Epidemiological Profile of Surgically-Treated Peripheral-Nerve Diseases

Objective To outline the epidemiological profile of surgical patients treated at the peripheral-nerve outpatient clinic of a public hospital in the state of Pernambuco, Brazil, from 2008 (the year this service was implemented in the hospital ) to 2016. Material and Methods A cross-sectional study with data collection from the medical records. A descriptive analysis was performed with the qualitative variables presented as relative and absolute frequencies, and the quantitative variables, as means and standard deviations. The studied variables were gender, age, diagnosis, and surgical techniques. Results In total, 506 medical records were analyzed. Of these, 269 were of male patients (53%), and 238 were of female patients (46%). The age of the sample ranged from 5 to 84 years (41 14 years). The most prevalent diagnoses were: carpal tunnel syndrome (38.9%) followed by traumatic brachial plexus injury (33.2%). The first diagnosis was more frequent among women, while the second, among men. This collaborates with the predominant findings of upper-limb lesions (91%), in which men accounted for 52,75% (244) and women, for 47,25% (217). Conclusion The present study provided relevant information regarding the reality of peripheral-nerve surgeries performed at a public hospital in the state of Pernambuco, Brazil. Public health issues increasingly require the continuity of public policies and government incentive.

Polineuropatia periférica na doença de Parkinson: prevalência e fatores de risco em uma amostra na cidade de Campina Grande - PB / Peripheral neuropathy in Parkinson's disease: prevalence and risk factors in a sample of Campina Grande city - Paraíba

Polineuropatia periférica (PNP) tem sido descrita na doença de Parkinson idiopática (DP), porém a prevalência e os fatores de risco não estão bem definidos. Objetivo: Investigar a prevalência e os fatores de risco para PNP na DP, em comparação com a população geral. Método: Participaram 36 pacientes com DP recrutados no ambulatório de Neurologia do Hospital Universitário Alcides Carneiro (HUAC) da Universidade Federal de Campina Grande (UFCG), Paraíba, e 30 sujeitos controles. Todos os participantes foram submetidos a caracterização clínica da PNP, ao estudo de neurocondução (ENC) dos nervos peroneal e sural bilateral e as dosagens de vitamina B12, homocisteina, ácido metilmalônico e ácido fólico. A Escala Unificada de Avaliação da Doença de Parkinson - III e a de Hoehn-Yahr foram utilizadas na avaliação motora do grupo Parkinson (GP). Resultados: Sinais e sintomas neuropáticos foram mais frequentes no GP (61%). Alterações nos parâmetros do ENC foram observadas em 44,4% do GP e 26,7% do grupo controle, sendo a PNP confirmada em três pacientes e um controle. Análise de regressão revelou associação significativa entre os sintomas neuropáticos e a DP, sem associação com aspectos clínicos e bioquímicos. Conclusão: Pacientes com DP possuem maiores escores neuropáticos e maior prevalência de PNP que controles. Os dados sugerem a própria DP como fator de risco para o desenvolvimento da PNP, minimizando o papel da vitamina B12 e de seus metabólitos neste processo.(AU)

Peripheral neuropathy (PN) has been described in idiopathic Parkinson disease (PD) however the prevalence and the risk factors are not well established. Objective: To assess the prevalence of PN and the risk factors for neuropathy in PD against the general population. Method: Participated in the study 36 PD patients recruited from Neurology Outpatient Unit of Hospital Universitário Alcides Carneiro of the Federal University of Campina Grande, Paraíba, and 30 controls. All the participants were submitted to clinical characterization of PN, nerve conduction study (NCS) and biochemical dosages (B12 vitamin, homocysteine, methylmalonic acid and folic acid). Results: Neuropathic signs and symptoms were more frequent in PD (61%). Alterations in parameters of NCS were observed in 44.4% of Parkinson group and 26.7% of control group, and PN was confirmed in 3 PD patients and 1 control. Regression analyses showed a significant association between symptoms of PN and PD, without association with clinical and biochemical features. Conclusion: PD patients have higher neuropathic scores and frequency of PN than controls. Data suggests the PD by itself as a risk factor for development of PN, reducing the role of B12 vitamin and its metabolites in this process.(AU)

Hyperuricemia in systemic lupus erythematosus: is it associated with the neuropsychiatric manifestations of the disease? / Hiperuricemia no lúpus eritematoso sistêmico: está associada a manifestações neuropsiquiátricas da doença?

