[Training of executive function in preschool children with combined attention deficit hyperactivity disorder: a prospective, controlled and randomized trial]. / Entrenamiento de la función ejecutiva en preescolares con trastorno por déficit de atención/hiperactividad combinado: estudio prospectivo, controlado y aleatorizado.

INTRODUCTION: School-age children with attention deficit hyperactivity disorder, combined type (ADHD-C) have executive function (EF) alterations. ADHD-C and EF alterations improve with methylphenidate or after training of working memory. AIM: To determine EF training effect on ADHD-C and EF alterations in preschoolers. INCLUSION CRITERIA: randomly assigned, 2-4 years old with ADHD-C, from 7-1-2004 to 6-30-2005, normal neurological examination, no evidences of underlying chronic disorders, no taking long term medications and parents agree to train or no EF daily. Parents filled out DSM-IV diagnostic criteria form for ADHD-C and children were tested with the Standard Dimensional Change Card Sort Task at the first visit and once a year from 1 to 3 years. Inattention, hyperactivity/impulsivity and EF average scores were statistically analyzed by the t Student for significance. RESULTS: Of 25, 13 were trained. ADHD-C incidence went down to 16 (64%), 6 (24%) and 10 (40%) trained and untrained. Incidence was 50, 40 and 25% 100, and 66.66 y 100 after 1, 2 and 3 years with and without training. Inattention average score was 8.25, 8.4 and 7 before and 6, 5.8, and 5.5 before and after 1, 2 and 3 years of training. Hyperactivity/impulsivity average score was 8.5, 8.4 and 7.75 before and 5.75, 5.6, and 5.25 after 1, 2 and 3 years of training. EF average score was 5.2, 4.8, and 5.5 before and 8.5, 10 and 9.5 after 1, 2 and 3 years of training. Degree of improving of inattention, hyperactivity/impulsivity and EF were statistically significant for training of EF for 1, 2 and 3 years (p = 0.013, 0.002, 0.0249). CONCLUSIONS: Children with preschool ADHD-C and EF disorders should receive training of EF for at least 3 years from age of diagnoses to improve their condition.

Entrenamiento de la función ejecutiva en preescolares con trastorno por déficit de atención/hiperactividad combinado: estudio prospectivo, controlado y aleatorizado / Training of executive function in preschool children with combined attention deficit hyperactivity disorder: A prospective, controlled and randomized trial

Introducción. Los escolares con trastorno por déficit de atención/hiperactividad combinado (TDAH-C) presentan alteraciones de la función ejecutiva (FE) que mejoran mediante la administración de metilfenidato o con el entrenamiento de la memoria de trabajo. Objetivo. Determinar el efecto del entrenamiento de las FE sobre sus alteraciones y sobre el TDAH-C en preescolares. Sujetos y métodos. Criterio de inclusión: distribución aleatoria, niños de 2 a 4 años de edad, afectados de TDAH-C, incluidos entre el uno de julio de 2004 y el 30 de junio de 2005, con examen neurológico normal, sin enfermedades crónicas, que no estaban recibiendo tratamiento farmacológico a largo plazo y cuyos padres estaban de acuerdo en entrenar o no entrenar a sus hijos. Los padres completaron el cuestionario del DSM-IV para determinar la presencia o la ausencia de TDAH-C y las FE se evaluaron mediante la Dimensional Change Card Sort Task en la primera evaluación y una vez al año durante tres años. El promedio de puntuación de la inatención, hiperactividad/impulsividad y FE en los grupos entrenado o no entrenado se analizaron estadísticamente mediante la t de Student. Resultados. De 25 niños, 13 recibieron entrenamiento. La incidencia de TDAH-C descendió a 16 casos (64%), 6 niños (24%) con entrenamiento y 10 niños (40%) sin él. La incidencia de TDAH-C fue del 50, 40 y 25% y del 100, 66,66 y 100% después de uno, dos y tres años con entrenamiento o sin él. El promedio de puntuación de la inatención fue de 8,25, 8,4 y 7 antes del entrenamiento y de 6, 5,8, y 5,5 después de uno, dos y tres años. El promedio de la hiperactividad/impulsividad fue de 8,5, 8,4 y 7,75 antes del entrenamiento y de 5,75, 5,6 y 5,25 después de uno, dos y tres años, y el de las FE, de 5,2, 4,8 y 5,5 antes del entrenamiento y de 8,5, 10 y 9,5 después de uno, dos y tres años de entrenamiento. El grado de mejora de la inatención, de la hiperactividad/impulsividad y de las FE fue estadísticamente significativo con el entrenamiento de las FE durante uno, dos y tres años (p = 0,013, 0,002, 0,0249). Conclusiones. Los preescolares con TDAH-C y alteraciones de las FE deberían recibir entrenamiento de éstas durante, como mínimo, tres años desde el momento del diagnóstico para mejorar su condición (AU)

