[Randomised controlled study of inter-hemispheric electroencephalographic coherence following assisted therapy with dolphins in children with autism spectrum disorders]. / Estudio aleatorizado controlado de la coherencia interhemisferica del electroencefalograma tras terapia asistida con delfines en niños con trastorno del espectro autista.

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with impairments in executive function, language, emotional function, and social function. Its anatomofunctional substrate is related to a disorganization of the brain's functional connections. The aim is to investigate the cerebral connections in subjects with ASD through the analysis of the interhemispheric coherence (IHC) of the quantified electroencephalogram and its changes after dolphin assisted therapy (DAT) versus therapeutical intervention without dolphins (TIWD). PATIENTS AND METHODS: The IHC was determined in 44 subjects with ASD before randomly assigning them to two therapeutic groups: DAT (n = 22) and TIWD (n = 22). The results were statistically analyzed through the multi-measure ANOVA test for within-subject (time) and between-subject (DAT vs TIWD) factors. RESULTS: The IHC showed a significant reduction (p < 0.05) for both groups in the delta, theta, beta, and alpha frequencies (p < 0.001) in the anterior frontal region (F3-F4), alpha in the central region (C3-C4) (p < 0.05), and alpha (p < 0.05) and beta (p < 0.001) in the temporal region (T3-T4). In the intersection with the specific treatment (DAT), the coherence in the alpha band increased in Fp1-Fp2 (p < 0.05), and the delta did not decline in F3-F4 (p < 0.05). CONCLUSION: In 5-year-old children with ASD, DAT increases the IHC in the anterior frontal region and stabilizes the tendency to reduce the delta band in the posterior frontal region.

TITLE: Estudio aleatorizado controlado de la coherencia interhemisferica del electroencefalograma tras terapia asistida con delfines en niños con trastorno del espectro autista.Introduccion. El trastorno del espectro autista (TEA) es un trastorno del neurodesarrollo asociado con trastornos de la funcion ejecutiva, el lenguaje, la funcion emocional y la funcion social, cuyo sustrato anatomofuncional se relaciona con una desorganizacion de las conexiones funcionales cerebrales. El objetivo es investigar las conexiones cerebrales en sujetos con TEA mediante analisis de la coherencia interhemisferica (CIH) del electroencefalograma cuantificado y sus cambios tras la terapia asistida con delfines (TAD) frente a la intervencion terapeutica sin delfines (ITSD). Pacientes y metodos. Se determino la CIH en 44 sujetos con TEA antes de asignarse aleatoriamente a dos grupos de tratamiento: TAD (n = 22) e ITSD (n = 22). Los resultados se analizaron estadisticamente mediante el test de la ANOVA multimedida para los factores intrasujeto (tiempo) e intersujeto (TAD frente a ITSD). Resultados. La CIH mostro una reduccion significativa (p < 0,05) para ambos grupos en las frecuencias delta, theta, beta y alfa (p < 0,001) en la region frontal anterior (F3-F4). Se hallo tambien una reduccion en la frecuencia alfa en la region central (C3-C4) (p < 0,05), y alfa (p < 0,05) y beta (p < 0,001) en la region temporal (T3-T4). En la interseccion con el tratamiento especifico (TAD), la coherencia en la banda alfa aumento en Fp1-Fp2 (p < 0,05) y no descendio la delta en F3-F4 (p < 0,05). Conclusion. En niños de 5 años con TEA, la TAD aumenta la CIH en la region frontal anterior y estabiliza la tendencia a la reduccion de la banda delta en la region frontal posterior.

[Methods for diagnosing seronegative myasthenia gravis]. / Métodos diagnósticos de la miastenia grave seronegativa.

