El diagnóstico en medicina tiene su piedra angular en la obtención de la historia clínica y la exploración física; sin embargo, en algunas de las patologías el uso de pruebas diagnósticas es de gran utilidad como apoyo para confirmar o descartar una enfermedad. Las pruebas diagnósticas incluyen una amplia variedad de procedimientos y dentro de estas se incluyen las pruebas terapéuticas, también llamadas desafíos o retos, en los que se administra una sustancia activa para evaluar la respuesta y apoyar la impresión diagnóstica. En el contexto de los trastornos del movimiento las pruebas terapéuticas más frecuentemente utilizadas son la de levodopa, apomorfina y etanol. En esta revisión se presenta, describe y discute el alcance y utilidad de estas.
Artículos de Revisión
Las Funciones Ejecutivas del Lóbulo Frontal y su Asociación con el Desempeño Académico de Estudiantes de Nivel Superior. The Executive Functions Of The Frontal Lobe And Its Association With The Academic Performance Of Students In Higher Education.
Introduction. Executive functions (EF) are a set of mental skills that allow to regulate the behavior, metacognition and emotions; executing a conscious control of the own thought. The development is progressive along the vital cycle of the human being, therefore, they meet involved in the social, emotional and academic development of the persons. There exist studies that affirm that the academic performance meets influenced by the level of development of the EF (inhibitory control, working memory, cognitive flexibility, monitoring and self-regulation) which relation has been progressively studied in diverse ages ranges and educational levels. Method. This article, has the aim to define and explain principal EF that they influence in the academic performance in university students. For it, there was realized a method of systematic review that allows to compile the investigations that affirm the above mentioned relation. Results and Conclusions. The scopes of the studies affirm that the principal EF involved in the academic performance of the university students is the working memory and in minor measure, the skills of planning, inhibitory control and cognitive flexibility. Finally, there are discussed the limitations and projections that this study allows to approach; considering the EF to be a key factor for the academic university success and the implementation of instances of pedagogic supports that should favor the professional development of the students.
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Neurocisticercosis, Epilepsia y Uso de Drogas Antiparasitarias. Neurocysticercosis, Epilepsy And The Use Of Antiparasitic Drugs.
Cysticidal drugs have been used for more than three decades. However, its efficacy has been questioned on the assumption that cysts would die spontaneously, and thus, inflammatory reactions related to therapy are unnecessary. In addition, isolated reports have also questioned whether neurocysticercosis (NCC) causes epilepsy. A large body of evidence is currently available and little – if any – doubt exists on NCC as a cause of unprovoked seizures. NCC is consistently associated with seizures when suitable groups are compared, and in a sizable subset of patients, the semiology of seizures correlates with the anatomical location of parasites. Cyst degeneration and the subsequent inflammatory reaction related to therapy may transiently increase seizure expression, and this can be anticipated and managed with the additional use of corticosteroids. Several controlled trial support the concept that cysticidal drug efficacy, safety, and the impact of cyst destruction in decreasing seizures largely overcome the potential risks of therapy, and have provided evidence of the role of NCC as a cause of r ecurrent unprovoked seizures (epilepsy).
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Características Clínicas del Síndrome de Guillain-Barré en Relación a Chikungunya Y Zika: Revisión Sistemática. Clinical Manifestations Of Guillain-Barre Syndrome And Its Relation To Chikungunya And Zika.
In the last five years, there have been several cases of zika and chikungunya infections in the world, simultaneous with the increase in cases of Guillain-Barre syndrome, which have shown a potential causal relationship that is still not entirely clear. Objective: To describe the main clinical manifestations of Guillain-Barre syndrome in relation to chikungunya and zika, according to scientific literature. Methods: The databases PubMed and ScienceDirect were used to perform the search for the period 2014-2016 using with the keywords: zika, chikungunya and Guillain-Barre Syndrome; articles in English and Spanish were included. Results: 35 articles were found, one for the year 2014, two for 2015 and 32 for 2016. Conclusion: Variations in clinical characteristics and the increased incidence of GBS in the presence of zika and chikungunya, highlight the need to monitor these infections and perform analytic studies to determine the association between arboviruses and different neurological alterations.
