[Models of intervention in children with autism]. / Modelos de intervención en niños con autismo.

INTRODUCTION: Autism spectrum disorders make up a group of neurodevelopmental disorders that globally affect different higher brain functions in the individual, such as intelligence, the capacity to use language and social interaction. Today, although there is still no curative treatment for autism, there are a number of non pharmacological interventions that can modify the poor prognosis that is generally associated to this type of disorders. AIM: To briefly review the different approaches to the neuro rehabilitation of patients suffering from autism spectrum disorders, which are usually known as methods of intervention. DEVELOPMENT: From the categorical point of view, three types of methods of intervention can be distinguished, depending on whether the orientation is psychodynamic, biomedical or psycho educational. It is difficult to compare the results of the different methods of intervention, but researchers have identified several common elements that they should have if they are to be effective. At present, the psycho educational methods are preferred, since they are the only ones that, to date, have proved to be effective in research studies. CONCLUSIONS: Early intervention by diagnostic and early care centres, with the use of mixed models of psycho educational intervention that nevertheless also include an important percentage of behavioural elements, has proved to be capable of modifying the course of patients with autism spectrum disorders and is currently the most suitable approach.

Modelos de intervención en niños con autismo / Introduction. Autism spectrum disorders make up a group of neurodevelopmental disorders that globally affect different

Introducción. Los trastornos del espectro autista constituyen un grupo de alteraciones del neurodesarrollo que afectan de manera global distintas funciones cerebrales superiores del individuo, como la inteligencia, la capacidad del lenguaje y la interacción social. Aunque no existe hoy día ningún tratamiento curativo del autismo, sí hay diversas intervenciones no farmacológicas que pueden modificar el mal pronóstico generalmente asociado a este tipo de trastornos. Objetivo. Revisar de manera sucinta las diferentes aproximaciones para la neurorrehabilitación de los pacientes afectados de trastornos del espectro autista, lo que se conoce habitualmente como métodos de intervención.Desarrollo. Desde un punto de vista categórico, se pueden distinguir tres tipos de métodos de intervención, según que la orientación sea psicodinámica, biomédica o psicoeducativa. Existen dificultades para comparar los resultados de los distintos métodos de intervención, pero se han identificado unos elementos comunes que deberían tener para resultar eficaces. Actualmente se prefieren los métodos psicoeducativos, pues son los únicos que han demostrado eficacia en losestudios de investigación. Conclusiones. La intervención precoz, en el contexto de los centros de diagnóstico y atención temprana, dentro de modelosde intervención psicoeducativa mixtos, aunque con gran presencia de elementos conductuales, ha demostrado podermodificar la evolución de los pacientes con trastornos del espectro autista y constituye hoy día el abordaje más indicado (AU)

Introduction. Autism spectrum disorders make up a group of neurodevelopmental disorders that globally affect differenthigher brain functions in the individual, such as intelligence, the capacity to use language and social interaction. Today,although there is still no curative treatment for autism, there are a number of non pharmacological interventions that can modify the poor prognosis that is generally associated to this type of disorders. Aim. To briefly review the different approaches to the neuro rehabilitation of patients suffering from autism spectrum disorders, which are usually known as methods of intervention. Development. From the categorical point of view, three types of methods of intervention can be distinguished, dependingon whether the orientation is psychodynamic, biomedical or psycho educational. It is difficult to compare the results of the different methods of intervention, but researchers have identified several common elements that they should have if they are to be effective. At present, the psycho educational methods are preferred, since they are the only ones that, to date,have proved to be effective in research studies. Conclusions. Early intervention by diagnostic and early care centres, with the use of mixed models of psycho educational intervention that nevertheless also include an important percentage of behavioural elements, has proved to be capable of modifying the course of patients with autism spectrum disorders and is currently the most suitable approach (AU)

[The psychopharmacology of the comorbid disorders associated with attention deficit hyperactivity disorder]. / Psicofarmacología de los trastornos comórbidos asociados al trastorno por déficit de atención/hiperactividad.

