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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Disfagia Orofaríngea y Ataque Cerebrovascular: Implicaciones de un nuevo Síndrome Geriátrico

Dear Editor:

Oropharyngeal dysphagia (OD) is a condition that increases in frequency with aging. It is multifactorial, resulting from the accumulation of deficits across various systems, and is associated with adverse health outcomes in older adults (OA). Consequently, it has been recognized over the last decade as an emerging geriatric syndrome.

Prominent among its causes is ischemic stroke, which caused approximately 14,000 deaths and 246,400 disability-adjusted life years among older adults in Colombia during 2021, ranking as the leading cause of disability. This burden is largely explained by swallowing disorders, which appear to be highly prevalent among older adults in Colombia; this was evidenced by a study in Medellín in which 3 out of 4 participants with stroke presented with OD, with age being identified as one of the specific factors that increased the likelihood of developing it.

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Palabras clave: Ataque Cerebrovascular, Disfagia Orofaríngea,

Keywords: Oropharyngeal Dysphagia, stroke,

Restaurando la Homeostasis Metálica en Alzheimer: Avances y Desafíos en la Terapia de Quelación

To the Editor:

Alzheimer’s disease (AD) continues to challenge conventional therapeutic approaches, necessitating alternative strategies based on its pathophysiology. Among these, metal chelation therapy emerges as a promising option that directly addresses the metal dyshomeostasis implicated in AD, offering disease-modifying effects beyond symptomatic relief. Copper, iron, and zinc actively participate in the progression of AD, promoting amyloid-β oligomerization, oxidative stress, and tau hyperphosphorylation. Post-mortem studies have identified elevated concentrations of these metals in the brains of AD patients, particularly copper in amyloid plaques, which reaches levels three times higher than normal.

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Palabras clave: Enfermedad de Alzheimer, Homeostasis Metálica, Terapia de Quelación,

Keywords: Alzheimer’s Disease, chelation therapy, Metal homeostasis,

¿Por qué la Investigación en Astrobiología, Astroquímica y Ciencias del Espacio es Relevante para la Neurología y Ciencias Relacionadas?

To the Editor:

Modern neurology faces the major challenge of understanding the plasticity and vulnerability of the nervous system (NS) under extreme conditions, such as the space environment. Therefore, the interrelationships between astrobiology, astrochemistry, neuroscience, and space medicine must be discussed.

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Palabras clave: Astrobiología, Neurología Espacial, SANS (Síndrome Neuro-ocular Asociado al Vuelo Espacial),

Keywords: Astrobiology, SANS (Spaceflight-Associated Neuro-ocular Syndrome), Space Neurology,

Desafíos, Inequidades y Oportunidades en la Atención Pre Hospitalaria de la Enfermedad Cerebrovascular en América Latina

To the Editor:

Cerebrovascular disease (CVD) constitutes a leading cause of both acquired disability and mortality in Latin America. Although notable advances have been made in areas such as neuroimaging, thrombolysis, and thrombectomy, the reality in the region reveals marked disparities that hinder the provision of timely and effective care. Among these limitations, prehospital care remains a vulnerable link and, in many countries, is given low priority in health policies.

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Palabras clave: Atención Prehospitalaria, enfermedad cerebrovascular (ECV),

Keywords: Cerebrovascular disease (CVD), Emergency Medical Services,

Las Enfermedades Priónicas Como Amenaza Permanente a la Salud Neurológica en América Latina

To the Editor:

The article by Sánchez Espinoza et al., published in the Revista Ecuatoriana de Neurología, makes a valuable contribution by addressing the Heidenhain variant of Creutzfeldt-Jakob disease (CJD), highlighting its clinical evolution and the relevance of differential diagnosis regarding other rapidly progressive dementias. This Letter to the Editor complements that discussion by emphasizing the persistent, transmissible, and potentially zoonotic nature of prion diseases in the Latin American context, in light of recent research.

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Palabras clave: Enfermedades Priónicas, Salud Neurológica,

Keywords: Neurological Health, prion diseases,

Incidencia de Eventos Isquémicos en Pacientes con Arteritis de Células Gigantes: ¿Es una Complicación de Importancia Clínica?

