Revista de neurologia最新文献

Objective: This study aimed to systematically review the available evidence on the effects of boxing interventions on people with Parkinson disease.

Methods: Four electronic databases were searched systematically from their inception until December 2023. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database and Methodological Index for Non-Randomized Studies scales.

Results: A total of 13 studies were included. Data synthesis indicated that participants who performed boxing programs did not have a significant effect in the polled data on functional mobility, balance, motor symptoms, gait and cardiorespiratory fitness Accordingly, for the effects of boxing on self-reported quality of life, the polled data showed a non-significant trend towards improving Hedges' g. Also, when the analysis was performed by comparing the experimental and control groups, the results remained non-significant.

Conclusions: The evidence regarding the use of boxing as a program exercise for patients with Parkinson disease remains uncertain. Preliminary findings indicate that participation in boxing does not demonstrate a substantial impact on either physical or mental health outcomes.

Introduction: Neuropsychology is an area of psychology that studies, through different methodologies, the relationship between the nervous system and behavior. This study aims to describe the profile of the patient who most frequently received a neuropsychological assessment at HULP between 2018 and 2023.

Patients and methods: This is a retrospective observational study of 394 clinical records of subjects aged 18 years or older who were attended in the neuropsychology consultation of HULP between 2018 and 2023. The data was recorded and anonymized in a database properly guarded. Frequency tables were extracted and χ² tests were made. SPSS 26 was the programme used to make data analysis.

Results: A total of 232 women (mean age of 46,47 years) and 162 men (mean age 43,31 years) were evaluated. The most frequent reason for consultation in both groups was suspicion of dementia (112 consultations for this reason in the female group; 76 in the male group). Regardless of the reason for consultation, there were more cases of patients who had studied up to the age of 18 years. Binomial analysis reveals a statistically significant relationship between being assessed in the neuropsychology consultation at HULP and having completed studies before the age of 18.

Conclusions: The profile of the patient who is most frequently attended at the neuropsychology consultation of HULP is a middle-aged woman with education up to 18 years of age, referred by the Mental Health Service for suspected dementia. The information obtained from this analysis will help to guide future planning of assessment strategies for patients with neuropsychological problems.

Introduction: Drug-resistant epilepsy has a cumulative incidence between 14 and 20% of patients with epilepsy. It is associated with more comorbidities and with higher healthcare expenditure and impact on quality of life.

Patients and methods: A retrospective longitudinal descriptive study was performed covering the period from 01/01/2010 to 02/28/2024. All patients with epilepsy seen in the Pediatric Neurology unit of our center were collected and a review of medical records was carried out to collect the characteristics and evolution during the study period. The classification and definitions used were those established by the International League Against Epilepsy.

Results: A total of 325 patients with epilepsy were identified, with a cumulative incidence of DRE of 29%. The most frequent etiology was structural both in all patients with epilepsy (22%), and in drug-resistant epilepsy (36%). A statistically significant association was established between refractoriness and genetic and structural causes, and between having status epilepticus and the development of drug-resistant epilepsy. Seventy-nine percent of patients with drug-resistant epilepsy developed epileptic encephalopathy. The most commonly used antiseizure drug was valproic acid (90%), 19% received a ketogenic diet and 4.2% received epilepsy surgery.

Conclusions: In our setting the incidence of drug-resistant epilepsy is high, more so than previously described. Genetic and structural etiologies are associated with a higher incidence. Having suffered status epilepticus is associated with refractoriness. A higher incidence was observed in patients with defined electroclinical syndromes, probably influenced by epileptic and developmental encephalopathies.

Glioblastoma (GBM) is the most frequent and aggressive malignant primary tumor of the central nervous system in adults, with an incidence of 3.23 per 100,000 people. Despite the existence of various therapeutic approaches, the absence of a cure and the unfavorable prognosis persist for this neoplasm, with a median survival of approximately 8-15 months and a 5-year survival rate of 6.9%. In this review, we address the epidemiology, histopathology, molecular characteristics, and treatment of GBM. We highlight the relationship of GBM with the microenvironment in the lateral ventricle wall and the cerebrospinal fluid. The location of GBM in this region results in more aggressive tumors and shorter life expectancy for patients. Understanding the malignancy mechanisms that hinder remission, treatment, and positive prognosis opens the possibility of improving diagnostic and therapeutic interventions against GBM.

Introduction and aims: The diagnosis of headache in children can be challenging due to its clinical variability and inability to verbalize certain symptoms. The use of drawing has been proposed to overcome these difficulties. The objective was to evaluate drawing as a diagnostic tool in primary headaches.

Materials and methods: Cross-sectional and descriptive study to assess the agreement between the 'artistic' diagnosis of headache and the clinical diagnosis. We consider an artistic diagnosis to be the one issued after reviewing the drawing of the patient that was made by a neuropediatrician and two neurologists who are experts in headache. The clinical diagnosis would be the classic diagnosis made in consultation after a complete history and examination in consultation and was issued by another neuropediatrician.

