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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Neuronavegación en Tumores de Fosa Posterior en Pediatría

Introduction. Primary tumors of the central nervous system represent about 2% of the total of the neoplasms in adults and 20% of total neoplasms in children. Posterior fossa tumors represent 48% of pediatric population and are the first cause of malignancy of solid organs in the pediatric age. In our environment, the use of neuronavigation in the excision of posterior fossa tumors in pediatric population has not yet been adequately standardized.

Materials and methods. A retrospective observational study from january 2014 to may 2016 of patients diagnosed with posterior fossa tumors is reviewed. We included 20 patients with diagnosis of space-occupying lesion in posterior fossa.

Results. The relationship man: woman was 1:1. The average age was 4 years and 4 months. The degree of precision of the intraoperative neuronavigation prior to craniotomy had an average error margin less than 1.5 millimeters, varying from 1 to 3 millimeters.

Conclusions. Neuronavigation is useful in performing a precise surgery, reducing risks associated with the intervention and shortening the surgical times. Because of greater tumor resecting, neuronavigation is usefel in increasing survival of oncologic pediatric patients.

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Palabras clave: Neuronavegación, Planificación quirúrgica, Tumores de fosa posterior,

Keywords: Neuronavigation, Posterior fossa tumors, Surgical planning,

Deterioro Cognitivo y Riesgo de Demencia, una Realidad para el Ecuador. Estudio de Factores de Riesgo en un Grupo de Pacientes Jubilados del IESS en Cuenca en el año 2013

According to WHO in 2050, 110 million people will be affected by dementia. Ecuador will see among the diseases related to underdevelopment, those related to increased life expectancy. We conducted a cross-sectional study in a health facility IESS in Cuenca. 391 peopled signed an informed consent and answered a form to define the demographics and identify potential risk factors associated to dementia. The mental state was studied using the Minimental-test (MMSE) tool and comorbidity of depression by Yesabage screening test. Data was analyzed using SPSS 15 for Windows. The average age was 70 years, 84% were women and 97% of them live as urban residents in Cuenca. By applying the MMSE, 17.1% showed cognitive impairment with RR of 3.81 for ages 65 and older and female condition. Chronic diseases such as diabetes and arthrosis were the most frequent comorbidities with statistical association for risk; hypertension, COPD, etc., showed no statistical association. 40.9% of the sample group where possitive for depression showing serious nature in 37.5%.

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Palabras clave: demencia, deterioro cognitivo,

Keywords: cognitive deterioration, dementia,

Capacidad Diagnóstica y Validación Preliminar del Test del Reloj, Versión de Cacho a la Orden, para Enfermedad de Alzheimer de Grado Leve en Población Chilena

Background: To perform a study with discriminant power and validity using the Clock drawing Test by instruction (CDTI) in patients with mild Alzheimer’s disease (MAD).
Materials and Methods: Phase I diagnostic test study. We included a healthy control arm of 58 elderly people and 40 cases with mild Alzheimer’s disease. All participants were examined and diagnosed by clinical consensus. The MMSE, CDTI and clinical record were obtained.
Results: There were significant differences between the study groups regarding cognitive tests’ performance when comparing age and education, but no differences were found when comparing gender. ANCOVA test showed no significant effect exerted by the demographic variables on cognitive performance in any group. The sensitivity (CTO=84% vs MMSE=79,3%), specificity (92,5% vs
82,5%) and diagnostic utility of the CDTO were higher than one’s resulting form the MMSE (=0,90, p=0,000). The combined use of both
instruments increased diagnostic capacity. The best cutoff point for the diagnosis of mild dementia was ≤6 points in CDTO and ≤23 in
MMSE. Both instruments correlated statistically.
Conclusions: The CTO is a useful test and can discriminate between cognitively healthy subjects and patients with EAL when appliying the “to order” criteria from Cacho’s version.

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Palabras clave: ancianos, Enfermedad de Alzheimer, test del reloj a la orden, validación,

Keywords: Alzheimer, Clock Test, elderly, validation,

Validación de Diferentes Escalas en la Evaluación del Pronóstico de Pacientes con Hemorragia Subaracnoidea Espontánea en el Hospital Regional “Dr. Teodoro Maldonado Carbo” entre Mayo-2011 y Mayo-2014

