Trastorno paroxístico no epiléptico en paciente referido por sospecha de epilepsia / Paroxysmal non-epileptic events in patients referred for suspicion of epilepsy

Los Trastornos Paroxísticos No Epilépticos (TPNE), son diagnóstico diferencial de crisis epilépticas. En Chile no existen reportes de frecuencia. OBJETIVO: Determinar frecuencia de TPNE en pacientes derivados por sospecha de epilepsia a Unidad de Electroencefalografía, Hospital Roberto del Río. METODOLOGÍA: Estudio observacional, transversal. Se revisó registros clínicos de pacientes derivados por sospecha de epilepsia(2012- 2014). Inclusión: paciente con TPNE, >1 mes, sin epilepsia previa. Caracterización: sexo, edad, tipo/subtipo TPNE, comorbilidades, electroencefalograma (EEG), uso fármaco antiepiléptico (FAE). Aprobado por comité de ética. RESULTADOS: Derivados 913 pacientes por sospecha de epilepsia. 36% TPNE (2,3% con epilepsia concomitante), 22% epilepsia aislada. TPNE más frecuente: escolares (31%), adolescentes (29%), femenino (52%). 30,1% hipoxia cerebral (síncope, Espasmo Sollozo); 22,4% trastornos del comportamiento (Descontrol Episódico, Crisis Psicógena no Epiléptica). 32,8% con comorbilidades no epilépticas (Trastornos psiquiátricos/neurodesarrollo). 4,3 % recibieron FAE. CONCLUSIONES: La frecuencia de TPNE en niños/adolescentes supera a la de epilepsia. Es fundamental evaluación multidisciplinaria.

Paroxysmal non-epileptic events (PNE) are differential diagnosis of epileptic seizures. In Chile, there are no reports on its frequency. OBJECTIVE: To determine the frequency of PNE in patients referred for suspicion of epilepsy to the Electroencephalography Unit of Roberto del Río Hospital. METHODOLOGY: Observational, cross-sectional study. Clinical records of patients referred for suspicion of epilepsy (2012-2014) were reviewed. Inclusion: Patient with PNE, >1 month, without previous epilepsy. Characterization: gender, age, PNE type/subtype, comorbidities, electroencephalogram, use of antiepileptic drug (AED). Approved by the ethics committee. RESULTS: 913 patients were referred for suspected epilepsy: 36% PNE (2,3% with concomitant epilepsy), 22% isolated epilepsy. PNE were more frequent in children (31%) adolescents (29%), and in females (52%). 30.1% Cerebral hypoxia (syncope, breathholding-spells); 22,4% Behavioral disorders (Episodic loss of control, Non-Epileptic Psychogenic Seizures). 32.8% non-epileptic comorbidities (Psychiatric/ neurodevelopmental disorders). 4.3% received AEDs. CONCLUSIONS: The frequency of PNE in children and adolescents exceeds that of epilepsy. A multidisciplinary medical evaluation is of the outmost importance. Keywords: Paroxysmal Non-Epileptic Disorder, Non-epileptic episodes, Epilepsy.

Zika virus: what do we know about the viral structure, mechanisms of transmission, and neurological outcomes?

Abstract: The Zika virus epidemic that started in Brazil in 2014 has spread to >30 countries and territories in Latin America, leading to a rapid rise in the incidence of microcephalic newborns and adults with neurological complications. At the beginning of the outbreak, little was known about Zika virus morphology, genome structure, modes of transmission, and its potential to cause neurological malformations and disorders. With the advancement of basic science, discoveries of the mechanisms of strain variability, viral transfer to the fetus, and neurovirulence were published. These will certainly lead to the development of strategies to block vertical viral transmission, neuronal invasion, and pathogenesis in the near future. This paper reviews the current literature on Zika virus infections, with the aim of gaining a holistic insight into their etiology and pathogenesis. We discuss Zika virus history and epidemiology in Brazil, viral structure and taxonomy, old and newly identified transmission modes, and neurological consequences of infection.

Trastornos neurológicos en niños con síndrome de Down / Prevalence of neurological disorders among children with Down syndrome

Background: Neurological disturbances are common problems in children with Down Syndrome (DS). Aim: To determine the prevalence of neurological disorders affecting children with Down Syndrome. Patients and Methods: Review of medical records of253 children aged from 1 day to 23 years affected with DS, attended at a public hospital and a University clinic. Results: The overall prevalence of neurological disorders was 38.7%. The most common problems were ocular motor disorders in 26% of cases and epilepsy in 12%. Conclusions: Neurological disorders are more common in children with DS than in the general population. Motor ocular disorders and epilepsy are the predominant disturbances detected.

