Nuevas evidencias en la alopecia por strés: papel de los nutricosméticos con pasiflora / New evidences in stress alopecia: role of nutricosmetics with passiflora

RESUMEN: El estrés es un factor desencadenante del efluvio telógeno y de otros tipos de alopecia, dificultando su control. Elmodelo del "eje cerebro-folículo piloso", establece que el estrés altera el ciclo del folículo capilar, terminando prematuramente su crecimiento y activando la apoptosis y distintos eventos inflamatorios nocivos, alrededor del folículo. En él, la sustancia SP, un neuropéptidoinmunomodulador, desempeña un papel esencial. El extracto de pasiflora (Passifloraincarnata L.),autorizado por la EMA para el alivio temporal de los síntomas leves de estrés mental, ha demostrado ser eficaz y seguro frente al estrés subyacente a la alopecia. Actúa sobre la sustancia P y sobre el sistema de neurotransmisión del ácido gamma-aminobutírico (GABA), además de presentar propiedades antioxidantes. Se revisa a continuación la evidencia científica disponible.

SUMMARY: Stress is a trigger for telogen effluvium and other types of alopecia and makes it difficult to control. The "brain-hair follicle axis" establishes that stress alters the hair follicle cycle, prematurely ending its growth and activating apoptosis and various harmful inflammatory events around the follicle. Substance P, an immunomodulatory neuropeptide, plays a key role in this cascade. The extract of passionflower (Passifloraincarnata L.), authorized by the EMA for the temporary relief of mild symptoms of mental stress, has shown to be effective and safe against the stress underlying alopecia. It acts on substance P and on the neurotransmission system of gamma-aminobutyric acid (GABA), in addition to its antioxidant properties. The available evidence is reviewed below.

Eficacia terapéutica frente a la caspa grasa y la caspa seca de compuestos basados en terpineol, ácido salicílico y climbazol / Therapeutic effectiveness against oily or dry dandruff of compounds based on terpineol, salicylic acid and climbazole

Introducción: la caspa se define como una descamación excesiva del cuero cabelludo, en general acompañada de prurito. Su etiología es multifactorial y depende de la presencia de levaduras del género Malassezia, de la producción de sebo y de la susceptibilidad individual. Más allá de los tratamientos tradicionales para controlar la caspa, existen nuevas formulaciones que pueden incluir queratolíticos como el ácido salicílico, el climbazol, que además de agente antimicótico presenta potenciales propiedades antiproteolíticas o el terpineol, antimicótico de amplio espectro con acción antiinflamatoria. Objetivo: el objetivo principal de este estudio, consistió en evaluar el efecto sobre la caspa grasa de un champú con terpineol, extracto de sauce, ácido salicílico, climbazol y lipoaminoácido seborregulador y de una loción con terpineol, ácido salicílico, climbazol y glucósidos del extracto de roble y té verde. Se evaluó igualmente la eficacia sobre la caspa seca de un champú con terpineol, extracto de sauce, ácido salicílico y climbazol. Se realizaron una visita inicial (T0), otra al finalizar tratamiento (T28) y una final (T42), para evaluar la eventual reaparición de la caspa una vez suspendido el tratamiento. Material y Método: estudio unicéntrico abierto, no aleatorizado, a simple ciego, de 42 días de duración, llevado a cabo en 78 pacientes con caspa grasa o seca. Se clasificó la gravedad de la caspa en 4 grados. Según el tipo de caspa y su grado, se administraron un champú para caspa grasa (A), un champú para caspa seca (B), una loción para caspa grasa (C) o un champú neutro (D). Se establecieron 4 grupos de tratamiento en función del producto asignado (A, B, AC y CD). Resultados: un 59% de los participantes fueron mujeres y un 41% varones. La edad media fue de 47 años (rango 20-72). Del total de pacientes: 20 presentaron caspa grasa en grado medio-bajo (grupo A), 20 caspa seca en cualquier grado (grupo B), 17 caspa grasa en grado elevado (grupo AC) y 21 caspa grasa en grado medio-alto (grupo CD). Al cabo de cuatro semanas de tratamiento, el grado de caspa se redujo vs. basal en ≥70% de los casos en todos los grupos. Estas cifras ascendieron, en los pacientes con caspa grasa, a un 70% (grado bajo-medio), un 76,2% (grado medio-alto) y un 88,2% (grado elevado); el efecto fue más notable en aquellos con caspa seca, donde la cifra fue del 90%. La eliminación de la caspa fue completa en el 78,5%, 62,5%, 47% y 44,4% de ellos, respectivamente. Una vez transcurridas las dos semanas de lavado posterior al tratamiento, el nivel de caspa siguió descendiendo en un 55% de los pacientes tratados con el champú A, un 57,1% de los que emplearon la loción C, el 58,8% de los que usaron el champú A + la loción C, y el 35% de los que recibieron el champú B. Se declararon satisfechos o muy satisfechos con el producto un 70% de los pacientes del grupo A, un 80% del grupo B, un 66,7% del grupo CD y un 70,6% del grupo AD. Conclusiones: los resultados obtenidos en este estudio, orientan acerca de la eficacia frente a la caspa grasa y la caspa seca de dos champúes y una loción basados en terpineol, ácido salicílico y climbazol. Se requieren investigaciones adicionales que amplíen los resultados en este campo.