INTRODUCTION: The pharmacological treatment most commonly used in attention deficit hyperactivity disorder (ADHD) has traditionally consisted in the administration of psychostimulants. The particular association with comorbid disorders makes it essential to utilise different therapeutic approaches and this accounts for the growing therapeutic arsenal currently available for use in this condition. DEVELOPMENT: It is important to be familiar with the different comorbidities because they are especially frequent and also because of their effect on the prognosis. Thus, it is necessary to reach a good diagnosis as early as possible in order to implement a therapy that allows the problem to be curbed. To do so, we need to know about the different pharmaceuticals that have to some extent or other proved to be effective. CONCLUSIONS: This paper aims to offer a global view of the problem by analysing the characteristics of the comorbid disorders associated with ADHD and the pharmacological tools that enable us to modify their deleterious effects.

Psicofarmacología de los trastornos comórbidos asociados al trastorno por déficit de atención/hiperactividad / The psychopharmacology of the comorbid disorders associated with attention deficit hyperactivity disorder

Introducción. Clásicamente, el tratamiento farmacológico más utilizado en el trastorno por déficit de atención/hiperactividad (TDAH) lo han constituido los psicoestimulantes. En la actualidad, el arsenal terapéutico para utilizar en esta patología es creciente, lo cual está motivado por la especial asociación a trastornos comórbidos, que hacen imprescindible abordajes terapéuticos distintos. Desarrollo. La importancia del conocimiento de las distintas comorbilidades radica en su especial frecuencia y efecto pronóstico. De este modo, es necesario llegar a un diagnóstico lo más acertado y precoz posible con el objetivo de implantar una terapéutica que permita yugular el problema. Para ello se precisa del conocimiento de los distintos psicofármacos que en mayor o menor medida han demostrado su eficacia. Conclusiones. Este artículo aporta una visión global del problema mediante el análisis de las características de los trastornos comórbidos asociados al TDAH y las herramientas farmacológicas que permiten modular sus efectos deletéreos

Introduction. The pharmacological treatment most commonly used in attention deficit hyperactivity disorder (ADHD) has traditionally consisted in the administration of psychostimulants. The particular association with comorbid disorders makes it essential to utilise different therapeutic approaches and this accounts for the growing therapeutic arsenal currently available for use in this condition. Development. It is important to be familiar with the different comorbidities because they are especially frequent and also because of their effect on the prognosis. Thus, it is necessary to reach a good diagnosis as early as possible in order to implement a therapy that allows the problem to be curbed. To do so, we need to know about the different pharmaceuticals that have to some extent or other proved to be effective. Conclusions. This paper aims to offer a global view of the problem by analysing the characteristics of the comorbid disorders associated with ADHD and the pharmacological tools that enable us to modify their deleterious effects

Bases neurobiológicas de los trastornos específicos de la comunicación (espectro autista) / No disponible

Desarrollo. Se analizan los factores neurobiológicos de los trastornos de la comunicación relacionados con el espectroautista, en base a las evidencias científicas por los hallazgos neuroanatomopatológicos, de neuroimagen, neurobioquímicosy neurofisiológicos descritos. Se ponen de manifiesto los distintos sistemas implicados en esta patología, que conllevasu variabilidad clínica y la dificultad en la orientación terapéutica. Conclusión. El análisis de los factores descritos y la comparaciónde hallazgos de los distintos casos clínicos con estas patologías puede permitir una aproximación para una mejorcompresión de estos trastornos

[Intrathecal baclofen and Botulinum toxin in infantile cerebral palsy]. / Baclofén intratecal y toxina botulínica en la parálisis cerebral infantil.

