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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Actualización en Neuropatía Óptica Isquémica No Arterítica. Nonarteritic Ischemic Optic Neuropathy: An Updated Review

Introduction: Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury is the second most common optic neuropathy after glaucoma.

Development: Patients are over the age of 50 years with vascular risk factors. This condition typically presents with acute, painless, monocular loss of vision associated with a variable visual field defect and optic disc edema. NAION is produced by inadequate perfusion of the optic nerved head, supposedly because of nocturnal hypotension and small cup/disk ratio. Diagnosis is mainly clinical and prognosis is generally guarded.

Conclusion: There is no treatment for this condition despite numerous medical and surgical attempts. This article reviews the literature and summarizes current data of proposed treatments.

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Palabras clave: fisiopatología, neuropatía óptica isquémica anterior no arterítica, Tratamiento,

Keywords: nonarteritic anterior ischemic optic neuropathy, physiopathology, Treatment,

Modelos de Organización Cerebral: un recorrido neuropsicológico. Brain Organization Models: a neuropsychological journey

There has always been an interest in understanding how the human brain functions in relation to behavior and cognition. An approach that seeks to solve this intrigue lies in the proposal of models of brain organization that try to explain how the work of the brain mass is. In this sense, this article proposes a theoretical review of the main models. Jackson proposes a theory where three levels of brain structure are considered: lower or medullary level, middle level, and higher level. McLean postulates the existence of three brains: reptile, paloemamiferous / limbic and neocortex. The Wernicke-Geswind model manifests the interaction of language structures in favor of brain function. Luria’s model of brain organization highlights the interactive role of three functional units: first, in charge of regulating tone and wakefulness; second, it receives, processes and stores the information; and the third, plans, monitors and verifies mental and behavioral activity. This review highlights the high complexity involved in the work of the human brain. This article closes highlighting the need to carry out research that can generate empirical evidence in favor of understanding the efficacy of each of the models described in this work.

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Palabras clave: Jackson, Luria, MacLean, modelos de organización cerebral, neuropsicología,

Keywords: brain organization models, Jackson, Luria, MacLean, neuropsychology,

Principios del aprendizaje motor: Una revisión sobre sus aplicaciones en la rehabilitación del accidente cerebrovascular. Motor learning principles: A review of their applications in stroke rehabilitation

Stroke is one of the leading causes of disability worldwide. Despite the functional consequences, a recovery process can occur in these patients thanks to the neuroplasticity mechanisms preserved after brain damage. Recovery of movement patterns after stroke has been suggested to be based on a learning process. Motor learning is an approach that has recently generated a great deal of attention in the field of neurorehabilitation. Thanks to its association with neuroplastic mechanisms, the implementation of motor learning principles has shown positive results during motor skills learning in stroke patients. The present study offers a review of the fundamentals of motor learning and its various strategies to promote the learning of a motor skill. This article provides a concise overview of the implications of motor learning in stroke rehabilitation, describing the strategies, therapeutic approaches, and assessment parameters used respectively to promote and evaluate motor learning in stroke patients.

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Palabras clave: Accidente Cerebrovascular, Aprendizaje motor, Desempeño motor, Habilidad motora, Rehabilitación,

Keywords: Motor learning, Motor performance, Motor skill, Rehabilitation, stroke,

Aplicación de Realidad Virtual Para Tratamiento de la Mano Espástica en la Hemiplejía. Revisión Sistemática. Virtual Reality For Spastic Hand In Stroke Patient. Systematic Review.

Introduction: The virtual reality is as a real-time computer technology system whose use in neurological patients is an innovative process at the service of motor function recovery.

Aim: To determine the effect of virtual reality on the motor function of the spastic hand of the adult with hemiparesis.

Materials and methods: A systematic review of the literature was performed in PubMeD, Science direct, EMBASSE, PeDro, OT Seeker, Cochrane databases; they were selected results and controlled clinical analyzes from an analytical perspective according to the quality standards established to report experimental studies using the CONSORT 2010 strategy, for the inclusion criteria and the methodological quality studies was analyzed using the PEDro scale.

Results: The virtual reality therapy showed effectiveness in the function of the spastic hand of the adult with hemiparesis in selective activities that involve dexterity and execution of daily life skills, as well as favors the recovery of spasticity

Conclusions: Virtual reality therapy is effective in the spastic hand function of the adult with hemiplegia as a cerebrovascular consequence disease in selective activities that involve the dexterity and activities living of daily execution, as well as the recovery of the spasticity.

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Palabras clave: enfermedad cerebrovascular, Extremidad superior, Hemiparesia, Terapia de realidad virtual,

Keywords: hemiplegia, stroke, upper extremity, virtual reality therapy,

Complicaciones neurológicas del COVID-19 (SARS-CoV-2), revisión de la literatura. Neurological complications of COVID-19 (SARS-CoV-2), literature review.

