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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Estimulación Magnética Trascraneal en los Retrovirus Humanos: Una Revisión Sistematica Desde 1985 a 2009.

Pyramidal tract is affected in tropical spastic paraparesis (HAM/TSP) and AIDS; the best paraclinic tool so far known to evaluate such involvement, in humans, is transcranial magnetic stimulation. A thorough investigation was done in MEDLINE database for the period between 1985 and 2009, and in Scielo.org between 1996 and 2009 using the terms “HTLV-I, HTLV-II, HTLV-III, HIV; HIV1, HIV2, evoked potential, motor evoked potential, transcranial magnetic stimulation, magnetic stimulation, corticomotor physiology, motor tracts, pyramidal tract, corticospinal tract, myelopathy, acquired immunodeficiency syndrome, AIDS, SIDA, tropical spastic paraparesis, HTLV-I associated myelopathy, HAM, TSP, HAM/TSP”. Papers in English, Spanish, Portuguese, French and Japanese were reviewed. Thirteen manuscripts reporting motor evoked potentials obtained by transcranial magnetic stimulation were identified. In HAM/TSP the pyramidal tract involvement is mainly at low thoracic levels, following a centripetal pattern; in HIV, such involvement follows a centrifugal pattern  which is greater at brain level. These findings should allow to redirect neurohabilitation and neuromodulation measures hopefully before fatal outcome or disability take place in these retroviruses-associated neurodegenerative disorders.

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Trastorno Obsesivo-Compulsivo: Hacia Un Modelo Integrador.

The main purpose of this paper is to present a general view of the advances in the last three decades concerning the conceptualization and treatment of the OCD phenomena. This disorder is more frequent and heterogeneous than it was thought before. Biological and psychological aspects suggest a crucial task for both, clinicians and researchers: to develop integrated models. Emphasis should be made on the importance of combined treatments to increase well being, social and personal functioning and quality of life.

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Origins of Addictive Behavior: A Nature Heritage Or A Neuropsychiatric Nurtured Reality?

In this paper we present a revision on the origins of Addictive Behavior and related neural basis. Although there are abundant specific bibliography and professions focusing on addictions treatment, the reasons why people started with addictive behaviors and consequently maintain are still not well understood. This article explores the construction, meaning, and impact of addiction in historical and psychological perspective. The challenge to the usual concept of addictions causes has significant implications for medical practice and for treatment programs. Furthermore, with this article we present the phenomena of Multifactorial Polygenic Heritage as a possible theory for the explanation of addictive behavior, being consequently important for its prevention and treatment. The roles of social, cultural, and population differences, as they may relate to addictive behaviors, are explored.

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Muerte Encefálica: Revisión de la literatura y actualización del tema.

One of the most complex situations that neurologists face is brain death. It is a painful state for the patient’s family, but by the other hand, it constitutes the hope for patients waiting for organ donation. Therefore it is essential to have a clear concept to achieve a correct diagnosis and management of this delicate situation.

 

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Emociones y Neurociencia. Una aproximación desde la productividad científica.

The neuroscientific approach to the emotion has been termed affective neuroscience. This multidisciplinary approach has emerged as an influential source of data and theory for the basic, clinical and applied sciences. The aim of this study was to perform a bibliometric analysis over the scientific production in the affective neuroscience field. As in most scientific areas, the scientific productivity in affective neuroscience is lead by North American research centers. Latin-American research in the field is marginal. This asymmetrical observation is a warning to the Latin-American researchers as well as an incentive to improve the scientific productivity in the affective neuroscience field.

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Improving writer’s cramp dystonia after prolonged muscle stimulation. Report of two cases.

Focal primary dystonia has been recognized as a motor disorder; nevertheless, some studies suggest that sensory dysfunction might be involved. We report two patients who improved their writer’s cramp dystonia after deep muscle stimulation using acupuncture needles. We support the hypothesis that deep and prolonged stimulation of muscles related to dystonia can modify the cortical sensory-motor response and improve writer’s cramp.

