[Psychiatric and cognitive complications arising from subthalamic stimulation in Parkinson's disease]. / Complicaciones psiquiátricas y cognitivas de la estimulación subtalámica en la enfermedad de Parkinson.

INTRODUCTION AND DEVELOPMENT: Subthalamic stimulation is a therapeutic option that can be used to treat advanced cases of Parkinson's disease. However, psychiatric or cognitive disorders have been reported in some patients treated using this technique. Age and a long disease history are two important risk factors for the appearance of these problems. The complications that have been reported include cases of depression, apathy, manias and psychosis. Surgery can also exacerbate the syndrome of addiction to levodopa that is sometimes observed. In contrast, sleep disorders usually improve with this technique. As far as the cognitive sphere is concerned, verbal fluency has been seen to deteriorate and the executive functions become impaired in patients over 69 years of age. These disorders are usually due to a number of different causes and have been attributed to the action of stimulating areas close to the subthalamic nucleus, to the presence of previously existing cognitive or psychiatric problems, to unrealistic expectations about this technique or to the individual's inability to adapt to the functional situation after surgery. CONCLUSIONS: Although generally speaking these disorders are not usually serious, they must be borne in mind so that adequate treatment can be indicated.

Complicaciones psiquiátricas y cognitivas de la estimulación subtalámica en la enfermedad de Parkinson / Psychiatric and cognitive complications arising from subthalamic stimulation in parkinson’s disease

Introducción y desarrollo. La estimulación subtalámica esuna opción terapéutica para los casos de enfermedad de Parkinsonavanzada. En algunos pacientes tratados con esta técnica se handescrito alteraciones psiquiátricas o cognitivas. La edad y la largaevolución de la enfermedad son dos factores de riesgo importantespara la aparición de estos problemas. Así, se han descrito casos dedepresión, apatía, manía y psicosis. La cirugía puede empeorar elsíndrome de adicción a la levodopa que se ve en ocasiones. Por elcontrario, esta técnica suele mejorar los trastornos del sueño. Sobrela esfera cognitiva, se ha constatado un empeoramiento de la fluenciaverbal, y en los pacientes mayores de 69 años, un empeoramientode las funciones ejecutivas. Las causas de estos trastornos suelenser variadas y se han atribuido a la acción de la estimulación sobreáreas próximas al núcleo subtalámico, a la existencia de problemascognitivos o psiquiátricos previos, a expectativas poco realistas sobreesta técnica o a la incapacidad de adaptarse a la situación funcionaltras cirugía. Conclusión. Aunque estas alteraciones en generalno suelen ser graves, se deben tener en cuenta para poder indicarun tratamiento adecuado

Introduction and development. Subthalamic stimulation is a therapeutic option that can be used to treat advancedcases of Parkinson’s disease. However, psychiatric or cognitive disorders have been reported in some patients treated usingthis technique. Age and a long disease history are two important risk factors for the appearance of these problems. Thecomplications that have been reported include cases of depression, apathy, manias and psychosis. Surgery can also exacerbatethe syndrome of addiction to levodopa that is sometimes observed. In contrast, sleep disorders usually improve with thistechnique. As far as the cognitive sphere is concerned, verbal fluency has been seen to deteriorate and the executive functionsbecome impaired in patients over 69 years of age. These disorders are usually due to a number of different causes and havebeen attributed to the action of stimulating areas close to the subthalamic nucleus, to the presence of previously existingcognitive or psychiatric problems, to unrealistic expectations about this technique or to the individual’s inability to adapt tothe functional situation after surgery. Conclusions. Although generally speaking these disorders are not usually serious, theymust be borne in mind so that adequate treatment can be indicated

Oxcarbacepina en el tratamiento de la coreoatetosis paroxística cinesigénica / Oxcarbacepine in the treatment of kinesigenic paroxysmal choreoathetosis

No disponible

No disponible

[Seasonal variations in the outbreaks in patients with multiple sclerosis]. / Variaciones estacionales de los brotes en pacientes con esclerosis múltiple.

INTRODUCTION: It has been suggested that there is an environmental factor at play in the aetiology and pathogenesis of multiple sclerosis (MS) that acts as an essential component of the disease process, and a number of studies also point to a relationship between the seasons of the year and the appearance of outbreaks. AIMS: Our aim was to study the possible relation between seasonal variations and the appearance of outbreaks in patients with relapsing-remitting forms of MS. PATIENTS AND METHODS: We studied 31 patients over the period between 1997 and 2002 and calculated the monthly and quarterly rate of incidence of outbreaks. The statistical evaluation of the results was performed by applying the Chi-squared test. RESULTS: We observed a higher incidence of outbreaks in the summer months (more in June) and a lower incidence in winter (less in December), with statistically significant differences. CONCLUSIONS: In our patients, outbreaks of MS are related to seasonal variations, with a higher number in the warmer months and fewer in the colder months.

