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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Perfil de efectividad y seguridad de preparaciones orales de cannabis para el tratamiento de epilepsias refractarias en la población infantojuvenil. Una revisión de alcance. Effectiveness and safety profile of oral cannabis preparations for the treatment of refractory epilepsies in infant-young population: A Scoping Review

Introduction: Refractory epilepsies (RE) are a common neurological condition expressed in childhood and adulthood, highlighting the current use of cannabis as an alternative treatment. Oral Cannabis Preparations (OCP) have demonstrated effectiveness in the adult population; however, knowledge is limited in the infant-young population.

Aim: To synthesize the available evidence on the efficacy and safety of OCP for the treatment of refractory epilepsies in the infant-young population.

Methods: The present study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and included studies from January 2013 until December 2020 from electronic databases, including SciELO, ScienceDirect, PubMed, and Web of Science.

Results: 7 articles were included in this scoping review for critical analysis. The results indicate that pharmaceutical and artisanal origin OCP has 41.3% effectiveness in reducing seizures and low safety after administration (≤ 27.4%). Likewise, after administration, the most frequent adverse symptoms were somnolence/fatigue, weight loss/decreased appetite, and irritability/aggressiveness.

Conclusion: The low levels of effectiveness and safety of OCP suggest that they should be administered with caution and as a complementary treatment and not as the first choice for managing RE in the infant-young population.

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Palabras clave: Cannabidiol, Cannabis, Crisis convulsiva, Epilepsia refractaria, Revisión de Alcance,

Keywords: Cannabidiol, Cannabis, Refractory epilepsy, Scoping Review, Seizures,

Hemorragia en área dependiente de circulación cerebral posterior por síndrome de hiperperfusión tras stenting en arteria carótida interna. Hemorrhage on a dependent area of posterior cerebral circulation due to hyperperfusion syndrome after stenting in internal carotid artery

Cerebral hyperperfusion syndrome (CHS) after stent placement has a low incidence, between 0.37- 1.9% (1,2). We present a case of CHS due to recanalization in right internal carotid artery (ICA) which, contrary to expectations, produces a hematoma on a dependent area of the posterior cerebral circulation. Through the clinical case, we proceed to delve into the CHS and the characteristics that give the patient a higher risk. In addition, we expose the potential usefulness of the neurosonological study of inter-individual variability for better perioperative management. In this way, we can ensure a good therapeutic approach that minimizes morbidity and mortality as much as possible.

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Palabras clave: Hemorragia intracerebral, Neurorradiología, Síndrome de hiperperfusión cerebral, Stent, Tálamo,

Keywords: Cerebral hyperperfusion syndrome, Intracerebral hemorrhage, Neuroradiology, Stent, Thalamus,

Neuropatía craneal múltiple: Posible asociación a infección por HTLV 1. Multiple cranial neuropathy: Possible association with HTLV 1 infection

Human lymphotropic virus type 1 (HTLV 1) is an oncoretrovirus that chronically and persistently infects T lymphocytes; which can cause serious neoplastic or inflammatory diseases, however, most are asymptomatic and only a small number of patients develop the disease. Although this virus particularly affects the hematological system in the form of T-cell leukemia or lymphoma, the nervous system is also an important target, both the central and peripheral components. In recent years, different associations have been found between this viral infection and multiple neuroinflammatory pathologies such as encephalitis, motor neuron diseases, polyneuropathies, cranial neuropathies and even myopathies, enriching the syndromic spectrum of this entity. On this occasion, the clinical particularities of a rare and possible association between HTLV 1 and multiple cranial neuropathy expressed in a patient managed in a tertiary care hospital in Cali, Colom bia will be described.

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Palabras clave: HTLV-1, Neuropatía craneal múltiple, paraparesia espástica tropical,

Keywords: HTLV-1, multiple cranial neuropathy, tropical spastic paraparesis,

Síndrome de cabeza caída en Miastenia gravis tras una infección por SARS-CoV2. Dropped head syndrome in Myasthenia gravis after a SARS‐CoV2 infection

Objective: To report a case with an unusual presentation of myasthenia gravis after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and literature review.