Introduction: dandruff is defined as excessive flaking of the scalp accompanied by itching. The etiology is multifactorial and depends on the presence of Malassezia yeasts, sebum production and individual susceptibility. Beyond traditional treatments to control dandruff, there are new formulations that may include keratolytics such as salicylic acid; climbazole, an antifungal agent which potential antiproteolytic properties, or terpineol, broad-spectrum antifungal with antiinflammatory action. Objective: the main objective of this study was to evaluate the effect on seborrheic dandruff of a shampoo with terpineol, willow extract, salicylic acid, climbazole and sebum-regulating lipoaminoacid, and a lotion with terpineol, salicylic acid, climbazole and glycosides from oak and green tea extract. Effectiveness on dry dandruff of a shampoo containing terpineol, willow extract, salicylic acid and climbazole was also evaluated. Three study visits were performed (T0, T28 and T42). Methods: single-center, open, non-randomized, single-blind, 42-day study conducted in 78 patients with seborrheic or dry dandruff. Dandruff severity was classified into 4 grades. A shampoo for oily dandruff (A), a shampoo for dry dandruff (B), a lotion for oily dandruff (C) and a neutral shampoo (D) were administered. Four treatment groups were established according to the assigned treatment (A, B, AC and CD). Results: 59% of participants were women and 41% men. The average age was 47 years (range 20-72). Of the total patients, 20 had medium-low oily dandruff (group A), 20 dry dandruff at any level (group B), 17 severe oily dandruff (AC) and 21 medium-high oily dandruff (group CD). After four weeks of treatment the severity of dandruff was reduced vs. baseline in ≥70% of cases in all groups; for oily dandruff results were 70% (low-medium grade), 76.2% (medium-high) and 88.2% (high level); the effect was most marked in patients with dry dandruff (90%). Dandruff removal was complete in 78.5%, 62.5%, 47% and 44.4% of them, respectively. Two weeks after having suspended the treatment, dandruff level continued to decline in 55% of patients treated with shampoo A, 57.1% of those who used the lotion C, 58.8% of patients who used shampoo A + lotion C, and 35% of those receiving shampoo B. Seventy per cent of patients in group A, 80% in group B, 66.7% of the CD group and 70.6% of the AD group were satisfied or very satisfied with the study treatments. Conclusions: the results obtained in this study suggest the effectiveness against oily and dry dandruff of two shampoos and a lotion based on terpineol, salicylic acid and climbazole. Further research to extend the results in this field is required.

