LGI1-antibody associated epilepsy successfully treated in the outpatient setting.

We report six patients with anti-LGI1 associated epilepsy. Two patients presented with new-onset generalized tonic-clonic seizures, four developed faciobrachial dystonic seizures and two piloerection. All patients had significant cognitive complaints at the time of diagnosis. All patients described seizure reduction during the first week of carbamazepine, and seizure freedom was obtained at a median of 13 days (range 7-22), sustained after the initiation of immunosuppression. Median time from symptom onset to carbamazepine initiation was 164 days (range 38-206 days). We discuss the particular seizure response to sodium channel blocking antiepileptic drugs, alone or associated with immunosuppression in this antibody mediated seizures.

Biomechanical and functional effects of shoulder kinesio taping® on cerebral palsy children interacting with virtual objects.

The reaching of objects is usually practiced by CP children in conventional or Virtual Reality-based therapies to enhance motor skill performance. Recently, Kinesio Taping® method has been studied to increase mechanical stability and improve functional movement of the upper limb; however, its influence on CP children´s upper limb motion has been rarely quantified due to lack of sensory measurement. Therefore, in this paper, we evaluate the biomechanical and functional effects of applying shoulder Kinesio Taping® on CP children in the reaching-transporting of virtual objects, by using a low-cost tracking device, exact robust differentiation of data and a simple nonlinear biomechanical dynamic model of the trunk and arm.

Efecto inmediato del vendaje neuromuscular aplicado en tronco para disminuir la espasticidad en extremidades superiores e inferiores en niños con parálisis cerebral nivel V conforme al sistema de clasificación de la función motora gruesa / Immediate effect of neuromuscular bandage applied on trunk to reduce spasticity in upper and lower limbs in children with cerebral palsy

Objetivo: Evaluar el efecto inmediato de la aplicación del vendaje neuromuscular en el tronco para disminuir la espasticidad en las extremidades superiores e inferiores en niños con parálisis cerebral GMFS V. Diseño: Se llevó a cabo un estudio prospectivo, comparativo, de enfoque ensayo clínico, tipo cuasiexperimental, con mediciones pretest-postest, donde se estudió a 21 pacientes con parálisis cerebral GMFS V. La espasticidad se evaluó con la escala de Ashworth modificada para miembros superiores e inferiores, escala del tono aductor bilateral de caderas y mediciones goniométricas de los ángulos de flexión, extensión y abducción de caderas, flexión y extensión de rodillas, dorsiflexión y flexión plantar de tobillos, flexión, extensión y abducción de hombros, flexión y extensión de codos, todas las anteriores tomadas por el médico especialista en rehabilitación pediátrica. Para el análisis estadístico se utilizó la prueba no paramétrica de Wilcoxon para muestras apareadas, previa comprobación de la distribución de los datos, con el paquete estadístico SPSS versión 17.0, tomando un valor de p ≤ 0,05 como estadísticamente significativo. Resultados: La disminución obtenida en la espasticidad de las 4 extremidades, como la disminución del tono muscular de los aductores de caderas y el aumento en los rangos de flexión, extensión y abducción de caderas y hombros, en la flexión, extensión de rodillas y tobillos, fue estadísticamente significativa, p < 0.05, y clínicamente relevante en una sesión de aplicación del vendaje neuromuscular. Conclusiones: El vendaje neuromuscular aplicado en el tronco es un método efectivo para disminuir la espasticidad

Objective: To evaluate the immediate effect of the application of neuromuscular bandage on trunk to reduce spasticity in upper and lower limbs in children with cerebral palsy GMFS V. Design: We performed a prospective comparative study, clinical testing approach, quasi-experimental with measures pre test-post test, where 21 patients with cerebral palsy GMFS V were studied. Spasticity was assessed with the modified Ashworth scale for upper and lower limbs, bilateral adductor tone scale hips and goniometric measurements of the angles of flexion, extension and hip abduction, knee flexion and extension, dorsiflexion and plantar flexion ankles, flexion, extension and shoulder abduction, elbow flexion and extension, all of the above made by the specialist physician in pediatric rehabilitation. For statistical analysis nonparametric Wilcoxon test was used for paired samples, after verification of the distribution of the data using SPSS version 17.0, considering a P value ≤.05 as statistically significant. Results: The obtained reduction in spasticity in all four limbs, decreased muscle tone hip adductors and increased ranges of flexion, extension and abduction of the hips and shoulders, bending, knee extension and ankle was statistically significant, P<.05 and clinically relevant in an application session of neuromuscular bandage. Conclusions: The neuromuscular bandage applied on the trunk is an effective method to reduce spasticity

[Prevalence of multiple sclerosis in Ecuador]. / Prevalencia de esclerosis múltiple en Ecuador.