ABSTRACT Objectives: To assess the association between hyperuricemia and different neuropsychiatric manifestations and stroke risk factors in systematic lupus erythematosus (SLE) patients. Methods: This study was conducted on 204 SLE patients who were admitted to a tertiary referral center. A standardized questionnaire was completed for all the participants and the medical records were reviewed regarding the occurrence of arterial or venous thrombotic events, stroke, seizure, depression, headache, psychosis, and peripheral neuropathy. In addition blood samples were drawn to obtain serum uric acid, triglyceride (TG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and total cholesterol levels. Results: Hyperuricemia (serum uric acid ≥6 mg/dl for women and ≥7 mg/dl for men) was detected in 16.1% of SLE patients and was significantly associated with the occurrence of stroke (OR, 2.38; 95%CI, 1.2-7.24), and peripheral neuropathy (OR, 3.49; 95% CI, 1.52-12.23), independent of hypertension and hyperlipidemia. Hyperuricemia was also significantly associated with hypertension (OR, 7.76; 95% CI, 2.72-15.76), hyperlipidemia (OR, 5.05; 95% CI, 1.59-11.32), and history of arterial thrombosis (OR, 4.95; 95% CI, 1.98-15.34), independent of age and body mass index. Conclusions: Hyperuricemia in SLE patients is independently associated with the occurrence of stroke and peripheral neuropathy. It is also independently associated with hypertension, hyperlipidemia, and history of arterial thrombosis, which are the major stroke and myocardial infarction risk factors in SLE patients.

RESUMO Objetivos: Avaliar a associação entre a hiperuricemia e diferentes manifestações neuropsiquiátricas e os fatores de risco para AVE em pacientes com lúpus eritematoso sistêmico (LES). Métodos: Este estudo foi feito em 204 pacientes com LES que foram internados em um centro de referência de atenção terciária. Todos os participantes preencheram um questionário padronizado e os prontuários médicos foram analisados quanto à ocorrência de eventos trombóticos arteriais ou venosos, acidente vascular encefálico, convulsão, depressão, cefaleia, psicose e neuropatia periférica. Além disso, foram coletadas amostras de sangue para se mensurarem os níveis de ácido úrico, triglicerídeos (TG), lipoproteínas de alta densidade (HDL), lipoproteínas de baixa densidade (LDL) e colesterol total do sangue. Resultados: A hiperuricemia (ácido úrico sérico ≥ 6 mg/dL para mulheres e ≥ 7 mg/dL para homens) foi detectada em 16,1% dos pacientes com LES e esteve significativamente associada à ocorrência de AVE (OR, 2,38; IC 95%, 1,2-7,24) e neuropatia periférica (OR, 3,49; IC 95%, 1,52-12,23), independentemente da hipertensão arterial e da hiperlipidemia. A hiperuricemia também esteve significativamente associada à hipertensão arterial (OR, 7,76; IC 95%, 2,72-15,76), hiperlipidemia (OR, 5,05; IC 95%, 1,59-11,32) e história de trombose arterial (OR, 4,95; 95% CI, 1,98-15,34), independentemente da idade e do índice de massa corporal. Conclusões: A hiperuricemia em pacientes com LES está independentemente associada à ocorrência de acidente vascular encefálico e neuropatia periférica. Também está independentemente associada à hipertensão, hiperlipidemia e história de trombose arterial, que são os principais fatores de risco para acidente vascular encefálico e infarto agudo do miocárdio em pacientes com LES.

The Clinical Measures Associated with C-peptide Decline in Patients with Type 1 Diabetes over 15 Years

This study was done to characterize the natural course of C-peptide levels in patients with type 1 diabetes and identify distinguishing characters among patients with lower rates of C-peptide decline. A sample of 95 children with type 1 diabetes was analyzed to retrospectively track serum levels of C-peptide, HbA1c, weight, BMI, and diabetic complications for the 15 yr after diagnosis. The clinical characteristics were compared between the patients with low and high C-peptide levels, respectively. The average C-peptide level among all patients was significantly reduced five years after diagnosis (P < 0.001). The incidence of diabetic ketoacidosis was significantly lower among the patients with high levels of C-peptide (P = 0.038). The body weight and BMI standard deviation scores (SDS) 15 yr after diagnosis were significantly higher among the patients with low C-peptide levels (weight SDS, P = 0.012; BMI SDS, P = 0.044). In conclusion, C-peptide level was significantly decreased after 5 yr from diagnosis. Type 1 diabetes patients whose beta-cell functions were preserved might have low incidence of diabetic ketoacidosis. The declines of C-peptide level after diagnosis in type 1 diabetes may be associated with changes of body weight and BMI.

