Variantes normales de aspecto epileptiforme en el electroencefalograma. Revisión de la bibliografía e implicaciones clínicas / Normal variants with an epileptiform appearance in electroencephalograms. A literature review and clinical implications

Las variantes normales de aspecto epileptiforme, o variantes epileptiformes benignas, son un reto diagnóstico en la interpretación de los electroencefalogramas que requiere su conocimiento y una amplia experiencia por parte de los responsables del informe electroencefalográfico. Incluyen un grupo heterogéneo de hallazgos, algunos muy infrecuentes, que inicialmente se relacionaron con epilepsia y patologías neurológicas diversas. En la actualidad, la mayoría se consideran variantes sin significado patológico, y su sobreinterpretación habitualmente acarrea diagnósticos erróneos y tratamientos innecesarios. Los datos de prevalencia de estas variantes son muy diversos y proceden habitualmente de poblaciones seleccionadas, por lo que son difícilmente extrapolables a población sana. No obstante, estudios con electrodos invasivos y series más recientes vuelven a asociar algunas de estas variantes con epilepsia. Nuestro objetivo es revisar las características y la prevalencia de las principales variantes epileptiformes benignas y actualizar su significado clínico. (AU)

[Normal variants with an epileptiform appearance in electroencephalograms. A literature review and clinical implications]. / Variantes normales de aspecto epileptiforme en el electroencefalograma. Revisión de la bibliografía e implicaciones clínicas.

Normal epileptiform-like variants or benign epileptiform variants are a diagnostic challenge in the interpretation of electroencephalograms, which require the knowledge and extensive experience of those responsible for the electroencephalographic report. They include a heterogeneous group of findings, some quite uncommon, initially related to epilepsy and various neurological conditions. Most of them are currently considered variants with no pathological significance, and their over-interpretation usually leads to misdiagnosis and the establishment of unnecessary treatments. Prevalence data are variable and usually come from selected populations, so they are difficult to extrapolate to a healthy population. Studies with invasive electrodes and recent series link some of these variants with epilepsy. We aim to review the characteristics and prevalence of the main benign epileptiform variants and to update their clinical significance.

TITLE: Variantes normales de aspecto epileptiforme en el electroencefalograma. Revisión de la bibliografía e implicaciones clínicas.Las variantes normales de aspecto epileptiforme, o variantes epileptiformes benignas, son un reto diagnóstico en la interpretación de los electroencefalogramas que requiere su conocimiento y una amplia experiencia por parte de los responsables del informe electroencefalográfico. Incluyen un grupo heterogéneo de hallazgos, algunos muy infrecuentes, que inicialmente se relacionaron con epilepsia y patologías neurológicas diversas. En la actualidad, la mayoría se consideran variantes sin significado patológico, y su sobreinterpretación habitualmente acarrea diagnósticos erróneos y tratamientos innecesarios. Los datos de prevalencia de estas variantes son muy diversos y proceden habitualmente de poblaciones seleccionadas, por lo que son difícilmente extrapolables a población sana. No obstante, estudios con electrodos invasivos y series más recientes vuelven a asociar algunas de estas variantes con epilepsia. Nuestro objetivo es revisar las características y la prevalencia de las principales variantes epileptiformes benignas y actualizar su significado clínico.

Novel avian oropharyngeal trichomonads isolated from European turtle doves (Streptopelia turtur) and racing pigeons (Columba livia): genetic and morphometric characterisation of clonal cultures.