Introduction. School-age children with attention deficit hyperactivity disorder, combined type (ADHD-C) have executive function (EF) alterations. ADHD-C and EF alterations improve with methylphenidate or after training of working memory. Aim. To determine EF training effect on ADHD-C and EF alterations in preschoolers. Subjects and methods. Inclusion criteria: randomly assigned, 2-4 years old with ADHD-C, from 7-1-2004 to 6-30-2005, normal neurological examination, no evidences of underlying chronic disorders, no taking long term medications and parents agree to train or no EF daily. Parents filled out DSM-IV diagnostic criteria form for ADHD-C and children were tested with the Standard Dimensional Change Card Sort Task at the first visit and once a year from 1 to 3 years. Inattention, hyperactivity/impulsivity and EF average scores were statistically analyzed by the t Student for significance. Results. Of 25, 13 were trained. ADHD-C incidence went down to 16 (64%), 6 (24%) and 10 (40%) trained and untrained. Incidence was 50, 40 and 25% 100, and 66.66 y 100 after 1, 2 and 3 years with and without training. Inattention average score was 8.25, 8.4 and 7 before and 6, 5.8, and 5.5 before and after 1, 2 and 3 years of training. Hyperactivity/impulsivity average score was 8.5, 8.4 and 7.75 before and 5.75, 5.6, and 5.25 after 1, 2 and 3 years of training. EF average score was 5.2, 4.8, and 5.5 before and 8.5, 10 and 9.5 after 1, 2 and 3 years of training. Degree of improving of inattention, hyperactivity/impulsivity and EF were stadistically significant for training of EF for 1, 2 and 3 years (p = 0.013, 0.002, 0.0249). Conclusions. Children with preschool ADHD-C and EF disorders should receive training of EF for at least 3 years from age of diagnoses to improve their condition (AU)

[Treatment of herpes simplex encephalitis in children]. / Tratamiento de las encefalitis herpéticas en niños.

INTRODUCTION: Herpes simplex encephalitis (HSE) is a focal infectious disease of the central nervous system (CNS) acknowledged the world over as being severe. DEVELOPMENT: The epidemiology is well known in developed countries. It presents in patients over the age of 3 months. The mechanism by which the virus reactivates and penetrates into the CNS is still not fully understood. A timely diagnosis is crucial so that early treatment can be established within the first four days of the infectious process. By so doing, it becomes possible to raise the chances of survival by over 50%. The physician should have a strong suspicion when faced with a patient with symptoms of encephalitis, especially if he or she has focal neurological manifestations, including manifestations in the neuropsychiatric sphere. The non-invasive diagnostic method par excellence is high-sensitivity magnetic resonance imaging studies of the brain within the first 24-48 hours following the onset of the clinical signs and symptoms. Determination of viral DNA in cerebrospinal fluid by the polymerase chain reaction method is the technique with the highest degree of sensitivity and specificity available for carrying out the diagnosis. Effective treatment is intravenous acyclovir: 30 mg/kg/day in three doses. CONCLUSIONS: Encephalitis produced by the herpes virus is a disease that is dreaded because of the high mortality rate and the devastation it causes in the living conditions of survivors. Our aim is to stimulate the clinical suspicion of HSE so that pharmacological treatment can be established even while diagnostic tests are being carried out. We suggest early neuropsychological evaluation and follow-up of the manifestations of focal sequelae related to the frontotemporal regions.

[Cerebrovascular accidents in full-term newborn infants]. / Accidentes vasculares encefálicos en neonatos a término.

INTRODUCTION: The purpose of this paper is to review the role of the neurologist in the management of cerebrovascular accidents (CVA) (insults resulting from a sudden obstruction or rupture of an intracranial vessel). This was accomplished by reviewing the literature (PubMed) under the heading of stroke and term neonate. DEVELOPMENT: CVA in full-term neonates are classified as hematomas and infarcts. Hematomas are classified according to: location, structure (arterial, venous, or sinus), type of malformation (aneurysm, venous malformation, and telangiectasia), and cause of the bleed (vessel wall rupture or hypo-coagulation). Classification according to location is based on compartment supra or infratentorial; space -extra-axial (epidural, subdural, or subarachnoid) or intra-axial (parenchymal or ventricular)-; and region -parietal, temporal, thalamic, etc.-. Infarcts are classified according to vascular and parenchymal factors. The vascular factors are the structure, the cause of the obstruction -extramural, mural or intramural (thrombus or embolus)-. The parenchymal factors are type of damage (pale vs hemorrhagic) and location. Patients with suspected embolism should have ultrasound neck. Coagulation studies should be done in patients with hematomas and infracts. Multiple causes may be present in each case. Anticoagulation is only used in small pale infarcts of cardiac embolic origin. CONCLUSION: The neurologist roles in the management of CVA are to classify the event, select the appropriate investigation, and implement treatment.