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Síndrome de POEMS, reporte de un caso con doble patrón monoclonal.

POEMS síndrome is an uncommon multisystemic paraneoplastic disorder characterized by the presence of a predominantly motor polyneuropathy associated with other manifestations like organomegaly, endocrinopathy, monoclonal gammopathy and skin changes. We report a case of a 36 years old female with diagnostic criteria for this disorder, and a particular double monoclonal pattern IgG and IgA type., demonstrated by immunofixation.

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Metástasis orbitaria e intracraneal: primera manifestación clínica de cáncer de tiroides.

Metastatic follicular thyroid carcinoma is very rare. We report a case of a 42 years old patiente with a retro-orbital and intracranial metastases, as first clinical manifestation of thyroid cancer.

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Ciclopía Con Sinoftalmía En Un Feto De 27 Semanas.

Cyclopia is a rare congenital malformation that is non-compatible with life, it is characterized by the presence of a single eye in a central position secondary to alobar holoporsencephaly. The cyclopia is of heterogeneous etiology and has a prevalence of 1,05 per 100.000 births. We report a case of cyclopia with synophthalmia in a fetus at 27 weeks.

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Pseudotumor Inflamatorio del Seno Frontal asociado a Crisis Comiciales.

Inflammatory pseudotumor of the paranasal sinuses is a rare, chronic, benign entity that results in symptoms according to the location of the lesion. Sometimes it can be locally invasive, so it must be distinguished from malignant processes. We report a case of a patient who presented with headache and seizures in whom an inflammatory pseudotumor was diagnosed histologically. To our knowledge there are not documented cases of frontal sinus involvement and associated seizures due to intracranial invasion. The differential diagnosis with other entities is difficult despite imaging studies so the biopsy and pathology are key determinants.

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Schwannoma Intraparenquimatoso Cerebral: Un hallazgo infrecuente, a propósito de un caso clínico.

Schwannomas are benign tumors, representing 8% of all intracranial tumors. Those located in acoustic, trigeminal and facial nerve, represent 90 and 95% approximately. Occasionally they localize in brain parenchyma. At present time, there are only 64 reported cases.

Case report: A 31 years old patient without previous history, consults with frontal headache and abnormal movements, initially diagnosed as seizures. In neuroimaging a left frontal intraparenchymal tumor is described.

Conclusions: Schwannomas are benign tumors unusually localized in brain parenchyma. Treatment consists in total or partial surgical resection, with histological confirmation, and radiotherapy treatment.

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Intoxicación por Monóxido de Carbono, Presentación de un Caso.

A 35-year-old patient experienced 2 months, low levels of carbon monoxide exposure, produced by the motor of his vehicle. He experienced drowsiness in the morning. Because of drowsiness he had an automotomobile accident with traumatic brain injury. The only symptom at the time of neurological examination was anterograde amnesia. The magnetic resonance (MRI) of the brain revealed bilateral necrosis of the globus pallidus. We present this case for prevention of carbon monoxide poisoning and as an example of the utility of MRI and neuropsychological examinations in detecting central nervous system dysfunction secondary to CO exposure.

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De La Equidad y Las Leyes.

Not Available.

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Declaración de Quito.

Not Available.

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Patrones de Perfusión Cerebral en la Epilepsia Rolándica: Formas Típicas y Atípicas.

Introduction: Cerebral perfusion patterns in typical rolandic Epilepsy and its variants remain unknown.

Objective: To describe interictal cerebral perfusion patterns in this Epilepsy and in one of its variants.

Patients and methods: Twenty four children were followed-up for 6 years after their first seizure. Magnetic Resonance Imaging and Single Photon Emission Tomography were performed during follow-up. We investigated for perfusion asymmetries in different cerebral structures using statistical parametric map. The perfusion images were registered whether atypical evolution was diagnosed or if we found some cognitive deficits suggestive of focal cortical lesion.