Extensive diversity has been described within the avian oropharyngeal trichomonad complex in recent years. In this study we developed clonal cultures from four isolates selected by their different ITS1/5.8S/ITS2 (ITS) genotype and their association with gross lesions of avian trichomonosis. Isolates were obtained from an adult racing pigeon and a nestling of Eurasian eagle owl with macroscopic lesions, and from a juvenile wood pigeon and an European turtle dove without clinical signs. Multi-locus sequence typing analysis of the ITS, small subunit of ribosomal rRNA (SSUrRNA) and Fe-hydrogenase (Fe-hyd) genes together with a morphological study by optical and scanning electron microscopy was performed. No significant differences in the structures were observed with scanning electron microscopy. However, the genetic characterisation revealed novel sequence types for the SSUrRNA region and Fe-hyd gene. Two clones were identified as Trichomonas gallinae in the MLST analysis, but the clones from the racing pigeon and European turtle dove showed higher similarity with Trichomonas tenax and Trichomonas canistomae than with T. gallinae at their ITS region, respectively. SSUrRNA sequences grouped all the clones in a clade that includes T. gallinae, T. tenax and T. canistomae. Further diversity was detected within the Fe-hyd locus, with a clear separation from T. gallinae of the clones obtained from the racing pigeon and the European turtle dove. In addition, morphometric comparison by optical microscopy with clonal cultures of T. gallinae revealed significant statistical differences on axostyle projection length in the clone from the European turtle dove. Morphometric and genetic data indicate that possible new species within the Trichomonas genus were detected. Taking in consideration the diversity in Trichomonas species present in the oral cavity of birds, a proper genetic analysis is highly recommended when outbreaks occur.

Effect of Ag Addition on the Electrochemical Performance of Cu10Al in Artificial Saliva.

In this work we proposed to evaluate the corrosion resistance of four different alloys by electrochemical techniques, a binary alloy Cu10Al, and three ternary alloys Cu10Al-xAg (x = 5, 10, and 15 wt.%) to be used like biomaterials in dental application. Biomaterials proposed were tested in artificial saliva at 37°C for 48 h. In addition, pure metals Cu, Al, Ag, and Ti as reference materials were evaluated. In general the short time tests indicated that the Ag addition increases the corrosion resistance and reduces the extent of localized attack of the binary alloy. Moreover, tests for 48 hours showed that the Ag addition increases the stability of the passive layer, thereby reducing the corrosion rate of the binary alloy. SEM analysis showed that Cu10Al alloy was preferably corroded by grain boundaries, and the Ag addition modified the form of attack of the binary alloy. Cu-rich phases reacted with SCN(-) anions forming a film of CuSCN, and the Ag-rich phase is prone to react with SCN(-) anions forming AgSCN. Thus, binary and ternary alloys are susceptible to tarnish in the presence of thiocyanate ions.

[Usefulness of electroencephalograms in evaluating transient global amnesia]. / Utilidad de la electroencefalografia en la valoracion de la amnesia global transitoria.

INTRODUCTION: Transient global amnesia (TGA) is a perfectly well defined clinical picture, but nevertheless even today its aetiology remains unknown. The three most widely accepted theories suggest it has a vascular origin, it is related with the pathophysiology of migraine or it is of an epileptiform nature. AIM: To analyse whether there is an electroencephalographic pattern that is consistently repeated in a series of electro-encephalograms (EEG) carried out on patients with TGA. PATIENTS AND METHODS: The study consists in a retrospective analysis of a sample of 345 patients referred to have an EEG after an episode of TGA. RESULTS: In almost 20% of the EEGs something that could be considered abnormal was found, although most of these findings (64%) were of little pathological significance. Of the remaining 26%, attention should be drawn to the cases of two patients with subclinical rhythmic electroencephalogram discharges of adults (a pattern with a meaning that is not altogether clear and which has previously been associated with TGA). CONCLUSIONS: A considerable percentage of patients have TGA and EEG alterations, although most of them are of scarce pathological significance or can be attributed to some other underlying condition. We have not succeeded in identifying any pattern that is consistently repeated. Our results suggest that the EEG is a test with low diagnostic effectiveness in this pathology and it is necessary to reconsider the need to systematically perform such tests in suspected cases of TGA.

Inheritance of resistance to pyrethroids in Triatoma infestans, the main Chagas disease vector in South America.

