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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Asociación de Tumores Neuroepiteliales y Displasia Cortical Focal Microscópica en Pacientes con Epilepsia del Lóbulo Temporal Fármaco Resistente.

Introduction: There is controversy between the extension of the surgical resection of electrophysiologically monitored brain tumors and the postoperative clinical evolution of patients with pharmacoresistant temporal lobe epilepsy (TLE).

Objective: To evaluate the histopathological spectrum and the electroclinical and imagenologic characteristics, as well as the clinical evolution in patients with neuroepithelial tumors included in the program of epilepsy surgery at CIREN.

Patients and methods: Cases with tumors and pharmaco resistant epilepsy operated from 2002 – 2009 were selected from the database. The patients underwent temporal lobectomy adjusted by electrocorticography (ECoG). The histopathological pattern, ictal video-EEG and intraoperative EcoG are described here.

Results: Of the 25 analyzed patients, 5 presented MRI neocortical structural lesions. One of them was an arachnoid cyst, a reason for its exclusion from the study. The histopathologic exam evidenced a patient with pilocytic astrocytoma, two ganglioglioma (GG) and a dysembryoplastic neuroepithelial tumour (DNT); the last one associated to a focal cortical dysplasia (FCD) type IA and IB. The seizure – type in these patients previous to surgery was partial complex. All cases were free of seizure until the last clinical evaluation.

Conclusions: The association of glioneuronal tumors is evidenced (GG and TND) with microscopic FCD in TLE patients. The temporal lobectomy adjusted by ECoG allowed to achieve the condition of no seizure in TLE patients / tumors of the neuroepithelial tissue, even in cases associated to FDC.

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Palabras clave: Displasia cortical focal, Electrocorticografía, Epilepsia focal fármaco resistente, Evolución clínica, Tumores lóbulo temporal,

Keywords: Clinical outcome, Electrocorticography, Focal cortical dysplasia, Pharmacoresistant focal epilepsy, Temporal lobe tumors,

Epidemiología del Ictus entre los años 2007-2009 en el Hospital Regional Dr. Teodoro Maldonado Carbo.

Objective: Determine the prevalence of the different epidemiological features and risk factors of stroke patients of the Regional Hospital Dr. Teodoro Maldonado Carbo.

Methods:Cross-sectional study of 521 patients with diagnosis of stroke, admitted to the Neurology Service of the Social Security Hospital between the years 2007-2009. Data was recollected from the discharge notes and medical records. The measured variables were duration of hospital stay, diagnosis, mortality, non-modifiable risk factors, and modifiable risk factors. In case of hemorrhagic stroke variables that could represent its cause were also recollected.

Results: Most patients were males (70.5%), the most prevalent risk factors were hypertension (81.1%), diabetes mellitus (27%) and dyslipidemia (16.88%). The mean age was 67±13 years. There was an increased tendency of hypertension in males and of diabetes mellitus in females (p=0.45, p=0.17 respectively). There was a significant difference in the presence of coagulopathy (p=0.01), valvulopathy (p=0.04) and anticoagulant use (p=0.004) in females. Ischemic stroke represented the 80.9% and hemorrhagic stroke the 19.1% of cases.

Conclusions: These results are similar to those found in Latin American and North American publications. The correction of the most prevalent risk factors in our population would markedly decrease the incidence of this disabling disease.

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Palabras clave: epidemiología, evento cerebrovascular, hemorragia, isquemia,

Keywords: epidemiology, hemorrhage, ischemia, stroke,

Carbamazepina y Valproato de Magnesio en el tratamiento de la Epilepsia del Lóbulo Temporal Mesial de debut.

Introduction: Mesial Temporal Lobe Epilepsy is the most frequent symptomatic focal epilepsy in adults. There are no prospective studies that compare the efficacy and effectiveness of carbamazepine and valproic acid in this group of patients.

Objective: to compare the efficacy, effectiveness and tolerability of Carbamazepine and Valproic Acid in patients with Mesial Temporal Lobe Epilepsy.

Methods: We conducted a prospective, controlled and randomized study of parallel groups in patients with Mesial Temporal Lobe Epilepsy at time of onset. The patients were followed-up for one year. Fifty six patients were recruited. Forty three patients participated in a crossover study and only thirty three concluded it. We evaluated the efficacy, effectiveness and tolerability of two antiepileptic drugs.

Results: After cross-over, the efficacy of Valproic Acid was superior to Carbamazepine reducing seizure frequency from 7,9 to 2,6 seizures per month (p = 0,02). None of antiepilpetic drugs were associated with an improvement in Hamilton scale. Treatment with valproic Acid improved the quality of life by 20 % after a year of treatment (p < 0,01) . The number of patients with side effects was not significant statistically, even though valproic acid produced a greater variety of adverse effects.

Conclusion: The effectiveness and efficacy of Valproic Acid in patients with mesial Temporal Lobe Epilpesy at onset is superior to carbamazepine althought it is less tolerated.

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Palabras clave: carbamazepina, efectividad, eficacia, Epilepsia del Lóbulo Temporal mesial, tolerabilidad, valproato,

Keywords: Carbamazepine, effetiveness, Mesial Temporal Lobe Epilpesy, tolerability and efficacy, Valproic Acid,

Predictores de Ansiedad y Depresión en Cuidadores Primarios de Pacientes Neurológicos.