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Anticoagulación en Pacientes con Injuria Traumática Cerebral: Revisión Narrativa. Anticoagulation In Patients With Traumatic Brain Injury: Narrative Review.
Patients receiving anticoagulation and those with traumatic cranial lesions are at increased risk of hemorrhagic phenomena at the intracranial level. Mortality in this class of patients is high, which makes them a population that deserves a careful approach and follow-up. Usually the patients we observe in emergency services are mild cranial traumas but the evolution of the anticoagulated patient in some cases is unpredictable. Currently, several studies have been published in relation to anticoagulation and traumatic brain injury. We present a concise review of the literature focused on neurologists and neurosurgeons.
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Batería Neuropsicológica Set de Datos Uniformes (UDS) Para la Evaluación de Enfermedad de Alzheimer y Deterioro Cognitivo Leve: Una Revisión Sistemática. Neuropsychological Battery Uniform Data Set (Uds) For The Evaluation Of Alzheimer’s Disease And Mild Cognitive Impairment: A Systematic Review.
The neuropsychological battery UDS (of the English Uniform Data Set), is used worldwide to homogenize the investigations of Alzheimer’s disease. Objective: Quantitatively synthesize the results of the subtests of the UDS for the cognitive profile of controls, patients with mild cognitive impairment and dementia of the Alzheimer type. Method: An advanced and manual systematic search was performed in databases (PubMed / MedLine, Web of Science, Scopus, Lilacs, Science Direct, Cochrane Library, PsycINFO) evaluating the diagnostic performance of the UDS. Results: The systematic review showed a narrative synthesis where 8 articles were included that included 9260 subjects, with an age range between 60 and 90 years. The quantitative synthesis used 13 articles with a total sample of 2,884 participants, with an average age of 74 years and an average of 15 years of education. Conclusion: We described a synthesis of the medial scores, which generate cut-off points for Alzheimer’s type dementia (DTA), mild cognitive impairment (MCI) and cognitively normal controls, evidencing an adequate diagnostic precession.
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El Pensamiento Moral Después del Daño Cerebral Adquirido. Moral Thought After Acquired Cerebral Damage.
Introduction. Moral thinking is a mental skill that allows respecting implicit and explicit social norms. One factor that can alter its functioning is acquired brain damage, as is the case of subjects who have suffered a brain injury at the frontal lobe. Aim. To analyze the relationship between the process of moral thinking and brain functioning, through the description of cases that have suffered acquired brain damage, with the purpose of explaining the situation that an individual lives after presenting brain damage and becoming unable to respect social norms. Development. The clinic of patients who have suffered brain damage at the frontal level, such as Phineas Gage, NN and Elliot, is shown, in which it was observed that its state after the traumatic event was characterized by going back to previous stages of thinking moral, unlike a subject who may present brain damage in later structures. Conclusions. We discuss the analysis performed on the role of the frontal lobe in the process of respecting social norms that allow human interaction and how it can be affected by brain damage.
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Encefalopatía Posterior Reversible en el Contexto de la Eclampsia. Reporte de Caso y Revisión de la Literatura. Reversible Posterior Encephalopathy In The Context Of Eclampsia. Case Report And Review Of Literature.
Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder characterized by headaches, visual disturbances, altered level of consciousness, seizures, and a variety of neurological deficits that are caused by a severe increase in blood pressure. Hypertensive disorders of pregnancy, mainly preeclampsia and eclampsia, continue to be one of the main causes of morbidity and mortality during pregnancy worldwide, causing neurological complications ranging from singular seizures to the development of status epilepticus and the advent of potentially fatal cerebrovascular events. We describe the presentation of posterior reversible encephalopathy syndrome in a pregnant adolescent who developed a hypertensive disorder of pregnancy.
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Factores Pronósticos de la Esclerosis Múltiple Prognostic Factors In Multiple Sclerosis.
