An important part of cognitive status evaluation is the determination of general cognitive ability. However, the most common tests are not standardized for use in Ecuador. This has limited the extent and accuracy of clinical neuropsychological assessments within the country. We used the 7-subtest Wechsler Adult Intelligence Scale-IV (WAIS-IV) with 155 mainly city-living Ecuadorian adults, recruited from a range of socioeconomic backgrounds around 4 different sites in Ecuador. The sample was matched to the Ecuadorian urban population for gender, education, and ethnicity. We show that this version of the WAIS-IV is a reliable and valid assessment for this context. In addition, we provide a method to adjust standard scores derived from the Spanish population, and used in the WAIS-IV manual, so that they are more appropriate for use in Ecuador. These can potentially be used to calculate full IQ scores. We also describe methods of comparing the Ecuador-adjusted standard scores so that they can be used in clinical neuropsychological evaluations of Ecuadorian adults.
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Uso de la Escala de Inteligencia de Adultos de Wechsler-IV para la evaluación neuropsicológicas en Ecuador. The Wechsler Adult Intelligence Scale-IV for use in Neuropsychological Assessments in Ecuador
Cognición, afectividad y resiliencia en el perdón de una transgresión en la pareja. Cognition, affectivity and resilience in the forgiveness of a transgression in the couple
The transgression of the agreements between the couple is a current problem that generates discomfort on a personal, family and social level. In this article, an investigation is reported that analyzes a model that proposes the interaction between the variables positive cognition, positive affect and resilience as predictive factors that contribute to the understanding of the process of forgiveness of a transgression in the couple. 203 adults (103 women 60%, 88 men 40%) between 18 and 26 years of age participated in the research (Mage = 20.4, SD = 1.68). The hypothesized model was tested through the process of structural equations, finding adequate levels of goodness of fit x2 = 113.87, GL = 84, p = .02, SRMR = .05, RMSEA = .04 (.03 – .06), CFI = .97. The results found contribute to two essential levels in the line of investigation of the interaction between couples, firstly, at a theoretical level, it is provided with an innovative theory that allows us to understand the process of forgiveness in the couple and, secondly, to clinical level, for psychotherapeutic intervention in variables such as cognition and positive affect that would benefit a couple to overcome a conflict and reach a forgiveness.
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Estudio piloto sobre el funcionamiento sexual en mujeres con Esclerosis Múltiple en México. Pilot Study on Sexual Functioning in Women with Multiple Sclerosis in Mexico
Introduction: Sexual dysfunction in women with Multiple Sclerosis (MS) is frequent. The way it is approached by physicians and communication with patients has not been widely explored.
Objective: Describe the sexuality of women with MS, their satisfaction with their relationship and communication with doctors.
Material and Methods: Descriptive cross-sectional study, carried out in the MS Clinic in the main concentration center in Mexico, with self-administered questionnaires through an online survey, on mental health, couple relationships, doctor-patient interaction on the subject of health sexual and reproductive, female sexual functioning, intimacy and sexuality.
Results: 37 women participated, average age 35.0 ± 8.25 years. They have been with the disease for 4.3 ± 3.8 years and the main course is relapsing remitting MS (79.2%). 89.1% report sexual intercourse and 43.8% used contraceptives in their first relationship. Out of self-interest, 40% spoke to a doctor about sexuality. Women who are not in a relationship and have not spoken to a doctor about sexuality score low in the domains of sexual functioning.
Discussion and Conclusions: Communication about sexual health is fundamental and for this the doctor-patient relationship is central.
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Actualización y aproximación clínica a los modelos teóricos de la apraxia de extremidades. Approaching theorical models of limb apraxia: a clinical update
Apraxia is a common disorder in people who have suffered a left hemispheric stroke, with significant impact on their quality of life. Although several models have been proposed for its interpretation and approach, some aspects are still under study. The objective of this study is to review the current models of limb apraxia, to analyze the available evaluation tools and to make recommendations for clinical practice. The review shows that in the literature there is a greater interest in the conceptual system within the lexical-semantic route, without developing in detail the conceptual system within the visuomotor route. This article proposes a model of apraxia that overcomes these limitations and describes an assessment method focused on body knowledge within the visuomotor route. Finally, it is concluded that more studies are necessary to experimentally validate the proposed model and the associated evaluation methods.