INTRODUCTION: Infantile cerebral palsy is considered to be a motor disorder affecting both posture and movement. It is the manifestation of a cerebral lesion that took place during the maturing process of the brain. Spastic cerebral palsy is the most frequent variety. The spasticity presented by these patients strongly influences their functioning and gives rise to several complications that affect their quality of life. AIMS AND DEVELOPMENT: The main aim of this study is to determine a set of suitable and effective therapeutic steps that can be used to improve patients' spasticity and to prevent the complications that stem from them, such as contractures, deformities, surgery, etc. Multiple treatments were used, including physiotherapy, rehabilitation and oral pharmacotherapy, with few satisfactory results. At present there are two very promising therapeutic alternatives for patients with infantile cerebral palsy: Botulinum toxin, which we already have a great deal of experience with, and intrathecal treatment with baclofen. We report on a series of 10 patients aged between 8 and 15 years who had had an intrathecal baclofen infusion pump implanted. To date (maximum follow-up: 12 months), their clinical course has been satisfactory in most cases, with no severe complications related to the surgical technique, except in one individual who presented a fistula that resolved spontaneously. CONCLUSIONS: Intrathecal baclofen seems to be a very useful alternative in the treatment of spasticity to improve the quality of life of these patients and those around them.

Baclofén intratecal y toxina botulínica en la parálisis cerebral infantil / Intrathecal baclofen and botulinum toxin in infantile cerebral palsy

Introducción. La parálisis cerebral infantil se considera un trastorno motor que afecta tanto a la postura como al movimiento. Constituye la manifestación de una lesión cerebral que tuvo lugar durante el proceso madurativo del cerebro. La parálisis cerebral espástica es la variedad mas frecuente. La espasticidad que presentan estos pacientes interfiere de forma muy importante en la funcionalidad del mismo, produciendo diversas complicaciones que afectan a su calidad de vida. Objetivo y desarrollo. El objetivo principal es lograr unas medidas terapéuticas adecuadas y eficaces para mejorar la espasticidad y evitar las complicaciones que de ella se derivan: contracturas, deformidades, cirugía, etc. Se han utilizado múltiples tratamientos, como fisioterapia, rehabilitación y farmacoterapia oral, con escasos resultados satisfactorios. Actualmente existen dos alternativas terapéuticas muy a tener en cuenta en pacientes con parálisis cerebral infantil: la toxina botulínica, de la que ya tenemos amplia experiencia, y el tratamiento intratecal con baclofén. Se presenta una serie de 10 pacientes, de edades comprendidas entre 8 y 15 años, a los que se les ha implantado una bomba de perfusión intratecal de baclofén. Hasta el momento actual (seguimiento máximo: 12 meses), la evolución ha sido satisfactoria en la mayoría de los casos, sin encontrarse graves complicaciones en relación a la técnica quirúrgica, excepto en un caso que presentó una fístula que se resolvió espontáneamente. Conclusión. El baclofén intratecal se considera una alternativa muy a tener en cuenta en el tratamiento de la espasticidad para la mejora de la calidad de vida de estos pacientes y su entorno (AU)

Introduction. Infantile cerebral palsy is considered to be a motor disorder affecting both posture and movement. It is the manifestation of a cerebral lesion that took place during the maturing process of the brain. Spastic cerebral palsy is the most frequent variety. The spasticity presented by these patients strongly influences their functioning and gives rise to several complications that affect their quality of life. Aims and development. The main aim of this study is to determine a set of suitable and effective therapeutic steps that can be used to improve patients’ spasticity and to prevent the complications that stem from them, such as contractures, deformities, surgery, etc. Multiple treatments were used, including physiotherapy, rehabilitation and oral pharmacotherapy, with few satisfactory results. At present there are two very promising therapeutic alternatives for patients with infantile cerebral palsy: Botulinum toxin, which we already have a great deal of experience with, and intrathecal treatment with baclofen. We report on a series of 10 patients aged between 8 and 15 years who had had an intrathecal baclofen infusion pump implanted. To date (maximum follow-up: 12 months), their clinical course has been satisfactory in most cases, with no severe complications related to the surgical technique, except in one individual who presented a fistula that resolved spontaneously. Conclusions. Intrathecal baclofen seems to be a very useful alternative in the treatment of spasticity to improve the quality of life of these patients and those around them (AU)

