Cognitive versus behavioral ADHD phenotype: what is it all about?

The ADHD PASS assessment is discussed. 100 combined and 50 inattentive ADHD patients with DSM IV - TR criteria, no comorbidity, and no previous treatment were enrolled. Those with SNAP-IV> or =2.5/1.8 (teacher/parents) [n=96] were randomly assigned to 1 of 3 treatment groups: Concerta, humanistic psychology, and Concerta+psychology. Those with SNAP-IV<2.5/1.8 [n=54] to 1 of 2 groups: Concerta and Concerta+psychology. All of them [n=150] we administered the SNAP-IV and cognitive DN:CAS battery at baseline and 6 and 12 months later. Cluster analysis and paired Student t-test were applied. The cluster analysis produced three cognitive profiles: one [n=96] with planning dysfunction and SNAP-IV> or =2.5/1.8, the majority [n=76] combined ADHD; another [n=38] with successive processing dysfunction and SNAP-IV<2.5/1.8, the majority [n=28] inattentive ADHD; and another [n=16] without cognitive dysfunction and with SNAP-IV<2.5/1.8, [n=8] combined and [n=8] inattentive. Only planning ameliorated at 12 months assessment. It was better in group 3 (p<0.1) than in group 1 (p<0.5), than in group 2 (p<0.4/0.3). Remission was parallel to planning improvement, group 3>group 1> group 2. PASS assessment in ADHD may be relevant.

¿Procesamiento cognitivo, procesamiento fonémico o procesamiento temporal? / Cognitive, phonemic or temporal processing?

Introducción. Procesamiento cognitivo, procesamiento temporaly procesamiento fonémico son términos aplicados al procesamientodel lenguaje y la lectoescritura.Objetivo. Comprobar si el procesamiento fonémico se relacionacon el procesamiento temporal y con el procesamiento cognitivo.Métodos. Previo examen médico, se seleccionaron 36 niños condificultades fonémicas entre 7 y 14 años, niños/niñas en proporciónde 2:1, utilizando pruebas de procesamiento fonémico. Por cada sujetose seleccionaron con las mismas pruebas fonológicas dos controlesnormales. A los sujetos se administró la batería cognitiva DN:CASpara diagnóstico de procesamiento cognitivo y a sujetos y controlesuna prueba de procesamiento temporal acústica creada en laboratoriocuyos ítems eran dos tipos de sílabas: unas con período de transiciónde 40 ms y otras con más de 40 ms. Frecuencias y medias se analizaronestadísticamente. Se aplicó también análisis factorial con laspuntuaciones del DN:CAS y la prueba acústica.Resultados. Los sujetos cometieron más errores en comparacióncon controles en la prueba acústica (z=6,73; p<0,0000). La puntuaciónmedia en el DN:CAS de los sujetos fue inferior al grupo controlnormativo (t=3,64; p=0,001). El análisis factorial identificó la pruebaacústica como una prueba secuencial, con una explicación de lavarianza del 77%.Conclusiones. Se argumenta que las disfunciones fonológica,temporal y cognitiva pueden ser distintas expresiones de un mismomecanismo, lo que es de aplicación diagnóstica y terapéutica independientementede la edad. Se sugiere la posible utilidad práctica dela prueba acústica (AU)

Objective. To test whether temporal, phonemic, and cognitiveprocessing are interrelated.Methods. After medical screening, 36 subjects with phonemic difficulties,7 to 14 years-old, boy/ girl ratio of 2:1, were selected with phonemicprocessing tests. For every subject, two normal controls were alsoselected with the same phonemic tests. DN:CAS cognitive battery fordiagnosing of cognitive processing was administered to the subjectsand both subjects and controls were examined with an acoustic temporalprocessing test made in laboratory. This consisted of two kinds ofitems, syllables with transition period of 40 milliseconds and anotherlonger one. Proportions and means were statistically analyzed. Factorialanalysis was applied to scores in DN:CAS and syllabic acoustic tests.Results. When compared to the controls, the subjects mademore errors in the acoustic test (z=6.73; p<0.000). The DN:CASmean obtained by the subjects was lower than the standardardizedgroup (t=6.73; p=0.001). The factorial analysis accountingfor 77% of the variance identified the acoustic test as a sequentialprocessing test.Conclusions. Arguments are presented that suggest that phonemic,temporal, and cognitive processing may be differentexpressions of the same central neurological mechanism regardlessof the age. This implies diagnostic and therapeutic considerations.On the other hand, the acoustic test is suggested as a usefultest in assessing cognitive function (AU)

[Cognitive, phonemic or temporal processing?]. / ¿Procesamiento cognitivo, procesamiento fonémico o procesamiento temporal?

