Trastornos Paroxísticos No Epilépticos En Pre-Escolares / Non-epileptic paroxysmal disorders in pre-school children

Los trastornos paroxísticos no epilépticos son comunes en la población de niños pre-escolares. Estas condiciones incluyen una variedad de eventos cuyas manifestaciones y fisiopatología son muy distintas. Por esa razón, el diagnóstico puede representar un difícil reto. En algunas ocasiones, estudios como el EEG o la polisomnografía pueden ayudar a clarificar el diagnóstico y descartar un trastorno epiléptico. Sin embargo, la historia clínica y el examen físico suelen ser suficientes para llegar al diagnóstico correcto. En este artículo, presentamos información sobre los trastornos paroxísticos no epilépticos más comunes en la población de niños pre-escolares, incluyendo: tics, discinesias, eventos relacionados al sueño, etc. Además, discutimos estrategias para el diagnóstico y opciones de tratamiento.

Paroxysmal events are commonly encountered in toddlers. These events include a variety of conditions with different manifestations and pathophysiology. For that reason, the diagnosis of these events can be challenging. In some instances, studies such as EEG and polysomnogram may be useful to differentiate between epileptic and non-epileptic events. In the majority of cases, a complete clinical history is enough to make an appropriate diagnosis. In this article, we review some of the most common paroxysmal non-epileptic events affecting toddlers, such as: tics, dyskinesias, sleep related events, etc. We also discuss diagnostic strategies and treatment options.

Can clinical observation differentiate individuals with and without scapular dyskinesis? / O exame clínico de observação da discinese escapular é capaz de diferenciar portadores da disfunção dos normais?

Background: Altered scapular rotation and position have been named scapular dyskinesis. Visual dynamic assessment could be applied to classify this alteration based on the clinical observation of the winging of the inferior medial scapular border (Type I) or of the prominence of the entire medial border (Type II), or by the excessive superior translation of the scapula (Type III). Objective: The aim of this study was to determine if there were differences in scapular rotations (Type I and II) and position (Type III) between a group of subjects with scapular dyskinesis, diagnosed by the clinical observation of an expert physical therapist, using a group of healthy individuals (Type IV). Method: Twenty-six asymptomatic subjects volunteered for this study. After a fatigue protocol for the periscapular muscles, the dynamic scapular dyskinesis tests were conducted to visually classify each scapula into one of the four categories (Type IV dyskinesis-free). The kinematic variables studied were the differences between the maximum rotational dysfunctions and the minimum value that represented both normal function and a small dysfunctional movement. Results: Only scapular anterior tilt was significantly greater in the type I dyskinesis group (clinical observation of the posterior projection of the inferior angle of the scapula) when compared to the scapular dyskinesis-free group (p=0.037 scapular and p=0.001 sagittal plane). Conclusions: Clinical observation was considered appropriate only in the diagnoses of dyskinesis type I. Considering the lower prevalence and sample sizes for types II and III, further studies are necessary to validate the clinical observation as a tool to diagnose scapular dyskinesis. .

Contextualização: A movimentação ou posição alterada da escápula é definida como discinese escapular. O exame visual dinâmico pode ser utilizado para classificá-la de acordo com o julgamento clínico de projeção posterior excessiva da borda inferior medial (tipo I), da borda medial (tipo II) ou ainda translação excessiva no sentido cranial (tipo III). Objetivo: Determinar se há diferenças nas rotações escapulares (tipo I e II) e posição (tipo III) entre grupos de discinese e normais (tipo IV), os quais foram diagnosticados visualmente por um fisioterapeuta experiente. Método: Vinte e seis participantes assintomáticos foram voluntários neste estudo. Após um protocolo de fadiga periescapular, a avaliação dinâmica da discinese foi conduzida para classificar visualmente cada uma das escápulas em uma das quatro categorias (tipo IV - sem discinese). As variáveis cinemáticas estudadas foram a diferença entre o valor máximo indicativo da disfunção e o mínimo valor correspondente ao padrão normal esperado para o movimento ou o mínimo do próprio movimento disfuncional. Resultados: Apenas a inclinação anterior da escápula foi significantemente maior no grupo de discinese tipo I (observação visual de projeção posterior do ângulo inferior da escápula) quando comparada com o grupo sem discinese (p=0,037 plano escapular e p=0,001 plano sagital). Conclusões: A avaliação visual foi considerada apropriada apenas para o diagnóstico da discinese do tipo I. Considerando a baixa prevalência e o tamanho amostral dos tipos II e III, mais estudos são necessários para validar completamente a observação clínica como método adequado para o diagnóstico ...