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Estado Epiléptico Refractario de Aparición Reciente (NORSE): Revisión y actualización. New-Onset Refractory Status Epilepticus (NORSE): Review and Update
The New-Onset Refractory Status Epilepticus (NORSE) is a rare entity that is defined as a clinical presentation, in a patient without active epilepsy or other relevant neurological disorder, who presents a refractory status epilepticus (RSE) without an acute or active structural, toxic, or metabolic cause. NORSE constitutes a diagnostic challenge that implies high morbidity and mortality in the short and long term. Clinically, NORSE is characterized by a prodromal phase, an acute phase, where seizures with diverse semiology that evolve to an RSE occur, and a chronic phase, with neurological deterioration and drug-resistant epilepsy. After an extensive work-up, the cause of NORSE is identified in only half of the cases. The initial treatment is based on the use of conventional anti-seizure drugs, requiring most of patients the use of anesthetics and mechanical ventilation. Better results have been observed with immunotherapy, more recently with anti-cytokine drugs, such as tocilizumab and anakinra, consistent with the immunological/inflammatory mechanisms proposed for the pathophysiology of NORSE.
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Enfermedad de Creutzfeldt-Jakob. Creutzfeldt-Jakob disease
Síndrome de Arlequín. Harlequin syndrome
We herein report the case of a 37-year-old woman who sought medical attention due to facial erythema on the right side of her face as well as diaphoresis following stressful events or exercise. Clinical examination was unremarkable. Blood tests and Thorax CT excluded any structural causes. Given this, she was diagnosed with Harlequin syndrome. Therapeutic options were explained, and follow-up provided.
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Asterixis and dysarthria-clumsy hand originated of lacunar infarction: A series of six cases. Asterixis y disartria-mano torpe originado a partir de los infartos lacunares: Una serie de seis casos
La asterixis y la disartria-mano torpe son signos neurológicos poco frecuentes que pertenecen a los trastornos del movimiento después de un accidente cerebrovascular. Clínicamente ellos son clasificados como parte del infarto lacunar y la mayoría de los casos se resuelven espontáneamente en un periodo entre 10 semanas y un mes. El objetivo de este estudio fue reportar seis casos de pacientes masculinos con infarto lacunar y describir los síntomas, localización y tamaño de las lesiones. Se describen casos de infarto lacunar y síntomas motores leves (disartria y asterixis) sin ningún indicio de demencia. En conclusión, nuestros casos presentan movimientos neurológicos anormales como asterixis y disartria-mano torpe en pacientes con hipertensión y / o diabetes mellitus tipo 2. Debido a la transitoriedad de esos movimientos, el diagnóstico en el tiempo adecuado es importante, a partir de eso los médicos pueden solicitar los exámenes de imagen, tratar al paciente y luego acompañarlo previniendo futuros ictus con consecuencias aún más graves. Así, estudios como el nuestro pueden contribuir al correcto diagnóstico de los infartos lacunares.
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Giant bilateral open-lip schizencephaly. Esquizencefalia bilateral gigante de labio abierto
La esquizencefalia es una malformación cerebral congénita caracterizada por hendiduras en la corteza cerebral, se clasifica en Tipo I (labio abierto) y tipo II (labio cerrado). Los pacientes con esquizencefalia presentan convulsiones, hidrocefalia, déficit motor y mental. La ecografía se utiliza para el diagnóstico intra útero y recién nacidos, y la resonancia magnética o tomografía computarizada en pacientes ya nacidos. El manejo de la esquizencefalia es conservador, con rehabilitacción de los déficits motores o mentales, medicación o cirugía para convulsiones y derivación en hidrocefalia con aumento de la presión intraacraneal. En la literatura, solo se han informado unos pocos casos bilaterales gigantes. Presentamos un caso de esquizencefalia gigante bilateral de labio abierto, en un paciente masculino de 10 días, que se presenta con hipotonía leve y sin convulsiones. Este caso es raro debido a las características relativamente beningnas en comparación con otros casos notificados.
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Aplicación móvil de realidad virtual para el entrenamiento de la mano espástica. Virtual reality mobile application for spastic hand training
Background: The hand is a structure with a complex neuromuscular organization that in hemiparesis is compromised, affecting function.
Aim: To determine the changes in the motor function of the spastic hand of an adult with hemiparesis through the use of a mobile application for virtual reality.
Method: Case report of a 29-year-old adult with hemiparesis, evaluated with the Fugl Meyer upper extremity assessment (FMA-ES), the Trail Making test and the force dynamometry test. A therapeutic intervention was performed with exercises of the least affected hand for 12 sessions using special glasses for a total immersion 20 minutes using mobile application Mirror box Therapy VR®.
