of the spiral ganglion neurons and their peripheral processes, before both undergo significant losses.

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Palabras clave: cóclea, Microscopia electrónica de transmisión, Neuronas del ganglio espiral, ototoxicidad, Procesos periféricos,

Keywords: Cochleae, ototoxicity, Peripheral processes, Spiral ganglion neurons, Transmission electron microscopy,

Alteraciones del reflejo H, reflejo de parpadeo y neuroconducción en pacientes alcohólicos crónicos.

Introduction: The objective of this study was to determine alterations of the Blink-reflex (BR), H-reflex (HR) and nerve-conduction in a group of alcoholic patients. Methods: A cross-sectional study was carried out on 21 alcoholic patients with an average age of 43.5 years. The history of alcohol abuse was 22 ± 7.4 years. At the time of the study, none of the patients had ingested alcohol for more than 30 days. Results: BR component alterations were as follows: R1 right 19.0%, R2 right 57.1%, R2 right contralateral 71.4%, R1 left 9.5%, R2 left 61.9% y R2 left contralateral 52.4%. Only the R2 right and left ipsi and contralateral latancies were significantly prolonged (P < 0.05). The H-reflex was absent in 90.5% of the patients. There was no significant difference in the comparison of sensitive or motor nerve-conduction speed between alcoholics and healthy subjects. Conclusions: The absence of H-reflex was the most frequently found electrophysiological alteration in this group of alcoholic individuals.

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Palabras clave: Alcoholismo, Neuroconducción, Neuropatía, Reflejo de parpadeo, Reflejo H,

Keywords: Alcoholism, Blink-reflex, H-reflex, Nerve-conduction, Neuropathy,

Conversión de Deterioro Cognitivo Leve a Demencia.

Great social efforts and sanitary conditions have decreased child mortality rates, decreased birth rates and increased life expectancy. Consequently, the proportion of adults has increased. The increased incidence of neurodegenerative disease such as dementia occurs in parallel to this demographic transition. Dementia may be associated with several risk factors. However, few studies have examined the rate of cognitive and functional decline.

Objective: To determine the prevalence of cognitive decline and dementia, risk factors and report results of cognitive and functional decline in patients in the National Institute of Neurology and Neurosurgery.

Methods: We included all outpatients aged ≥ 50 years attending between 1999 and 2000. We sought to asses the Petersen criteria for the mild cognitive impairment (MCI). Patients were assessed using the Consortium to Establish a Registry for Alzheimer’s Disease, Diagnostic and Statistical Manual of Mental Disorders (4th edition), and the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association criteria. We followed for up to 8 years.

Results: A total of 239 individuals were included. The conversion of MCI was of 25.6% per year and 56.4% at the eight years. The consumption of alcohol were associated with dementias (p<0.01).

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Palabras clave: Conversión, demencia, deterioro cognitivo, Factores de riesgo,

Keywords: Cognitive decline, dementia, Progression, Risk factors,

Caracterización del paciente lesionado medular según deterioro neurológico y discapacidad.

Introduction: Assessment of spinal cord injured patients helps to determine the neurological impairment in a precise and unified way and to estimate in a reliable way, the prognosis of rehabilitation by tracing adequate objectives for the neurorehabilitation treatment.

Objective: To characterize those patients with spinal cord lesion hospitalized at our clinic, starting from the determination of the level and intensity of the spinal cord injury, as well as the level of functional independence.

Material and method: All the patients hospitalized at the International Center of Neurologic Restoration (CIREN) with traumatic spinal cord injury were evaluated from March to June 2008. All international standards were applied for the neurologic classification of the spinal cord injured patient (ASIA-American Spinal Injury Association) and Barthel’s Functional Independence Scale. The groups were classified according to the intensity and level of the lesion.

Results: 25 patients with traumatic spinal cord lesions were evaluated. 21 patients out of 25 were classified as paraplegic and the remaining four as tetraplegic according to the intensity of the lesion, the neurologic level and functional independence.

Conclusions: The patients with post-traumatic spinal cord lesion were characterized in a precise way. Paraplegia predominated as well as lesions in men. There was a relation between the degree of neurological impairment and functional independence.

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Palabras clave: clasificación ASIA, Escala de independencia funcional de Barthel, Lesión medular, Tratamiento Neurorrestaurador,

Keywords: ASIA clasification, Barthel functional scale, Medular Lesion, Neurologic restoring,

Construcción de una tabla de valores referenciales para un laboratorio de neurofisiología.