Multiple sclerosis is an inflammatory and degenerative disease of the central nervous system which affects young adults. The prevalence of multiple sclerosis in the world is heterogeneous and is low in Ecuador. The diagnosis is based on the McDonald 2017 criteria. Once the diagnosis has been made, it is necessary that any negative factors which will impact the type of treatment used be identified. At this time, factors such as epidemiological, clinical, biomolecular, and magnetic resonance images, which will allow us to identify if the case is aggressive or benign, are studied. The number of lesions shown in a brain MRI, the presence of lesions in the brain stem and spinal cord are factors which have been demonstrated to have an impact on the progression of disability. The presence of oligoclonal bands in the cerebrospinal fluid has a fundamental role in the conversion of an isolated clinical syndrome to multiple sclerosis. Low levels of vitamin D have been associated with a negative prognosis, however how important vitamin D is in the prognosis of MS in countries such as Ecuador is still an area to be studied.
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La Musicoterapia Neurológica Como Modelo de Neurorrehabilitación. Neurologic Music Therapy As A Neurorehabilitation Model.
Neurologic music therapy (NMT) is being implemented in hospitals and neurorehabilitation facilities around the world, thanks to the abundant neuroscience research and to the growing interest in the effects of music on the brain. Recognized and endorsed by the World Federation for Neurorehabilitation, neurologic music therapy is utilized as a non-pharmacological, non-invasive intervention to treat patients with neurologic disease that present cognitive, motor, and/or language impairments. This article aspires to introduce this discipline as an effective, evidence-based method of treatment for neurologic disease.
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Oxigenación y Flujo Sanguíneo Cerebral, Revisión Comprensiva de la Literatura. Brain Oxygenation And Cerebral Blood Flow, A Comprehensive Literature Review.
Background: The brain is an organ that has a broad blood perfusion. Many factors such as hypoxia, anaesthesia, stress or the presence of CO2 as well as hydrogen ions within arterial blood, modify cerebral blood flow and tisular perfusion. Objectives: The objective of this review is to analyse the available literature about cerebral blood flow and tisular oxygenation. Methods: A targeted literature review and specific search was carried out aimed at the identification, recovery and bibliographic review of several independent studies that are key in brain physiology and that allow us to better understand cerebral perfusion and oxygenation. Conclusions: Cerebral blood flow is highly dependent on both, internal and external factors. Maintaining adequate cerebral oxygenation is essential to ensure the proper functioning of the brain and maintain neuronal homeostasis. The cerebral blood flow of the brain is on average 45-50 ml/100g/min and the partial pressure of cerebral oxygen (PtO2) ranges between 20 to 30 mmHg under normal conditions.
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Encefalopatía Traumática Crónica: Revisión de la Literatura. Chronic Traumatic Encephalopathy: Review Of Literature.
Repetitive exposure to cranial trauma is one of the hallmarks of chronic traumatic encephalopathy. Neuropathologically, hyperphosphorylated protein tau (p-tau) deposits are found. Initially it was described as pugilistic dementia, but it has been associated with other types of sports, explosive traumas among others. Symptoms of this disease include memory loss, cognitive impairment, mood swings and dementia. We present a review of the literature on this interesting disease.
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Características Neuroendocrinas del Trauma Temprano y su Relación con el Bullying. Neuroendocrine Characteristics Of Early Trauma And Its Relation To Bullying.
The aim of this article is to review the theoretical basis of neurobiological and neuroendocrine mechanisms that develop early trauma, which can be generators cognitive and emotional vulnerability in subjects exposed to environments with characteristics of child abuse; furthermore, it seeks to identify the relationship between early vulnerability cognitive expressed and affectively with relationships concerning profiles of child victims of bullying in early childhood and propose an explanatory framework for the development of profiles of vulnerability or resilience from the role that school as a protective factor for modifying the expression of genes in children and adolescents in vulnerable conditions.
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Síncope en Urgencias: Aproximación Clínica. Syncope In Emergency Room: Clinical Approach.