Results: The virtual reality therapy applied through the Mirror Box Therapy VR® mobile application, shows in a short time favorable changes in the motor and sensory hand function of the patient.
Discussion: Virtual reality provides a functional interaction, making it an effective tool to motivate patients during sessions.
Conclusion: An intervention through the use of virtual reality generates changes in the motor and sensory function of the hand of a patient with hemiparesis after 12 work sessions.
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Índice leucoglucémico alto como predictor de mortalidad intrahospitalaria en pacientes con ictus isquémico agudo. High leuko-glycemic index as an in-hospital mortality predictor in patients with acute ischemical ictus
Objective: To demonstrate that the high leuko-glycemic index was a predictor of in-hospital mortality in patients with acute ischemic stroke of the Neurology Department at Belen of Trujillo Hospital in the period from January 2014 to December 2018.
Material and method: Observational, analytical, cohort and retrospective research, conducted at Belen of Trujillo Hospital, with a census sample of patients hospitalized in the Neurology department with diagnosis of acute ischemic stroke in the period from January 2014 to December 2018 , who met the selection criteria.
Results: 281 medical records were analyzed, where 18 were of deceased patients, of which 56% died with a leuko-glycemic index greater than 1600, the association being statistically significant (RRa: 6.33, CI: 95% [1.35 – 29.64]; p = 0.019). In addition, in the multivariate analysis, age greater than or equal to 80 years, admission moderate awareness disorder and in-hospital pneumonia were also relevant.
Conclusion: The high leuko-glycemic index was a predictor of in-hospital mortality in patients with acute ischemic stroke of the Neurology Department at Belen of Trujillo Hospital in the period from January 2014 to December 2018.
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Prevalencia de neuromitos en académicos universitarios de Chile. Neuromyth prevalence in university academics in Chile
Introduction: A neuromyth is an interpretation error derived from a misunderstanding or mistaken belief about scientific findings, being frequent in educational contexts, but also in the area of neurology and other neurosciences. This research aimed to determine the prevalence of neuromyths among Chilean university scholars.
Methodology: Quantitative, non-experimental, cross-sectional study. The instrument used was the Neuromyth Prevalence Questionnaire, Spanish version. The sample considered 64 scholars from six Chilean universities.
Results: Among university teachers of education careers, four neuromyths had a prevalence higher than 70% in the items related to the relevance of the stimuli in the preschool stage and that individuals learn better when they receive information according to a learning style (visual, auditory or kinesthetic, VAK).
Conclusions and Recommendations: In conclusion, there is a high prevalence of neuromyths among the Chilean university scholars studied. As a challenge of scholar performance, they should adequately disseminate neuroscience research, as this impacts student training and their professional future. Furthermore, the awareness about neuromyths that prevail among them will allow us to address the dismissal of misconceptions that have lasted for a long time in the complex scenario of the interaction between educational sciences and neurosciences.
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Función cognitiva en adultos mayores con y sin dedos de Dawson relacionados con enfermedad de pequeño vaso cerebral. Cognitive performance in older adults with and without Dawson’s fingers-related cerebral small vessel disease
Background/objective: Dawson’s fingers have been traditionally associated with multiple sclerosis. However, this imaging biomarker has also been linked to white matter hyperintensities related to cerebral small vessel disease. In the latter, Dawson’s fingers could represent damage of small venules in subjects with severe small vessel disease and could theoretically be associated with cognitive decline. In this study, we aimed to assess the association between Dawson’s fingers and cognitive performance in a population of older adults.
Methods: Population-based study conducted in individuals aged 60 years or older, residing in three rural villages of coastal Ecuador (Atahualpa, El Tambo and Prosperidad). Of 712 older adults identified by means of a door-to-door survey, 590 underwent a brain MRI. Of them, 575 also had the Montreal Cognitive Assessment (MoCA). We selected the 157 individuals with moderate-to-severe white matter hyperintensities to assess the presence of Dawson’s fingers. The independent association between Dawson’s fingers and cognitive performance (as the dependent variable) was assessed by means of a linear regression model, after adjusting for demographics, cardiovascular risk factors, and the other biomarkers of cerebral small vessel disease.