An outbreak of pyrethroid resistance was recently detected in Triatoma infestans from northern Argentina. To analyze the inheritance of the resistant phenotype, we carried out experimental crosses between resistant (R) and susceptible (S) strains captured in Argentina during 2005. The R strain was collected from sprayed houses in the north of the province of Salta while the S strain was collected in the province of Chaco. Both strains were bred in the laboratory for reciprocal crosses (F1), intercrosses (F2) and backcrosses (BC). The descendents were tested by a standard insecticide resistance bioassay. Resistance ratios were 1 for S strain, 103.36 for R strain and 18.34 for F1. The regression lines of F1 generations (R×S and S×R) showed no significant differences and were closer to that of the R parents, indicating that inheritance of deltamethrin resistance in T. infestans is autosomal and incompletely dominant (D=0.20). Chi-square analysis from responses of intercross and backcross progenies rejected the hypothesis of a single gene being responsible for resistance. The minimum number of independent segregation genes was three, as calculated with Lande's method. The genetic basis here described for the resistant phenotype indicate that, under pyrethroid selective pressure, the resistant genotypes could be easily spread to susceptible insects from resistant individuals, posing a major threat to vectorial control of Chagas disease.

El papel diagnóstico del Holterelectroencefalograma ambulatorio: experiencia y resultados en 264 registros / The role of ambulatory electroencephalogram monitoring: experience and results in 264 records

Introducción. La monitorización continua con Holterelectroencefalograma(Holter-EEG) permite el registro encefalográficoambulatorio de un paciente durante un tiempoprolongado. El objetivo de este estudio es describir yanalizar los resultados obtenidos con la determinación delHolter-EEG en nuestra práctica clínica.Métodos. Se analizaron de forma retrospectiva los resultadosde los 264 registros de Holter-EEG, agrupados segúnel motivo de solicitud: a) grupo 1: evaluación diagnósticade los episodios de naturaleza epiléptica; b) grupo 2:evaluación diagnóstica de episodios paroxísticos, y c) grupo 3:valoración del riesgo de recidiva durante la retirada del tratamientoanticomicial en determinados pacientes epilépticos.Resultados. a) Grupo 1 (n=137): en 54 registros (39,4%)el resultado fue normal, en 20 (14,6%) se detectó actividadepileptiforme generalizada (5 con actividad ictal), en 57 (42%)se detectó actividad epileptiforme focal (8 con actividad ictal)y en 6 (4%) el diagnóstico del EEG fue inadecuado por lapresencia de artefactos; b) grupo 2 (n=99): en 47 registros(47,5%) no se registró ningún episodio y el Holter-EEG fuenormal, en 14 (14,2%) se documentó un episodio clínico sinregistrarse anomalías críticas en el Holter-EEG y en 29(29,3%) se registró actividad epileptiforme focal (ictal en 4)y generalizada (ictal en 1) en 4 pacientes (4%). En 5 registros(5%) el diagnóstico del EEG fue inadecuado, y c) grupo3 (n=28): el estudio fue normal en 15 casos (53,6%), mostrabaactividad epileptiforme focal interictal en 8 (28,6%) ygeneralizada en 5 (17,8%).Conclusiones. Consideramos que los registros de Holter-EEG en casos adecuadamente seleccionados puedenaportar una importante información complementaria en laevaluación global del paciente epiléptico (AU)

Introduction. Ambulatory electroencephalogram (EEG)monitoring allows for long-term, mobile electroencephalographicrecordings of patients. This study aims to describeand analyze the results obtained with ambulatory EEG inour clinical practice.Methods. We have analyzed the results of 264 ambulatoryEEG records, grouped according to the reasonfor the request: a) group 1: diagnostic evaluation of episodesof epileptic nature; b) group 2: diagnostic evaluationof paroxysmal episodes, and c) group 3: evaluationof the risk of relapse during anti-seizure treatment withdrawalin certain epileptic patients.Results. a) Group 1 (n=137): normal results werefound in 54 records (39.4%). There was generalized epilepticactivity in 20 (14.6%) of them (5 with ictal activity)and focal epileptic activity was detected in 57 cases(42%) (8 with ictal activity). No EEG diagnosis could bereached in 6 (4%) recordings due to the presence of artefacts;b) group 2 (n=99): in 47 records (47.5 %), therewere no episodes and the Holter-EEG was normal. Therewas a clinically documented episode without anomaliesduring Holter-EEG registration in 14 cases (14.2%). In 29records (29.3%), focal epileptic activity was recorded (ictal 4)and generalized epileptic activity (ictal in 1) was recordedin 4 patients (4%). No EEG diagnosis could be reached in5 cases (5%), and c) group 3 (n=28): the study was normalin 15 cases (53.6%) and showed focal interictal epilepticactivity in 8 (28.6 %) and generalized interictal epilepticactivity in 5 of them (17.8%).Conclusion. We believe that the ambulatory EEG recordingsin correctly selected cases can provide importantadditional information regarding global assessmentof patients with epilepsy (AU)

