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The present review offers a revision of neuropsychological assessment and the contribution that it makes to the diagnosis, prognosis, and treatment of various medical, neurological and psychiatric disorders. Neuropsychological assessment provides the clinician with information regarding the interaction between the patients’ neurologic, psychological and behavioral functioning, which frequently determines clinical management and outcome. This revision presents a summary of the contribution of neuropsychological assessment as a useful clinical tool, with the goal of helping clinicians determine the utility of such an assessment for individual patients.

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Encefalomielitis Aguda Diseminada: Formas de Presentación y Espectro Clínico. Serie de Casos.

Acute disseminated encephalomyelitis is an inflammatory demyelinating disease of the central nervous system. Although it often follows an infection or immunization, there are some cases without previous history. It develops usually as a monophasic disease, however recurrent and multiphasic cases have been reported. Its diagnosis is suggested based on clinical features, magnetic resonance imaging and negative complementary test results. We report 5 cases of acute disseminated encephalomyelitis illustrating its wide clinical and prognostic variety. Both mild and significant cases are reported. A previous history of infection was present only in one case. No patient developed symptoms suggesting multiple sclerosis during an 18 to 48 months follow-up. Conclusions: Acute disseminated encephalomyelitis is an uncommon condition that presents with a variety of symptoms. The major differential diagnosis is MS; however other demyelinating and infectious processes must be included. Treatment options include intravenous corticoids, immunoglobulins or plasmapheresis. The patient’s response to treatment is proportional to the prognosis.

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Palabras clave: Encefalomielitis aguda diseminada, esclerosis múltiple,

Keywords: Acute disseminated encephalomyelitis, multiple sclerosis,

Síndrome de Moyamoya en un niño con Drepanocitosis.

Sickle cell disease is one of the main causes of ischemic stroke in the childhood, generally related with stenosis of the arteries of the anterior carotid circulation. We present the results of the studies carried out in a patient with sickle cell with no history of stroke, in treatment with hidroxyurea. Transcraneal Doppler and Magnetic Resonance Imaging demonstrated the existence of stenosis in medial cerebral arteries and a Moyamoya pattern in the cerebral circulation with hemodynamic ischemic lesions.

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Palabras clave: Doppler transcraneal, Drepanocitosis, enfermedad cerebrovascular, Hematología, Ictus, Moyamoya,

Keywords: Cerebrovascular disease, Hematology, Moyamoya, Sickle cell disease, stroke, Transcraneal Doppler,

Sindrome parkinsoniano “rígido-acinético” debido a mielinosis extrapontina y mielinosis pontina asintomática secundarios a corrección rápida de hiponatremia.

The osmotic demyelinating syndromes are not always restricted to the pons. The extrapontine myelinolysis is seen in 10% of patients with central pontine myelinolysis. We present a 62-year-old woman who developed hyponatremia due to repeated vomiting. An acute akinetic-rigid syndrome followed rapid correction of hyponatremia. Bilateral putaminal and caudate lesions were seen on MRI. There were no clinical features of pontine involvement even though a typical lesion was seen on MRI. She recovered well with only symptomatic treatment. Although the exact pathogenesis is unknown, the most widely accepted hypothesis is that cellular edema secondary to the fluctuating osmotic forces, with rapid correction of hyponatremia, results in fibre-tract compression and demyelination. In contrast to the generally expected poor outcome in this condition, patients do have good recovery with symptomatic treatment and good nursing care.

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Palabras clave: Enfermedades desmielinizantes, Extrapontino, Hiponatremia, Mielinolisis, parkinsonismo, Puente,

Keywords: Demyelinating disease, Extrapontine, Hyponatremia, Myelinolysis, parkinsonism, Pons,

La Formación de los Neurólogos del Siglo 21.

Not available.

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Tamaño de Muestra a Considerarse en un Estudio de Resonancia Magnética Funcional (RMF) con un Equipo de Resonancia Magnéticade 1.5 T.

This work presents an analysis of the necessary tools and special considerations to develop investigation in brain using fMRI with a magnetic resonator of 1.5 T field. This work presents the sample size and the necessary task time to use for showing results.