INTRODUCTION: A peculiar feature of seronegative myasthenia gravis is that it presents negative acetylcholine-receptor antibodies; determination of muscle-specific receptor tyrosine kinase (MuSK) antibodies defines a subgroup of patients with generalised myasthenia gravis with certain clinical and neurophysiological peculiarities. DEVELOPMENT: Its diagnosis requires the presence of weakness with fatigability, determination of positive anti-MuSK antibodies and alterations in neurophysiological testing of the neuromuscular junction. It is usually more serious and has a poorer prognosis than the seropositive forms, develops in an acute or subacute manner, and the neurological deficit predominates in the facial, bulbar and respiratory muscles. CONCLUSIONS: Titration of the anti-MuSK antibodies and conducting neurophysiological tests, especially jitter assessment using single-fibre electromyography in clinically deficient muscles, are not only necessary for an early diagnosis of these clinical forms, but also so as to be able to carry out an objective evaluation of the clinical progression and response to treatment.

Métodos diagnósticos de la miastenia grave seronegativa / Methods for diagnosing seronegative myasthenia gravis

La miastenia grave generalizada seronegativa tiene la peculiaridad de presentar anticuerpos contrael receptor de la acetilcolina negativos; sin embargo, la determinación de anticuerpos contra el receptor de tirosincinasa muscular específica (MuSK) define un subgrupo de pacientes con miastenia grave generalizada con peculiaridades desde un punto de vista clínico y neurofisiológico. Desarrollo. Para su diagnóstico, es necesaria la presencia de debilidad con fatiga,determinación de anticuerpos anti-MuSK positivos y pruebas neurofisiológicas de placa neuromuscular alteradas. Suele ser clínicamente más grave y con peor pronóstico que las formas seropositivas, cursa de forma aguda o subaguda y el déficit neurológicopredomina en la musculatura facial, bulbar y respiratoria. Conclusión. La titulación de los anticuerpos anti-MuSK y la realización de pruebas neurofisiológicas, especialmente la valoración del jitter con electromiografía de fibra simple enmúsculos clínicamente deficitarios, no sólo son necesarias para el diagnóstico precoz de estas formas clínicas, sino también para valorar de forma objetiva la evolución clínica y la respuesta al tratamiento

A peculiar feature of seronegative myasthenia gravis is that it presents negative acetylcholine-receptorantibodies; determination of muscle-specific receptor tyrosine kinase (MuSK) antibodies defines a subgroup of patients with generalised myasthenia gravis with certain clinical and neurophysiological peculiarities. Development. Its diagnosis requires the presence of weakness with fatigability, determination of positive anti-MuSK antibodies and alterations in neurophysiological testing of the neuromuscular junction. It is usually more serious and has a poorer prognosis than the seropositive forms, develops in an acute or subacute manner, and the neurological deficit predominates in the facial, bulbar and respiratory muscles. Conclusions. Titration of the anti-MuSK antibodies and conducting neurophysiological tests, especially jitter assessment using single-fibre electromyography in clinically deficient muscles, are not only necessary for an early diagnosis of these clinical forms, but also so as to be able to carry out an objective evaluation of the clinical progression and response to treatment

[Zonisamide and neuropathic pain]. / Zonisamida y dolor neuropático.

INTRODUCTION: In neuropathic pain, as occurs in epilepsy, researchers are striving to find a drug capable of inhibiting the pain-generating ectopic discharges that are produced as a result of neuronal hyperexcitability. This is mediated by ionic exchanges across the channels of the synaptic membrane. This is why the drugs that act on the different types of channels involved in this transmission can regulate neuronal hyperexcitability and therefore have an effect on the pain. DEVELOPMENT: In recent years researchers have gained a deeper understanding of the mechanisms of action of antiepileptic drugs and, since the discovery of their action on one or several synaptic channels, the use of these agents to treat neuropathic pain has become increasingly common. Patients suffering from central pain are also beginning to benefit from the administration of these drugs, especially agents that have proved to be capable of acting with several mechanisms of action and on several channels at the same time. In addition, fewer and less severe side effects are produced, something that is fundamental if we bear in mind the characteristics of patients with central pain, most of whom are adults and elderly. This, together with the fact that there are fewer interactions with other drugs, has led to the new antiepileptic drugs' becoming the preferred medication for this pathology today. CONCLUSIONS: Zonisamide acts on several types of channels and it is known to have four different mechanisms of action, which means it can be effective in treating these patients, although further studies are required (above all randomised double-blind trials) in order to really evaluate the usefulness of these drugs in the treatment of neuropathic pain.