This is an study performed to develop a normal reference table of values for nerve conduction studies including sensory, motor and late responses (F Wave and H Reflexes) of the median, ulnar, radial, sural and peroneal nerves; same as also its correspondent late responses and the study of the median-flexor carpi radialis and tibial-soleus complexes in a neurophysiology laboratory located in an Andean city about 2600 m above the level of the sea. This consecutive study includes 100 patients referred for evaluation, free of neuropathic pathology same as also without risk factors associated to peripheral nerve disease. The mean age was 49 year old; with the lower and upper limits between 15 and 71 years old. The normal conduction values (and standard deviation) for sensory responses are (in meter by second): median nerve 53.3±2.2, ulnar nerve 55.2±3.6, radial nerve 54.8±4.2, sural nerve 57.5±5, and 53.1±4.5 in the superficial peroneal nerve. The motor conduction normal values are: 57.5±4.6 for the median nerve, 63.7±5.3 for the ulnar nerve, 57.9±4.2 the radial nerve, and 55.7±3.6 for the common peroneal nerve. The latency when we study the late responses showed as normal values (in milliseconds); 23.5±1.3 for the median nerve, 23.9±1.5 for the ulnar nerve, and, 40.0±2 for the peroneal nerve. The H Reflex latency also in milliseconds was 16.3±1.2 for the median-flexor carpi radialis complex; and 28.7±2 for the tibial-soleus complex. The results are very similar compared to the international published data, in relation to the height of the included subjects; the difference is related to this factor and shows normal responses once we eliminated the confound factors depending in the environment (skin temperature as the principal).

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Palabras clave: electromiografía, Estudios de conducción nerviosa, neurofisiología,

Keywords: electromyography, Nerveconduction studies, neurophysiology,

Principales factores multicausales en la epilepsia que inducen al deterioro de funciones cognitivas.

By studying a group of epileptic patients we try to know the low levels of intelligence quotient (IQ) and positive cognitive deterioration index (DI) and its relation to a group of multietiologic factors. Wechsler’s IQ and DI were used in the study with 130 epilepsy diagnosed patients that were divided into two groups: in the first one were those with CI < 89 and > 90, and in the other those that had either DI positive or not. These variables were analyzed according to biological, psychosocial and drug factors. The data was processed with statistigraphs as Fisher, Odds Ratio, and ANOVA. Out of the total of studied patients 52.31% had a CI <89 and 47.69% had CI >90. 52.3% of the patients had no deterioration and 47.7% showed deterioration index. The factors related to patients with CI < 89 were: past history of alcoholism, first seizure < of 15 years, seizures presented for more than 10 years, high frequency of the seizures, partial seizures with secondary generalization and phenytoin treatment.

Factors related to the DI were: alcoholism, high frequency of seizures, partial seizures with secondary generalization, association with chronic psychosis, treatment with phenytoin and a mixture of phenytoin and carbamazepine. Half of the patients had IQ < 89, and more than one fourth of them showed deterioration. It´s considered that although the deterioration, detected by Weschler Adults Intelligence Scale (WAIS), may not be visible, it is important to know its existence to diminish the risk factors.

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Palabras clave: Antiepilépticos, Coeficiente de inteligencia, deterioro cognitivo, Epilepsia, Factores multicausales, Factores Psicosociales,

Keywords: Antiepileptic drugs, cognitive deterioration, Epilepsy, intelligence quotient, psychosocial factors and multietiologic factors,

Comparison of hemorheology and plasma contents of TXB2, 6-Keto-PGF1 alpha in model rats with three kinds of cerebral ischemia.

Objective: To compare changing features of hemorheological, TXB2 and 6-keto-PGF1 alpha in plasma in three kinds of model rats with cerebral ischemia.

Materials and Methods: 128 adult male Sprague-Dawley rats were randomly divided into four groups: a middle cerebral artery occlusion with intraluminal thread group (MCAO-group), a bilateral common carotid artery ligation group (BCCA-group), a unilateral common carotid artery ligation group (UCCA-group) and a normal control group (NC-group). Blood for hemorheological testing of all rats was taken from abdominal aorta 24h following cerebral ischemia and hemorheological index was determined. Plasma contents of TXB2 and 6-keto-PGF1 alpha were detected by radio-immunity.