To the Editor:

Cerebrovascular disorders represent a growing burden on health systems, particularly in aging populations. Giant cell arteritis (GCA), the most common form of systemic vasculitis in older adults, can lead to severe ischemic complications such as visual loss or stroke. However, there is a substantial gap in understanding the incidence and predictors of these ischemic complications in patients with GCA, limiting the design of preventive clinical protocols and the implementation of personalized medicine strategies based on robust evidence.

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Palabras clave: arteritis de células gigantes,

Keywords: giant cell arteritis,

Riesgo Cardiovascular en el Uso de Anticoagulación Oral Posterior a Hemorragia Intracerebral: ¿Qué Desenlaces Considerar?

To the Editor:

The use of oral anticoagulation in patients with atrial fibrillation has been shown to significantly reduce thromboembolic events, including ischemic stroke. However, this therapeutic strategy poses significant clinical dilemmas in survivors of intracerebral hemorrhage (ICH), where the risk of rebleeding is weighed against the potential benefit of preventing new ischemic events. Despite the advancement of direct oral anticoagulants (DOACs), a critical gap in evidence remains to guide optimal management in this high-risk subgroup, particularly regarding the selection of neurological outcomes of greatest interest.

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Palabras clave: anticoagulación oral, Hemorragia intracerebral, riesgo cardiovascular,

Keywords: cardiovascular risk, Intracerebral hemorrhage, oral anticoagulation,

Tratamiento de la Migraña Durante el Embarazo y la Lactancia

To the Editor:

With reference to the excellent systematic review by Sanchez-Landers et al. regarding migraine treatment during pregnancy, we wish to emphasize several aspects. First, it should be noted that when evaluating any patient with headache, one must always suspect a secondary headache and screen for “red flags”; pregnancy is one such flag. Migraine is a risk factor for hypertensive disorders and cardiovascular complications during pregnancy, such as preeclampsia, cerebral venous thrombosis, reversible cerebral vasoconstriction syndrome, subarachnoid hemorrhage, and ischemic stroke.

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Palabras clave: embarazo, Migraña,

Keywords: Migraine, pregnancy,

La teoría del Síndrome de Bleuler: Una investigación en respuesta a las deficiencias epistemológicas y metodológicas en el diagnóstico y tratamiento de la enfermedad mental sin neurodegeneración

To the Editor:

November 2024 marked the twentieth anniversary of the inception of a mental health research initiative conducted jointly by public and private entities in Venezuela and Ecuador. This original and unprecedented initiative focused on non-neurodegenerative mental disorders, such as Pervasive Developmental Disorders, Autism Spectrum Disorders, Recurrent Depressive Disorders, and similar conditions. The primary purpose of the research was to generate knowledge for the creation of a standardized, universally applicable method, in response to the significant epistemological and methodological deficiencies identified in the theories and processes by which Psychology and Psychiatry construct their diagnostic classifications.

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Palabras clave: enfermedad mental, Síndrome de Bleuler,

Keywords: Bleuler Syndrome, mental illness,

Células T como Vehículos Terapéuticos para el Tratamiento de Trastornos del Sistema Nervioso. Central T-Cells As Therapeutic Vehicles For The Treatment Of Central Nervous System Disorders

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Palabras clave: células T,

Keywords: t-cells,

De la Trepanación al Abordaje Subfrontal: Saltos Temporales de una Evolución Histórica del Desarrollo de la Intervención Quirúrgica Frontocerebral en la Medicina Iberoamericana. From Trepanation To The Subfrontal Approach: Temporal Leaps In The Historical Evolution Of Frontocerebral Surgical Intervention In Ibero-American Medicine

Exactly 20 years ago, Dr. Boris Zurita-Cueva published in this journal an article entitled “The Subfrontal Approach: Is It Really Minimally Invasive?”, the reading of which prompted us to recall and write about how medicine has evolved in its surgical intervention techniques over the years.