INTRODUCTION: Cognitive, temporal and phonemic processing are different terms applied to language and, in particular, reading- writing processing. OBJECTIVE: To test whether temporal, phonemic, and cognitive processing are interrelated. Methods. After medical screening, 36 subjects with phonemic difficulties, 7 to 14 years-old, boy/ girl ratio of 2:1, were selected with phonemic processing tests. For every subject, two normal controls were also selected with the same phonemic tests. DN:CAS cognitive battery for diagnosing of cognitive processing was administered to the subjects and both subjects and controls were examined with an acoustic temporal processing test made in laboratory. This consisted of two kinds of items, syllables with transition period of 40 milliseconds and another longer one. Proportions and means were statistically analyzed. Factorial analysis was applied to scores in DN:CAS and syllabic acoustic tests. RESULTS: When compared to the controls, the subjects made more errors in the acoustic test (z=6.73; p<0.000). The DN:CAS mean obtained by the subjects was lower than the standardized group (t=6.73; p=0.001). The factorial analysis accounting for 77% of the variance identified the acoustic test as a sequential processing test. CONCLUSIONS: Arguments are presented that suggest that phonemic, temporal, and cognitive processing may be different expressions of the same central neurological mechanism regardless of the age. This implies diagnostic and therapeutic considerations. On the other hand, the acoustic test is suggested as a useful test in assessing cognitive function.

Anfotericina B liposomal y leishmaniasis visceral en un paciente inmunocompetente / Liposomal amphotericin B and visceral leishmaniasis in an immunocompetent patient

Presentamos el caso de un lactante de 19 meses, previamente sano, con antecedentes de vivir en una zona semirrural y de tener un perro como animal de compañía, que presentaba la clínica de fiebre de 2 semanas de evolución y esplenomegalia gigante. La pancitopenia y la hipergammaglobulinemia características de la enfermedad estaban presentes. En la biopsia de médula ósea no se detectó el parásito, pero la serología para Leishmania infantum resultó positiva. Se comenta la sensibilidad del aspirado de médula ósea en el diagnóstico. El paciente recibió tratamiento con anfotericina B liposomal, y la respuesta fue excelente. Este caso amplía la poca experiencia acumulada respecto al tratamiento de esta enfermedad con anfotericina B liposomal, en particular en niños menores de 2 años

We report the case of a previously healthy 19-month-old boy whose family lived in the countryside and had a dog. He presented with a two-week history of fever and massive splenomegaly. The characteristic pancytopenia and hypergammaglobulinemia were also detected. Bone marrow biopsy was negative, but serology was positive for Leishmania infantum. We point out the sensitivity of the bone marrow aspirate in the diagnosis. The child was treated with liposomal amphotericin B with an excellent response. This case broadens the limited cumulative experience in treating this disease with liposomal amphotericin B, in particular, in children less than two years old

Rotavirus y su papel en la génesis de convulsiones / Rotavirus and its role in the genesis of afebrile seizures

No disponible

No disponible

Mecanismos cerebrales implicados en la toma de decisiones: ¿de qué se trata? / The brain mechanisms involved in making decisions: what exactly are we talking about?

No disponible

No disponible

[Topiramate and epilepsy in the light of Das-Naglieri Cognitive Assessment System]. / Topiramato y epilepsia a la luz del Das-Naglieri Cognitive Assessment System.

INTRODUCTION: Cognitive side effect is a possible effect of topiramate. Cognitive function is not unanimously defined and a test measures according to the concept is based on. On the other hand, behavioral dysfunction is frequent in epileptics and the euthimic effect of topiramate on impulsive dysfunction is known. AIMS: To asses the cognitive effect of topiramate with a modern battery, Das-Naglieri Cognitive Assessment System (DN:CAS), which diagnoses mental programs, but not only achievement. Also, to test the influence of topiramate on behavior. PATIENTS AND METHODS: As a prospective study, 35 patients with idiopathic or cryptogenic epilepsies were administered DN:CAS battery, and, simultaneously, patients and parents were given behavioral questionnaires at baseline, and after 6 and 12 months on topiramate. Cognitive scores were compared to those of a group of healthy controls at baseline, and baseline scores were compared to 6 and 12 months follow-up scores within the patient group. t-Student was applied. RESULTS: Patient scores were lower in successive processing before treatment as compared to controls (p < 0.001). After 6 months no change was noted. After 12 months of treatment, patients scored significantly better in planning processing than before treatment (p = 0.04) and, moreover, improved behavioral scores were noted. CONCLUSIONS: The patients showed a successive processing dysfunction not related with topiramate. An improved planning processing and behavioral pattern were observed 12 months after treatment. According to the euthimic effect of topiramate and the neurocognitive-neuroimpulsive interaction, a positive effect of topiramate on DN:CAS cognition and behavior can be postulated.

