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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Complicaciones Neurológicas de las Mordeduras de Arañas Neurological Complications of Spider Bites.
Spiders are venomous arthropods with worldwide distribution. Most spider bites are clinically insignificant, as the size of their chelicerae is too small to inject enough amount of venom to human beings. Despite this, there are hundreds of reported cases of human envenoming related to spider bites. While clinical manifestations related to spider-bite envenoming are pleomorphic, three main clinical syndromes could be recognized: latrodectism, loxoscelism, and funnel-web spider envenoming. Latrodectism is caused by the potent neurotoxin α-latrotoxin present in the venom of widow spiders (Latrodectus sp.). Most cases present with severe pain at the site of the bite, with arterial hypertension being the most frequent systemic manifestation. Neurological complications mostly consist of headache, lethargy, irritability, generalyzed myalgia, tremor, fasciculations, ataxia, or paresthesias. The latter manifestations are related to an exhaustive release of cholinergic neurotransmitters at the neuromuscular junction. Loxoscelism is caused by envenoming by spiders of the family Sicariidae, genera Loxosceles and Sicarius. It presents in two different forms, cutaneous (with changes restricted to the affected skin) area and viscerocutaneous. In the latter, a severe coagulopathy may occur, associated or not with acute renal failure, jaundice, fever, multi-organ failure and shock. The venom of fennel-web spiders have potent neurotoxins, called δ-atracotoxins, that stimulates neurotransmitter release from the presynaptic vesicle, causing hyperstimulation of post-synaptic receptors resulting in sensory disturbances and muscle paralysis. Also, sympathetic and parasympathetic manifestations, including diaphoresis, hypersalivation, arterial hypotension, and cardiac arrhythmias may occur.
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Hidrocefalia de Presión Normal. Normal Pressure Hydrocephalus.
Normal pressure hydrocephalus is a pathology causing dementia that is reversible. Despite the time elapsed since its discovery, its pathophysiology has not been clearly established and two theories have been proposed that try to explain the process, one based on changes in cerebrospinal fluid flow and the other on cerebral blood flow. In addition, the evaluation and diagnosis process is not determined, since there is no standard method and the symptoms are similar to other pathologies of the central nervous system, leading to the diagnosis as the summation of clinical symptoms and some findings in imaging which are not always constant.
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Encefalitis Autoinmune Antirreceptor de NMDA: Reporte de un Caso y Revisión de la Literatura. Anti-NMDA Receptor Encephalitis: Case Report And Review Of Literature.
Encephalitis caused by N-methyl-D-aspartate receptor antibodies is associated with auto antibodies against the heteromeric NR1/NR2 units of NMDA receptors. This type of encephalitis occurs more commonly in young adults, most of them women, and shows a good response to known treatments. Clinical features include neuropsychiatric manifestations, advancing through a series of stages up to a gradual recovery. This type of encephalitis can be associated with the presence, or lack thereof, lesions caused by tumors. It can easily be mistaken with infectious encephalitis, therefore is important to recognize its clinical features for an appropriate diagnosis and treatment in order to prevent higher morbidity and mortality. In this article, I describe a case study of autoimmune encephalitis caused by NMDA receptor antibodies in a twenty-two year old man, admitted to the Enrique Garcés Hospital in Quito-Ecuador, and I make a literature review on this pathology.
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Conceptos Fundamentales en la Teoría Neuropsicológica. Fundamental Concepts In The Neuropsychological Theory.
This article presents three concepts that are fundamental in the neuropsychological theoretical: (a) historical data in the study of the human brain, (b) neuropsychological evaluation of brain functions and (c) neuropsychological rehabilitation of brain functions. As relevant data in the theoretical development of the study of the human brain is a tour of the trepanation acts performed hundreds of years ago, the contributions of phrenology, the masterful findings of Broca and Wernicke, the heuristic contribution of Luria and the current revolution with the neuro-image. In the neuropsychological evaluation of brain functions, the role of specific, non-specific and delayed observation tests in the interpretation of the neuropsychological state of the human being is analyzed, which allow analyzing neuropsychological functions in the laboratory and in real lifeactivities. Finally, we analyze the process of neuropsychological rehabilitation of brain functions, where mention is made of the processes of restoration, compensation, substitution, activation-stimulation and integration, which are very useful when intervening in a brain that has suffered an acquired damage. It is concluded that the current accelerated pace has determined the advance of neuroscience, where technology and the forceful scientific contribution propose new techniques and theories to understand the processes of evaluation and rehabilitation of brain functioning.
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Exposición de Ondas de Radiofrecuencia en Relación con Alteraciones en la Salud. Radiofrequency Waves Exposure And Health Changes.