INTRODUCTION: Multiple sclerosis (MS) is less frequent in areas near to the Equator, while the incidence and prevalence rises with increasing distance from this particular area, determining a clear north to south gradient. During the last decade several published reports provide recent data on the prevalence in Latin America. The main objective of this article is to report prevalence data in the three largest cities of Ecuador, a South American Country located on Latitude zero North-South. METHODS: In order to determine the prevalence and other epidemiological variables we conducted a cross-sectional, observational study in the three largest cities of Ecuador. Based on capture and recapture methodology we identified patients with MS who received medical care in the 12 state and private hospitals and in the Ecuadorian Foundation of Multiple Sclerosis (FUNDEM-Quito). The main inclusion criteria to determine the diagnosis of MS was based on the criteria proposed by Poser. For the relative and absolute frequencies calculation, as well as the 95% confidence interval, the EpiInfo 6.01 and EpiDat 3.1. programs were used. RESULTS: A total of 159 patients were identified in the three largest cities included in the study. In Quito, the capital city: 5.05/100,000 inhabitants (95% CI, 4.03-6.03), Guayaquil, on the coast: 2.26/100,000 inhabitants (95% CI, 1.62-2.91) and Cuenca in the south: 0.75/100,000 inhabitants (95% CI, 0.024-0.175). CONCLUSIONS: Ecuador is a low prevalence country although we believe it is possible that the number of MS cases is underestimated since this is not a population based study. We believe that more studies should be carried out on general populations where the disease has been seldom reported or as non-existent. Important exogenous factors may be involved in the pathogenesis of MS in Ecuador.

Prevalencia de esclerosis múltiple en Ecuador / Prevalence of multiple sclerosis in Ecuador

Introducción: La esclerosis múltiple (EM) es menos frecuente en las áreas cercanas a la línea ecuatorial, mientras que la incidencia y la prevalencia aumentan conforme se alejan de estas áreas, creando un gradiente norte-sur bien definido. Reportes publicados en la última década proveen datos recientes de la prevalencia en Latinoamérica. El objetivo de este artículo es comunicar las cifras de prevalencia en las tres ciudades más importantes del Ecuador, país localizado en la misma línea ecuatorial latitud N0-S0. Métodos: Se realizó un estudio observacional transversal en un determinado periodo con el fin de determinar la prevalencia y otras características epidemiológicas de la EM en 12 hospitales de tercer nivel en las tres ciudades principales de Ecuador. Basados en el método captura y recaptura y utilizando una encuesta, se procedió a identificar los pacientes con EM que cumplen los criterios señalados por Poser y que acuden a los principales hospitales estatales, privados y a la Fundación Ecuatoriana de Esclerosis Múltiple (FUNDEM-Quito). Para el cálculo de frecuencias absolutas y relativas, comparación de porcentajes e intervalos de confianza (IC) del 95% se utilizaron los programas EpiInfo 6.01 y EpiDat 3.1. Resultados: Se identificó a 159 pacientes en las ciudades donde se llevó a cabo el estudio. Quito, la ciudad capital, 5,05/100.000 habitantes (IC del 95%, 4,03-6,03); Guayaquil, en la costa, 2,26/100.000 habitantes (IC del 95%, 1,62-2,91); Cuenca, en el sur, 0,75/100.000 habitantes (IC del 95%, 0,024-0,175). Conclusiones: Ecuador es un país de baja prevalencia, aunque creemos que hay un subregistro importante del número de pacientes, ya que éste no es un estudio poblacional. Creemos que se deben realizar estudios de prevalencia en poblaciones abiertas y en áreas en que la enfermedad es rara o inexistente. Importantes factores exógenos parecen estar involucrados en la patogénesis de la EM en Ecuador (AU)