Evaluación de la disquinesia escapular con método fotográfico digital / A photographic method for identifing scapular dyskinesis

To evaluate the exactitude, precision, reliability, sensitivity and specificity of Scapular Photographic Analysis (SPA Test) for the diagnosis of scapular dyskinesis. Material and Methods: We realized a study of reproducibility and diagnostic capability of SPA test for scapular dyskinesis. Reproducibility was assessed with exactitude (correlation of pairs), precision and reability (Intraclass correlation coefficient) in 26 healthy subjects. Subsequently, two independent operators evaluated and classified a group of patients as tehe presence or absence of scapular dyskinesis, defined as scapular asymmetry. Finally, we evaluated the diagnostic capability of the test (sensitivity, specificity) in 11 patients with scapular dyskinesis and 11 healthy controls. Was considered significant p < 0,05. The data were analyzed using STATA 9. Results: The average exactitude of the method was 81,97 +/- 1,57 percent, the precision was 0,999 and the reliability was 0,9995. The sensitivity and specificity of the test for scapular dyskinesis diagnosis were 72,73 and 90,91, respectively. Conclusions: SPA test is an objective method, precise and reliable to assess the position and rotation scapula. It presents criteria with highly sensitivity and specificity for scapular dyskinesis diagnosis.

Objetivo: Evaluar la confiabilidad, precisión, exactitud, sensibilidad y especificidad del Análisis Fotográfico Escapular. Material y Método: Se realizó un estudio de reproducibilidad y capacidad diagnóstica del test AFE para disquinesia escapular. La reproducibilidad fue evaluada con la exactitud (Correlación de pares), precisión y confiabilidad (Coeficiente de Correlación Intraclase) en 26 sujetos sanos. Posteriormente, se realizó una evaluación por 2 operadores de forma independiente, clasificando a un grupo de pacientes según la presencia o ausencia de disquinesia escapular, definida como asimetría escapular. Finalmente, se evaluó la capacidad diagnóstica del test (sensibilidad, especificidad) en 11 pacientes con disquinesia escapular y 11 controles sanos. Se consideró significativo un p < 0,05. Los datos fueron analizados con STATA 9. Resultados: La exactitud promedio del método fue 81,97 +/- 1,57 por ciento, la precisión fue 0,999 y la confiabilidad fue de 0,9995. La sensibilidad y especificidad del test para el diagnóstico de disquinesia escapular fueron 72,73 y 90,91, respectivamente. Conclusiones: El test AFE es un método objetivo, preciso y confiable para evaluar la posición y la rotación de la escápula. Además, presenta criterios con capacidad diagnóstica altamente sensibles y específicos para el diagnóstico de disquinesia escapular.

Hemibalismo invalidante transitorio como debut de diabetes mellitus / Transient hemiballism as the presenting symptom of diabetes mellitus: report of one case

Hemiballism is an uncommon neurological disorder characterized by uncontrollable movements of one lateral half of the body. We report a 56 years old male with a history of three weeks of polydipsia, polyuria and weight loss that, three days before consultation, started with hemiballism. A CAT scan without contrast showed a higher density in the lenticular nucleus and calcifications in caudate and lenticular nuclei. Diabetes was treated with regular insulin and hemiballism was controlled with neruoleptics. Ten days after admission a new CAT scan shows a partial regression of the lenticular lesion. After two months of follow up, the patient is asymptomatic.