Restless legs syndrome in subjects with a knee prosthesis: evidence that symptoms are generated in the periphery

OBJECTIVE: There are no data adressing the prevalence of restless legs syndrome in subjects who have knee prosthesis. Therefore, we conducted a cross-sectional survey of subjects who underwent knee prosthesis surgery. METHOD: A total of 107 subjects (30 male, 77 female) were interviewed over the telephone regarding restless legs syndrome symptoms. If the patients exhibited symptoms of the syndrome, we conducted face-to-face interviews. Lastly, a therapeutic test with pramipexole was proposed for each subject. RESULTS: In our cohort, 7 males (23 percent) and 30 females (39 percent) had restless legs syndrome. Of these, 6 males and 23 females were submitted to face-to-face-interview. Of the males, 5 (83 percent) had restless legs after the knee surgeryexclusively in the operated leg- and reported no family restless legs history. One man had a prior case of bilateral restless legs syndrome, a positive family history and claimed exacerbation of symptoms in the operated leg. Among the females, 16 (69 percent) had restless legs prior to surgery. A total of 10 female patients reported bilateral symptoms, with fewer symptoms in the operated leg, while 6 displayed a worse outcome in the operated leg. The 7 females (31 percent) without restless legs prior to surgery and without a family history experienced symptoms only in the operated leg. All subjects responded favorably to the pramipexole therapeutic test. CONCLUSION: Our results suggest that secondary unilateral restless legs syndrome may ensue from knee prosthesis surgery and that the symptoms are generated in the peripheral nervous system.

Vincristine induced neurotoxicity in cancer patients.

Ten out of 20 children, treated with usual doses of vincristine for various types of childhood cancers, developed neurotoxicity during treatment. Peripheral neurotoxicity (mixed motor-sensory 4/10, pure motor 3/10, pure sensory 3/10) was seen in the form of weakness of lower limbs, areflexia, neuropathic pain, or sensory loss. Autonomic neuropathy presented as constipation and urinary retention in 2 children, while 2 children developed encephalopathy in form of seizures, confusion, aphasia, and transient blindness. In children with severe neuropathy, vincristine administration was withheld/dose reduced till clinical improvement started, which took about 2-3 weeks time. Nerve conduction velocity showed motor-sensory axonal polyneuropathy. Electrophysiological abnormalities were found to persist even six months after clinical recovery in children with neurotoxicity. We found a relatively higher incidence of vincristine induced neuropathy in Indian children, which was probably due to coexistence of severe malnutrition in them.

Complicaciones neurológicas en pacientes adultos sometidos a trasplante hepático ortotópico: experiencia de un centro universitario / Neurological complications following a liver transplantation: experience from a Chilean center

Background: Orthotopic liver transplantation (OLT) is the treatment of choice for multiple acute and chronic end-stage liver diseases as well as for selected cases of liver malignancy and ¡iver-site metabolic disorders. Neurological impairment is a major source of morbidity and moñality following OLT. Aim: To describe the incidence and the type of neurological complications occurring in the post-operative period of OLT in patients transplanted in our hospital. Material and methods: Between March 1994 and August 2007, 76 adult patients underwent OLT. Data on incidence, time of onset, and outcome of central nervous system (CNS) complications have been obtained from our program data base and patient charts. Results: Twenty three patients (30.3 percent) had CNS complications following OLT. The leading complications were immunosuppressive drug-related neurological impairment in nine patients (39.1 percent), peripheral nerve damage in five patients (21.7 percent), central pontine myelinolysis in four patients (17.4 percent), cerebrovascular disease in three (13 percent) and CNS infection in three (13 percent). Most CNS events (90 percent) occurred in the first 2 weeks after OLT. Five patients with neurological complications died (22 percent). Conclusions: CNS complications occurred in almost one fifth of the population studied, and they had a poor outcome, as previously reported).

