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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La Atención Involuntaria: Aspectos clínicos y electrofisiológicos.

One of the brain functions presenting more interest within the study of cognitive neurosciences is attention, which has a voluntary and an involuntary component. Involuntary attention is related to the detection of potentially relevant stimulus but originally not attended. It is considered that involuntary attention is made up by at least three stages: a) an automatic mismatch detection of a stimulus related to a given sensory context, b) an involuntary attention change associated to the orientation response, and c) a re-orientation towards the originally carried out task. The three-stage model of involuntary attention has been originated mainly based on the results obtained by Event Related Potentials (ERP) technique, by which three electrophysiological components associated with each stage of the theoretical model have been identified: mismatch negativity (MMN), P3a, and reorientation negativity (RON). This work reviews describing experimental, morphological, and topographic characteristics of each one, as well as their appearance through the development, and their alteration in clinical populations, such as traumatic brain injury, alcoholism and attention deficit disorder, is made. Finally, research perspectives are defined for future studies.

 

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Palabras clave: atención involuntaria, orientación,

Keywords: Involuntary attention, orientation,

Infarto cerebral y síndrome antifosfolípido primario.

Antiphospholipid syndrome (AFS) is one of the most frequent acquired thrombophilias, is characterized by venous thromboembolism, and/or arterial thromboembolism, and/or pregnancy morbidity, together with the presence of antiphospholipid antibodies. Thrombosis can be at both venous and arterial level, are usually recurrent and frequently affect cerebral circulation. Cerebral ischemia associated with antiphospholipid antibodies is the most common arterial manifestation and the only neurological manifestation accepted for diagnosis. Although it is difficult to predict which patients with antiphospholipid antibodies will develop thrombosis, once a thrombotic event has taken place, secondary prevention with anticoagulation is mandatory. We review the main epidemiological and diagnostic aspects and secondary prevention treatment in patients with ischemic stroke secondary to AFS.

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Palabras clave: infarto cerebral, Síndrome antifosfolípidos, trombosis,

Keywords: Antiphospholipid syndrome, ischemic stroke, thrombosis,

Jerarquía de los diseños epidemiológicos. Revisión de las publicaciones de los 17 años de la Revista Ecuatoriana de Neurología.

There are several types of epidemiological designs and they can be organized in levels of evidence. These designs are divided in observational and experimental. The observational studies can be cohort, case control and cross sectional studies. The experimental studies are the clinical trials. Due to the importance of the meta-analysis they will also be mentioned. All the articles published in the Ecuadorian Journal of Neurology were gathered since its first edition in 1992. During these 17 years, 271 articles have been published from which 94 are original articles. Clinical trials represented 12.8% of all the original articles. A decrease in the number of series reports and an increase of cohort and cross sectional studies was observed. From 1992 to 2004 most of the articles were from national authors but then, foreign authors represented the higher percentage. We think it is very important to promote the national production especially of clinical trials because they would provide a better evidence and, more importantly, evidence that could be applied to the Ecuadorian population.

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Palabras clave: Jerarquía de diseños epidemológicos, niveles de evidencia,

Keywords: Epidemological designs hierarchy, levels of evidence,

Video filmación en Neurociencias: Informe técnico-clínico.

Near the end of the 19th century, cinematography developed and was immediately recognized as a new technique applicable to the field of the medicine and we owe Gheorghe Marinescu and Arthur Van Gehuchten their introduction in the field of the neurology. Between 1899 and 1914 Marinescu and Van Gehuchten perfected the use of the cinematography like a diagnostic method in neuroscience based mainly on the recording of several patients with the same dysfunctions to be able to appreciate the wide spectrum of oneself entity, or to value certain therapy filming the patients before and after certain treatment. This contribution to the medicine and in short to the clinical neurology it marked an important landmark that lasts and it is continued using after more than one century.

 

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Palabras clave: informática, neurociencias, Vídeo,

Keywords: informatics, neurosciences, Video,

Hemangioblastoma de fosa posterior asociado a enfermedad de Von Hippel Lindau.