Method: We report a case of a patient with head drop and a postsynaptic myasthenic syndrome after a SARS-CoV-2 infection and a retrospective review of the literature of all the reported cases of myasthenia gravis de novo associated with SARS-CoV2 infection from march-2020 to september-2022. Written informed consent was obtained from the patient for publication of this case report and accompanying images or videos.

Conclusion: Myasthenia gravis could also be the result of an autoimmune re action triggered by SARS-CoV-2 infection.

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Palabras clave: autoinmune, cabeza caída, Miastenia gravis, SARS-CoV2,

Keywords: autoimmune, dropped head, Myasthenia gravis, SARS-CoV-2,

Rehabilitación neuropsicológica de la memoria de trabajo sobre la conducta ejecutiva y el rendimiento académico en un niño con trastorno específico del aprendizaje. Neuropsychological rehabilitation of working memory on executive behavior and academic performance in a child with specific learning disorder

Introduction: Learning disorders are a clinical condition that manifests itself at school age, affecting the cognitive, social and emotional functioning of the individuals who suffer from it. There are studies that show a positive effect of interventions on executive functioning, impacting the executive behaviors and ac ademic performance of children.

Objective: To assess the effect of a neuropsychological rehabilitation program for working memory on executive behavior and academic performance in a child with specific learning disor der.

Clinical case: An 11-year-old boy, diagnosed with a specific learning disorder according to the DSM-5, a working memory rehabilitation program was designed and applied and its impact on executive behaviors and academic performance was measured.

Results: The measurements of the treatment phase show a downward trend reflecting a positive impact. For the global index of executive function, the percentage of data that exceeds the median (PEM= 100%) indicates a very effective treatment and the non-overlapping of all pairs (NAP=89%) indicates a medium effect of the intervention.

Discussion: The results suggest a positive impact at the level of cognitive, behavioral and emotional functioning of the patient, reflected in executive behavior and academic performance.

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Palabras clave: Conductas ejecutivas, Memoria de Trabajo, rehabilitación neuropsicológica, Trastornos Específicos del Aprendizaje,

Keywords: executive behaviors, neuropsychological rehabilitation, Specific Learning Disorders, working memory,

From hypokinesia to hyperkinesia: An 86-year-old-woman with abnormal movements. De hipocinesia a hipercinesia: Mujer de 86 años con movimientos anormales

An 86-year-old woman presented with an acute onset of confusion, garbled speech, and decreased left arm movement. On exam, she had a forced right gaze, left homonymous hemianopsia, left hemiparesis, and left face and arm hypoesthesia. Forty-eight hours after successful revascularization therapies, the patient started complaining of abnormal involuntary movements. This manuscript discusses the phenomenology of these involuntary movements, their neuroanatomical correlates, management, and evolution. Neurologists should be mindful of post-stroke movement disorders, their latency period after stroke, and the functional-anatomic networks involved.

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Palabras clave: corea, Ictus, reporte de caso, trombectomía mecánica,

Keywords: case report, chorea, mechanical thrombectomy, stroke,

El valle del rift y los australopitecos. Rift valley and australopithecines.

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Palabras clave: valle del rift,

Keywords: rift valley,

Neurociencias y quinta revolución industrial: El futuro ha llegado Neurosciences and fifth industrial revolution: The future has arrived

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Palabras clave: Dispositivos Inteligentes, Ingeniería Neuromédica, Inteligencia Artificial, Sistemas Ciberfísicos,

Keywords: Artificial Intelligence, Cyber-Physical Systems, Neuromedical Engineering, Smart Devices,

Programas de control de cisticercosis y erradicación de epilepsia relacionada a neurocisticercosis, Cysticercosis control programs and neurocysticercosis-related epilepsy eradication

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Palabras clave: cisticercosis, Epilepsia, Erradicación, neurocisticercosis,

Keywords: Cysticercosis, Epilepsy, Eradication, neurocysticercosis,

Testing the reliability of the Downton Fall Risk Index for predicting incident falls in community-dwelling older adults. A prospective population-based study. Evaluación de la confiabilidad del “Índice Downton de riesgo de caídas” como predictor de caídas incidentes en adultos mayores que viven en la comunidad. Estudio poblacional prospectivo.