[Attention deficit hyperactivity disorder and epilepsy]. / Trastorno por déficit de atención e hiperactividad y epilepsia.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is currently one of the morbid clinical pictures in childhood and adolescence that is most frequently diagnosed in the Neuropaediatric clinic. DEVELOPMENT: ADHD is sometimes associated to other important neurological problems, such as behavioural disorders, tics or headaches, and may occasionally be related to epilepsy, although in this particular case the epileptic syndromes often involve disorders affecting behaviour and attention. Due to the frequent association of these disorders (epilepsy and ADHD) it is wise to perform an electroencephalographic study in patients who visit because of symptoms of disattention. Likewise, the neuropsychological assessment of epileptic children must not be neglected. We analyse the therapeutic options regarding the use of stimulants when both disorders coexist and we endorse the association of antiepileptic and psychostimulant drugs when necessary.

Trastorno por déficit de atención e hiperactividad y epilepsia / Attention deficit hyperactivity disorder and epilepsy

Introducción. El trastorno por déficit de atención e hiperactividad (TDAH) constituye hoy en día uno de los cuadros mórbidos de la edad infantil y adolescencia más frecuentemente diagnosticados en la consulta de Neuropediatría. Desarrollo. El TDAH se asocia en ocasiones a otros problemas neurológicos de importancia, como los trastornos de conducta, tics, cefaleas y, en ocasiones, puede relacionarse con epilepsia, con la particularidad de que los síndromes epilépticos conllevan en muchos casos alteraciones de la conducta y la atención. Debido a la frecuente asociación de estos trastornos, epilepsia y TDAH, es oportuno realizar un estudio electroencefalográfico en los pacientes que consultan por síntomas disatencionales, del mismo modo que no debemos olvidar la valoración neuropsicológica de los niños epilépticos. Se analizan las opciones terapéuticas en relación con el uso de los estimulantes cuando coexisten ambos trastornos, y se valida la asociación de antiepilépticos y psicoestimulantes cuando se precisen (AU)

Introduction. Attention deficit hyperactivity disorder (ADHD) is currently one of the morbid clinical pictures in childhood and adolescence that is most frequently diagnosed in the Neuropaediatric clinic. Development. ADHD is sometimes associated to other important neurological problems, such as behavioural disorders, tics or headaches, and may occasionally be related to epilepsy, although in this particular case the epileptic syndromes often involve disorders affecting behaviour and attention. Due to the frequent association of these disorders (epilepsy and ADHD) it is wise to perform an electroencephalographic study in patients who visit because of symptoms of disattention. Likewise, the neuropsychological assessment of epileptic children must not be neglected. We analyse the therapeutic options regarding the use of stimulants when both disorders coexist and we endorse the association of antiepileptic and psychostimulant drugs when necessary (AU)

Formas clínicas inhabituales de presentación del trastorno por déficit de atención con hiperactividad / Usual forms of clinical presentation of attention déficit hyperactivity disorder

Introducción y desarrollo. El trastorno por déficit de atención con hiperactividad (TDAH) es uno de los procesos que observamos más frecuentemente en nuestra consulta de neuropediatría, y ha pasado a ocupar en los últimos años uno de los primeros puestos, junto con las cefaleas. El diagnóstico que debe hacerse, siempre según los criterios recogidos en el DSM IV, en ocasiones, se hace más difícil, ya que inicialmente son pacientes que consultan por otra problemática que adquiere el protagonismo clínico. Las cefaleas, en nuestra experiencia, son el motivo de consulta principal en estos casos. Una anamnesis cuidadosa y la exploración de los pacientes, y su observación durante la entrevista, hacen sospechar el contexto de un auténtico TDAH que subyace en el problema que se presenta con otra sintomatología no específica. Principalmente, se trata de niños (menos frecuente), que ven como sus expectativas de fracaso escolar y social aumentan y les preocupan hasta tal punto que se inicia una cefalea tensional importante. A veces, si se centra únicamente el estudio y la terapéutica exclusivamente en solucionar la cefalea, se produce el fracaso terapéutico, que a veces se ha prolongado durante meses. Otros síntomas como tics, mareos inespecíficos, abdominalgias y trastornos visuales, también pueden ser motivo de consulta en pacientes con TDAH. Conclusiones. Ante la consulta de esta sintomatología, debe tenerse siempre en cuenta /principalmente con las cefaleas) la posibilidad referida y tener especial cuidado en no diagnosticar en exceso el TDAH, y siempre basándonos en pruebas objetivas que reúnan los criterios exigidos para su diagnóstico. La terapia dirigida al tratamiento farmacológico y una intervención psicopedagógica adecuada resuelven en estos casos el problema y disminuyen significativamente la sintomatología motivo de consulta (AU)

