Lance-Adams Syndrome in the Intensive Care Unit: A Case Report.

Lance-Adams syndrome (LAS), or chronic post-hypoxic myoclonus, is a myoclonic disorder following acute cerebral hypoxia after successful cardiopulmonary resuscitation (CPR). LAS is distinct from acute post-hypoxic myoclonus (acute PHM), presenting with myoclonic jerks and cerebellar ataxia after regaining consciousness. However, the overlap at the onset complicates differentiation and may lead to the withdrawal of life-sustaining measures, especially in sedated ICU patients. The presented case involves a 77-year-old male diagnosed with LAS post-CPR. Despite the presence of early myoclonic jerks EEG, laboratory testing, and neuroimaging showed no definitive proof of irreversible neurological damage. Once diagnosed, treatment involved sequential antiseizure medications and physical therapy when the patient achieved full consciousness. However, the patient ultimately faced severe disabilities and was unable to recover. This case report emphasizes the importance of limiting sedation, comprehensive clinical examination, and the use of complementary tests when no definitive proof of irreversible neurological damage is present after acute cerebral hypoxia. While LAS has a better vital prognosis than acute PHM, it is associated with poor neurofunctional recovery and chronic disability in most cases. Further research is essential for evidence-based management.

Inherited SCN1A missense mutation in a Dravet Syndrome family: Neuropathological correlation, family screening and implications for adult carriers.

INTRODUCTION: Neuropathological findings in Dravet Syndrome (DS) are scarce, especially in adult patients, and often do not have a genetic confirmation. Additionally, the missense SCN1A pathogenic variant found has only been described as de novo mutation in previous literature. METHODS: We describe the clinical and genetic findings of a family (including three sisters and his father), using Sanger sequencing in the three sisters and in postmortem brain tissue in the father. The present study also shows the neuropathological findings of the father. RESULTS: Despite the presence of long term drug resistant epilepsy, starting with febrile seizures between 6 and 12 months of age, and intellectual disability (ID), the three sisters were diagnosed with DS in adulthood, identifying a missense SCN1A pathogenic variant in exon 20, previously described as de novo -p.Gly1332Glu (c .3995 G>A). The oldest sister had the most severe phenotype, with severe ID and wheel chair dependency, passing away at 52. The other two sisters had a moderate phenotype, being at the present seizure free, but with significant comorbidities, such as crouch gait and parkinsonism. Several relatives from the paternal path (including the father) presented epilepsy, but without ID. The father was diagnosed with Alzheimer´s Disease (AD) at 60, and because he donated his brain, the same variant was confirmed in postmortem study. Neither the MRI nor the histopathology showed specific morphological changes for DS, consistent with previous studies. CONCLUSIONS: This work supports the need to review the clinical and genetic spectra of DS in adults with epilepsy and unknown ID. The clinical consequences of this syndrome seem to have a functional rather than a structural basis, supported by the absence of specific neuropathological findings.

Seizures in children undergoing stem cell transplantation.

BACKGROUND: Neurological complications (NCs) are of major concern following hematological stem cell transplantation (HSCT), most of which present with seizures. PROCEDURES: We performed a retrospective study (2002-2018) of patients undergoing HSCT in order to analyze the incidence and aetiologies related to seizures. RESULTS: Of 155 children undergoing HSCT, 27 (17.4%) developed seizures at some point in 2 years of follow-up. The most frequent etiologies were central nervous system (CNS) infection (n = 10), drug toxicity (n = 8), and vascular disease (n = 5). A statistically significant association was found between seizure and the HSCT type (lower risk for a related identical donor, p = .010), prophylactic or therapeutic mycophenolate use (p = .043 and .046, respectively), steroid use (p = .023), selective CD45RA+ depletion (p = .002), pre-engraftment syndrome (p = .007), and chronic graft-versus-host disease (GVHD) severity (p = .030). Seizures predicted evolution to life-threatening complications and admission to intensive care (p < .001) and higher mortality (p = .023). A statistically significant association was also found between seizures and sequelae in survivors (p = .029). Children who developed seizures had a higher risk of CNS infection and vascular disease (odds ratio 37.25 [95% CI: 7.45-186.05] and 12.95 [95% CI 2.24-74.80], respectively). CONCLUSIONS: Neurological complications highly impact survival and outcomes and need to be addressed when facing an HSCT procedure.

