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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El Proyecto Atahualpa, Protocolo, Definiciones Operacionales y Diseño Inicial. The Atahualpa Project: Protocol, Operational Definitions, And Initial Study Design

Non-communicable diseases are the new health epidemics in developing countries due to increased life expectancy, and changes in lifestyle and dietary habits of the population. The Atahualpa Project was designed as a multi-step population-based cohort study designed to reduce the increasing burden of these conditions in rural Ecuador. The first step of the study followed a 3-Phase design, aimed to get information on demographics and cardiovascular risk factors of Atahualpa residents aged ≥40 years, as well as to assess the prevalence of stroke and ischemic heart disease. During Phase I, participants were screened with standardized questionnaires to evaluate their cardiovascular health and to identify those with suspected stroke or ischemic heart disease. In Phase II, neurologists and cardiologists examined suspected cases of stroke or ischemic heart disease, as well as a random sample of matched negative individuals, to assess prevalence of these conditions. In Phase III, patients with diagnosis of stroke and ischemic heart disease underwent complementary tests for achieving more specific diagnosis. Implementation of public health strategies directed to improve the cardiovascular health status of a given population must be based on studies evaluating specific risk factors at regional levels. Epidemiologic surveys such as the Atahualpa Project may prove cost-effective for improving the cardiovascular health status of people living in Latin American rural villages by increasing the knowledge on the particular needs of these populations.

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Palabras clave: Atahualpa, cardiopatía isquémica, Ecuador, enfermedad cerebrovascular, epidemiología, estudio poblacional, salud cardiovascular,

Keywords: Atahualpa, cardiovascular health, Cerebrovascular disease, Ecuador, epidemiology, ischemic heart disease, population-based study,

Salud Cardiovascular en Habitantes de Atahualpa: Características y Correlatos. Cardiovascular Health Status In Atahualpa Residents: Characteristics And Correlates

Stroke and cardiovascular diseases will be the next epidemics in Latin America due to changes in lifestyle and increased life expectancy. Knowledge of cardiovascular health (CVH) status of the population is mandatory to implement cost-effective strategies directed to reduce the burden of vascular diseases in the region. In the Atahualpa Project, we assessed the CVH status of participants using the metrics proposed by the American Heart Association. The basal study included 616 subjects free of stroke and ischemic heart disease aged ≥40 years. Of these, 2.1% had ideal, 28.1% had intermediate and 69.8% had poor CVH status. Poorest metrics were blood pressure, fasting glucose, and BMI. The odds for having a poor CVH status were increased in persons aged ≥ 60 years and in those with only primary school education. Then, we compared our results with the Hispanic population of the Northern Manhattan Stroke Study (NOMAS), and found that Atahualpa residents had significantly better metrics than those enrolled in the NOMAS, with the exception of fasting glucose levels. Likewise, the odds for having 5 to 7 ideal metrics were also better in Atahualpa residents, irrespective of age. We also conducted a case-control study to assess the CVH status of Atahualpa residents according to their living arrangements, and found that social isolation was associated with a worse CVH status in this population. A couple of studies showed correlation between some sleep related disorders and poor CVH status. We have also started an ongoing program called “known your numbers”, which, together with community talks, is directed to improve the CVH status and to reduce the burden of vascular diseases in the region.

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Palabras clave: apoyo comunitario, Atahualpa, Ecuador, epidemiología, estudio poblacional, salud cardiovascular, síndrome metabólico, trastornos de sueño,

Keywords: Atahualpa, cardiovascular health, community support, Ecuador, epidemiology, metabolic syndrome, population-based study, sleep disorders,

Sub-estudio de Neuroimagen del Proyecto Atahualpa. Neuroimaging Substudy Of The Atahualpa Project