Syncope is a symptom defined as a transient loss of consciousness, of rapid onset, of short duration and with complete and spontaneous recovery. Peaks of presentation are in adolescence and after the 8th decade of life. The incidence of syncope represents 1% to 3% of hospital admissions and is associated with cardiovascular comorbidity and cardiovascular pharmacotherapy, being an important cause of morbidity and mortality in the elderly. The accumulative incidence of syncope in women is almost double than in men. Its onset is explained by a decrease in cerebral blood flow due to the decrease in cardiac output, whether due to a drop in systolic blood pressure below 60 mmHg or a decrease in peripheral resistance. The syncope is divides into 3 groups: 1) Reflex syncope, in which there is a sudden change in the autonomic nervous system activity that leads to a drop in blood pressure; 2) Syncope secondary to orthostatic hypotension, where sympathetic efferent activity does not provide sufficient vasoconstriction; and 3) Syncope of cardiopulmonary cause, characterized by an abrupt and sudden decrease in cardiac output due to arrhythmias or structural heart diseases. Depending on the cause of syncope it may or may not present prodrome, which is more commonly composed of diaphoresis, heat and flushing. True loss of consciousness usually lasts less than a minute, although some patients may take several minutes to fully regain consciousness. Therefore, the diagnosis is based on a good medical history with a complete physical examination. Treatment depends on the cause and mechanism of syncopal episodes. In addition, the goals should be to alleviate symptoms and improve prognosis, which means avoiding or reducing recurrences.
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Futbolistas Talentosos, el Gran Secreto Está en el Cerebro: La Gran Tragedia del Marshal y la Suerte de los Magos con un Sistema Nervioso Indemne. Talented Soccer Players, The Big Secret Is In The Brain: The Great Tragedy Of The Star Player And The Fate Of Magicians With A Preserved Nervous Systems.
In previous work, we have presented case studies from fascinating films for the eye of the neuropsychologist;1,2,3 continuing with this line of research, we describe here for your consideration a critical analysis of the role of brain functions in one of the most fascinating sports, soccer. In this analysis, we will look more closely at the brain damage suffered by the great footballer Salvador Cabañas and the role of the highly complex brain functions that allow the magical players to stand out in this sport. In the next pages, we present the case of Salvador Cabañas, both before and after his cerebral accident, and later we analyze the cerebral functions that are activated in brilliant players like Messi or Ronaldinho. We conclude this article by reflecting on the role of the brain in our normal human activities, and how catastrophic it becomes on a daily basis when our brain tissue is damaged so that as a result of this condition we can lose everything.
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Tumores de Sistema Nervioso Central en Pediatría: Presente y Futuro del Abordaje Diagnóstico. Central Nervous System Tumors In Pediatrics: Present And Future Of Diagnostic Approach.
Introduction: Central nervous system tumors are neoplasms with high frequency during childhood, with an incidence of 31,2 cases per million children, the most common being astrocytoma. These are the product of a combination of genetic and epigenetic factors that determine not only their appearance, but also their behavior and prognosis. The clinical presentation of these neoplasms ranges from the sudden and clear, to the gradual and ambiguous, which represents a barrier to carrying out an adequate approach and an early diagnosis. That is the reason to destinate many resources for evaluation and standarization of new diagnostic methods like tumor markers. Objective: To provide a clear review of central nervous system tumors and new perspectives in diagnosis. Methods: A search of the literature was carried out in databases using the descriptors central nervous system, neoplasms, astrocytoma. 25 articles were included in spanish and english. Conclusion: Central nervous system tumors have a significant relevance in the pediatric population. Their behavior and prognosis necessitate searching for new aids for an early diagnosis.
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Complicaciones Neurológicas de las Mordeduras de Arañas Neurological Complications of Spider Bites.