Catarata e diabetes mellitus tipo 1 / Cataract and type 1 diabetes mellitus

OBJETIVO: Avaliar a prevalência de catarata e seus fatores de risco em uma população portadora de diabetes mellitus tipo 1 (DM1). MÉTODOS: Estudo de casos e controles de um banco de dados de 181 pacientes (362 olhos) com diagnóstico de diabetes mellitus tipo 1. Os pacientes foram classificados como casos quando apresentavam diagnóstico de catarata. As variáveis estudadas foram a presença ou não de retinopatia diabética, tratamento com panfotocoagulação, presença de hipertensão arterial sistêmica e neuropatia periférica, colesterol total, triglicerídios séricos, HDL, LDL, índice de massa corporal, creatinina sérica, albuminúria, hemoglobina glicosilada e glicemia de jejum. RESULTADOS: A prevalência de catarata foi de 19,9 por cento. Na análise univariada foi encontrada associação estatisticamente significativa (p<0,005) entre a presença de catarata e retinopatia diabética, neuropatia periférica, creatinina sérica elevada, panfotocoagulação e hipertensão arterial. Após a análise de regressão logística a variável que permaneceu com associação estatisticamente significativa foi a presença de retinopatia diabética. CONCLUSÃO: A prevalência de catarata foi de 19,9 por cento, sendo a presença e a gravidade da retinopatia diabética os principais fatores de risco para desenvolvimento desta.

PURPOSE: To evaluate the prevalence of cataract and associated risk factors in a diabetic type 1 population. METHODS: 181 patients (362 eyes) were evaluated in a case-control study. Cases were classified when cataract was present at the time of the examination. The studied outcomes were the presence of diabetic retinopathy, retinal panphotocoagulation, high blood pressure, peripheral neuropathy, total cholesterol levels, triglyceride levels, HDL, LDL, body mass index, creatinine levels, albuminuria, glycosylated hemoglobin and glycemia levels. RESULTS: Cataract was present in 19.9 percent of the studied patients. The association of the presence of cataract and diabetic retinopathy, peripheral neuropathy, elevated levels of creatinine, panphotocoagulation and high blood pressure were statistically significant (univariate analysis). After the logistic regression analysis the presence of cataract was significantly associated with the presence of diabetic retinopathy. CONCLUSION: The prevalence of cataract was 19.9 percent and the presence and severity of the diabetic retinopathy were the main risk factors for its development.

role of hyperlipidemia on nerve conduction

Previous reports suggested a relationship between hyperlipidemia and neuropathy as a cause of focal neuropathy or generalized poly-neuropathy. Only few cases were reported and they are often involved individuals with other illnesses which cause neuropathy, such as diabetes mellitus, hypertension, hyperuricemia and fatty liver. To study the association of peripheral neuropathy with hyperlipidemia and to detect the type of peripheral neuropathy and its distribution. Prospective study. Neurophysiology unit in Basra teaching hospital and the department of physiological chemistry, College of Medicine, University of Baghdad. Sixty-eight patients [38 males and 30 females] aged 25-77 years with a mean age of [48.9 +/- 13.5] years. Forty-two healthy subjects [24 males and 18 females] of matching age were enrolled as control. Biochemical investigations included lipid profile, post parandial blood glucose, blood urea, serum creatinin and uric acid. Electrophysiological investigations included: 1. Sensory nerve conduction study: measurement of sensory latency, amplitude and conduction velocity of median, ulnar, common peroneal and posterior tibial nerves bilaterally. 2. Motor nerve conduction study: measurement of latency amplitude and conduction velocity of the CMAP of median, ulnar, common peroneal and posterior tibial bilaterally. 3. F-wave conduction study: measurement of minimal f-wave latency and conduction velocity of median and common peroneal nerves bilaterally. The result of the sensory nerve conduction study revealed variable levels of significance between measured parameters of the same nerve and between different nerves. As for the motor nerve conduction study and f-wave conduction study, they were all normal and with no abnormality that could be elicited. Hyperlipidemia could be associated with subclinical peripheral neuropathy which may occur more frequently in patients with very high levels of TG, TC and LDL. The type of peripheral neuropathy that occurs is mainly a sensory type, although motor neuropathy cannot be excluded

Polineuropatía diabética periférica en diabéticos tipo 1 con limitación de los movimientos articulares (LMA) / Diabetic peripheral polyneuropathy in type 1 diabetic patients with limited joint mobility (LJM)

La LMA es una complicación crónica de la diabetes mellitus (DM) que se observa con relativa frecuencia específicamente en la diabetes tipo 1 (DM 1). Con el objetivo de determinar la frecuencia de la LMA y su asociación con la polineuropatía diabética periférica, se estudiaron 56 personas con DM 1, con edades entre 9 y 23 años. En todos se determinó: la edad, el sexo, la talla, el tiempo de evolución de la enfermedad y el control metabólico; así como la presencia de LMA y de neuropatía diabética periférica, mediante el examen físico y el resultado del estudio de conducción nerviosa en los miembros inferiores. Se separaron en 2 grupos, según tuvieran o no LMA. Al compararlos no se confirmaron diferencias significativas en relación con la edad, la talla, el tiempo de evolución y el control metabólico de la DM. Las manifestaciones clínicas neurológicas predominaron en las personas con LMA, aunque sin diferencias estadísticamente significativas. El estudio electrofisiológico no mostró diferencias estadísticamente significativas. No se comprobó tampoco asociación entre la neuropatía periférica de los miembros inferiores y la presencia de LMA(AU)