Hemangioblastomas are benign tumors with a cystic appearance. They represent between 1-2% of tumors affecting the nervous system and between 8-12% of all expanding processes of the posterior fossa in adults. Hemangioblastomas are characteristically found in young adults and have a peak incidence in the fourth decade of life. They are associated with Von Hippel Lindau (VHL) disease, an autosomic dominant trait with incomplete penetrance. We report a case of a 33 years old female with no significant family history, the past medical history was significant for ventriculoperitoneal shunting due to hydrocephalus secondary to reactive gliosis of the posterior fossa.

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Palabras clave: Enfermedad de VHL, Hemangioblastoma, Tumores cerebelosos,

Keywords: cerebellar tumors, Hemangioblastoma, VHL disease,

Tratamiento del Temblor Esencial mediante Talamotomía Estereotáxica.

Essential tremor is characterized by its low frequency, mainly affecting upper extremities and less frequently lower limbs and head. The origin of this disease is not well known, but it has been described in familiar forms as an autosomic dominant hereditary transmission pattern. We report three patients with essential tremor refractory to pharmacotherapy who underwent stereotactic thalamotomy of the ventrolateral nucleus. In all cases the procedure was unilateral. In two patients, the tremor completely remitted and in one patient the tremor decreased more than 50%. Tremor was defined by the Unified Parkinson’s scale. There were no complications related to surgery. We conclude that stereotactic ventrolateral nucleus thalamotomy can be of benefit in patients with essential tremor due to its low morbidity in selected patients.

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Keywords: Essential tremor, stereotactic, thalamotomy,

Diagnóstico de un paciente con crisis porfírica hepática aguda.

We present a 21 year old woman treated with carbamazepine because of epileptic seizures. She was evaluated at the epilepsy section for possible seizures associated with abdominal pain, psychosis, dysautonomic features and elevated hepatic enzymes. Diagnosis was based on clinical features and biochemical determination of urinary porphobilinogen and absence of fluorescence for porphyrin in blood sample and hepatic tissue. Conclusions: Acute Intermittent Porphyria constitutes a rare cause of symptomatic seizures but the association of seizures with abdominal pain, dysautonomic features, and psychosis suggest the disease and its recognition is very important because it is potentially mortal but suitable to improve with adequate treatment.

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Palabras clave: Biopsia Hepática, Convulsión, Disautonomía, Epilepsia, Porfiria Aguda Intermitente, Porfirinas,

Keywords: Acute Intermittent Porphyria, Dysautonomic Features, Epilepsy, Hepatic Biopsy, Seizures,

Síndrome de Wolf-Hirschhorn. A propósito de un caso con un cromosoma 4 con satélites.

Introduction: Wolf-Hirschhorn Syndrome (WHS) constitutes an illness of great neuropediatric interest. The correlation cariotype-phenotype in WHS is debated and two phenotypes one “classic” and other “half,” and two genes candidates WHSC 1 and WHSC 2 are reported.

Case report: in the present article we report the clinical and cytogenetics findings in a 13 year-old patient, with “sui generis” cariotype 46, XY, 4ps in high resolution chromosomal study with G bands and Nor techniques. The different clinical findings, cytogenetics studies and the correlation genotype-phenotype were reviewed and discussed according to the current knowledge.

Conclusions: The discovery of the chromosome 4 with satellites in patient with clinical manifestations of the syndrome, it constitutes an evidence that the SWH is the true syndrome for contiguous genes. The human genome and molecular markers studies in this case, give us light in the physiological and pathological roles of those genes WHSC 1 and WHSC 2, reported in the literature.

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Palabras clave: Cromosoma 4, Cromosoma 4 con satélites, Deleción 4p, Retardo del Neurodesarrollo, Síndrome por Genes Contiguos, Síndrome Wolf-Hirschhorn,

Keywords: 4p Deletion, Chromosome 4, Chromosome 4 with satellites, Continuous genes syndrome, Neurodevelopment Delay, Wolf-Hirschhorn Syndrome,

El Médico del Siglo 21: Una visión bioética.

Not Available.