Objective: To describe predictors of depression and anxiety in caregivers of neurological patients.

Methods: To a sample of 145 caregivers, from the outpatient clinic of the National Institute of Neurology and Neurosurgery, sociodemographic variables were collected and the following questionnaires were applied: Ways of Coping with Stress of Lazarus and Folkman, Zarit Burden Scale, Hospital Anxiety and Depression Scale. Additionally, Activities of Daily Living were assessed in patients.

Results: 97% of caregivers were provided by the informal system, usually a woman (82%) with an average age of 47.7 ± 15.1, house-wife (60%) and close relative of the sick person (78% . They suffer from a current illness (48%) and 62% presented the condition after caregiving. The regression model for anxiety included: negative impact, cognitive distancing, patient age and caregiver education. The depression model included: negative impact, caregiver education and cognitive distancing. Both explained 37% of variance.

Conclusions: Anxiety and depression depend on the skills and resources of the caregiver, the burden and impact of the disease. These correlate with physical, mental and socioeconomic issues that affect social relationships, intimacy and freedom of the caregiver.

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Palabras clave: Afrontamiento, ansiedad, Cuidador Primario, depresión,

Keywords: anxiety, Caregiver, Coping, depression,

Influencia de la Reserva Cognitiva en la Función Ejecutiva en Sujetos Sanos y con enfermedad tipo Alzheimer de Inicio Tardío en una Muestra Portuguesa.

The Cognitive Reserve concept, generally understood as the acquired protective effect, is considered by many authors as an active mechanism that is based on the application of previously learned resources, due to a good education, profession and/or premorbid intelligence. The Stroop Test has been used in the neuropsychological assessment of executive functions in aging-related disease, such as Alzheimer’s Disease.

Objectives: We intend to study the influence of cognitive reserve in executive functions in subjects with late onset Alzheimer´s disease, and in healthy subjects in a Portuguese sample.

Method: We used two samples, one consisting of 91 healthy subjects and a second sample of 32 subjects diagnosed with senile dementia of the Alzheimer type.

Results: The group of healthy subjects showed better performance on the test, than the pathologic group. Significative differences were found in the healthy group between high and low cognitive reserve subgroups.

Conclusions: The Stroop Test, shows a high sensitivity in determining alterations in executive functions and the influence of cognitive reserve in that function.

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Palabras clave: Enfermedad de Alzheimer, Envejecimiento normal, Envejecimiento patológico, Funciones Ejecutivas, Reserva Cognitiva, Test de Colores y Palabras de Stroop,

Keywords: Alzheimer's disease. Cognitive reserve, Executive function, Normal aging, Pathological aging, Stroop Color and Word Test,

Effect of cold irritation on peripheral white blood cell and ICAM-1, IL-1β expression of brain tissue in rat.

Background: Some studies have showed that hypothermia is a neuroprotective factor for cerebral ischemic injury. Inflammation reaction plays a very important role in pathomechanism of neuron degeneration disease induced by cerebral ischemia. However whether there is relationship between cold irritation and inflammation reaction is not well known.

Objective: To explore effect of cold irritation on peripheral white blood cell and ICAM-1, IL-1β expression of brain tissue in rat with cerebral ischemia.

Methods: Model rats were put into low temperature water (0º) for cold irritation for 5 minutes one time every day for 20 days. MCAO rats were subjected to middle cerebral artery occlusion (MCAO) using an intraluminal suture method with permanent ligation of the ipsilateral common carotid artery. We assessed count of the peripheral white blood cells.The brains of all rats were cut at 1, 3, and 5 days after cerebral ischemia and frozen brain tissues were continuously sliced and stained immunohistochemically with Intercellular Adhesion Molecule-1 (ICAM-1) or Interleukin-1(IL-1) antibody.

Results: Cold irritation model rats were associated with increased leukocyte at 1 and 3 days post-ischemia, increased ICAM-1-positive vessels at 1, 3, and 5 days, and increased interleukin-1(IL-1) at 3 and 5 days. Vascular pathology of the hippocampus at electron microscope levels showed that the blood vessel has inflammation infiltration at 1, 3 and 5 days. Conclusion: These data demonstrate that cold irritation significantly increased endothelial adhesion molecule expression, leukocyte infiltration, and vascular pathology of the hippocampus in rat. The mechanism of neuron injury may be related to the inflammation reaction induced by cold irritation.

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Keywords: cold irritation, inflammation reaction, intercellular adhesion molecule, interleukin-1,

Estimulación Magnética Trascraneal en los Retrovirus Humanos: Una Revisión Sistematica Desde 1985 a 2009.

