RESUMEN
Plant species are precursors of a wide variety of secondary metabolites that, besides being useful for themselves, can also be used by humans for their consumption and economic benefit. Pepper (Capsicum annuum L.) fruit is not only a common food and spice source, it also stands out for containing high amounts of antioxidants (such as vitamins C and A), polyphenols and capsaicinoids. Particular attention has been paid to capsaicin, whose anti-inflammatory, antiproliferative and analgesic activities have been reported in the literature. Due to the potential interest in pepper metabolites for human use, in this project, we carried out an investigation to identify new bioactive compounds of this crop. To achieve this, we applied a metabolomic approach, using an HPLC (high-performance liquid chromatography) separative technique coupled to metabolite identification by high resolution mass spectrometry (HRMS). After chromatographic analysis and data processing against metabolic databases, 12 differential bioactive compounds were identified in sweet pepper fruits, including quercetin and its derivatives, L-tryptophan, phytosphingosin, FAD, gingerglycolipid A, tetrahydropentoxylin, blumenol C glucoside, colnelenic acid and capsoside A. The abundance of these metabolites varied depending on the ripening stage of the fruits, either immature green or ripe red. We also studied the variation of these 12 metabolites upon treatment with exogenous nitric oxide (NO), a free radical gas involved in a good number of physiological processes in higher plants such as germination, growth, flowering, senescence, and fruit ripening, among others. Overall, it was found that the content of the analyzed metabolites depended on the ripening stage and on the presence of NO. The metabolic pattern followed by quercetin and its derivatives, as a consequence of the ripening stage and NO treatment, was also corroborated by transcriptomic analysis of genes involved in the synthesis of these compounds. This opens new research perspectives on the pepper fruit's bioactive compounds with nutraceutical potentiality, where biotechnological strategies can be applied for optimizing the level of these beneficial compounds.
Asunto(s)
Capsicum/química , Capsicum/metabolismo , Óxido Nítrico/farmacología , Capsicum/efectos de los fármacos , Capsicum/crecimiento & desarrollo , Carbolinas/análisis , Carbolinas/metabolismo , Cromatografía Líquida de Alta Presión , Flavina-Adenina Dinucleótido/análisis , Flavina-Adenina Dinucleótido/metabolismo , Frutas/química , Frutas/efectos de los fármacos , Frutas/crecimiento & desarrollo , Frutas/metabolismo , Humanos , Espectrometría de Masas/métodos , Metabolómica/métodos , Quercetina/análisis , Quercetina/metabolismo , Quercetina/farmacología , Esfingosina/análogos & derivados , Esfingosina/análisis , Esfingosina/metabolismo , Triptófano/análisis , Triptófano/metabolismoRESUMEN
Systemic primary carnitine deficiency (PCD) is a genetic disorder caused by decreased or absent organic cation transporter type 2 (OCTN2) carnitine transporter activity, resulting in low serum carnitine levels and decreased carnitine accumulation inside cells. In early life, PCD is usually diagnosed as a metabolic decompensation, presenting as hypoketotic hypoglycemia, Reye syndrome, or sudden infant death; in childhood, PCD presents with skeletal or cardiac myopathy. However, the clinical presentation of PCD characterized by autism spectrum disorder (ASD) with intellectual disability (ID) has seldom been reported in the literature. In this report, we describe the clinical features of a seven-year-old girl diagnosed with PCD who presented atypical features of the disease, including a developmental delay involving language skills, concentration, and attention span, as well as autistic features and brain alterations apparent in magnetic resonance imaging. We aim to highlight the difficulties related to the diagnostic and therapeutic approaches used to diagnose such patients. The case reported here presented typical signs of PCD, including frequent episodes of hypoglycemia, generalized muscle weakness, decreased muscle mass, and physical growth deficits. A molecular genetic study confirmed the definitive diagnosis of the disease (c.1345T>G (p.Y449D)) in gene SLC22A5, located in exon 8. PCD can be accompanied by less common clinical signs, which may delay its diagnosis because the resulting global clinical picture can closely resemble other metabolic disorders. In this case, the patient was prescribed a carnitine-enriched diet, as well as oral carnitine at a dose of 100 mg/kg/day. PCD has a better prognosis if it is diagnosed and treated early; however, a high level of clinical suspicion is required for its timely and accurate diagnosis.
