Times have always been difficult for the SEN, from the initial efforts to constitute it involving all the neurologists of that era, to the present day. I can imagine the tremendous and arduous task faced by the neurologists of that time, as it was first necessary to dissolve the former SENNCA (Ecuadorian Society of Neurology, Neurosurgery, and Related Sciences). This event took place on October 28, 1981, within the context of the VII Latin American Congress of Neurosurgery and the XIII Latin American Congress of Electroencephalography and Neurophysiology. I can envision the intense level of that dialectic and the maieutics applied to give birth to our society in March 1983.
issue_article
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.
Leer artículo completo
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.
Leer artículo completo
¿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.
Leer artículo completo
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.
Leer artículo completo
Palabras clave: Atención Prehospitalaria,
enfermedad cerebrovascular (ECV),
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.
Leer artículo completo
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.
Leer artículo completo
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.
Leer artículo completo
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.
Leer artículo completo
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.
Leer artículo completo
Mini Mental State Examination (MMSE): Cut-off Scores for Ecuadorian Adult Population
Background: The MMSE is one of the most widely used tests for the detection of dementia and cognitive impairment, however, cut-off points differ between countries.
Objective: To generate MMSE cut-off scores for the detection of Alzheimer’s disease in Ecuadorian population aged 55 to 85 years.
Methods: 390 subjects were evaluated, 76 had a diagnosis of Alzheimer’s disease. The level of dementia, functional autonomy, depression levels, sociodemographic and clinical variables of interest were measured. A regression model was performed to adjust the MMSE scores for the estimated values. The results were corrected using a multiple regression model. Cut-off points were obtained by ROC curve analysis.
Results: The variables Grade (T=5.2, p<0.001) and Age range (T=-7.95, p<0.001) were the only variables that had an effect on MMSE scores of 22% of the variance (R2 adjRadj2 =0.22). An education-adjusted cut-off point of 22.81 was obtained with a sensitivity of 0.97 and a specificity of 0.88.
Conclusion: This information may increase the accuracy in the use and interpretation of the MMSE in the Ecuadorian population.
Leer artículo completo
Palabras clave: demencia,
deterioro cognitivo,
Enfermedad de Alzheimer,
escala de tamizaje,
nivel educativo,
Integración Sensorial en Usuarios con Parálisis Cerebral
Humans are capable of interacting with the environment thanks to sensory integration, a process that allows the nervous system to capture, organize and interpret information to generate an adaptive response which could be affected in Cerebral Palsy. The objective is to determine the sensory profile in users with cerebral palsy from 3 to 14 years old in the Specialized and Inclusive Education Institutions of the City of Cuenca – Ecuador, 2024.
Methodology: An observational, descriptive, cross-sectional study was carried out between September 2024 and February 2025, in 61 users with Cerebral Palsy from 3 to 14 years old enrolled in the Azuay Cerebral Palsy Institute and the Stephen Hawking Educational Unit. The Brief Sensory Profile-2 questionnaire was used.
Results: Alteration was demonstrated in all sensory patterns, highlighting 100% in registration, 100% sensory state and 93.4% behavioral state. Users aged 3-5 years show 100% alteration in 3 of the 4 sensory patterns. Men show alteration in the search patterns (97.3%), sensitivity (94.6%) and registration (100%).
Conclusions: In addition to the motor component affected in Cerebral Palsy, there is an alteration in sensory integration, therefore, it is important to evaluate the sensory profile.
Leer artículo completo
Executive Functions Scale for University Students: Protocol for the Second Version (UEF-2)
Executive Functions (EFs) comprise a set of mental skills that enable university students to consciously regulate their academic performance and learning behaviors. Research has identified several EFs as critical determinants of academic success, including emotion regulation, responsibility monitoring, working memory, cognitive flexibility, metacognitive learning, study planning, and decision-making. This protocol article presents an enhanced version of a scale designed to assess EF in the university context. The principal innovation of this revised instrument lies in its incorporation of five additional EFs, thereby providing a more comprehensive evaluation of these cognitively demanding skills essential for academic achievement. Our proposed methodology follows a psychometric validation process to examine the scale’s reliability, validity, and practical utility. Through this protocol, we anticipate establishing robust measurement properties for the new scale, advancing our understanding of university students’ cognitive processes. Furthermore, we expect the findings to facilitate the development of improved assessment tools and targeted interventions to enhance executive functioning in higher education settings. This research contributes to the growing literature seeking to optimize academic outcomes through evidence-based cognitive evaluation and support.