The cell phone is a device widely used by people of all ages and all over the world. Among the studies regarding the harmful effects of radiation on the human body there is no consensus. It is therefore necessary to analyze the theoretical references about the deleterious effects of radiation on humans and identify a set of actions to help reduce exposure to this radiation. The overall objective is to give information to the user about excessive exposure to radio frequency by the indiscriminate use of cell phone and to warn about the health problems that can occur and the consequences that could trigger in the future. Radiation can affect humans negatively, especially prolonged exposure. Various studies reviewed indicate that radiation is associated with the onset of health disorders and described that fundamental mechanism to produce damage in man are thermal, non-thermal and athermal effects, but it is required to extend studies, with emphasis on epidemiological, to analyze the generated hypotheses about this particular.
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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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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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Síndrome de Encefalopatía Posterior Reversible (PRES). Posterior Reversible Encephalopathy Syndrome.
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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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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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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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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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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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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Miositis Esporádica por Cuerpos de Inclusión
Sporadic inclusion body myositis is a common acquired inflammatory myopathy in people over 50 years of age. It presents with slowly progressive asymmetric weakness that affects preferentially the quadriceps and deep finger flexors. The pathogenesis is poorly understood. The diagnosis is made with a combination of the clinical history, physical exam, electrodiagnostic tests, imaging, serology and histopathology. There is no treatment for this condition but multiple therapies are currently being investigated.
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El Cerebro y la Música
Sound and music share a lot, but they are not totalitarian synonyms. Each one has some qualities or elements that define them even when they are equivocally seen as equals. Sound is a physical event, while music is an art that uses that event as material to develop itself. In our brain, music is processed through neural networks that involve areas of auditory and motor processing, in turn, their perception and execution involve various cognitive functions. Although current knowledge of the structures involved in hearing and the effect of music in our brain is still uncertain, a review of the most up-to-date literature on the subject is useful.
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Manifestaciones Neurológicas Asociadas a Infección por Virus Zika
Zika virus is a flavivirus and it is part of the flaviviridae family. This virus is transmitted by Aedes mosquito bites and sexual intercourse. The virus was discovered in 1947 but it was almost unknown until it spread along America in 2015 and was associated with multiple neurological disorders. Due to this incidence, the World Health Organization declared an emergency status in 2016. In Ecuador, the first case of Guillain-Barre Syndrome associated with Zika virus infection was reported during
the same year.
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Tratamiento Neuropsicológico del TDAH en Preescolares: Entrenamiento de la Función Ejecutiva
Preschoolers who have symptoms of impulsivity, hyperactivity and attention deficit manifest alterations in the executive functions: inhibitory control, working memory, monitoring and self-directed speech. It is essential in the preschool classroom to identify children who have difficulty regulating their behavior. The importance of this early detection is the possibility of avoiding a picture of ADHD with greater complexity in the child’s future. Training of executive function in children who could present these symptoms has been described as a highly effective strategy. Researches affirm that training of executive function would decrease the likelihood that a child will have ADHD at school age if he had received early attention from preschool. From the clinical experience it has witnessed the evolution of cases of children identified preschool with symptoms of ADHD, and then do a training executive functions for periods of one to two years better, and even at the beginning of schooling have a less severe psychopathology, unlike children who have not received this early intervention. In this paper I will describe the clinical picture of ADHD in initial preschool, the relationship between this disorder and executive function and some strategies in the training of executive functions.
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Síndrome de Guillain-Barré: Un Caso Atípico
Guillain Barre Syndrome (GBS), is an acute inflammatory polyneuropathy, of autoimmune etiology that produces an inflammation in the peripheral nerves and its spinal roots. GBS generally presents as flaccid, symmetric, ascendent and areflexic palsy, along with a previous respiratory or gastrointestinal infection. It has been reported atypical forms of presentation. We describe the case of a 53 years old male patient, without previous infections in the last months, who is admitted to the emergency department presenting walking difficulties due to decreased muscle strength, pain and numbness in the lower limbs, deep tendon reflexes present, followed few days later by a right peripheral facial palsy. Examination of cerebrospinal fluid (CSF) revealed albumino-cytological dissociation, leading to diagnose GBS of atypical presentation, which was treated with intravenous immunoglobulin followed by a favorable outcome.
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Parkinsonismo y Mielinolisis Osmótica. Descripción de caso
Introduction: Osmotic demyelination syndrome is a rare medical condition in which parkinsonian signs are relatively non frequent. Objective: To report a case of a patient with hyponatremia rapidly corrected and treated with neuroleptics. The cranial MRI showed demyelinating lesions in pons and basal ganglia. The patient clinically developed parkinsonism, with no response to dopamine. Conclusion: The inadequate correction of hyponatremia causes demyelinating lesions. As we appreciate in this case, the prescription of neuroleptic drugs may negatively affect the response to dopaminergic therapy.