Limited joint mobility is a chronic complication of diabetes mellitas (DM) that is commonly observed in type 1 diabetes mellitus (T1DM). In order to determine the LJM frequency and its association with diabetic peripheral polyneuropathy, 56 type 1 diabetics aged 9-23 were studied. Age, sex, height, time of evolution of the disease and metabolic control, as well as the presence of LJM and of diabetic peripheral neuropathy were determined by physical examination and by the result of the nerve conduction study of the lower limbs. They were divided into 2 groups, according to the existance or not of LJM. On comparing them, no important differences were confirmed in relation to age, height, the time of evolution, and the metabolic control. The clinical and neurological manifestations predominated in the individuals with LJM, even though the differences were not statistically significant. The electrophysiological study did not show statistically marked differences, either. No association between the peripheral neuropathy of the lower limbs and the presence of LJM was proved(AU)

Peripheral neuropathy in patients with hepatitis virus C infection in the Amazon region / Neuropatia periférica em pacientes com infecção pelo vírus C da hepatite na região amazônica

INTRODUCTION: Hepatitis virus C (HCV) infection is considered a health problem in the State of Acre localized in the Brazilian Amazon which has a prevalence rate of 5.9 percent. Peripheral neuropathy is a common extra-hepatic manifestation in patients with HCV. OBJECTIVE: To determine the prevalence of peripheral neuropathies using clinical and neurophysiological parameters. METHOD: A cross sectional study was performed in patients assisted by a specialized center of infectious diseases in the State of Acre. All patients completed a clinicoepidemiological questionnaire, physical examination and nerve conduction studies (NCS). RESULTS: We studied 78 patients with mean age 45.5 years (range from 10 to 76 years), two thirds were male, 51 percent had at least 8 years of formal education and 96 percent lived in the capital city of Acre State. Roughly 34 percent of patients complained about paresthesias mainly in upper limbs. The NCS diagnosed multiple mononeuropathy in 11 (14.1 percent; IC95 percent 7.6-23.2) patients and carpal tunnel syndrome in 4 (5.1 percent) patients. CONCLUSION: Subclinical involvement of peripheral nerves seems common in patients with HCV, with multiple mononeuropathy the main manifestation of nerve injury in this region as suggested by electrophysiological studies.

INTRODUÇÃO: A infecção pelo vírus da hepatite C (VHC) é considerada um problema de saúde pública no Estado do Acre com uma prevalência de 5,9 por cento. Neuropatia periférica é uma manifestação extra-hepática comum em pacientes com VHC. OBJETIVO: Determinar a prevalência de neuropatias periféricas através de parâmetros clínicos e neurofisiológicos. MÉTODO: Foi realizado estudo transversal em pacientes atendidos em uma clínica especializada de doenças infecciosas do Estado do Acre. Todos os pacientes foram submetidos a um questionário clínico-epidemiológico, exame físico e eletroneuromiografia (ENMG). RESULTADOS: Foram estudados 78 pacientes, com idade média de 45,5 anos (10 a 76), dois terços eram do sexo masculino, 51 por cento tinha pelo menos 8 anos de educação formal e 95 por cento moravam na capital do Estado. Aproximadamente 34 por cento dos pacientes se queixaram de parestesias, principalmente nos membros superiores. A ENMG diagnosticou mononeuropatia múltipla em 11 (14,1 por cento, IC95 por cento 7,6-23,2) pacientes e síndrome do túnel do carpo em 4 (5,1 por cento). CONCLUSÃO: Comprometimento dos nervos periféricos é comum em pacientes com VHC, sendo neuropatia múltipla a apresentação mais comumente diagnosticada pela ENMG.