Since the diagnosis of the first person infected with SARS-Cov-2, it has quickly spread throughout the world causing a pandemic and putting healthcare systems on maximal alert. Currently, evidence indicates that SARS-Cov-2 infection is not a disease limited to the respiratory system but it can also affect the central nervous system, causing anosmia, headache, seizures, stroke and altered mental status.  For this reason, it is important to be aware of the neurological complications associated SARS-CoV-2 infection.

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Palabras clave: neuroinvasión, neurotropismo, SARS-CoV-2,

Keywords: neuroinvasion, neurotropism, SARS-CoV-2,

Análisis neurofutbolístico de Loris Karius: de la gloria al infierno. Loris Karius neurofutbolistic analysis: from glory to hell.

In the soccer context there have been huge errors that have cost the teams dearly. Sometimes they occur due to nerves or deconcentration, however, according to our clinical eye, sometimes the brain plays a trick and its malfunction, the product of traumatic brain injury that occurred in the same game, is what determines the score of an encounter. This is what happened to the Liverpool goalkeeper in the final of the 2018 Champions League, who, from our neuro-soccer reflection, had errors that cost him the match, due to an affectation of the cerebral magnocellular pathway that allows processing spatial visual perceptual information. In the featured article, we reflect on his brain state before and after the trauma suffered and highlight that a footballer who is awake and expressing that he can continue, is not necessarily an individual with his brain preserved, since it may be only a part of his brain mass speaking, but, as seen in Karius, however, other silencers may have been altered. We close the work by highlighting the need to incorporate neuropsychological knowledge to understand the effect of trauma on the playfield, since this work confirms that humans do not play soccer with their legs or hands, they do so with your brain.

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Palabras clave: estado de conciencia, fútbol, neuropsicología, traumatismo craneoencefálico,

Keywords: neuropsychology, soccer, state of consciousness, traumatic brain injury,

Deterioro Cognitivo y Demencias en Adultos con Trastorno del Espectro Autista. Cognitive Impairment and Dementia in Adults with Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) has been studied mainly in children. However, currently, 1/68 adults live with this neurodevelopmental disorder. ASD in adulthood shows suggestive symptoms of cognitive impairment, quickly compromising various cognitive functions. Cognitive impairment and behavioral disorders help to develop neurodegenerative diseases such as Frontotemporal dementia (FTD) and Alzheimer’s Disease (AD) in people with ASD during adulthood, which affects activities of daily living (ADL). The objective of this systematic review is to investigate the progression of ASD to cognitive impairment and dementia in adulthood. The methodology included the qualitative analysis of studies published in the years 2000 and 2020, exclusively in english. Results reveal that adults with ASD develop early cognitive impairment and dementia according to the general population, mainly affecting cognitive functions such as memory and executive functions. In conclusion, moderate to a profound degree of intellectual disability, as well as reductions in white matter, seems to be precursors for the development of cognitive impairment and dementia in adults with ASD.

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Palabras clave: Adultez, Demencias, deterioro cognitivo, Discapacidad Intelectual, Trastorno del Espectro Autista,

Keywords: Adulthood, Autism Spectrum Disorder, Cognitive Dysfunction, dementia, Intellectual Disability,

Factores Clínicos y Radiológicos Relacionados Con la Progresión de la Discapacidad en Esclerosis Múltiple. Clinical And Radiological Factors Related To The Progression Of Disability In Multiple Sclerosis

Multiple Sclerosis is a chronic demyelinating disease of the central nervous system, of unknown cause, of variable prognosis with high cost treatment. It may include sensory, motor, cognitive and behavioral alterations, as well as fatigue, pain, sexual and sphincter dysfunction, it represents a common cause of severe physical disability in young adults. Different factors that contribute to the progression of disability have been described. This work aims to describe clinical and radiological factors related to the progression of disability in patients with multiple sclerosis. A narrative review about clinical and radiological factors related to disability progression was made in PubMed, Embase, Science Direct, Scopus, and Lilacs data bases. We found 217 articles, after removing duplicates and systematic reviews, meta-analysis and clinical trials, 20 articles were left. Some factors such as vitamin D levels, general symptoms, brain atrophy, gray matter lesions, among others, are related to disability progression in multiple sclerosis. Magnetic resonance is the most important test for diagnosis and follow-up of the disease. The most appropriate way to assess the progression of disability includes clinical evaluation, magnetic resonance imaging, and other diagnostic tests.