The Atahualpa Project includes a Neuroimaging sub-study, which consists in the practice of MRIs and MRAs to all participants aged ≥60 years, as well as those presenting with specific neurological complains. Likewise, all participants aged ≥20 years have been invited for the practice of a head CT. MRIs and MRAs have been performed with the use of a Philips Intera 1.5T MRI machine, and TCs with the use of a Philips Brilliance 64 CT scanner, following established protocols. All exams have been independently reviewed by a neurologist and a neuroradiologist, with adequate kappa coefficients for inter-rater agreement. MRIs studies have been focused on the evaluation of global cortical atrophy, posterior parietal atrophy, bicaudate index, Evans index, hippocampal atrophy, signatures of cerebral small vessel disease, and lesions consistent with ischemic or hemorrhagic strokes. By the use of MRI, we have assessed the prevalence of intracranial artery stenosis, intracranial dolichoectasia and variations in the configuration of the circle of Willis. Using CT, we have focused on the diagnosis of neurocysticercosis, pineal gland calcifications, as well as in variations and characteristics of skull bones, cerebellar atrophy, and severity of carotid siphon calcifications. In the present study, we focused on the description of basic protocols used for assessment of previously mentioned lesions of interest.

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Palabras clave: angio-resonancia, Atahualpa, Ecuador, epidemiología, estudio poblacional, resonancia magnética, tomografía computada,

Keywords: Atahualpa, computed tomography, Ecuador, epidemiology, magnetic resonance angiography, magnetic resonance imaging, population-based study,

Búsqueda de Substitutos Para Estudios de Neuroimagen con Propósitos de Investigación: Experiencia del Proyecto Atahualpa. The Search Of Surrogates For Neuroimaging Studies For Research Purposes: The Atahualpa Project Experience

Diagnosis of many non-communicable neurological diseases require the use of MRI, which is not readily available in remote rural populations. Efforts should be directed to find portable screening diagnostic tools that may help identify candidates for MRI screening. In the Atahualpa Project, all participants aged ≥60 years have been invited for the practice of MRI, and about 80% of them have underwent the procedure. Therefore, we have the unique opportunity to test the accuracy of non-invasive exams to be used as surrogates to MRI for identifying candidates for the practice of this exam. To date, we have assessed the value of the ankle-brachial index (ABI), the reliability of the neutrophil-to-lymphocyte ratio (NLR), the accuracy of hypertensive retinopathy, and the value of transcranial Doppler (TCD) to detect individuals with cerebral small vessel disease. Individuals with an abnormal ABI have 4 times de odds of having a silent lacunar infarct than those with a normal ABI. A high NLR has a poor sensitivity but is highly specific for detecting persons with at least one imaging signature of small vessel disease. Individuals with hypertensive retinopathy Grades 2-3 are almost four times more likely to have moderate-to-severe white matter hyperintensities than those with no- or only Grade 1 retinopathy. Finally, the correlation between the pulsatility indexes of major cerebral arteries with imaging markers of small vessel disease, as assessed by TCD, was poor. We are still in the search of some non-expensive and readily available biomarker that allow the identification of apparently healthy persons at risk of suffering a catastrophic cerebrovascular event.

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Palabras clave: Atahualpa, Doppler transcraneal, Ecuador, epidemiología, estudio poblacional, índice tobillo-brazo, relación neutrófilos-linfocitos, Retinopatía,

Keywords: ankle-brachial index, Atahualpa, Ecuador, epidemiology, neutrophil-to-lymphocyte ratio, population-based study, Retinopathy, Transcranial Doppler,

Trastornos de Sueño en Residentes de Atahualpa. Sleep Disorders In Atahualpa Residents.

Health problems related to sleep disorders are likely on the rise in rural areas of Latin America, partly related to changes in life style, shift work, and other factors. However, little is known on the burden of these conditions in remote rural settings. In the Atahualpa Project, we have investigated sleep disorders using standardized field instruments associated with sophisticated technology such as polysomnography. A poor sleep quality has been associated with frailty and with the presence of neuroimaging markers of cerebral small vessel disease and global cortical atrophy. On the contrary, dietary intake of oily fish was associated with a better sleep quality. We have also investigated the prevalence and some correlates of the restless legs syndrome (Willis-Ekbom disease), and found a prevalence relatively higher than that described in most other tropical regions, as well as the association of this condition with psychological stress. Finally, a preliminary report shows a high prevalence of moderate-to-severe obstructive sleep apnea in Atahualpa residents aged ≥60 years (27%) and its correlation with diffuse subcortical damage of vascular origin. Further studies are needed to better understand consequences of sleep-related symptoms in underserved populations.