Pyramidal tract is affected in tropical spastic paraparesis (HAM/TSP) and AIDS; the best paraclinic tool so far known to evaluate such involvement, in humans, is transcranial magnetic stimulation. A thorough investigation was done in MEDLINE database for the period between 1985 and 2009, and in Scielo.org between 1996 and 2009 using the terms “HTLV-I, HTLV-II, HTLV-III, HIV; HIV1, HIV2, evoked potential, motor evoked potential, transcranial magnetic stimulation, magnetic stimulation, corticomotor physiology, motor tracts, pyramidal tract, corticospinal tract, myelopathy, acquired immunodeficiency syndrome, AIDS, SIDA, tropical spastic paraparesis, HTLV-I associated myelopathy, HAM, TSP, HAM/TSP”. Papers in English, Spanish, Portuguese, French and Japanese were reviewed. Thirteen manuscripts reporting motor evoked potentials obtained by transcranial magnetic stimulation were identified. In HAM/TSP the pyramidal tract involvement is mainly at low thoracic levels, following a centripetal pattern; in HIV, such involvement follows a centrifugal pattern  which is greater at brain level. These findings should allow to redirect neurohabilitation and neuromodulation measures hopefully before fatal outcome or disability take place in these retroviruses-associated neurodegenerative disorders.

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Palabras clave: estimulación magnética trascraneal, estimulación trascraneal no invasiva, HAM/TSP, HTLV-I, SIDA, tracto piramidal, VIH,

Keywords: AIDS, HAM/TSP, HIV, HTLV-I, noninvasive transcranial stimulation, pyramidal tract, SIDA, transcranial magnetic stimulation,

Patrones de Perfusión Cerebral en la Epilepsia Rolándica: Formas Típicas y Atípicas.

Introduction: Cerebral perfusion patterns in typical rolandic Epilepsy and its variants remain unknown.

Objective: To describe interictal cerebral perfusion patterns in this Epilepsy and in one of its variants.

Patients and methods: Twenty four children were followed-up for 6 years after their first seizure. Magnetic Resonance Imaging and Single Photon Emission Tomography were performed during follow-up. We investigated for perfusion asymmetries in different cerebral structures using statistical parametric map. The perfusion images were registered whether atypical evolution was diagnosed or if we found some cognitive deficits suggestive of focal cortical lesion.

Results: Seven patients with atypical Benign Partial Epilepsy and seventeen with typical Rolandic Epilepsy were recruited. The vast majorly of the patients showed a cortical hyperperfusion pattern associated with asymmetric hypoperfusion pattern in basal ganglia and thalamus. Patients with atypical Benign Partial Epilepsy showed a well defined different cerebral perfusion pattern characterized by symmetrical hypoperfusion at the level of basal ganglia including thalamus.

Conclusions: Different cerebral perfusion patterns were documented in different variants of Rolandic epilepsy.

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Palabras clave: deterioro cognitivo, Epilepsia Parcial benigna de la Infancia, Epilepsia Rolándica, perfusión cerebral, puntas centro-temporales, SPECT,

Keywords: atypical Benign Partial Epilepsy, centro-temporal spikes, cerebral perfusion, cognitive impairment, rolandic epilepsy, SPECT,

Activador del Plasminógeno tisular, realidad actual. Estudio transversal retrospectivo entre los años 2007-2009 en el Hospital Regional Dr. Teodoro Maldonado Carbo.

Objective: To determine the proportion in which the variables for the administration of tissue plasminogen inhibitor (tPA) are present in the population admitted to a hospital in Guayaquil-Ecuador.

Methods: Cross-sectional study with patients admitted to the Neurology service at the Regional Hospital Dr. Teodoro Maldonado Carbo between January 1, 2007 and December 31, 2009 with diagnosis of acute stroke. The inclusion and exclusion criteria were the same ones used on the guidelines for the use of tPA in patients with stroke during the first 3 hours and between the first 3-4.5 hours of onset.

Results: 550 patients were included in the analysis. 434 patients had ischemic stroke and 116 hemorrhagic stroke. 6 patients arrived to the hospital in the first 3 hours from onset and 13 patients arrived between the 3-4.5 hours from onset. In the first 3 hours, 4 out of 6 patients (66%) were candidates for the administration of tPA and between the first 3-4.5 hours, 6 out of 13 patients (59%) were candidates for tPA.

Conclusions: The majority of the patients that arrived to this hospital; did so after 4.5 hours from the onset of symptoms. If these patients would have arrived earlier, a great proportion could have received a treatment potentially beneficial that would produce a clinical improvement and a better prognosis if the treatment was available in the hospital.

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Palabras clave: Ictus, isquemia, tPA,

Keywords: ischemia, stroke, tPA,

Esclerosis Multiple en un Hospital del Litoral Ecuatoriano.

Objective: An observational study was conducted in 45 patients with Multiple Sclerosis in a hospital in the Ecuadorian Coast, in order to characterize the disease in our environment.

Methods: During the period of 8 years (2002 – 2010), demographic and clinical characteristics, disability status using the modified Kurtzke, assessment of functional systems and response to immunomodulatory treatment are evaluated.

Results: Of the 45 patients studied 58% were women, the most common age group was between 30 – 39 years. The predominating type was relapsing remitting (RR) followed by secondary progressive (SP). It is determined that the nuclear magnetic resonance (RM) is the complementary method of choice for diagnosis and monitoring of patients and the relapse rate was low using immunomodulatory therapy.

Conclusions: The study suggests that the presentation of the disease in a hospital in the Ecuadorian coast is lower than in the inter-Andean region probably due to demographics or other factors yet to be determined, but that the clinical features, the subtypes of the disease and immunomodulatory treatment response is similar to the series found in countries of the same characteristics.