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Depression and Anxiety in Parkinson’s Disease, Metric Properties of the Beck´s Depression and Anxiety Inventories. A K2 Factorial Design.

Background: Study to investigate the concurrent validity of the Beck Depression Inventory and Beck Anxiety Inventory evaluation scales against the ICD-10.
Methods: A K2 factorial design for studying the metrics properties of the BDI and BAI in parkinsonian outpatients.
Results: 147 parkinsonian patients were included; 44 patients has anxiety and depression; only depression 19; only anxiety 31; finally 53 subjects don’t have depression or anxiety. The BDI AUC was [0.858]. The BAI AUC was of [0.907]. The cut score was of 14/15 for the BDI and 13/14 for the BAI. The factorial design resulted in the two factors (depression and anxiety) has the best functional correlation in the regression.
Conclusions: The results we present bear out this lack of dimensionality, since we found that the BDI AUC-measured discriminative ability for anxiety was [0.739]. With regard to the BAI, this is employed to discriminate the depressed, AUC values of [0.771].

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Keywords: anxiety, depression, Metric properties, Parkinson’s disease, Psychometric properties,

Características Neuropsicológicas del Proceso del Pensamiento en los Subtipos de Esclerosis Múltiple.

Introduction: The study of thinking has been a superior but forgotten psychological process in the neuropsychological investigation field. But it plays an important role in the human being auto regulation. Objective: to identify the neuropsychological characteristics of thinking process in patients with Multiple Sclerosis considering its expression in the different subtypes of the disease. Material and methods: It included a sample of 60 admitted patients in “Faustino Pérez Hernández” Rehabilitation Hospital in Sancti Spíritus province, Cuba. A neuropsychological battery of thinking was applied from Luria’s postulates, directed to explore its practical-constructive and logical-verbal expression with techniques of simple analogies, test of lineal syllogism, interpretation of proverbs, construction of cubes, test of prepositional structures, solving of arithmetic problems and Paced Auditory Serial Addition Test (PASAT-3). Results: Investigating the structure of thinking in its logical-verbal expression, difficulties were evident in the establishment of logical links, in simultaneous synthesis, andhypothesis contrast, while in their practical-constructive expression, moderate and partial difficulties were evidenced in space synthesis and in programming activities and behavioural planning. Conclusions: Deterioration was verified in the processes of practical-constructive and logical-verbal thinking. Greater deficiencies were found in progressive clinical forms, specifically the secondary progressive multiple sclerosis.

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Palabras clave: esclerosis múltiple, pensamiento práctico-constructivo y lógico-verbal, procesos del pensamiento,

Keywords: multiple sclerosis, neuropsychology of thinking, practical-constructive and logical-verbal thinking,

Caracterización Clínico-Epidemiológica del Temblor Esencial en Familias de Holguín y Matanzas, Cuba.

Essential tremor (ET) is a bilateral mostly simmetric disorder, usually postural but kinetic and rest tremor can be present, it involves the arms and hands. A tranversal study was made to get an epidemiological, functional and fenomenological characterization of ET. Patients with clinical criteria of ET were selected from movement disorders clinic from two cuban provinces; the Fahn, Tolosa and Marín functional disability scale was applied to the sample. A total of 105 patients were evaluated, 64.7% female, 40.0% over 60 years, 80.9% were white, in 36.1% tremor began between 21 and 40 years, superior limbs were affected in 90.4%, 85.9% showed a beginning age anticipation, 87.7% were from Holguín, just 8 sporadic cases; in 53.8% associated diseases were found, an autosomal dominant inheritance was evident. Functions included in the scale’s part B showed a moderate disability (25-49%) and those which belong to part C had low disability (1-24%).

Conclusions. Most of the sample was from Holguín. Female, whites and older than 60 years were predominant, tremor mostly began between 21 and 40 years, superior limbs were the most affected body part, dominant autosomal inheritance was predominant, with anticipation in begining age. Association with some other diseases was frequent, many patients showed functional disability.