Altered Vergence Eye Movements and Pupil Response of Patients with Alzheimer's Disease and Mild Cognitive Impairment During an Oddball Task.

BACKGROUND: Alzheimer's disease (AD) is characterized by progressive deterioration of cognitive functions and may be preceded by mild cognitive impairment (MCI). Evidence shows changes in pupil and vergence responses related to cognitive processing of visual information. OBJECTIVE: Here we test the hypothesis that MCI and AD are associated with specific patterns in vergence and pupil responses. METHODS: We employed a visual oddball task. In the distractor condition (80%of the trials), a blue stimulus was presented whereas in the target condition (20%of trials) it was red. Participants (23 Controls, 33 MCI patients, and 18 AD patients) were instructed to press a button when a target appeared. RESULTS: Participants briefly converged their eyes 200 ms after stimulus presentation. In controls, this transient peak response was followed by a delay response to targets but not to distractor stimuli. In the patient groups, delay responses to distractors were noticed. Consequently, the differential vergence response was strong in the control group, weak in the MCI group, and absent in the AD group. Pupils started to dilate 500-600 ms after the appearance of a target but slightly contracted after the presentation of a distractor. This differential pupil response was strongest in the AD group. CONCLUSION: Our findings support the idea of a role of vergence and pupil responses in attention and reveal altered responses in MCI and AD patients. Further studies should assess the value of vergence and pupil measurements as an objective support tool for early diagnosis of AD.

External trigeminal nerve stimulation: A long term follow up study.

PURPOSE: External trigeminal nerve stimulation is an emerging noninvasive therapy for drug resistant epilepsy (DRE). The aim of this study is to describe the long-term outcome of a series of patients treated with eTNS. METHODS: We present a retrospective observational study of patients with DRE who received eTNS treatment, comparing the monthly seizure frequency during the 3-months period before eTNS initiation with the monthly seizure frequency at 6, 12, 24, 36 and 48 months after eTNS. We analyze the responder rate, the retention rate and the tolerability. RESULTS: 17 patients with highly drug-resistant epilepsy were included. Mean follow-up was 2194 [6-56] months. The responder rate was 35% at 6 months and 12 months, 23% at 24 months, 19% at 36 months, and 14% at 48 months. Retention rates at the same periods were 88%, 53%, 41%, 37.5% and 28.5%. There were no reports of serious adverse events. Four patients reported improvement in sleep and better mood. CONCLUSION: The effectivity of eTNS is similar to some of the new treatments available, with a retention rate of 52% in the first year and 285% at 4 years. Tolerability is excellent with only mild effects reported by a minority of patients.

Functional surgery in pediatric drug-resistant posterior cortex epilepsy: Electro-clinical findings, cognitive and seizure outcome.

PURPOSE: Epilepsies originated from the occipital, parietal and/or the posterior edge of the temporal lobe are grouped together into posterior cortex epilepsy (PCE). Our objective was firstly to describe electro-clinical and imaging findings in the presurgical evaluation of children with PCE, and secondly to identify potential factors associated with surgical and cognitive outcomes. METHOD: From the total of patients referred to the Epilepsy Monitoring Unit of 'Hospital Universitario Niño Jesús' from 2003 to 2016, 55 had drug-resistant PCE. Different variables obtained from the multimodal presurgical work-up were analyzed among patients achieving seizure freedom after surgery (ILAE class 1) and patients with persistent seizures. Categorical variables were compared with Fishers exact test and numeric variables with t-Student for independent samples, and multiple logistic regression were used to analyze predictive values. RESULTS: Median duration of epilepsy until surgery was 5 years [3-10 years]. Fifty patients showed lesions in the MRI, and 62.5% had concordant MRI-PET corregistration. 37 (67%) patients were operated (lesionectomy in 21 subjects, tailored resection based on intracranial studies in 16), and 23 (62,2%) reached ILAE class 1, with a mean follow-up period of 3.51 [1-12] years. A lower number of basal seizures and antiepileptic drugs, a well-defined lesion on the MRI, an epileptogenic zone (EZ) restricted to the posterior quadrant and the normalization of postsurgical EEGs were associated with seizure freedom (p<0.05). Additionally, 65% of patients had a long-term improvement of cognitive performances. CONCLUSIONS: Epilepsy surgery should be considered in children with drug-resistant PCE, especially in those with a restricted EZ.