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Palabras clave: 1.5 Teslas, Procesamiento digital de imágenes, resonador magnético, resonancia magnética funcional, tamaño de muestra,

Keywords: 1.5 Tesla magnetic resonance, Digital image processing, functional magnetic resonance, sample size,

Raíz Conjunta Lumbo Sacra Simulando Hernia Discal.

MRI examinations of lumbosacral region during eleven years were included to determine frequency of imaging similarity between an extruded discal fragment and a conjoint root. In 7,117 studies included in our casuistic we detected conjoint root in 175 (2.4 %), resembling an extruded discal fragment which is usually well shown by MRI but in our observations corresponded to a conjoint root. Bibliography related with conjoint root was reviewed. Our conclusion support that MRI is the method of choice to differentiate a conjoint root from an extruded discal fragment.

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Palabras clave: Hernia Discal, Raíz Conjunta,

Keywords: conjoined nerve root, disk herniation,

Análisis Demográfico Comparativo de Pacientes Adultos con y sin Enfermedad Neurológica que Asisten a una Consulta Externa de Neurología en Guayaquil, Ecuador.

Background: Studies carried out in European countries suggest a high prevalence of patients consulting for non-neurological conditions among persons evaluated in outpatient neurologic clinics. However, there is no information on the prevalence of such patients in developing countries.

Objective: To describe the demographic profile of patients with and without neurologic symptoms evaluated at an outpatient neurologic clinic in Guayaquil. Methods: Cohort of 7,519 adults evaluated over a 20-year period. We evaluated data concerning age, gender, year of first evaluation, reason for consultation, diagnosis, complementary neurodiagnostic tests, and follow-up. Patients were classified into three groups according to their main complain: neurologic patients, psychiatric patients, and persons with non-specific clinical manifestations.

Results: Neurologic diseases were found in 6,764 (90%) patients, psychiatric disorders in 186 (2.5%) and non-specific complaints in 569 (7.5%). Non-neurologic patients were younger than those with neurologic diseases (p<0.0001). The smallest prevalence of women was found among persons with non-specific complaints (p=0.017). We noted a lower prevalence of nonneurologic patients during the years that our country experienced a economic crisis. About 50% of patients with psychiatric disorders, and 30% of persons with non-specific complains had one or more neurodiagnostic tests, which did not modify the therapeutic approach in any case. In most cases, those exams were requested by the patients themselves.

Conclusions: The prevalence of non-neurologic disorders in our series is smaller than that reported from European studies, and their demographic profile is somewhat different. There are some characteristics of patients in our population that may account for such differences.

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Sistema de Actividades para la Compensación del Déficit Motor de las Habilidades Manipulativas en Pacientes con Parálisis Cerebral Adulta.

Cerebral palsy is the commonest cause of motor disability. Under this term are grouped people with special educational needs, who have in common a persistent disorder of tone and movement due to a non-progressive brain injury. Although cerebral palsy affects muscle movement, it is not caused by problems in the muscles or the nerves, but by abnormalities in brain impairing its ability to control movement and posture. In order to assess the influence of activities for the prefunctional motor deficit of manual abilities in patients with cerebral palsy, a therapeutic intervention was applied to 15 patients (7 men and 8 women) who had motor disorders in upper limbs. A quasi experimental 60 days study, conceived by 2 hours daily treatment was carried out. Initial and final qualitative functional scales of hands were applied to compare results. This novel therapeutic system influenced positively in the recovery of lost abilities as was statistically demonstrated.

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Palabras clave: Compensación, Déficit Motor, Escala Cualitativa para la funcionalidad de las manos, Habilidades Manipulativas, Parálisis Cerebral Adulta, Sistema Terapéutico,

Keywords: Cerebral Palsy Adult, Compensation, Manipulative Skills, Motor Deficit, Scale Qualitative for the Functionality of Hands, Therapeutic System,

Adaptación del Test de Colores y Palabras de Stroop: Su Importancia en la Detección Precoz de los Déficits en las Funciones Ejecutivas.