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Palabras clave: apnea de sueño, Atahualpa, calidad de sueño, Ecuador, enfermedad de Willis-Ekbom, epidemiología, estudio poblacional, somnolencia diurna,

Keywords: Atahualpa, daytime somnolence, Ecuador, epidemiology, population-based study, Sleep apnea, sleep quality, Willis-Ekbom disease,

Alcohol: Consumo, Consecuencias y Complicaciones Neurológicas. Resultados del Proyecto Atahualpa. Alcohol: Intake, Consequences and Neurological Complications. Results From The Atahualpa Project.

Information about the burden and consequences of alcohol intake in rural communities of Latin America is scarce. This study aims to assess the magnitude of alcohol intake in Atahualpa as well as its consequences and prevalence of neurological complications. Male residents aged ≥40 years (n=277) were interviewed with a structured questionnaire designed to evaluate prevalence, drinking patterns and consequences of chronic alcohol intake. Most of them were current drinkers and 40% started drinking below the legal age (18 years). Weekly binge drinking were admitted by 81% individuals, 58% referred physical consequences related to alcohol intake, 59% had social consequences, and 51% recognized alcohol intake as a major economic burden. Individuals who started drinking below the legal age were more often involved in binge drinking and consumed more alcohol than those aged ≥18 years at first regular drink. The relationship between alcohol intake and alcoholic cerebellar degeneration was evaluated by the use of the BARS scale, with 14.6% of individuals having clinically relevant alcoholic cerebellar degeneration. Predictive models showed significant relationships between BARS score margins and years of drinking and the amount of alcohol intake. Our study also provided robust evidence favoring an independent and synergistic effect of age and years of drinking in the relationship between ACD and cognitive decline. This study shows a high prevalence of chronic alcohol intake in community-dwelling men living in Atahualpa.

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Palabras clave: alcohol, Atahualpa, degeneración cerebelosa alcohólica, Ecuador, epidemiología, estudio poblacional,

Keywords: alcohol, alcoholic cerebellar degeneration, Atahualpa, Ecuador, epidemiology, population-based study,

Enfermedad Cerebrovascular en Atahualpa: Prevalencia e Incidencia. Cerebrovascular Disease In Atahualpa: Prevalence And Incidence

Stroke burden is on the rise in rural regions of South America. We evaluated prevalence, pattern of subtypes and pathogenetic mechanisms underlying stroke in Atahualpa. In a three-phase epidemiologic study, suspected cases were detected by a door-to-door survey. Then, neurologists evaluated suspected cases and randomly selected negative persons, and confirmed patients underwent complementary exams. We found 20 stroke patients among 642 persons aged ≥ 40 years. Stroke prevalence was 31.15‰ that increased with age. Hypertensive arteriolopathy was the most likely mechanism underlying strokes (55% patients). Extracranial atherosclerotic lesions or cardiac sources of emboli were not found in any case. Comparison of our findings with a previous survey performed in the same village showed an alarming increase in stroke prevalence (from 14.08‰ in 2003 to 31.15‰ in 2012, p=0.03). Thereafter, we conducted an incidence study. For this, first-ever strokes occurring over four years were identified from yearly door-to-door surveys and other overlapping sources. Of 807 stroke-free individuals prospectively enrolled in the Atahualpa Project, follow-up was achieved in 718 (89%), contributing 2,499 years of follow-up (average 3.48±0.95 years). Stroke incidence rate was 2.97 per 100 person-years of follow-up (95% C.I.: 1.73–4.2), which increased to 4.77 (95% C.I.: 1.61–14.1) when only persons aged ≥57 years were considered. Poisson regression models, adjusted for relevant confounders, showed that high blood pressure (IRR: 5.24; 95% C.I.: 2.55–7.93) and severe edentulism (IRR: 5.06; 95% C.I.: 2.28–7.85) were the factors independently increasing stroke incidence. Stroke incidence in Atahualpa is comparable to that reported from the developed world. Besides age and high blood pressure, severe edentulism is a major factor independently predicting incident strokes.

