Revista de neurologia最新文献

Introduction: Post-traumatic stress disorder (PTSD) develops in response to a traumatic experience, whether real or threatening, which produces emotions of intense fear and memory problems, significantly damaging the quality of life of those who manifest it. In recent years, anatomical-functional changes in the amygdala-hippocampus-prefrontal cortex circuit have begun to be studied as a key factor in the prevention, vulnerability, and treatment of PTSD, with neuroplasticity being one of the factors of greatest interest. Therefore, this review will address the latest published data regarding PTSD and neuroplasticity.

Development: Data from preclinical and clinical models support that a traumatic experience modifies both synaptic plasticity through electrophysiological and chemical variables, as well as myelin plasticity which enables short and long-distance connections. This remodelling of circuitry is crucial for the development of PTSD. However, it is also closely associated with prevention and positive treatment outcomes. Variables such as social support or the use of psychotherapy following a traumatic experience are linked to a good prognosis.

Conclusions: Therefore, there is an interesting connection between neuroplasticity and PTSD, although many questions remain open today, along with promising lines of prevention and intervention, including psychedelic substances.

Introduction: Stroke is highly prevalent worldwide; however, associated symptoms and risk factors are unknown in the general population. Our aim was to describe the knowledge of early signs of stroke and its association with the risk of stroke at 5 and 10 years according to the "Stroke Riskometer™".

Subjects and methods: This was an observational, descriptive, cross-sectional study, including adults in the Neurology outpatient clinic of the University Hospital "Dr. José Eleuterio González". Vital signs were recorded, anthropometric and the "Stroke Riskometer™" measurements were collected, and the risks at 5 and 10 yearswere calculated. Patients were questioned about the early signs of stroke (with emphasis on the acronym FAST: F = Face uneven, A = Arm hanging down, S = Speech slurred, T = Time is vital [CAMALEÓN in Spanish]). Spearman's evaluation was used to measure the association between risk and knowledge of signs.

Results: A total of 300 participants were included; 208 (69.3%) were women and the mean age was 54.5 (±14.0) years. The most prevalent risk factors for stroke were sedentary lifestyle (46.3%), high blood pressure (40.0%), and diabetes (31.0%). The population median risk at 5 years was 3.6% (interquartile range (IQR) 1.9-7.0) and at 10 years 6.3% (IQR 3.1-14.0). Of all participants, 31.2% were aware of at least one early sign of stroke. No significant correlation was found between awareness of early signs and risk at 5 or 10 years (r = 0.039, p = 0.5; r = -0.05, p = 0.380, respectively).

Conclusions: Knowledge of the signs of stroke is low but remains an ongoing goal for educational campaigns in Mexico. A large-scale national and long-lasting campaign is necessary, given the high risk of stroke in the population.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects attentional and executive functions, which may interfere with facial emotion recognition. This study explored the recognition of basic and complex emotions in pediatric subjects with ADHD.

Method: This was a prospective, cross-sectional, controlled study. A total of 60 participants were included, divided into two groups: the ADHD Group (n = 30) and the Control Group (n = 30) with neurotypical development. Each participant was presented with a series of photographs and video clips of children and adults and was asked to identify the emotion expressed on the face.

Results: No significant differences were found in the recognition of basic emotions between the Control Group (M = 44.43; SD = 2.01) and the ADHD Group (M = 43.90; SD = 2.14; t(58) = -0.995; p = 0.324), nor in the recognition of complex emotions [t(58) = 0.514; p = 0.609]. No differences were found by age [Z = 463; p = 0.843] or by sex (p = 0.92). We observed significantly better performance with a large effect size when recognizing child faces (M = 29.56; 95% CI 28.98-30.14) compared with adult faces (M = 14.86; 95% CI 14.46-15.26; p < 0.001; d = 11.03), with performance on adult faces improving with age (rho = 0.39; p = 0.03).

Conclusion: The ADHD Group did not show differential performance compared with the neurotypical group in emotion recognition. Performance significantly improved for child faces, suggesting that adult faces should be avoided when assessing this population. Recognition of adult faces improved with age.

Migraine is a complex condition when considered from the perspective of its pathophysiology. Moreover, it is highly prevalent and of priority interest in public health. Gepants are a highly-effective and specific therapeutic option, although their recent arrival in Latin America raises particular questions and expectations. A narrative review of the four medications available outside Latin America at this time is provided and the main considerations that should be borne in mind before and during their adoption are presented. Appropriate patient selection and marketing cost will be key determinants for their consolidation as an alternative to traditional medications used in migraine.

Background: Stroke is a leading cause of death and disability worldwide, prompting significant interest in rehabilitation. Despite existing recommendations and clinical guidelines, the current state of stroke rehabilitation practices in Catalonia remains unclear. This study aims to identify physiotherapists' main approaches for stroke survivors in Catalonia across recovery stages.