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Palabras clave: autosómico dominante, desórdenes del movimiento, herencia, incapacidad funcional, Temblor esencial,

Keywords: autosomal dominant, Essential tremor, functional disability, inheritance, movement disorder,

Combinación de un Programa de Rehabilitación y Estímulo Eléctrico en Pie Equino para las Alteraciones de la Marcha en Niños con Parálisis Cerebral.

There are many factors that cause gait disorders as is the case of patients suffering encephalic lesions that cause brain palsy with hemiplegia as sequelae. One of the most important and interesting features of rehabilitation of the patient with hemiplegia is gait reeducation. Because of that, a therapeutic strategy was created with the application of electric stimulus and a program of exercises in order to preserve the maximum of functional capabilities. For this reason, a retrospective study was performed including a sample of 10 patients with cerebral spastic palsy hospitalized at CIREN’s Clinic of Child Neurology with clubfoot and gait disorder. Every child was submitted to a rehabilitation treatment for four to eight weeks -six times per week- assessing the effectiveness of the neuromuscular stimulation over gross motor function and gait, including frequency of steps in 10 meters and its amplitude. At the end of the treatment, improvement was observed in the treated cases.

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Palabras clave: Marcha funcional, parálisis cerebral, Tratamiento rehabilitador,

Keywords: cerebral palsy, Functional gait, Rehabilitation treatment,

Tipificación del Trastorno Afectivo en Pacientes con Epilepsia del Lóbulo Temporal.

 

Introduction: Affective disorders in people with epilepsy seem to be different from patients with primary mood disorders.

Objective: to determine the clinical characteristics that typifies depression in patients with temporal Lobe Epilepsy.

Patients and methods: Forty patients with Temporal Lobe Epilepsy and depression were enrolled in the study. Thirty one patients with primary depressive disorder were recruited as control group. Depression was clinically evaluated in both groups. The discriminate analysis was used to determine the main clinical features of depression in patients with epilepsy. The differentiation between groups in total scores of Mood disorders through the International Psychiatry Interview was used to determine the atypical sign of depressive symptoms in patients with epilepsy. Logistic regression was utilized to analyze the possible relationship between neurobiological functioning and depressive symptoms in patients with epilepsy. Results: Sixty two percent of patients had a mood disorder not classified in CIE-10 and DSM-IV. Perictal anhedonia associated with insomnia, guilty thoughts, psychomotor slowness, inattention, restlessness, irritability, faintness  became the clinical profiles of depression in patients with epilepsy. Age of onset of epilepsy, family history of psychiatric disorders, number of seizures per month, left temporal Lobe Epilepsy, and bilateral hippocampal atrophy were the most important determinants of mood disorders in our study.

Conclusion: Brief perictal depressive symptoms associated with dysphoria, anxiety and phobias, typify the clinical profile of depressive syndrome in patients with Temporal Lobe Epilepsy.

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Palabras clave: depresión, disforia, Epilepsia del Lóbulo temporal, hipocampo, trastorno afectivo disfórico somatomorfo interictal, trastorno afectivo interictal,

Keywords: depression, dysphoria, hippocampus, interictal affective disorder, interictal Somatoform dysphoric affective disorder, Temporal Lobe Epilepsy,

Asociación de Tumores Neuroepiteliales y Displasia Cortical Focal Microscópica en Pacientes con Epilepsia del Lóbulo Temporal Fármaco Resistente.

Introduction: There is controversy between the extension of the surgical resection of electrophysiologically monitored brain tumors and the postoperative clinical evolution of patients with pharmacoresistant temporal lobe epilepsy (TLE).

Objective: To evaluate the histopathological spectrum and the electroclinical and imagenologic characteristics, as well as the clinical evolution in patients with neuroepithelial tumors included in the program of epilepsy surgery at CIREN.

Patients and methods: Cases with tumors and pharmaco resistant epilepsy operated from 2002 – 2009 were selected from the database. The patients underwent temporal lobectomy adjusted by electrocorticography (ECoG). The histopathological pattern, ictal video-EEG and intraoperative EcoG are described here.