RESUMEN
Pompe disease is an autosomal recessive disorder caused by a deficiency of acid α-glucosidase. In addition to the severe infantile form with cardiac involvement, late-onset variants can affect older children, adolescents (aged >1 year old) or adults. Patients with juvenile (a subgroup of late-onset type) Pompe disease typically do not have cardiac alterations e.g. hypertrophic cardiomyopathy, and the diagnosis is often difficult because it can clinically resemble myriad other neuromuscular disorders. A high level of clinical suspicion is necessary for a timely and accurate diagnosis. We describe 3 interesting cases of patients with juvenile-onset Pompe disease who presented some uncommon clinical features e.g. skeletal alterations and developmental delay, and describe a new genetic variant. Juvenile-onset Pompe disease may be accompanied by uncommon clinical signs that could delay the diagnosis of Pompe disease due to the global pictures resembling other metabolic disorders.
Asunto(s)
Discapacidades del Desarrollo/genética , Glucano 1,4-alfa-Glucosidasa/genética , Enfermedad del Almacenamiento de Glucógeno Tipo II/genética , alfa-Glucosidasas/genética , Adolescente , Discapacidades del Desarrollo/diagnóstico , Enfermedad del Almacenamiento de Glucógeno Tipo II/diagnóstico , Enfermedad del Almacenamiento de Glucógeno Tipo II/patología , Humanos , Masculino , Músculo Esquelético/patología , Mutación/genéticaRESUMEN
Autism spectrum disorder (ASD) with intellectual disability (ID) is a life-long debilitating condition, which is characterized by cognitive function impairment and other neurological signs. Children with ASD-ID typically attain motor skills with a significant delay. A sub-group of ASD-IDs has been linked to hyperlactacidemia and alterations in mitochondrial respiratory chain activity. The objective of this report is to describe the clinical features of patients with these comorbidities in order to shed light on difficult diagnostic and therapeutic approaches in such patients. We reported the different clinical features of children with ID associated with hyperlactacidemia and deficiencies in mitochondrial respiratory chain complex II-IV activity whose clinical presentations are commonly associated with the classic spectrum of mitochondrial diseases. We concluded that patients with ASD and ID presenting with persistent hyperlactacidemia should be evaluated for mitochondrial disorders. Administration of carnitine, coenzyme Q10, and folic acid is partially beneficial, although more studies are needed to assess the efficacy of this vitamin/cofactor treatment combination.
Asunto(s)
Trastornos Generalizados del Desarrollo Infantil/complicaciones , Trastornos Generalizados del Desarrollo Infantil/tratamiento farmacológico , Hiperlactatemia/complicaciones , Discapacidad Intelectual/complicaciones , Enfermedades Mitocondriales/complicaciones , Vitaminas/administración & dosificación , Carnitina/uso terapéutico , Trastornos Generalizados del Desarrollo Infantil/psicología , Preescolar , Femenino , Ácido Fólico/uso terapéutico , Humanos , Hiperlactatemia/tratamiento farmacológico , Lactante , Discapacidad Intelectual/tratamiento farmacológico , Discapacidad Intelectual/psicología , Masculino , Enfermedades Mitocondriales/tratamiento farmacológico , Ubiquinona/análogos & derivados , Ubiquinona/uso terapéutico , Vitaminas/uso terapéuticoRESUMEN
INTRODUCTION. Glycogen storage disease type II, or Pompe disease, is a lysosomal disease with an autosomal recessive pattern of inheritance. Late-onset Pompe disease is a progressive metabolic myopathy caused by decreased activity of the enzyme acid alpha-glucosidase (GAA), which gives rise to reduced degradation and later accumulation of glycogen in the lysosomes and cell cytoplasm. CASE REPORT. A 16-year-old Venezuelan male, diagnosed with late-onset glycogen storage disease type II, or Pompe disease, based on the patient's clinical picture and the biochemical findings. The patient presented unmistakable signs of muscular atrophy in the upper and lower limbs, as well as positive Gowers' sign. Levels of creatinkinase in serum were high. His functional respiratory capacity was diminished. The quantification of the enzymatic activity of acid alpha-glucosidase on filter paper did not show any significant decrease in activity. A molecular genetic analysis revealed the existence of two homozygotic mutations in the gene GAA, c.547-67C>G and c.547-39T>G, both on exon 2 of chromosome 17. According to the human genome database and the review that was undertaken, the changes detected in this patient represent new mutations in the acid alpha-glucosidase gene, GAA. This claim is in agreement with the clinical features and biochemical changes found in the patient. CONCLUSION. A molecular genetic study is mandatory in patients suspected of having this disease.