Leer artículo completo
Palabras clave: análisis factorial confirmatorio,
Funciones Ejecutivas,
propiedades psicométricas,
validez,
Relación Entre el Desempeño en Memoria y el Funcionamiento Ejecutivo con la Funcionalidad de la Vida Diaria en Adultos de la Ciudad de Medellín: Un Estudio Observacional
Introduction: Neuropathological processes in older adults lead to changes in their independence and, therefore, in their functionality. The aim of this study was to analyze the relationship between individual characteristics, clinical history, memory performance and executive functioning, and daily life functionality.
Methods: Data from the Neuronorma-Co research project, obtained between January 2016 and January 2017, were analyzed. The database included data from clinical records and neuropsychological tests of 126 adults from the city of Medellín, between 47 and 94 years of age. The correlation between the score obtained in the Tower of London, the learning and memory task with controlled coding of Grober and Buschke, the Modified Lawton scale and the Geriatric Depression Scale was analyzed.
Results: A relationship was found between functionality and age, years of schooling, marital status, ophthalmological, neurological and cardiovascular history, risk of depression, memory and executive functions such as sequencing and problem solving.
Conclusion: The variables with the greatest impact on functionality are related to problem-solving and cognitive reserve.
Leer artículo completo
Probable Síndrome de Vasoconstricción Cerebral Reversible como Manifestación de Feocromocitoma
Introduction: The pathophysiology of reversible cerebral vasoconstriction syndrome remains incompletely understood. However, failure of cerebral autoregulation, sympathetic overactivity, disruption of the blood–brain barrier, and glymphatic system dysfunction play a central role.
Case report: We present the case of a 35-year-old woman with a history of cerebral vasoconstriction syndrome who developed new episodes of thunderclap headache and intermittent hypertension two years after the initial event. During hospitalization, non-invasive neuroimaging suggested a high probability of recurrent vasoconstriction syndrome. Due to persistent autonomic symptoms, further evaluation revealed a pheochromocytoma.
Conclusion: In patients with recurrent or atypical symptoms of reversible cerebral vasoconstriction syndrome, secondary and potentially treatable causes should always be considered.
Leer artículo completo
Valoración por Ultrasonido del Nervio Vago en el Síndrome de Guillain-Barré: A Propósito de un Caso Clínico
Introduction: In Guillain-Barré Syndrome (GBS), an increased cross-sectional area (CSA) of the vagus nerve (VN) has been described as a diagnostic tool and as an indicator of autonomic dysfunction.
Methods and Objectives: With the presentation of a GBS case, we aim to describe the technique for assessing the CSA of the VN using ultrasound (US).
Results: The evaluation of the VN CSA by US is a diagnostic technique with several advantages for clinicians. CSA values greater than 3 mm² are associated with the demyelinating variant of GBS and a higher likelihood of autonomic dysfunction.
Conclusion: The assessment of VN CSA by US is a useful tool in the diagnostic approach to patients with suspected GBS.
Leer artículo completo
Enfermedad de Moyamoya. De la Descripción de los Síntomas a la Afectación Neurocognitiva en un Caso Clínico
Moyamoya disease (MD) is a cerebrovascular pathology. Characterized by a stenosis of the terminal segments of the internal carotid artery. Currently the etiology of MD isn’t clear. Different studies have focused their research on understanding the disease from epidemiological aspects, its pathophysiology and recently the neurocognitive alterations presented by patients. This disease has a progressive course that impacts cognitive function. To identify the neurocognitive phenotype presented by a patient diagnosed with MD. He’s 9-year-old male patient with sudden deterioration of his neurological status. With motor aphasia, right hemiplegia and increased tone of his left hemibody. An evaluation protocol was applied by clinical neuropsychology with general and specific tests aimed at assessing the neurocognitive functioning of the patient. The patient presents alterations in information registration tasks, sustained attention, visuospatial functioning and visuoconstructive skills, compatible with dysexecutive syndrome.
Leer artículo completo
Cavum Septum Pellucidum Et Vergae y Epileptogénesis
The prevalence of Cavum septum pellucidum (CSP) and Cavum vergae (CV) is unknown. Bruyn et al, observed that 30-50 % of subjects with CSP had epileptic seizures and manifested some degree of psychosis, dementia or personality disorders. The presence of CSP was higher in patients with extra-temporal epilepsy than in temporal lobe epilepsy and also higher in patients with neuronal migration disorder than without.