Results: The whole blood viscosity value, plasma viscosity value, and hematocrit were higher in MCAO-group among three model groups, followed by BCCA-group and UCCA-group. The deformity index of RBC in MCAO-group was significantly lower than that in normal-group. There were significant differences for plasma contents of TXB2 and 6-keto-PGF1 alpha among the three model groups and the normal group. There were significant differences for plasma level of 6-Keto-PGF1a, TXB2 between MCAO-group and the normal group, but no difference among the three model groups(p>0.05).

Conclusion: MCAO was the greatest in contribute to changes of hemorheology and plasma contents of TXB2, 6-keto-PGF1 alpha among three rat models with cerebral ischemia.

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Palabras clave: 6 –keto-PGF1 alfa, Hemorreología, Isquemia Cerebral, Ligadura bilateral de la arteria carótida común, Obstrucción de la arteria cerebral media, Tromboxano B2,

Keywords: 6-keto-PGF1 alpha, Bilateral common carotid artery ligation, Cerebral ischemia, Hemorheology, Middle cerebral artery occlusion, Thromboxane B2,

Neuropsychological evaluation of 246 Portuguese normal subjects with Luria Nebraska Neuropsychological battery, MMSE, Clock Drawing Test, Luria’s Graphic Series & Depression symptomatology questionnaire.

A total of normal 246 adult subjects were evaluated with Luria Nebraska Neuropsychological Battery – LNNB (Portuguese Experimental Version – Maia et al, 2006), Mini Mental State Examination (MMSE), Clock Drawing Test, Luria’s Graphic Series and Depression symptomatology questionnaire (IACLIDE – anachronism for the Portuguese denomination Inventory of Clinical Assessment of Depression); they were randomly selected from the Portuguese population that voluntarily accepted to take part in this project. All subjects selected had right hand specialization and were Caucasian. The age range was selected following the usual procedures in Portugal (18 old – 65 old, with average = 35, 80 and S.D. 13,869). The major results of tests were evaluated having as grouping factors the age, sex and scholar level. The analysis of data with Chi Square test, T tests, Anova and Pearson correlation showed great consistency with results around the world about the internal consistency of LNNB in strongly discriminating normal subject from neuropsychological affected patients. The concurrent validity with the other tests used shows again a great relation about the variables that were studied. Finally, the first Portuguese normative data about LNNB -in an experimental phase, with almost a quarter of thousand patients- were presented. We believe that this article could be of great value and help for those who are engaged in neuropsychological assessment and are principally interested in the viability of the plethora of cognitive tests particularly used to adequately evaluate normal and abnormal neuropsychological performance.

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Palabras clave: Batería Neuropsicológica de Luria Nebraska, Datos Normativos, Funcionamiento neuropsicológico normal y anormal,

Keywords: Luria Nebraska Neuropsychological Battery, Normal and Abnormal neuropsychological data, Normative Data,

Fractura de cadera y deterioro cognitivo: un estudio seccional-cruzado.

Cognitive impairment is a non modifiable risk factor for hip fracture.

Objective: To determine if patients older than 60 years old with hip fracture presented association with cognitive impairment.

Method: Cross-sectional study.

Patients. All patients older than 60 years admitted in the traumatology service of Enrique Garcés Hospital in Quito-Ecuador.

Data recollection. It was made by: clinical history, interview with the patient that included valoration of cognitive state by minimental test and the photograph test, interview with the relatives of the patients if they where during his or her hospital stay. The variables were analyzed in percentages and the data was utilized to evaluate if there was a mayor association between cognitive impairment and hip fracture.

Results. Of the 56 patients included 83,92% presented cognitive impairment, of this patients 85,10% presented dementia and 42,55% presented severe dementia. The association between the following variables was significant: patients older than 80 years old with severe dementia OR 8 (IC 1,75 – 41,18), analphabets with severe dementia OR 5,33 (IC 1,13 – 27,97), hip fracture with severe dementia OR 6,28 (IC 1,54 – 30,24), hip fracture with falling OR 19,09 (IC 3,36 – 187,38).

Conclusions: Severe dementia presented an association with age older or equal to 80 years and analphabetism, and hip fracture presented an association with severe dementia and falling.

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Palabras clave: demencia, Demencia severa, deterioro cognitivo, Fractura de cadera,

Keywords: cognitive impairment, dementia, Hip fracture, Severe dementia,

Estudio de 20 pacientes con epilepsia del lóbulo temporal medial con esclerosis del hipocampo.