TITLE: Dos nuevas mutaciones en el gen que codifica la alfa-glucosidasa acida en un adolescente con enfermedad de Pompe de inicio tardio.Introduccion. La glucogenosis tipo II o enfermedad de Pompe es una enfermedad lisosomal con un patron de herencia autosomico recesivo. La enfermedad de Pompe de inicio tardio es una miopatia metabolica progresiva causada por una disminucion de la actividad de la enzima alfa-glucosidasa acida (GAA), lo que origina una disminucion de la degradacion y posterior acumulo del glucogeno dentro de los lisosomas y el citoplasma celular. Caso clinico. Adolescente venezolano, de 16 años, diagnosticado de glucogenosis tipo II o enfermedad de Pompe, de comienzo tardio, basado en la clinica del paciente y los hallazgos bioquimicos. La atrofia muscular de los miembros superiores e inferiores era evidente y presentaba maniobra de Gowers positiva. Los niveles sericos de creatincinasa eran elevados. Su capacidad funcional respiratoria estaba disminuida. La cuantificacion de la actividad enzimatica de la GAA en papel de filtro no mostraba una disminucion significativa de la actividad. El analisis genetico molecular revelo la existencia de dos mutaciones en condicion homocigotica en el gen GAA, c.547-67C>G y c.547-39T>G, ambas en el exon 2 del cromosoma 17. De acuerdo con la base de datos del genoma humano y la revision emprendida, los cambios detectados en este paciente representan nuevas mutaciones en el gen GAA. Esta afirmacion esta en concordancia con la clinica y cambios bioquimicos encontrados en el paciente. Conclusion. Es obligatorio el estudio genetico molecular en un paciente en el que se sospecha la enfermedad.
Asunto(s)
Glucano 1,4-alfa-Glucosidasa/genética , Enfermedad del Almacenamiento de Glucógeno Tipo II/genética , Mutación Missense , Mutación Puntual , Adolescente , Edad de Inicio , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Biomarcadores , Cromosomas Humanos Par 17/genética , Creatina Quinasa/sangre , Exones/genética , Enfermedad del Almacenamiento de Glucógeno Tipo II/sangre , Enfermedad del Almacenamiento de Glucógeno Tipo II/diagnóstico , Enfermedad del Almacenamiento de Glucógeno Tipo II/patología , Homocigoto , Humanos , L-Lactato Deshidrogenasa/sangre , Masculino , Músculo Esquelético/patología , Fenotipo , Análisis de Secuencia de ADN , VenezuelaRESUMEN
Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by a combination of reciprocal social deficits, communication impairment, and rigid ritualistic interest and stereotypies. The etiology is generally multifactorial, including genetic, immunological and/or environmental factors. A group of ASD has been linked to mitochondrial dysfunction with subsequent deficiency in energy production. Patients with ASD and mitochondrial disease often show signs and symptoms uncommon to idiopathic ASD such as cardiac, pancreatic or liver dysfunction, cardiac, growth retardation, fatigability, but in some cases semiology is different. We show two clinical cases of ASD associated to a deficiency of the mitochondrial respiratory chain (complex I+III and IV) with different clinical presentations. In one case, signs and symptoms of mitochondrial disorder were mild and the second diagnosis was attained many years after that of ASD. These findings support the recent growing body of evidence that ASD can be associated with mitochondrial disorder. Children with ASD and abnormal neurologic or systemic findings should be evaluated for mitochondrial disorder.