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Palabras clave: Biomarcadores, esclerosis múltiple, Imagen por Resonancia Magnética, Personas con Discapacidad, Pronóstico,

Keywords: Biomarkers, Disabled Persons, magnetic resonance imaging, multiple sclerosis, Prognosis,

Multiple Sclerosis: A Review Of The Clinical Practice Guidelines. Esclerosis Múltiple: Una Revisión de Las Guías de Práctica Clínica

Neurological disorders are considered as one of the serious issues worldwide. While, many of the disorders have cure, there are still neurological diseases that lacks of curative treatment. Multiple sclerosis is one of them. It doesn’t have any cure, and therefore the prognosis of the disease is not so good. For this reason, the attention of the healthcare providers is mostly on the clinical management of the patients suffering from multiple sclerosis. The available literature for the clinical guidelines is into various dimensions, with a central focus to care the patients according to the evidence-based recommendations and rationales. A narrative review methodology is used to identify, evaluate, and analyze the available clinical guidelines worldwide. In total, ten clinical guidelines were found out of which only two fulfilled the quality guideline criteria. A quality guideline is the one in which four components are present: systematic review, meta-analysis, expert feedback and levels of recommendations. 2/10 clinical guidelines is a very less number which clearly indicates that there are many loop holes that need to be fixed in order to have a good pool of clinically evident recommendations.

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Palabras clave: Enfoque GRADE, esclerosis múltiple, Guía de Práctica Clínica, Práctica Clínica Basada en la Evidencia,

Keywords: Evidence-Based Practice, GRADE Approach, multiple sclerosis, Practice Guideline,

The Utility Of Earlobe Crease For The Detection Of Sub-Clinical Atherosclerosis. La Utilidad Del Pliegue Del Lóbulo de la Oreja Para la Detección de Aterosclerosis Subclínica.

Traditionally a crease in the ear has been considered a visible marker of atherosclerosis. There is strong evidence of its association with coronary heart disease (CHD) revealed in several retrospective and prospective studies. However, the usefulness of the earlobe crease (ELC) as a marker of atherosclerotic diseases of other vascular beds, especially in the intracranial or extracranial carotid vasculature, is not clear. A non-systematic search of studies evaluating the association between ELC and atherosclerosis was performed. Observational studies that explored the association of ELC with atherosclerosis in many vascular beds were reviewed. Most studies presented methodological limitations, selection bias, and relatively small sample sizes. Discrepancies were found between studies, mainly due to the interaction of age in the association pathway. In a population cohort study, age was the main modifier of the effect of ELC with atherosclerosis in different vascular beds. The role of ELC as a marker of atherosclerosis remains unclear, at least for extra-coronary atherosclerosis.

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Palabras clave: aterosclerosis, enfermedades cardiovasculares, enfermedades cerebrovasculares, Pliegue de la oreja,

Keywords: Atherosclerosis, cardiovascular diseases, Cerebrovascular diseases, Earlobe crease,

Estimulación Eléctrica en Niños y Adolescentes Con Parálisis Cerebral: Una Revisión Sistemática. Electrical Stimulation In Children And Adolescents With Cerebral Palsy: A Systematic Review

Objectives: To analyze the most investigated age ranges in children with cerebral palsy. To identify the anatomical regions treated by electro stimulation. To determine the frequency and duration of the protocols used in the studies carried out between 2009 to 2019.

Methodology: A systematic review of the literature on the utilization of electro stimulation in children with cerebral palsy in the last 10 years was carried out. The search was considered in the Pub Med database. The observation technique was used to extract the information and the indicators were recorded in an evaluation form (type of study, sample, anatomical region treated, subjects investigated, frequency and duration of therapies).

Results: Most of the studies have developed the treatments with electro stimulation in the legs and extensors of the elbow and the wrist and one study -at the same time- in the face and legs. The ages investigated ranged between 1 and 16 years. The protocols have been used from 3 to 5 times per week and in a range of 2 to 12 weeks. The time of administration of the electro stimulation ranged between 20 to 60 minutes.

Conclusion: To obtain positive benefits it is necessary to develop programs from 3-5 times per week and each session in periods of 20 to 60 minutes. This systematization could contribute to an efficient organization in future intervention programs and in the stimulation of other anatomical regions less explored.