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Palabras clave: desmielinización, esclerosis múltiple, terapia inmunomoduladora,

Keywords: demyelination, immunomodulatory therapy, multiple sclerosis,

Propuesta Pedagógica para la Compensación de la Memoria Viso-Espacial en Pacientes con Secuelas Neurológicas.

During the perception of an object, a complex system of temporary connections, which reflects the links and relationships between objects, their parts and properties in the brain, appears.

Objective: To determine how the designed pedagogical proposal influences in the compensation of the viso- space memory in people with neurological sequels.

Material and method: A pre pedagogical experiment in a group of 20 patients was carried out. A neuropsychological battery was used evaluating visual memory, viso-construction, perceptual and motor speed, care, executive functions and verbal intelligence (NEUROPSI) both initial and final to verify the memory deficit. Results were compared and the percentage is reported.

Results: The studied group age range was between 21 and 55 years. The main feature found was the inaccuracy in the reproduction of the model due to the latent attention deficit. The disorders of the mechanism to fixate memories were one of the greatest difficulties presented. An improvement in each variable was observed.

Conclusion: The designed pedagogical proposal influenced positively the visospace memory compensation in the group of patients under investigation.

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Palabras clave: Compensación, Memoria Viso-Espacial, Neuropsi, Secuelas Neurológicas,

Keywords: demyelination, immunomodulatory therapy, multiple sclerosis,

Diabetes Mellitus y Cognición. Estudio Transversal.

Diabetes Mellitus Type 2 is associated with greater impairment of cognitive ability, and abnormalities in brain imaging studies compared with people without diabetes.

Objective: To determine if there is a difference in the score of cognitive function tests Addenbrooke (ACE) and Cognitive Ability Screening Instrument (CASI) among patients with type 2 diabetes and non-diabetics.

Methods: Cross sectional study of patients with a history of more than 5 years of diabetes mellitus type 2, between 45 and 64 years of Outpatient of Endocrinology Department, Hospital Teodoro Maldonado Carbo Guayaquil between September 1 and December 31, 2008, who had the cognitive assessment test: ACE and CASI.

Results: There were a total of 68 patients, of which 60.3% had diabetes mellitus, with an average age of 60 years, of this group: 53.6% were men and 46.3% were women. Hypertension was present in 39%. 14.6% were treated with oral antidiabetic agents and 73.2% with insulin. Glycated haemoglobin (Hb1Ac) was abnormal in 33.8%. With regard to the tests of cognitive assessment: the average score of ACE in diabetic patients was 88. 8 and in non-diabetic patients 90.1 and in the CASI the average was 91.5 in diabetics and 92.5 in non-diabetics.

Conclusions: The score of cognitive function tests Addenbrooke and CASI was lower in diabetics compared to non-diabetics, although there was no significant difference.

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Palabras clave: Addenbrooke, CASI, Cognición, Complicaciones de la Diabetes, demencia, Diabetes mellitus,

Keywords: Addenbrooke, CASI, Cognition, dementia, Diabetes Complications, Diabetes Mellitus,

Riesgo de enfermedad cerebrovascular en la fibrilación auricular. Hospital Lenin Enero 2006 – Diciembre 2007.

A case-series was performed in the Emergency Service of the University Hospital V. I. Lenin. The universe of the study was 413 patients in Observation at the Emergency Service of Internal Medicine. Considered as an objective was to determine the behavior of the different clinical, epidemiological and therapeutic variables of the patients with atrial fibrillation and with risk to develop cerebrovascular disease. Of these patients, 165 were selected according to the inclusion criteria. The main results were that the most frequent clinical pattern of presentation was recent diagnosis followed by recurrent and permanent diagnosis and that after 60 years of age the highest risk to develop stroke was in patients with permanent clinical pattern which were not properly protected to prevent it. We concluded that if cerebrovascular disease is to be prevented, then it is necessary to give the patients the proper anticoagulants and antiplatelet medications. We recommend insisting in the application of the protocols of management.

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Palabras clave: anticoagulación oral, Fibrilación auricular, patrón clínico,

Keywords: atrial fibrillation, clinical pattern, oral anticoagulation,

Sistema de actividades para la compensación de la memoria de trabajo en adultos con ataxia por trauma craneoencefálico.

Introduction: Working memory or operational memory is considered a distinct element of the executive function. Objective: To propose a system of activities that will contribute to the compensation of working memory in adults with Ataxia by craneoencephalic trauma assisted in CIREN.

Material and methods: A pre experiment with a single group was carried out, initial tests were applied to determine the cognitive deficits in the amnesic process, before implementing the strategy, and at the end of the intervention, the results were compared to quantify evolutionary development in the work of clearing of memory in these people with special educational needs.

Results: The results of the diagnostic analysis favored the interpretation of the need to implement corrective treatments – countervailing duties taking into account the allocation of the basic mechanisms of working memory to improve the prognosis of evolution of this amnesic skill.

Discussion: A system of activities is proposed as part of considering the diagnosis as an important element in the corrective compensatory work looking for restoration to the highest possible physical, psychological functioning and social adaptation of persons towards an optimal level of social integration.