Movement disorders in children: Recent advances in management.

In recent years there has been a growing interest towards pediatric movement disorders (PMD). The data derived from the synthesis of clinical observation, neuroimaging, biochemical and, molecular genetics studies have allowed for the identification of a significant number of pediatric diseases featuring movement disorders. The purpose of this review is to outline an approach to the advances in management of dystonia, neurotransmitter disorders, tics, and paroxysmal dyskinetic syndromes starting in children younger than 18 yr of age.

Study of the occurrence of abnormal involuntary movements after cerebral stroke

Abnormal involuntary movements [AIM] following cerebral stroke were reported after lesions in certain areas of the brain, but most of these studies were case reports or series of patients with a given type of abnormal movement or anatomical lesion. The aim is to study pattern of occurrence of AIM that may occur after cerebral stroke and their relationship to the cause of stroke, clinical and personal data of patients as well as sites of lesions based on imaging studies. Thirty four patients with AIM after cerebral strokes were included in this study. These patients were selected suffering first ever clinical stroke, with negative history of previous attacks. These patients were subjected to medical history taking, and thorough neurological examination. The type of AIM was evaluated by more than one of the authors separately with consultation of every case. Clinical follow up of these AIM was done using abnormal involuntary movements scale [AIMS] for detection of improvement or deterioration of these abnormal movements. Also clinical follow up of the motor power, sensory deficits, cerebellar manifestations etc was done. Follow up was done every two weeks in the first month and every month afterward and patients were followed up for at least a year after onset of AIM. Patients that died or did not comply with the study were excluded, also patients with previous history of AIM before onset of stroke were excluded as well. All patients were subjected to CT brain in the acute stage of stroke and those that had normal CT in the acute stage were resubjected to CT or MRI brain. Another 3 cases of central thalamic ischemic lesions, authors came across while doing this research, were included and studied as previously. Thirteen [38.2%] of patients suffered chorea, while only 4 [11.7%] suffered parkinsonism and patients with tremor and dystonia were 9 [26.4%], and 8 [23.5%] respectively. Group of patients with chorea were found significantly [P<0.05] the elder among the other groups. The shortest mean interval time between onset of stroke and development of AIM was that for chorea with statistical significant difference [P<0.05]. Most of the patients with AIM were grade 4 and 5 on MRC scale, and of moderate to severe affection of proprioceptive sensation and ataxia. Although lesions of the thalamus and/or basal ganglia were found common in these patients, good percent of patients were found suffering lesions in other areas of the brain. Central thalamic lesion was accompanied with contralateral hypothesis, chorea, and ataxia. Correlation between site of lesion and type of AIM could be difficult to establish. Although thalamic and basal ganglion lesions are common underlying cause for AIM, these AIM could occur in a good percentage after lesions in other areas of the brain and that could be due to concurrent ataxia and proprioceptive sensory impairment beside reasonable motor strength. Finally, pathogenesis of AIM needs more speculation and more scrutinized analysis of imaging studies with paying more attention to functional brain imaging studies

Síndrome Tako-Tsubo (Discinesia antero-apical transitoria): Primer caso descrito en América Latina y revisión de la literatura / Tako-Tsubo syndrome (transient antero-apical dyskinesia): first case reported in Latin America and review of the literature