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Palabras clave: Atahualpa, Ecuador, epidemiología, estudio poblacional, infarto cerebral hemorragia intracraneal,

Keywords: Atahualpa, Cerebral infarction, Ecuador, epidemiology, intracranial hemorrhage, population-based study,

Deterioro Cognitivo: Prevalencia y Correlatos en una Comunidad Rural Ecuatoriana. Lecciones del Proyecto Atahualpa. Cognitive Decline: Prevalence And Correlates In A Rural Ecuadorian Community. Lessons From The Atahualpa Project.

Assessment of cognitive impairment in rural areas of developing countries is complicated by illiteracy and cross-cultural factors. The Montreal Cognitive Assessment (MoCA) was used to estimate cognitive performance in individuals enrolled in the Atahualpa Project. Some problems were noticed with the use of this test, including issues related to naming animals, as well as the need to adjust a different cutoff for diagnosing mild cognitive decline than that used in highly educated individuals living in developed countries. After correlating MoCA scores with neuroimaging signatures of cortical and subcortical atrophy, a cutoff of 19-20 points would better define cognitive impaired individuals in rural areas. We also noticed that severe edentulism as well as psychological distress were associated with poor cognitive performance in older adults living in Atahualpa. In contrast, our study showed a linear, and dose-dependent, direct relationship between dietary oily fish intake and cognitive performance. We also aimed to assess the independent contribution and the interaction of age, the stroke itself and diffuse subcortical damage in the poor cognitive performance observed in patients with stroke, and noticed that interaction of age and diffuse subcortical damage are major determinants for poor cognitive performance among stroke patients. The total cerebral small vessel disease score can be used as a reliable predictor of poor cognitive performance, although its predictive power is not better than that of isolated neuroimaging signatures of cerebral small vessel disease. Finally, we noticed an inverse relationship between calcium content in the carotid siphon – used as a surrogate of intracranial atherosclerosis – and cognitive performance in our population.

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Palabras clave: Atahualpa, deterioro cognitivo, Ecuador, epidemiología, estudio poblacional, prueba de evaluación cognitiva de Montreal, Test de Leganés,

Keywords: Atahualpa, cardiovascular health, Cerebrovascular disease, Ecuador, epidemiology, ischemic heart disease, population-based study,

Residencia y Subespecialidades Neurológicas en los Estados Unidos. Neurology Residency And Subspecialities In The United States.

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Palabras clave: Residencia, Subespecialidades Neurológicas,

Estatus Epiléptico en Colombia: Análisis Descriptivo de Serie de Casos. Status Epilepticus In Colombia: A Case Series Descriptive Analysis.

Status Epilepticus (SE) is a neurological emergency that is by itself a syndrome defined according its clinical presentation and electroencephalographical manifestations, both highly variable. There aren’t any case series about this relatively common neurological emergency in Colombian indexed journals, for which a search for cases was performed in two neurological critical care institutions in the Colombian capital city in the period between 2011-2015. We describe demographical, diagnostic and therapeutic characteristics emphasizing in its clinical and paraclinical presentation, as the treatment applied according international guidelines. We found convulsive SE was three times more common that the non-convulsing time, 1.4 times more common in females that in males, more common in the pediatric group and less common in the geriatric group, the majority of this cases presented SE secondary to a congenital structural injury while adult and elder patients presented SE as a consequence of non-voluntary discontinuation of the therapy, and in 66% of the cases the SE described was not the first of its kind. The therapeutic regime applied corresponded to the stipulated in international guidelines in only 41.67%.

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Palabras clave: Electroencefalografía, Epilepsia, Estatus epiléptico, serie de casos,

Keywords: Case series, Electroencephalography, Epilepsy, Status Epilepticus,

Estudio Poblacional de Prevalencia de Cisticercosis Porcina en Atahualpa, Ecuador. Metodología y Definiciones Operacionales. Population-Based Study Of Porcine Cysticercosis Prevalence In Atahualpa, Ecuador. Methodology And Operational Definitions.