Topiramato y epilepsia a la luz del Das-Naglieri Cognitive Assessment System / Topiramate and epilepsy in the light of Das-Naglieri Cognitive assessment system

Introducción. El efecto cognitivo indeseable es un posible efecto del topiramato (TPM). La definición de función cognitiva no es unánime, y una prueba mide según el concepto en que se basa. También son frecuentes las disfunciones de comportamiento en los epilépticos y se conoce el efecto eutímico del TPM sobre la disfunción impulsiva. Objetivo. Comprobar el efecto cognitivo del TPM con la moderna batería cognitiva DN:CAS (Das-Naglieri Cognitive Assessment System) de fundamento neurológico, que diagnostica programas mentales y no exclusivamente rendimiento. Asimismo, comprobar si el TPM influye en los comportamientos. Pacientes y métodos. Como estudio prospectivo, a 35 pacientes con epilepsia idiopática o criptogenética se les administró el DN: CASy a pacientes y padres cuestionarios de comportamientos antes del tratamiento y 6 y 12 meses después. Las puntuaciones de antes del tratamiento se compararon con un grupo control. Se aplicó la t de Student. Resultados. Antes del tratamiento, los epilépticos de la muestra, en comparación con los controles, puntuaron significativamente peor en secuencial (p < 0,001). Seis meses después, las puntuaciones no cambiaron significativamente. 12 meses después, los pacientes puntuaron significativamente mejor en planificación (p = 0,04) con respecto a antes del tratamiento. A los 12 meses, asimismo, mejoraron significativamente los comportamientos, según las escalas aplicadas. Conclusiones. Los epilépticos de la muestra presentaron una disfunción secuencial no atribuible al tratamiento. A los 12 meses, mostraron una mejor planificación DN:CAS y un mejor comportamiento. Se postula una posible explicación según el efecto eutímico del TPM y los conocimientos actuales de interacción entre los circuitos neurocognitivos y neuroimpulsivos (AU)

Introduction. Cognitive side effect is a possible effect of topiramate. Cognitive function is not unanimously defined and a test measures according to the concept is based on. On the other hand, behavioral dysfunction is frequent in epileptics and the euthimic effect of topiramate on impulsive dysfunction is known. Aims. To asses the cognitive effect of topiramate with a modern battery, Das-Naglieri Cognitive Assessment System (DN:CAS), which diagnoses mental programs, but not only achievement. Also, to test the influence of topiramate on behavior. Patients and methods. As a prospective study, 35 patients with idiopathic or cryptogenic epilepsies were administered DN:CAS battery, and, simultaneously, patients and parents were given behavioral questionnaires at baseline, and after 6 and 12 months on topiramate. Cognitive scores were compared to those of a group of healthy controls at baseline, and baseline scores were compared to 6 and 12 months follow-up scores within the patient group. t-Student was applied. Results. Patient scores were lower in successive processing before treatment as compared to controls (p < 0.001). After 6 months no change was noted. After 12 months of treatment, patients scored significantly better in planning processing than before treatment (p = 0.04) and, moreover, improved behavioral scores were noted. Conclusions. The patients showed a successive processing dysfunction not related with topiramate. An improved planning processing and behavioral pattern were observed 12 months after treatment. According to the euthimic effect of topiramate and the neurocognitive-neuroimpulsive interaction, a positive effect of topiramate on DN:CAS cognition and behavior can be postulated (AU)

La función intelectual: ¿de qué se trata? / Intellectual function: what is it about?