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Palabras clave: Ataxia, Compensación, Memoria de Trabajo, Sistema de Actividades, Trauma Craneoencefálico,

Keywords: ataxia, Chraneoencephalic Trauma, Compensation, system of activities, working memory,

Alteraciones electroencefalográficas en niños con cardiopatías congénitas severas.

Introduction and objectives: Congenital cardiopathies (CC) are among the most common birth defects. Delays of neurodevelopment are among the most frequently observed diseases in school-age children presenting CC. The main objective of this study was to determine the possible impact of severe CC on central nervous system (CNS) development as determined after EEG recording.

Methods: Thirty children of ages between 15 days and 12 years presenting severe CC with hemodynamic consequences and/or chronic hypoxia were studied (21 acyanogenic and 19 cyanogenic). Conventional EEGs were performed on all cases.

Results: In the whole sample we found abnormal EEGs in 43.3% of cases, these mostly showing immature basal activity (slow for the age), and focal and multifocal paroxysmal activity characterised by sharp waves and spikes/slow waves complexes. Abnormal EEG activity was determined in 42.8% of non-cyanogenic CC and 44.4% of cyanogenic CC.

Conclusions: A high percentage of children carrying severe CC showed epiletiform EEG activity. It is possible that in afflicted children resulting from haemodynamic disturbances present from foetal stages onwards, these would favour the development of ectopic growth of grey matter leading to epileptiform activity.

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Palabras clave: Actividad epileptiforme, Cardiopatías congénitas acianógenas, Cardiopatías congénitas cianógenas, Electroencefalograma,

Keywords: Congenital acyanogenic heart diseases, Congenital cyanogenic heart diseases, electroencephalogram, Epileptiform activity,

Violencia en la díada cuidador-paciente en la Enfermedad de Parkinson: Tres métodos de medición.

Background: Violence between caregivers and patients is common and little studied. Their identification and assessment is complex considering the various types available and how they are perceived and reported. The instruments vary in the number of items, level and frequency of acts that constitute a case.

Objective: To determine the prevalence of violence in the caregiver-patient dyad in the context of Parkinson’s disease through three measurement methods, describe the correlation between them and demonstrate the complexity of the assessment of violence.

Methods: Descriptive study, on 46 caregiver-patient dyads selected INNN. They were given a battery composed of: 1. National Survey of Violence against Women (ENVIM), 2. Scale of Abuse Older Adults (EMA). 3. Perception Questionnaire Exercise of Power in Dyads (PEPD).

Results: the average age of participant patients was 62 years, with 50% women. The average age of caregivers was 50 years, with 80% women. Violence prevalence of patients according to ENVIM is 43.5%, patient or caregiver (any) is 60.9%; EMA reports 71.7% and the PEPD 60.9%. Mutual violence is present in 26% of dyads according to ENVIM. Correlations were found between the scales ranging from 0.32 to 0.78.

Conclusions: Prevalence of violence is higher than what is reported in international literature and the ENVIM. Correlations between the instruments utilized in this study are sensitive and show that multiple question assessments avoid underreports.

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Palabras clave: Díadas, enfermedad de Parkinson, Prevalencia, Severidad, Violencia,

Keywords: Dyads, Parkinson Disease, Prevalence, Severity, Violence,

Tamaño de Muestra a Considerarse en un Estudio de Resonancia Magnética Funcional (RMF) con un Equipo de Resonancia Magnéticade 1.5 T.

This work presents an analysis of the necessary tools and special considerations to develop investigation in brain using fMRI with a magnetic resonator of 1.5 T field. This work presents the sample size and the necessary task time to use for showing results.

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Palabras clave: 1.5 Teslas, Procesamiento digital de imágenes, resonador magnético, resonancia magnética funcional, tamaño de muestra,

Keywords: 1.5 Tesla magnetic resonance, Digital image processing, functional magnetic resonance, sample size,

Raíz Conjunta Lumbo Sacra Simulando Hernia Discal.

MRI examinations of lumbosacral region during eleven years were included to determine frequency of imaging similarity between an extruded discal fragment and a conjoint root. In 7,117 studies included in our casuistic we detected conjoint root in 175 (2.4 %), resembling an extruded discal fragment which is usually well shown by MRI but in our observations corresponded to a conjoint root. Bibliography related with conjoint root was reviewed. Our conclusion support that MRI is the method of choice to differentiate a conjoint root from an extruded discal fragment.

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Palabras clave: Hernia Discal, Raíz Conjunta,

Keywords: conjoined nerve root, disk herniation,

Análisis Demográfico Comparativo de Pacientes Adultos con y sin Enfermedad Neurológica que Asisten a una Consulta Externa de Neurología en Guayaquil, Ecuador.

Background: Studies carried out in European countries suggest a high prevalence of patients consulting for non-neurological conditions among persons evaluated in outpatient neurologic clinics. However, there is no information on the prevalence of such patients in developing countries.

Objective: To describe the demographic profile of patients with and without neurologic symptoms evaluated at an outpatient neurologic clinic in Guayaquil. Methods: Cohort of 7,519 adults evaluated over a 20-year period. We evaluated data concerning age, gender, year of first evaluation, reason for consultation, diagnosis, complementary neurodiagnostic tests, and follow-up. Patients were classified into three groups according to their main complain: neurologic patients, psychiatric patients, and persons with non-specific clinical manifestations.