In order to more precisely define temporomedial epilepsy with hippocampal sclerosis, we evaluated 20 patients with magnetic resonance imaging findings of it: 1. Abnormal high signal of the hippocampus on T2 and Flair, 2. Hippocampal atrophy and 3. Structural deformity in hippocampus. 6 patients (55%) had history of febrile seizures during early chilhood or infancy. 4 patients (36%) had head trauma and 1 patient (9%) had neonatal hypoxia. The mean age of seizure onset was 18 years. All patients had complex partial seizures at onset.15 patients (75%) had auras, with abnormal abdominal visceral sensation being the most common type (40%). 11 patients with identified risk factors had an interval between the presumed cerebral insult and the development of habitual seizures, with a mean seizure free interval of 11 years. All patients had oroalimentary automatisms, and 14 patients (70%) also had other automatisms. 9 patients (45%) had lateralizing signs, 6 patients had contralateral version of the head and eyes and 3 patients had dystonic posturing of the contralateral upper extremity. 15 patients (75%) had an abnormal electroencephalogram. 13 patients (87%) showed paroxysmal abnormalities that were localized in the anterior temporal region, over the side of the hippocampal sclerosis in 12 patients and over one temporal lobe in 1 patient with bilateral hippocampal sclerosis with paroxysmal activity. . 2 patients (13%) had interictal bilateral temporal slowing, these patients had bilateral hippocampal sclerosis.

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Palabras clave: Epilepsia del Lóbulo temporal, Esclerosis Mesial del Hipocampo,

Keywords: Mesial Hippocampal Sclerosis, Temporal Lobe Epilepsy,

Parkinsonismo inducido por neurolépticos. Caracterización clínica.

Background: Neuroleptic-induced parkinsonism is the most common clinical form of extrapyramidal syndrome induced by drugs. The objective of this research was to characterize its clinical spectrum.

Materials and methods: We collected the results of clinical neurological evaluation of 28 patients with chronic psychosis and parkinsonism, in treatment with parenteral decanoate of flufenacine and other classical antipsychotic drugs. The parkinsonism was confirmed by a specialist in neurology and was completed with the implementation of the motor section of the unified scale for the assessment of Parkinson’s disease (UPDRS).

Results: The mean age was 45.6 years and the relationship male / female 0.86:1. The average time of treatment with decanoate of flufenacine was 5 years and the 60.7% of patients had other neuroleptic associated. The parkinsonism is associated with the triad of bradicinesia, stiffness and tremor. We found no significant asymmetries and the predominant involvement was in the upper limbs. Generally these are mild forms that do not produce severe disability.

Conclusions: The drug-induced parkinsonism is different from Parkinson’s disease for more bilateral involvement of dominance in the upper limbs. And it can coexist with others extrapyramidal manifestations.

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Palabras clave: decanoato de flufenacina, neurolépticos, parkinsonismo,

Keywords: decanoate flufenacine, Neuroleptic-induced parkinsonism,

Gliomas en pediatría. Análisis anatomopatológico de 233 casos.

The purpose of this paper was to analyze the anatomopathologic characteristics (location, histopathologic classification and gradation) of 233 Central Nervous System gliomas registered in the National Pediatric Neurosurgery Reference Center (Cuba), and to compare these results with other series from the literature.

Results: Gliomas represented 49,6 % of the total nervous system tumors diagnosed while collecting this series. The histopathologic gradation of the gliomas was: Grade I: 71, Grade II: 84, grades III: 64 and grade IV: 6. The histopathologic classification was: 107 grade I-II Astrocytoma; 51 grade III-IV Astrocytoma; 37 grade I-II Ependymoma; 21 grade III Ependymoma ; 7 grade II Oligodendroglioma; 3 grade II Oligoastrocytoma and 1 grade III Oligoastrocytoma. The locations of the gliomas were: 222 intracranial (127 supratentorial y 95 infratentorial) and 11 in the spinal cord. Male to female ratio was1.3:1.

Conclusions: Supratentorial gliomas were more frequent, different from other reported series. Pilocytic Astrocytoma was the more frequent glioma in this study.