Although Zurita-Cueva’s work¹ refers to Krause’s description from 1908, it is worth highlighting that the technique originated from trepanations—one of the oldest examples of surgical procedures—practiced since the Neolithic period in a large number of primitive cultures spread across five continents

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Palabras clave: abordaje subfrontal, trepanación,

Keywords: Subfrontal key-hole approach, trepanation,

Periodontitis y Trastornos Neurológicos: Mirando al Cerebro, la Boca y el Sistema Digestivo. Periodontitis And Neurological Disorders: Looking At The Brain, The Mouth, And The Digestive System

Madam Editor,

I read with particular interest the publication by De la Cruz Rodríguez et al.¹, who mention that “…a wide range of neuropsychiatric disorders can be prevented through oral treatment and hygiene.”¹ It is relevant to highlight the interconnection between periodontitis and neurological disorders from a comprehensive perspective that encompasses not only the nervous system, but also its relationship with the oral and gastrointestinal microbiota.²

This letter emphasizes the connection between periodontitis and neurological disorders from a bidirectional perspective, where chronic periodontal inflammation not only impacts oral health, but also plays a crucial role in neurodegenerative and psychiatric diseases through neuroinflammation and dysbiosis of the oral and gastrointestinal microbiota.²,³

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Palabras clave: Periodontitis, trastornos neurológicos,

Keywords: neurological disorders, Periodontitis,

La Teoría de las Catástrofes: Modelo y Aplicaciones en Salud Mental y Enfermedad. Catastrophe Theory: A Conceptual Model And Its Applications In Mental Health And Disease

Madam Editor:

Catastrophe Theory, formulated by René Thom (1923–2002), has influenced the biological and health sciences by proposing a non-linear approach to explain abrupt transitions in complex systems. During the COVID-19 pandemic, sudden clinical transitions in respiratory conditions became evident, which motivates renewed interest in this model and its biomedical adaptation conceived by Dr. Bruno Günther Schaffeld (1914–2009).

This letter aims to highlight its conceptual and clinical relevance in the field of mental health, in order to understand complex conditions such as psychiatric crises, neurological disorders, and decompensated cognitive processes. Günther—a Chilean physiologist trained in Buenos Aires under Nobel Laureate Bernardo Houssay—stood out for applying this theory to the transition between health and disease. He proposed the “cusp catastrophe” model to describe how physiological states can change gradually or suddenly. These transitions may be reversible or irreversible, and their rapid inversion defines the concept of “anastrophe.”

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Palabras clave: teoría de las catástrofes,

Keywords: Catastrophe Theory,

Síndrome de Guillain-Barré como Complicación del Golpe de Calor. Guillain-Barré Syndrome As A Complication Of Heatstroke

Madam Editor:
Heatstroke (HS) is a medical emergency characterized by a body temperature above 40ºC and the development of neurological alterations such as delirium, seizures, or coma. HS may result from excessive exposure to environmental heat (classic HS) or from strenuous physical exertion.¹ Several factors have been identified that increase susceptibility to HS, including extreme ages of life, medical comorbidities (infections, fever, skin disorders, or cardiovascular insufficiency), the use of certain medications (diuretics, beta-blockers, antihistamines, and antidepressants), or alcohol consumption.

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Palabras clave: golpe de calor, Guillain Barré, Síndrome de Guillaín-Barré,

Keywords: Guillaín-Barré síndrome, heatstroke,

Ketamina en el Tratamiento del Estado Epiléptico Refractario. Ketamine In The Treatment Of Refractory Status Epilepticus

Madam Editor:
In relation to the work of Rivero Rodríguez D, et al., we would like to expand on some aspects of the role of ketamine in the treatment of refractory status epilepticus. The third-line drugs most commonly used in refractory status epilepticus are midazolam, propofol, and thiopental. As a general rule, thiopental is considered slightly more effective in the short term, while midazolam and propofol are used as alternatives with a more favorable adverse effect profile, without a significant difference in long-term outcomes.

Ketamine, an anesthetic that acts by blocking N-methyl-D-aspartate (NMDA) glutamate receptors, is characterized by its short half-life and its ability not to compromise respiration, preserving airway protective reflexes. Among other theoretical benefits are the reduction of NMDA receptor-mediated excitotoxicity, which decreases neuronal metabolic demands, as well as a direct neuroprotective effect by blocking NMDA receptor-mediated apoptosis induction.