Background: Accidental falls are a major cause of disability and death in older adults. However, the reliability of instruments designed to estimate the risk of future falls has not been adequately established in community dwellers.

Methods: Departing from a previous cross-sectional study of older adults living in rural Ecuador that estimated the potential risk of future falls, we carried out a prospective longitudinal study to assess the reliability of the Downton Fall Risk Index (DFRI) as a predictor of incident falls during three years of follow-up.

Results: Of 254 individuals, 158 (62%) experienced incident falls. The mean score of the baseline DFRI was 1.6±1.3 points, with 54 (21%) individuals showing an increased risk for future falls (DFRI score ≥3 points). Forty-seven of the 54 individuals with a positive DFRI had incident falls as opposed to 111/200 individuals with a negative DFRI (p<0.001). An adjusted logistic regression model found that individuals with a positive DFRI have a fivefold increase in incident falls compared with those having a negative DFRI (OR: 4.91; 95% C.I.: 1.94 – 12.4). Receiver operator characteristics curve analysis showed an area under the curve (AUC) of 0.612 (95% C.I.: 0.568 – 0.657) for a positive DFRI to predict incident falls. However, the AUC for the predictive value of incident falls given a history of previous falls (as a single variable) was 0.908 (95% C.I.: 0.875 – 0.942).

Conclusions: The DFRI has only a moderate predictive value for the occurrence of incident falls that is surpassed by that of previous falls.

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Palabras clave: Adultos Mayores, Caídas, Comunidades rurales, Estudio poblacional prospectivo, Índice Downton de riesgo de caídas,

Keywords: Downton Fall Risk Index, Falls, older adults, Population-based longitudinal cohort, Rural communities,

Memoria episódica evaluada a partir de estímulos neutros y emocionales en pacientes con antecedentes de trauma craneoencefálico y grupo control. Episodic memory evaluated from neutral and emotional stimuli in patients with a history of traumatic brain injury and a control group

Objective: To compare the performance in episodic memory evaluated with neutral and emotional stimuli in patients with a history of traumatic brain injury and a control group.

Method: This research had a non-experimental quantitative methodology, it was a quasi-experimental study of descriptive scope of comparison between groups; the group with a history was made up of 15 patients from the Hospital Universitario del Valle in the city of Cali, of which 8 were men and 7 women; the control group consisted of 15 participants: 5 men and 10 women. Episodic memory with emotional and neutral stimuli was assessed with the Auditory-Visual Emotional Memory Test and the California Verbal Learning Test (CVLT), respectively.

Results: Statistically significant differences were found in most of the episodic memory subtests evaluated with neutral stimuli, at the level of storage, interference, short- and long-term memory, and semantic false positives; Regarding the memory evaluated with emotional stimuli, significant differences were identified in encoding and recall.

Conclusion: There is evidence of a lower performance of patients with TBI in memory storage with neutral stimuli, which influences their low score in recall, in relation to the emotional they present a lower performance in the ability to estimate the value or general emotional weight of the story, which seems to influence proper encoding.

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Palabras clave: grupo control, memoria emocional, memoria episódica, Trauma Craneoencefálico,

Ejecución en el Test de Fluidez Verbal en pacientes con Trastorno Neurocognitivo Leve. Verbal fluency performance in patients with Mild Neurocognitive Disorder

Aim. To compare quantitative and qualitative aspects of semantic (i.e., animals) and phonological (i.e., F, A, S, M) verbal fluency test (VFT) in Mild Neurocognitive Disorder (mNCD) patients and healthy controls.