Regional Cerebral Blood Flow in Mild Cognitive Impairment and Alzheimer's Disease Measured with Arterial Spin Labeling Magnetic Resonance Imaging.

Alzheimer's disease (AD) depicts dynamic changes in regional brain function from early stages of the disease. Arterial spin labeling- (ASL-) based MRI methods have been applied for detecting regional cerebral blood flow (rCBF) perfusion changes in patients with AD and mild cognitive impairment (MCI). Nevertheless, the results obtained from ASL studies in AD and MCI are still controversial, since rCBF maps may show both hypoperfusion or hyperperfusion areas in brain structures involved in different cognitive functions. The goal of this review is to provide the current state of the art regarding the role of ASL for detecting distinctive perfusion patterns in subjects with MCI and/or AD. The ability to obtain this information using a noninvasive and widely available modality such as ASL should greatly enhance the knowledge into the broad range of hemodynamically related changes taking place during the cognitive decline process in AD.

Radiofrecuencia pulsada en el tratamiento de la epicondilitis / Pulsed radiofrequency in the treatment of epicondylitis

No disponible

Accuracy of arterial spin labeling magnetic resonance imaging (MRI) perfusion in detecting the epileptogenic zone in patients with drug-resistant neocortical epilepsy: comparison with electrophysiological data, structural MRI, SISCOM and FDG-PET.

BACKGROUND AND PURPOSE: Locating the epileptogenic zone (EZ) in patients with neocortical epilepsy presents major challenges. Our aim was to assess the accuracy of arterial spin labeling (ASL), an emerging non-invasive magnetic resonance imaging (MRI) perfusion technique, to locate the EZ in patients with drug-resistant neocortical epilepsy. METHODS: Twenty-five consecutive patients with neocortical epilepsy referred to our epilepsy unit for pre-surgical evaluation underwent a standardized assessment including video-electroencephalography (EEG) monitoring, structural MRI, subtraction ictal single-photon emission computed tomography co-registered to MRI (SISCOM) and fluorodeoxyglucose positron emission tomography (FDG-PET) studies. An ASL sequence was included in the MRI studies. Areas of hypoperfusion or hyperperfusion on ASL were classified into 15 anatomic-functional cortical regions; these regional cerebral blood flow maps were compared with the EZ determined by the other tests and the strength of concordance was assessed with the kappa coefficient. RESULTS: Of the 25 patients [16 (64%) women; mean age 32.4 (±13.8) years], 18 (72%) had lesions on structural MRI. ASL abnormalities were seen in 15 (60%) patients (nine hypoperfusion, six hyperperfusion). ASL had a very good concordance with FDG-PET (k = 0.84), a good concordance with structural MRI (k = 0.76), a moderate concordance with video-EEG monitoring (k = 0.53) and a fair concordance with SISCOM (k = 0.28). CONCLUSION: Arterial spin labeling might help to confirm the location and extent of the EZ in the pre-surgical workup of patients with drug-resistant neocortical epilepsy.

Seizure detection with automated EEG analysis: a validation study focusing on periodic patterns.

OBJECTIVE: To evaluate an automated seizure detection (ASD) algorithm in EEGs with periodic and other challenging patterns. METHODS: Selected EEGs recorded in patients over 1year old were classified into four groups: A. Periodic lateralized epileptiform discharges (PLEDs) with intermixed electrical seizures. B. PLEDs without seizures. C. Electrical seizures and no PLEDs. D. No PLEDs or seizures. Recordings were analyzed by the Persyst P12 software, and compared to the raw EEG, interpreted by two experienced neurophysiologists; Positive percent agreement (PPA) and false-positive rates/hour (FPR) were calculated. RESULTS: We assessed 98 recordings (Group A=21 patients; B=29, C=17, D=31). Total duration was 82.7h (median: 1h); containing 268 seizures. The software detected 204 (=76.1%) seizures; all ictal events were captured in 29/38 (76.3%) patients; in only in 3 (7.7%) no seizures were detected. Median PPA was 100% (range 0-100; interquartile range 50-100), and the median FPR 0/h (range 0-75.8; interquartile range 0-4.5); however, lower performances were seen in the groups containing periodic discharges. CONCLUSION: This analysis provides data regarding the yield of the ASD in a particularly difficult subset of EEG recordings, showing that periodic discharges may bias the results. SIGNIFICANCE: Ongoing refinements in this technique might enhance its utility and lead to a more extensive application.