Spiders are venomous arthropods with worldwide distribution. Most spider bites are clinically insignificant, as the size of their chelicerae is too small to inject enough amount of venom to human beings. Despite this, there are hundreds of reported cases of human envenoming related to spider bites. While clinical manifestations related to spider-bite envenoming are pleomorphic, three main clinical syndromes could be recognized: latrodectism, loxoscelism, and funnel-web spider envenoming. Latrodectism is caused by the potent neurotoxin α-latrotoxin present in the venom of widow spiders (Latrodectus sp.). Most cases present with severe pain at the site of the bite, with arterial hypertension being the most frequent systemic manifestation. Neurological complications mostly consist of headache, lethargy, irritability, generalyzed myalgia, tremor, fasciculations, ataxia, or paresthesias. The latter manifestations are related to an exhaustive release of cholinergic neurotransmitters at the neuromuscular junction. Loxoscelism is caused by envenoming by spiders of the family Sicariidae, genera Loxosceles and Sicarius. It presents in two different forms, cutaneous (with changes restricted to the affected skin) area and viscerocutaneous. In the latter, a severe coagulopathy may occur, associated or not with acute renal failure, jaundice, fever, multi-organ failure and shock. The venom of fennel-web spiders have potent neurotoxins, called δ-atracotoxins, that stimulates neurotransmitter release from the presynaptic vesicle, causing hyperstimulation of post-synaptic receptors resulting in sensory disturbances and muscle paralysis. Also, sympathetic and parasympathetic manifestations, including diaphoresis, hypersalivation, arterial hypotension, and cardiac arrhythmias may occur.
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Hidrocefalia de Presión Normal. Normal Pressure Hydrocephalus.
Normal pressure hydrocephalus is a pathology causing dementia that is reversible. Despite the time elapsed since its discovery, its pathophysiology has not been clearly established and two theories have been proposed that try to explain the process, one based on changes in cerebrospinal fluid flow and the other on cerebral blood flow. In addition, the evaluation and diagnosis process is not determined, since there is no standard method and the symptoms are similar to other pathologies of the central nervous system, leading to the diagnosis as the summation of clinical symptoms and some findings in imaging which are not always constant.
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Encefalitis Autoinmune Antirreceptor de NMDA: Reporte de un Caso y Revisión de la Literatura. Anti-NMDA Receptor Encephalitis: Case Report And Review Of Literature.
Encephalitis caused by N-methyl-D-aspartate receptor antibodies is associated with auto antibodies against the heteromeric NR1/NR2 units of NMDA receptors. This type of encephalitis occurs more commonly in young adults, most of them women, and shows a good response to known treatments. Clinical features include neuropsychiatric manifestations, advancing through a series of stages up to a gradual recovery. This type of encephalitis can be associated with the presence, or lack thereof, lesions caused by tumors. It can easily be mistaken with infectious encephalitis, therefore is important to recognize its clinical features for an appropriate diagnosis and treatment in order to prevent higher morbidity and mortality. In this article, I describe a case study of autoimmune encephalitis caused by NMDA receptor antibodies in a twenty-two year old man, admitted to the Enrique Garcés Hospital in Quito-Ecuador, and I make a literature review on this pathology.
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Conceptos Fundamentales en la Teoría Neuropsicológica. Fundamental Concepts In The Neuropsychological Theory.
This article presents three concepts that are fundamental in the neuropsychological theoretical: (a) historical data in the study of the human brain, (b) neuropsychological evaluation of brain functions and (c) neuropsychological rehabilitation of brain functions. As relevant data in the theoretical development of the study of the human brain is a tour of the trepanation acts performed hundreds of years ago, the contributions of phrenology, the masterful findings of Broca and Wernicke, the heuristic contribution of Luria and the current revolution with the neuro-image. In the neuropsychological evaluation of brain functions, the role of specific, non-specific and delayed observation tests in the interpretation of the neuropsychological state of the human being is analyzed, which allow analyzing neuropsychological functions in the laboratory and in real lifeactivities. Finally, we analyze the process of neuropsychological rehabilitation of brain functions, where mention is made of the processes of restoration, compensation, substitution, activation-stimulation and integration, which are very useful when intervening in a brain that has suffered an acquired damage. It is concluded that the current accelerated pace has determined the advance of neuroscience, where technology and the forceful scientific contribution propose new techniques and theories to understand the processes of evaluation and rehabilitation of brain functioning.
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Exposición de Ondas de Radiofrecuencia en Relación con Alteraciones en la Salud. Radiofrequency Waves Exposure And Health Changes.
