Latencia diagnóstica en la enfermedad de Parkinson: Estudio en 200 pacientes de novo en un hospital público de Chile / Delay in the diagnosis of Parkinson’s disease in a Chilean public hospital

Background: Early diagnosis is fundamental in patients with Parkinson’s disease (PD) to improve their quality of life. Aim: To determine the latency in the diagnosis of Parkinson’s disease (PD) after the onset of motor symptoms. Patients and Methods: Prospective study carried out during 16 months in a public hospital. Two hundred newly diagnosed patients aged 41 to 90 years (50% women), were included and analyzed. Results: The lapse between the first symptom -more commonly tremor- and the diagnosis made by a neurologist ranged from 1 to 84 months (19.1 ± 13.8). In 39% of patients, it was done in the first year, in 26% during the second year and in 35% of patients, it took more than two years. The referral by a general practitioner had a delay ranging from 1 to 36 months. Sixty nine and 95% of patients were evaluated within the first 6 months after referral if they came from primary care or the same hospital, respectively. Twenty six percent of patients were classified in stages III to V of Hoehn & Yahr’s staging and the Parkinson’s Disease Rating Scale motor examination ranged from 5 to 81 points, mean 24 (± 12.8). Conclusions: The diagnosis of PD has a delay in a public hospital that could be influenced by the referral system.

Crisis convulsiva inducida por estímulo laberíntico espontáneo: relación entre epilepsia y sistema vestibular / Convulsive seizure induced by spontaneous labirynthine stimulation: relation between epilepsy and vestibular system

La inducción refleja de crisis mediante estimulación laberíntica es un hecho raramente informado en la literatura. Presentamos el caso de un paciente varón de 24 años, sin historia previa de epilepsia, que en transcurso de un severo ataque de vértigo presentó una crisis convulsiva generalizada tónico-clónica. El examen otoneurológico demostró una paresia vestibular izquierda. E.E.G. basal reveló actividad irritativa temporal bilateral. Se realizó un estudio poligráfico con activación del E.E.G. mediante es estimulación calórica vestibular con agua a 30 y 44 grados. Durante este examen se apreció la aparición de actividad epileptiforme en el E.E.G. en región temporal derecha cuando se estimuló el laberinto sano. En nuestra opinión este caso traduce una forma de epilepsia vestibular latente que es muy sensible al estímulo laberíntico