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Palabras clave: Astrocitoma, Ependimoma, Glioblastoma, Glioma, Oligodendroglioma, Tumor Sistema Nervioso,

Keywords: Astrocytoma, Ependymoma, Glioblastoma, Glioma, Nervous System Tumours, Oligodendroglioma,

Información epidemiológica sobre la morbilidad hospitalaria en el Instituto Nacional de Neurología y Neurocirugía de la ciudad de México durante el período 2002-2007.

Hospital morbidity provides information for the strategic planning and implementation of health actions and programmes.

Objective: To determine the main causes of hospital morbidity, its distribution and behavior during the period 2000-2007 at the National Institute of Neurology and Neurosurgery in Mexico City (INNN).

Materials and Methods: An observational, transversal retrolective study was carried out. Data was collected from discharge notes and from the hospital database from the Epidemiology Department. The different rates of morbidity were calculated and their tendencies were determined for a period of six years.

Results: The main causes of morbidity were malignant encephalic tumors and benign tumors from other endocrine glands. However, a tendency to the increment of subarachnoid hemorrhage (p=0.03), cerebrovascular diseases (p=0.04) and benign brain tumors and from other parts of the central nervous system (p=0.01) was found.

Conclusions: Even though this is not a population study, the information obtained from one of the main training institutes and centers of the world and the largest in Latin America, is of great importance. It can be seen how, even though cerebrovascular diseases showed a tendency to increase, benign encephalic tumors occupy the main rates regarding morbidity.

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Palabras clave: Enfermedades Neurológicas, epidemiología, México, Morbilidad, Tasa, Tendencia, Variables,

Keywords: epidemiology, Mexico, morbidity, Neurological Diseases, rate, tendency, variables,

Depression and Anxiety in Parkinson’s Disease, Metric Properties of the Beck´s Depression and Anxiety Inventories. A K2 Factorial Design.

Background: Study to investigate the concurrent validity of the Beck Depression Inventory and Beck Anxiety Inventory evaluation scales against the ICD-10.
Methods: A K2 factorial design for studying the metrics properties of the BDI and BAI in parkinsonian outpatients.
Results: 147 parkinsonian patients were included; 44 patients has anxiety and depression; only depression 19; only anxiety 31; finally 53 subjects don’t have depression or anxiety. The BDI AUC was [0.858]. The BAI AUC was of [0.907]. The cut score was of 14/15 for the BDI and 13/14 for the BAI. The factorial design resulted in the two factors (depression and anxiety) has the best functional correlation in the regression.
Conclusions: The results we present bear out this lack of dimensionality, since we found that the BDI AUC-measured discriminative ability for anxiety was [0.739]. With regard to the BAI, this is employed to discriminate the depressed, AUC values of [0.771].

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Keywords: anxiety, depression, Metric properties, Parkinson’s disease, Psychometric properties,

Características Neuropsicológicas del Proceso del Pensamiento en los Subtipos de Esclerosis Múltiple.

Introduction: The study of thinking has been a superior but forgotten psychological process in the neuropsychological investigation field. But it plays an important role in the human being auto regulation. Objective: to identify the neuropsychological characteristics of thinking process in patients with Multiple Sclerosis considering its expression in the different subtypes of the disease. Material and methods: It included a sample of 60 admitted patients in “Faustino Pérez Hernández” Rehabilitation Hospital in Sancti Spíritus province, Cuba. A neuropsychological battery of thinking was applied from Luria’s postulates, directed to explore its practical-constructive and logical-verbal expression with techniques of simple analogies, test of lineal syllogism, interpretation of proverbs, construction of cubes, test of prepositional structures, solving of arithmetic problems and Paced Auditory Serial Addition Test (PASAT-3). Results: Investigating the structure of thinking in its logical-verbal expression, difficulties were evident in the establishment of logical links, in simultaneous synthesis, andhypothesis contrast, while in their practical-constructive expression, moderate and partial difficulties were evidenced in space synthesis and in programming activities and behavioural planning. Conclusions: Deterioration was verified in the processes of practical-constructive and logical-verbal thinking. Greater deficiencies were found in progressive clinical forms, specifically the secondary progressive multiple sclerosis.

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Palabras clave: esclerosis múltiple, pensamiento práctico-constructivo y lógico-verbal, procesos del pensamiento,

Keywords: multiple sclerosis, neuropsychology of thinking, practical-constructive and logical-verbal thinking,

Caracterización Clínico-Epidemiológica del Temblor Esencial en Familias de Holguín y Matanzas, Cuba.