Asunto(s)
Trastornos Generalizados del Desarrollo Infantil/complicaciones , Mitocondrias/enzimología , Enfermedades Mitocondriales/complicaciones , Niño , Trastornos Generalizados del Desarrollo Infantil/enzimología , Preescolar , Transporte de Electrón/fisiología , Femenino , Humanos , Ácido Láctico/sangre , Masculino , Enfermedades Mitocondriales/diagnóstico , Enfermedades Mitocondriales/enzimologíaRESUMEN
Autism is the prototype of generalized developmental disorders or what today are called autism spectrum disorders. In most cases it is impossible to detect a specific etiology. It is estimated that a causative diagnosis may be shown in approximately 10-37 percent of the cases, including, congenital rubella, tuberous sclerosis, chromosome abnormalities such as fragile X syndrome and 22q13.3 deletion syndrome, Angelman, Williams, Smith-Magenis, Sotos, Cornelia de Lange, Mõbius, Joubert and Goldenhar syndromes, Itos hypomelanosis, as well as certain cerebral malformations and several inherited metabolic disorders. The case of a 3-year old girl is described, who was considered as autistic according to the criteria established by the DSM-IV manual for psychiatric disorders. She showed a delay in psychomotor development since she was 18 months old; she pronounces very few words (10), points to some objects, does not look up and it is hard to establish eye contact with her. She has paradoxical deafness and therefore, does not respond when called or when she is given orders, she is beginning to walk. She has not convulsions. Laboratory tests showed an anion gap of 31.6 mEq/L, lactate: 2.55: mmol/L, pyruvate: 0.06 mmol/L, and elevated lactate to/pyruvate ratio: 42.5. Under optical microscopy a muscular biopsy showed a reduction of the diameter of muscular fibers. The study of energy metabolism showed a partial deficiency of complexes III and IV of the respiratory chain, which allowed us to conclude that this was a mitochondrial dysfunction with an autistic clinical spectrum.
El autismo es el prototipo de los trastornos generalizados del desarrollo o de lo que hoy se denominan trastornos del espectro autista. En la mayoría de los casos no es posible detectar una etiología específica. Se estima que aproximadamente entre el 10 y el 37 por ciento de los casos se puede demostrar una causa específica,como la rubéola congénita, la esclerosis tuberosa, anomalías cromosómicas como el sindrome del cromasoma X frágil y la microdelección 22q13.3, los sindromes de Angelman, Williams, Smith-Magenis, Sotos, Cornelia de Lange, Mõebius, Joubert y Goldenhar, la hipomelanosis de Ito, así como algunas malformaciones cerebrales y varios trastornos metabólicos. Se describe un preescolar de 3 años de edad, de sexo femenino,catalogada como autista de acuerdo a los criterios establecidos por el manual DSM-IV para trastornos psiquiátricos. Presentaba un retraso en la adquisición de su desarrollo psicomotor desde los 18 meses, pronunciaba pocas palabras (10), señalaba algunos objetos, no utilizaba la mirada y era dificil establecer contacto ocular con ella, mostraba sordera paradójica, por lo que no respondia cuando se le llamaba ni cuando se le daban órdenes. Empezaba a caminar y no había presentado convulsiones. Los exámenes de laboratorio mostraban anión gap: 31,6 mEq/L, lactato: 2,55 mmol/L, piruvato: 0,06 mmol/L y una relación lactato/piruvato elevada de: 42,50 mmol/L. La biopsia muscular practicada reportó en la microscopía óptica disminución del diámetro de las fibras musculares y el estudio del metabolismo energético demostró una deficiencia parcial en los complejos III y IV de la cadena respiratoria, el cual nos permitió concluir que se trataba de una disfunción mitocondrial con espectro autista.
Asunto(s)
Humanos , Femenino , Preescolar , Trastorno Autístico , Biopsia/métodos , Ácido Láctico , Enfermedades Mitocondriales , Ácido Pirúvico , NeurologíaRESUMEN
Autism is the prototype of generalized developmental disorders or what today are called autism spectrum disorders. In most cases it is impossible to detect a specific etiology. It is estimated that a causative diagnosis may be shown in approximately 10-37% of the cases, including, congenital rubella, tuberous sclerosis, chromosome abnormalities such as fragile X syndrome and 22q13.3 deletion syndrome, Angelman, Williams, Smith-Magenis, Sotos, Cornelia de Lange, Möbius, Joubert and Goldenhar syndromes, Ito's hypomelanosis, as well as certain cerebral malformations and several inherited metabolic disorders. The case of a 3-year old girl is described, who was considered as autistic according to the criteria established by the DSM-IV manual for psychiatric disorders. She showed a delay in psychomotor development since she was 18 months old; she pronounces very few words (10), points to some objects, does not look up and it is hard to establish eye contact with her. She has paradoxical deafness and therefore, does not respond when called or when she is given orders, she is beginning to walk. She has not convulsions. Laboratory tests showed an anion gap of 31.6 mEq/L, lactate: 2.55: mmol/L, pyruvate: 0.06 mmol/L, and elevated lactate to/pyruvate ratio: 42.5. Under optical microscopy a muscular biopsy showed a reduction of the diameter of muscular fibers. The study of energy metabolism showed a partial deficiency of complexes III and IV of the respiratory chain, which allowed us to conclude that this was a mitochondrial dysfunction with an autistic clinical spectrum.