We present the case of a woman with focal epilepsy since childhood, who restarted seizures in adulthood, with no family history of epilepsy, whose son with chromosomopathy 18 died 21 days after birth. Cranial MRI showed a CSP and a CV, EEG (electroencephalogram) confirmed a left temporal focus and epilepsy was controlled with eslicarbazepine 800 mg.
We can conclude that the presence of CSP and CV is not a simple anatomical variation but may be related to the occurrence of epilepsy being a developmental anomaly that may contribute to epileptogenesis, as well as a marker of poor seizure control. We alert clinicians to be aware of this malformation in cases of diagnostic uncertainty. In addition, a wide CSP would justify a more detailed ultrasound examination and genetic counseling in trisomy 18 fetuses.
Leer artículo completo
Hematoma Subdural en Puerperio Temprano por Anestesia Regional
Intracranial subdural hematoma is an entity characterized by the rupture of the bridging veins that are found in the subdural space and promote the slow outflow of blood. A 23-year-old first-time pregnant patient presented with severe preeclampsia, for which an emergency cesarean section was performed using regional anesthesia. During the postpartum period, the patient presented a single generalized seizure episode with secondary headache. The imaging study reported the presence of a lamellar subdural hematoma. This type of injury is a rare complication of lumbar puncture, where factors such as the use of very large needles, large dural orifice, multiple punctures, pregnancy, dehydration, use of anticoagulants, coagulopathies, cerebral vascular anomalies and atrophy cerebral.
Leer artículo completo
Avances Recientes del Proyecto Atahualpa: Impacto en la Salud Pública Rural. Recent Advances Of The Atahualpa Project: Impact On Rural Public Health
The Atahualpa Project, since its inception, has made it possible to identify specific risk factors for the development of non-communicable diseases and to suggest public health strategies adapted to local needs.
Through detailed studies, it has been possible to gain a better understanding of the prevalence of these diseases and their impact on the community, which will undoubtedly translate into the implementation of more effective preventive measures. Recent findings have revealed risk patterns that were not previously considered relevant in these populations, such as the influence of dietary habits and the high social vulnerability of their inhabitants.
In addition, the project has demonstrated the importance of epidemiological studies in specific communities and has allowed the establishment of correlations between genetic and environmental factors. These data have opened new lines of research to better understand the interaction between genetics and epigenetics in the development of these pathologies.
Likewise, the Atahualpa Project has served as a model of how research can directly impact people’s quality of life, providing valuable information for the prevention of non-communicable diseases, which, according to the Pan American Health Organization, represent the new epidemics of Latin America.
Leer artículo completo
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
Leer artículo completo
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
Leer artículo completo
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.”
Leer artículo completo
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.
Leer artículo completo
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.
Leer artículo completo
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.
Leer artículo completo
Palabras clave: ambientes saludables,
desarrollo cognitivo,
Funciones Ejecutivas,
infancia temprana,
Estudio de la Vida Real del uso de Agentes Modificadores de la Enfermedad en Pacientes Ecuatorianos con Esclerosis Múltiple. Real-Life Study Of Disease-Modifying Agents In Ecuadorian Patients With Multiple Sclerosis
Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system and the leading cause of non-traumatic disability in young adults. Disease-modifying therapies (DMTs) have transformed its management, reducing relapses and delaying progression, with over fifteen options approved worldwide. However, access to DMTs in Ecuador began only in 2008, with limited data available on their impact on adherence and therapeutic persistence. This study aims to describe the experience with disease-modifying agents in a tertiary-level care unit.
Methods: A retrospective study was conducted involving 142 MS patients treated at a tertiary hospital in Ecuador who met the McDonald 2017 diagnostic criteria and received DMTs between 1995 and 2022. Patients who left the country or social security system were excluded. Demographic and clinical data (EDSS), disease chronology, therapeutic lines, and treatment changes were analyzed. Statistical analysis was performed using SPSS.
Results: The study population consisted of MS patients evaluated at a tertiary hospital in Quito, Ecuador. Among them, 30.3% were male an 69.7% female. The average time between diagnosis and treatment initiation showed a progressive decrease, from 59.3 months for Betaferon to 4.2 months for Rituximab, reflecting improvements in access to DMTs and an improvement in the diagnostic criteria. Regarding the first-line treatment, interferons predominated during earlier periods, while advanced therapies such as Fingolimod, Rituximab, Ocrelizumab and Cladribine gained relevance after 2016. A total of 59% of patients changed treatment, primarily due to therapeutic failure. In the second line, Fingolimod (28.92%) and Rituximab (17.9%) were the most frequently used, although 53.6% of patients required another change. In third- and fourth-line treatments, the use of high-efficacy therapies increased, with Rituximab and Ocrelizumab being prominent. Final treatment data showed that Rituximab (30.3%) was the most commonly used therapy, followed by Rebif (21.8%) and Fingolimod (17.6%). Overall, 41.5% of patients received high-efficacy therapies, while interferons accounted for 36% of treatments. These findings highlight a transition toward more effective and personalized therapies in the management of MS in Ecuador.