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Razonamiento Clínico: Hombre de 57 Años de Edad con Dolor y Debilidad Muscular Proximal
We present a case of a 57-year-old man with a two-month history of shoulder pain and proximal weakness. The history and physical examination are reviewed and a stepwise approach to the differential diagnosis is made to reach the final diagnosis.
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Infarto Talámico Bilateral
Feasibility of Global Sleep Research in Rural Areas of Low-and-Middle-Income Countries. The Atahualpa Project Experience
Changes in lifestyle, including sedentarism, shift work and increased visual contamination, have modified sleep patterns and increased the prevalence of sleep-related disorders in remote rural areas of many low- and middle-income countries (LMIC). However, there is scarce information on the public health impact of sleep-related disorders in these regions and publications lack consistency in their design and use of research tools, which creates barriers for proper comparison of results across populations. Moreover, in the largest studies on sleep-related disorders conducted in LMIC, individuals were interviewed with only one or two questions, which might not reflect the actual magnitude of the problem. In our opinion, the goal should not be to interview tens of thousands of individuals but to study them well by selecting representative populations of different regions to evaluate them thoughtfully and uniformly.
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Trombectomía Mecánica: Técnica de Primera Elección en el Tratamiento del Ictus Isquémico Agudo. Análisis de Beneficios y Resultados
The main objective of this article is to portrait mechanical thrombectomy as the modality of choice for interventional stroke treatment.
Methods and materials: Nine patients with acute ischemic stroke were diagnosed. Mechanical thrombectomy was perfomed in all of them with a solitaire type device associated with intraarterial rTPA. Eight patients (89%) had anterior vascular occlusion and only one (11%) had posterior vascular compromise. Treatment efficacy was assesed using a modified Rankin scale (mRs).
Results: Five patients (55%) had complete recovery while three of them (33%) had partial recovery. Only one patient (11%) showed no recovery at all.
Discussion: Although more data is needed, mechanical thrombectomy prooved to be effective and shows promising outcomes in patients with acute ischemic stroke.
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Experiencia Quirúrgica de Dos Años en el Manejo de la Epilepsia Refractaria Multifocal
Objective: To describe the series of patients with multifocal refractory epilepsy who have undergone surgery in our center.
Methods: A prospective analysis of patients with multifocal refractory epilepsy treated in our hospital during the last two years was performed.
Results: In this period we studied 25 patients with multifocal refractory epilepsy who have completed > or =1 year postoperative follow-up after callosotomy. The ages of the patients were between 3.8 and 18.8 years (mean 11, SD 4.46). The most common cause of refractory epilepsy in our series was Lennox Gastaut syndrome (ten patients). We perform 14 callosotomy in 13 patients. Of these, 10 were of the above callosotomías 2/3 and four complete. Overall there was a 66.5% reduction in seizures; in the case of total callosotomías this reduction was 90%. We report two minor complications and death from a pneumonic process.
Conclusion: The surgical management of multifocal refractory epilepsy is a safe procedure that provides good results in controlling the crisis. The complete callosotomy is the most efficient procedure in this population.
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Impacto del Aprendizaje del Inglés Sobre los Procesos Cognitivos en Adultos Mayores. Un Estudio Preliminar en Cuenca
A descriptive exploratory study, before and after a six-month english learning course for seniors is conducted to evaluate the cognitive effect of learning another language in this age group in the city of Cuenca.
Materials and Methods: 80 adults of average age 70.48 ± 4.9 years (31 men, 19 women) were included; who underwent neurological and neuropsychological evaluation at baseline, six and twelve months after the course; including tests for executive function (working memory and attention processes).
Results: Data show significant statistical association between impaired olfactory perception related to age. Neuropsychological tests show interesting data relating cognitive maintenance and even improvement in the Performance Testing Direct and inverse series (Wais III) and Symbol Digital Modality Test (SMDT) six and twelve months after initiating a learning course of English.
Conclusion: The study suggests that learning English, even without functional objective of a new language, may have protective effect on the executive functions and neuronal brain networks are claimed the first findings in patients with cognitive impairment. We suggest perform this follow up long term in time to find strongest evidence, related to international bibliography.
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Validación de la Escala de Impulsividad Bis 11-C para su Aplicación en Adolescentes Ecuatorianos
Barratt scale (BIS) is an assessment tool often used to evaluate impulsivity. In this study, an analysis of the psychometric properties of the BIS 11 c scale Ecuadorian adolescent students (N = 245) is performed. Internal consistency through Cronbach’s alpha coefficient and homogeneity of the items were evaluated. For assessing the construct validity we perform a confirmatory factor analysis. The results obtained were acceptable parameters of valid and reliability to use the BIS 11 c scale in Ecuadorian adolescents. Finally, a discriminant analysis in a clinical sample of 18 students with ADHD was conducted.