Variaciones estacionales de los brotes en pacientes con esclerosis múltiple / Seasonal variations in the outbreaks in patients with multiple sclerosis

Introducción. En la etiología y la patogenia de la esclerosis múltiple (EM) se ha sugerido un factor ambiental como componente esencial del proceso de la enfermedad, y diversos estudios sugieren además una relación entre las estaciones del año y la aparición de brotes. Objetivo. Estudiar la posible relación entre las variaciones estacionales y la aparición de brotes en pacientes con formas remitentes-recurrentes de EM. Pacientes y métodos. Estudiamos 31 pacientes durante el período comprendido entre 1997 y 2002 y calculamos la tasa de incidencia mensual y trimestral de los brotes. La evaluación estadística de los resultados se realizó aplicando el test de Chi-cuadrado . Resultados. Observamos una mayor incidencia de brotes en los meses de verano (más en junio) y una menor incidencia en invierno (menos en diciembre), con diferencias estadísticamente significativas. Conclusiones. En nuestros pacientes existe una relación estacional de los brotes de la EM, con un número mayor en los meses cálidos y menor en los meses fríos

Introduction. It has been suggested that there is an environmental factor at play in the aetiology and pathogenesis of multiple sclerosis (MS) that acts as an essential component of the disease process, and a number of studies also point to a relationship between the seasons of the year and the appearance of outbreaks. Aims. Our aim was to study the possible relation between seasonal variations and the appearance of outbreaks in patients with relapsing-remitting forms of MS. Patients and methods. We studied 31 patients over the period between 1997 and 2002 and calculated the monthly and quarterly rate of incidence of outbreaks. The statistical evaluation of the results was performed by applying the Chi-squared test. Results. We observed a higher incidence of outbreaks in the summer months (more in June) and a lower incidence in winter (less in December), with statistically significant differences. Conclusions. In our patients, outbreaks of MS are related to seasonal variations, with a higher number in the warmer months and fewer in the colder months

Evolución temporal de TNF-a, VCAM-1, IL-4, IL-10, neopterina y CD-30 en pacientes tratados con interferón / Time evolution of TNF-alpha, VCAM-1, IL-4, IL-10, neopterin and CD-30 in patients treated with interferon

Introducción. El interferón (IFN) disminuye los brotes de la esclerosis múltiple (EM) y enlentece su evolución. El seguimiento de los enfermos se realiza empleando parámetros clínicos y de resonancia, al no disponer de marcadores biológicos que permitan conocer su eficacia. Objetivos. 1. Conocer el efecto del IFN sobre la concentración sérica de TNF-a, IL-4, IL-10, VCAM-1, neopterina y CD-30 en pacientes con EM; 2. Conocer la evolución temporal de esas modificaciones, y 3. Conocer la utilidad clínica de su determinación aislada. Pacientes y métodos. Estudiamos 19 pacientes con EM clínicamente estables y en tratamiento con IFN. Las muestras se obtuvieron cada tres meses durante dos años y medio, siempre inmediatamente antes de inyectar el fármaco. Las interleucinas se determinaron mediante el método ELISA. Resultados. Las concentraciones séricas de neopterina, CD-30 y VCAM-1 no se modificaron, el TNF-a sufrió oscilaciones independientes del estado clínico del enfermo y la IL-4 y la IL-10 tuvieron un pico sérico significativo a los 9-12 meses del tratamiento. Conclusiones. La existencia de un pico significativo de IL-4 e IL-10 entre los 6 y los 12 meses del tratamiento indica que el IFN consigue su posible efecto inmunomodulador después de varios meses, por lo que una mala respuesta clínica inicial no debe ser motivo de suspensión del fármaco. La determinación puntual de las concentraciones séricas de IL no es útil en el seguimiento de los pacientes tratados con IFN (AU)

Introduction. Interferon (IFN) diminishes the outbreaks of multiple sclerosis (MS) and slows down its progression. Follow-up of patients is performed using clinical and resonance imaging parameters, and no biological markers are available that allow us to determine its efficiency. Aims. 1. To discover the effects of IFN on the serum levels of TNF-alpha, IL-4, IL-10, VCAM-1, neopterin and CD-30 in patients with MS; 2. To determine how these modifications evolve over time; 3. To find out the clinical value of its determination in isolation. Patients and methods. We studied 19 patients with MS who were clinically stable and undergoing IFN therapy. Samples were obtained every 3 months over a 2.5 year period and always immediately before injecting the drug. The ELISA method was used to determine interleukins. Results. Serum levels of neopterin, CD-30 and VCAM-1 were not modified, TNF-alpha levels oscillated regardless of the clinical status of the patient and IL-4 and IL-10 had a significant serum peak at 9-12 months after beginning treatment. Conclusions. The existence of a significant IL-4 and IL-10 peak between 6 and 12 months of therapy indicates that IFN reaches its possible immunomodulatory effect after several months and, therefore, a poor initial clinical response must not be a reason for discontinuing medication. The specific determination of the serum levels of IL is not useful in following up patients treated with IFN (AU)

[Time evolution of TNF-alpha, VCAM-1, IL-4, IL-10, neopterin and CD-30 in patients treated with interferon]. / Evolución temporal de TNF-a, VCAM-1, IL-4, IL-10, neopterina y CD-30 en pacientes tratados con interferón.

