Revista de neurologia最新文献

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.

Introduction: Angelman syndrome is a genetic disorder characterised by severe mental retardation, subtle dysmorphic facial features, a characteristic behavioural phenotype, seizures and abnormalities in video electroencephalograms (video EEG). Angelman syndrome may be associated with genetic mechanisms involving the region of chromosome 15q11-13. Up to 90% of cases have epileptic seizures, usually in the early years of life. Videoelectroencephalography patterns with some typical characteristics associated with Angelman syndrome have been reported, although these are not specific to it, and as such it is also useful for early diagnosis, especially in the first months or years of life.

Objective: To characterise the videoelectroencephalography findings of 17 patients diagnosed with Angelman syndrome, and compare them with previously published studies.

Patients and methods: We conducted a retrospective observational study of 34 video EEGs performed on 17 patients diagnosed with Angelman syndrome at the clinical neurophysiology service of the Puerta de Hierro University Hospital in Madrid between 2019 and 2022. The primary objective was to characterise the videoelectroencephalographic findings and compare them with previously published studies. As secondary objectives, we analysed the patterns proposed by Dan and Boyd, and other demographic, genetic and clinical data.

Results: Video EEG supported the clinical suspicion in our study, as baseline brain activity was altered in all the patients. We identified a pattern similar to those defined by Dan and Boyd in 88% of the cases, and the type III pattern was the most common in our series.

Conclusions: These findings confirm that video EEG is highly sensitive for the diagnosis of Angelman syndrome, and very useful as a diagnostic biomarker in the early stages of life.

Parkinson's disease (PD) is a neurodegenerative disorder that significantly affects patients' quality of life. Treatment of PD requires accurate assessment of motor and non-motor symptoms, which is often complicated by subjectivity in reporting symptoms, and the limited availability of neurologists. Commercial wearable devices, which monitor PD symptoms continuously and outside the clinical setting, have appeared to address these challenges. These devices include PKG™, Kinesia 360™, Kinesia U™, PDMonitor™ and STAT-ON™. These devices use advanced technologies, including accelerometers, gyroscopes and specific algorithms to provide objective data on motor symptoms, such as tremor, dyskinesia and bradykinesia. Despite their potential, the adoption of these devices has been limited, due to concerns about their accuracy, complexity of use and the lack of independent validation. The correlation between the measurements obtained from these devices and traditional clinical observations varies, and their usability and patient adherence are critical areas for improvement. Validation and usability studies with a sufficient number of patients, standardised protocols and integration with hospitals' IT systems are essential to optimise their usefulness and improve patient outcomes.

Aim: To determine the treatment of hyperglycemia in the stroke unit, and to compare the morbidity and mortality of patients treated with an intravenous (iv) insulin therapy protocol compared to subcutaneous (sc) insulin when reaching glycemia levels of = 155 mg/dL.

Patients and methods: We performed a prospective observational study of patients admitted to our stroke unit between July and October 2022. Demographic, glycemic and prognostic variables were collected. Glycemic variability was defined as the standard deviation (SD) of the mean individual glycemia during the first 24-72 hours. Acute complications during admission and mortality at discharge and at 3 months were determined. The variables were analysed by subgroup according to the insulin regime in patients with type 2 diabetes mellitus (DM2) or stress hyperglycemia.

Results: The sample consisted of 181 patients, of whom 63.5% were male, with a mean age of 74.2 (SD: 11.6) years. 25.4% required insulin due to glycemia = 155 mg/dL (18 patients iv and 28 sc). 31.5% had DM2 (82.6% of the group receiving insulin and 14% of group without insulin). The group receiving insulin presented higher levels of glycemic variability, at 33.3 (SD: 21.7) mg/dL vs. 11.7 (SD: 7) mg/dL (p < 0.01), more acute complications (43.5% vs. 19.2%; p < 0.01) and higher mortality at 3 months (19.5% vs. 6.6%; p = 0.04) than the group without insulin, and no differences were observed between the type of insulin regime in the subgroups with DM2 or stress hyperglycemia.

Conclusions: The patients with glycemia = 155 mg/dL presented higher levels of glycemic variability, acute complications and mortality at 3 months, and no differences were observed in the type of insulin regime, regardless of whether they had DM2.

Introduction: Multiple factors can cause sleep disturbances in Parkinson's disease. The quality of sleep and therefore of life is usually improved with continuous dopaminergic stimulation therapies, such as continuous subcutaneous infusion of apomorphine.

Patients and methods: We present an observational retrospective study of patients at our centre with advanced Parkinson's disease, treated with continuous infusion of apomorphine, with treatment extended to nights, between 2011 and 2022. We collected data from 37 patients, and evaluated the indication for nocturnal treatment, efficacy, safety and reasons for withdrawal.

Results: Fifty percent of patients began nocturnal treatment for motor complications, 19% for non-motor complications and 31% for both. The most common non-motor symptoms were sleep fragmentation and disturbances, neuropathic pain, psychiatric symptoms and intense nocturia. Twenty of the 37 patients (54%) were continuing treatment at the end of the study follow-up, 16 (43%) discontinued the infusion, and one (3%) was lost to follow-up. The adverse reactions that led to termination of the infusion were severe nodules (two), dopaminergic psychosis (one) and a positive Coombs test with/without anaemia (one). Four patients terminated the nocturnal infusions while continuing the daytime infusions due to suboptimal adaptation to the device. Patients whose symptoms improved without any significant adverse effects continued the treatment.

Conclusions: Continuous infusion of apomorphine during the night was an effective and safe treatment in our series.

Introduction: The global burden of dementia will continue to increase and Latin America will be one of the most affected regions. It is urgent to have new and better cognitive screening tools. There are few screenings composed entirely of auditory-verbal items and even more so for Argentine culture. The objective was to build and validate a test for verbal auditory screening of cognitive alterations (CAVAC) in Argentina.

Subjects and methods: Evidence based in test content was analyzed through 16 experts collaborated. In addition, evidence based on relationships to other variables, internal consistency and the ability to discriminate between cognitively healthy subjects, Mild Cognitive Impairment (MCI) and dementia were investigated. The CAVAC was applied to 316 Argentines (M age = 68,5). Volunteers from the general population and patients from neurology services from two Argentine hospitals participated.

Results: The CAVAC test explores orientation/attention, memory/learning, language and executive functions, and is administered in 10 minutes with a score of 0 to 30. Aiken's V coefficient was satisfactory for all items. The CAVAC achieved a high correlation with the Mini Mental (0.762) and an acceptable Cronbach's alpha (0.746). The CAVAC score differs between controls, mild cognitive impairment (MCI) and dementia, and the ROC curves reveal adequate area values ??to discriminate MCI and dementia (>0.7), and cut-off points with good sensitivity-specificity.

Conclusions: A new auditory-verbal test is made available for the screening of cognitive alterations with acceptable evidence of validity, good reliability, with the capacity to identify MCI and dementia, and free of charge for use.