Statins are associated with decreased mortality risk after status epilepticus.

BACKGROUND AND PURPOSE: Statins display anti-inflammatory and anti-epileptogenic properties in animal models, and may reduce the epilepsy risk in elderly humans; however, a possible modulating role on outcome in patients with status epilepticus (SE) has not been assessed. METHODS: This cohort study was based on a prospective registry including all consecutive adults with incident SE treated in our center between April 2006 and September 2012. SE outcome was categorized at hospital discharge into 'return to baseline', 'new disability' and 'mortality'. The role of potential predictors, including statins treatment on admission, was evaluated using a multinomial logistic regression model. RESULTS: Amongst 427 patients identified, information on statins was available in 413 (97%). Mean age was 60.9 (±17.8) years; 201 (49%) were women; 211 (51%) had a potentially fatal SE etiology; and 191 (46%) experienced generalized-convulsive or non-convulsive SE in coma. Statins (simvastatin, atorvastatin or pravastatin) were prescribed prior to admission in 76 (18%) subjects, mostly elderly. Whilst 208 (50.4%) patients returned to baseline, 58 (14%) died. After adjustment for established SE outcome predictors (age, etiology, SE severity score), statins correlated significantly with lower mortality (relative risk ratio 0.38, P = 0.046). CONCLUSION: This study suggests for the first time that exposure to statins before an SE episode is related to its outcome, involving a possible anti-epileptogenic role. Other studies are needed to confirm this intriguing finding.

Patrones de mucosa en el antro gástrico identificados con magnificación endoscópica y ácido acético / Mucosal patterns in the gastric antrum identified with endoscopic magnification and acetic acid

Los patrones de mucosa gástrica no se identifican con endoscopia estándar. Su visualización solo es posible con magnificación con o sin cromoscopia y para el antro gástrico la información es escasa al respecto. Objetivo: Identificar en antro gástrico los patrones de mucosa con magnificación y rociado de acido acético. Pacientes: Previo consentimiento se incluyeron a los individuos con indicación electiva de endoscopia digestiva superior. Materiales y Métodos: Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400. Se practicó endoscopia consecutivamente con: a) alta resolución, b) magnificación, c) alta resolución con instilación de acido acético al 5% en antro distal y d) magnificación en área rociada. Cada patrón encontrado se grabó, se fotografió y se guardó en JPEG en programa Power Point. Resultados: Se evaluó el tipo de patrón de mucosa en 107 áreas de 89 pacientes, 57 mujeres (64,04%) y 32 hombres (35,95%), con edades de 19-81 años y promedio de 46,25 años. El Tipo 1 y el 2 se observaron en 30,84% y 57,94% respectivamente. Conclusión: La magnificación endoscópica con rociado de acido acético en antro evidenció los diferentes patrones de mucosa gástrica.

Patterns of gastric mucosa are not identified with standard endoscopy. There is scarce information with the use of magnification cromoendoscopy in the viewing. Aim: Identify the patterns of mucosa with magnification and acetic acid spraying in distal antrum. Patients: Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Materials and Methods: Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. Endoscopy was consecutively performed with: a) high resolution, b) magnification, c) high resolution with instillation of 5% acetic acid in distal antrum, d) magnification in sprayed area. Each found pattern was recorded, was photographed and was saved in JPEG in Power Point program. Results: 89 Patients were included, 57 women (64.04%) and 32 (35.95%) men, with ages of 19-81 years and average 46.25 y/o. We evaluated 107 areas and the types of mucosa pattern most frequently found were Type 1 and type 2 in 30.84% and 57.94% respectively. Conclusions: In distal antrum only the endoscopic magnification with spraying of acetic acid showed the different patterns of gastric mucosa.