Neuronosology: historical remarks / Neuronosologia: observações históricas

Classifications for neurological disorders have evolved from following the theory of the humors to modern anatomical pathology and, recently, to the germ theory that stared the etiological era, as seen in book content lists. The symptomatic approach towards neuronosology was widely used until the middle of the 19th century. The following books are representatives of this: "De Cerebri Morbis (1549)"; "De anima brutorum (1672)"; and "A Treatise on Nervous Disease (1820-1823)". During the Enlightenment, "Synopsis Nosologiae Methodicae (1769)" had a great repercussion subsequently on neuronosology. "Lehrbuch der Nerven-Krankheiten des Menschen (1840-1846)" was the first systematic treatise in neurology, and "A Treatise on the Diseases of the Nervous System (1871)" was the first American textbook of neurology, and probably the first comprehensive one. The first Brazilian textbook was "Lições sobre as moléstias do sistema nervoso, feitas na Faculdade de Medicina do Rio de Janeiro (1878)". A presentation going from causes of death to the International Classification of Diseases and their importance for neurology is also made.

A evolução da classificação de transtornos neurológicos seguiu desde a teoria dos humores até à anatomia patológica moderna e, recentemente, à teoria do germe, que iniciou a era etiológica, tendo em vista o sumário dos livros. A abordagem sintomática na neuronosologia foi extensamente usada até meados do século XIX. Os livros seguintes são representativos disso: "De Cerebri Morbis (1549)"; "De anima brutorum (1672)"; "A Treatise on Nervous Disease (1820-1823)". Durante o Iluminismo, "Synopsis Nosologiae Methodicae (1769)" teve grande repercussão posterior na neuronosologia. "Lehrbuch der Nerven-Krankheiten des Menschen (1840-1846)" é o primeiro tratado sistemático em neurologia e "A Treatise on the Diseases of the Nervous System (1871)" é o primeiro livro americano de neurologia, provavelmente o primeiro livro de neurologia abrangente. O primeiro brasileiro foi "Lições sobre as Moléstias do Sistema Nervoso, feitas na Faculdade de Medicina do Rio de Janeiro (1878)". São apresentadas desde Listas de mortalidade até as Classificações Internacionais de Doenças e a sua importância na neurologia.

Curso de reumatologia: aula 7: manifestações neurológicas nas colagenoses / Course of rheumatology: class 7: neurologic manifestations in collagenosis

O propósito deste artigo é focar as principais manifestações neurológicas das doenças difusas do tecido conjuntivo, com ênfase nas suas manifestações clínicas. Os autores discutem as várias complicações do sistema nervoso central e periférico na doença muscular inflamatória (polimiosite e dermatomiosite), policondrite recidivante, esclerose sistêmica, artrite reumatoide, síndrome de Sjõgren, doença mista do tecido conjuntivo (doença de Sharp), lúpus eritematoso sistêmico e síndrome do anticorpo antifosfolipide.

The purpose of this article is to focus on the major nervous system manifestations in connective tissue diseases, with emphasis on their clinica findings. Authors discuss several complications in inflammatory muscle disease (polymyositis an dermatomyositis), relapsing polychondritis, systemic sclarosis, rheumatoid arthritis, Sjõgren syndorme, mixed connective tissue (Sharp disease), systemic lupus erythematosus and antiphospholipid syndrome.

Prevalencia de trastornos temporomandibulares y relación con estrés emocional en patologías neurológicas de base / Prevalence of temporomandibular joint disorders and their relationship with emotional stress and pre-existent neural pathologies

Los trastornos temporomandibulares han sido definidos como un término colectivo que encierra muchos problemas clínicos que comprometen la musculatura masticatoria, articulaciones y estructuras asociadas, siendo indentificado como la causa principal de dolor de origen no dental. Actualmente se está de acuerdo en que la etiología de estos trastornos es multifactorial, donde se combinan los factores físicos y psicosociales, siendo el estrés emocional un factor esencial en la etiología de estos trastornos. Para realizar diagnósticos estandarizados de los subtipos de trastornos temporomandibulares, se requieren criterios válidos y confialbes, donde los criterios diagnósticos para la investigación de los TTM (CDI/TTM) son recomendados como instrumento estandarizado para medios los signos de estos desórdenes. En este estudio se intenta demostrar que los pacientes con patologías neurológicas de base, presentan mayor prevalencia de trastornos temporomandibulares. Método: para realizar este estudio de prevalencia se seleccionó una muestra de 25 pacientes pertenecientes al Centro de Rehabilitación y Capacitación Santa Fe de Curicó. Resultados: el 96 por ciento de los pacientes presentó algún tipo de TTM, siendo las alteraciones articulares las más prevalentes (84 por ciento), mientras sólo un 12 por ciento de ellos presentó algún grado de estrés emocional (alteraciones conductuales, sicológicas y psicosociales). Conclusión: en base a lo anterior, no se puede relacionar estrés y TTM en la muestra estudiada, lo que se debería al ambiente protegido en que se encuentran, por pertenecer a un centro de rehabilitación.