Results: Neurologic diseases were found in 6,764 (90%) patients, psychiatric disorders in 186 (2.5%) and non-specific complaints in 569 (7.5%). Non-neurologic patients were younger than those with neurologic diseases (p<0.0001). The smallest prevalence of women was found among persons with non-specific complaints (p=0.017). We noted a lower prevalence of nonneurologic patients during the years that our country experienced a economic crisis. About 50% of patients with psychiatric disorders, and 30% of persons with non-specific complains had one or more neurodiagnostic tests, which did not modify the therapeutic approach in any case. In most cases, those exams were requested by the patients themselves.

Conclusions: The prevalence of non-neurologic disorders in our series is smaller than that reported from European studies, and their demographic profile is somewhat different. There are some characteristics of patients in our population that may account for such differences.

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Sistema de Actividades para la Compensación del Déficit Motor de las Habilidades Manipulativas en Pacientes con Parálisis Cerebral Adulta.

Cerebral palsy is the commonest cause of motor disability. Under this term are grouped people with special educational needs, who have in common a persistent disorder of tone and movement due to a non-progressive brain injury. Although cerebral palsy affects muscle movement, it is not caused by problems in the muscles or the nerves, but by abnormalities in brain impairing its ability to control movement and posture. In order to assess the influence of activities for the prefunctional motor deficit of manual abilities in patients with cerebral palsy, a therapeutic intervention was applied to 15 patients (7 men and 8 women) who had motor disorders in upper limbs. A quasi experimental 60 days study, conceived by 2 hours daily treatment was carried out. Initial and final qualitative functional scales of hands were applied to compare results. This novel therapeutic system influenced positively in the recovery of lost abilities as was statistically demonstrated.

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Palabras clave: Compensación, Déficit Motor, Escala Cualitativa para la funcionalidad de las manos, Habilidades Manipulativas, Parálisis Cerebral Adulta, Sistema Terapéutico,

Keywords: Cerebral Palsy Adult, Compensation, Manipulative Skills, Motor Deficit, Scale Qualitative for the Functionality of Hands, Therapeutic System,

Adaptación del Test de Colores y Palabras de Stroop: Su Importancia en la Detección Precoz de los Déficits en las Funciones Ejecutivas.

Neuropsychological assessment is increasingly used as complementary diagnostic test for different brain pathologies, and Portugal is not an exception. Therefore urges that the instruments used for the evaluation present adequate psychometric criteria and normative data adjusted to the same population. Aging is a dynamic and progressive process, leading to greater vulnerability and incidence of pathological processes. Within these processes included neurodegenerative diseases, the most common, Alzheimer’s Disease.1 Executive functions seem to be the most involved in the overall functioning of the individual and the Stroop Test, is frequently used to evaluate these functions. We present a study of adaptation of this instrument in a Portuguese sample, trying to verify the importance of sociodemographic variables on test performance and whether there were significant differences between healthy subjects and with neuropathology. The results have allowed verifying the importance of adaptation of populations where tests are used. Thus, the Stroop Test seems a test to take into account when establishing a neuropsychological evaluation protocol, as well unlike the patterns of performance between normative and pathological aging.

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Palabras clave: Enfermedad de Alzheimer, Envejecimiento normal, Funciones Ejecutivas, Test de Colores y Palabras de Stroop,

Keywords: Alzheimer’s Disease, Executive functions, Normal aging, Stroop Color and Word Test,

Intervención Neurolingüística en la Respiración y la Voz en Pacientes con Lesiones Estáticas Encefálicas Portadores de Trastornos Disártricos.

Objective: To prove the effectiveness of the neurolinguistic rehabilitation program for dysarthric patients, applied at the Encephalic Static Lesions Adults Clinic, International Center of Neurologic Restoration, in voice and breathing areas. It is a single sample pre-experiment obtained from logopedic records, contrasting them with the results of the external diagnosis, application of therapy and final evaluation.

Results: Males were prevalent and encephalic trauma as clinical diagnosis, there was great dispersion in age and time of evolution. Of the 54 patients, 40 increased their spirometric index: 22 the inspiration puff; 39 phono-respiratory coordination: 36 modified intensity; 11 tone; 18 modified their stamp vowel. The results evidence efficient functional recovery after the program was applied.

Conclusions: It was confirmed that there is not such established recovery pattern: none of the different variables influences significantly, the dispersion of the results is overwhelming and it is only possible to talk about tendencies. The program is effective but it cannot be affirmed that this variant is the correct one: more emphasis should be given to vocal indicators, other respiratory dimensions that are used should be measured as they have functional connotation.

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Palabras clave: disartria, intervención neurolingüística, Lesiones estáticas encefálicas,

Keywords: dysarthria, Encephalic static lesions, neurolinguistic intervention,

Trastornos del Sueño: Conocimiento de Apnea Obstructiva del Sueño en Médicos no Neurólogos y su Manejo Perioperatorio.

Objective: Obstructive sleep apnea syndrome (OSA) is a common sleep-related disorder that has been associated with a higher perioperative risk. Our purpose is to determine the level of knowledge and attitudes towards OSA among surgeons and traumatologists, knowing their important role in the prevention of potential perioperative complications in these patients.