Gastritis histológica del cuerpo identificada con magnificación endoscópica y “Flexible Spectral Imaging Colour Enhancement” (FICE) / Histologiacal gastritis of the body identified with endoscopic magnification and flexible spectral imaging colour enhancement (FICE)

Introducción: La endoscopia estándar no diagnostica gastritis histológica y requiere biopsia para confirmarla. Con magnificación se observan micro estructuras que sugieren su presencia. Objetivo: Diagnosticar gastritis histológica en el cuerpo gástrico según el patrón de mucosa identificado con magnificación y “Flexible Spectral Imaging Colour Enhancement” (FICE). Pacientes: Previo consentimiento se incluyeron a los individuos con indicación electiva de endoscopia digestiva superior. Materiales y Métodos: Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y el procesador EPX 4400. En ambas caras del cuerpo gástrico se realizó consecutivamente: a) alta resolución, b) magnificación, c) alta resolución, d) efecto FICE, e) magnificación, f) alta resolución y g) biopsias de ambas caras del cuerpo evaluadas por los patólogos sin información clínica. Todo el procedimiento se grabó, se fotografió y se guardó en JPEG en programa Power Point. Resultados: Se evaluaron 60 áreas en 30 pacientes: 10 hombres y 20 mujeres con edades de 23-82 años y promedio 49,60 años. Solo la magnificación identificó los patrones de mucosa gástrica que se resaltaron con FICE. No se corroboró gastritis histológica en patrón Z0 pero sí en todas las áreas con Z2 y Z3. Conclusión: El patrón de mucosa en cuerpo gástrico observado con magnificación y FICE diagnostica gastritis histológica.

Introduction: Standard endoscopy requires biopsy to diagnose histological gastritis. Gastric mucosa micro structures are observed with magnification suggesting its presence. Objective: Diagnosing histological gastritis in the gastric body according to the mucosal pattern identified with magnification and "Flexible Spectral Imaging Colour Enhancement" (FICE). Patients: Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Materials and methods: Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. On both sides of the gastric corpus endoscopy was performed consecutively with: a) high-resolution, b) magnification, c) high resolution d) FICE, e) magnification, f) high resolution and g) biopsies of both sides of the body evaluated by pathologists without clinical information. The entire procedure was recorded, was photographed and was saved in JPEG in program Power Point. Results: 60 areas in 30 patients were evaluated: 10 men and 20 women with ages of 23-82 years and average 49.60. Only magnification identified patterns of gastric mucosa and they were highlighted with FICE. Histological gastritis was found in all identified Z2 and Z3 areas but none in Z0 pattern. Conclusion: The pattern of mucosa in gastric body observed with magnification and FICE diagnosed histological gastritis.

Yield of intermittent versus continuous EEG in comatose survivors of cardiac arrest treated with hypothermia.

INTRODUCTION: Electroencephalography (EEG) has a central role in the outcome prognostication in subjects with anoxic/hypoxic encephalopathy following a cardiac arrest (CA). Continuous EEG monitoring (cEEG) has been consistently developed and studied; however, its yield as compared to repeated standard EEG (sEEG) is unknown. METHODS: We studied a prospective cohort of comatose adults treated with therapeutic hypothermia (TH) after a CA. cEEG data regarding background activity and epileptiform components were compared to two 20-minute sEEGs extracted from the cEEG recording (one during TH, and one in early normothermia). RESULTS: Thirty-four recordings were studied. During TH, the agreement between cEEG and sEEG was 97.1% (95% CI: 84.6 to 99.9%) for background discontinuity and reactivity evaluation, while it was 94.1% (95% CI 80.3 to 99.2%) regarding epileptiform activity. In early normothermia, we did not find any discrepancies. Thus, concordance results were very good during TH (kappa 0.83), and optimal during normothermia (kappa = 1). The median delay between CA and the first EEG reactivity testing was 18 hours (range: 4.75 to 25) for patients with perfect agreement and 10 hours (range: 5.75 to 10.5) for the three patients with discordant findings (P = 0.02, Wilcoxon). CONCLUSIONS: Standard intermittent EEG has comparable performance with continuous EEG both for variables important for outcome prognostication (EEG reactivity) and identification of epileptiform transients in this relatively small sample of comatose survivors of CA. This finding has an important practical implication, especially for centers where EEG resources are limited.