[Executive function disorders]. / Trastornos de las funciones ejecutivas.

AIM: To review the development, anatomy and physiology of executive functions (EF) in normal and pathological conditions. DEVELOPMENT: EF consist of several internal mental process design to solve mental and environmental complex problems in an efficient and acceptable way to the person and the society. EF include inhibition of behavior and irrelevant information, nonverbal working memory, verbal working memory, self-regulation of affect, motivation and arousal, planning, decision making, self monitoring of the entire solving problem process and self evaluation of the results of the action taken. The anatomical substrate is at the prefrontal lobe cortex and its afferent and efferent structures. Neurotransmitters involved in activation of neurons at the prefrontal cortex are dopamine and norepinephrine and in less degree acetylcholine and serotonine. CONCLUSIONS: Disorders of one or more of the EF in children and adolescents are found in attention deficit/hyperactivity disorder, Tourette syndrome, bipolar disease, depression, obsessive-compulsive disorders, autism and traumatic brain injury.

Accidentes vasculares encefálicos en neonatos a término / Cerebrovascular accidents in full-term newborn infants

Introducción. El propósito de este artículo es revisar elpapel del neurólogo en el manejo de los recién nacidos a términocon accidentes vasculares encefálicos (AVE) (lesiones debidas auna súbita obstrucción o ruptura de un vaso intracraneal). Coneste fin se revisaron las fuentes bibliográficas (PubMed) mediantela búsqueda de los términos ‘stroke’ y ‘term neonate’. Desarrollo.Los AVE se dividen en hematomas e infartos. Los hematomas debenclasificarse de acuerdo con su localización; estructura vascularenvuelta (arteria, vena o seno), el tipo de anomalía vascular (aneurisma,malformaciones venosas, telangiectasia) y la causa de laextravasación de la sangre (ruptura de la pared vascular o hipocoagulación).La clasificación de acuerdo con la localización incluye:compartimentos (supra e infratentoriales), espacios –extraaxial(epidural, subdural o aracnoideo) o intraaxial (parénquima oventrículos)– y regiones –parietal, temporal, talámica, etc.–. Losinfartos se clasifican de acuerdo con factores vasculares y parenquimatosos;los factores vasculares son el tipo de estructura vascularenvuelta, causa de la obstrucción –extramural, mural o intramural(émbolo o trombo)–; los factores parenquimatosos son el tipode infarto –pálido o hemorrágico– y la localización de éste. Lospacientes con procesos embólicos requieren ecografía del corazóny del cuello. La posibilidad de causas múltiples debe sospecharse.Se deben realizar estudios de coagulación. La cirugía puede sernecesaria en determinados casos. En pacientes con cardioembolismose sugiere la anticoagulación en infartos pálidos y pequeños.Conclusión. La función del neurólogo en estos pacientes consisteen clasificar el evento, guiar las investigaciones y decidir el tratamiento

Introduction. The purpose of this paper is to review the role of the neurologist in the management of cerebrovascularaccidents (CVA) (insults resulting from a sudden obstruction or rupture of an intracranial vessel). This was accomplished byreviewing the literature (PubMed) under the heading of stroke and term neonate. Development. CVA in full-term neonates areclassified as hematomas and infarcts. Hematomas are classified according to: location, structure (arterial, venous, or sinus), typeof malformation (aneurysm, venous malformation, and telangiectasia), and cause of the bleed (vessel wall rupture or hypocoagulation).Classification according to location is based on compartment supra or infratentorial; space –extra-axial (epidural,subdural, or subarachnoid) or intra-axial (parenchymal or ventricular)–; and region –parietal, temporal, thalamic, etc.–.Infarcts are classified according to vascular and parenchymal factors. The vascular factors are the structure, the cause of theobstruction –extramural, mural or intramural (thrombus or embolus)–. The parenchymal factors are type of damage (pale vshemorrhagic) and location. Patients with suspected embolism should have ultrasound neck. Coagulation studies should be donein patients with hematomas and infracts. Multiple causes may be present in each case. Anticoagulation is only used in small paleinfarcts of cardiac embolic origin. Conclusion. The neurologist roles in the management of CVA are to classify the event, selectthe appropriate investigation, and implement treatment