Introduction: Multiple sclerosis (MS) is less frequent in areas near to the Equator, while the incidence and prevalence rises with increasing distance from this particular area, determining a clear north to south gradient. During the last decade several published reports provide recent data on the prevalence in Latin America. The main objective of this article is to report prevalence data in the three largest cities of Ecuador, a South American Country located on Latitude zero North-South. Methods: In order to determine the prevalence and other epidemiological variables we conducted a cross-sectional, observational study in the three largest cities of Ecuador. Based on capture and recapture methodology we identified patients with MS who received medical care in the 12 state and private hospitals and in the Ecuadorian Foundation of Multiple Sclerosis (FUNDEM-Quito). The main inclusion criteria to determine the diagnosis of MS was based on the criteria proposed by Poser. For the relative and absolute frequencies calculation, as well as the 95% confidence interval, the EpiInfo 6.01 and EpiDat 3.1. programs were used.Results: A total of 159 patients were identified in the three largest cities included in the study. In Quito, the capital city: 5.05/100,000 inhabitants (95% CI, 4.03-6.03), Guayaquil, on the coast: 2.26/100,000 inhabitants (95% CI, 1.62-2.91) and Cuenca in the south: 0.75/100,000 inhabitants (95% CI, 0.024-0.175). Conclusions: Ecuador is a low prevalence country although we believe it is possible that the number of MS cases is underestimated since this is not a population based study. We believe that more studies should be carried out on general populations where the disease has been seldom reported or as non-existent. Important exogenous factors may be involved in the pathogenesis of MS in Ecuador (AU)

Stroke in rural Ecuador: a three-phase, door-to-door survey.

The authors carried out a three-phase door-to-door survey in Atahualpa, Ecuador to assess epidemiologic and pathogenetic mechanisms of stroke. They found 10 stroke patients among 1,568 individuals aged > or =15 years (crude prevalence, 638 per 100,000). There was only one incident case (incidence, 64 per 100,000). Six of the 10 patients had hypertensive arteriolopathy (five with ischemic and one with hemorrhagic stroke). Additional work is needed to increase knowledge on stroke in developing countries.

[Validation of a screening questionnaire for stroke detection in Spanish-speaking communities]. / Validación de un cuestionario para detección de ictus en poblaciones hispanoparlantes.

OBJECTIVE: To evaluate the accuracy of an screening questionnaire for stroke detection in speaking-speaking communities. PATIENTS AND METHODS: We performed a door-to-door survey in Atahualpa (a rural community in coastal Ecuador) using a modified version of the Spanish translation of the OMS questionnaire for stroke detection. Subjects suspected of having a stroke as well as a 2% sample of negative subjects were evaluated by neurologists to evaluate sensitivity, specificity, and predictive value of the questionnaire and that of each of its questions. RESULTS: We found 18 possible cases among 1,568 individuals around 15 years old. Of these, 10 were confirmed stroke patients and 8 were false-positive (crude stroke prevalence of 6.38 per 1,000). We did not find false-negative cases. Sensitivity of the questionnaire was 100%, specificity was 99.5%, positive predictive value was 0.55 and negative predictive value was 1. The accuracy of each question as well as the number of questions answered as affirmative were different between patients and false-positive cases. CONCLUSIONS: The current questionnaire is highly sensitive but its positive predictive value is poor. This causes problems in large-scale studies, as the detection of many false-positives may compromise its viability. We propose a modification of the questionnaire that will turn it more accurate.

Validación de un cuestionario para la detección del ictus en poblaciones hispanoparlantes / Validation of a screening questionnaire for stroke detection in Spanish-speaking communities

Objetivo. Evaluar la fiabilidad de un cuestionario para la detección del ictus en comunidades hispanoparlantes. Pacientes y métodos. Realizamos un estudio puerta a puerta en Atahualpa -población rural del litoral ecuatoriano- empleando una versión modificada de la traducción al español del cuestionario de la OMS para la detección del ictus. Los casos sospechosos, así como el 2 por ciento de los no sospechosos, fueron examinados examinados por neurólogos para valorar la sensibilidad, la especificidad y el valor predictivo del cuestionario y de cada una de sus preguntas. Resultados. Encontramos 18 sospechosos entre 1.568 individuos de más de 15 años de edad. De éstos, 10 se confirmaron -prevalencia realista de ictus de 6,38 por 1.000- y ocho fueron falsos positivos. No se encontraron falsos negativos entre los no sospechosos. La sensibilidad del cuestionario fue del 100 por ciento, su especificidad, del 99,5 por ciento, su valor predictivo positivo fue 0,55 y su valor predictivo negativo, 1.La confiabilidad de cada pregunta, así como el número de preguntas respondidas afirmativamente, fue diferente entre los pacientes y los falsos positivos. Conclusiones. El cuestionario utilizado es altamente sensible, pero su valor predictivo positivo es relativamente bajo. Esto causa problemas en estudios a gran escala, ya que la detección de muchos falsos positivos puede afectar su viabilidad. Sugerimos una modificación, que volverá al cuestionario más confiable (AU)