Identificación de los patrones de mucosa del cuerpo gástrico con magnificación endoscópica y "flexible spectral imaging colour enhancement" (FICE) / Patterns of gastric mucosa of the corpus with endoscopic magnification and flexible spectral imaging colour enhancement (FICE)

Con endoscopia estándar no se visualizan los patrones ni las micro estructuras de la superficie de la mucosa gástrica. Solo la magnificación permite observarlas. Identificar los patrones de mucosa gástrica del cuerpo con magnificación y "Flexible Spectral Imaging Colour Enhancement" (FICE). Previo consentimiento se incluyeron a los individuos con indicación electiva de endoscopia digestiva superior. Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400. Individualmente en ambas caras del cuerpo gástrico se practicó consecutivamente: a) alta resolución, b) magnificación, c) alta resolución, d) efecto FICE, d) magnificación y e) alta resolución. Para los patrones de mucosa gástrica identificados con magnificación se utilizó la clasificación de Yagi K, et al. Todo el procedimiento se grabó, se fotografió y se guardó en JPEG en programa Power Point. Se evaluaron 60 áreas en 30 pacientes: 10 hombres y 20 mujeres con edades de 23-82 años y promedio 49,60 años. Solo la magnificación identificó los patrones de mucosa gástrica que se resaltaron con efecto FICE. Los patrones encontrados fueron: 5 Z0 (8,33%), 13 Z1 (21,66%), 20 Z2 (33,33%) y 22 Z3 (36,66%). Solo la magnificación endoscópica identificó en cuerpo gástrico los patrones de mucosa que se resaltaron con efecto FICE

With standard endoscopy is not possible to display patterns nor the microstructures of the surface of the gastric mucosa, only endoscopic magnification allows to observe the patterns. Identify the patterns of corpus gastric mucosa with magnification and "Flexible Spectral Imaging Colour Enhancement" (FICE). Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Upper gastrointestinal endoscopy was performed with Fujinon Inc. EG 590 ZW, and processor 4400 EPX. On both sides of the gastric corpus endoscopy was performed consecutively with: a) high-resolution, b) magnification, c) high resolution, d) FICE, e)magnification and f) high resolution. The classification of Yagi K, et al with endoscopic magnification, was used to identify patterns of gastric mucosa. The entire procedure was recorded, was photographed and was saved in JPEG in Power Point. 60 areas in 30 patients were evaluated: 10 men and 20 women with 23-82 years and 49.60 years average age range. Only magnification identified patterns of gastric mucosa and FICE highlighted them. The patterns found were: 5 Z0 (8.33%), 13 Z1 (21.66%), 20 Z2 (33.33%) and 22 Z3 (36.66%). Only magnifying endoscopy identifies patterns of gastric mucosa of the body and FICE highlighted them

Ictal EEG-fMRI in localization of epileptogenic area in patients with refractory neocortical focal epilepsy.

PURPOSE: To evaluate the usefulness of ictal electroencephalography (EEG)-combined functional magnetic resonance imaging ( MRI) (EEG-fMRI) in localizing epileptogenic zone in refractory neocortical focal epilepsy. METHODS: From the EEG-fMRI database of our institution including 62 adult patients, 14 (age 18-46 years) experienced some ictal event during the test. Data were segmented into 10-s blocks, and the results were analyzed by contrasting each block to the contiguous 10-s block from the onset of seizure onward, in all cases. In seizures lasting >10 s (five cases), a supplementary analysis was performed, contrasting each block to a baseline condition, in the framework of the general linear model (GLM) of analysis. Regions of activations were compared to results from the different techniques performed during presurgical evaluation, such as SISCOM, positron emission tomography (PET), and invasive subdural EEG monitoring. KEY FINDINGS: Regarding the structural MRI findings, nine cases presented some lesion, with blood oxygen level- dependent (BOLD) signal activation placed in the same location in eight of them (89%). SISCOM studies were performed in 11 patients; 5 were concordant with the increase in BOLD signal in a sublobar level, whereas in 3 cases the concordance was in a lobar level. Eleven patients underwent PET studies, being also concordant in a sublobar level in four of them and in a lobar level in four additional cases. Finally, invasive EEG evaluation was performed in three patients and all of them had the seizure-onset zone in the initial area of BOLD activation. SIGNIFICANCE: This study adds relevant information to support the integration of EEG-fMRI in the multidisciplinary presurgical workup in patients with refractory epilepsy.