Introducción: La función intelectual no está claramente definida en términos neurológicos. Desde 1994, se dispone de una concepción basada en evidencias neurológicas, conocida como teoría PASS, acrónimo de los cuatro programas definidos: planificación, atención, simultáneo y secuencial. Objetivo: Comprobar si la batería WISC-R (Wechsler InteIligence Scale for Children-Revised) valora la función cognitiva PASS y, en particular, la planificación, el programa de mayor rendimiento intelectual y el más susceptible de ser tratado. Material y métodos: Se seleccionaron 60 pacientes, con una escolaridad normal, de edades comprendidas entre los 5 y 12 años: mitad niños y mitad niñas. Procedimiento: administración del WISC-R y DN:CAS (Das Naglieri: Cognitive Assessment System), batería traducida y validada para la valoración de los procesamientos PASS. Resultados: Mediante análisis factorial se verificó la discriminación de los cuatro procesamientos PASS (planificación, atención, secuencial y simultáneo) y, a la vez, su correspondencia con las pruebas del WISC-R. Las pruebas de este último se corresponden, sobre todo, con el procesamiento simultáneo y menos con el secuencial y la atención; ninguna prueba se corresponde con la planificación; y algunas pruebas lo hacen con un factor que no es procesamiento PASS. Discusión y conclusiones: Se explica el concepto PASS haciendo énfasis en la planificación y su relación con la denominada función ejecutiva. Se sostiene la ventaja, desde el punto de vista diagnóstico y terapéutico, que supone poder valorar la capacidad intelectual como mecanismo de producción neurológico, utilizando pruebas específicas no heterogéneas al alcance, incluso, de pediatras del desarrollo y pediatría social. Se insiste en la concepción dinámica de inteligencia y se sugiere una redefinición del retraso mental

Introduction. Intellectual function has not yet been clearly defined in neurological terms. In 1994, a conception was introduced based on neurological evidence, the theory known as PASS, which stands for four programs: planning, attention, simultaneous and successive. Objective. To determine whether the Wechsler Intelligence Scale for Children-Revised (WISC-R) cognitive battery assesses the cognitive PASS function, in particular, planning, the program involving the highest intellectual performance and that most susceptible to treatment, if necessary. Material and methods. Sixty children (30 boys and 30 girls aged 5 to 12 years) with a normal level of schooling were selected. The procedure consisted of administering the WISC-R and the Das-Naglieri Cognitive Assessment System (DN:CAS), a battery translated and validated for assessing PASS processing. Results. The discrimination of the four PASS processes, planning, attention, simultaneous and successive, was verified by factorial analysis. The correspondence between PASS processing and the WISC-R tests was also established. The WISC-R tests primarily assess PASS simultaneous processing and, to some extent, successive and attention. No WISC-R test identifies PASS planning processing. Some tests identify a factor that is not a PASS process. Discussion and conclusions. The PASS concept places particular emphasis on planning and its relationship to the so-called executive function. The advantage, from both the diagnostic and therapeutic points of view, is that it enables the assessment of intellectual capacity as a neurological mechanism of production by means of specific, non-heterogeneous tests that can be used by pediatricians in both the developmental and social areas. We insist on the dynamic conception of intelligence this knowledge implies, and suggest a redefinition of mental retardation

[Emotional behaviors as a neurological dysfunction]. / Conductas emocionales como disfunción neurológica.

INTRODUCTION: The hypothesis of the emotional component of behaviors can be explained by a specific neurological mechanism was stated. PATIENTS AND METHODS: A sample of 749 cases, all between 5 and 14 year old, with different behavioral and cognitive problems was selected from attendance to the Neuropediatric/Neuropsychopedagogic Unit from 1994 to 2000. A sub sample of 20 cases with PASS planning processing scoring less than 1SD was also selected. A design of mainly qualitative research according to case analysis was followed, behavioral data being provided by patients and their parents and analyzed with video recorder assistance. To avoid the study to be biased techniques as triangulation were applied. Quantitative cognitive data were obtained by using DN:CAS battery for diagnosis of PASS processing. A procedure for diagnosis and treatment of behaviors, previously reported, was followed. The cases of the sub sample were tested before and after emotional treatment without cognitive remediation, the results being tested by Student t. RESULTS: The responders were 82% according to not only the criterion of solution of the behavioral problem, for example, anorexia, psychosomatism, non neurological paroxysm an so on, but also, the sufficient amelioration assessed by the patients, their parents and the researchers. All cases, however, were required the disappearance of observable defensive behaviors in enough quantity to deduce an important maturation change. Significant difference was observed in planning. DISCUSSION: Defensive behaviors as masquerade behaviors are explained in the light of neurological reasons. The neurological processing of the sensibility of danger is emphasized according to the most recent knowledge. CONCLUSION: All behaviors can activate the neurological processing of danger feeling

Conductas emocionales como disfunción neurológica / Emotional behaviors as a neurological dysfunction