Method. The sample was comprised by 70 participants: 35 mNCD patients, with a mean age of 71.5 (± 8) years old and 13.1 (± 3.6) years of formal education; and 35 healthy controls, with a mean age of 72.1 (± 7.1) years old, and 13.2 (± 3.7) years of formal education. A VFT analysis, in terms of hits and errors, clusters’ number and size, and number of switches was performed.

Results. No significant differences among groups were observed in hits and errors. However, statistical differences were found regarding the employed strategies, whereas healthy controls achieved more clusters than the mNCD group in both semantic and phonological VFT. Moreover, the clusters´ size of phonological VFT was larger in healthy controls than mNCD. No differences were found among groups in number of switches.

Conclusions. Qualitative analysis of VFT provide more specific information regarding cognitive processing and may be a useful tool to differentiate the executive functioning of healthy aging and mNCD, in a brief period of time.

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Palabras clave: Agrupamientos, Fluidez Fonológica, Fluidez Semántica, Saltos, Trastorno Neurocognitivo Leve,

Keywords: Clusters, Mild cognitive disorder, Phonological Fluency, Semantic Fluency, Switches,

Rol de los canales de sodio voltaje dependientes en la fisiopatología de la neuralgia del trigémino. Role of voltage-dependent sodium channels in the pathophysiology of trigeminal neuralgia

Trigeminal neuralgia is a severe chronic disorder that causes paroxysmal pain and dramatically decreases the quality of life of its patients. Although the pathophysiology of this disease has been extensively studied, the underlying molecular processes are still unclear, especially the role of voltage-dependent sodium channels in the triggering of painful crises. The main objective of this review is to summarize and update the important role of voltage-dependent sodium channels in the pathophysiology of trigeminal neuralgia, emphasizing the structural, functional and genetic alterations of these channels. It is concluded that trigeminal neuralgia is related to both congenital and acquired alterations in the e xpression of various voltage-dependent sodium channel isoforms.

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Palabras clave: Canal de sodio, Dolor Facial, Neuralgia del Trigémino,

Keywords: Facial Pain, Sodium channel, Trigeminal neuralgia,

Genotipo polimórfico del gen MAOA y comportamiento antisocial en adolescentes y adultos varones. Polymorphic genotype of the MAOA gene and antisocial behavior in adolescent and adult males

Studies have shown the relationship between polymorphisms of the MAOA gene and the development of antisocial behavior, as men with low activity polymorphisms (MAOA-L) are more susceptible to develop violent behaviors than men with high activity polymorphisms (MAOA-H). The objective of the present work was to analyze the available scientific literature on the relationship of the polymorphic genotype of MAOA and the development of antisocial behavior in men, considering the environment as a genotypic modulator. A bibliographic review was carried out. Articles were selected whose sample consisted of male adolescents and adults with polymorphisms of the MAOA gene. Studies in women, reviews, unpublished data, and animal models were omitted. Twelve articles were analyzed: 10 studies (83.4%) concluded that the MAOA-L genotype plus childhood adversities, psychosocial factors, or alcoholism, had a higher risk of developing antisocial behaviors, 1 study (8.3%) concluded that the MAOA- genotype- H, associated with excessive alcohol consumption and abuse during childhood, had a higher risk of committing crimes and 1 study (8.3%) suggested the non-existent relationship between the MAOA-SNPs genotype and violence. We concluded that men with MAOA-L associated with environmental factors are more susceptible to develop antisocial behavior than those with the MAOA-H genotype.