Introduction and development. Attention deficit hyperactivity disorder (ADHD) is one of the most frequently observed processes in our Neuropaediatric unit, and in recent years has become one of the leading reason for visits, together with headaches. On occasions, the diagnosis that should be made, in accordance with the criteria included in the DSM IV, is more difficult because initially they are patients who visit because of some other problem that becomes the centre of our clinical attention. Headaches, in our experience, are the main reason for visiting in these cases. A careful review of the patient’s history and a physical examination, together with their observation during the interview, lead us to suspect a genuine case of ADHD underlying the problem that presents with other non-specific symptoms. These patients are mainly boys and, less frequently, girls who see how the chances of academic and social failure increase and then become worried to such an extent that they start suffering from important tension-type headaches. Concentrating the study and the therapy on just solving the problem of the headaches sometimes gives rise to therapeutic failure, which occasionally goes on for months. Other symptoms, such as tics, unspecific dizziness, pains in the abdomen and visual disorders, can also be the reason that brings ADHD patients to visit. Conclusions. When faced with these symptoms we should always bear in mind (mainly in the case of headaches) the possibility referred to above and special care must be taken not to diagnose ADHD in excess, and always base our judgment on objective proof that meets the criteria required for its diagnosis. Therapy based on pharmacological treatment and a suitable psychopedagogical intervention solves the problem in these cases and significantly reduces the symptomatology that led to the visit (AU)

[Adopted children: risk factors and neuropsychological problems]. / Niños adoptados: factores de riesgo y problemática neuropsicológica.

In recent years there has been a striking increase in the number of transnational adoptions in our country, which follows the trend already observed in other developed European countries. Major contributing factors to this phenomenon have been the improvements in socioeconomic conditions in our country, the drop in the birth rate, with the corresponding decrease in the number of children available for adoption, and the disappearance of orphanages. This growing demand can be met by developing countries, in which the birth rate is still high and there are only limited chances of being able to maintain offspring. The children that are adopted come mainly from countries in Central and South America, Eastern Europe and Asia. Pathologies that can be expected in adopted children include general paediatric conditions, especially infections (which are often autochthonous ailments in their own country) and malnutrition, as well as neuropsychological and developmental disorders, such as psychomotor retardation, conduct and behavioural disorders, which sometimes stem from conflicts arising in the process of adaptation, communication problems, which occasionally reflect an autistic like disorder, and the problems deriving from the circumstances that condition the donation of the child for adoption (perinatal pathology, maternal drug addiction and withdrawal symptoms, maternal psychopathology.). The pathology, history and prognosis of the adopted child depend on several different factors that act in an accumulative fashion. The country of origin plays a decisive role in the type of pathology, according to the level of the health care system that exists there, the existence of adoption programmes that are regulated by law, etc. The child's age at adoption marks the difference in the optimisation of their development, if they have early access to a stable family unit. Having stayed in institutions and the length of time spent there is a risk factor for presenting a neuropsychological pathology. On many occasions the scarce information available about the child's medical history makes it more difficult to anticipate the appearance of certain problems. The existence of social risk factors in the biological families is a conditioning factor in increased morbidity. We describe a short series of adopted patients who were attended in our Neuropaediatric clinic, and we analyse the above mentioned conditioning variables and the most frequent pathologies.

[Neuropsychological problems of cerebrovascular pathology in children]. / Problemas neuropsicológicos de la patología vascular cerebral en el niño.