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Palabras clave: Estimulación eléctrica, intervenciones, niños y adolescentes, parálisis cerebral,

Keywords: cerebral palsy, children and adolescents, Electrical stimulation, interventions,

Desempeño en Funciones Ejecutivas de Adultos Mayores: Relación Con su Autonomía y Calidad de Vida. Executive Functions Performance In Old Adults: Relationship With Autonomy And Quality Of Life

Throughout the life cycle, the human being is able to consciously control his thoughts, emotions and behavior in a way that adjusts to the demands of the environment, which is lost with old age, affecting the independent and autonomous life of people, negatively impacting their quality of life. The purpose of this review is to determine the executive functions that are most impaired over the years. The narrative review method was used to collect articles that addressed the relationship between executive functions and quality of life in older adults without severe cognitive impairment. The results show that the executive functions that are most affected over the years are attention, working memory and verbal fluency, involved in the search and updating of information; cognitive flexibility, responsible for generating modifications in behavior, thinking and reasoning, fundamental in efficient cognitive functioning. In addition, a slowdown in reasoning, inhibitory deficit, transmission deficit and sensory-perceptive is reported. It is concluded that executive functions are sensitive to the aging process and progressively affect the autonomy and quality of life of older adults. It is considered relevant to generate a maintenance program for these cognitive functions, as a way to promote successful aging.

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Palabras clave: adulto mayor, autonomía en adultos mayores, calidad de vida, Funciones Ejecutivas,

Keywords: autonomy in older adults, Executive functions, older adults, quality of life,

Encefalopatía Hepática: Diagnóstico y Tratamiento en 2019. Hepatic Encephalopathy: Diagnosis And Treatment In 2019

Hepatic encephalopathy is a clinical syndrome of neuropsychiatric disturbances secondary to the variable combination of hepatocellular dysfunction and portal hypertension. It is an ominous entity, which marks a high risk of death in patients with cirrhosis, since its appearance occurs in advanced stages of it. The spectrum of manifestations ranges from subclinical EH, which is only diagnosed by alterations in neuro-psychometric tests, to coma. Currently, the treatment has ammonium as a therapeutic target, either inhibiting or decreasing its production or modifying its extraction and the two most important complications are rifaximin and lactulose, which have proven efficacy both in the management of the acute episode and in preventing recurrence. In 90% of patients, a precipitating factor can be identified and makes part of the entity’s management treat that factor. Despite its wide recommendation, there are recommendations that lack enough evidence to be implemented. As with other complications of portal hypertension, hepatic encephalopathy is an indication of liver transplantation.

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Palabras clave: cirrosis, Encefalopatía, lactulosa, rifaximina,

Keywords: cirrhosis, Encephalopathy, lactulose, rifaximin,

Neurologic Manifestations Associated With SARS-CoV-2 Infection: A Neuro-Review of COVID-19. Manifestaciones Neurológicas Asociadas a la Infección Por SARS-CoV-2: Una Neuro-Revisión de COVID-19

Background. In December 2019, multiple cases of pneumonia of unknown etiology surged in China. In January 2020, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was the identified cause. The World Health Organization (WHO) defined the condition as “Coronavirus 2019 Disease” (COVID-19). In February, its presence was confirmed in South America and Ecuador. On March 11th, the WHO declared COVID-19 as a pandemic. This condition mainly afflicts the respiratory system. However, reports of neurological manifestations in confirmed COVID-19 patients have recently emerged.

Methods. Multiple databases were reviewed, the information was extracted and analyzed independently by 3 authors.

Results. Neurological manifestations associated with COVID-19 were identified. Including: myalgia, headache, altered mental status, cerebrovascular events, dizziness, hypogeusia, hyposmia, neuropathic pain, visual impairment, ataxia, seizures, Central Hypoventilation Syndrome, encephalopathy, rhabdomyolysis, Acute Hemorrhagic Necrotizing Encephalopathy, Guillain Barre Syndrome (GBS), meningitis and encephalitis.

Conclusion. COVID-19 is associated with neurological involvement. It is most frequently observed in cases that are severe, atypical, and with comorbidities. Health care providers and neurologists alike, must remain alert and keep high suspicion of severity when these manifestations are present. Timely recognition might help initiate early treatment and isolation, preventing clinical decline and viral spread.

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Palabras clave: Coronavirus, COVID-19, neurología, Pandemia, SARS-CoV-2,

Keywords: Coronavirus, COVID-19, neurology, Pandemic, SARS-CoV-2,

Neurogénesis y Ejercicios Físicos: Una Actualización. Neurogenesis And Physical Exercise: An Update

Neurogenesis is a brain mechanism of structural plasticity that could be defined as a process of production of new neurons from neural stem cells or progenitor cells. Currently is accepted that neurogenesis occurs mainly in two different neurogenic niches of humans and rodents’ adult brain, the granular zone (ZSG) in the dentate gyrus (GD) of the hippocampus, and the subventricular zone (ZSV) in the lateral ventricles. It is a complex process that depends on various factors being finely regulated, takes four to six weeks to complete and could be regulated positively or negatively by intrinsic or extrinsic factors.