Avaliação dos efeitos tóxicos sobre o sistema nervoso periférico, decorrentes da exposição ocupacional ao chumbo / Evaluation of toxic effects on the peripheral nervous system, as a consequence of the occupational exposure to lead

Após descrever a interação do homem com meio ambiente, em particular nas atividades laborativas, se destaca a extração e o processamento dos minérios de chumbo como importante fonte de exposição ocupacional a este metal, que gerou no passado grandes casuísticas de intoxicação. Em seguida é feito um relato de como ocorreu a exposição ocupacional ao chumbo em Santo Amaro da Purificação na Bahia, e uma revisão da toxicologia deste metal, identificando-se a necessidade de se trabalhar com indicadores, parâmetros, que melhor reflitam os efeitos cumulativos, como os que ocorrem no sistema nervoso periférico. Analisar e discutir as alterações do sistema nervoso periférico pós exposição ocupacional, em um grupo de ex-empregados de uma metalurgia primária de chumbo; e identificar marcadores que melhor reflitam os efeitos da bioacumulação deste metal. A partir de dados secundários, foi construída uma serie de casos, na qual se analisou o passado clínico e toxicológico, e a relação com os achados neurofisiológicos. Os dados analisados, demonstraram a ocorrência, de um leque de neuropatias periféricas em todo o grupo, mas as alterações da condução motora em membros superiores, que tem sido melhor relacionadas aos efeitos tóxicos do chumbo, não foram tão consistentes. Ficou comprovado ser a media acumulada do chumbo no sangue um marcador biológico mais fidedigno, para avaliações de efeitos de longo prazo como as alterações sobre o sistema nervoso periférico.

The frequency of peripheral neuropathy in a group of HIV positive patients in Brazil

A neuropatia periférica é complicação neurológica comum, podendo ocorrer nas fases assintomáticas e sintomáticas da infecção pelo vírus da imunodeficiência humana (HIV). As síndromes mais comuns são a polineuropatia distal simétrica, polineuropatia desmielinizante inflamatória, polirradiculopatia, mononeuropatia, mononeuropatia múltipla e neuropatia autonômica. OBJETIVO: Avaliar a freqüência da neuropatia periférica em um grupo de pacientes HIV positivo em São Paulo, Brasil. MÉTODO: Em um período de 17 meses, foram avaliados clinicamente 49 pacientes HIV positivos. Foram solicitados exames laboratoriais e eletroneuromiografia (ENMG) para todos os pacientes. RESULTADOS: Foi estabelecido o diagnóstico clínico de neuropatia periférica em 34 (69,4%) dos 49 pacientes. O sinal neurológico mais comum foi a alteração da sensibilidade (97,1%). Treze (33,3%) dos 39 pacientes que realizaram a ENMG tiveram o diagnóstico de neuropatia periférica, sendo a neuropatia sensitivo-motora axonal o achado mais comum. Não foram encontradas alterações significativas nos exames laboratoriais (42 pacientes realizaram os exames), com exceção de quatro pacientes em que o VDRL foi positivo. CONCLUSÃO: A neuropatia periférica foi um achado freqüente no grupo de pacientes HIV positivo estudados clinicamente.

Estudio neuroepidemiológico nacional (EPINEURO) colombiano / National neuroepidemiological study in Colombia (EPINEURO)

OBJETIVO: Determinar la prevalencia de ocho problemas neurológicos -migraña, enfermedad cerebrovascular, enfermedad de Parkinson, neuropatía periférica, trastornos del desarrollo neurológico, epilepsia, demencia y secuelas de traumatismo craneoencefálico- en Colombia como parte del estudio neuroepidemiológico nacional (EPINEURO). MÉTODOS: Se realizó una encuesta transversal en dos fases entre septiembre de 1995 y gosto de 1996. En la primera fase se identificó a las personas que podían estar padeciendo alguna enfermedad neurológica y en la segunda se hizo el diagnóstico específico. Se xaminó una muestra de 8 910 personas distribuidas en proporción con la población de cada una de las cinco zonas geográficas de Colombia, que son las regiones entral, sudoccidental, noroccidental, oriental y la costa caribe. La evaluación se realizó según una versión odificada del protocolo de neuroepidemiología de la Organización Mundial de la Salud, además de un examen físico simplificado. A los posibles pacientes de demencia identificados se les aplicó un examen neuropsicológico, diseñado para este estudio, con el fin de profundizar en los aspectos cognoscitivos. Se aplicaron las escalas de Hachinski, Yesavage y Blessed y los criterios iagnósticos del NINCDS-ADRDA para la enfermedad de Alzheimer, los del NINDS-AIREN para la demencia de origen vascular y los del DSM-IV para todo tipo de demencia. Se realizó una ncuesta para determinar si había secuelas de traumatismo craneoencefálico. Las personas mayores de 12 años fueron evaluadas por neurólogos de adultos y los menores de 12 años por un neuropediatra. Se calcularon las prevalencias de trastornos neurológicos por edad y sexo, tanto por egión como para el país en su totalidad, y sus intervalos de confianza de 95 por ciento. RESULTADOS: La prevalencia por 1 000 habitantes de los trastornos investigados ueron las siguientes: migraña, 71,2 (intervalo de confianza de 95 por ciento [IC95 por ciento]: 65,5 a 76,8); trastornos del desarrollo neurológico, 46,1 (IC95 por ciento: 35,5 a 58,9); enfermedad cerebrovascular, 19,9 (IC95 por ciento: 14,3 a 27,4); demencia, 13,1 (IC95 por ciento: 8,5 a 9,3); epilepsia, 10,3 (IC95 por ciento: 8,5 a 13,0); neuropatía periférica, 8,5 (IC95 por ciento: 6,8 a 10,7); secuelas de traumatismo craneoencefálico, 6,4 (IC95 por ciento: 5,0 a 7,8) y enfermedad de Parkinson 4,7 (IC95 or ciento: 2,2 a 8,9)...