Material and Method: Crosssectional survey study, using the “Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire” (OSAKA), administered to 105 surgeons and traumatologists and 27 surgery residents to measure the level of knowledge and attitudes towards OSA.

Results: Knowledge scores ranged from 3 (14%) to 17 (81%). The mean value for surgeons and traumatologists was below 62% (p=0.04), and lower than 48% (p=0.02) for residents. There is a positive correlation between the level of knowledge and the importance of identifying patients with OSAS (r = 0.26), and the confidence in themselves to identify this patients (r = 0.38). There was a negative correlation between knowledge and years of practice (r= -0.23).

Conclusion: Obstructive Sleep Apnea Syndrome is widely unknown among Surgeons and Traumatologists from Guayaquil. We recommend educational interventions that improve the level of knowledge and promote the use of guidelines in the management of patients in the perioperative period to decrease the risk of complications.

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Palabras clave: Apnea Obstructiva del Sueño, aptitud, Conocimiento, cuestionario,

Keywords: attitude, Knowledge, Obstructive Sleep Apnea, questionnaire,

The Impact of Rheumatoid Arthritis in Neuropsychology, Depression and Anxiety. A Case-Control Study, with 90 Portuguese Female Subjects.

Objectives: The study of the impact of Rheumatoid Arthritis in cognitive functions has not been well documented in Portugal. So, with this original article we tried to clarify this reality in this particular country.

Methods: We assessed the results of 45 Rheumatoid Arthritis female patients (intervention group), comparing each patient in a case control paired strategy (years in school and age), with control subjects (n = 45, in a total of 90 subjects). All subjects were evaluated with Paced Auditory Selective Attention Test, Word List Generation Test, Luria Nebraska Neuropsychological Battery, a Portuguese depression screening test (IACLIDE), STAI (anxiety trace and trait test) and the Mini Mental state examination.

Results: The results show, for the first time in Portuguese patients, the presence of major deficits in terms of cognitive function and symptoms of depression and anxiety.

Conclusion: This article strengthens the argument of the necessity to pay attention in psycho-educational, psychotherapeutic and cognitive stimulation as well as neuropsychological intervention in these types of patients.

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Palabras clave: ansiedad, depresión, enfermedades inflamatorias reumáticas, evaluación neuropsicológica,

Keywords: anxiety, depression, inflammatory rheumatic diseases, Neuropsychological assessment,

The “8-foot Up and Go” Test as a Physical Performance Measurement in Parkinson’s Disease: A Pilot Study.

Blackground: Parkinson disease (PD), is a movement disorder, so physical assessment should be a key component in the diagnosis of individuals suffering from this disease. There is a neeed to assess the utility of some motor tests in PD, specially those which include assessment of straight line walking and turning.

Objective: This pilot study aimed to asses the utility of the “8-foot up and go” test as a physical performance measurement in PD, as well as the relationship between functional mobility and quality of life in this population.

Material and Methods: Twenty-four patients with a diagnosis of idiopathic Parkinson’s disease volunteered and finished the study. They performed the “8 foot up-and-go” test and answered the 9-item Parkinson’s Disease Questionnaire.

Results: The motor test’s total score correlated significantly with different sub-scales of the 9-item Parkinson’s Disease Questionnaire, especially with the mobility sub-scale and with the total score.

Conclusions: The “8 foot up-and-go” test is useful and easy to perform by Parkinson’s disease patients and it has turned out to be a clear indicator of the way the illness affects their quality of life.

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Palabras clave: actividad física, calidad de vida, enfermedad de Parkinson, fitness, test motor,

Keywords: fitness, motor test, Parkinson’s disease, physical activity, quality of life,

Efectos de la Subtalamotomía en la Inducción o Modificación de Disquinesias en Pacientes con Enfermedad de Parkinson Idiopática.

We performed a longitudinal, analytic and retrospective study in order to evaluate the effect of subthalamotomy in the induction or modification of dyskinesias in patients with Parkinson’s disease. Was study the motor behaviour, the cardinal features of Parkinson’s disease, the mean daily Levodopa dose and the dyskinesias induced by Levodopa or subthalamotomy in 50 patients with Parkinson’s disease that were operated between 1995 and 2005 in our center. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at least for one year. Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol. In our study the cardinal features of the disease improved in more than 50 %, it were evaluated through the Unified Parkinson’s Disease Rating Scale (UPDRS), as well as the mean daily Levodopa dose was reduced by 40% compared with baseline. The dyskinesias induced by Levodopa were reducing too, and we think that it’s not explainable only for the reduction of the Levodopa dose. Subthalamotomy induced contralateral dyskinesias in approximately 50% of our patients but were generally mild and short lasting. The risk of persistent and severe dyskinesias postoperative was smallest. This study indicates that the presence of severe preoperative dyskinesias and the dorsal location of the lesion are relevant for the development of chorea after subthalamotomy in patients with Parkinson’s disease. These find must to be confirm in a prospective randomized study.

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Morphological Changes Induced by Three Aminoglycosides on the Cochlear Stria Vascularis.