Eficacia terapéutica frente a la caspa grasa y la caspa seca de compuestos basados en terpineol, ácido salicílico y climbazol / Therapeutic effectiveness against oily or dry dandruff of compounds based on terpineol, salicylic acid and climbazole

Introducción: la caspa se define como una descamación excesiva del cuero cabelludo, en general acompañada de prurito. Su etiología es multifactorial y depende de la presencia de levaduras del género Malassezia, de la producción de sebo y de la susceptibilidad individual. Más allá de los tratamientos tradicionales para controlar la caspa, existen nuevas formulaciones que pueden incluir queratolíticos como el ácido salicílico, el climbazol, que además de agente antimicótico presenta potenciales propiedades antiproteolíticas o el terpineol, antimicótico de amplio espectro con acción antiinflamatoria. Objetivo: el objetivo principal de este estudio, consistió en evaluar el efecto sobre la caspa grasa de un champú con terpineol, extracto de sauce, ácido salicílico, climbazol y lipoaminoácido seborregulador y de una loción con terpineol, ácido salicílico, climbazol y glucósidos del extracto de roble y té verde. Se evaluó igualmente la eficacia sobre la caspa seca de un champú con terpineol, extracto de sauce, ácido salicílico y climbazol. Se realizaron una visita inicial (T0), otra al finalizar tratamiento (T28) y una final (T42), para evaluar la eventual reaparición de la caspa una vez suspendido el tratamiento. Material y Método: estudio unicéntrico abierto, no aleatorizado, a simple ciego, de 42 días de duración, llevado a cabo en 78 pacientes con caspa grasa o seca. Se clasificó la gravedad de la caspa en 4 grados. Según el tipo de caspa y su grado, se administraron un champú para caspa grasa (A), un champú para caspa seca (B), una loción para caspa grasa (C) o un champú neutro (D). Se establecieron 4 grupos de tratamiento en función del producto asignado (A, B, AC y CD). Resultados: un 59% de los participantes fueron mujeres y un 41% varones. La edad media fue de 47 años (rango 20-72). Del total de pacientes: 20 presentaron caspa grasa en grado medio-bajo (grupo A), 20 caspa seca en cualquier grado (grupo B), 17 caspa grasa en grado elevado (grupo AC) y 21 caspa grasa en grado medio-alto (grupo CD). Al cabo de cuatro semanas de tratamiento, el grado de caspa se redujo vs. basal en ≥70% de los casos en todos los grupos. Estas cifras ascendieron, en los pacientes con caspa grasa, a un 70% (grado bajo-medio), un 76,2% (grado medio-alto) y un 88,2% (grado elevado); el efecto fue más notable en aquellos con caspa seca, donde la cifra fue del 90%. La eliminación de la caspa fue completa en el 78,5%, 62,5%, 47% y 44,4% de ellos, respectivamente. Una vez transcurridas las dos semanas de lavado posterior al tratamiento, el nivel de caspa siguió descendiendo en un 55% de los pacientes tratados con el champú A, un 57,1% de los que emplearon la loción C, el 58,8% de los que usaron el champú A + la loción C, y el 35% de los que recibieron el champú B. Se declararon satisfechos o muy satisfechos con el producto un 70% de los pacientes del grupo A, un 80% del grupo B, un 66,7% del grupo CD y un 70,6% del grupo AD. Conclusiones: los resultados obtenidos en este estudio, orientan acerca de la eficacia frente a la caspa grasa y la caspa seca de dos champúes y una loción basados en terpineol, ácido salicílico y climbazol. Se requieren investigaciones adicionales que amplíen los resultados en este campo.(AU)