Introducción. Se plantea la hipótesis de si el componente emocional de las conductas puede explicarse por un mecanismo neurológico determinado. Pacientes y métodos. Se seleccionó una muestra de 749 casos, de edades entre 5 y 14 años, con diversos problemas conductuales y cognitivos atendidos en la Unidad de Neuropediatría/ Neuropsicopedagogía, entre 1994-2000, y una submuestra de 20 casos seleccionados por tener, además, el procesamiento cognitivo PASS planificación en valores de -1 DE. El diseño es de investigación preferentemente cualitativa de análisis de casos con el empleo de datos conductuales, aportados por pacientes y padres, analizados con registro audiovisual. Se emplearon técnicas consideradas adecuadas, como la triangulación, para obviar posibles sesgos. Los datos cognitivos fueron, fundamentalmente, los valores cuantitativos proporcionados por la batería DN:CAS para el diagnóstico PASS. Se aplicó un procedimiento de diagnóstico-intervención previamente publicado. Se practicó un estudio pretest-retest con la submuestra antes y después del tratamiento emocional sin tratamiento cognitivo, con la aplicación de la t de Student. Resultados. Los respondedores fueron 82 por ciento, y el criterio fue la curación del problema motivo de la consulta, anorexia, trastorno somatomorfo, paroxismo no neurológico, etc., o la mejora en un grado mínimamente suficiente según el/la paciente, los padres y los investigadores; se exigió, además, la desaparición de las conductas defensivas objetivables, en cantidad suficiente como para indicar un cambio madurativo importante. La planificación mejoró con significación estadística. Discusión. Se explican con detalle las conductas de defensa denominadas enmascaradoras y se hace hincapié en el procesamiento neurológico de la `sensibilidad' de peligro, según los conocimientos más actuales. Conclusión. Todas las conductas pueden activar el procesamiento neurológico del `sentir peligro' (AU)

Hair dye treatment use and clinical course in patients with systemic lupus erythematosus and cutaneous lupus.

The etiological role of hair dye treatment (HDT), some of them such as permanent hair dyes containing aromatic amines, in the development of SLE has been previously ruled out. However, the possible influence of HDT use on the course and prognosis of lupus patients has been assessed only in one short-term study. Since HDT is very extensive among the population, the knowledge of this possible negative effect may be very important. Thus, the aim of this study was to assess the long-term influence of several HDTs on the course and clinical severity of patients with both systemic lupus erythematosus (SLE) and cutaneous lupus (CL). In this longitudinal case series study, 91 SLE patients and 22 CL patients were prospectively studied from October 1988 to May 2000. They were divided into three groups: (a) non-HDT users--patients who have never used HDT (n = 65); (b) P-HDT users--HDT permanent type users, alone or in combination with other types of HDT (n = 28); (c) non P-HDT--users of other treatments different from permanent tinting (bleach, lowlights, etc; n = 20). In each patient we determined: (1) number of flares/year in SLE patients and worsening of cutaneous lesions for CL; (2) Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index; (3) predominant damaged organs/systems according to the HDT use and type of HDT; and (4) subjective impression about the disease evolution in relation to HDT use. No significant differences were found with respect to flares/year and SLICC/ACR damage index between the study groups. Non-HDT group presented more renal involvement and serositis than both HDT-user groups. No patient related the HDT use to the worsening of his disease. Therefore, in this study no evidence of an association between the long-term use of several types of HDT and the clinical activity and course of SLE and CL was found.

[PASS neurocognitive dysfunction in attention deficit]. / Disfunción neurocognitiva PASS del déficit de atención.

INTRODUCTION: Attention deficit disorder shows both cognitive and behavioral patterns. OBJECTIVE: To determine a particular PASS (planning, attention, successive and simultaneous) pattern in order to early diagnosis and remediation according to PASS theory. PATIENTS AND METHODS: 80 patients were selected from the neuropediatric attendance, aged 6 to 12 years old, 55 boys and 25 girls. Inclusion criteria were inattention (80 cases) and inattention with hyperactive symptoms (40 cases) according to the Diagnostic and Statistical Manual (DSM-IV). Exclusion criteria were the criteria of phonologic awareness previously reported, considered useful to diagnose dyslexia. A control group of 300 individuals, aged 5 to 12 years old, was used, criteria above mentioned being controlled. DN:CAS (Das-Naglieri Cognitive Assessment System) battery, translated to native language, was given to assess PASS cognitive processes. Results were analyzed with cluster analysis and t-Student test. Statistical factor analysis of the control group had previously identified the four PASS processes: planning, attention, successive and simultaneous. RESULTS: The dendrogram of the cluster analysis discriminated three categories of attention deficit disorder: 1. The most frequent, with planning deficit; 2. Without planning deficit but with deficit in other processes, and 3. Just only a few cases, without cognitive processing deficit. Cognitive deficiency in terms of means of scores was statistically significant when compared to control group (p = 0.001). CONCLUSIONS: According to PASS pattern, planning deficiency is a relevant factor. Neurological planning is not exactly the same than neurological executive function. The behavioral pattern is mainly linked to planning deficiency, but also to other PASS processing deficits and even to no processing deficit.