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Palabras clave: comportamiento antisocial, gen MAOA, varones,

Keywords: antisocial behavior, males, MAOA gene,

Relación entre el desarrollo psicomotor y funciones ejecutivas en la primera infancia de niños/as de 3 a 5 años. Relationship between psychomotor development and executive functions in early childhood of children from 3 to 5 years old

Psychomotor development is understood as the maturation of the central nervous system, which progresses as the child goes through stages in a linear and systematized manner. In relation to executive functions, these are known as a series of mental processes that allow managing and coordinating thoughts, emotional responses, and behavior. The main objective of the research was to analyze the relationship between psychomotor development and executive functions in children between 3 and 5 years old. For this, a bi bliographical systematic review study was carried out on psychomotor development and executive functions in children aged 3 to 5 years in the last 10 years. Likewise, the Scielo database was considered, and the observation technique was used to extract the information and bibliographic records were manipulated as a data collection instrument. The findings found that psychomotor development and executive functions are related, given that they have a predictive value in certain child development deficits. It can be concluded that language, social development, and motor skills are associated with cognitive processes, such as inhibition and working memory. In this sense, it is considered relevant that, in this age range, given the early psychomotor development and executive functions, nursery educators must be trained in this subject so that they can generate early intervention plans adapted for the promotion and prevention of certain deficits in early childhood development.

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Palabras clave: Desarrollo psicomotor, Funciones cognitivas superiores, Funciones Ejecutivas, Primera infancia,

Keywords: early childhood, Executive functions, Higher Cognitive Functions, Psychomotor development,

Perspectiva histórica y actualidad de los síndromes antigangliósidos. Historical perspective and current scenarios of the antiganglioside syndrome

The antiganglioside syndromes constitute a large clinical spectrum. Its knowlegde has evolved from the classical pure clinical descriptions to a wide development of the immunopathology underlying these processes and its possibilities of treatment.

In this work we realize a bibliographical review analyzing its evolution from a historical perspective to date at four levels: clinical, topographic, immunologic, and therapeutic. We analyze critically well-known topographical and immunologic notions that are scarcely integrated in daily clinical practice. We debate about the need of establish a new nomenclature for these syndromes in two levels: clinical and immunologic. Finally, we review the current and under development therapeutic lines.

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Palabras clave: Gangliósidos, Inmunopatología, Nodopatías, Polineurorradiculopatía aguda, Síndrome de Bickerstaff, Síndrome de Guillaín-Barré, Síndrome de Miller-Fisher,

Keywords: Acute polyneuroradiculopathy, Bickerstaff syndrome, Gangliosides, Guillain Barre syndrome, Immunopathology, Miller-Fisher syndrome, Nodopathies,

Perfiles cognitivos-lingüísticos en personas mayores con Deterioro Cognitivo Leve, Demencia Vascular, Demencia con Cuerpos de Lewy y Enfermedad de Parkinson. Cognitive-linguistic profiles in older people with Mild Cognitive Impairment, Vascular Dementia, Dementia with Lewy Bodies and Parkinson’s Disease

Introduction: There is a wide heterogeneity of neuropsychological symptoms reported in pathological ageing. Current research has focused on patients with Alzheimer’s disease and frontotemporal dementia. However, still no detailed knowledge of the cognitive-linguistic profiles in patients whit Mild Cognitive Impairment (MCI) and other forms of dementia.

Objective: To characterize cognitive and linguistic profiles in older people with MCI, vascular dementia, Lewy body dementia, and Parkinson’s disease.

Methods: The present study followed the PRISMA guidelines and included studies from the PubMed, Scopus, and Web of Science databases, published between 2000 and 2020.

Results: 49 articles were included in this literature review for critical analysis. Older people with MCI, vascular dementia, Lewy body dementia, and Parkinson’s disease shows a significant decline in the following cognitive domains: memory, executive function, attention, and visuospatial/visuoconstructive skills. However, linguistic symptoms are also reported, especially the deficit in verbal fluency (semantic and phonological) and syntactic-grammatical and discursive skills.

Conclusion: This literature review characterized cognitive-linguistic profiles in older people with MCI, vascular dementia, Lewy body dementia, and Parkinson’s disease. These profiles could be helpful in clinical practice to improve early neuropsychological assessment processes and even determin e differential diagnoses between these clinical conditions.