El síndrome Tako-Tsubo es una entidad clínica de reciente descripción que simula un infarto agudo del miocardio. Comprende la asociación de dolor precordial con elevación de ST-T en derivaciones precordiales en ausencia de la oclusión de alguna arteria coronaria y con una deformación típica y reversible del ventrículo izquierdo como consecuencia de discinesia anteroapical con hipercinesia basal. Afecta predominantemente al sexo femenino y en una revisión de 2001 se refiere que sólo dos casos habían sido reportados en pacientes no japoneses. Presentamos un caso típico de síndrome Tako-Tsubo recurrente y desencadenado por estrés emotivo. Este es el primer caso informado de Latinoamérica, el que se complementa con una revisión actualizada de la literatura. Esta última sugiere que el síndrome Tako-Tsubo es más frecuente de lo sospechado, pero suele pasar desapercibido. Es importante reconocer este síndrome ya que su manejo y pronóstico es diferente al del infarto agudo del miocardio que resulta de la oclusión trombótica de una placa ateroesclerosa coronaria.

Tako-Tsubo syndrome (TTS) is a recently described entity that can mimic an acute myocardial infarction. It is characterized by anginal chest pain with ST-T elevation in precordial leads, no coronary obstruction on angiography, and as its distinctive feature, a reversible left ventricular antero-apical ballooning with basal hyperkinesis. TTS is more frequent in female and elderly patients and in an article published in 2001 it was mentioned that only two cases had been reported outside Japan. We describe a typical case of recurrent TTS triggered by intense emotional stress. This is the first case reported from Latin America. A review of the literature suggests that TTS is more frequent than previously thought but apparently due to lack of awareness of this entity it can go unrecognized. Identification of TTS is of clinical importance because its management and prognosis differs significantly from that of an acute myocardial infarction that results from the thrombotic occlusion of a coronary atherosclerotic plaque.

Hemiballismus and hemichorea following general anesthesia: report of a rare case

Hemiballism is an uncommon movement disorder occuring most commonly in elderly subjects with a history of hypertension or diabetes, or both. We present a 43 year old diabetic woman who developed hemiballism following lumbar disc surgery under general anesthesia. Because of the rarity of this complication following general anesthesia, the case is being presented to emphasize the issue

Hemicoréia-hemibalismo associado a granuloma criptocócico em paciente com SIDA: relato de caso / Hemichorea-hemiballism associated to cryptococcal granuloma in AIDS: case report

Distúrbios do movimento sao pouco frequentes na síndrome de imunodeficiência adquirida (SIDA). Dentre eles destaca-se a hemicoréia-hemibalismo (HC-HB), relacionada a infecçao oportunística pelo Toxoplasma gondii. Relatamos caso de HC-HB em um paciente de 28 anos portador de SIDA associada a lesao granulomatosa no núcleo sub-talâmico direito. Após insucesso no tratamento para neurotoxoplasmose, com a pesquisa de antígeno criptocóccico positiva no líquor, houve melhora clínica e radiológica com terapia antifúngica, estabelecendo-se o diagnóstico etiológico de granuloma por Cryptococcus neoformans. Discorre-se acerca das causas de HC-HB, com mençao especial ao diagnóstico diferencial deste distúrbio em indivíduos infectados pelo HIV

Cognitive dysfunction in tardive dyskinesia

Tardive Dyskinesia is a serious, long term side effect of chronic neuroleptic treatment. The magnitude of this iatrogenic health problem has been compounded by the inadequate currently available. All schizophrenic patents residing in the three main hospitals in Alexandria with Psychiatric inpatient units were studied during May and June 1988. The aim of this work was to detect Tardive Dyskinesia [TD] among schizophrenic inpatients and to study the relationship between TD and cognitive impairment. Only case fitting the DSM III diagnostic criteria for schizophrenia and who were under neuroleptic treatment for more than one year were included in this study [280 patients, 161 males and 119 females]. The study showed that TD prevalence rate among the schizophrenic population was 4.2% [lips and personal movements in 58.3% and tongue movements in [41.6%]. Patients with TD performed significantly lower than patients without TD on the comprehension, digit span and similarities subscales of Wechsler Adult Intelligence Scale [t= 3.51, 6.022 and - 3.26 respectively]. All the correlation between scores on comprehension and digit span subscales and lip movements were statistically significant [r=0.467 and 0.622]