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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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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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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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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Cambios Fisiológicos en el Sueño.
Not available.