Results: Of the 25 analyzed patients, 5 presented MRI neocortical structural lesions. One of them was an arachnoid cyst, a reason for its exclusion from the study. The histopathologic exam evidenced a patient with pilocytic astrocytoma, two ganglioglioma (GG) and a dysembryoplastic neuroepithelial tumour (DNT); the last one associated to a focal cortical dysplasia (FCD) type IA and IB. The seizure – type in these patients previous to surgery was partial complex. All cases were free of seizure until the last clinical evaluation.

Conclusions: The association of glioneuronal tumors is evidenced (GG and TND) with microscopic FCD in TLE patients. The temporal lobectomy adjusted by ECoG allowed to achieve the condition of no seizure in TLE patients / tumors of the neuroepithelial tissue, even in cases associated to FDC.

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Palabras clave: Displasia cortical focal, Electrocorticografía, Epilepsia focal fármaco resistente, Evolución clínica, Tumores lóbulo temporal,

Keywords: Clinical outcome, Electrocorticography, Focal cortical dysplasia, Pharmacoresistant focal epilepsy, Temporal lobe tumors,

Utilidad del Levetiracetam como Terapia Adjunta en Pacientes con Crisis Parciales Refractarias.

We conducted a metanalysis of controled trials on the efficacy of levetiracetam (LVT) as add-on therapy for patients with refractory partial seizures. A MEDLINE search revealed five trials comparing the efficacy of different doses of LVT over placebo. Combined data confirmed the efficacy of LVT over placebo for the 50% reduction of seizures during therapy (x2=96.9; p<0,0001; OR=3.73; 95% CI=2.02-4.95), as well as for the complete resolution of seizures (x2=27.01; p<0,0001; OR=7.31; 95% CI=3.08-21.09). Only two trials showed a dose-related (1000 mg/d, 2000 mg/d o 4000 mg/d) efficacy of LVT. This suggest that the initial dose of LVT in these patients should be 1000 mg/d, and that the dose may be increased only in those who do not respond to therapy.

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Palabras clave: convulsiones parciales, refractaria, terapia adjunta,

Keywords: adjuvant therapy, partial seizure, refractory,

Lesión del Nervio Espinal Accesorio. Importancia de los Estudios Electromiográficos.

The spinal accessory nerve (XI cranial nerve) injury is an unusual clinical entity and, sometimes, of complex diagnosis. The objective of this study is to describe the syndromic picture attending to its main etiologic factors, the different forms of presentation and the value of the neurophysiological studies, especially of electromyography in its diagnosis. The information that neurophysiology brings is of great value at the moment of establishing a precocious diagnosis as well as in the evolution and prognosis of the lesion. There are few available data in the literature that describe neurophysiological techniques for its correct management.

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Palabras clave: electromiografía, Electroneurografía, Lesión nerviosa, Nervio espinal accesorio,

Keywords: Accessory spinal nerve, electromyography, Electroneurography, Nerve injury,

Cirugía de Epilepsia en Ecuador 2010.

Epilepsy is one of the most common chronic neurological conditions in children and adults. The lifetime risk of developing epilepsy is 3.2%. In this review article we suggest how to apply a safety protocol for the surgical treatment of antiepileptic drugs resistant patients. We review who the ideal candidate for a pre-surgical evaluation is and when to do it; how to do it, using clinical, physiological, imaging and neuro-cognitive biomarkers in order to achieve medical benefit from epilepsy surgery; why patients should go and receive a surgical evaluation. Finally we review the current concepts of drug resistant epilepsy and the surgical intervention benefit/risk relationship.

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Palabras clave: Cirugía, Drogas Antiepilépticas, Electroencefalograma, Epilepsia, Epilepsia Resistente a Drogas Antiepilépticas, Imagen por Resonancia Magnética, Video-EEG prolongado,

Keywords: Antiepileptic Drug-resistant Epilepsy, Antiepileptic drugs, electroencephalogram, Epilepsy, Magnetic Resonance Image, Surgery, Video EEG,

Enfermedad de Creutzfeldt Jakob Esporádico: Presentación del Primer Caso Clínico – Patológico en Ecuador.