Results: Seven patients with atypical Benign Partial Epilepsy and seventeen with typical Rolandic Epilepsy were recruited. The vast majorly of the patients showed a cortical hyperperfusion pattern associated with asymmetric hypoperfusion pattern in basal ganglia and thalamus. Patients with atypical Benign Partial Epilepsy showed a well defined different cerebral perfusion pattern characterized by symmetrical hypoperfusion at the level of basal ganglia including thalamus.

Conclusions: Different cerebral perfusion patterns were documented in different variants of Rolandic epilepsy.

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Activador del Plasminógeno tisular, realidad actual. Estudio transversal retrospectivo entre los años 2007-2009 en el Hospital Regional Dr. Teodoro Maldonado Carbo.

Objective: To determine the proportion in which the variables for the administration of tissue plasminogen inhibitor (tPA) are present in the population admitted to a hospital in Guayaquil-Ecuador.

Methods: Cross-sectional study with patients admitted to the Neurology service at the Regional Hospital Dr. Teodoro Maldonado Carbo between January 1, 2007 and December 31, 2009 with diagnosis of acute stroke. The inclusion and exclusion criteria were the same ones used on the guidelines for the use of tPA in patients with stroke during the first 3 hours and between the first 3-4.5 hours of onset.

Results: 550 patients were included in the analysis. 434 patients had ischemic stroke and 116 hemorrhagic stroke. 6 patients arrived to the hospital in the first 3 hours from onset and 13 patients arrived between the 3-4.5 hours from onset. In the first 3 hours, 4 out of 6 patients (66%) were candidates for the administration of tPA and between the first 3-4.5 hours, 6 out of 13 patients (59%) were candidates for tPA.

Conclusions: The majority of the patients that arrived to this hospital; did so after 4.5 hours from the onset of symptoms. If these patients would have arrived earlier, a great proportion could have received a treatment potentially beneficial that would produce a clinical improvement and a better prognosis if the treatment was available in the hospital.

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Esclerosis Multiple en un Hospital del Litoral Ecuatoriano.

Objective: An observational study was conducted in 45 patients with Multiple Sclerosis in a hospital in the Ecuadorian Coast, in order to characterize the disease in our environment.

Methods: During the period of 8 years (2002 – 2010), demographic and clinical characteristics, disability status using the modified Kurtzke, assessment of functional systems and response to immunomodulatory treatment are evaluated.

Results: Of the 45 patients studied 58% were women, the most common age group was between 30 – 39 years. The predominating type was relapsing remitting (RR) followed by secondary progressive (SP). It is determined that the nuclear magnetic resonance (RM) is the complementary method of choice for diagnosis and monitoring of patients and the relapse rate was low using immunomodulatory therapy.

Conclusions: The study suggests that the presentation of the disease in a hospital in the Ecuadorian coast is lower than in the inter-Andean region probably due to demographics or other factors yet to be determined, but that the clinical features, the subtypes of the disease and immunomodulatory treatment response is similar to the series found in countries of the same characteristics.

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Propuesta Pedagógica para la Compensación de la Memoria Viso-Espacial en Pacientes con Secuelas Neurológicas.

During the perception of an object, a complex system of temporary connections, which reflects the links and relationships between objects, their parts and properties in the brain, appears.

Objective: To determine how the designed pedagogical proposal influences in the compensation of the viso- space memory in people with neurological sequels.

Material and method: A pre pedagogical experiment in a group of 20 patients was carried out. A neuropsychological battery was used evaluating visual memory, viso-construction, perceptual and motor speed, care, executive functions and verbal intelligence (NEUROPSI) both initial and final to verify the memory deficit. Results were compared and the percentage is reported.

Results: The studied group age range was between 21 and 55 years. The main feature found was the inaccuracy in the reproduction of the model due to the latent attention deficit. The disorders of the mechanism to fixate memories were one of the greatest difficulties presented. An improvement in each variable was observed.