Objective: To assess sero-prevalence of porcine cysticercosis in Atahualpa, a rural Ecuadorian village endemic for human neurocysticercosis.

Design: We aim to collect at least 600 blood samples of local pigs, to quantify the number of positive bands in the EITB, and to estimate crude prevalence rates of porcine cysticercosis in the village. Sampling will only include pigs older than 2 months of age. Only healthy pigs will be sampled, to avoid risks inherent to manipulation of sick animals. There will be no risk for pigs as the result of the procedure. According to the estimated endemicity of human cysticercosis, we expect to find about 25% of infected pigs in this study. In the event of prevalence rates above or below the expected percentage, we will attempt to assess the causes of such discrepancies. All pig positive to 3 bands of more in the EITB will receive treatment with oxfendazole at a single dose of 30 mg/kg.

Comment: The importance of defining the prevalence of porcine cysticercosis in a village endemic for human neurocysticercosis is to confirm the existence of active transmission. If this is true, treatment of infected pigs will help to interrupt the life cycle of Taenia solium, thus reducing the prevalence of this disease in humans.

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Palabras clave: Atahualpa, cisticercosis, cisticercosis porcina, estudio poblacional, Inmunoblot, neurocisticercosis, Western Blot,

Keywords: Atahualpa, Cysticercosis, Immunoblot, neurocysticercosis, population-based study, Porcine cysticercosis, Western Blot,

Prevalencia de la Enfermedad de Parkinson: Estudio Puerta-Puerta en la Provincia de Manabí-Ecuador. Prevalence of Parkinson’s Disease: Door-to-door Study in Manabi-Ecuador.

Parkinson’s disease (PD) is one of the most frequent neurodegenerative disorders after dementias, with a worldwide prevalence of more than 1% in patients older than 65 years. In Ecuador, there are not direct statistical data on this disease. The aim of our research lies in establishing for the first time, the prevalence of Parkinson’s disease in the province of Manabi. For that, a door-to-door study was designed in two phases. They were selected 116,983 people, over forty years old. During the first phase, they were evaluated by survey, according to the London Brain Bank criteria for diagnosis. In the second phase, patients who met the criteria were referred to a neurologist for a definitive diagnosis. A total of 285 people (0.24%) were positive for Parkinson’s disease, predominating those aged over 61 years (33.33%), and with a slightly higher prevalence among males (56.14%) than in women (43.86%).

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Palabras clave: Ecuador, enfermedad de Parkinson, epidemiología, estudio puerta a puerta, Prevalencia,

Keywords: door-to-door study, Ecuador, epidemiology, Parkinson’s disease, Prevalence,

Evaluación Neuropsicológica del Control Inhibitorio y el Control de la Interferencia: Validación de Tareas Experimentales en el Contexto Ecuatoriano. Neuropsychological Evaluation Of Inhibitory Control And Interference Control: Validation Of Experimental Tasks In The Ecuadorian Context.

In this article we report a study in which three experimental tasks (SIMON, Go / No-Go and Stroop Victoria) were adapted and validated to evaluate the inhibitory control and interference control in a sample of Ecuadorian students. The sample consisted of 100 students between 6 and 15 years old (M = 10.13 years, SD = 2.48) belonging to the public education system of Ecuador. The process followed in the adaptation and validation was through the linguistic translation of the experiments, followed by an expert judgment and a pilot study. In the results it was found that there are no statistically significant differences in the measures that assess the inhibitory control and the interference considering the sociodemographic variables of the participants as comparison factors. In the correlation analysis we found a statistically significant association between the measurements of the experiments. We conclude by analyzing the associations found and underlining the need to continue providing evidence in the research line of adaptation and validation of test for using in neuropsychological evaluation.