Among the main positive regulators of neurogenesis is the physical exercise. Several studies showed the importance of regular practice of physical exercise for general health and cognitive functions. In the hippocampus, it is able to increase the cellular proliferation, differentiation and neuronal survival. In addition, physical exercise acts in synapses remodeling and modifying neuronal properties, protecting cognitive deterioration due to diseases or the natural aging process.

Thus, the objective of this review is to bring information on neurogenesis and an update that seeks to elucidate the possible mechanisms by which physical exercise favors adult hippocampal neurogenesis.

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Palabras clave: Ejercicio físico, Giro Dentado, Neurogénesis, Neuroplasticidad hipocampal,

Keywords: Dentate Gyrus, Hippocampal neuroplasticity, Neurogenesis, Physical exercise,

Perspectivas en el Abordaje Farmacológico de la Epilepsia: Una Revisión Extensa de la Farmacoterapia Perspectives On The Pharmacologic Management Of Epilepsy: A Comprehensive Review

Background. Epilepsy represents the third most common reported neurologic disorder, surpassed only by cerebrovascular accidents and Alzheimer’s disease. Iyt is believed that around 70% to 80% of all convulsive disorders can be successfully controlled with monotherapy alone and an additional 10% to 15% with combination therapy. Around 10% of cases never achieve remission through pharmacological therapy alone. Objectives. Through this comprehensive review of the literature describing the current available pharmacologic therapies for the management of epilepsy and their recognized indications, the authors intend to provide an educational tool that could assist the general practitioner to make decisions when selecting a suitable treatment strategy according to a specific clinical scenario (and as guided by their own professional judgment, circumstances and clinical reality). Methods. We used a wide variety of medical search engines, articles and abstracts for the purpose of data collection and interpretation. Conclusions. Through this review the authors managed to present all current and innovative approaches regarding the pharmacologic management of epilepsy encompassing the scope of current knowledge.

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Palabras clave: Anticonvulsivantes, Convulsiones, Epilepsia, Farmacoterapia,

Keywords: Anticonvulsants, Epilepsy, Pharmacotherapy, Seizures,

Primera Crisis Epiléptica en Adultos: ¿Epilepsia o no? First Seizure In Adults: Epilepsy Or Not?

First epileptic seizure is a fact that impacts the life of who suffers and its environment as a relationship with the possibility of a manifestation of epilepsy. It is one of the main causes of consultation in the emergency service, so neurologists and general doctors must have a basic and global knowledge of this. However, there are factors (provoked or unprovoked seizures, risk of recurrence) that it will allow to diagnose of epilepsy with the aim of establishing a timely pharmacological treatment that reduces the possibilities of a new crisis also to resolve the doubts that patients have regarding this disease.

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Palabras clave: adulto (DeCs), Convulsiones, Epilepsia, primer crisis epiléptica,

Keywords: adult (MeSH), Epilepsy, first seizures,

Fundamentos Neurobiológicos del Sueño. Neurobiological Basis Of Sleep

Sleep is one of the most important behaviors for the cognition of the human being. It has between 4 to 6 cycles that are characterized by presenting different electromagnetic activity that causes a certain brain activity to occur in each of them. When the sleep pattern is affected, there are alterations in the daily life of the subject who suffers it, generating a negative impact on the activities carried out in the personal, family and social environment. In this article we report a theoretical review of the dream, its electrical activity during each of its phases, sleep disorders and the impact of sleep disorders on the individual’s life. It is concluded by emphasizing the role of maintaining a balance in the sleep pattern as a benefit for the daily life of the subject.

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Palabras clave: conducta humana, ondas electromagnéticas, REM, Sueño, trastornos del sueño,

Keywords: electromagnetic waves, human behavior, REM, sleep, sleep disorders,

Encefalopatía Posterior Reversible Asociada a Exacerbación de Enfermedad Pulmonar Obstructiva Crónica. Reporte de Caso y Revisión de la Literatura. Reversible Posterior Encephalopathy associated with Exacerbation of Chronic Obstructive Pulmonary Disease. Case Report and Review Of Literature

Posterior Reversible Encephalopathy Syndrome (PRES) is a reversible clinical and radiological entity. There are several entities that are associated with PRES. Chronic obstructive pulmonary disease (COPD) is a rare factor for the development of this condition. We present the case of a 71-years-old woman who was being treated for an acute exacerbation of COPD and developed sensory impairment and seizures. The findings of characteristic images, associated clinical symptoms and their medical history led to a diagnosis of PRES in our patient. Although the association of PRES and COPD is a rare entity, the diagnosis of PRES should be a differential if a patient develops encephalopathy or seizures in the exacerbation of COPD.