Introduction: Sporadic Creutzfeldt-Jakob disease (sCJD) has not yet been described in Ecuador.

Methods: We present a 53-year-old patient who came to the Neurology Department of the Eugenio Espejo Hospital because of clinical symptoms and EEG and MRI tests that met the criteria for a diagnosis of CJD, which was later confirmed by neuropathological findings.

Results: That patient was admitted to the hospital because of visual impairments and ataxia. During his stay in the hospital, in addition to blindness, myoclonus and bilateral cortico-spinal signs, the patient’s cognitive functions declined rapidly and progressively. The clinical symptoms, the EEG and MRI were highly suggestive of CJD. The neuropathological findings confirmed this diagnosis.

Conclusion: We report the first case in Ecuador, with neuropathological confirmation, of a patient diagnosed with the Heidenhain variant of sCJD.

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Palabras clave: Creutzfeldt Jakob esporádico, Hallazgos clínico patológicos, Variante de Heidenhain,

Keywords: Clinical Pathological Findings, Heidenhain Variant, Sporadic Creutzfeldt Jakob Disease,

Quiste Aracnoideo de Presentación Ictal.

Arachnoid cysts are benign cystic cavities surrounded by membranes that are indistinguishable from the arachnoid membrane. They contain cerebrospinal fluid in contact with the subarachnoid space. They are frequently asymptomatic and incidentally diagnosed in the adult. Their clinical onset is variable and depends on their size and possible triggering factors. We report a case in which a big arachnoid cyst presented in an unusual way, not finding a background or any triggering factors that might justify this clinical presentation. It is necessary to perform a differential diagnosis from other common affections of sudden onset. Surgical treatment by cystoperitoneal shunting resulted in a complete resolution of symptoms.

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Palabras clave: derivación cistoperitoneal, disfasia, quiste aracnoideo, quiste aracnoideo primario, resonancia magnética, tratamiento quirúrgico,

Keywords: arachnoid cyst, cystoperitoneal shunting, dysphasia, magnetic resonance imaging, primary archnoid cyst, surgical treatment,

Meningioma Anaplásico del Surco Olfatorio: Reconstrucción Craneofacial Secundaria a Resección Radical de Tumor.

Surgical management of olfactory sulcus meningioma with extension to orbit and perinasal cavities is very complex. It requires a careful and multidisciplinary intervention for complete resection and to avoid potential harmful complications. We report a clinical case of an olfactory sulcus anaplastic meningioma and describe the surgical techniques applied.

 

 

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Palabras clave: anaplásico, intervención, meningioma, técnicas quirúrgicas,

Keywords: anaplastic, intervention, meningioma, surgical techniques,

Síndrome de Dejérine – Roussy en un Paciente con Prolapso Valvular Mitral de Reciente Diagnóstico.

Introduction. Dejérine and Roussy described a painful state (spontaneous, persistent and sometimes sharping) as a result of thalamic nuclei vascular lesion (ventro-posterolateral and ventro-posteromedial); other features of this syndrome are hemicoreoatetosis, hemiataxia, homonymous hemianopia and sensitive disorders. We report a clinical case of a male who was diagnosed with this syndrome.

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Palabras clave: prolapso valvular mitral, Síndrome talámico,

Keywords: mitral valve prolapse, Thalamic syndrome,

Meningoencefalitis Eosinofílica: A propósito de un Caso.

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Déficit de Vitamina B12 y Degeneración Combinada Subaguda de la Médula Espinal: Presentación de un caso y Revisión de la Literatura.

Myelopathy caused by vitamin B12 deficiency is an uncommon entity, because a long period of time must pass in order to appear its signs and symptoms and for the structural lesion to be irreversible. We present a case of a patient with signs and symptoms suggestive of Subacute Combined Degeneration of the Spinal Cord secondary to autoimmune gastritis with a persistent lesion in the posterior columns of the spinal cord as sequelae. The literature about the topic is reviewed.