Essential tremor (ET) is a bilateral mostly simmetric disorder, usually postural but kinetic and rest tremor can be present, it involves the arms and hands. A tranversal study was made to get an epidemiological, functional and fenomenological characterization of ET. Patients with clinical criteria of ET were selected from movement disorders clinic from two cuban provinces; the Fahn, Tolosa and Marín functional disability scale was applied to the sample. A total of 105 patients were evaluated, 64.7% female, 40.0% over 60 years, 80.9% were white, in 36.1% tremor began between 21 and 40 years, superior limbs were affected in 90.4%, 85.9% showed a beginning age anticipation, 87.7% were from Holguín, just 8 sporadic cases; in 53.8% associated diseases were found, an autosomal dominant inheritance was evident. Functions included in the scale’s part B showed a moderate disability (25-49%) and those which belong to part C had low disability (1-24%).

Conclusions. Most of the sample was from Holguín. Female, whites and older than 60 years were predominant, tremor mostly began between 21 and 40 years, superior limbs were the most affected body part, dominant autosomal inheritance was predominant, with anticipation in begining age. Association with some other diseases was frequent, many patients showed functional disability.

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Palabras clave: autosómico dominante, desórdenes del movimiento, herencia, incapacidad funcional, Temblor esencial,

Keywords: autosomal dominant, Essential tremor, functional disability, inheritance, movement disorder,

Combinación de un Programa de Rehabilitación y Estímulo Eléctrico en Pie Equino para las Alteraciones de la Marcha en Niños con Parálisis Cerebral.

There are many factors that cause gait disorders as is the case of patients suffering encephalic lesions that cause brain palsy with hemiplegia as sequelae. One of the most important and interesting features of rehabilitation of the patient with hemiplegia is gait reeducation. Because of that, a therapeutic strategy was created with the application of electric stimulus and a program of exercises in order to preserve the maximum of functional capabilities. For this reason, a retrospective study was performed including a sample of 10 patients with cerebral spastic palsy hospitalized at CIREN’s Clinic of Child Neurology with clubfoot and gait disorder. Every child was submitted to a rehabilitation treatment for four to eight weeks -six times per week- assessing the effectiveness of the neuromuscular stimulation over gross motor function and gait, including frequency of steps in 10 meters and its amplitude. At the end of the treatment, improvement was observed in the treated cases.

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Palabras clave: Marcha funcional, parálisis cerebral, Tratamiento rehabilitador,

Keywords: cerebral palsy, Functional gait, Rehabilitation treatment,

Tipificación del Trastorno Afectivo en Pacientes con Epilepsia del Lóbulo Temporal.

Introduction: Affective disorders in people with epilepsy seem to be different from patients with primary mood disorders.

Objective: to determine the clinical characteristics that typifies depression in patients with temporal Lobe Epilepsy.

Patients and methods: Forty patients with Temporal Lobe Epilepsy and depression were enrolled in the study. Thirty one patients with primary depressive disorder were recruited as control group. Depression was clinically evaluated in both groups. The discriminate analysis was used to determine the main clinical features of depression in patients with epilepsy. The differentiation between groups in total scores of Mood disorders through the International Psychiatry Interview was used to determine the atypical sign of depressive symptoms in patients with epilepsy. Logistic regression was utilized to analyze the possible relationship between neurobiological functioning and depressive symptoms in patients with epilepsy. Results: Sixty two percent of patients had a mood disorder not classified in CIE-10 and DSM-IV. Perictal anhedonia associated with insomnia, guilty thoughts, psychomotor slowness, inattention, restlessness, irritability, faintness became the clinical profiles of depression in patients with epilepsy. Age of onset of epilepsy, family history of psychiatric disorders, number of seizures per month, left temporal Lobe Epilepsy, and bilateral hippocampal atrophy were the most important determinants of mood disorders in our study.

Conclusion: Brief perictal depressive symptoms associated with dysphoria, anxiety and phobias, typify the clinical profile of depressive syndrome in patients with Temporal Lobe Epilepsy.

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Palabras clave: depresión, disforia, Epilepsia del Lóbulo temporal, hipocampo, trastorno afectivo disfórico somatomorfo interictal, trastorno afectivo interictal,

Keywords: depression, dysphoria, hippocampus, interictal affective disorder, interictal Somatoform dysphoric affective disorder, Temporal Lobe Epilepsy,

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