Síndrome de piernas inquietas: estudi clínico en población general adulta y en pacientes urémicos / Restless legs syndrome: a clinical study in chilean general population and in uremic patients

Background: The restless legs syndrome (RLS) is a movement disorder characterized by an imperative urge to move the legs, associated with paraesthesias, motor restlessness and worsening of symptoms at night with at least partial relief by activity. Its prevalence ranges between 2-15 percent of general adult population and 20-30 percent of uremic patients. Aim: To evaluate the frecuency and the clinical features of RLS in a sample of general adult population and in uremic patients, in Chile, correlating it with biochemical parameters. Method: 100 relatives of outpatients and 166 uremic patients undergoing chronic haemodialysis were interviewed assessing the presence and severity of RLS according to current diagnostic criteria. Biochemical parameters assessed were hematocrit, serum ferritin, phosphate, intact parathyroid hormone (iPTH) levels. Results: 13 percent of the general population sample was affected, 15 percent of them were severe. Forty three cases were found among uremic patients (25.9 percent) (p <0.01 vs general population), 60 percent of them were severe and women were affected with higher frequency (p <0.05) and severity (p <0.01). Four patients presented RLS even during hemodialysis. No correlation was found with biochemical parameters. Most RLS cases had not been diagnosed previously. Conclusions: In our population RLS is common and undetected. It is especially prevalent and severe in uremic patients: we found no evidence that anaemia, iron deficiency or iPTH level play a major pathogenic role. Our findings emphasize the need of greater medical awareness of RLS because available therapy may improve the quality of life

Neuropatía epidémica cubana: algunos factores de riesgo en la población / Cuban epidemic neuropathy: the risk factors in the population

A cross-sectional study was conducted in 1995 in a representative sample of the Cuban population aged 15 years or over with the objective of describing prevalence and characteristics of smoking, alcohol consumption, and physical inactivity in the urban population which could have been affected by epidemic neuropathy from 1991-1993. The sampling was stratified at provincial and municipal levels and then by cluster samplings. 93 of the sample was surveyed (14 300 people). 30 of the population aged 17 years and over smoked; the highest proportion of smokers was located in 40-49 years age group; men smoked more than woman regardless of age. The prevalence of alcohol consumption was 45.2 in which Eastern provinces exceeded the domestic average with males predominating. The prevalence of physical inactivity at national level was 33, 25.7 for males and 39.8 for females. 47.3 of males and 25.4 of females classified as physically active because of their useful extra activity. It was considered that irregular relationships between these 3 risk factors and the incidence of epidemic neuropathy at the ecological level make it think that, although they have a real influence on the determinants of the disease, other factors may also better account for the occurrence of these cases.

Aspectos de la ozonoterapia en pacientes con neuropatía periférica epidémica / Ozone therapy in patients with epidemic peripheral neuropathy

Se analizó un ensayo clínico sobre el efecto de la ozonoterapia en pacientes con neuropatía periférica de febrero a mayo de 1996 en el Centro Provincial de Retinosis Pigmentaria de Camagüey y a una muestra de 40 pacientes, con predominio del sexo femenino, el grupo de edades comprendido entre 36 y 45 años; los más afectados fueron los profesionales en 12 pacientes, seguido de los obreros con 7. Los signos y síntomas más relevantes fueron las mialgias con 34 casos, calambres con 25 casos, cefaleas con 22, pérdida del equilibrio 2 casos, decaimiento 20 casos. La vía más usada para el tratamiento fue la rectal y se observó una evolución satisfactoria en 34 pacientes, lo que demuestra la efectividad de la ozonoterapia en pacientes con neuropatía periférica

