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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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
Demencia Rápidamente Progresiva Como Manifestación de Recaída en Linfoma de Células Del Manto: Experiencia en Diagnóstico y Tratamiento. Rapidly Progressive Dementia As A Manifestation Of Relapse In Mantle Cell Lymphoma: Experience In Diagnosis And Treatment
Introduction: Rapidly progressive dementia is an entity that has a multiple and heterogeneous etiology. It is characterized by the alteration of two or more cognitive domains in a period of less than 1 to 2 years. The involvement of the central nervous system attributed to mantle cell lymphoma is rare with a poor prognosis and mainly debuts in the late stages of the disease as a relapse. Case Report: A 61-year-old male with a history of mantle cell lymphoma who presents a relapse of the central nervous system, given by a clinical course compatible with a rapidly progressive dementia and which is confirmed by flow cytometry studies in cerebrospinal fluid. It presents an adequate response to management with a tyrosine kinase inhibitor (Ibrutinib), resolving clinical symptoms and imaging findings. Discussion: The involvement of the central nervous system secondary to mantle cell lymphoma is a rare complication and debuts as a relapse with variable clinical manifestations that requires a timely intervention with the aim of improving patient survival. Therapy with a single agent such as Ibrutinib seems to be a good alternative in cases of refractoriness and neurological involvement.
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Cirugía de Epilepsia en Ecuador 2010.
Epilepsy is one of the most common chronic neurological conditions in children and adults. The lifetime risk of developing epilepsy is 3.2%. In this review article we suggest how to apply a safety protocol for the surgical treatment of antiepileptic drugs resistant patients. We review who the ideal candidate for a pre-surgical evaluation is and when to do it; how to do it, using clinical, physiological, imaging and neuro-cognitive biomarkers in order to achieve medical benefit from epilepsy surgery; why patients should go and receive a surgical evaluation. Finally we review the current concepts of drug resistant epilepsy and the surgical intervention benefit/risk relationship.