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Palabras clave: estado epiléptico refractario, ketamina,

Keywords: ketamine, Refractory status Epilepticus,

Ambientes Saludables en la Infancia Temprana. La Clave para el Desarrollo de Funciones Ejecutivas. Healthy Environments In Early Childhood: The Key To The Development Of Executive Functions

Madam Editor:
We would like to complement the findings of the article “Daily Stress, Executive Functions, and Academic Performance in Primary School Children” by Armstrong-Gallegos and Troncoso-Díaz, published in the Revista Ecuatoriana de Neurología (Vol. 33, No. 1, 2024). In this regard, we propose adding the perspective of the first two years of life, understanding it as a critical stage in this process.

Brain development in early childhood is rapid and crucial, and nutrition plays a fundamental role during these first years of life. Nutrients such as iron, fatty acids like omega-3, and B-complex vitamins support key processes such as myelination and synaptogenesis. These processes, in turn, are essential for executive functions (EF) such as working memory, inhibitory control, and cognitive flexibility. Conversely, the lack of these nutrients may lead to long-term difficulties in self-regulation, affecting performance in social and educational environments.

Additionally, glucose, as the brain’s main source of energy, when blood levels fluctuate excessively, may hinder focus and impulse control, thereby affecting both performance and interactions with others.

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Palabras clave: ambientes saludables, desarrollo cognitivo, Funciones Ejecutivas, infancia temprana,

Keywords: cognitive development, early childhood, Executive function, healthy environments,

Estado funcional en la Enfermedad de Alzheimer: Más allá del deterioro cognitivo. Functional status in Alzheimer’s Disease: Beyond cognitive impairment.

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Palabras clave: actividades de la vida diaria, Enfermedad de Alzheimer, fragilidad, multimorbilidad, valoración geriátrica integral,

Keywords: activities of daily living, Alzheimer disease, comprehensive geriatric assessment, frailty, multimorbidity,

Neurociencia Ambiental y salud mental: Realidades invisibilizadas en las comunidades rurales. Environmental Neuroscience and mental health: Invisible realities in rural communities.

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Palabras clave: Cambio Climático, Comunidad Rural, Educación Ambiental, neurociencia, salud mental,

Keywords: Climate Change, Environmental Education, mental health, neuroscience, Rural Community,

Sobre el artículo “Modelos de Organización Cerebral”: La relevancia de la hipótesis organizacional-activacional. On the article “Brain Organization Models”: The relevance of the organizational-activational hypothesis.

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Palabras clave: conducta, desarrollo cerebral, diferenciación sexual, esteroides, mamíferos,

Keywords: Behaviour, brain development, mammals, sex differentiation, steroids,

Trastorno del desarrollo de la coordinación en la infancia: Interacción con la condición física y estado nutricional. Developmental coordination disorder in childhood: Interaction with physical condition and nutritional status.

Dear Editor:

Developmental coordination disorder (DCD), or dyspraxis, is a challenge of interest to both clinical researchers and education professionals, particularly pre-service teachers. This disorder, as described by Castelluci et al., is characterized by impaired motor performance and difficulties learning motor skills in childhood.

Recent evidence suggests that infants with greater motor impairment are at increased risk of developing health problems, given that decreased levels of physical activity and participation in sports activities could aggravate this condition. In this case, infants with probable DCD have demonstrated lower levels of muscle strength, aerobic fitness, and endurance compared to their peers without DCD.

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Mejorando la Atención del Evento Cerebrovascular en Ecuador a través de una Red Articulada de Atención Improving Cerebrovascular Event Care in Ecuador through an Articulated Care Network

In the era of “big data” in health and healthcare, the need for high-quality information on population health has never been more critical. In the context of cerebrovascular events (CVD) in Ecuador, the increasing burden of the disease, the inequity in the distribution of neurologists, and the recent enactment of the Universal Health Care Law underscore the urgency of establishing effective networks between primary care and hospitals prepared to treat CVD. This article reviews the existing literature and evidence highlighting the role of primary care providers (PCPs) and specialists in the different stages of CVD management, as well as care transitions and the use of telemedicine/teleneurology.