Objective. To evaluate the accuracy of an screening questionnaire for stroke detection in speaking-speaking communities. Patients and methods. We performed a door-to-door survey in Atahualpa (a rural community in coastal Ecuador) using a modified version of the Spanish translation of the WHO questionnaire for stroke detection. Subjects suspected of having a stroke as well as a 2% sample of negative subjects were evaluated by neurologists to evaluate sensitivity, specificity, and predictive value of the questionnaire and that of each of its questions. Results. We found 18 possible cases among 1,568 individuals ≥ 15 years old. Of these, 10 were confirmed stroke patients and 8 were false-positive (crude stroke prevalence of 6.38 per 1,000). We did not find false-negative cases. Sensitivity of the questionnaire was 100%, specificity was 99.5%, positive predictive value was 0.55 and negative predictive value was 1. The accuracy of each question as well as the number of questions answered as affirmative were different between patients and false-positive cases. Conclusions. The current questionnaire is highly sensitive but its positive predictive value is poor. This causes problems in large-scale studies, as the detection of many false-positives may compromise its viability. We propose a modification of the questionnaire that will turn it more accurate (AU)

Relapses in the Guillain-Barré syndrome after treatment with intravenous immune globulin or plasma exchange.

To clarify the question of whether Guillain-Barré syndrome (GBS) patients treated with intravenous immune globulin (i.v.IG) relapse at a higher frequency than those treated with plasma exchange (PE), 54 patients with GBS were studied retrospectively. A higher frequency of relapses was noted in the PE-treated patients than in those receiving i.v.IG. The presence of an associated medical condition correlated with an increased risk of relapses, while earlier onset of treatment resulted in a decrease of relapses of GBS. This study found no support for prior suggestions of increased relapses in patients with GBS treated with i.v.IG as opposed to those treated with PE.

Epilepsy due to neurocysticercosis: analysis of 203 patients.

We reviewed clinical, EEG, and CT findings of 203 patients with epilepsy due to neurocysticercosis. Seizures were generalized in 121 patients and partial in 82. Thirty-two patients had focal signs and eight had papilledema. Eighty-one had generalized and 16 had focal EEG abnormalities. CT showed parenchymal brain calcifications in 53 patients and cysts in 150. There was an increased rate of focal signs in patients with single cysts as compared with patients with multiple cysts, and focal EEG abnormalities were present only in patients with single cysts. Fifty patients were lost to follow-up. The remaining 153 patients were followed for 28 +/- 6 months; of these, 31 had calcifications and 122 had cysts. Anticonvulsants were started after the first visit in every patient. The 31 patients with calcifications remained free of seizures. Ninety-five of the 122 patients with cysts were also treated with anticysticercal drugs; of these, 79 (83%) had control of seizures. In contrast, only seven (26%) of 27 patients who did not receive anticysticercal drugs had control of seizures, indicating a strong correlation between the use of anticysticercal drugs and seizure control. Finally, of the 21 patients in whom anticonvulsants were withdrawn, 16 had relapses.

Composición química y calidad biológica de harina desgrasada de avellana / Chemical composition and biological quality of defatted hazelnut flour

Se proporcionan los resultados de la composición química y calidad biológica de la harina desgrasada de avellana. Las muestras analizadas contenían cantidades significativas de proteínas (19%), comparables a las de harina de leguminosas, mayores que las de cereales y menores que las de tortas de oleaginosas. El aceite extraído de la semilla se analizó, obteniéndose los resultados promedio siguientes. Indice de refracción, 1.47; saponificación No. 184.8; yodo, No. 85,0. La composición promedio de los ácidos grasos obtenidos por cromatografía de gas líquido fue: Acido palmítico 2.3%; Acido palmitoleico 37.0%; Acido estéarico 0.5%; Acido oleico 39.5%; Acido linoleico 6.9%; Acido linolénico 1.1%; Acido eicosanoico 2.3%; Acido eicosaenoico 4.6%; Acido docosaenoico 3.4%; Acido tetraicosanoico 0.3%. Estos resultados indican un aceite de buena calidad debido debido a su bajo contenido de ácido linolénico. El valor nutritivo de la torta desgrasada, medido en ratas, dio una razón proteínica neta (RPN) de 3.58, inferior al valor correspondiente a la caseína (4.10). La digestibilidad proteínica verdadera medida en ratas, dio un valor de 73%, en comparación con 95% para caseína. Las cantidades de hierro y fósforo son, comparativamente, más bajas que las informadas para harina de raps y de maravilla