INTRODUCTION: Interferon (IFN) diminishes the outbreaks of multiple sclerosis (MS) and slows down its progression. Follow-up of patients is performed using clinical and resonance imaging parameters, and no biological markers are available that allow us to determine its efficiency. AIMS: 1. To discover the effects of IFN on the serum levels of TNF-alpha, IL-4, IL-10, VCAM-1, neopterin and CD-30 in patients with MS; 2. To determine how these modifications evolve over time; 3. To find out the clinical value of its determination in isolation. PATIENTS AND METHODS: We studied 19 patients with MS who were clinically stable and undergoing IFN therapy. Samples were obtained every 3 months over a 2.5 year period and always immediately before injecting the drug. The ELISA method was used to determine interleukins. RESULTS: Serum levels of neopterin, CD-30 and VCAM-1 were not modified, TNF-alpha levels oscillated regardless of the clinical status of the patient and IL-4 and IL-10 had a significant serum peak at 9-12 months after beginning treatment. CONCLUSIONS: The existence of a significant IL-4 and IL-10 peak between 6 and 12 months of therapy indicates that IFN reaches its possible immunomodulatory effect after several months and, therefore, a poor initial clinical response must not be a reason for discontinuing medication. The specific determination of the serum levels of IL is not useful in following up patients treated with IFN.

Ausencia de ADN de herpesvirus humano 6 en LCR, mediante técnica de PCR anidada, en pacientes con esclerosis múltiple / Lack of human herpesvirus type 6 DNA in CSF by nested PCR among patients with multiple sclerosis

Antecedentes. Hasta la actualidad se desconoce la etiología de la esclerosis múltiple (EM) habiéndose intentado imputar algunos virus, hasta ahora sin éxito, como agentes desencadenantes de la respuesta autoinmune que conlleva a las placas de desmielinización. Existe controversia acerca del papel que puede desempeñar el herpesvirus humano tipo 6 (HVH-6), habiéndose detectado aumento de los títulos serológicos, amplificación del ADN del virus en sangre y líquido cefalorraquídeo (LCR) mediante técnica de reacción en cadena de la polimerasa (PCR), así como su presencia por métodos de inmunohistoquímica en muestras histológicas de sustancia blanca procedente de pacientes con EM. Todo esto ha llevado a algunos autores a imputar a este virus como agente etiológico desencadenante de esta enfermedad. Pacientes y métodos. Se estudia el LCR de 23 pacientes con esclerosis múltiple recurrente-remitente. Se utilizan como controles el LCR procedente de 23 pacientes a los que se les había practicado punción lumbar para realizar raquianestesia, sin presentar ninguno de ellos patología neurológica. En las muestras recogidas se realiza PCR anidada para detectar secuencias de ADN de HVH-6.Resultados. No se ha detectado amplificación de ADN de HVH-6, virus de Epstein-Barr (VEB), virus varicela zóster (VVZ), citomegalovirus (CMV), ni virus del herpes simple (VHS) en ninguna de las muestras estudiadas. Conclusiones. No hemos detectado en LCR de pacientes con EM la presencia de ADN de HVH-6, por lo que creemos que métodos distintos al utilizado por nosotros son imprescindibles para aclarar el papel de este virus en la patogenia de la enfermedad (AU)

[Lack of human herpesvirus type 6 DNA in CSF by nested PCR among patients with multiple sclerosis]. / Ausencia de ADN de herpesvirus humano 6 en LCR, mediante técnica de PCR anidada, en pacientes con esclerosis múltiple.

BACKGROUND: The etiology of multiple sclerosis (MS) is currently unknown. Different viruses have tentatively been involved as causative agents of MS that would trigger an autoimmune response leading to demyelination plaques. There is controversy regarding the role that the human herpesvirus 6 (HHV-6) might play in this condition, and high antibody titers have been detected to HHV-6. HHV-6 DNA has also been detected by PCR both in blood and cerebrospinal fluid by means of the Polymerase Chain Reaction (PCR). Immunohistochemistry studies were performed with histologic specimens from the white matters of patientes with MS. All this has led some authors to incriminate this virus as the triggering etiologic agent of this disease. PATIENTS AND METHODS: CSF specimens from 23 patients with Relapsing-Remitting MS were studied. The CSF specimens from 23 patients undergoing rachianesthesia were used as controls, and none of them had neurologic disorders. A nested PCR was performed in the collected specimens to detect specific DNA sequences of HHV-6. RESULTS: No DNA sequences of HHV-6, EBV, VZV, CMV and HSV were detected in the tested specimens. CONCLUSIONS: No HHV-6 DNA sequences were detected from CSF specimens of patients with MS. Further investigations on the association between HHV-6 and MS should be performed to elucidate the role of HHV-6 in the pathogenesis of this disease.