Neuropsychological assessment is increasingly used as complementary diagnostic test for different brain pathologies, and Portugal is not an exception. Therefore urges that the instruments used for the evaluation present adequate psychometric criteria and normative data adjusted to the same population. Aging is a dynamic and progressive process, leading to greater vulnerability and incidence of pathological processes. Within these processes included neurodegenerative diseases, the most common, Alzheimer’s Disease.1 Executive functions seem to be the most involved in the overall functioning of the individual and the Stroop Test, is frequently used to evaluate these functions. We present a study of adaptation of this instrument in a Portuguese sample, trying to verify the importance of sociodemographic variables on test performance and whether there were significant differences between healthy subjects and with neuropathology. The results have allowed verifying the importance of adaptation of populations where tests are used. Thus, the Stroop Test seems a test to take into account when establishing a neuropsychological evaluation protocol, as well unlike the patterns of performance between normative and pathological aging.

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

Keywords: Alzheimer’s Disease, Executive functions, Normal aging, Stroop Color and Word Test,

Intervención Neurolingüística en la Respiración y la Voz en Pacientes con Lesiones Estáticas Encefálicas Portadores de Trastornos Disártricos.

Objective: To prove the effectiveness of the neurolinguistic rehabilitation program for dysarthric patients, applied at the Encephalic Static Lesions Adults Clinic, International Center of Neurologic Restoration, in voice and breathing areas. It is a single sample pre-experiment obtained from logopedic records, contrasting them with the results of the external diagnosis, application of therapy and final evaluation.

Results: Males were prevalent and encephalic trauma as clinical diagnosis, there was great dispersion in age and time of evolution. Of the 54 patients, 40 increased their spirometric index: 22 the inspiration puff; 39 phono-respiratory coordination: 36 modified intensity; 11 tone; 18 modified their stamp vowel. The results evidence efficient functional recovery after the program was applied.

Conclusions: It was confirmed that there is not such established recovery pattern: none of the different variables influences significantly, the dispersion of the results is overwhelming and it is only possible to talk about tendencies. The program is effective but it cannot be affirmed that this variant is the correct one: more emphasis should be given to vocal indicators, other respiratory dimensions that are used should be measured as they have functional connotation.

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Palabras clave: disartria, intervención neurolingüística, Lesiones estáticas encefálicas,

Keywords: dysarthria, Encephalic static lesions, neurolinguistic intervention,

Trastornos del Sueño: Conocimiento de Apnea Obstructiva del Sueño en Médicos no Neurólogos y su Manejo Perioperatorio.

Objective: Obstructive sleep apnea syndrome (OSA) is a common sleep-related disorder that has been associated with a higher perioperative risk. Our purpose is to determine the level of knowledge and attitudes towards OSA among surgeons and traumatologists, knowing their important role in the prevention of potential perioperative complications in these patients.

Material and Method: Crosssectional survey study, using the “Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire” (OSAKA), administered to 105 surgeons and traumatologists and 27 surgery residents to measure the level of knowledge and attitudes towards OSA.

Results: Knowledge scores ranged from 3 (14%) to 17 (81%). The mean value for surgeons and traumatologists was below 62% (p=0.04), and lower than 48% (p=0.02) for residents. There is a positive correlation between the level of knowledge and the importance of identifying patients with OSAS (r = 0.26), and the confidence in themselves to identify this patients (r = 0.38). There was a negative correlation between knowledge and years of practice (r= -0.23).

Conclusion: Obstructive Sleep Apnea Syndrome is widely unknown among Surgeons and Traumatologists from Guayaquil. We recommend educational interventions that improve the level of knowledge and promote the use of guidelines in the management of patients in the perioperative period to decrease the risk of complications.

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Palabras clave: Apnea Obstructiva del Sueño, aptitud, Conocimiento, cuestionario,

Keywords: attitude, Knowledge, Obstructive Sleep Apnea, questionnaire,

The Impact of Rheumatoid Arthritis in Neuropsychology, Depression and Anxiety. A Case-Control Study, with 90 Portuguese Female Subjects.

Objectives: The study of the impact of Rheumatoid Arthritis in cognitive functions has not been well documented in Portugal. So, with this original article we tried to clarify this reality in this particular country.