Conclusion: The designed pedagogical proposal influenced positively the visospace memory compensation in the group of patients under investigation.

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Diabetes Mellitus y Cognición. Estudio Transversal.

Diabetes Mellitus Type 2 is associated with greater impairment of cognitive ability, and abnormalities in brain imaging studies compared with people without diabetes.

Objective: To determine if there is a difference in the score of cognitive function tests Addenbrooke (ACE) and Cognitive Ability Screening Instrument (CASI) among patients with type 2 diabetes and non-diabetics.

Methods: Cross sectional study of patients with a history of more than 5 years of diabetes mellitus type 2, between 45 and 64 years of Outpatient of Endocrinology Department, Hospital Teodoro Maldonado Carbo Guayaquil between September 1 and December 31, 2008, who had the cognitive assessment test: ACE and CASI.

Results: There were a total of 68 patients, of which 60.3% had diabetes mellitus, with an average age of 60 years, of this group: 53.6% were men and 46.3% were women. Hypertension was present in 39%. 14.6% were treated with oral antidiabetic agents and 73.2% with insulin. Glycated haemoglobin (Hb1Ac) was abnormal in 33.8%. With regard to the tests of cognitive assessment: the average score of ACE in diabetic patients was 88. 8 and in non-diabetic patients 90.1 and in the CASI the average was 91.5 in diabetics and 92.5 in non-diabetics.

Conclusions: The score of cognitive function tests Addenbrooke and CASI was lower in diabetics compared to non-diabetics, although there was no significant difference.

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Riesgo de enfermedad cerebrovascular en la fibrilación auricular. Hospital Lenin Enero 2006 – Diciembre 2007.

A case-series was performed in the Emergency Service of the University Hospital V. I. Lenin. The universe of the study was 413 patients in Observation at the Emergency Service of Internal Medicine. Considered as an objective was to determine the behavior of the different clinical, epidemiological and therapeutic variables of the patients with atrial fibrillation and with risk to develop cerebrovascular disease. Of these patients, 165 were selected according to the inclusion criteria. The main results were that the most frequent clinical pattern of presentation was recent diagnosis followed by recurrent and permanent diagnosis and that after 60 years of age the highest risk to develop stroke was in patients with permanent clinical pattern which were not properly protected to prevent it. We concluded that if cerebrovascular disease is to be prevented, then it is necessary to give the patients the proper anticoagulants and antiplatelet medications. We recommend insisting in the application of the protocols of management.

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Sistema de actividades para la compensación de la memoria de trabajo en adultos con ataxia por trauma craneoencefálico.

Introduction: Working memory or operational memory is considered a distinct element of the executive function. Objective: To propose a system of activities that will contribute to the compensation of working memory in adults with Ataxia by craneoencephalic trauma assisted in CIREN.

Material and methods: A pre experiment with a single group was carried out, initial tests were applied to determine the cognitive deficits in the amnesic process, before implementing the strategy, and at the end of the intervention, the results were compared to quantify evolutionary development in the work of clearing of memory in these people with special educational needs.

Results: The results of the diagnostic analysis favored the interpretation of the need to implement corrective treatments – countervailing duties taking into account the allocation of the basic mechanisms of working memory to improve the prognosis of evolution of this amnesic skill.

Discussion: A system of activities is proposed as part of considering the diagnosis as an important element in the corrective compensatory work looking for restoration to the highest possible physical, psychological functioning and social adaptation of persons towards an optimal level of social integration.

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Alteraciones electroencefalográficas en niños con cardiopatías congénitas severas.

Introduction and objectives: Congenital cardiopathies (CC) are among the most common birth defects. Delays of neurodevelopment are among the most frequently observed diseases in school-age children presenting CC. The main objective of this study was to determine the possible impact of severe CC on central nervous system (CNS) development as determined after EEG recording.