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Palabras clave: control inhibitorio, evaluación neuropsicológica, GO/NO-GO, SIMON, STROOP,

Keywords: GO / NO-GO, inhibitory control, Neuropsychological Evaluation, SIMON, STROOP,

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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Palabras clave: envenenamiento, latrodectismo, loxoscelismo, Mordeduras de araña,

Keywords: envenoming, latrodectism, loxoscelismo, Spider bites,

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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Palabras clave: demencia, Derivación ventriculoperitoneal, Hidrocéfalo normotenso, Incontinencia urinaria, líquido cefalorraquídeo, Trastornos neurológicos de la marcha,

Keywords: cerebrospinal fluid, dementia, Neurological gait disorders, Normotensive hydrocephalus, Urinary incontinence, Ventriculoperitoneal shunt,

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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Palabras clave: anticuerpos contra receptores N-metil-D-aspartato, Encefalitis autoinmune, no paraneoplásico, paraneoplásico,

Keywords: Autoimmune encephalitis, N-methyl-D-aspartate receptor antibodies, non-paraneoplastic, paraneoplastic,

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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Palabras clave: cerebro humano, Desarrollo teórico, estudio, evaluación neuropsicológica, neurociencia, rehabilitación neuropsicológica,

Keywords: human brain, Neuropsychological Evaluation, neuropsychological rehabilitation, neuroscience, Theoretical development study,

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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Palabras clave: efectos salud, Exposición, radiofrecuencia,

Keywords: exposure, Health effects, radio frequency,

Hemorragia Talámica Bilateral. Bilateral Thalamic Hemorrhage.

Thalamic hemorrhages represent a small group of cerebrovascular diseases of which only 0.7-3% is manifested bilaterally, being chronic hypertension the key factor for its development. We report a case of a 45-year-old patient with 10-years history of arterial hypertension who presented with brachiocrural motor deterioration accompanied by dysarthria, dyspnea, vomiting in number of two, with increased basal blood pressure. Neurimaging demostrated a bilateral thalamic hematoma.

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Palabras clave: bilateral, Eventos cerebrovasculares, Hemorragia talámica, hipertensión arterial crónica,

Keywords: bilateral, Cerebrovascular diseases, chronic hypertension, thalamic hemorrhages,

Evolución Natural de la Siringomielia: Presentación de un Caso. Natural Evolution Of Syringomyelia: Case Report.

Syringomyelia is a chronic degenerative and progressive disease of the spinal cord characterized by a dissociated loss of brachial sensitivity and amyotrophy, with evidence of centromedullary cavitation.

We report the case of a 62-year-old female patient with syringomyelia associated with Arnold Chiari malformation (type 1) who spontaneously rejected any surgical intervention five years after her diagnosis, which has been followed up for 21 years. Magnetic resonance imaging demonstrates the natural evolution of syringomyelia from 1998 to the present.

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Palabras clave: malformación de Arnold-Chiari, siringobulbia, Siringomielia,

Keywords: Arnold-Chiari malformation, syringobulbia, Syringomyelia,

Síndrome de Encefalopatía Posterior Reversible (PRES). Posterior Reversible Encephalopathy Syndrome.

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Palabras clave: neurología, patologias neurologicas,

Fe de Erratas

Esta fe de erratas se refiere al autor que faltó mencionar y su afiliación académica.

ARTÍCULO ORIGINAL
Esclerosis Lateral Amiotrófica: Revisión de Evidencia Médica para Tratamiento.
Autor:
Miriam E. Bucheli, Mauricio Campos, Diana B. Bermudes, Jean P. Chuquimarca, Katherin Sambache, Jonathan F. Niato,
Priscila Villalba, Johana Montalvo, Andrés Andino, Cristian Calero, Pilar Guerrero
Rev. Ecuat. Neurol. VOL 22 N° 1-3, 2013
Esclerosis Lateral Amiotrófica: Revisión de Evidencia Médica para Tratamiento

Autores:
Miriam E. Bucheli Ph.D.,1 Mauricio Campos,2 Diana B. Bermudes,2 Jean P. Chuquimarca,2 Katherin Sambache,2 Jonathan F. Niato,2 Dayra Navarrete,6
Priscila Villalba, Johana Montalvo,3 Andrés Andino,3 Cristian Calero M.D.,4 Pilar Guerrero M.D.5
1University of Massachusetts Medical School, Department of Neuro logy, Worcester, Massachusetts, USA.