Conclusions: This study demonstrates the evolving use of DMTs in MS treatment un Ecuador. It was evident that prior to 2005, there was no access to DMTs. Throughout the study period, interferons were the most widely used drugs but also had the highest rates of therapeutic failure. Adherence and tolerability improved with the introduction of high-efficacy drugs such as Fingolimod, cladribine, Ocrelizumab and Rituximab. Treatment initiation times were notably shortened, primarily due to advancements in diagnostic criteria and improved meditation access.
Leer artículo completo
Palabras clave: esclerosis múltiple,
Fingolimod,
Interferón beta,
Ocrelizumab,
Rituximab,
Terapia modificadora de la enfermedad,
Investigating Lack Of Adherence To Medications Used For Primary Or Secondary Stroke Prevention In Rural Ecuador: Rationale And Protocol Of A Population-Based Study Investigación de la Falta de Adherencia a Medicamentos Utilizados para la Prevención Primaria y Secundaria de Ictus en Zonas Rurales del Ecuador: Fundamentación y Protocolo de un Estudio Poblacional
Background: Stroke is an emerging public health crisis in Latin America, particularly in rural areas of low- and middle-income countries (LMIC), where limited healthcare access exacerbates disease burden. Medication adherence plays a fundamental role in stroke prevention, yet information on this topic remains insufficiently known due to issues related to socioeconomic, educational, and infrastructural barriers.
Aims: This study introduces a protocol designed to assess adherence to primary and secondary stroke prevention medications in rural Ecuador. By identifying behavioral patterns and underlying barriers, this research aims to provide evidence-based recommendations for improving adherence and informing public health interventions.
Methods: The study will be conducted in Atahualpa, Ecuador, using a population-based design with an initial cross-sectional assessment followed by a 10-year longitudinal follow-up. Medication adherence will be evaluated through validated questionnaires, clinical examinations, and annual updates on vascular risk factors and social determinants of health. Statistical analyses will assess the relationship between adherence levels, demographic variables, and cerebrovascular outcomes.
Comment: This research provides essential insights into adherence behaviors in underserved populations, offering a foundation for targeted interventions. Findings will support healthcare accessibility, strengthen patient education, and improve adherence strategies to reduce stroke incidence and improve health outcomes in rural LMIC settings.
Leer artículo completo
Palabras clave: Adherencia a medicación,
ambientes rurales,
Ecuador,
enfermedad cerebrovascular,
estudio poblacional,
prevención,
Electroencefalografía Cuantitativa y Evaluación Neuropsicológica en el Diagnóstico del Deterioro Cognitivo en Adultos Mayores Ecuatorianos Quantitative Electroencephalography and Neuropsychological Assessment in the Diagnosis of Cognitive Impairment in Older Ecuadorian Adults
Objective: To evaluate the usefulness of quantitative electroencephalography (qEEG) and neuropsychological assessment in the diagnosis of cognitive impairment in Ecuadorian older adults.
Patients and method: Twelve older adults from the Cuenca canton with suspected cognitive impairment were selected. Neuropsychological tests (Neuropsi and Mini-Mental State Examination) were applied and EEG recordings were performed and analyzed using Persyst software. Average voltage amplitude values of brain waves (alpha, beta, theta and delta) and heat maps were obtained to identify specific patterns.
Results: Neuropsychological tests detected significant deficiencies in executive functions, memory and attention, with greater impairment in patients with Alzheimer’s. EEG analysis showed a generalized slowing of the basal rhythm, predominance of slow waves (theta and delta) and decreased alpha frequency (<8 Hz) in occipital and frontal regions. A significant correlation was found between cognitive deficits and EEG alterations.
Conclusions: The combination of qEEG and neuropsychological assessment offers a comprehensive tool for the early diagnosis of cognitive impairment, allowing for personalized therapeutic strategies. These findings reinforce the relevance of accessible and noninvasive methods in the care of older adults in resource-limited settings.