Diagnóstico de infección por Helicobacter pylori en cuerpo gástrico con magnificación endoscópica y "flexible spectral imaging colour enhancement" (FICE) / Diagnosis of Helicobacter pylori infection in gastric body with endoscopic magnification and flexible spectral imaging colour enhancement (FICE)

La endoscopia estándar no diagnostica infección por Helicobacter pylori. Con magnificación y "Flexible Spectral Imaging Colour Enhancement" (FICE) se observan patrones de mucosa gástrica que sugieren su presencia. Diagnosticar infección por Helicobacter pylori con magnificación endoscópica y "Flexible Spectral Imaging Colour Enhancement" (FICE). Previo consentimiento se incluyeron a los individuos con indicación electiva de endoscopia digestiva superior. Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400. En ambas caras del cuerpo gástrico se realizó consecutivamente: a) alta resolución, b) magnificación, c) alta resolución, d)FICE, e)magnificación y f) biopsia en el antro y del patrón mas prevalente en cada cara del cuerpo evaluadas sin información del paciente. Todo el procedimiento se grabó, se fotografió y se guardó en JPEG en programa Power Point. Se evaluaron 60 áreas en 30 pacientes: 10 hombres y 20 mujeres con edades de 20-82 años y promedio 49,60 años. Solo magnificación y FICE identificaron los patrones de mucosa en cuerpo gástrico. En 37,03% se diagnosticó Helicobacter pylori con histología, 53,33% y 61,11% en patrón Z2 y Z3 respectivamente. La magnificación y FICE permiten identificar los patrones de mucosa gástrica que sugieren infección por Helicobacter pylori

Helicobacter pylori infection is not diagnosed with standard endoscopy. With high resolution and magnification patterns of gastric mucosa suggesting its presence are observed. Diagnose Helicobacter pylori infection with endoscopic magnification and "Flexible Spectral Imaging Colour Enhancement" (FICE). Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. Endoscopy was practiced on both sides of the gastric body consecutively with: a) high-resolution, b) magnification, c) high-resolution, d) FICE, e) magnification and g) biopsy of the antrum and the pattern more prevalent on each side of the body evaluated without patient information. The entire procedure was recorded, was photographed and was saved in JPEG in program Power Point. 60 Areas in 30 patients were evaluated: 10 men and 20 women with ages of 20-82 years and average 49.60. Only magnification and FICE identified patterns of mucosa in gastric body. Helicobacter pylori was diagnosed in 37.03% with histology and in pattern Z2 and Z3 in 53.33% and 61.11% respectively. The endoscopic magnification and Flexible Spectral Imaging Colour Enhancement (FICE) identify patterns of gastric mucosa suggesting Helicobacter pylori infection

Vellosidades duodenales: endoscopia de alta resolución, magnificación, “flexible spectral imaging colour enhancement” (FICE) y correlación histológica / Duodenal villi: High resolution endoscopy, magnification, Flexible Spectral Imaging Colour Enhancement (FICE) and histological correlation

Introducción: La endoscopia estándar no visualiza las vellosidades en la mucosa duodenal. Con alta resolución y magnificación con o sin cromoscopia se logra observarlas e identificar sus alteraciones. Objetivo: Identificar las vellosidades duodenales y sus alteraciones con endoscopia de alta resolución, magnificación y “Flexible Spectral Imaging Colour Enhancement” (FICE) corroborándolas con histología. Pacientes: Previo consentimiento se incluyeron a los individuos que tenían indicación electiva de endoscopia digestiva superior. Materiales y Métodos: Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400, consecutivamente se practicó: a) alta resolución, b) FICE, c) alta resolución, d) magnificación, e) FICE y f) alta resolución. Se tomaron dos muestras en bulbo y en segunda porción duodenal, evaluadas por los patólogos sin información del paciente. El procedimiento se grabó, se fotografió y se guardó en JPEG en programa Power Point. Resultados: Se incluyeron 33 pacientes y se evaluaron 66 áreas en 11 hombres y 22 mujeres con edades de 20-85 años y promedio 52,66 años. La correlación histológica fue: 100 % en patrón normal Z1 y 90 % en Z2. Conclusión: La magnificación endoscópica identifica los patrones de las vellosidades duodenales que se resaltan con Flexible Spectral Imaging Colour Enhancement (FICE) con alta correlación histológica.