Methods: We assessed the results of 45 Rheumatoid Arthritis female patients (intervention group), comparing each patient in a case control paired strategy (years in school and age), with control subjects (n = 45, in a total of 90 subjects). All subjects were evaluated with Paced Auditory Selective Attention Test, Word List Generation Test, Luria Nebraska Neuropsychological Battery, a Portuguese depression screening test (IACLIDE), STAI (anxiety trace and trait test) and the Mini Mental state examination.

Results: The results show, for the first time in Portuguese patients, the presence of major deficits in terms of cognitive function and symptoms of depression and anxiety.

Conclusion: This article strengthens the argument of the necessity to pay attention in psycho-educational, psychotherapeutic and cognitive stimulation as well as neuropsychological intervention in these types of patients.

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Palabras clave: ansiedad, depresión, enfermedades inflamatorias reumáticas, evaluación neuropsicológica,

Keywords: anxiety, depression, inflammatory rheumatic diseases, Neuropsychological assessment,

Esclerosis Lateral Amiotrófica: Criterios de El Escorial y la Electromiografía en su Temprano Diagnóstico.

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease of unknown etiology characterized by death of motor neurons. In the last 20 years, over 25 ALS genes were discovered. 10% of cases are considered to be familial cases (FALS) with the majority inherited as autosomal dominant. In Western countries, ALS is considered an adult onset disease with a mean age of 65, while in developing countries onset is approximately 10 years earlier. Similarly, survival is reportedly on average 9 months less in South America compared to Europe and North America. ALS is more frequent in males than females with an incidence in Europe and North America of 1.5 to 2.7 cases per 100,000 individuals and a prevalence of 2.7 to 7.4 (/100,000 individuals). Preliminary studies in the Caribbean and South America suggest a lower incidence of ALS in these regions. The diagnosis of ALS is based on signs and symptoms of degeneration of upper and lower motor neurons, the absence of alternative explanations, and progression of symptoms. Electrophysiology is essential for early diagnosis, in addition to other neuroimaging and laboratory tests. In this review, we summarize the literature concerning the El Escorial criteria for diagnosis and the electromyography.

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El Estrés Crónico, ¿Factor de Riesgo para la Enfermedad de Alzheimer?

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder, with epidemiological importance due to the high prevalence of people affected worldwide. Over time, various hypotheses have been raised in the pathophysiology and etiology of the disease and now the study of this disorder, is tackled from a multi-causal perspective, taking into account different etiological factors, among which are: genetics, oxidative stress, intracellular calcium dynamics, vascular effects, inflammation and stress, among others. The following literature review, aims to show studies that correlate stress as a risk factor in AD, recognizing the pathophysiological findings of AD, due to augmentation on glucocorticoids by chronic stress and the subsequent alteration of the hypothalamic-pituitary-adrenal axis. Critical view of these findings according to the literature.

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Palabras clave: depresión, Eje hipotálamo-hipófisis-adrenal, Enfermedad de Alzheimer, estrés, Glucocorticoides, ovillos neurofibrilares, proteína tau,

Keywords: Alzheimer’s Disease, depression, Glucocorticoids, hypothalamic-pituitary-adrenal axis, neurofibrillary tangles, stress, tau protein,

Neurobiología del Estrés Agudo y Crónico: Su Efecto en el Eje Hipotálamo-Hipófisis-Adrenal y la Memoria.

The presently available data about stress and its effects is too broad. That’s why this paper will focus on the effect of stress hormones in some brain areas, like limbic structures and the hypothalamo-pituitary-adrenal axis. In this way we will discuss how repetitive stress can change those areas, mainly by the effect on its two types of nuclear receptors, changing the basal activity of the amygdala, hippocampus and the medial prefrontal cortex, resulting in an increased hypothalamo-pituitaryadrenal axis function and impairing cognitive functions like memory. However, the exact mechanism by which these effects are produced is poorly understood. That is why one of the challenges for future research is to link the cellular changes with its behavioral effects in order to understand how it works in a living organism.

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Palabras clave: Eje hipotálamo-hipófisis-adrenal, Estrés crónico, Glucocorticoides, Memoria, Potenciación sináptica a largo plazo,

Keywords: Chronic stress, Glucocorticoids, Hypothalamo-pituitary-adrenal axis, Long-term synaptic potentiation, Memory,

Consideraciones en la Monitorización Intraoperatoria del Nervio Facial.