Background: Subarachnoid Hemorrhage (SAH) is associated with a high mortality rate and functional consequences. Several scales have been created in order to assess prognosis after SAH, and even though they have been widely studied, neither has achieved universal acceptance.
Objective: Validate different scales assessing the prognosis of patients with spontaneous SAH in a local hospital population.
Methods: A retrospective, cross-sectional study was conducted on patients admitted to the “Dr. Teodoro Maldonado Carbo” Hospital, diagnosed with spontaneous SAH, between 18 and 75 years. Descriptive statistics and Spearman correlation coefficient were calculated in order to evaluate the association of the Hunt and Hess, WFNS and Fisher Scales with functional outcome.
Results: Hunt and Hess Scale had a higher correlation (60,3%; p=0,000) with the functional outcome at discharge or death, compared to 55,3% (p=0,000) obtained by the World Federation of Neurological Surgeons Scale and 50% (p=0,000) by Fisher Scale. In addition, the Glasgow Coma Scale score (-58,4%; p=0,000), altered pupillary response (54,7%; p=0,000) and the need for invasive mechanical ventilation (73,8%; p=0,000) were factors associated with functional score.
Conclusion: Hunt and Hess Scale revealed a good correlation with the Rankin functional scale at discharge or death, and is superior to the other scales in evaluating the prognosis of patients with spontaneous subarachnoid hemorrhage.

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Palabras clave: escala, evaluación., Hemorragia Subaracnoidea, Pronóstico,

Keywords: evaluation, Prognosis, scale, Subarachnoid Hemorrhage,

Concepto de la Demencia como Enfermedad en un Grupo Poblacional de la Ciudad de Guayaquil

Background: Dementia is a clinical condition that causes progressive cognitive impairment, and early diagnosis may have a significant impact on the quality of life. So far, no studies have been conducted to evaluate the conception of the general population about this disease.
Methods: Cross-sectional, descriptive and analytical study, which surveyed individuals between 55 and 65 years old without neurocognitive pathology about the concept of the term “dementia”. The educational level of each respondent was also collected. The responses were assigned to one of 6 possible response groups for analysis, depending on which group better matched each individual response. The percentage of each type of response was calculated, and chi-square was used to observe the relationship between level of education and the type of answers given.
Results: a total of 274 individuals were surveyed, 35.8% were male and 64.2% female. Most patients (36.5%) had only elementary education. 11.7% did not know what dementia means. 45.5% defined it as memory loss and 23% incorrectly identified it as a psychiatric illness. A very small percentage of individuals correctly defined it as a type of cognitive impairment. We found a statistically significant relationship between the level of education and the type of answers obtained (p <0.001).
Discussion: more than half of respondents gave an acceptably correct answer about the concept of dementia, but there is still a significant percentage of people who do not know its meaning, or confuse it with psychiatric illness. It is imperative to carry out health campaigns to alert people about this disease and how to delay it’s onset by lowering risk factors, and to train as well primary care physicians to provide better information to their patients in order to improve the prevention of dementia and lessen its impact on quality of life.

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Palabras clave: demencia, deterioro cognitivo, Ecuador, epidemiología, escolaridad,

Keywords: cognitive impairment, dementia, Ecuador, education, epidemiology,

Electroestimulación En Músculos Rectos Abdominales Para el Aumento de la Capacidad Respiratoria Proporcional Para el Habla en Personas con Lesiones Medulares Cervicales.

Cervical spine injuries present with dysfunctions of the respiratory system characterized by: a reduction in forced vital capacity, ineffective cough, decreased peak expiratory and speech problems. Speech therapy intervention using an exercise program improves the intensity of the voice and fluency, the objective of this study was to determine the effect of electrotherapy in abdominal muscles on respiratory capacity proportional to speak in cervical injuries. We studied 60 people with chronic traumatic cervical spinal cord injury and restrictive breathing; they were divided in two groups: experimental (n=30) and control (n=30). Control group received speech therapy exercises and the experimental group received speech therapy and electrotherapy in abdominal muscles prior to the workout. Patients were assessed before and after application of the treatment with the following variables: forced vital capacity, peak expiratory flow, maximum phonation time, reading the words of two syllabes, vocal intensity and rate of speech disabilities. Two groups showed significant improvement in speech therapy variables evaluated after treatment (p ≤0.05). However, the use of electrical stimulation significantly increased the recovery of variables: vocal intensity (p =0.0485) and peak expiratory flow (p =0.0000) and both variables showed positive correlation [F (1, 28)=7.5478, p <0.01]. Conclusions: electrotherapy in abdominal muscles is beneficial for the improvement of peak expiratory flow and vocal intensity. Peak expiratory flow demonstrated to be a predictor of vocal in tensity.

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Palabras clave: electroestimulación, función respiratoria, Habla, lesión medular cervical, terapia logopédica, tetraplejia, voz,

Keywords: cervical spinal cord injury, electrotherapy, quadriplegia, respiratory function, Speech, speech therapy, voice,

Estudio de ochenta pacientes con Epilepsia Benigna de la Niñez con Espigas Centrotemporales.