Introduction: Standard endoscopy has limits to visualize the duodenal mucosa. With high resolution, magnification with or without chromoscopy it is possible to identify the duodenal villi and its alterations. Objective: Identify duodenal villi and its alterations with endoscopy of high resolution, magnification and Flexible Spectral Imaging Colour Enhancement (FICE). Patients: Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Materials and methods: Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG and EPX 4400 processor, consecutively we practiced: a) high-resolution, b) FICE, c) high resolution d) magnification, e) FICE and f) high resolution. Two samples were taken in bulb and second duodenal portion evaluated by pathologists without patient information. The procedure was recorded, was photographed and was saved in JPEG in program Power Point. Results: 33 patients were included and 66 areas were evaluated in 11 men and 22 women with 20-85 years and 52.66 years average age range. The Z1 pattern of normal duodenal villi agreed in all cases with histopathology. Conclusion: Endoscopic magnification identifies patterns of the duodenal villi and Flexible Spectral Imaging Colour Enhancement (FICE) highlighted them. We found high histological correlation.

Magnificación endoscópica, ácido acético y “flexible spectral imaging colour enhancement” (FICE) para el diagnóstico de esófago de Barrett / Endoscopic magnification, acetic acid and flexible spectral imaging colour enhancement (FICE) for the diagnosis of Barrett´s esophagus

Con endoscopia estándar no se precisa esófago de Barrett, pero la magnificación endoscópica con o sin cromoscopia puede identificarlo. Objetivo: Diagnosticar esófago de Barrett con magnificación endoscópica, rociado de ácido acético y “Flexible Spectral Imaging Colour Enhancement” (FICE). Pacientes: Previo consentimiento se incluyeron a los individuos con indicación de endoscopia digestiva superior. Materiales y Métodos: Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400, consecutivamente se practicó: a) alta resolución, b) FICE, c) alta resolución, d) magnificación, e) FICE, f) alta resolución con instilación de acido acético al 5% en esófago distal y lavado con agua, g) magnificación y h) FICE. Se tomó biopsia del patrón observado, evaluada sin información del paciente. El procedimiento se grabó, se fotografió y se guardó en JPEG en programa Power Point. Resultados: En 120 pacientes: 44 hombres y 76 mujeres con edades de 20-85 años, el ácido acético destacó los patrones de mucosa observados con magnificación y resaltados con FICE. Esófago de Barrett se diagnosticó en 87,50% de patrón tipo 3 identificados en lengüetas largas. Conclusión: Magnificación endoscópica con rociado de ácido acético, y “Flexible Spectral Imaging Colour Enhancement” (FICE), identificó y resaltó en esófago el patrón sugestivo de esófago de Barrett.

Standard endoscopy does not identify Barrett´s esophagus, but endoscopic magnification and chromoendoscopy diagnose it accurately. Ojective: Diagnose Barrett’s esophagus with magnification endoscopy, spraying of acetic acid and Flexible Spectral Imaging Colour Enhancement (FICE). Patients: Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Materials and Methods: Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. Endoscopy was consecutively performed with: a) highresolution, b) FICE, c) high resolution d) magnification, e) FICE, f) high resolution with spraying of 5% acetic acid in distal esophagus inmediately washed with 20cc of water, g) magnification and h) FICE. Biopsy was taken and evaluated without patient information. The procedure was recorded, was photographed and was saved in JPEG in Power Point program. Results: In 120 patients: 44 men and 76 women aged 20-85 years, pit patterns of mucosa were enhanced with acetic acid sprayed in distal esophagus and highlighted with magnification and FICE. Barrett’s esophagus was diagnosed in 87.50% of cases with long columnar tongues and pit pattern type 3. Conclusion: Endoscopic magnification with spraying of acetic acid, and Flexible Spectral Imaging Colour Enhancement (FICE), identified and highlighted the pattern suggestive of diagnosis of Barretts esophagus.