[Disorders affecting the emotional sphere and impulse control in Parkinson's disease]. / Alteraciones de la esfera emocional y el control de los impulsos en la enfermedad de Parkinson.

INTRODUCTION: Parkinson's disease (PD) is associated with mood and behavioral symptoms contributing to morbidity and reduced quality of life of the patients. Most characteristic are depression, anxiety and impulse control disorder. DEVELOPMENT: Identification and treatment of neuropsychiatric symptoms is necessary for an appropriate management of PD. Affective symptoms may be the initial manifestation of PD, are highly prevalent and pathogenically complex. Impulse control disorders are usually not a spontaneous complaint, so asking about these symptoms may be the only way to detect and treat a serious socio-familial problem. Pharmacological treatment of these manifestations is difficult to balance with an adequate control of motor symptoms. Psychological support from early stages and throughout the evolution of PD is fundamental. CONCLUSIONS: Neurologist and other healthcare professionals treating PD patients need to be aware of behavioral and emotional manifestations of the disease. This will lead to an appropriate patient management and better adaptation of the familial and social situation.

[Behavioral disorders in Parkinson's disease. Genetic, pharmacological and medico-legal aspects]. / Trastornos del comportamiento en la enfermedad de Parkinson. Aspectos genéticos, farmacológicos y médico-legales.

INTRODUCTION: Patients with Parkinson's disease (PD) may present neuropsychiatric and conduct disorders at different stages of the development of the disease that make treatment even more difficult. DEVELOPMENT: The neurologist must be on the lookout for the possible appearance of alterations affecting impulse control, even from the early stages of the disease, so as to be able to prevent them or to plan a suitable adjustment of treatment. Some of the most common impulsivity disorders include hypersexuality, compulsive gambling and other addictive behaviours which, if left undetected and untreated, can end up having a destructive effect on the patient's socio-familial surroundings. Psychotic disorders (hallucinations, delusions) are often associated to advanced phases of PD and to the effect of dopamine therapy, and they are associated to a higher morbidity and mortality rate. Factors of a genetic or pharmacogenetic nature or a gene-environment interaction may account for the different individual susceptibility to disorders in the neuropsychiatric realm among patients with PD. It is wise to bear in mind the possible medico-legal implications that may stem from behavioral disorders, both for the patient and his or her family and for the physician, because situations could arise that trigger conflicts between confidentiality and preventing third parties from being harmed, as well as harm that can be attributed to the side effects of medicines. CONCLUSIONS: The specialist must be familiar with, foresee and propose suitable treatment for behavioral and neuropsychiatric disorders in PD with potential medico-legal implications.

Trastornos del comportamiento en la enfermedad de Parkinson. Aspectos genéticos, farmacológicos y médico-legales / Behavioral disorders in parkinson´s disease genetic, pharmacological and medico legal aspects

Resumen. Introducción. Los pacientes con enfermedad de Parkinson (EP) pueden presentar alteraciones neuropsiquiátricas y del comportamiento en diferentes estadios evolutivos de la enfermedad que dificulten el tratamiento. Desarrollo. Es necesario que el neurólogo esté atento a la posible aparición de alteraciones en el control de los impulsos, incluso desde fases tempranas de la enfermedad, para poder prevenirlas o planificar un ajuste adecuado del tratamiento. Entre los trastornos de impulsividad más comunes están la hipersexualidad, la ludopatía y otras conductas adictivas que, si no se detectan y tratan, pueden resultar destructivas para el entorno sociofamiliar del paciente. Los trastornos de la esfera psicótica (alucinaciones, ideas delirantes) a menudo están asociados a fases avanzadas de la EP y al efecto del tratamiento dopaminérgico, y se asocian con una mayor morbimortalidad. Es posible que factores genéticos, farmacogenéticos o una interacción gen-ambiente expliquen la diferente susceptibilidad individual a alteraciones en la esfera neuropsiquiátrica entre los pacientes con EP. Es conveniente recordar las posibles implicaciones médico-legales que pueden tener los trastornos de la conducta, tanto para el paciente y su familia como para el médico, pues se podrían plantear conflictos entre la confidencialidad y la prevención de daños a terceros, así como daño atribuible al efecto secundario de medicamentos. Conclusiones. Se debe conocer, prever y tratar adecuadamente las alteraciones de la conducta y neuropsiquiátricas en la EP, con implicaciones médicas y legales (AU)

Summary. Introduction. Patients with Parkinson’s disease (PD) may present neuropsychiatric and conduct disorders at different stages of the development of the disease that make treatment even more difficult. Development. The neurologist must be on the lookout for the possible appearance of alterations affecting impulse control, even from the early stages of the disease, so as to be able to prevent them or to plan a suitable adjustment of treatment. Some of the most common impulsivity disorders include hypersexuality, compulsive gambling and other addictive behaviours which, if left undetected and untreated, can end up having a destructive effect on the patient’s socio-familial surroundings. Psychotic disorders (hallucinations, delusions) are often associated to advanced phases of PD and to the effect of dopamine therapy, and they are associated to a higher morbidity and mortality rate. Factors of a genetic or pharmacogenetic nature or a gene-environment interaction may account for the different individual susceptibility to disorders in the neuropsychiatric realm among patients with PD. It is wise to bear in mind the possible medico-legal implications that may stem from behavioral disorders, both for the patient and his or her family and for the physician, because situations could arise that trigger conflicts between confidentiality and preventing third parties from being harmed, as well as harm that can be attributed to the side effects of medicines. Conclusions. The specialist must be familiar with, foresee and propose suitable treatment for behavioral and neuropsychiatric disorders in PD with potential medico-legal implications (AU)

[Primary cerebral lymphoma of T phenotype in an immunocompetent patient]. / Linfoma cerebral primario de fenotipo T en paciente inmunocompetente.

INTRODUCTION: Primary lymphoma of the central nervous system (PLCNS) makes up 1% of all intracranial tumours and 1% of all lymphomas [1]. It has been described in different types of immunodeficiencies, but in recent years has been increasingly found in immunocompetent persons. The LPSNC are usually B cell tumours, so the T phenotype is yet another rare aspect. CLINICAL CASE: A 62-year-old man, smoker, BCO, presented with a clinical picture (for the previous month and a half) of holocranial headache, positive Valsalva manoeuvre, unsteadiness, tendence to retropulsion and difficulty in starting to walk. On physical examination there was deficient orientation in time and space, slight dysarthria, regressive reflexes and ataxia on walking. Cerebral CT scan and MR scans showed periventricular, thalamic and mesencephalic lesions with behaviour suggestive of a lymphoma. Neoplasia was confirmed on biopsy. Three months later, whilst on corticotherapy and holocranial radiotherapy, the patient died from intercurrent infection. CONCLUSIONS: To date, including the present case, 51 cases of T lymphoma have been described in immunocompetent patients. Our case showed aspects described in the literature. These were: more often made [2], more often infratentorial [2-4] and of poor prognosis with regard to the degree of histological malignancy [5].