The experience in Ecuador with the “Act with Speed” campaign launched by the Vice Presidency of the Republic in coordination with the Global Angels initiative provides a valuable model. This campaign has certified hospitals as Stroke Ready Centers, trained thousands of professionals, and raised awareness among the population about the importance of a rapid response to a CVD. Implementing a CVD referral network between primary care and specialized hospitals could significantly improve patient outcomes, especially in underserved areas.

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Palabras clave: evento cerebrovascular,

Keywords: Cerebrovascular,

Ambientes Saludables en la Infancia Temprana. La clave para el desarrollo de Funciones Ejecutivas Healthy Environments in Early Childhood. The key to the development of Executive Functions.

We would like to complement the findings of the article “Daily Stress, Executive Functions, and Academic Performance in Elementary School Children” by Armstrong-Gallegos and Troncoso-Díaz, published in the Ecuadorian Journal of Neurology (Vol. 33, No. 1, 2024). Along these lines, we propose adding the perspective of the first two years of life, understanding that this is a critical stage in this process.

The brain development of children is rapid and crucial. Nutrition plays a fundamental role during these first years of life. Nutrients such as iron, omega-3 fatty acids, and B vitamins support important processes such as myelination and synaptogenesis. These processes, in turn, are key to executive function (EF) skills such as working memory, inhibitory control, and cognitive flexibility.1,2 Conversely, a lack of these nutrients can lead to long-term difficulties with self-regulation, impacting social and educational environments.3 Furthermore, glucose, as the brain’s primary energy source, when blood levels fluctuate too much, may make it harder for individuals to stay focused or control their impulses, which can affect their performance and interactions with others.

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Palabras clave: Funciones Ejecutivas, infancia temprana,

Keywords: early childhood, Executive function,

Consideraciones neurodidácticas del uso del teléfono móvil en clases: Educación en conjunto familia-escuela. Neurodidactic considerations of the use of mobile phones in classes: Family-school joint education.

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La suspensión de Ataluren para la distrofia muscular de Duchenne debido a mutaciones sin sentido es una decisión equivocada. Stopping Ataluren for Duchenne muscular dystrophy due to nonsense mutations is a wrong decision.

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Columbo y la enfermedad de Alzheimer. Columbo and Alzheimer’s disease.

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Palabras clave: demencia, Enfermedad de Alzheimer, series de televisión, trastornos cerebrales,

Keywords: Alzheimer’s Disease, brain disorders, dementia, television drama,

Materiales nanoestructurados como potenciales neurotóxicos. Nanostructured materials as potential neurotoxins.

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Palabras clave: dióxido de titanio, materiales, nanoestructurados, nanotecnología, nanotoxicidad,

Keywords: materials, nanostructured, nanotechnology, nanotoxicity, titanium dioxide,

Influencia del ejercicio aeróbico sobre la atención alternante, planificación y memoria visuoconstructiva en estudiantes universitarios. Análisis metodológico. Influence of aerobic exercise on alternating attention, planning and visuoconstructive memory in university students. Methodological analysis.

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Palabras clave: ejercicio aeróbico, Memoria, Neuroeducación,

Keywords: aerobic exercise, Memory, Neuroeducation,

Rompiendo silencios desde la neurodiversidad: Mujeres universitarias con TDAH. Breaking silences from neurodiversity: University women with ADHD.

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Palabras clave: educación superior, Mujeres, neurodiversidad, sesgo de género, TDAH,

Keywords: ADHD, gender bias, higher education, neurodiversity, Women,

Deterioro Cognitivo Leve: detección y costo de enfermedad en Perú. Mild Cognitive Impairment: screening and cost of illness in Peru.

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Palabras clave: costo de enfermedad, demencia, Deterioro Cognitivo Leve, Perú,

Keywords: cost of illness, dementia, Mild Cognitive Impairment, Peru,

Boro y la ruta hacia el diagnóstico temprano de enfermedades neurodegenerativas. Boron towards early diagnosis of neurodegenerative diseases.

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Palabras clave: boro, Enfermedad de Alzheimer, enfermedad de Parkinson, Neurodegeneración,

Keywords: Alzheimer’s Disease, boron, Neurodegeneration, Parkinson’s disease,
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