Neuropatia periférica em crianças infectadas pelo vírus da imunodeficiência humana (HIV). Estudo de prevalência e de caracterização clínica / Peripheral neuropathy in children infected with human immunodeficiency virus (HIV). Study of prevalence and clinical characterization

A escassez de estudos versando sobre neuropatias em crianças infectadas pelo vírus da imunodeficiência humana (HIV) contrasta com a quantidade de trabalhos publicados sobre o mesmo tema em adultos. A fim de determinar se sintomas e sinais de neuropatia periférica ocorrem em crianças infectadas pelo HIV e estimar a prevalência de neuropatia periférica nesta população, elaborou-se um estudo descritivo transversal. Avaliou-se um corte de crianças acima de cinco anos de idade do serviço de atendimento a pacientes infectados pelo HIV do Instituto de Puericultura e Pediatria Martagão Gesteira da Universidade Federal do Rio de Janeiro. estes pacientes foram entrevistados e examinados sistematicamente para detecção de sintomas e sinais de neuropatia periférica e referidos a estudo de neurocondição. Do total de 39 pacientes avaliados, 13 (34%) apresentavam sintomas e sinais de neuropatia periférica. Parestesias distais e/ou dor associados a hiperrreflexia de aquileus e/ou hipopalestesia foram as manifestações mais comuns. À neurocondução houve predomínio de alterações indicativas de lesão axonal. Conclui-se que neuropatia periférica ocorre em um terço de crianças com mais de cinco anos de idade infectadas pelo HIV com características semelhantes à polineuropatia sensitiva distal descrita em adultos

Neuropatias periféricas: desordens relevantes na comunidade? / Peripheral neuropathies: relevant disorders ar the community level?

Os estudos epidemiológicos das neuropatias periféricas costumam se ocupar de tipos distintos dessas neuropatias, principalmente quando elas se agrupam temporal - geográfica ou familiarmente - essas såo as de investigaçåo facilitada. As neuropatias mais incidentes em países de primeiro mundo såo a por herpes zoster, as mononeuropatias e polineuropatias (principalmente por diabetes), paralisia de Bell, traumatismo de nervo periférico, nevralgia do trigêmio, s. de Guillain-Barré, trauma de nervo craniano e a doença de Charcot-Marie-Tooth, nesta ordem. Eventualmente, em países de transiçåo epidemiológica como o nosso, onde se somam doenças de países industrializados e em desenvolvimento, as mononeurites e polineurites teriam maior relevância epidemiológica pois seus determinantes mais comuns (diabetes, morbus hansen, alcoolismo, desnutriçåo, p. ex.) seriam mais freqüentes do que nos países avançados. Também nesses países, como os acidentes såo mais freqüentes, as lesöes dos nervos teriam maior relevância epidemiológica

La ozonoterapia en la neuropatía epidémica forma óptica ¿Beneficio y riesgo? / Ozone therapy in the management of the optic neuritis epidemic. Benefits od risks?

Se realizó un ensayo clínico terapéutico multicéntrico en Ciudad de La Habana, en 576 pacientes afectados de neuropatía epidémica forma óptica, en el período comprendido entre abril de 1993 y febrero de 1994. Se emplearon 11 esquemas de tratamiento, distribuidos aleatoriamente entre los hospitales participantes. Los grupos de tratamiento incluidos fueron : dexametasona, metilprednisolona, hidroxicobalamina+metionina+tiosulfato de sodio, vitaminas, magnetoterapia, ozonoterapia, oxigenación hiperbárica, electroforesis endonasal con vitamina B1, factor de trasnferencia, interferón (INF) alfa natural e interferón alfa 2b recombinante. A todos los pacientes del estudio se les administró vitaminas de base y se consideró a aquéllos tratados con vitaminas sólo como grupo control. La evaluación de los casos se realizó a los 21 días (alta hospitalaria), al mes, 3 y 6 meses, respectivamente. El tratamiento con ozono reflejó diferencias estadísticamente significativas (p<0,05) (en cada uno de los cortes evaluativos efectuados) en cuanto a mejoría y recuperación de los casos tratados con ese proceder. En el resto de los esquemas terapéuticos empleados no se encuentran diferencias significativas. Se evidenció la utilización de las vitaminas