2Universidad Central del Ecuador, Quito, Ecuador.
3Universidad San Francisco de Quito, Quito, Ecuador.
4Departamento de Neurología, Hospital Carlos Andrade Marín. Quito, Ecuador.
5Departamento de Neurología, Hospital Nacional de Policía. Guaya quil, Ecuador.
6Universidad de las Americas. Quito, Ecuador.

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Adicciones Comportamentales e Interdicción por Disipación

La dinámica del mundo actual hace que la ansiedad cause estragos, disfrazándose de múltiples propuestas sintomáticas entre las cuales, las adicciones comportamentales
o conductuales están adquiriendo la mayor tasa de crecimiento con edades de inicio cada vez más tempranas.
En la psiquiatría moderna (DSM-5) estas se categorizan entre las patologías de los Trastornos Adictivos a sustancias y no relacionados con sustancias (adicciones) y el Trastorno Obsesivo Compulsivo y trastornos relacionados (conductas compulsivas), siendo conceptualmente actividades humanas diversas, a menudo placenteras y sin relación con la ingestión de sustancias químicas.

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Funcionamiento de los Comités de Ética de Investigación en Seres Humanos en Ecuador, 2015

Research Ethics Committees play an important role in securing the quality of interventional studies in humans; in Ecuador, they are in process of becoming stronger. The aim of this observational study was to describe the evolution of Ecuadorian legislation, training processes implemented by the health authority in the period of 2006-2015 and the performance of six committees (Quito and Guayaquil) during 2015. A self-assessment survey and a questionnaire to determine training needs were applied. Each committee was visited to evaluate its performance. The average member number was 10 and, although there was no gender equity, all members had the profile required for membership. The average response time was 26 days and the average quorum at meetings was of six members. Among the weaknesses are, little training in biostatistics and clinical research methodology and a poor follow-up of the studies; concerning strengths, we highlight the willingness of the members to improve the performance of the committees, and the willingness of Ministry of Public Health to support them. This study reports for the first time, the evolution of Ecuadorian legislation regarding ethics committee, its basic characteristics, weakness and strengths.

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Palabras clave: bioética en el Ecuador, comités de ética, investigación en seres humanos,

Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones

Background. Cerebrovascular disease is the second cause of death and occupies the third place as a factor causing disability worldwide. At present, despite the recognition of its importance, the available data about Ecuador is scarce and there are not published analysis of its behavior. Methods. Retrospective longitudinal analysis of available public data on cerebrovascular disease in Ecuador, from 1991 to 2015. Results Cerebrovascular disease was the leading cause of mortality by 77 897 (6.70%) deaths and it is the only one with a constant trend pattern in the last 25 years. Conclusions. Cerebrovascular disease is the number one cause of death in Ecuador and its mortality is steadily increasing. Government policies must be implemented to reduce their mortality.

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Palabras clave: Ecuador, enfermedad cerebrovascular, Ictus, Mortalidad,

Keywords: Cerebrovascular diseases, Ecuador, Mortality, stroke,

Prevalencia de Enfermedades Neurológicas no Transmisibles en una Población Rural del Estado de Chiapas, México: Protocolo y Resultados Basales. Estudio Pro-Mas (Proyecto Comunitario La Soledad)

Objective: We aimed to assess cardiovascular health and neurological status of community-dwelling adults living in “La Soledad,” Chiapas, México, to calculate prevalence and incidence of cerebrovascular diseases, epilepsy and cognitive decline. Among others, these conditions are currently considered as the new epidemics in rural.
Design: Following a protocol similar to that used for the Atahualpa Project, we conducted a two-phase epidemiological study. During phase I, La Soledad residents were interviewed with validated field instruments to assess cardiovascular health status and well as to detect suspected stroke, epilepsy and cognitive impairment patients. During phase II, trained physicians examined suspected individuals as well as a random sample of non-suspected individuals to assess prevalence of diseases of interest.
Comment: Public health strategies must be based on the study of region-specific risk factors. Studies such the Atahualpa Project were proven to be effective for the assessment of public health problems in a rural Ecuadorian village. PROMAS will likely be cost effective to increase current knowledge on these conditions in Mexican rural villages and to promote a better cardiovascular health status among their inhabitants.