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Palabras clave: Cognición, demencia, Deterioro Lingüístico, Disfunción cognitiva, evaluación neuropsicológica,

Keywords: Cognition, Cognitive Dysfunction, dementia, language impairment, Neuropsychological assessment,

Paraproteinemic Neuropathies: A Review for Neurologists Neuropatías. Paraproteinémicas: Revisión de tema para Neurólogos

As part of the workup of polyneuropathy, neurologists often encounter patients with paraproteinemias, also called monoclonal gammopathies. Given the relatively rising prevalence of both polyneuropathy and paraproteinemias in our aging population, this coexistence is frequently due to chance. Still, certain types of paraproteinemias have a well-defined causal role in the development of polyneuropathy, and therefore has implications in their subsequent work-up and management. Once a monoclonal gammopathy has been deemed as “benign” or of undetermined significance, looking at the heavy chain subtype is paramount in deciding whether it is related to a polyneuropathy. Conversely, polyneuropathies associated with monoclonal gammopathies tend to have a distinct clinical, serological, and/or electrodiagnostic phenotype that helps in establishing an association. Recognizing this association will determine approp riate workup and management.

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Palabras clave: gammapatía monocl onal, Neuropatía, paraproteinemia, polineuropatía,

Keywords: monoclonal gammopathy, Neuropathy, paraproteinemia, polyneuropathy,

Embolismo gaseoso cerebral: a propósito de un caso de ictus masivo. Cerebral air embolism: about a case of massive stroke

Introduction: Cerebral air embolism is a rare but potentially fatal entity, that occurs due to the entry of air into the cerebral blood circulation and is caused by multiple causes, including t hose associated with medical procedures.

Clinical case: We present the case of an 81-year-old male patient who, after removal of the high-flow hemodialysis catheter, begins with a deterioration of the level of consciousness, which worsens progressively. Multiple hypodense lesions, compatible with gas embolism, are evidenced in the cerebral tomography. Due to his slow evolution, he was transferred to the intensive care unit and died a few hours later.

Conclusion: It is essential to know the preventive measures to avoid this complication and the general and specific measures to adopt when it occurs.

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Palabras clave: Accidente Cerebrovascular, Diálisis Renal, Embolia Aérea,

Keywords: Air Embolism, Renal Dialysis, stroke,

Psicosis orgánica, tipo trastorno esquizofreniforme, posterior a hemorragia subaracnoidea. Organic psychosis, schizophreniform disorder type, after subarachnoid hemorrhage

Organic psychosis refers to a group of diseases currently classified as “mental disorders due to a medical illness”, unlike the absence of specific organic causality that exists in primary disorders. These are secondary to long-term processes , which is necessary to re-evaluate frequently due to the association between age-related deterioration, comorbidity and the evolution of psychosis itself. We present the case of a patient with subarachnoid hemorrhage secondary to a ruptured arteriovenous malformation, who suffered from a slight change in behavior and decreased cognitive functions with subsequent evolution to dissociative symptoms, episodes of hypersomnia and disconnection from the environment, through assessment joint of specialties was reached the diagnosis of organic psychosis type schizophreniform disorder.

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Palabras clave: adulto mayor, Esquizofrenia tardía, Hemorragia Subaracnoidea, Psicosis orgánica, Psiquiatría geriátrica,

Keywords: elderly, Geriatric psychiatry, Late-onset schizophrenia, Organic psychosis, Subarachnoid Hemorrhage,

Infarto cerebeloso bilateral simultáneo en un paciente con fibrilación auricular paroxística no valvular: una presentación atípica. Simultaneous bilateral cerebellar infarction in a patient with paroxysmal atrial fibrillation: an atypical presentation

Introduction: Cerebellar infarcts usually occur in the territory of the posterior inferior cerebellar artery (PICA) and tend to be unilateral. Simultaneous bilateral involvement is extremely rare.

Case report: We present the case of a 67-year-old male who developed an acute cerebellar syndrome secondary to acute infarction in the territory of both PICA confirmed by nuclear magnetic resonance imaging. Non-valvular paroxysmal atrial fibrillation was the most plausible etiology after digital cerebral angiography ruled out vascular abnormalities.

