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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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,

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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Palabras clave: estimulación magnética trascraneal, estimulación trascraneal no invasiva, HAM/TSP, HTLV-I, SIDA, tracto piramidal, VIH,

Keywords: AIDS, HAM/TSP, HIV, HTLV-I, noninvasive transcranial stimulation, pyramidal tract, SIDA, transcranial magnetic stimulation,

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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Palabras clave: avances en TOC, modelos integradores, tratamientos combinados,

Keywords: advances in OCD, combined treatments, integrated models,

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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Palabras clave: Adicción, Historia de las Drogas, Neuropsiquiatria de las Drogas, Vulnerabilidad,

Keywords: Accessory spinal nerve, Addiction, electromyography, Electroneurography, History of Drugs, Nerve injury, Neuropsychiatry of Drugs, Vulnerability,

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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Palabras clave: diagnóstico, donación de órgano, manejo, Muerte encefálica,

Keywords: Brain death, diagnosis, management, organ donation,

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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Palabras clave: Neurociencia Afectiva, productividad científica,

Keywords: Affective Neuroscience, scientific productivity,

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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Palabras clave: Calambre del escribiente, Estimulación muscular profunda, Nuevo enfoque,

Keywords: Deep muscle stimulation, New approach, Writer’s cramp,

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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Palabras clave: electroforesis de proteínas, gammapatía monoclonal, paraneoplásico, polineuropatía, Síndrome de Crow- Fukase, Síndrome de POEMS,

Keywords: Crow-Fukase syndrome, monoclonal gammopathy, paraneoplastic, POEMS syndrome, polyneuropathy, protein electrophoresis,

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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Palabras clave: Ciclopía, holoprosencefalía alobar,

Keywords: alobar holoprosencephaly, Ciclopia,

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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Palabras clave: Crisis comiciales, Granuloma de células plasmáticas, Pseudotumor inflamatorio, Seno frontal, Senos paranasales,

Keywords: Frontal sinus, Inflammatory pseudotumor, Plasma cell granuloma, Seizures, Sinuses,

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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Palabras clave: radioterapia, Schwannoma, tumores intraparenquimatosos,

Keywords: intraparenchymal tumors, radiotherapy, Schwannoma,

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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Palabras clave: ganglios basales, Monóxido de carbono, neuropsicología, RM,

Keywords: basal ganglia, Carbon monoxide, MRI, neuropsychology,

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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Palabras clave: deterioro cognitivo, Epilepsia Parcial benigna de la Infancia, Epilepsia Rolándica, perfusión cerebral, puntas centro-temporales, SPECT,

Keywords: atypical Benign Partial Epilepsy, centro-temporal spikes, cerebral perfusion, cognitive impairment, rolandic epilepsy, SPECT,

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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Palabras clave: Ictus, isquemia, tPA,

Keywords: ischemia, stroke, tPA,

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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Palabras clave: desmielinización, esclerosis múltiple, terapia inmunomoduladora,

Keywords: demyelination, immunomodulatory therapy, multiple sclerosis,
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