Introduction: dandruff is defined as excessive flaking of the scalp accompanied by itching. The etiology is multifactorial and depends on the presence of Malassezia yeasts, sebum production and individual susceptibility. Beyond traditional treatments to control dandruff, there are new formulations that may include keratolytics such as salicylic acid; climbazole, an antifungal agent which potential antiproteolytic properties, or terpineol, broad-spectrum antifungal with antiinflammatory action. Objective: the main objective of this study was to evaluate the effect on seborrheic dandruff of a shampoo with terpineol, willow extract, salicylic acid, climbazole and sebum-regulating lipoaminoacid, and a lotion with terpineol, salicylic acid, climbazole and glycosides from oak and green tea extract. Effectiveness on dry dandruff of a shampoo containing terpineol, willow extract, salicylic acid and climbazole was also evaluated. Three study visits were performed (T0, T28 and T42). Methods: single-center, open, non-randomized, single-blind, 42-day study conducted in 78 patients with seborrheic or dry dandruff. Dandruff severity was classified into 4 grades. A shampoo for oily dandruff (A), a shampoo for dry dandruff (B), a lotion for oily dandruff (C) and a neutral shampoo (D) were administered. Four treatment groups were established according to the assigned treatment (A, B, AC and CD). Results: 59% of participants were women and 41% men. The average age was 47 years (range 20-72). Of the total patients, 20 had medium-low oily dandruff (group A), 20 dry dandruff at any level (group B), 17 severe oily dandruff (AC) and 21 medium-high oily dandruff (group CD). After four weeks of treatment the severity of dandruff was reduced vs. baseline in ≥70% of cases in all groups; for oily dandruff results were 70% (low-medium grade), 76.2% (medium-high) and 88.2% (high level); the effect was most marked in patients with dry dandruff (90%). Dandruff removal was complete in 78.5%, 62.5%, 47% and 44.4% of them, respectively. Two weeks after having suspended the treatment, dandruff level continued to decline in 55% of patients treated with shampoo A, 57.1% of those who used the lotion C, 58.8% of patients who used shampoo A + lotion C, and 35% of those receiving shampoo B. Seventy per cent of patients in group A, 80% in group B, 66.7% of the CD group and 70.6% of the AD group were satisfied or very satisfied with the study treatments. Conclusions: the results obtained in this study suggest the effectiveness against oily and dry dandruff of two shampoos and a lotion based on terpineol, salicylic acid and climbazole. Further research to extend the results in this field is required.(AU)

Eficacia de un complemento alimenticio con serenoa serrulata y tocotrienol-tocoferol frente a la alopecia androgenética y el efluvio telógeno femeninos: A propósito de un estudio piloto / Effectiveness of a dietary supplement with serenoa serrulata and tocotrienol-tocopherol against female androgenetic alopecia and telogen effluvium: Report of a pilot study

Introducción: la alopecia androgenética femenina (FAGA) y el efluvio telógeno (ET), son causas comunes de pérdida de cabello en las mujeres. Un hecho conocido en estos tipos de alopecia es la mayor actividad de la 5α-reductasa, que reduce la testosterona a dihidro-testosterona, andrógeno que acelera el ciclo capilar y acorta su duración. La Serenoa serrulata es una especie vegetal, cuyos componentes presentan un efecto inhibidor de la 5α-reductasa. Objetivo: el objetivo principal de este estudio, consistió en valorar la eficacia y la tolerancia, frente a la alopecia femenina de la administración diaria oral, de un complemento alimenticio con extracto de Serenoa serrulata, L-cistina, complejo tocotrienol-tocoferol, hierro, zinc y vitaminas H, B1, B2, B3, B5, B6 y B12 durante seis meses. Material y Método: estudio piloto unicéntrico, abierto, no aleatorizado, a simple ciego, de 180 días de duración, llevado a cabo en voluntarias con FAGA o ET. Se valoró el aspecto macroscópico del cabello, la densidad capilar mediante microfotografía, la relación anágena / telógena (A/T) mediante tricograma, el número de cabellos desprendidos mediante ensayos de peinado ("combing test") y de lavado ("wash test"). Se realizó una encuesta de autovaloración de los resultados. Resultados: la edad media de las participantes (n=10) fue de 40±15,5 años. El tiempo de evolución fue de 4,5±2 años y de tres meses para la FAGA y el ET, respectivamente. Al final del tratamiento las participantes presentaron un incremento medio del 6,9%, en la proporción de cabellos en fase anágena y la relación A/T media aumentó a 3,3. El 80% mostraron una mayor densidad capilar al finalizar el estudio. Al cabo de tres meses, todas las participantes presentaron una reducción media de la pérdida de cabellos del 56%, respecto de la visita basal. El 90% percibieron una mayor o igual cantidad de cabello al final del estudio y el 80% lo notaron más fuerte. No se registró ninguna molestia inducida por el tratamiento. Conclusiones: la buena evolución de las variables analizadas apunta a un beneficio terapéutico, frente a la FAGA y el ET. Estudios con mayor número de pacientes, son necesarios a futuro.