Currently, intraoperative facial nerve monitoring practice is considered a complementary part during surgery of cerebellopontine lesions and skull base surgery to decrease the likelihood of functional and aesthetic sequelae. It is therefore essential to understand the main technical and neurophysiological aspects for appropriate performance. Intraoperative monitoring requires joined efforts of neurosurgeon, otologist, neurologist and neurophysiologist to increase the chances of success.

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Palabras clave: ángulo ponto cerebeloso, nervio facial, neurocirugía,

Keywords: cerebellopontine angle, facial nerve, neurosurgery,

Disfagia en el Paciente con Enfermedad Cerebrovascular.

Dysphagia in patients with cerebrovascular disease is a common problem that is associated with increased rates of pneumonia, malnutrition, hospital stay and mortality. A literature search was conducted in MEDLINE and Cochrane Library for recommendations for assessment and management of dysphagia in patients with stroke. Because the evidence is poor in quality, hence doubtful, there are no clear guidelines. Emerging data suggest that the implementation of a protocol for early screening and management of dysphagia improves the prognosis of these patients. Further studies are needed to provide reliable evidence to make valid recommendations.

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Palabras clave: enfermedad cerebrovascular, técnicas y procedimientos diagnósticos, Trastornos de deglución,

Keywords: deglutition disorders, diagnostic techniques and procedures, stroke,

Demencia y Parkinsonismo como Síntomas Iniciales en un Paciente con SIDA.

Dementia and Parkinsonism as early symptoms of AIDS are infrequent. We report the case of a male patient 62 years old, with a history of diabetes – insulin dependent and illicit drug use, who began his symptomatology with dementia and parkinsonism two months before his death.

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Palabras clave: demencia, parkinsonismo, SIDA, VIH,

Keywords: AIDS, dementia, HIV, parkinsonism,

Enfermedad de Osler-Weber-Rendu y Neuroinfección: A Propósito de un Caso.

A 68 years old man with a previous diagnostic of Hemorragic Hereditary Telangiectasia (HHT) or Osler-Weber-Rendu Syndrome has been transferred to the emergency room of Metropolitano´s Hospital of Quito because of altered mental status, fever and nuchal rigidity. Complementary studies reported images of ventriculitis and left temporal abscess.

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Palabras clave: absceso cerebral, Sindrome de Osler-Weber-Rendu, THH, Ventriculitis,

Keywords: Cerebral abscess, HHT, Osler-Weber-Rendu Syndrome, Ventriculitis,

Epilepsia Parcial Benigna Atípica de la Infancia: Presentación de un Caso Peculiar y Revisión de la Bibliografía.

Introduction: Atypical benign partial epilepsy of childhood is a rare form of epilepsy characterized by a combination of partial seizures, as observed in Partial Benign Epilepsy of Childhood, as well as with centre-temporal paroxysms and generalized seizures; showing furthermore, a continuos peak wake electroencephalographic pattern characteristic of NREM sleep.

Clinical Case: Patient presenting with partial seizures is admitted to the hospital with EEG findings compatible with continuos peak wave electric status of NREM sleep.

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Palabras clave: Electroencefalograma, Epilepsia, Infancia, Sueño,

Keywords: childhood, electroencephalogram, Epilepsy, sleep,

Enfermedad de Creutzfeldt-Jakob. Presentación de un Caso Clínico y Revisión de la Literatura.

Creutzfeldt-Jakob disease is the prototypic rapidly progressive dementia. Esporadic CJD is the most common presentation. We report a 65 year-old patient with primary visual complaints, afterward psychosis with memory and higher cerebral functions complaints. After 4 months of evolution, the patient showed akinetic mutism and myoclonus. In the MRI, anormal hyperintensity was seen on T2 sequences in the subcortical and cortical regions of the occipital lobes. EEG revealed periodic generalized triphasic waves. We present this patient with the Heindenhain variant of sporadic CJD, in order to consider it when were are faced with a patient with rapidly progressive dementia (RPD). We emphasize the importance of early diagnosis for prognostic value and for minimize the risk of accidental iatrogenic transmission.