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Palabras clave: Convulsiones, Encefalopatía, Encefalopatía posterior reversible, Enfermedad pulmonar obstructiva crónica,

Keywords: Chronic obstructive pulmonary disease, Convulsions, Encephalopathy, reversible posterior encephalopathy,

La Autorregulación en la Primera Infancia: Avances Desde la Investigación. Self-Regulation In Early Childhood: Advances From Research.

A robust body of literature confirms the importance of developing the skills of self-regulation (working memory, attention and inhibitory control) from the early years, considering their impact on the achievements of the present and future success (eg adaptation to the school context, academic achievements, social participation). The aim of this review is to summarize the information on neuroscientific research on the topic of self-regulation, between 2000 and 2019, which has provided information to better understanding: (1) development processes between 0 and 8 years of age, each of these skills mentioned and (2) some of the factors involved in this process. The results confirm that both the chronological maturity and the experiences of the children will favor the optimal development of these skills. Additionally, each skill emerges and takes roots according to its own processes and time frames, turning into behavioral and neurological manifestations. Relevant factors can be either biological or contextual/social that will influence how these skills are developed and expressed in everyday life.

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Palabras clave: autorregulación; primera infancia; desarrollo, neurociencia cognitiva,

Keywords: cognitive neuroscience, development, early childhood, Self-regulation,

Relación del Estado Nutricional con el Desarrollo Cognitivo y Psicomotor de los Niños en la Primera Infancia. Relationship Between Nutritional Status And Cognitive And Psychomotor Development Of Children In Early Childhood.

Gestation, the first years of life and nutritional status are important role in physical, psychosocial, emotional and cognitive development in childhood and adolescence. Different investigations have found a relationship between nutritional status with better cognitive performance, although conversely, malnutrition in these stages can cause imbalances between nutritional needs that could lead to obesity or malnutrition and influence cognitive development. The aim of this article was to review the relationship between nutritional status and cognitive and psychomotor development of children in early childhood. The method was systematic review in the databases ProQuest, Redalyc, Science Direct and Scopus in the years 2013-2018. This article concludes that both the intellectual capacity and the development of fine and gross motor skills depend on the nutritional status of infants and therefore a relationship between nutrition and psychomotor and cognitive development is suggested.

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Palabras clave: coeficiente intelectual, desarrollo cognitivo, Desarrollo psicomotor, estado nutricional, Malnutrición, rendimiento académico,

Keywords: academic performance, cognitive development, IQ, Malnutrition, nutritional status, Psychomotor development,

El Perfil Epidemiológico y Clínico de la Esclerosis Múltiple en el Ecuador. The Clinical And Epidemiological Profile Of Multiple Sclerosis In Ecuador.

In recent years, the number of publications on Multiple Sclerosis (MS) from Ecuador has seen a significant increase. As a result, the research on the clinical and epidemiological behaviour of the disease has allowed us to make comparisons with other cohorts of patients with MS that come from regions where the prevalence of the disease is high. Nevertheless, Ecuador is still a country in which the prevalence of MS is low with a prevalence that fluctuates between 3 to 5 cases per 100,000 inhabitants. The epidemiological behaviour of MS is very similar to that of european cohorts, for example female patients are the most affected. However, the clinical behaviour of multiple sclerosis differs in terms of cognitive impairment and fatigue being less frequent. The impact of vitamin D on patients with MS is still unknown as only one study has been carried out. This study show that there is a high prevalence of vitamin D deficiency and insufficiency in ecuadorian patients, but this does not translate into an increase in prevalence or disability as it does in european populations. Although we have a better understanding of the disease in the country, more studies are necessary, and it is imperative that all ecuadorian patients with MS be included in future studies in order to improve our knowledge about the behaviour of this disease in our region.

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Palabras clave: deterioro cognitivo, Ecuador, esclerosis múltiple, Fatiga, Prevalencia, vitamina D,

Keywords: cognitive impairment, Ecuador, Fatigue, multiple sclerosis, Prevalence, vitamin D,

Infección por el Virus Linfotrópico de Células T Humano HTLV-1 y Paraparesia Espástica Tropical en Ecuador: Paradigma de Enfermedad Tropical Desatendida. Human T-Lymphotrophic Virus Infection (HTLV-1) And Tropical Spastic Paraparesis: Paradigms Of An Overlooked Tropical Disease.

The human T cell lymphotropic virus (HTLV-1) infection is considered endemic in South America. For more than two decades clinical cases of HTLV-1 associated mielopaties have been reported in Ecuador, pathology known as tropical spastic paraparesis. There is only two studies about HTLV-1 seroprevalence in Ecuador, both of them with small sample size but showing a high prevalence of HTLV-1 infection, at least for afrodescendants and indigenous communities. However, there is not a currently screening for blood and organ banks carried out by ecuadorian public health authorities. This scenario makes HTLV-1 infection and associated pathologies (like tropical spastic paraparesis) neglected diseases in Ecuador. More epidemiological studies need to be implemented in order to develop control and prevention strategies in the country.