Cerebrovascular pathology in infancy is, unlike in adults, infrequent. However, this must not lead us to think it is unimportant. There are a number of different vascular processes that exert an influence to varying degrees on the neurological and psychological future of our young patients. These sequelae can be of more or less importance and, on some occasions, can be lesions that will accompany them throughout the rest of their lives, in spite of the therapeutic methods we have available today. We basically differentiate vascular organic lesions that are pre-established or due to malformations from other causes acquired as a consequence of an anomalous situation inherent to other pathologies and that have an extravascular origin. The most striking of these, because of their frequency, gravity and cellular pathology, are peri/intraventricular haemorrhages (PIVH) in those born premature and those weighing very little at birth. The causes from malformations remain and are relatively rare with a stable frequency, while the number of cases of PIVH has risen sharply in recent years due to different causes, the most notable of which is the increase in preterm multiple births, at around 30-32 weeks of gestation. This group of the population requires early and continuous neuropaediatric monitoring. Some of the sequelae are detected and dealt with quickly; others may appear later and will need the joint, coordinated attention of neuropaediatricians, psychologists, educators and physiotherapists.

Problemas neuropsicológicos de la patología vascular cerebral en el niño / Neuropsychological problems of cerebrovascular pathology in children

La patología vascular cerebral en la infancia es, a diferencia del adulto, poco frecuente; sin embargo, esto no nos debe impulsar a no considerarla importante. Existen diferentes procesos vasculares que repercuten en diferente medida en el porvenir neurológico y psicológico de nuestros pequeños pacientes; estas secuelas son más o menos importantes y, en algunas ocasiones, lesiones que les acompañarán toda la vida a pesar de nuestros métodos terapéuticos actuales. Básicamente, diferenciamos las lesiones orgánicas vasculares preestablecidas o malformativas de aquellas otras causas adquiridas como consecuencia de una situación anómala inherente a otras patologías y de origen extravascular. Destacan entre todas éstas, por su frecuencia, gravedad y patología celular, las hemorragias intraperiventriculares (HIPV) de los prematuros y pacientes con muy bajo peso al nacimiento. Las causas malformativas permanecen y son una relativa rareza y estables en su frecuencia, mientras que las HIPV han experimentado un incremento importante en los últimos años, debido a diferentes causas, entre las que destacan el aumento de partos múltiples de pretérminos, alrededor de las 30-32 semanas de gestación. Este grupo de población precisa un control neuropediátrico precoz y continuado. Algunas de las secuelas se detectan e intervienen rápidamente; otras pueden aparecer más tarde y precisarán la labor de neuropediatras, psicólogos, educadores y fisioterapeutas de forma coordinada (AU)

Cerebrovascular pathology in infancy is, unlike in adults, infrequent. However, this must not lead us to think it is unimportant. There are a number of different vascular processes that exert an influence to varying degrees on the neurological and psychological future of our young patients. These sequelae can be of more or less importance and, on some occasions, can be lesions that will accompany them throughout the rest of their lives, in spite of the therapeutic methods we have available today. We basically differentiate vascular organic lesions that are pre-established or due to malformations from other causes acquired as a consequence of an anomalous situation inherent to other pathologies and that have an extravascular origin. The most striking of these, because of their frequency, gravity and cellular pathology, are peri/intraventricular haemorrhages (PIVH) in those born premature and those weighing very little at birth. The causes from malformations remain and are relatively rare with a stable frequency, while the number of cases of PIVH has risen sharply in recent years due to different causes, the most notable of which is the increase in preterm multiple births, at around 30-32 weeks of gestation. This group of the population requires early and continuous neuropaediatric monitoring. Some of the sequelae are detected and dealt with quickly; others may appear later and will need the joint, coordinated attention of neuropaediatricians, psychologists, educators and physiotherapists (AU)

Niños adoptados: factores de riesgo y problemática neuropsicológica / Adopted children: risk factors and neuropsychological problems