Methods: Thirty children of ages between 15 days and 12 years presenting severe CC with hemodynamic consequences and/or chronic hypoxia were studied (21 acyanogenic and 19 cyanogenic). Conventional EEGs were performed on all cases.

Results: In the whole sample we found abnormal EEGs in 43.3% of cases, these mostly showing immature basal activity (slow for the age), and focal and multifocal paroxysmal activity characterised by sharp waves and spikes/slow waves complexes. Abnormal EEG activity was determined in 42.8% of non-cyanogenic CC and 44.4% of cyanogenic CC.

Conclusions: A high percentage of children carrying severe CC showed epiletiform EEG activity. It is possible that in afflicted children resulting from haemodynamic disturbances present from foetal stages onwards, these would favour the development of ectopic growth of grey matter leading to epileptiform activity.

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Violencia en la díada cuidador-paciente en la Enfermedad de Parkinson: Tres métodos de medición.

Background: Violence between caregivers and patients is common and little studied. Their identification and assessment is complex considering the various types available and how they are perceived and reported. The instruments vary in the number of items, level and frequency of acts that constitute a case.

Objective: To determine the prevalence of violence in the caregiver-patient dyad in the context of Parkinson’s disease through three measurement methods, describe the correlation between them and demonstrate the complexity of the assessment of violence.

Methods: Descriptive study, on 46 caregiver-patient dyads selected INNN. They were given a battery composed of: 1. National Survey of Violence against Women (ENVIM), 2. Scale of Abuse Older Adults (EMA). 3. Perception Questionnaire Exercise of Power in Dyads (PEPD).

Results: the average age of participant patients was 62 years, with 50% women. The average age of caregivers was 50 years, with 80% women. Violence prevalence of patients according to ENVIM is 43.5%, patient or caregiver (any) is 60.9%; EMA reports 71.7% and the PEPD 60.9%. Mutual violence is present in 26% of dyads according to ENVIM. Correlations were found between the scales ranging from 0.32 to 0.78.

Conclusions: Prevalence of violence is higher than what is reported in international literature and the ENVIM. Correlations between the instruments utilized in this study are sensitive and show that multiple question assessments avoid underreports.

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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria. RESUMEN.

Not Available.

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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 1: Introducción.

Not Available.

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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 2: Valoración prequirúrgica.

Not Available.

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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 3: Cirugía de la Epilepsia Farmacorresistente.

Not Available.

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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 4: Unidades Multidisciplinares de Epilepsia y Cirugía de la Epilepsia.

Not Available.

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Miopatías asociadas al uso de estatinas: Un enfoque actual.

Statins are the drugs of choice for the treatment of hyperlipidemia, cardiovascular disease, and coronary disease, among others. Their safety and tolerance allows its use on multiple branches in medicine. However, its long- erm use is associated with adverse effects that affect the quality of life of patients, and therefore, their adherence to treatment. Among these, myopathies are described. They represent a variety of clinical presentations ranging from mild myalgia to fatal rhabdomyolysis. In this literature review, the safety of statin use is assessed objectively in order to determine what attitude should be taken regarding the therapy for muscle disorders.

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Utilidad del doppler transcraneal en la evaluación del stroke criptogénico.

Cryptogenic stroke accounts for 40% of patients with ischemic stroke and it is considered that in which after conducting a thorough investigation, a cause cannot be determined. For several years there has been a close association between cryptogenic stroke and paradoxical embolism through right-to-left shunt, which occurred specially in patients with patent foramen ovale (PFO), whose prevalence is significantly higher in patients with cryptogenic stroke than in patients with stroke of a definite cause. The study of this type of cardiac abnormalities has been strengthened today with the advent of new technologies including transesophageal echocardiography (TEE) which remains the gold standard in the diagnosis of PFO, however, there are increasing reports of the usefulness of transcraneal doppler in the evaluation of these patients in a way that makes its recommendation comparable to TEE. This review is intended to expand the knowledge available on this specific procedure according to the current existing evidence.

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