Introduction: female androgenetic alopecia (FAGA) and telogen effluvium (TE) are common causes of hair loss in women. A known fact in these types of alopecia is the increased activity of 5a-reductase which reduces testosterone to dihydrotestosterone, accelerating hair cycle and shortening its duration. Serenoa serrulata is a plant species whose components have an inhibitory effect on 5a reductase. Objective: the main objective of this study was to evaluate the efficacy and tolerance against female alopecia of a food supplement with Serenoa serrulata extract, L-cystine, tocotrienol-tocopherol complex, iron, zinc, and vitamins H, B1, B2, B3, B5, B6 and B12 administered daily for six months. Material and Methods: single-center, open-label, non-randomized, single-blind, 180-days pilot study conducted in women with FAGA or TE. The study assessed the macroscopic appearance of the hair, hair density by microphotograph, the anagen / telogen ratio (A/T) by trichogram, and the number of detached hair by combing and wash tests. Self-assessment survey of the results was performed. Results: the mean age of participants (n = 10) was 40 ± 15.5 years. FAGA and ET had an evolution of 4.5 ± two years and three months, respectively. After treatment the participants had an average increase of 6.9% in the proportion of hairs in anagen phase, and the mean A/T ratio increased to 3.3. Eighty percent or patients showed an increased capillary density at study end. After three months, all participants had a mean reduction of hair loss of 56% vs baseline. Ninety percent perceived a greater or equal amount of hair at the end of the study and 80% noticed it stronger. No adverse effects induced by treatment were observed. Conclusions: the good results of the analyzed variables suggest a therapeutic benefit against FAGA and ET. Additional research is warranted to confirm the observed data.

Eficacia de un complemento alimenticio con serenoa serrulata y tocotrienol-tocoferol frente a la alopecia androgenética y el efluvio telógeno femeninos: A propósito de un estudio piloto / Effectiveness of a dietary supplement with serenoa serrulata and tocotrienol-tocopherol against female androgenetic alopecia and telogen effluvium: Report of a pilot study

Introducción: la alopecia androgenética femenina (FAGA) y el efluvio telógeno (ET), son causas comunes de pérdida de cabello en las mujeres. Un hecho conocido en estos tipos de alopecia es la mayor actividad de la 5α-reductasa, que reduce la testosterona a dihidro-testosterona, andrógeno que acelera el ciclo capilar y acorta su duración. La Serenoa serrulata es una especie vegetal, cuyos componentes presentan un efecto inhibidor de la 5α-reductasa. Objetivo: el objetivo principal de este estudio, consistió en valorar la eficacia y la tolerancia, frente a la alopecia femenina de la administración diaria oral, de un complemento alimenticio con extracto de Serenoa serrulata, L-cistina, complejo tocotrienol-tocoferol, hierro, zinc y vitaminas H, B1, B2, B3, B5, B6 y B12 durante seis meses. Material y Método: estudio piloto unicéntrico, abierto, no aleatorizado, a simple ciego, de 180 días de duración, llevado a cabo en voluntarias con FAGA o ET. Se valoró el aspecto macroscópico del cabello, la densidad capilar mediante microfotografía, la relación anágena / telógena (A/T) mediante tricograma, el número de cabellos desprendidos mediante ensayos de peinado ("combing test") y de lavado ("wash test"). Se realizó una encuesta de autovaloración de los resultados. Resultados: la edad media de las participantes (n=10) fue de 40±15,5 años. El tiempo de evolución fue de 4,5±2 años y de tres meses para la FAGA y el ET, respectivamente. Al final del tratamiento las participantes presentaron un incremento medio del 6,9%, en la proporción de cabellos en fase anágena y la relación A/T media aumentó a 3,3. El 80% mostraron una mayor densidad capilar al finalizar el estudio. Al cabo de tres meses, todas las participantes presentaron una reducción media de la pérdida de cabellos del 56%, respecto de la visita basal. El 90% percibieron una mayor o igual cantidad de cabello al final del estudio y el 80% lo notaron más fuerte. No se registró ninguna molestia inducida por el tratamiento. Conclusiones: la buena evolución de las variables analizadas apunta a un beneficio terapéutico, frente a la FAGA y el ET. Estudios con mayor número de pacientes, son necesarios a futuro.(AU)