Results: Of 157 individuals with moderate-to-severe White matter hyperintensities, 17 (11%) had Dawson’s fingers on MRI. The mean MoCA score in subjects with Dawson’s fingers was 14.5±6.4 points and that of those without this neuroimaging biomarker was 17.3±6.2 points. The association between Dawson’s fingers and the MoCA score was marginal in univariate models (p=0.082), but it completely vanished in a multivariate linear regression model adjusted for relevant covariates (β:-0.31; 95% C.I.: -3.23 – 2.60; p=0.833). A mediation model disclosed that 83.5% of the effect of Dawson’s finger on cognitive performance was mediated by age.
Conclusion: Dawson’s fingers are not independently associated with cognitive performance in individuals with cerebral small vessel disease. Most of the effect of this association is mediated by age.
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Síntomas de depresión, ansiedad y estrés en la población general ecuatoriana durante la pandemia por COVID-19. Depression, anxiety and stress symptoms experienced by the ecuadorian general population during the pandemic for COVID-19
Objective: To describe the mental health state of Ecuadorian adults during the COVID-19 pandemic from March to August 2020. Data from a larger study involving several Spanish-speaking countries were analyzed. This research was non-experimental, quantitative, and cross-sectional, conducted through an anonymous online survey used as the collection tool.
Results: A total of 766 people participated, 64.23% were women and the mean age was 32.35 (SD = 12.54). Around 8% of the participants declared having presented a diagnosis of COVID-19, and 12.9% having experienced associated symptoms. Most participants (77.4%) indicated not having had mental health problems in the past, and 87.6% did not have these problems during the pandemic. However, 41% acknowledged having experienced greater psychological distress. Participants presented low levels of symptoms of depression, anxiety, and stress. Women and young adults were the most affected groups by the assessed symptoms.
Conclusions: In pandemic and confinement situations, providing mental health care services for the general population is essential, especially for women and young adults.
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Music therapy intervention for memory, attention, and language in children with dyslalia. Intervención musicoterapéutica para mejorar la memoria, atención y lenguaje in niños con dislalia
Dyslalia is a language disorder that is present in a wide percentage of children. This work proposes an intervention protocol in music therapy to improve attention, memory, and language for children with the dyslalia disorder. A confirmatory mixed-method design composed of two studies was conducted: the first included a quantitative and pre-experimental design with a sample of 20 children aged between 5 and 8 years (Mage=6.45, SD=1.23) diagnosed with dyslalia. The second study used a qualitative confirmatory methodology, where participants’ parents and therapists participated. Wepman’s and the initial Luria pre- and post-tests measurements were applied. The results of the pre-experiment found statistically significant improvements in verbal regulation t(19)=-5.03, p=<.001, d=.76, attention t(19)=-5.05, p=<.001, d=.76, and memory t(19)=-2.88, p=.009, d=.55. In the qualitative phase, narratives were found that affirmed the positive results of the pre-experiment. Moreover, data surrounding the benefits of the music therapy intervention protocol in the improvement of cognitive processes and the relationship with previous literature that found positive results with this type of intervention are discussed.
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Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática. Cognitive, biological, anatomical and behavioral markers of mild cognitive impairment and Alzheimer’s disease. A systematic review
Alzheimer’s disease (AD) is a progressive neurodegenerative disease that affects 50% of people over 85 years of age and is one of the most common in adulthood and the most common cause of dementia in developed countries. The objective was to determine which have been the most studied cognitive, biological, anatomical and behavioral markers of mild cognitive impairment (MCI) and AD in the last 10 years. Observational studies were searched in the Scopus, Pubmed and Sciencedirect databases. 187 articles were identified, of which 23 with full text were finally selected. The studies corresponded to cognitive (15 studies), biological (8 studies), anatomical (3 studies) and behavioral (2 studies) markers. The identified markers will help guide the design of early detection programs and future interventions that reduce neuropathological effects and significant alterations in quality of life.
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Manifestaciones neurológicas del lupus eritematoso sistémico: Revisión de literatura. Neurological manifestations of systemic lupus erythematosus: A comprehensive literature review
Among autoimmune diseases, systemic lupus erythematosus (SLE) stands out. This disease is characterized by the involvement of several organs and systems, including the central nervous system, in which it produces various complications, some rare or documented in the literature, which makes its diagnosis difficult, resulting in delays for its treatment. Many of these complications occur after the initial diagnosis of SLE; for that reason, a neurological evaluation is recommended in the followup of patients with SLE.