Neurological intensive care in India--disease spectrum and outcome.

In recent years neurological and neurosurgical intensive care (NNICU) has evolved into a well-recognized subspeciality world over. However it is still a novel concept in the developing world. The admission criteria are variable and flexible. The pattern of disease in the NNICU varies according to the admission policy. In the west, cerebrovascular diseases account for a significant proportion of admissions. In a few studies from the developing countries infections of central nervous system are additional causes requiring intensive care. At our center the disease admission pattern was similar to the pattern reported from the developed countries. Predictors of outcome of neurointensive care have not been systematically evaluated. Limited available data concerns patients of neurotrauma. In addition to the disease severity indices, pre-existing chronic illness, adverse events during ICU stay, and the 24-hour presence of a physician also influence patient outcome in the NNICU.

Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96).

One hundred patients (95 males, 5 females, mean age at presentation 31.6 +/- 9.4 yr) with various neurological disorders associated with HIV infection during 1989-1996 were evaluated at NIMHANS, Bangalore. Eighty patients belonged to group I associated with opportunistic neuroinfections and 20 to group II--non infectious neurological disorders. Cryptococcal meningitis either alone (n = 31) or associated with tuberculous meningitis (n = 6) was the most common (46.3%) followed by neurotuberculosis either alone (n = 24) or with cerebral toxoplasmosis (n = 4) accounting for 35 per cent. Other opportunistic neuroinfections included cerebral toxoplasmosis, herpes zoster, fulminant pyogenic meningitis and neurosyphilis. Clinical characteristics, diagnostic clues, their laboratory and radiological profiles and problems encountered in diagnosis and management of these opportunistic infections are highlighted. In group II (19 males and one female; mean age of 32.6 +/- 9.4 yr), two patients had cortical dementia, three acute brain stem involvement, two epilepsy and one had features suggestive of progressive multifocal leukoencephalopathy. Two patients of group I during follow up developed cortical dementia. Six had peripheral nervous system involvement similar to Guillain-Barre syndrome. Sixty six patients (63 of group I and 3 of group II) progressed to AIDS, 33 patients from group I and one patient from group II succumbed to the disease. With the rapid increase in the incidence of HIV/AIDS and an increase in the neurological manifestations of HIV/AIDS it is important to recognise the magnitude of the problem for health planning in India.

Mortalidad por causas neurológicas en el área metropolitana (República Argentina): un avance en su conocimiento, aspectos metodológicos y resultados / Neurological mortality in the metropolitan area of Buenos Aires, Argentina

La práctica asistencial nos lleva a sospechar la importancia de la patología neurológica en el proceso enfermedad-muerte. El presente trabajo tiene como objetivo identificar ese impacto en el perfil de morbimortalidad en nuestro medio, lo cual permitirá orientar medidas preventivas. Para el análisis se utilizaron los tabulados de mortalidad del área metropolitana (Capital Federal y Gran Buenos Aires), 1985, donde se concentra el 33 por ciento de la población del país. De los 17 capítulos de causas que se agrupan en la CIE (9oR), el VI corresponde a las enfermedades del SN y órganos de los sentidos. Para el logro de los objetivos fue necesario incorporar causas incluídas en otros capítulos. Del capítulo XVII (accidentes y envenenamientos) no se pudieron reconocer y recuperar los traumatismos de cráneo, dado que se consignan por el origen de la lesión. El total de causas neurológicas representó el 14 por ciento de las defunciones del área durante 1985. Si solo se hubiera incluído el capítulo VI no superaría el 1 por ciento de la mortalidad. De cada 10 personas que fallecieron por motivos neurológicos, en 8 fue por enfermedad cerebrovascular. Más del 60 por ciento de las muertes analizadas ocurrieron en mayores de 65 años. Este análisis reveló: 1) que la importancia de la mortalidad por causas neurológicas excede ampliamente a lo referido en su capítulo de la CIE; 2) la escasa especificación de diagnósticos neurológicos en el certificado de defunción; 3) que las enfermedades cerebrovasculares continúan siendo la principal causa de muerte neurológica; y 4) que las muertes por causa neurológica se concentran en edades avanzadas