Revista de neurologia


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Publications in this journal

  • Revista de neurologia 05/2014; 58(10):478-9.
  • Revista de neurologia 05/2014; 58(10):476-7.
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    ABSTRACT: INTRODUCTION. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) is safe and effective. Most series report stable long-term motor responses. AIM. To report the long-term outcome of STN-DBS in advanced stage PD patients at a Portuguese center. PATIENTS AND METHODS. Motor status was evaluated before surgery ('off' medication and best 'on'), post-operatively, and at five years ('on' medication and stimulation) using UPDRS part III. Axial symptoms subscores were quantified. Disability was assessed with the modified Rankin Scale (mRS). Development of dementia was assessed at 6 months and five years post-DBS. RESULTS. Of the 183 patients submitted to STN-DBS, 71 had completed 5 years of follow-up. Ten patients were not included: two died (cancer, myocardial infarction), five were lost to follow-up and three had their stimulation systems removed. Motor function improved by 78% and 66% postoperatively and at five years, respectively. There was improvement of axial symptoms postoperatively, with significant worsening at five years (p < 0.001). mRS scores improved postoperatively, but declined at five years, although most patients (88.5%) remained ambulatory (mRS < 4). One patient (1.6%) and 19 patients (31,2%) were demented at 6 months and 5 years, respectively. Patients who developed dementia were significantly older than non-demented patients (56.5 ± 7.8 vs 63.7 ± 5.9 years-old; p < 0.001). CONCLUSIONS. In this series STN-DBS proved its efficacy regarding motor symptom improvement even five years after the procedure. Deterioration of axial symptoms and disability, as well as new onset dementia were observed in this period, but the possible role of STN-DBS as a causative factor is yet to be defined.
    Revista de neurologia 05/2014; 58(10):433-440.
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    ABSTRACT: INTRODUCTION. The type of diet has been related with the inflammatory process that forms part of multiple sclerosis. In recent years, different lines of research have generated a large body of knowledge about the role played by diet in the pathogenesis of multiple sclerosis. AIM. To conduct a critical examination of the evidence suggesting the existence of a relationship between different types of diets and foods and multiple sclerosis. DEVELOPMENT. The work includes an update of the most significant studies that have analysed the role played by diet in the pathogenesis and treatment of multiple sclerosis. In order to explore the association between diet and the risk of multiple sclerosis, the authors examined the currently available evidence, which ranged from observation-based studies to intervention studies. CONCLUSIONS. Further research on nutrition as a risk factor is needed, as it could be related with the disease and controlling it could lead to a significant reduction in the incidence or progression of the disease.
    Revista de neurologia 05/2014; 58(10):455-64.
  • Revista de neurologia 05/2014; 58(10):480.
  • Revista de neurologia 05/2014; 58(9):429-30.
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    ABSTRACT: INTRODUCTION. Migraine may present with cranial autonomic symptoms typical of trigeminal-autonomic cephalalgias, thus posing diagnostic difficulties. AIM. To report a series of patients with prominent eyelid oedema associated with migraine. PATIENTS AND METHODS. Ten patients attending the headache offices in three hospitals (nine women, one man; age: 26-53 years-old) with recurrent eyelid oedema as a migraine accompaniment. RESULTS. According to the diagnostic criteria of the International Classification of Headache Disorders (ICHD-III, beta version), eight patients had migraine without aura, one had migraine with aura, and one had chronic migraine. Eyelid oedema appeared during the most severe headache attacks, and had longer duration than the pain. Pharmacological or systemic causes of the oedema were ruled out in all cases. Other associated autonomic symptoms were conjunctival injection (n = 3), lacrimation (n = 2) and rhinorrhoea (n = 1). Both the pain and the oedema improved with symptomatic and preventive therapies for migraine. CONCLUSIONS. Eyelid oedema may occasionally be a migraine accompaniment. It appears in some patients during their most severe migraine attacks, and may improve with the acute and preventive treatment for migraine.
    Revista de neurologia 05/2014; 58(9):385-8.
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    ABSTRACT: INTRODUCTION. Brainstem dysgenesis is a heterogeneous clinical entity, with low incidence and high clinical variability, which affects structures in the brainstem. Diagnosis is based on the combination of symptoms, neuroimaging and neurophysiological studies. AIM. To determine the common clinical features, functional prognosis and rehabilitative treatment needs in a group of children with brainstem dysgenesis. PATIENTS AND METHODS. Observation-based retrospective study of nine patients diagnosed with brainstem dysgenesis monitored in an outpatients department. RESULTS. The mean age of the patients was 5.5 years. Five presented alterations in the neuroimaging scan and, in the five with a neurophysiological study, the results showed it to be altered. Six presented muscular hypotonia, eight had amimia/hypomimia, six had central hypoacusis and five had gastrostomy. A third of them presented an episode of cardiorespiratory arrest. Delayed psychomotor skills were detected in all cases. Currently five of them are capable of walking autonomously indoors and four of them outdoors. A high percentage of them (77.7%) understand simple orders and are capable of communicating (66.6%). CONCLUSIONS. Alterations affecting the cranial nerves and muscle tone together with dysphagia are the most common manifestations in our population. The risk of bronchial aspiration and cardiorespiratory arrest is a threat to the lives of these patients. All the children present psychomotor retardation and half of them manage to accomplish autonomous walking. Given the diversity of the disability displayed by these patients, we believe a personalised, integral rehabilitative treatment is needed to obtain an optimal level of functioning. Further studies with wider samples are required to be able to obtain homogeneous groups and to establish the functional prognosis and needs in terms of rehabilitative treatment.
    Revista de neurologia 05/2014; 58(9):396-400.
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    ABSTRACT: INTRODUCTION. Parallel forms of neuropsychological tests are scarce. Practice effects associated to repeated testing with the same test confound the interpretation of observed changes in serial assessments. Practice effects are especially likely with memory testing. AIM. To develop an alternate form to the test de aprendizaje verbal España-Complutense (TAVEC), one of the most common memory tests used for Spanish speaking population. SUBJECTS AND METHODS. Participants in the normative study were 110 undergraduates. Participants in the study of the alternate vs original forms were 70 neurologically normal volunteers ranged in age from 18 to 89 years. Forms were administered in counterbalanced order, with a test-retest interval of 15-20 days. RESULTS. Multivariate analyses showed that none of the effects for form, order of administration or session achieved significance. Interactions also failed to reach significance. Aforementioned results were observed in the total sample and the different age groups: young adults (18-29 years), middle-age (30-59 years) and older (60-89 years). Correlational analyses supported the validity and internal consistence of the alternate form. CONCLUSIONS. Results indicate the equivalence between the original TAVEC and the form elaborated in this study. This alternate form may be used in serial assessment of learning and memory deterioration.
    Revista de neurologia 05/2014; 58(9):389-95.
  • Revista de neurologia 05/2014; 58(9):430-2.
  • Revista de neurologia 05/2014; 58(9):420-1.
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    ABSTRACT: Seizures are one of the main reasons for visits to emergency and neurology. Represent a traumatic event with potential medical and social consequences. A first epileptic seizure, can be the initial manifestation of malignancy, systemic disorder or infection, but can also be the first manifestation of epilepsy. The misdiagnosis of symptomatic seizures and unprovoked seizure, significantly affects prognosis and patient outcomes. The aim of this review is to examine the general concepts that enable successful diagnostic and therapeutic approach to the patient presenting with a first epileptic seizure.
    Revista de neurologia 04/2014; 58(8):365-74.