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Palabras clave: Ecuador, HTLV-1, paraparesia espástica tropical,

Keywords: Ecuador, HTLV-1, tropical spastic paraparesis,

Las Aquaporinas y el Sistema Nervioso Central. Aquaporins and Central Nervous System.

The discovery of aquaporins, which constitute a family of integral membrane proteins, has meant a change with respect to the understanding of water transport in biological membranes. The most important is aquaporin 4 (AQP4) which we will focus on below, although there are two other aquaporins, 1 and 9. These aquaporins are of great importance in the physiology of cell volume control and osmotic control mechanisms of the cells. Also in the control of the flow of glycerol and other solutes. In addition, alterations in its functioning have been related to various diseases of the central nervous system such as neuromyelitis optics, cerebral edema, idiopathic intracranial hypertension or chronic hydrocephalus of the adult among others. A review is made on this topic.

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Palabras clave: Aquaporin 1, Aquaporin 4, Aquaporins, central nervous system, Cerebrospinal fluid, Intracranial hypertension,

Keywords: Aquaporin 1, Aquaporin 4, Aquaporins, Central nervous system, cerebrospinal fluid, Intracranial hypertension,

Escala de Observación Clínica Para Valorar la Tercera Unidad Funcional de la Teoría de Luria: EOCL-1. Scale Of Clinical Observation To Valuate The Third Functional Unit Of The Luria Theory: EOCL-1.

Luria’s brain organization model proposes the interaction of three functional units to understand the work performed by the human brain. The first of them is responsible for the regulation of tone and wakefulness. The second one to receive, process and store the information. The third, and of central interest of the investigation, is responsible for programming, executing and verifying mental activity. To evaluate this theory, a series of experimental neuropsychological tests have been developed, however, a scale has not been proposed that, based on the theoretical precepts on the third functional unit, allows to assess it based on the behaviors of the daily life of the human being. This research proposes a scale that will allow the clinician to assess the mental abilities associated with the ability to program, execute and verify the most complex form of mental activity; integrated in the third functional unit of Luria. The proposal is discussed, based on the benefit that is generated by having a scale that will allow to assess this theory, in the different environments where the individual develops through the action of the cerebral abilities of the third functional unit.

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Palabras clave: córtex prefrontal, escala de observación clínica, Modelo de organización cerebral de Luria, tercera unidad funcional,

Keywords: Brain organization model of Luria, clinical observation scale, Prefrontal cortex, third functional unit,

Funcionalidad de la Marcha en la Calidad de Vida Relacionada con la Salud en Adultos con Enfermedad Cerebro Vascular: Revisión Sistemática – Metaanálisis. Functionality Of The Gait In The Quality Of Life Related To Health In Adults With Stroke: Systematic Review – Metaanalysis.

Introduction: Stroke causes deficiencies that affect movement; these include deficit in motor function, reflex integrity, sensory integrity, and gait.

Objective: determine the effect of gait functionality on health-related quality of life in adults with Stroke.

Method: databases PUBMED / MEDLINE, EMBASE, LILACS, SCIELO, Central Cochrane Registry of Controlled Trials (CENTRAL) were consulted between November 2016 and February 2017. Randomized clinical trials were selected. For the analysis, the methodological quality was evaluated using the Physiotherapy Evidence Database, PEDro score and the Risk of bias with the Review Manger 5.3 (RevMan) criterias, also RevMan was being used for analysis and data extraction according to the eligibility criteria.

Results: Lokomat as a rehabilitation strategy for gait functionality has a positive effect on improving the quality of life in people with stroke. The analysis of the included studies demonstrated a low level of statistical heterogeneity based on I2 and Chi2, for the global scale of quality of life. The results obtained for quality of life related to health, when the proposed intervention is carried out with the use of Lokomat and measured with the SF-36 scale, an increase of 1.83 points.

Conclusions: The rehabilitation of gait functionality through different protocols and intervention strategies does not present differences, due to its variability in terms of technique, application method, clinical involvement of stroke and the duration of its application. However, clinical changes that favor quality of life related to health are observed.

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Palabras clave: Accidente Cerebrovascular, Adulto, Anciano, Balance postural, calidad de vida, marcha, Persona de mediana edad,

Keywords: Adult, Aged, gait, Middle aged, Postural balance, quality of life, stroke,

Síndrome de Sturge-Weber: Reporte de un Caso y Revisión de la Literatura. Sturge-Weber Syndrome: A Case Report And Literature Review.