Conclusion: This case shows that bilateral infarction in the territory of both PICA can occur in the context of cardiac embolism, even in the absence of an anomalous common PICA.

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Palabras clave: arteriografía, cerebelo, embolia, Fibrilación auricular, infarto cerebral (DeCS),

Keywords: angiography, atrial fibrillation, cerebellum, cerebral infarction (MeSH), embolism,

Infarto cerebral en mujeres. Stroke in women

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Palabras clave: infarto cerebral, Mujeres,

Keywords: stroke, Women,

Disfunción neurológica y exposición a agrotóxicos. Neurological dysfunction and exposure to agrotoxics

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Palabras clave: Agrotóxicos, Disfunción Neurológica, Neurodegeneración, neurotoxicidad, Plaguicidas,

Keywords: Agrotoxics, Neurodegeneration, Neurological Dysfunction, neurotoxicity, Pesticides,

Plantas medicinales: Comprendiendo sus beneficios para la salud y advirtiendo sobre sus efectos psicoactivos y neurotóxicos. Medicinal plants: Understanding their health benefits and warning about their psychoactive and neurotoxic effects

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Palabras clave: Botánica medicinal, fitoterapia, neurotoxicidad,

Keywords: Medicinal botany, neurotoxicity, phytotherapy,

Beneficios de la musicoterapia sobre el lenguaje. Benefits of music therapy on language

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Palabras clave: aprendizaje, desarrollo del lenguaje, musicoterapia,

Keywords: language development, learning, music therapy,

Embarazo y esclerosis múltiple: ¿Existe una relación positiva entre ambas entidades? Pregnancy and multiple sclerosis: Is there a positive relationship between the two?

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Palabras clave: embarazo, esclerosis múltiple, fertilidad,

Keywords: fertility, multiple sclerosis, pregnancy,

Factores asociados al tiempo libre de discapacidad en pacientes con Esclerosis Múltiple de un instituto de neurología en Medellín, Colombia. Factors associated with disability-free time in patients with Multiple Sclerosis of a neurology institution in Medellin, Colombia

Introduction: Multiple Sclerosis is the leading neurological cause of disability in young adults. The objective of this study was to describe the time free from disability since diagnosis and to analyze associated factors.

Method: Retrospective follow-up study of a cohort based on records of patients who consulted the Neurological Institute of Colombia between 2013 and 2021. Progression to disability was defined as the time to obtain a value greater than 3.5 on the EDSS scale. Parametric survival model for interval censored data with Weibull distribution was used to estimate survival function and Hazard Ratios.

Results: 216 patients were analyzed. The median disability-free time was 12 years (95% CI 7.56-17.66). Cerebellar complications (aHR = 8.18; 95% CI 4.09-16.35), vision (aHR = 2.25; 95% CI 1.25-4.05) and age at diagnosis over 40 (aHR = 1 .28; 95% CI 0.68-2.4) were associated with shorter time to progression, other initial symptoms (aHR = 0.35; 95% CI 0.18-0.68), stem lesions (aHR = 0.6; 95% CI 0.33-1.1), MSRR (aHR = 0.17; 95% CI 0.08-0.33) and women were associated with a longer time to progression.

Conclusion: Clinical and imaging factors allow identifying patients at high risk of rapid progression to disability.

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Palabras clave: Análisis de Supervivencia, Discapacidad, esclerosis múltiple, Supervivencia sin Progresión,

Keywords: Disability, Disability-Free Survival, multiple sclerosis, Survival Analysis,

Correlación entre variables clínicas sugestivas de hipertensión intracraneal y alteraciones en la neuroimagen en trauma craneoencefálico. Correlation between clinical variables suggestive of intracranial hypertension and alterations in neuroimaging in traumatic brain injury

Methods: Retrospective observational cohort study where patients admitted for TBI to the ICU area of the HLV were included. 