Results: We included 132 patients/drawing (61.1% girls; mean age 12 years) with clinical diagnoses of: migraine (59.1%), tension headache (38.2%), and other headaches (trigeminal autonomic and nummular) (2.7%). The agreement between the artistic and clinical diagnoses in migraine and tension headache was 78.5% and 78.6%, respectively when the drawings were evaluated by a neuropediatrician. This agreement was similar for the migraine drawings assessed by both neurologists (76.3% and 83.6%), but not in the case of tension headache (35.1% and 48.4%). The agreement between neurologists was moderate and similar in both types of headaches (migraine: k 0.51; tension headache: k 0.50).

Conclusions: Headache drawing is a useful instrument in the differential diagnosis of migraine. We suggest its inclusion in the initial diagnostic evaluation of headache in children.

One of the most common errors made by physicians in all developed countries is to say that the p-value of a test is the probability that the null hypothesis considered in the test is true or false. Eighty percent of those polled in many surveys make this mistake. The p-value of a test is the probability of obtaining a result like the one obtained in the investigation if the null hypothesis is true. The probability of a pregnancy involving three embryos is very small, at 0.00008 (8 in 100,000). In pregnancies with triplets, the probability of a caesarean section being performed is very high, at 0.98 (98%). These are two very different values, and two very different concepts. Saying that 0.98 is the probability of a pregnancy involving triplets would be a serious mistake. We make the same mistake when we say that the p-value of the test is the probability that the null hypothesis is true, or the probability that it is false.

Introduction: The prevalence of attention deficit hyperactivity disorder (ADHD) in the population is currently 4%. It is usually associated with problems related to executive functions, attention and emotional regulation. Non-invasive brain stimulation, such as transcranial direct current stimulation (tDCS), may compensate for cognitive impairment, thereby benefiting neuroplasticity and long-term outcomes.

Aim: The aim is to find evidence concerning the dual application of tDCS with cognitive stimulation activities in the treatment of ADHD in adults, in relation to attention, executive functions and emotional regulation.

Materials and methods: Two reviewers conducted a literature search of Web of Science and PubMed on 22.02.2023, and selected articles that included ADHD patients aged 17-65 years old. The results were analysed using synthesis without meta-analysis (SWiM).

Results: Seven of 956 articles were selected for the present review, and were all related to executive functions and attention. No article related to neuromodulation of emotional regulation in adults with ADHD was found. Significant results related to attention and executive functions, and specifically inhibitory control, were found. All studies followed the international 10-20 system developed for the electroencephalogram.

Conclusions: Further research is required in view of the limited number of studies found on the symptomatological treatment of ADHD with tDCS in adult populations and the lack of awareness of emotional regulation. This research should use a treatment involving more than two sessions. These tasks do not involve learning and involve a stimulation of more than 1.5 mA.

Introduction: Leukodystrophies are a group of developmental disorders of the white matter in the central nervous system. Their differential diagnosis is very broad, and as such information from neuroimaging can be very useful. We present the case of an infant diagnosed with leukoencephalopathy with vanishing white matter following neurological regression.

Case report: A 7-month-old male infant with no relevant history was admitted to a tertiary hospital as a result of vomiting, refusing food, and neurological symptoms. The episode was diagnosed as subacute rhombencephalitis based on the clinical findings and brain magnetic resonance imaging. Treatment with corticotherapy was undertaken, and led to gradual improvement. The patient was admitted once again three months later, due to an evident neurological regression after vaccination. A further MRI brain scan showed findings compatible with leukodystrophy, which was diagnosed as leukoencephalopathy with vanishing white matter after a genetic study. Treatment of symptoms was undertaken with follow-up by the home hospitalisation unit. However, the patient finally died at 15 months of age as a consequence of the evolution of his condition.

Conclusions: Dealing with neurological regression in paediatric patients is challenging, and neuroimaging may be very useful for an initial diagnosis. There is no curative treatment for most leukodystrophies and the prognosis is usually poor. The patient's comfort must therefore be optimised, and genetic counselling must be provided.

A paediatric stroke is a rare entity that can occur at any age. It may be arterial or venous, ischemic or haemorrhagic, and may occur in the neonatal or paediatric stage of life, as well as in adolescence. Prompt diagnosis means that adequate treatment can be administered and prevents recurrence, minimising the percentage of sequelae. This guide aimed to analyse, prepare and classify the literature currently available in order to determine the best recommendations on the treatment of strokes in paediatric patients. In each section, we attempted to answer the following questions: when should we think in terms of a stroke and thrombosis of the cerebral venous sinuses in a newborn or paediatric patient? What are the recommended complementary studies? Is treatment indicated? What are the recommended treatments? This guide was prepared based on the opinion of experts in the field, in order to determine how the recommendations were assessed according to the 2011 Oxford Levels of Evidence. Finally, the guidelines were reviewed by the scientific committee of the Iberoamerican Academy of Pediatric Neurology for subsequent dissemination.