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Palabras clave: Degeneración Combinada Subaguda de la Médula, Gastritis Autoinmune, Vitamina B12,

Keywords: Autoimmune Gastritis, Subacute Combined Degeneration of the Spinal Cord, Vitamin B12,

La SEN: Una Visión Personal.

Not Available.

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Epidemiología del Ictus entre los años 2007-2009 en el Hospital Regional Dr. Teodoro Maldonado Carbo.

Objective: Determine the prevalence of the different epidemiological features and risk factors of stroke patients of the Regional Hospital Dr. Teodoro Maldonado Carbo.

Methods:Cross-sectional study of 521 patients with diagnosis of stroke, admitted to the Neurology Service of the Social Security Hospital between the years 2007-2009. Data was recollected from the discharge notes and medical records. The measured variables were duration of hospital stay, diagnosis, mortality, non-modifiable risk factors, and modifiable risk factors. In case of hemorrhagic stroke variables that could represent its cause were also recollected.

Results: Most patients were males (70.5%), the most prevalent risk factors were hypertension (81.1%), diabetes mellitus (27%) and dyslipidemia (16.88%). The mean age was 67±13 years. There was an increased tendency of hypertension in males and of diabetes mellitus in females (p=0.45, p=0.17 respectively). There was a significant difference in the presence of coagulopathy (p=0.01), valvulopathy (p=0.04) and anticoagulant use (p=0.004) in females. Ischemic stroke represented the 80.9% and hemorrhagic stroke the 19.1% of cases.

Conclusions: These results are similar to those found in Latin American and North American publications. The correction of the most prevalent risk factors in our population would markedly decrease the incidence of this disabling disease.

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Palabras clave: epidemiología, evento cerebrovascular, hemorragia, isquemia,

Keywords: epidemiology, hemorrhage, ischemia, stroke,

Carbamazepina y Valproato de Magnesio en el tratamiento de la Epilepsia del Lóbulo Temporal Mesial de debut.

Introduction: Mesial Temporal Lobe Epilepsy is the most frequent symptomatic focal epilepsy in adults. There are no prospective studies that compare the efficacy and effectiveness of carbamazepine and valproic acid in this group of patients.

Objective: to compare the efficacy, effectiveness and tolerability of Carbamazepine and Valproic Acid in patients with Mesial Temporal Lobe Epilepsy.

Methods: We conducted a prospective, controlled and randomized study of parallel groups in patients with Mesial Temporal Lobe Epilepsy at time of onset. The patients were followed-up for one year. Fifty six patients were recruited. Forty three patients participated in a crossover study and only thirty three concluded it. We evaluated the efficacy, effectiveness and tolerability of two antiepileptic drugs.

Results: After cross-over, the efficacy of Valproic Acid was superior to Carbamazepine reducing seizure frequency from 7,9 to 2,6 seizures per month (p = 0,02). None of antiepilpetic drugs were associated with an improvement in Hamilton scale. Treatment with valproic Acid improved the quality of life by 20 % after a year of treatment (p < 0,01) . The number of patients with side effects was not significant statistically, even though valproic acid produced a greater variety of adverse effects.

Conclusion: The effectiveness and efficacy of Valproic Acid in patients with mesial Temporal Lobe Epilpesy at onset is superior to carbamazepine althought it is less tolerated.

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Palabras clave: carbamazepina, efectividad, eficacia, Epilepsia del Lóbulo Temporal mesial, tolerabilidad, valproato,

Keywords: Carbamazepine, effetiveness, Mesial Temporal Lobe Epilpesy, tolerability and efficacy, Valproic Acid,

Predictores de Ansiedad y Depresión en Cuidadores Primarios de Pacientes Neurológicos.

Objective: To describe predictors of depression and anxiety in caregivers of neurological patients.

Methods: To a sample of 145 caregivers, from the outpatient clinic of the National Institute of Neurology and Neurosurgery, sociodemographic variables were collected and the following questionnaires were applied: Ways of Coping with Stress of Lazarus and Folkman, Zarit Burden Scale, Hospital Anxiety and Depression Scale. Additionally, Activities of Daily Living were assessed in patients.