Asunto(s)
Trastorno Autístico/etiología , Deficiencia de Citocromo-c Oxidasa/complicaciones , Complejo III de Transporte de Electrones/deficiencia , Preescolar , Femenino , HumanosRESUMEN
Cryptococcus neoformans meningoencephalitis is the most common fungal central nervous system infection, in people affected by the human immunodeficiency virus. It is rare in inmunocompetent children and it is often fatal. It predominates in males at a ratio of 3 to 1. We describe the cases of two school children, one male and one female, with history of contact with pigeons (Columba livea), whose clinical symptoms were fever, headache, photophobia, diplopia, ataxia and meningeal signs, with unilateral involvement of cranial nerve VI. The diagnosis was established by the isolation of Cryptococcus neoformans in culture, staining with India ink and evidence of latex antigen agglutination in the cerebrospinal fluid. The determination of antibodies to human immunodeficiency virus and quantification of CD4, CD8 and T lymphocyte cells, were normal. In the first case, a chest X-ray showed a round mass, circumscribed in the bottom half of the left lung. A brain MRI revealed an image compatible with a nodular cryptococcoma in the parietal region. A pattern of intracranial hypertension was established, with papilledema and bilateral amaurosis, that evolved unsatisfactorily, with the subsequent death of the patient. Both were treated with amphotericin B (1 mg/Kg/day) or fluconazole (6 mg/Kg/day). The second case had a favorable evolution. The Crypotococcus neoformans is not a common fungus in inmunocompetent children. Early detection of the disease and appropriate treatment is essential to achieve a better prognosis ot the disease.
Asunto(s)
Meningitis Criptocócica/epidemiología , Anfotericina B/uso terapéutico , Animales , Animales Domésticos/microbiología , Antifúngicos/uso terapéutico , Ceguera/etiología , Líquido Cefalorraquídeo/microbiología , Niño , Columbidae/microbiología , Cryptococcus neoformans/aislamiento & purificación , Cryptococcus neoformans/metabolismo , Resultado Fatal , Femenino , Fluconazol/uso terapéutico , Humanos , Inmunocompetencia , Hipertensión Intracraneal/etiología , Enfermedades Pulmonares Fúngicas/microbiología , Imagen por Resonancia Magnética , Masculino , Meningitis Criptocócica/diagnóstico , Meningitis Criptocócica/tratamiento farmacológico , Meningitis Criptocócica/transmisión , Venezuela/epidemiologíaRESUMEN
La meningoencefalitis por Cryptococcus neoformans, es la infección fúngica mas frecuente del sistema nervioso central, en personas afectadas por el virus de inmunodeficiencia humana (VIH). Es rara en niños inmunocompetentes y a menudo es fatal; predomina en el sexo masculino en una proporción de 3 a 1. Se describen los casos de dos escolares, uno masculino y otro femenino con antecedentes de contacto con palomas (Columba livia), cuyas manifestaciones clínicas fueron fiebre, cefalea, fotofobia, diplopía, ataxia y signos meníngeos con afectación unilateral del VI nervio craneal. El diagnóstico se estableció con el aislamiento del criptococo en cultivo, la tinción con tinta china y las pruebas de aglutinación en látex en el líquido cefalorraquídeo. La determinación de anticuerpos para virus de la inmunodeficiencia humana (VIH) y la cuantificación de linfocitos T CD4 y CD8 fueron normales. En el primer caso, la radiografía de tórax mostró una masa redondeada circunscrita en la mitad inferior del pulmón izquierdo y la resonancia magnética cerebral (RNM) reveló una imagen nodular compatible con un criptococoma en la región parietal derecha; se estableció un cuadro de hipertensión endocraneana, con edema de papila y amaurosis bilateral con evolución no satisfactoria y posterior fallecimiento. El segundo caso tuvo una evolución favorable. Ambos recibieron tratamiento con anfotericina B (1 mg/kg/día) y fluconazol (6 mg/kg/día). El Cryptococcus neoformans no es un hongo usual en niños inmunocompetentes. La detección precoz de la enfermedad y el tratamiento adecuado es fundamental para lograr un mejor pronóstico de la enfermedad.