Introduction: female androgenetic alopecia (FAGA) and telogen effluvium (TE) are common causes of hair loss in women. A known fact in these types of alopecia is the increased activity of 5a-reductase which reduces testosterone to dihydrotestosterone, accelerating hair cycle and shortening its duration. Serenoa serrulata is a plant species whose components have an inhibitory effect on 5a reductase. Objective: the main objective of this study was to evaluate the efficacy and tolerance against female alopecia of a food supplement with Serenoa serrulata extract, L-cystine, tocotrienol-tocopherol complex, iron, zinc, and vitamins H, B1, B2, B3, B5, B6 and B12 administered daily for six months. Material and Methods: single-center, open-label, non-randomized, single-blind, 180-days pilot study conducted in women with FAGA or TE. The study assessed the macroscopic appearance of the hair, hair density by microphotograph, the anagen / telogen ratio (A/T) by trichogram, and the number of detached hair by combing and wash tests. Self-assessment survey of the results was performed. Results: the mean age of participants (n = 10) was 40 ± 15.5 years. FAGA and ET had an evolution of 4.5 ± two years and three months, respectively. After treatment the participants had an average increase of 6.9% in the proportion of hairs in anagen phase, and the mean A/T ratio increased to 3.3. Eighty percent or patients showed an increased capillary density at study end. After three months, all participants had a mean reduction of hair loss of 56% vs baseline. Ninety percent perceived a greater or equal amount of hair at the end of the study and 80% noticed it stronger. No adverse effects induced by treatment were observed. Conclusions: the good results of the analyzed variables suggest a therapeutic benefit against FAGA and ET. Additional research is warranted to confirm the observed data.(AU)

[Neuroprotection in Parkinson's disease: analysis though group of experts' methodology]. / Neuroprotección en la enfermedad de Parkinson: análisis a través de la metodología de informadores clave.

INTRODUCTION: Currently used antiparkinsonian drugs neither stop nor slow-down the progressive nature of the disease. The final phase of PD is characterized by the presence of symptoms and signs resistant to dopaminergic agents, such as depression, dementia, freezing and falls. Therefore, it is urgent to develop therapies able to positively modify this outcome. Despite neuroprotection is a research priority in PD, no effective strategies have been found so far. METHOD: A key informants study was conducted. A group of experts in PD fulfilled a questionnaire of 10 questions to explore the most important topics related to neuroprotection. Afterwards a consensus about the current situation of neuroprotection in PD was established and future directions of development were suggested. RESULTS: Most of the answers emphasized the need of new concepts, the limitations of animal models and the difficulties in the difficulties in demonstrating a neuroprotective effects in humans owing to a lack of biomarkers. Some of the experts believe that we are already exerting a disease modifying effect. CONCLUSIONS: The concept of neuroprotection should be widened. Animal models should be improved. A reliable biomarker to start neuroprotective therapies long before the appearance of motor symptoms and to evaluate the neuroprotective effect of any therapy should be urgently developed.

Neuroprotección en la enfermedad de Parkinson: análisis a través de la metodología de informadores clave / Neuroprotection in Parkinson’s disease: analysis though group of expert’s methodology