Aminoglycosides are efficient antimicrobials commonly used in clinical practice. Their effects on the cells of the organ of Corti and the spiral ganglion neurons have been extensively studied. However, there are only a few reports concerning aminoglycoside-induced morphological changes on the stria vascularis. The purpose of this study was to describe morphological and morphometrical changes on the rat stria vascularis after a profound sensorineural hearing loss induced by three aminoglycosides (kanamycin, gentamicin and amikacin) followed by furosemide. To analyze the stria vascularis area and the number of blood capillaries per stria vascularis, cochleae from fourteen rats sampled at eight weeks after deafness and from four control animals were processed. Serial semi thin cochlear sections from the apical, upper middle, lower middle and basal turns were examined under a light microscope. The cochlear damage degree depended on the aminoglycoside. Mean stria vascularis areas for both kanamycin and gentamicin groups were lower than controls. The mean number of blood capillaries per stria vascularis was reduced for the three aminoglycoside-deafened groups as compared to control animals. For both variables, the most severe damage was observed for gentamicin-deafened animals, followed by kanamycin and amikacin.

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Palabras clave: aminoglucósidos, capilares sanguíneos, cóclea, estría vascular, ototoxicidad,

Keywords: Aminoglycosides, blood capillaries, cochlea, ototoxicity, stria vascularis,

Efectos del Tratamiento Rehabilitador y el “Treadmill” en Pacientes con Ataxia.

Ataxia is a syndrome related to gait disorders that makes necessary a wide range of possibilities in rehabilitation in order to improve the disorder. The treadmill can be useful because it combines motor learning and sensory tricks. This study included 15 patients with ataxia from CIREN clinic. Treatment including treadmill was applied in 30 sessions, one hour each one. Motor function was evaluated pre and post treatment using ICARS scale, velocity, number and width of paces and Hausser index. Comparing results before and after intervention showed statistically significative improvement in ICARS scale and LEIS (p<0.001 and p<0.041 respectively). Rehabilitation treatment including treadmill has favorable effects over gait disorders in patients with ataxia.

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Palabras clave: evaluación., marcha, Treadmill,

Keywords: evaluation, gait, treadmill,

Neurofobia entre los estudiantes de la Carrera de Medicina de sexto a décimo semestre en la Universidad Católica Santiago de Guayaquil.

Background: Neurophobia is defined as fear to neuroscience and clinical neurology. By the impact of neurological diseases worldwide, management of these disorders could be affected. No data exist of this phenomenon in Ecuador. Objectives: To evaluate the difficulty, knowledge, confidence and interest in neurology, neuroscience specialties, affinity factors for difficulty in neurology and neurological training among medical students.

Methods and Materials: A descriptive study was conducted at the Catholic University of Santiago de Guayaquil, surveying: difficulty, knowledge, confidence and interest among specialties; affinity to neuroscience as a specialty, factors contributing neurology´s perception as difficult, and neurological undergraduate training.

Results: The response rate was 78.32% (401/512). Neurology was the most difficult (3.01±0.048), the second with less clinical confidence (2.01±0.056), and third with less knowledge (1.96±0.058). The differences were significant (p <0.001). 70.82% did not plan to pursue a specialty related to neuroscience, 59.85% for absent personal affinity; 10.97% for poor teaching; Contrary, 29.18% want a related specialty in neuroscience, 19.95% by personal affinity and 9.23% for good teaching. Need to know basic neuroscience was the most important for the perception of difficulty (2.76±0.055) followed by poor teaching factor in neurological involvement (2.68±0.57). Training in Neurological Semiology the lowest (1.70±0.061) followed by Neuroanatomy (1.98±0.58) and Neurology (2.52±0.81). Neurologic semiology had the highest percentage of inadequate training (20.45%) compared to Neuroanatomy (9.47%) and Neurology (6.16%).

Conclusions: There is neurophobia among our students. Research and modifications in teaching must be developed to prevent neurophobia and contribute to “neurophilia.”

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Palabras clave: Ecuador, Educación Basada en Evidencia, Enfermedades Neurológicas, Estudiantes de Medicina, Neurofobia,

Keywords: Evidence Based Education, Medical Students Ecuador, Neurological Diseases, Neurophobia,

Desarrollo Psicomotor y Variables Medioambientales en Dos Poblaciones del Ecuador.

Objective: To determine the influence of some environmental variables associated with psychomotor development in children from an indigenous community and mestizo community in Ecuador. Material and methods: For the observation and measurement of variables were used EEDP scale and a registration form of environmental factors. Data was analyzed using logistic regression test. The methods of observation and measurement of variables through the EEDP scale and a registry of environmental factors were used. Data was analyzed through a logistic binary regression. X2 omnibus test was applied; the same statistician was estimated by the Hosmer-Lemeshow test with global adjustment. Also, it was estimated -2 log likelihood (-2LL) in order to check the veracity of the results, the Cox and Snell R2, Nagelkerke R2 and Wald statistic. Results: The findings indicate that some of the independent variables were related to motor development and coordination in the populations studied. Furthermore, it was found that breastfeeding and type of housing have influence in the social and language development of both populations.

Conclusions: Only some of the studied variables exert influence on psychomotor development of two populations: breastfeeding, age and housing type.

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Palabras clave: comunidad indígena, comunidad mestiza, Desarrollo psicomotor, medio ambiente, neurodesarrollo,

Keywords: environment, indigenous community, mixed race community, neurodevelopment, Psychomotor development,
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