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Palabras clave: Demencia rápidamente progresiva, Enfermedad de Creutzfeldt-Jakob, Transmisión iatrogénica, Variante de Heidenhain,

Keywords: Creutzfeldt-Jakob disease, Heindenhain Variant, Iatrogenic transmission, Rapidly progressive dementia,

Investigación y Universidad.

Not available.

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The “8-foot Up and Go” Test as a Physical Performance Measurement in Parkinson’s Disease: A Pilot Study.

Blackground: Parkinson disease (PD), is a movement disorder, so physical assessment should be a key component in the diagnosis of individuals suffering from this disease. There is a neeed to assess the utility of some motor tests in PD, specially those which include assessment of straight line walking and turning.

Objective: This pilot study aimed to asses the utility of the “8-foot up and go” test as a physical performance measurement in PD, as well as the relationship between functional mobility and quality of life in this population.

Material and Methods: Twenty-four patients with a diagnosis of idiopathic Parkinson’s disease volunteered and finished the study. They performed the “8 foot up-and-go” test and answered the 9-item Parkinson’s Disease Questionnaire.

Results: The motor test’s total score correlated significantly with different sub-scales of the 9-item Parkinson’s Disease Questionnaire, especially with the mobility sub-scale and with the total score.

Conclusions: The “8 foot up-and-go” test is useful and easy to perform by Parkinson’s disease patients and it has turned out to be a clear indicator of the way the illness affects their quality of life.

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Palabras clave: actividad física, calidad de vida, enfermedad de Parkinson, fitness, test motor,

Keywords: fitness, motor test, Parkinson’s disease, physical activity, quality of life,

Efectos de la Subtalamotomía en la Inducción o Modificación de Disquinesias en Pacientes con Enfermedad de Parkinson Idiopática.

We performed a longitudinal, analytic and retrospective study in order to evaluate the effect of subthalamotomy in the induction or modification of dyskinesias in patients with Parkinson’s disease. Was study the motor behaviour, the cardinal features of Parkinson’s disease, the mean daily Levodopa dose and the dyskinesias induced by Levodopa or subthalamotomy in 50 patients with Parkinson’s disease that were operated between 1995 and 2005 in our center. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at least for one year. Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol. In our study the cardinal features of the disease improved in more than 50 %, it were evaluated through the Unified Parkinson’s Disease Rating Scale (UPDRS), as well as the mean daily Levodopa dose was reduced by 40% compared with baseline. The dyskinesias induced by Levodopa were reducing too, and we think that it’s not explainable only for the reduction of the Levodopa dose. Subthalamotomy induced contralateral dyskinesias in approximately 50% of our patients but were generally mild and short lasting. The risk of persistent and severe dyskinesias postoperative was smallest. This study indicates that the presence of severe preoperative dyskinesias and the dorsal location of the lesion are relevant for the development of chorea after subthalamotomy in patients with Parkinson’s disease. These find must to be confirm in a prospective randomized study.

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Morphological Changes Induced by Three Aminoglycosides on the Cochlear Stria Vascularis.

Aminoglycosides are efficient antimicrobials commonly used in clinical practice. Their effects on the cells of the organ of Corti and the spiral ganglion neurons have been extensively studied. However, there are only a few reports concerning aminoglycoside-induced morphological changes on the stria vascularis. The purpose of this study was to describe morphological and morphometrical changes on the rat stria vascularis after a profound sensorineural hearing loss induced by three aminoglycosides (kanamycin, gentamicin and amikacin) followed by furosemide. To analyze the stria vascularis area and the number of blood capillaries per stria vascularis, cochleae from fourteen rats sampled at eight weeks after deafness and from four control animals were processed. Serial semi thin cochlear sections from the apical, upper middle, lower middle and basal turns were examined under a light microscope. The cochlear damage degree depended on the aminoglycoside. Mean stria vascularis areas for both kanamycin and gentamicin groups were lower than controls. The mean number of blood capillaries per stria vascularis was reduced for the three aminoglycoside-deafened groups as compared to control animals. For both variables, the most severe damage was observed for gentamicin-deafened animals, followed by kanamycin and amikacin.