Introducción. La terapia convencional basada en fármacos dopaminérgicosno frena ni ralentiza de modo significativo el cursoprogresivo de la enfermedad de Parkinson (EP). La fase final de la EPse caracteriza por la presencia de síntomas y signos resistentes a laterapia dopaminérgica (depresión, demencia, disartria, caídas, etc.).Es urgente desarrollar terapias que eviten llegar a estas fases deteniendoo retardando la progresión de la enfermedad. Sin embargo,no se dispone de estrategias neuroprotectoras efectivas.Método. Se realizó un estudio de informadores clave en el queexpertos en EP que cumplimentaron un cuestionario de 10 preguntassobre la problemática más importante en el área de la neuroprotecciónen la EP. Tras ello se estableció un consenso sobre la situaciónactual y se sugirieron nuevas direcciones de investigación.Resultados. La mayoría de respuestas coincidieron en la necesidadde nuevos conceptos, en las limitaciones de los actuales modelosanimales o las dificultades de demostrar un efecto protector en humanospor la falta de biomarcadores. Algunos participantes opinanque ya se está ejerciendo un cierto efecto modificador del curso dela enfermedad.Conclusiones. El concepto de neuroprotección debe ser ampliado,los modelos animales deben mejorarse y urge encontrar un biomarcadorfiable para planificar la terapia en fases más precoces ypara determinar el efecto neuroprotector (AU)

Introduction. Currently used antiparkinsonian drugs neitherstop nor slow-down the progressive nature of the disease. The finalphase of PD is characterized by the presence of symptomsand signs resistant to dopaminergic agents, such as depression,dementia, freezing and falls. Therefore, it is urgent to develop therapies able to positively modify this outcome. Despite neuroprotectionis a research priority in PD, no effective strategieshave been found so far.Method. A key informants study was conducted. A group ofexperts in PD fulfilled a questionnaire of 10 questions to explorethe most important topics related to neuroprotection. Afterwardsa consensus about the cur-rent situation of neuroprotection inPD was established and future directions of development weresuggested.Results. Most of the answers emphasized the need of newconcepts, the limitations of animal models and the difficulties inthe difficulties in demonstrating a neuroprotective effects in humansowing to a lack of biomarkers. Some of the experts believethat we are already exerting a disease modifying effect.Conclusions. The concept of neuroprotection should be widened.Animal models should be improved. A reliable biomarkerto start neuroprotective therapies long before the appearance ofmotor symptoms and to evaluate the neuroprotective effect ofany therapy should be urgently developed (AU)

Encefalopatía aguda conmioclonías por fenitoína. A propósito de un caso / Acute myoclonic encephalopathy due to phenytoin. A case report

No disponible

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[Cocaine and cerebrovascular disease in young adults]. / Cocaína y enfermedad cerebrovascular en adultos jóvenes.

INTRODUCTION AND OBJECTIVE: The use of cocaine has been increasingly associated with cerebrovascular disease specially in young adults. We review the cases of stroke related to cocaine abuse in this group. PATIENTS AND METHODS: We performed a retrospective study between 1989-1998. Data were obtained from the Young Adults Stroke Registry. To investigate the etiology of stroke all patients underwent cardiologic examination, coagulation and neuroimaging tests. RESULTS: We identified 13 patients under 45 years of age with stroke related to cocaine abuse (0.39% of all strokes and 7.60% of the ones in young adults). Mean age in this group was 28.30 years. Eight developed ischemic manifestations (5 infarcts, 2 TIAs and 1 encephalopathy with multiple ischemic lesions), 4 had intraparenchymal hemorrhages and 1 had a subarachnoid hemorrhage. The principal route of administration was intranasal and the time course from cocaine use to stroke ranged from several hours to several years. 61.53% had history of other drug abuse and in 84.61% other risk factors were identified. Angiographic studies demonstrated: arterial occlusions (3 cases), changes consistent with vasospasm (1), segmental narrowing (1) and arterial wall irregularities (1). No aneurysms or arterio-venous malformations were found. The frequency of cocaine-related stroke in young adults has decreased from 8.33% in 1989 to 5% in 1998. CONCLUSIONS: Cocaine is a well known cause of stroke, specially in young adults. In most cases other risk factors can be identified. Multiple overlapping mechanisms may be involved (vasospasm-thrombosis, high blood pressure, embolism.

Migrainous syndrome with CSF pleocytosis. SPECT findings.