[Temporal lobe epilepsy. Aetiological classification in 61 paediatric patients]. / Epilepsia del lóbulo temporal. Clasificación etiológica en 61 pacientes en edad pediátrica.

INTRODUCTION: There are very few studies on the aetiology of temporal lobe epilepsy (TLE) in childhood. The purpose of the present study is to analyse the data of 61 children diagnosed with TLE, in order to describe the aetiology of TLE in children seen in a neuropaedriatic clinic. We also discuss the currently proposed classification. PATIENTS AND METHODS: A retrospective analysis was carried out on patients diagnosed with TLE. Patients consisted of 61 children less than 15 years old. RESULTS: Patients were classified into three groups: Group 1 (symptomatic temporal lobe epilepsy) consisted of 25 patients (40.98 %) with any temporal lesion on neuroimaging (tumours, malformations or infections) or significant history; Group 2 (Mesial temporal sclerosis) consisted of 17 patients (27.86 %), a history of simple and complex febrile seizure were common in this group; and Group 3 (Cryptogenic epilepsy) consisted of 19 patients (31.15 %) with no abnormalities on neuroimaging or significant history. CONCLUSION: To our knowledge, this is the largest paediatric series of childhood new-onset TLE assessed only by MRI in the literature. We have modified the previous aetiological classification in order to make the groups more realistic.

Epilepsia del lóbulo temporal. Clasificación etiológica en 61 pacientes en edad pediátrica / Temporal lobe epilepsy. Aetiological classification in 61 paediatric patients

Introducción. La etiología de la epilepsia del lóbulo temporal (ELT) en la edad pediátrica se ha descrito en escasas ocasiones. El propósito de este estudio es analizar el diagnóstico etiológico de 61 pacientes con ELT atendidos en una consulta de neurología infantil. Analizamos y comentamos la clasificación actual. Pacientes y métodos. Se trata de un estudio de carácter retrospectivo, en el que se incluyó a 61 pacientes con ELT. Resultados. Los pacientes fueron clasificados en tres grupos en función del diagnóstico etiológico: grupo 1 (ELT sintomática), incluye a 25 pacientes (40,98 %) con lesiones en el lóbulo temporal (malformación, tumor o infección) o antecedentes significativos para presentar epilepsia; grupo 2 (esclerosis mesial temporal [EMT]), incluye a 17 pacientes (27,86 %), el antecedente de crisis febriles (tanto simples como complejas) se encontraba presente en un porcentaje elevado de pacientes con EMT; grupo 3 (ELT criptogénica), incluye a 19 pacientes (31,15 %), sin hallazgos patológicos en la resonancia magnética (RM) craneal o antecedentes significativos. Conclusión. Hasta la fecha, es la mayor serie que analiza, mediante RM, la etiología de la ELT de comienzo en la edad pediátrica. Hemos pretendido matizar la clasificación etiológica más aceptada, con el propósito de hacer grupos más flexibles y realistas

Introduction. There are very few studies on the aetiology of temporal lobe epilepsy (TLE) in childhood. The purpose of the present study is to analyse the data of 61 children diagnosed with TLE, in order to describe the aetiology of TLE in children seen in a neuropaedriatic clinic. We also discuss the currently proposed classification. Patients and methods. A retrospective analysis was carried out on patients diagnosed with TLE. Patients consisted of 61 children less than 15 years old. Results. Patients were classified into three groups: Group 1 (symptomatic temporal lobe epilepsy) consisted of 25 patients (40.98 %) with any temporal lesion on neuroimaging (tumours, malformations or infections) or significant history; Group 2 (Mesial temporal sclerosis) consisted of 17 patients (27.86 %), a history of simple and complex febrile seizure were common in this group; and Group 3 (Cryptogenic epilepsy) consisted of 19 patients (31.15 %) with no abnormalities on neuroimaging or significant history. Conclusion. To our knowledge, this is the largest paediatric series of childhood new-onset TLE assessed only by MRI in the literature. We have modified the previous aetiological classification in order to make the groups more realistic