Trastornos de las funciones ejecutivas / Executive function disorders

Objetivo. Revisar el desarrollo, la anatomía y la fisiologíade las funciones ejecutivas (FE) en condiciones normales y patológicas.Desarrollo. Las FE consisten en varios procesos mentalesdiseñados para resolver problemas mentales y medioambientalescomplejos con eficiencia y el beneplácito de la persona y lasociedad. Las FE incluyen inhibición de la conducta y la informaciónirrelevante, memoria de trabajo no verbal, memoria de trabajoverbal, autorregulación de las emociones, motivaciones y gradode alerta, planeamiento, tomar decisiones, automonitorización delproceso y autoevaluación de los resultados de la acción tomada.Las estructuras anatómicas involucradas incluyen la corteza prefrontaly sus áreas aferentes y eferentes. Los neurotransmisoresimplicados son la dopamina y la norepinefrina y, en menor grado,la acetilcolina y la serotonina. Conclusiones. Se han encontradoalteraciones de una o varias de las FE en niños y adolescentes contrastorno por déficit de atención e hiperactividad, síndrome deTourette, enfermedad bipolar, depresión, trastorno obsesivo-compulsivo,autismo y postraumatismo cerebral

Aim. To review the development, anatomy and physiology of executive functions (EF) in normal and pathologicalconditions. Development. EF consist of several internal mental process design to solve mental and environmental complexproblems in an efficient and acceptable way to the person and the society. EF include inhibition of behavior and irrelevantinformation, nonverbal working memory, verbal working memory, self-regulation of affect, motivation and arousal, planning,decision making, self monitoring of the entire solving problem process and self evaluation of the results of the action taken.The anatomical substrate is at the prefrontal lobe cortex and its afferent and efferent structures. Neurotransmitters involved inactivation of neurons at the prefrontal cortex are dopamine and norepinephrine and in less degree acetylcholine and serotonine.Conclusions. Disorders of one or more of the EF in children and adolescents are found in attention deficit/hyperactivitydisorder, Tourette syndrome, bipolar disease, depression, obsessive-compulsive disorders, autism and traumatic brain injury

Tratamiento de las encefalitis herpéticas en niños / Treatment of herpes simplex encephalitis in children

Introducción. La encefalitis herpética (EH) es una enfermedadinfecciosa focal del sistema nervioso central (SNC) reconocidamundialmente como grave. Desarrollo. La epidemiología estábien establecida en países desarrollados. Se presenta en pacientesmayores de 3 meses. No está bien determinado el mecanismo por elque el virus se reactiva y penetra en el SNC. El diagnóstico precozes determinante para la instauración temprana del tratamiento enlos primeros cuatro días del proceso infeccioso, con lo que se puedelograr aumentar en más de un 50% la posibilidad de supervivencia.Se insta tener una sospecha importante ante un paciente con síntomasde encefalitis, especialmente si presenta manifestaciones neurológicasfocales, incluidas las del ámbito neuropsiquiátrico. El métododiagnóstico no invasivo por excelencia es el estudio de resonanciamagnética cerebral con alta sensibilidad en las primeras 24-48 horas tras el inicio de las manifestaciones clínicas. La determinaciónde ADN viral en el líquido cefalorraquídeo por reacción encadena de la polimerasa es el método de mayor sensibilidad y especificidaddisponible para el diagnóstico. El tratamiento efectivo esaciclovir por vía endovenosa: 30 mg/kg/día en tres dosis. Conclusión.La encefalitis producida por el virus herpes es una temibleenfermedad por la alta mortalidad y devastación de las condicionesde vida de los supervivientes. Se propone estimular la sospecha clínicade la EH de manera que se inicie un tratamiento farmacológicoincluso mientras se realizan las pruebas diagnósticas. Planteamosla evaluación neuropsicológica temprana y el seguimiento delas manifestaciones de secuelas focales relacionadas con las regionesfrontotemporales

Introduction. Herpes simplex encephalitis (HSE) is a focal infectious disease of the central nervous system (CNS)acknowledged the world over as being severe. Development. The epidemiology is well known in developed countries. Itpresents in patients over the age of 3 months. The mechanism by which the virus reactivates and penetrates into the CNS is stillnot fully understood. A timely diagnosis is crucial so that early treatment can be established within the first four days of theinfectious process. By so doing, it becomes possible to raise the chances of survival by over 50%. The physician should havea strong suspicion when faced with a patient with symptoms of encephalitis, especially if he or she has focal neurologicalmanifestations, including manifestations in the neuropsychiatric sphere. The non-invasive diagnostic method par excellence ishigh-sensitivity magnetic resonance imaging studies of the brain within the first 24-48 hours following the onset of the clinicalsigns and symptoms. Determination of viral DNA in cerebrospinal fluid by the polymerase chain reaction method is thetechnique with the highest degree of sensitivity and specificity available for carrying out the diagnosis. Effective treatment isintravenous acyclovir: 30 mg/kg/day in three doses. Conclusions. Encephalitis produced by the herpes virus is a disease thatis dreaded because of the high mortality rate and the devastation it causes in the living conditions of survivors. Our aim is tostimulate the clinical suspicion of HSE so that pharmacological treatment can be established even while diagnostic tests arebeing carried out. We suggest early neuropsychological evaluation and follow-up of the manifestations of focal sequelaerelated to the frontotemporal regions