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Calambres musculares relacionados con uso de donepezilo. Donepezil-related muscular cramps
Tuberculoma intramedular espinal que simulaba una lesión tumoral, en un paciente con desnutrición y consumo de estupefacientes. Spinal intramedullary tuberculoma that simulates a tumor lesion, in a patient with malnutrition and drug use
Intramedullary spinal tuberculoma is a rare form of extrapulmonary tuberculosis. In most cases the diagnosis is made by biopsy of the lesion and histopathological study. We present the case of a 28-year-old male with a history of malnutrition and drug use who presented progressive paraparesis with sphincter compromise secondary to a dorsal intramedullary tuberculoma. At the beginning a tumor lesion was suspected, however, findings of pulmonary tuberculosis, lymph node biopsy and a positive tuberculin protein derivative study confirmed the clinical diagnosis of spinal tuberculoma.
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Síndrome alcohólico fetal. Reporte de un caso. Fetal alcohol syndrome. Case report
Prenatal exposure to alcohol is one of the main preventable causes of birth defects and developmental disabilities. Fetal alcohol spectrum disorder (FASD) is a term used to describe the physical, behavioral, and neurodevelopmental disorders that can be detected in an individual who was prenatally exposed to alcohol.
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Encefalitis autoinmune. Autoimmune encephalitis
Autoimmune encephalitis is a recently described pathology as inflammatory disease of the central nervous system, previously characterized as a paraneoplastic syndrome. However, advances in technology have allowed to categorize it as an entity, with an specific physiopathology, and a clinical presentation based on the developed auto-antibody, but, the wide clinical presentation, the insidious development of the symptoms, the mimic with other pathologies and the lack of knowledge of this condition in the emergency room and hospitalization services, does not permit to diagnose this condition, leading to potentially fatal complications. We report the case of a 26-years-old female with autoimmune encephalitis, and a literature review regarding this topic.
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Discapacidad asociada a manifestaciones neurológicas de COVID-19. Disability associated with COVID-19’s neurological manifestations
Introduction: COVID-19 is mainly a respiratory illness, however, with an incidence in nearly a third of patients of neurological manifestations secondary to affection to the central or peripheral nervous system, used to be more frequent in severe illness, having a wide range of disability and mortality.
Clinical case: We present the clinical case of a 39 years old female ,previously healthy, with diagnosis of COVID-19, initiating her illness with encephalitis and status epilepticus, posteriorly longitudinally extensive myelitis and anoxic-ischemic encephalopathy, which, despite of opportune diagnosis and treatment, she had a poor outcome developing persistent vegetative state.
Conclusions: COVID-19’s neurological manifestations could lead to a high risk of disability and mortality, needing an opportune detection and treatment, with a high suspicion of encephalitis and status epilepticus in patients with decrease of alertness and focal motor symptoms.
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Estatus epiléptico no convulsivo por Lupus Eritematoso Sistémico y Síndrome Antifosfolípido. Non convulsive status epilepticus due to Systemic Lupus Erythematosus and Anti- phospholipid syndrome
Systemic Lupus Erythematosus is a chronic disease, with the presence of autoantibodies and lymphocyte hyperactivity. The presence of antiphospholipid antibodies is associated with seizures and vasculocerebral disease. We present the case of a patient with atypical absence seizures and mild cognitive impairment.
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Instrumentos que evalúan la inteligencia emocional en estudiantes universitarios: Una revisión sistemática. Instruments that assess emotional intelligence in college students: A systematic review
Objective: To identify the studies that have applied Emotional Intelligence instruments in university students in the last 20 years (2001 to 2020).
Methodology: A desk study (systematic review) was carried out. The selection of primary studies was carried out in the Scopus and Scielo databases. The range of years systematized was from 2001 to 2020. The studies are published in English, Spanish, Portuguese and French. The keywords in English were used: Instruments, emotion intelligence, evaluation; in Spanish: instruments, emotional intelligence, evaluation. The observation technique was used to record the information, and the instrument was an observation record.
Results: 75% (n = 12) of the primary studies were published in English, 18.8% (n = 3) in Spanish and 6% (n = 1) in French. Also, it is highlighted that 81.3% (n = 13) of the articles were published in the Scopus database, 18.8% (n = 3) in the Scielo database. The highest number of publications were in the last 5 years (62.5%, n = 10). The instruments that were used to evaluate EI were MSCEIT, Bar-On and TMMS.
Conclusion: It was verified that the Emotional Intelligence (EI) instruments that were most applied to university students were the MSCEIT, the Bar-On and TMMS, in addition, the studies from 2001 to 2020 were gradually increasing. The results suggest the use and application of these instruments for samples of young university students.