En los últimos años hemos asistido a un incremento llamativo en el número de adopciones transnacionales en nuestro país, que sigue las tendencias ya existentes en otros países desarrollados europeos. A este fenómeno ha contribuido la mejora en las condiciones socioeconómicas de nuestro país, el descenso de la natalidad, con una disminución en la oferta de niños en adopción, y la desaparición de los orfanatos. Esta demanda creciente tiene salida en los países en vías de desarrollo, en los que la natalidad es todavía elevada y las posibilidades de mantener a la descendencia muy limitadas. Los niños adoptados son originarios, principalmente, de países pertenecientes a Centroamérica, América de sur, Europa del este y Asia. La patología esperable en el niño adoptado comprende tanto problemas pediátricos generales, entre los que destacan las infecciones -amenudo autóctonas del país de origen- y la desnutrición, como trastornos neuropsicológicos y de desarrollo, como el retraso psicomotor, los trastornos de comportamiento y conducta -que en ocasionesresponden a conflictos adaptativos-, los problemas de comunicación -en ocasiones como expresión de un trastorno de características autistas- y los problemas derivados de las circunstancias que condicionaron la donación del niño en adopción (patología perinatal, drogadicción materna y síndrome de abstinencia, psicopatía materna, etc.). La patología, evolución y pronóstico del niño adoptado dependen de diversos factores que actúan de forma sumatoria. El país de origen es determinante del tipo de patología, en función del desarrollo del sistema sanitario, la existencia de programas de adopción regulados, etc. La edad del niño en el momento de su adopción marca la diferencia en la optimización de su desarrollo, si tiene acceso temprano a un núcleo familiar estable. La estancia previa en instituciones y su duración es un factor de riesgo para presentar patología neuropsicológica. La escasa información disponible en muchas ocasiones acerca de los antecedentes hace más difícil el anticiparse a la aparición de determinados problemas. Por último, la existencia de factores de riesgo social de las familias biológicas condiciona mayor morbilidad. Describimos una serie corta de pacientes adoptados atendidos en nuestra consulta de neuropediatría y analizamos las variables condicionantes citadas y las patologías más frecuentes (AU)

In recent years there has been a striking increase in the number of transnational adoptions in our country, which follows the trend already observed in other developed European countries. Major contributing factors to this phenomenon have been the improvements in socioeconomic conditions in our country, the drop in the birth rate, with the corresponding decrease in the number of children available for adoption, and the disappearance of orphanages. This growing demand can be met by developing countries, in which the birth rate is still high and there are only limited chances of being able to maintain offspring. The children that are adopted come mainly from countries in Central and South America, Eastern Europe and Asia. Pathologies that can be expected in adopted children include general paediatric conditions, especially infections (which are often autochthonous ailments in their own country) and malnutrition, as well as neuropsychological and developmental disorders, such as psychomotor retardation, conduct and behavioural disorders, which sometimes stem from conflicts arising in the process of adaptation, communication problems, which occasionally reflect an autistic-like disorder, and the problems deriving from the circumstances that condition the donation of the child for adoption (perinatal pathology, maternal drug-addiction and withdrawal symptoms, maternal psychopathology...). The pathology, history and prognosis of the adopted child depend on several different factors that act in an accumulative fashion. The country of origin plays a decisive role in the type of pathology, according to the level of the health care system that exists there, the existence of adoption programmes that are regulated by law, etc. The child’s age at adoption marks the difference in the optimisation of their development, if they have early access to a stable family unit. Having stayed in institutions and the length of time spent there is a risk factor for presenting a neuropsychological pathology. On many occasions the scarce information available about the child’s medical history makes it more difficult to anticipate the appearance of certain problems. The existence of social risk factors in the biological families is a conditioning factor in increased morbidity. We describe a short series of adopted patients who were attended in our Neuropaediatric clinic, and we analyse the above-mentioned conditioning variables and the most frequent pathologies (AU)

[Spontaneous resolution of a congenital depressed skull fracture]. / Fractura hundimiento craneal congénita con resolución espontánea.