Zonisamida y dolor neuropático / Zonisamide and neuropathic pain

Como ocurre en la epilepsia, en el dolor neuropático se busca un fármaco capaz de inhibir las descargasectópicas generadoras del dolor que se producen a causa de una hiperexcitabilidad neuronal. Ésta se encuentra mediada por el intercambio iónico a través de los canales de la membrana sináptica. Por esta razón, los fármacos que actúen sobre los diferentes tipos de canales involucrados en dicha transmisión pueden regular la hiperexcitabilidad neuronal y, por tanto,actuar frente al dolor. Desarrollo. En los últimos años, tras tener un mejor conocimiento de los mecanismos de acción de los antiepilépticos y al descubrirse su acción sobre uno o varios canales sinápticos, su uso en dolor neuropático se ha ido extendiendo.El dolor central comienza ahora a beneficiarse del uso de estos fármacos, sobre todo de aquellos que han demostrado ser capaces de actuar con varios mecanismos de acción y sobre varios canales al mismo tiempo. Todo ello unido a la aparición de menos efectos adversos y de menor gravedad, hecho fundamental al tener en cuenta la naturaleza de los pacientes con dolor central, la mayoría adultos y ancianos, junto con el menor número de interacciones con otros fármacos, hace que los nuevos antiepilépticos sean en este momento los fármacos de elección en esta patología. Conclusión. La zonisamidaactúa sobre varios tipos de canales y se le conocen cuatro mecanismos de acción diferentes, por lo que puede ser eficaz en el tratamiento de estos pacientes, aunque se precisan estudios más extensos, sobre todo aleatorizados doble ciego, para evaluarrealmente la utilidad de estos fármacos en el tratamiento del dolor neuropático

In neuropathic pain, as occurs in epilepsy, researchers are striving to find a drug capable of inhibitingthe pain-generating ectopic discharges that are produced as a result of neuronal hyperexcitability. This is mediated by ionic exchanges across the channels of the synaptic membrane. This is why the drugs that act on the different types of channels involved in this transmission can regulate neuronal hyperexcitability and therefore have an effect on the pain. Development.In recent years researchers have gained a deeper understanding of the mechanisms of action of antiepileptic drugs and, since the discovery of their action on one or several synaptic channels, the use of these agents to treat neuropathic pain has becomeincreasingly common. Patients suffering from central pain are also beginning to benefit from the administration of these drugs, especially agents that have proved to be capable of acting with several mechanisms of action and on several channels at thesame time. In addition, fewer and less severe side effects are produced, something that is fundamental if we bear in mind the characteristics of patients with central pain, most of whom are adults and elderly. This, together with the fact that there are fewer interactions with other drugs, has led to the new antiepileptic drugs’ becoming the preferred medication for thispathology today. Conclusions. Zonisamide acts on several types of channels and it is known to have four different mechanisms of action, which means it can be effective in treating these patients, although further studies are required (above all randomised double-blind trials) in order to really evaluate the usefulness of these drugs in the treatment of neuropathic pain

Síndrome de piernas inquietas grave tras estimulación subtalámica bilateral para tratar una paciente con enfermedad de Parkinson / Severe restless legs syndrome following bilateral subthalamic

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Síndrome de Guillain-Barré que simula un ictus vertebrobasilar / Guillain-Barre syndrome mimicking a vertebrobasilar stroke

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[Encephalitis caused by Rickettsia conorii without exanthema]. / Encefalitis por Rickettsia conorii sin exantema.