Tentative identification of the species of Balantidium from ostriches (Struthio camelus) as Balantidium coli-like by analysis of polymorphic DNA.

The characteristics of Balantidium from ostriches (Struthio camelus) are similar to those of Balantidium coli; however, the species Balantidium struthionis was proposed on the basis of the host species (ostriches) and the shape of the macronucleus (with a deep depression in one side). In the present work, we have performed morphological and genetic comparisons between isolates of Balantidium from ostriches and B. coli from pigs to determine the specific status of B. struthionis. The morphological characteristics of the trophozoites of Balantidium from ostriches were reviewed in 100 trophozoites from two isolates. The macronucleus' shape of the ostrich Balantidium was highly variable, thus the use of this criterion for diagnostic purposes is not reliable. Besides, very few trophozoites showed a deep depression in their macronucleus and almost all the trophozoites conform to the description of B. coli. The complete sequence of the DNA coding for the 18s-rRNA-ITS1-5.8s-rRNA-ITS2 regions were obtained by PCR from five pig and five ostrich isolates. The sequences corresponding to the 18s and 5.8s-rRNA genes were identical for the ostrich and pig isolates. Two clearly different genotypes were found in the analysis of the ITS1 and ITS2 regions of the pig isolates; the genotype A was identified in all isolates, while the genotype B was found in only two of them. Their sequences show clear differences from that published corresponding to a B. coli gorilla isolate, which we will consider as a different genotype, C. In our opinion, these different B. coli genotypes reflect the genetic variability of this organism, but further studies would be necessary to determine if it could have practical importance. The polymorphism of the ITS regions have been also found in the ostrich isolates. The same genotypes A and B have been identified, although not as mixed infections. The morphological characteristics and the genetic results suggest that the species name B. struthionis is a synonym of B. coli; however, until experimental infections are carried out to determine if the parasite is transmissible between pigs and ostriches, it would be preferable to tentatively designate it as B. coli-like.

[The role of ambulatory electroencephalogram monitoring: experience and results in 264 records]. / El papel diagnóstico del Holterelectroencefalograma ambulatorio: experiencia y resultados en 264 registros.

INTRODUCTION: Ambulatory electroencephalogram (EEG) monitoring allows for long-term, mobile electroencephalographic recordings of patients. This study aims to describe and analyze the results obtained with ambulatory EEG in our clinical practice. METHODS: We have analyzed the results of 264 ambulatory EEG records, grouped according to the reason for the request: a) group 1: diagnostic evaluation of episodes of epileptic nature; b) group 2: diagnostic evaluation of paroxysmal episodes, and c) group 3: evaluation of the risk of relapse during anti-seizure treatment withdrawal in certain epileptic patients. RESULTS: a) Group 1 (n=137): normal results were found in 54 records (39.4%). There was generalized epileptic activity in 20 (14.6%) of them (5 with ictal activity) and focal epileptic activity was detected in 57 cases (42%) (8 with ictal activity). No EEG diagnosis could be reached in 6 (4%) recordings due to the presence of artefacts; b) group 2 (n=99): in 47 records (47.5 %), there were no episodes and the Holter-EEG was normal. There was a clinically documented episode without anomalies during Holter-EEG registration in 14 cases (14.2%). In 29 records (29.3%), focal epileptic activity was recorded (ictal 4) and generalized epileptic activity (ictal in 1) was recorded in 4 patients (4%). No EEG diagnosis could be reached in 5 cases (5%), and c) group 3 (n=28): the study was normal in 15 cases (53.6%) and showed focal interictal epileptic activity in 8 (28.6 %) and generalized interictal epileptic activity in 5 of them (17.8%). CONCLUSION: We believe that the ambulatory EEG recordings in correctly selected cases can provide important additional information regarding global assessment of patients with epilepsy.