The cell phone is a device widely used by people of all ages and all over the world. Among the studies regarding the harmful effects of radiation on the human body there is no consensus. It is therefore necessary to analyze the theoretical references about the deleterious effects of radiation on humans and identify a set of actions to help reduce exposure to this radiation. The overall objective is to give information to the user about excessive exposure to radio frequency by the indiscriminate use of cell phone and to warn about the health problems that can occur and the consequences that could trigger in the future. Radiation can affect humans negatively, especially prolonged exposure. Various studies reviewed indicate that radiation is associated with the onset of health disorders and described that fundamental mechanism to produce damage in man are thermal, non-thermal and athermal effects, but it is required to extend studies, with emphasis on epidemiological, to analyze the generated hypotheses about this particular.
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Miositis Esporádica por Cuerpos de Inclusión
Sporadic inclusion body myositis is a common acquired inflammatory myopathy in people over 50 years of age. It presents with slowly progressive asymmetric weakness that affects preferentially the quadriceps and deep finger flexors. The pathogenesis is poorly understood. The diagnosis is made with a combination of the clinical history, physical exam, electrodiagnostic tests, imaging, serology and histopathology. There is no treatment for this condition but multiple therapies are currently being investigated.
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El Cerebro y la Música
Sound and music share a lot, but they are not totalitarian synonyms. Each one has some qualities or elements that define them even when they are equivocally seen as equals. Sound is a physical event, while music is an art that uses that event as material to develop itself. In our brain, music is processed through neural networks that involve areas of auditory and motor processing, in turn, their perception and execution involve various cognitive functions. Although current knowledge of the structures involved in hearing and the effect of music in our brain is still uncertain, a review of the most up-to-date literature on the subject is useful.
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Manifestaciones Neurológicas Asociadas a Infección por Virus Zika
Zika virus is a flavivirus and it is part of the flaviviridae family. This virus is transmitted by Aedes mosquito bites and sexual intercourse. The virus was discovered in 1947 but it was almost unknown until it spread along America in 2015 and was associated with multiple neurological disorders. Due to this incidence, the World Health Organization declared an emergency status in 2016. In Ecuador, the first case of Guillain-Barre Syndrome associated with Zika virus infection was reported during
the same year.
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Tratamiento Neuropsicológico del TDAH en Preescolares: Entrenamiento de la Función Ejecutiva
Preschoolers who have symptoms of impulsivity, hyperactivity and attention deficit manifest alterations in the executive functions: inhibitory control, working memory, monitoring and self-directed speech. It is essential in the preschool classroom to identify children who have difficulty regulating their behavior. The importance of this early detection is the possibility of avoiding a picture of ADHD with greater complexity in the child’s future. Training of executive function in children who could present these symptoms has been described as a highly effective strategy. Researches affirm that training of executive function would decrease the likelihood that a child will have ADHD at school age if he had received early attention from preschool. From the clinical experience it has witnessed the evolution of cases of children identified preschool with symptoms of ADHD, and then do a training executive functions for periods of one to two years better, and even at the beginning of schooling have a less severe psychopathology, unlike children who have not received this early intervention. In this paper I will describe the clinical picture of ADHD in initial preschool, the relationship between this disorder and executive function and some strategies in the training of executive functions.
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Código Ictus: Protocolo de Tratamiento del Ictus Cerebral Isquémico
Cardiovascular diseases are the leading causes of mortality worldwide and Ecuador is not an exception. One of the great issues about these phenomena is the impact on vital organs such as the brain. Several features of cerebrovascular diseases, such as the high rate of associated disability and radiological advances, have encouraged the different government health institutions to establish standardized procedures, which are executed in order to generate an early diagnosis and individually analyze following procedures in affected patients. This article reviews the literature about CODE STROKE, which is a standardized approach performed in spaniards hospitals.
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Malformaciones vasculares de la médula espinal.
Congenital vascular malformations are largely known as rare entities. The prevalence of vascular malformations of the spinal cord is around 16%. Spinal arteriovenous malformations (AVM) are a heterogeneous group of lesions that may impair spinal cord function, and can be considered as a treatable cause of myelopathy.