Results: We included a total of 297 subjects. The most common neuroimaging lesion was multiple lesions (35.4%). We found that there is a significant correlation between the presence of lesion in neuroimaging and the presence of fixed pupils at admission (p = <0.001), score ≤ 8 on the Glasgow scale (p = <0.001) and need for orotracheal intubation (p = <0.001). Similarly, the same 3 variables were significant when related to the score ≥ III on the Marshall scale. In the logistic regression model, pupil fixation was the only one that was shown to increase the risk of a score ≥ III on the Marshall scale (OR: 3.50, 95% CI 1.53-7.99). 

Conclusion: The clinical variables: pupil fixation, need for endotracheal intubation and Glasgow ≤ 8 are related to the development and severity of lesion on neuroimaging in patients with TBI.

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Palabras clave: escala de Marshall, hipertensión intracraneal, injuria cerebral aguda, injuria cerebral traumática, neuroimagen, tomografía, traumatismo craneoencefálico,

Keywords: acute brain injury, Cranioencephalic traumatism, Intracranial hypertension, Marshall scale, neuroimaging, tomography, traumatic brain injury,

Entrenamiento sensoriomotor en casa en personas mayores con Enfermedad Parkinson durante el periodo de confinamiento por COVID-19: Estudio piloto. Sensorimotor training at home in elderly people with Parkinson’s Disease during the period of confinement due to COVID-19: A pilot study

The pandemic caused those therapeutic activities associated with people with Parkinson’s disease to be suspended (PD) with the aim of preventing COVID-19 infections by increasing motor and non-motor symptoms, due to social isolation and stress. Therefore, there was a rise of care based on telemedicine to continue the treatment in the context of a health emergency, promoting training at home. The objective of this experimental research was to document the effects of a sensorimotor training program (NM-FITT®) in people with PD through weekly telematic follow-up during the COVID-19 pandemic. A quasi-experimental study was carried out with pre, inter and post test evaluations that characterized the physical, functional condition and quality of life, in an intervention group (n=5) and a control group (n=5) of elderly people (69.5 ±4.5 years) with PD in Hoehn & Yahr stages 1 to 3, for 18 weeks, through an exercise manual, video calls and telephone follow-up. Favorable and significant effects were demonstrated on all the parameters studied after the application of the intervention in detriment of the health condition of the persons who did not participate in the home training program.

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Palabras clave: calidad de vida, COVID, ejercicio, enfermedad de Parkinson, entrenamiento en casa, entrenamiento sensoriomotor, monitorización remota de pacientes (RPM), Rehabilitación, Telemedicina,

Keywords: COVID, exercise therapy, home training, Parkinson’s disease, quality of life, Rehabilitation, remote patient monitoring (RPM), sensorimotor training, telemedicine,

Caracterización histológica de las dendritas de la amígdala por alto consumo de fructosa en un modelo experimental de isquemia cerebral. Histological features of dendrites in the amygdala due to high fructose consumption in an experimental model of cerebral ischemia

Introduction. High fructose consumption has been shown to magnify cerebral ischemic injury in the ischemic focus and penumbra region. However, ischemia also produces changes in exofocal areas such as the amygdala, an important structure in emotional processing. Therefore, the objective of the investigation was to characterize the histological changes of the amygdala dendrites caused by high fructose consumption in an experimental model of cerebral ischemia.

Method. Wistar rats fed with standard food were used; the control group was given water and the fructose (HDF) group was given add libitum 20% fructose in water for 11 weeks. Some rats were subjected to cerebral ischemia. Therefore, there were four experimental groups: Sham control, Sham HDF, Ischemia control, Ischemia HDF. 50 um coronal sections of the brains were made and microtubule-associated protein 2 (MAP2) immunohistochemistry was performed. Images were captured and processed in Image J software.

Results. Loss of dendrite immunoreactivity was found in ischemic groups, and also cluster-type MAP2 immunoreactivity in HDF groups.

Conclusion. According to the above, both ischemia and high fructose consumption generate dendritic alterations in the amygdala.

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Palabras clave: amígdala, dendritas, fructosa, isquemia,

Keywords: amygdala, dendrites, fructose, ischemia,
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