The Benign Epilepsy of Childhood with centrotemporal Spikes (BECCTS) constitutes the most common form of idiopathic epilepsy in the paediatric population.
We present 80 cases with this diagnosis analyzing its clinical and electrophysiological characteristics, and particularly its atypical evolution. Results: 71% were male (relation 2.5:1), the partial motor seizures were the most frequent (40%) followed by the partial generalized secondarily (35%). 75% of the seizures appeared during sleep. The 66% of our patients were not medicated and a patient showed an electro-clinical picture of BECCTS and of Occipital Benign Epilepsy, Panayiotopoulos type, in concomitant form. 5% evolved in atypical form: a patient as atypical BECCTS with compromised language and hyperactivity, another developed a continuous point-wave syndrome of slow sleep and a patient debuted as focal epileptic state in hemi face with anarthria. Conclusions: The present study remarks its differential diagnosis and alerts about the phenomena of secondary bisynchronism that can appear in this type of epilepsy, the role that antiepileptic drugs play in its probable appearance and the proper and adequate changes to avoid future cognitive compromise. However, in 95% of our cases, the evolution of the BECCTS was favourable.

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Palabras clave: Epilepsia Benigna de la Niñez,

Keywords: Benign Epilepsy of Childhood,

Valor de la pulsioximetría nocturna en pacientes tetrapléjicos.

Sleep breathing disorders are common in quadriplegic patients and can be accompanied by significative oxygen desaturations. The purpose of this investigation was to evaluate the behavior of the oxygen saturation during sleep in 20 patients diagnosed as traumatic cervical tetraplegia admitted at the Julio Diaz National Rehabilitation Center, considering the intensity of the injury according to ASIA scale as well as the behavior of demographic, anthropometric, spiro metrical, oxymetrical variables and the muscle strength in both complete and incomplete injuries.

Ventilatory function and nocturnal oxygen saturation were studied, with findings of higher percent of incomplete injuries (70%) toward the complete ones (30%). There were not significant differences between both groups age, body mass index, neck circumference, neck length, time of injury, espiratory volume in the first second, forced vital capacity, espiratory volume in the first second/forced vital capacity index, vital capacity, maximal inspiratory pressure, and maximal espiratory pressure.

All patients showed a restrictive ventilatory disorder. Though significant oxyhemoglobin desaturations were not found in any case; complete injuries displayed a higher rate of desaturations after an hour sleep than the incomplete ones and they showed a significant negative correlation between the desaturation episode per hour of sleep index, and mean oxygen saturation.

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Palabras clave: Funcion ventilatoria,

Keywords: Ventilatory function,

Programa de Riesgo Vasculocerebral Multifactorial orientado a la Comunidad. Policlínica Buenaventura 2005.

Community-oriented multifactorial cerebrovascular risk program is a community health project for cerebrovascular risk factors control. Primary objective was to reduce morbimortality of this group of patients as risk was stratified.

Material and method: This intra-group controlled study included 101 patients, any gender, older than 45 years with a a past history of hypertension. A multidisciplinary group applied a Cerebrovascular Risk Evaluation Scale, which divided patients in low, moderate and high risk. Results were compared before and after intervention over modifiable risk factors. Statistical significance was considered at 95%.

Results: Modifiable risk factors control was beneficial in case of arterial hypertension. Lack of knowledge in the population stroke management was high. There was not good adherence to different treatments including diet, drug therapy and routine exercises. All these indicators were considered positive and were validated for the scale.

Conclusions: Clinical and administrative indicators in the evaluation of program effectiveness permitted to validate the applied instrument as an alternative in primary care assistance.

 

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Prevalencia y Tendencia de Trastornos Mentales en el Instituto Nacional de Neurología y Neurocirugía.

A mental disorder is the result of an imbalance between biological and social aspects that reflect an alteration of cerebral functions which intervene in the life and productiveness of each individual. In this study the prevalence and trend of mental disorders were estimated in the National Institute of Neurology and Neurosurgery in Mexico City. This was a transversal study. The information was obtained during 1995 to 2004 of clinical records of patients admitted by first time in the Institute with diagnosis of mental disorder according to ICD-10, and different epidemiological variables were identified.

One thousand four hundred eighty three cases were identified. 56% were woman. The more frequent group of age was 20-29 years. In first place was Schizophrenia (22%), followed by Depressive Episode (16.5%) and in third place Bipolar Affective Disorder (8.6%). The prevalence was higher in 1995. In general, a tendency to decrease of mental disorders was observed, although it was not statistically significant.

Previous reports affirm that the number or patients with neuropsychiatric disorders will increase around the world in next years. Because most patients are assisted in the beginning by general or alternative medicine, it is essential for cases to be promptly identified and be addressed to specialized institutions for their attention.

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Palabras clave: epidemiología, Prevalencia, Tendencia, Trastornos mentales,

Keywords: epidemiology, Mental disorders, Prevalence, Trend,

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,
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