Sturge-Weber Syndrome is a rare developmental neuroectodermical disorder. It is characterized by a facial port-wine stain and a leptomeningeal angiomata, frequently localized ipsilateral to the facial port-wine stain. This syndrome predisposes either to brain atrophy, calcifications and refractory seizures.

In this paper a Sturge-Weber Syndrome literature review was made and a 18 month aged child case with this diagnosis is reported. He was admitted to the emergency department of a local hospital with a history of three days of fever and tonic-clonic seizures localized on the right side and refractory to conventional treatment.

This review highlights the importance of an early diagnosis and an appropriate follow up. To carry out this review a search in PubMed, Science Direct and Scielo databases was done, confirming that there are some issues about this disorder that are still unknown. However, with the GNAQ somatic mutation discovery, there is an open field for new researches. It is very important in medical practice not to understimate a facial port-wine stain over trigeminal territory in newborns in order to make an early diagnosis and try to achieve a better future neurodevelopment.

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Palabras clave: angioma, Convulsión, leptomeninges, nevus, Sturge-weber,

Keywords: angiomata, facial stain, leptomeningeal, seizure, Sturge-weber,

Las Curvas Para Medir Circunferencia Cefálica y las Potenciales Diferencias Antropométricas en Latinoamérica y el Mundo. Cephalic Circumference Curves And Potential Anthropometric Differences In Latin America And The World.

The cephalic circumference (CC) is a measurement that detects alterations in the proper growth of the brain. CC curves most used worldwide are those proposed by the CDC, NCHS and WHO. Despite criticism of the methodology used to create them, updates have been made to correct inconsistencies, and that has helped to detect and treat on time problems of cranial size at both the small (microcephaly) and large (macrocephaly) ends. Several authors have suggested that regional reference curves should be made, and others, like Kenton Holden and colleagues, have proposed new curves that consolidate different databases, aiming to reduce the risk of errors in the diagnosis of microcephaly or mild macrocephaly. It is necessary to study what the normal cranial growth pattern of Latin American children is for each region or country, as well as to determine the interethnic differences.

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Palabras clave: biometría, cefalometría, macrocefalia, microcefalia, perímetro craneal,

Keywords: biometrics, cephalometrics, cranial perimeter, macrocephaly, microcephaly,

La Actividad Embrionaria Espontánea de las Redes Neuronales y su Función en la Maduración Sináptica. Embryonic Spontaneous Network Activity And Its Role On Synaptic Development.

Embrionic neural networks exibit a temporary special form of electrical activity known as Spontaneous Network Activity (SNA). SNA occurs as soon as synaptic conections are stablished and consists on synchronized action potential firing for most of the neurons on the network, followed by long silents periods where network excitability is gradually recovered till a new SNA episode can happen. This kind of neural activity allows a high level of synchronization among neurons on developing networks, contributing to synaptic connection and maturation. SNA has been described in several regions of the developing nervous system due to conserved properties among developing neural networks: redundant intercellular connectivity and the fact that the neurotransmitter gamma-aminobutiric acid (GABA) is excitatory during early embryonic development (GABA is inhibitory in the adult nervous system).In this review we discuss the hypothesis that SNA contributes to synaptic strenght for glutamatergic and gabaergic synapsis while both of them are excitatory, by using the same synaptic plasticity mechanism known as homeostatic plasticity.

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Palabras clave: Actividad embrionaria espontánea, desarrollo embrionario, plasticidad homeostática,

Keywords: embryonic development, homeostatic plasticity, Spontaneous network activity,

Telesalud y Telemedicina para el Manejo de la Epilepsia. Telehealth and Telemedicine for the Management of Epilepsy.

Introduction. Epilepsy is one of the most frequent chronic neurological diseases, with figures close to 70 million cases worldwide; for which telehealth and telemedicine are framed as promising models that can bring multiple benefits.

Objective. To evaluate the initial schemes that have been proposed from telemedicine and telehealth in the management of the patient with epilepsy and the benefits that they have in the management.

Methods. A search of scientific literature was carried out in (PubMed, Cochrane library and LILACS). Different models of telehealth and telemedicine implemented in the management of patients with epilepsy are presented and the main benefits in terms of acceptability, costs and clinical results are described.

Conclusions. Current research of these models of care for the management of patients with epilepsy has the potential to effectively reduce the diagnostic and treatment gap, with the possibility of reducing costs in care for the institutions, the health system, patients and their families and harmoniously integrate with education in the self-control of the disease. Proving that there is a need for a more personalized approach to stimulate the use of these tools.

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Palabras clave: ensayos clínicos, Epilepsia, estudios observacionales, Telemedicina, teleneurología, telesalud,

Keywords: clinical trial, observational study, telehealth, telemedicine, teleneurology epilepsy,
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