Congenital depressed skull fracture is rare and in most cases its etiology remains unclear. We present a female newborn infant with a congenital depressed skull fracture and no evidence of antepartum or intrapartum traumatism. The baby had normal neurological status and the depressed fracture healed spontaneously in a few weeks. Based on our experience of this case and a literature review, we conclude that congenital depressed skull fractures should be managed conservatively if the skull depression is less than 2cm, there is no previous trauma, no local edema or hematoma, and if the neonate shows normal neurological status.

Fractura-hundimiento craneal congénita con resolución espontánea / Spontaneous resolution of a congenital depressed skull fracture

Las fracturas craneales congénitas son un proceso poco frecuente cuya etiología queda en la mayoría de casos sin aclarar. Se presenta el caso de una recién nacida con fractura hundimiento craneal congénita, sin antecedente de traumatismo anteparto o intraparto, que evolucionó sin presentar ninguna sintomatología que, manteniendo una actitud expectante, presentó resolución espontánea de la fractura dentro de las primeras semanas de vida. Basándose en la experiencia de este caso y tras revisar la bibliografía sobre el tema la conclusión es que si no existe traumatismo previo, el recién nacido permanece neurológicamente asintomático, no hay signos locales de edema o hematoma y el hundimiento es menor de 2 cm, lo más recomendable consiste en una actitud expectante sin proceder a la reducción quirúrgica inmediata, ya que en estos casos la resolución espontánea es el resultado más probable (AU)

[Periventricular leukomalacia: neurological and radiological sequelae and long term neuropsychological repercussions]. / Leucomalacia periventricular: secuelas neurológicas, radiológicas y repercusiones neuropsicológicas a largo plazo.

INTRODUCTION: Periventricular leukomalacia is an anatomical diagnosis made by neuroimaging technics, of hypoxic-ischemic origin and a characteristic neurological syndrome consisting in cerebral palsy, visual impairment and/or mental retardation. Is more frequently seen in pre-term infant (5-10%) as a spastic diplegia or tetraplegia. Real prevalence in a-term infant is unknown and is presented as hemiplegia. The correlation between periventricular leukomalacia severity and clinical severity is not absolutely clarified. Is not still known if we can predict mental retardation in an infant with periventricular leukomalacia on magnetic resonance image. DEVELOPMENT: This paper revise the clinical and radiological diagnosis of periventricular leukomalacia and shows the results of a series of 31 patients diagnosed radiologically of periventricular leukomalacia. We correlate the degree of neurological and mental disabilities with the severity of periventricular leukomalacia. CONCLUSION: We reach a good correlation between the severity of periventricular leukomalacia and the severity of neurological disturbances and mental retardation.

Leucomalacia periventricular: secuelas neurológicas, radiológicas y repercusiones neuropsicológicas a largo plazo / Periventricular leukomalacia: neurological and radiological sequelas and long term neuropsychological repercussions

Introducción. La leucomalacia periventricular es un diagnóstico anatómico realizado por técnicas de neuroimagen, de etiología hipóxico-isquémica y de sintomatología neurológica residual, en la mayor parte de casos en forma de parálisis cerebral infantil, alteraciones visuales y/o retraso psicomotor. Afecta con más frecuencia al neonato prematuro y su incidencia se estima entre el 5 y 10 por ciento; provoca diplejía espástica o tetraplejía. En el recién nacido a término se desconoce la frecuencia real y suele presentarse como hemiplejía. La correlación entre la gravedad de las lesiones clínicas y las radiológicas no está del todo determinada, y se desconoce en qué medida se puede predecir un retraso psicomotor ante un diagnóstico de leucomalacia periventricular. Desarrollo. Este trabajo incluye una revisión sobre el diagnóstico clínico-radiológico de esta entidad y presenta los resultados de un estudio realizado sobre 31 niños con diagnóstico radiológico de leucomalacia periventricular. Se correlaciona el grado de lesión neurológica y de retraso psicomotor con la gravedad de las lesiones de leucomalacia periventricular. Conclusión. Se obtiene una buena correlación entre la gravedad de las lesiones de leucomalacia periventricular y el grado de afectación motora y neuropsicológica (AU)