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Palabras clave: aminoglucósidos, capilares sanguíneos, cóclea, estría vascular, ototoxicidad,

Keywords: Aminoglycosides, blood capillaries, cochlea, ototoxicity, stria vascularis,

Efectos del Tratamiento Rehabilitador y el “Treadmill” en Pacientes con Ataxia.

Ataxia is a syndrome related to gait disorders that makes necessary a wide range of possibilities in rehabilitation in order to improve the disorder. The treadmill can be useful because it combines motor learning and sensory tricks. This study included 15 patients with ataxia from CIREN clinic. Treatment including treadmill was applied in 30 sessions, one hour each one. Motor function was evaluated pre and post treatment using ICARS scale, velocity, number and width of paces and Hausser index. Comparing results before and after intervention showed statistically significative improvement in ICARS scale and LEIS (p<0.001 and p<0.041 respectively). Rehabilitation treatment including treadmill has favorable effects over gait disorders in patients with ataxia.

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Palabras clave: evaluación., marcha, Treadmill,

Keywords: evaluation, gait, treadmill,

Neurofobia entre los estudiantes de la Carrera de Medicina de sexto a décimo semestre en la Universidad Católica Santiago de Guayaquil.

Background: Neurophobia is defined as fear to neuroscience and clinical neurology. By the impact of neurological diseases worldwide, management of these disorders could be affected. No data exist of this phenomenon in Ecuador. Objectives: To evaluate the difficulty, knowledge, confidence and interest in neurology, neuroscience specialties, affinity factors for difficulty in neurology and neurological training among medical students.

Methods and Materials: A descriptive study was conducted at the Catholic University of Santiago de Guayaquil, surveying: difficulty, knowledge, confidence and interest among specialties; affinity to neuroscience as a specialty, factors contributing neurology´s perception as difficult, and neurological undergraduate training.

Results: The response rate was 78.32% (401/512). Neurology was the most difficult (3.01±0.048), the second with less clinical confidence (2.01±0.056), and third with less knowledge (1.96±0.058). The differences were significant (p <0.001). 70.82% did not plan to pursue a specialty related to neuroscience, 59.85% for absent personal affinity; 10.97% for poor teaching; Contrary, 29.18% want a related specialty in neuroscience, 19.95% by personal affinity and 9.23% for good teaching. Need to know basic neuroscience was the most important for the perception of difficulty (2.76±0.055) followed by poor teaching factor in neurological involvement (2.68±0.57). Training in Neurological Semiology the lowest (1.70±0.061) followed by Neuroanatomy (1.98±0.58) and Neurology (2.52±0.81). Neurologic semiology had the highest percentage of inadequate training (20.45%) compared to Neuroanatomy (9.47%) and Neurology (6.16%).

Conclusions: There is neurophobia among our students. Research and modifications in teaching must be developed to prevent neurophobia and contribute to “neurophilia.”

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Palabras clave: Ecuador, Educación Basada en Evidencia, Enfermedades Neurológicas, Estudiantes de Medicina, Neurofobia,

Keywords: Evidence Based Education, Medical Students Ecuador, Neurological Diseases, Neurophobia,

Desarrollo Psicomotor y Variables Medioambientales en Dos Poblaciones del Ecuador.

Objective: To determine the influence of some environmental variables associated with psychomotor development in children from an indigenous community and mestizo community in Ecuador. Material and methods: For the observation and measurement of variables were used EEDP scale and a registration form of environmental factors. Data was analyzed using logistic regression test. The methods of observation and measurement of variables through the EEDP scale and a registry of environmental factors were used. Data was analyzed through a logistic binary regression. X2 omnibus test was applied; the same statistician was estimated by the Hosmer-Lemeshow test with global adjustment. Also, it was estimated -2 log likelihood (-2LL) in order to check the veracity of the results, the Cox and Snell R2, Nagelkerke R2 and Wald statistic. Results: The findings indicate that some of the independent variables were related to motor development and coordination in the populations studied. Furthermore, it was found that breastfeeding and type of housing have influence in the social and language development of both populations.

Conclusions: Only some of the studied variables exert influence on psychomotor development of two populations: breastfeeding, age and housing type.

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