HDA por metástasis gástrica como presentación de un carcinoma epidermoide de esófago / No disponible

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Diterpenoid alkaloids from Delphinium gracile.

Two highly oxygenated hetisine-type diterpenoid alkaloids, delphigraciline (1), 14-hydroxyhetisinone N-oxide (2), and the norditerpenoid alkaloid 8-methoxykarakoline (3), were isolated from a neutral extract of Delphinium gracile. Their structures were elucidated on the basis of spectroscopic data and by comparison with previously reported spectroscopic data of similar alkaloids. Their antiparasitic and insecticidal activities are also discussed.

Neuralgia supraorbitaria: una alternativa intervencionista. Réplica / Supraorbital neuralgia: an interventionist alternative. Reply

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Neuralgia supraorbitaria postraumática: una entidad benigna / Post-traumatic supraorbital neuralgia: a benign condition

Introducción. La neuralgia supraorbitaria es una entidad de reciente descripción. La mayor parte de los pacientes publicados sufre neuralgias idiopáticas, crónicas, de difícil tratamiento, que en ocasiones requieren cirugía de liberación del nervio. Presentamos nuestra experiencia en pacientes con una variante de esta neuralgia de causa conocida, aparición frecuente y pronóstico benigno. Casos clínicos. Estudiamos cinco pacientes, cuatro mujeres y un varón de 55 años de edad media (rango: 29-69 años). Todos sufrieron un traumatismo directo banal sobre la región frontal, de causa diversa. Cuatro desarrollaron un dolor continuo, de tipo pinchazo o quemazón, tres un dolor paroxístico y uno prurito. No hubo manifestaciones autonómicas. Todos presentaron una exploración de la sensibilidad anómala en el territorio afectado, con hipoestesia tactil, hiperalgesia o alodinia y signo de Tinel positivo. Las pruebas de neuroimagen fueron normales. Dos recibieron tratamiento con gabapentina y amitriptilina. Uno fue tratado con un bloqueo anestésico, con una mejoría transitoria. Tres no recibieron tratamiento alguno. Tras un año de seguimiento, todos mejoraron y tres quedaron sin dolor, si bien en todos persistieron alteraciones sensitivas. Conclusiones. La neuralgia supraorbitaria postraumática es una entidad frecuente, aunque probablemente infradiagnosticada. Presenta características clínicas y evolutivas particulares que la diferencian de la neuralgia supraorbitaria idiopática. Suele tener una buena evolución y una respuesta favorable al tratamiento sintomático, si es que llega a requerir alguno

Introduction. Supraorbital neuralgia has only recently been described. Most of the cases reported involve patients suffering from chronic idiopathic neuralgias that are difficult to treat and sometimes require surgery to release the nerve. We present our experience in patients with a variant of this neuralgia which has a known causation, is commonly seen and has a benign prognosis. Case reports. We studied five patients, four females and one male, with a mean age of 55 years (range: 29-69 years). They had all suffered direct banal traumatic injury to the frontal region due to different causes. Four of them developed continuous, piercing or burning-type pain; three of them had paroxysmal pain and one had itching. There were no autonomic manifestations. All of them were found to be abnormally sensitive in the affected area, with tactile hypaesthesia, hyperalgesia or allodynia and a positive Tinel’s sign. Neuroimaging tests were normal. Two patients were treated with gabapentin and amitriptyline. One was treated with an anaesthetic blockade, which afforded temporary relief. Three of them received no treatment at all. After one year of follow-up, all of them had improved and three were no longer in pain, although sensory alterations persisted in all cases. Conclusions. Post-traumatic supraorbital neuralgia is a frequent condition, although it is probably underdiagnosed. It has its own characteristic clinical and developmental features that distinguish it from idiopathic supraorbital neuralgia. Progress is usually good and it responds favourably to symptomatic treatment, if needed