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Palabras clave: deterioro cognitivo, enfermedad cerebrovascular, Epilepsia, estudio poblacional, PROMAS, salud cardiovascular,

Keywords: cardiovascular health, Cerebrovascular disease, cognitive impairment, Epilepsy, population-based study, PROMAS,

Características Pre y Perinatales de Niños que Viven en Sectores de Alto Riesgo Ambiental por Exposición a Solventes Orgánicos en el Municipio de Sampués-Sucre

The purpose of this study is to characterize -through the Maternal and Perinatal Risk Questionnaire CMRP – the pre and perinatal aspects of children whose mothers had frequent exposure to organic solvents during pregnancy.
The results demonstrates that exposed mothers had a higher number of urinary infections both before and during pregnancy, pre term deliveries, motor decline and cesarean deliveries, which are potential causes of developmental disorders, cerebral palsy, decreased growth of the baby and impaired psychomotor development. A significant data was the number of children who suffered hypoxia and anoxia during delivery, with subsequent risk of brain damage, learning disabilities, reduced IQ and potential behavior problems.

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Palabras clave: características pre y perinatales, conducta, desarrollo cognitivo, desarrollo físico, neurotoxicidad, Solventes orgánicos,

Keywords: behavior, cognitive development, neurotoxicity, Organic solvents, physical development, pre and perinatal characteristics,

Sistemas de Atención Focalizada, Sostenida y Selectiva en Universitarios de Quito-Ecuador

Introduction. Attention is a neuropsychological function that has threads of targeting, selectivity, sustainability, division and alternation, which enable human beings identify a particular stimulus for cognitive and brain processing. Objective. To analyze the performance of college students in a focused, sustained and selective attention test, considering age group, gender and academic level comparing factors. Method. A quantitative, non experimental, transectional and based on the comparison group research design was used. The sample size was 246 college students (50.8% men and 49.2% women), within17 and 29 years (M = 21.01, SD = 2.35) Results. It was found that targeting attentional processes, sustainability and selectivity are similar between the different age groups, educational level and gender. Conclusions. The basic attentional processes are fully developed in college students. Data are discussed around previous research and theoretical postulates of cognitive neuroscience.

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Palabras clave: atención selectiva, atención sostenida, Ecuador, estudiantes universitarios, focalización, neuropsicología,

Keywords: college students, Ecuador, focusing, neuropsychology, selective attention, sustained attention.,

Uso del Electroencefalograma en un Hospital de Tercer Nivel

Objective: To describe the EEG indications in Baca Ortiz Children Hospital and how they are related to the EEG results. Materials and Methods: This is a descriptive study with a sample of 659 pediatric EEG records from March to June 2016. Data of variables related to EEG indications and EEG results were obtained, and it was done a descriptive statistics analysis. Results: Fifty-six percent of the patients were male. The mean age was 6.46 years. Seventy percent of EEG requests came from the Outpatient Area and 88.16% from Neurology as specialty. Fifty-six percent of indications were related to Epilepsy. Fifty-one percent of requests were inadequate, where Epilepsy had again the highest percentage, 24.13% of all indications or 47,04% or all inadequate indications. Eighty-one percent of the EEG results were abnormal. Conclusions: These results reflect that EEG was misused as a routine diagnostic method, even in Epilepsy.

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Palabras clave: Electrodiagnóstico, Electroencefalografía, Electrofisiología, neurofisiología, Técnicas de Diagnóstico Neurológico, Técnicas y Procedimientos Diagnósticos (DeCS),

Keywords: Diagnostic Techniques, Electrodiagnosis, Electroencephalography, Electrophysiology, Neurological Diagnostic Techniques and Procedures (MeSH), neurophysiology,

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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Palabras clave: cuerpos de inclusión, inflamación, miopatía, patogénesis, patología,

Keywords: inclusion bodies., inflammation, myopathy, pathogenesis, pathology,
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