Brain single photon emission computed tomography (SPECT) findings are described in four adult patients with the transient syndrome of headache with neurological deficits and cerebrospinal fluid (CSF) pleocytosis. Focal deficits consisted of right-sided hemisensory changes with or without motor dysphasia or dysarthric speech (n = 4) and confusional episodes (n = 1). All patients had a CSF pleocytosis (with a mean of 309 cells/mm3 on the first spinal tap; range 75 to 590) and an elevated total protein (mean 130.5 mg/dL; range 70 to 193). The EEG showed excessive focal slowing (n = 2). A technetium Tc 99m hexamethyl propylenamine oxime (HMPAO) brain SPECT was performed during a symptom-free period, within 8 and 25 days after the onset of symptoms (n = 4). Three patients showed a decreased tracer uptake in the anterior left hemisphere, topographically consistent with the neurological deficits and EEG slowing. One patient showed no abnormalities. These findings indicate either focally impaired neuronal metabolism or hypoperfusion in regional cerebral blood flow, which could bear some relationship with the clinical features. The possibility that SPECT abnormalities may represent an epiphenomenon was also considered.

Electro-oculogram in multiple system and late onset cerebellar atrophies.

The present investigation uses electrooculogram to evaluate multiple system atrophy (MSA) and late onset cerebellar atrophies (LOCAs), both idiopathic (ILOCA) and late onset autosomal dominant cerebellar ataxia (ADCA). Forty cases were clinically examined using scales for cerebellar, pyramidal, parkinsonian, mental status and neuroimaging quantitative evaluations. The patients were classified into three groups: olivopontocerebellar atrophy (OPCA), striatonigral degeneration (SND), Shy-Drager syndrome (SDS), and LOCA. We have used direct current electro-oculography in order to establish their validity in making the diagnosis. Cerebellar signs were significantly correlated with impaired VOR-fix gain and OKN, abnormalities of saccades, and reduced smooth pursuit gain (p < 0.05). Pons atrophy was significantly correlated with impaired VOR-fix gain (p < 0.01), abnormalities of saccades (p < 0.01), and reduced smooth pursuit gain (p < 0.05). Cerebellar hemisphere atrophy was significantly correlated only with impaired VOR-fix gain (p < 0.05), and medulla oblongata atrophy only with abnormalities of saccades (p < 0.05). Gaze-evoked nystagmus was found in 42.8% of patients with OPCA, and only in 14.2% with SND, but was not found in LOCA patients (t test, p < 0.05). In patients with OPCA, the combination of gaze-evoked nystagmus, abnormalities of sinusoidal VOR and reduced OKN gain measurements was very frequent, while infrequent in both LOCA (Fisher's exact test, p < 0.05) and SND subjects (p < 0.01). SDS also showed abnormalities of the oculomotor system.

[Atypical neuroradiologic manifestation of systemic lupus erythematosus]. / Manifestación neurorradiológica atípica del lupus eritematoso sistémico.

The most frequent neurological lesions found on Cranial Computerized Tomography (CT scan) in patients with Systemic Lupus Erythematosus (SLE) are cortical atrophy (psychosis, although in general atrophy is not associated with a particular clinical presentation), infarcts and haemorraghes (strokes). We describe a patient diagnosed of SLE who developed a psychotic clinical picture followed by generalized epileptic seizures within a context of diffuse lupus encephalopathy. On the neurological examination, she presented cortical blindness, generalized piramidalism and extrapiramidal rigidity. Various electroencephalographic recordings showed signs of diffuse cerebral involvement predominantly in posterior regions. Cerebrospinal fluid analysis showed a slight increase of IgG without oligoclonal bands and a positive anti-DNA antibody with an homogeneous pattern. Sequential CT images were carried out demonstrating hypodense areas initially in the occipital regions that extended progressively to the temporal, parietal and finally to the frontal lobes, with a moderate mass effect on the lateral ventricles and with no contrast enhancement. The images of the lesions on the CT disappeared completely with the adequate treatment as the symptomatology resolved. A MRI and cerebral angiography were performed when the patient recovered. Both MRI and angiography showed no alterations. We consider that this neuroradiological finding is exceptional, because of its total resolution. Nevertheless, more observations will be necessary to determine the exact meaning of these abnormalities.