Methods: An observational study was conducted via an anonymous survey distributed among all the registered members of the College of Physiotherapists of Catalonia (CPC). A total of 118 physiotherapists from both the public and private sector participated. The study collected data on therapists' experience, preferred therapeutic modalities, user demographics, and work settings. The data was collected from January to March, 2023.

Results: The survey on stroke rehabilitation approaches showed that 57.60% of participants use a mix of methods (Basal Stimulation, Proprioceptive Neuromuscular Facilitation (PNF), neurodevelopmental or neurocognitive therapy) tailored to individuals or stroke stages, regardless of the work setting. Regarding the techniques, the most used were passive mobilization, stretching, task-oriented approaches, motor imagery, intensive therapy, mirror therapy, and balance training. In contrast, electrotherapy, music therapy, mindfulness, and advanced technologies were the least used.

Conclusions: Physiotherapists did not rely on a single technique or approach; instead, they combined various methods. Therefore, we are unable to definitively determine what constitutes conventional physiotherapy. Considering this ambiguity, it is recommended to explicitly identify the techniques and methods used during conventional physical therapy in all scientific studies.

Clinical trial registration: No: NCT05546840. 15 September 2022, https://clinicaltrials.gov/study/NCT05546840?cond=NCT05546840&rank.

Introduction: There are many variables to consider when withdrawing anti-epileptic seizure treatment and risk-benefit evaluation is required.

Material and methods: Retrospective study of patients from a neuropediatric clinic who were discontinued from pharmacological treatment for epilepsy and continued without treatment.

Results: Of 57 children from whom treatment was withdrawn, 34 remained without treatment. In 23 cases, treatment was withdrawn once, with a mean seizure-free time until withdrawal of 21 months and a mean age of 10.5 years. Three cases presented seizures but treatment was not reintroduced; the average time without a crisis was 44.78 months. Treatment was withdrawn twice in nine children and three times in two children, with a mean seizure-free time until withdrawal of 28.5 months; the average age was 16.3 years. Two cases presented seizures but treatment was not reintroduced; the average time without a crisis was 5.7 years. High-risk cases of recurrent epileptic seizures were left without anti-seizure medication: seven cases of intellectual disability, one refractory epilepsy, two cases of epilepsy with onset in adolescence, and in 11 children, 13 instances of failure in previous withdrawal attempts.

Discussion: The indication and maintenance of treatment with anti-seizure drugs in children must prioritize patient welfare and be based on three premises: the treatment is indicated, the treatment is tolerated, and the treatment is effective. The decision to withdraw must be made on a case-by-case basis, acknowledging the risk of relapse and taking into account efficacy and tolerance, especially in children with behavioral and neurodevelopmental disorders.

Landau-Kleffner syndrome is a developmental epileptic encephalopathy that manifests mainly in pediatric patients, characterized by verbal auditory agnosia and focal, bilateral, and focal and diffuse epileptic activity, visualized through electroencephalographic recordings performed during sleep. It is a rare syndrome with a variable, multifactorial presentation and unknown etiology, although it has a genetic component in some cases. It is often associated with variants of the glutamate ionotropic receptor N-methyl-D-aspartate (NMDA) type subunit 2A (GRIN2A) gene, which encodes an NMDA receptor subunit of the same name that is involved in various neurophysiological processes. Modifications to this receptor could be associated with the clinical manifestations observed in patients. This review proposes a pathophysiological mechanism related to one of the clinical presentations of this disease, using information published in recent years, and contributes to the understanding of its pathology and the improvement of its management. This syndrome is a rare and complex disease; both its diagnosis and treatment are challenging, limiting patients' therapeutic options and compromising their quality of life.

Introduction: Cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease (AD) are essential for the early identification of non-amnestic phenotypes. Increased levels of total tau (t-tau) and phosphorylated tau (p-tau) have been reported in atypical AD cases, although the specific pattern remains a subject of debate. This study aimed to evaluate CSF biomarker profiles in relation to clinical phenotype.

Materials and methods: A retrospective review was performed, analyzing demographic data, time to diagnosis, clinical phenotype, and core AD biomarkers (beta-amyloid peptide 1-42 (Aβ1-42), t-tau, p-tau) in CSF from patients evaluated at University Hospital in Navarra between 2019 and 2022.

Results: The study included 57 patients (54% female, mean age 67 years), of whom 41 met AD diagnostic criteria. Among these, 10 patients (25%) presented with atypical phenotypes (50% aphasic, 30% frontal, 20% mixed non-amnestic). Compared with the amnestic phenotype, the atypical group exhibited significantly higher t-tau (562.9 pg/mL vs 320.3 pg/mL, p = 0.021) and p-tau (81.5 pg/mL vs 37.7 pg/mL, p = 0.016) levels, independent of age, sex, and time to diagnosis.

Conclusions: Atypical cases demonstrated increased tau levels, suggesting earlier and more extensive cortical damage than the amnestic phenotype. These findings underscore the significance of CSF biomarkers in phenotypic differentiation, disease course prediction, and individualized treatment strategies for AD.