INTRODUCTION: Mediterranean boutonneuse fever, caused by Rickettsia conorii, is an endemic disease in the Mediterranean area. The serious forms of the disease, which include encephalitis, are infrequent but are associated with a high mortality rate. Diagnostic suspicion is backed up by the development of exanthema. We report the case of a patient who developed encephalitis caused by Rickettsia conorii without exanthema. Clinical case. A 27 year old woman who had nauseas, headache, fever, abdominal upset and generalised pain during the days before being admitted to hospital. On the day she was admitted, she noticed reduced strength in the left limbs, together with numbness and pins and needles in the left side of the body. In the casualty department she presented tonic seizures in the left extremities and later generalised tonic clonic seizures. Exploration showed facial paresis and 4/5 hemiparesis on the left side. Complementary tests carried out in casualty, including cerebrospinal fluid (CSF), did not reveal any significant findings. She was admitted after a loading dose of phenytoin. After 48 hours she presented fever and repeated complex partial seizures. A new CSF analysis was normal. She was treated with valproate, clonazepam, ceftriaxone, doxycycline and acyclovir. An electroencephalogram (EEG) showed theta activity in the left centroparietal areas and slow delta waves in the right temporal regions. Magnetic resonance imaging (MRI) of the brain showed contrast enhancement in the meninges. 24 later, due to the frequency of the seizures, phenobarbital and methylprednisolone were added, which enabled the seizures to be controlled. The posterior brain MRI revealed a right parasylvian lesion. Serological Rickettsia conorii IgM +, IgG 1/256 was administered. After eight months, she has presented no seizures or neurological deficit. CONCLUSIONS: There are cases of encephalitis from Rickettsia conorii that can present without exanthema. This means that in endemic areas early treatment with doxycycline could be advisable when faced with encephalitis of unknown aetiology, bearing in mind the high mortality rate that occurs when no early treatment is administered and the good tolerance to doxycycline.

Encefalitis por Rickettsia conorii sin exantema / Encephalitis caused by Rickettsia conorii without exanthema

Introducción. La fiebre botonosa mediterránea, causada por Rickettsia conorii, es una enfermedad endémica en el área mediterránea. Las formas graves, entre las que se encuentra la encefalitis, son infrecuentes, pero se asocian a una elevada mortalidad. La sospecha diagnóstica se apoya en el desarrollo de exantema. Presentamos un paciente que desarrolló encefalitis por R. conorii sin exantema. Caso clínico. Mujer de 27 años que días antes del ingreso había presentado náuseas, cefalea, fiebre, malestar abdominal y dolor generalizado. El día del ingreso notó una disminución de la fuerza en las extremidades izquierdas, así como adormecimiento y hormigueos en el hemicuerpo izquierdo. En urgencias presentó crisis tónica en las extremidades izquierdas y posteriormente una crisis generalizada tonicoclónica. En la exploración mostró paresia facial y hemiparesia 4/5 izquierdas. Las pruebas complementarias que se realizaron en urgencias no mostraron hallazgos significativos, incluido el líquido cefalorraquídeo (LCR).Se le ingresó tras dosis de carga de fenitoína. Después de 48 horas presentó fiebre y crisis parciales complejas repetidas. Un nuevo análisis del LCR fue normal. Se trató con valproato, clonacepam, ceftriaxona, doxiciclina y aciclovir. Se realizó un electroencefalograma (EEG) con actividad theta en las áreas centroparietales izquierdas y ondas lentas delta temporales derechas. La imagen por resonancia magnética (IRM) cerebral mostró captación de contraste en las meninges. 24 horas después, ante la frecuencia de las crisis, se añadió fenobarbital y metilprednisolona, con lo que se controlaron las crisis. En la IRM cerebral posterior se detectó una lesión parasilviana derecha. Se recibió serología R. conorii IgM +, IgG 1/256. Después de ocho meses, no ha presentado crisis ni déficit neurológico. Conclusiones. Existen casos de encefalitis por R. conorii que pueden presentarse sin exantema, por lo que en áreas endémicas podría estar indicado el tratamiento precoz con doxiciclina ante una encefalitis de etiología no filiada, dada la elevada mortalidad que representa no tratar de forma precoz y dada la buena tolerancia a la doxiciclina (AU)