Results: 97% of caregivers were provided by the informal system, usually a woman (82%) with an average age of 47.7 ± 15.1, house-wife (60%) and close relative of the sick person (78% . They suffer from a current illness (48%) and 62% presented the condition after caregiving. The regression model for anxiety included: negative impact, cognitive distancing, patient age and caregiver education. The depression model included: negative impact, caregiver education and cognitive distancing. Both explained 37% of variance.

Conclusions: Anxiety and depression depend on the skills and resources of the caregiver, the burden and impact of the disease. These correlate with physical, mental and socioeconomic issues that affect social relationships, intimacy and freedom of the caregiver.

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Palabras clave: Afrontamiento, ansiedad, Cuidador Primario, depresión,

Keywords: anxiety, Caregiver, Coping, depression,

Influencia de la Reserva Cognitiva en la Función Ejecutiva en Sujetos Sanos y con enfermedad tipo Alzheimer de Inicio Tardío en una Muestra Portuguesa.

The Cognitive Reserve concept, generally understood as the acquired protective effect, is considered by many authors as an active mechanism that is based on the application of previously learned resources, due to a good education, profession and/or premorbid intelligence. The Stroop Test has been used in the neuropsychological assessment of executive functions in aging-related disease, such as Alzheimer’s Disease.

Objectives: We intend to study the influence of cognitive reserve in executive functions in subjects with late onset Alzheimer´s disease, and in healthy subjects in a Portuguese sample.

Method: We used two samples, one consisting of 91 healthy subjects and a second sample of 32 subjects diagnosed with senile dementia of the Alzheimer type.

Results: The group of healthy subjects showed better performance on the test, than the pathologic group. Significative differences were found in the healthy group between high and low cognitive reserve subgroups.

Conclusions: The Stroop Test, shows a high sensitivity in determining alterations in executive functions and the influence of cognitive reserve in that function.

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Palabras clave: Enfermedad de Alzheimer, Envejecimiento normal, Envejecimiento patológico, Funciones Ejecutivas, Reserva Cognitiva, Test de Colores y Palabras de Stroop,

Keywords: Alzheimer's disease. Cognitive reserve, Executive function, Normal aging, Pathological aging, Stroop Color and Word Test,

Effect of cold irritation on peripheral white blood cell and ICAM-1, IL-1β expression of brain tissue in rat.

Background: Some studies have showed that hypothermia is a neuroprotective factor for cerebral ischemic injury. Inflammation reaction plays a very important role in pathomechanism of neuron degeneration disease induced by cerebral ischemia. However whether there is relationship between cold irritation and inflammation reaction is not well known.

Objective: To explore effect of cold irritation on peripheral white blood cell and ICAM-1, IL-1β expression of brain tissue in rat with cerebral ischemia.

Methods: Model rats were put into low temperature water (0º) for cold irritation for 5 minutes one time every day for 20 days. MCAO rats were subjected to middle cerebral artery occlusion (MCAO) using an intraluminal suture method with permanent ligation of the ipsilateral common carotid artery. We assessed count of the peripheral white blood cells.The brains of all rats were cut at 1, 3, and 5 days after cerebral ischemia and frozen brain tissues were continuously sliced and stained immunohistochemically with Intercellular Adhesion Molecule-1 (ICAM-1) or Interleukin-1(IL-1) antibody.

Results: Cold irritation model rats were associated with increased leukocyte at 1 and 3 days post-ischemia, increased ICAM-1-positive vessels at 1, 3, and 5 days, and increased interleukin-1(IL-1) at 3 and 5 days. Vascular pathology of the hippocampus at electron microscope levels showed that the blood vessel has inflammation infiltration at 1, 3 and 5 days. Conclusion: These data demonstrate that cold irritation significantly increased endothelial adhesion molecule expression, leukocyte infiltration, and vascular pathology of the hippocampus in rat. The mechanism of neuron injury may be related to the inflammation reaction induced by cold irritation.

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Keywords: cold irritation, inflammation reaction, intercellular adhesion molecule, interleukin-1,
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