According to localization they are classified as: dural, intradural, extradural, and complex, each one with a different arterial nutrition. According to the pathological anatomy it classifies in: cavernous angiomas, capillary hemangiomas and AV lesions.
The clinical manifestations of the spinal AVM are acute neurological deficits caused mainly by bleeding, or a subacute myelopathy, presenting as an insidious onset paraparesis associated with sensorial, intestinal, sexual and urinary dysfunction, based on the level (cervical to lumbar) of the lesion. The most common spinal vascular lesion in adults and elderly are dural arteriovenous fistulas prevalent in men and representing 56% of spinal vascular malformations.
After clinical suspicion, diagnosis is made by magnetic resonance imaging (IRM) which leads to selective medullary angiographies in order to determine type and subtype of medullary vascular malformation and, therefore, establish the most appropriate treatment.
Early rehabilitation permits acceptable functional recovery.
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Mioclonías benignas de la infancia temprana: Revisión de la literatura a propósito de dos casos clínicos.
Benign myoclonus of early infancy (BMEI) is a non epileptic paroxystic disorder unknown in our pediatric population. We analyze the clinical characteristics in two patients with BMEI, and emphasize their differential diagnosis in four groups: encephalopathies with a non epileptic myoclonus, myoclonus without encephalopathy and without epilepsy, epileptic encephalopathies with myoclonus seizures and myoclonic epilepsy without encephalopathy. We consider to the BMEI as an autolimited, age-dependent, non epileptic paroxystic disorder without encephalopathy with onset in the early infancy. This study could be useful in order to identify the BMEI and avoid the incorrect use of antiepileptic drugs in our patients.
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Síndrome de apnea obstructiva del sueño y accidentes de tráfico.
In recent years many studies have shown that Obstructive Sleep Apnea Syndrome is one of the biggest risk factors for drivers. The most severe patients report that they become sleepiness not only while driving on the highway or over long distances – during which the driver may stop the vehicle to sleep for a short time – but also during short distances around town. The interest raised by this problem has caused several studies to centre their objective on identifying the factors that are responsible for this increase in traffic accidents. Polysomnographic testing has verified that the sleep of these patients is fragmented which causes an excessive daily sleepiness and a sensation of tiredness and fatigue, which, up to a point can cause traffic accidents. Current work is revising some the studies which have been undertaken in order to evaluate the prevalence of traffic accidents in patients with Obstructive Sleep Apnea Syndrome according to the statistics. At present the nasal Continuous Positive Airway Pressure is the treatment of choice of this syndrome. For that reason and in relation to the problem that we are studying, the traffic accidents in patients with Obstructive Sleep Apnea Syndrome, we have recently revised some of the studies that have been undertaken to evaluate up to what point the therapy of Continuous Positive Airway Pressure diminishes the frequency of traffic accidents in patients with Obstructive Sleep Apnea Syndrome.
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La evaluación neuropsicológica en la Cirugía de Epilepsia.
Since the decade of the sixties objective systems of evaluation of the superior functions have been developed with the purpose of being able to establish the cognitive state from the patients candidates to epilepsy surgery, for that, the neuropsychological evaluation is made by means of the use of suitable instruments that allows to identify the cerebral dysfunction and taking into account the following aspects: a) to establish the global cognitive state, b) to guide in the lateralization of the cerebral dysfunction, c) to predict the risk of deterioration or cognitive improvement, with base in the preserved functions and in the altered functions, and d) after the surgery, to describe the patient’s cognitive state by means of periodic evaluations, with the purpose of having an evolutionary control of the neuropsychological functioning, providing in a precise and integrated way the effects that the surgical intervention produces in the cognitive functioning of the patients. The neuropsychological evaluation is an integrated process that requires of several hours to be completed, for that, it is important that this is carried out without the previous knowledge of the discoveries of image and/or electroencephalographic methods, since this could slant the exploration and the results, when it is not possible the identification of other possible cognitive alterations, or, one runs the risk of supposing the existence of cerebral pathology where there is not. In this article the theoretical-methodological aspects of the neuropsychological exploration are described in the area of epilepsy surgery.