Cryptococcus neoformans meningoencephalitis is the most common fungal central nervous system infection, in people affected by the human immunodeficiency virus. It is rare in inmunocompetent children and it is often fatal. It predominates in males at a ratio of 3 to 1. We describe the cases of two school children, one male and one female, with history of contact with pigeons (Columba livea), whose clinical symptoms were fever, headache, photophobia, diplopia, ataxia and meningeal signs, with unilateral involvement of cranial nerve VI. The diagnosis was established by the isolation of Cryptococcus neoformans in culture, staining with India ink and evidence of latex antigen agglutination in the cerebrospinal fluid. The determination of antibodies to human immunodeficiency virus and quantification of CD4, CD8 and T lymphocyte cells, were normal. In the first case, a chest X-ray showed a round mass, circumscribed in the bottom half of the left lung. A brain MRI revealed an image compatible with a nodular cryptococcoma in the parietal region. A pattern of intracranial hypertension was established, with papilledema and bilateral amaurosis, that evolved unsatisfactorily, with the subsequent death of the patient. Both were treated with amphotericin B (1 mg/Kg/day) or fluconazole (6 mg/Kg/day). The second case had a favorable evolution. The Crypotococcus neoformans is not a common fungus in inmunocompetent children. Early detection of the disease and appropriate treatment is essential to achieve a better prognosis ot the disease.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Anfotericina B , Criptococosis/patología , Cryptococcus neoformans/patogenicidad , Meningoencefalitis/diagnóstico , Neurología , PediatríaRESUMEN
Primary hyperoxaluria is a congenital innate error of the metabolism of the amino acids, that is transmitted like an autosomal recessive character. Two types of hyperoxaluria exist: the primary type I, that corresponds to the peroxisomal enzymatic deficit of the alanine glyoxylate aminotransferase in the liver (AGT) and type II, due to the deficit of the glyoxylate reductase/hydroxypyruvate reductase deficiency (GRHPR). The primary type I (AGT) is the most frequenty. We report the case of a female infant of one month of age, that on her first day post birth, presented myoclonic convulsions and tonic spasms, both during wakefullness and sleep periods, that became more frequent and did not respond to the use of anticonvulsants. The ictal Electroencephalogram presented an intermittent activity of spikes and spike-waves of high voltage in the right hemisphere. Eight minutes after the intravenous administration of 150 mg of pyridoxine, it was observed a diminution of the epileptic activity, as well as the clinical manifestations. The determination of organic acids in urine revealed an increase in the concentration levels of oxalic acid (3064 mmol/mol of creatinine). The molecular genetic study of the AGXT gene, showed the existence of a R197Q mutation in exón 5 of the patient and her father. She received treatment with pyridoxine at a dose of 50 mg/day. When she reached the age of three months both a normal electroencephalogram and biochemistry were obtained. Although it is a rare cause of neonatal convulsions, hyperoxaluria, due to new mutations is an underdiagnosed disease by neonatologists and paediatricias.
Asunto(s)
Hiperoxaluria Primaria/genética , Mutación/genética , Transaminasas/genética , Femenino , Humanos , Lactante , Polimorfismo GenéticoRESUMEN
Mitochondrial encephalopathies are a group of diseases that have as their pathogenic basis an alteration of the mitochondrial DNA (mtDNA). The MELAS phenotype (mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes) has been related to mutation A3243G in approximately 80% of the cases reported. MERRF (epilepsy myoclonus with ragged red fibers) has been related to mutation A8344G and A8566G of tRNA Lys. We report the case of a 7 months-old female with early clinical signs of encephalopathy associated to the A3243G mutation. Laboratory tests showed lactic acidosis and the EEG pattern was compatible with an encephalopathic process. The infant was treated with ACTH during one month, with clinical and electroencephalographic improvements. Currently, she is receiving treatment with B-vitamins, L-Carnitine and urinary alkalizing agents. It is concluded that an analysis of mtDNA must be made in infants who present convulsions, delay in their psychomotor development, lactic acidosis and an EEG pattern compatible with an encephalopathy, to rule out a mitochondrial disease.
Asunto(s)
Síndrome MELAS/genética , Mutación , Femenino , Humanos , Lactante , Síndrome MELAS/diagnósticoRESUMEN
Las Encefalopatías mitocondriales son un grupo de enfermedades que tienen base una alteración del ADN mt. (ADN mitocondrial). El fenotipo MELAS (Encefalopatía mitocondrial, con acidosis láctica y accidentes cerebro vasculares) se ha relacionado con la mutación A3243G en aproximadamente el 80 por ciento de los casos reportados. El fenotipo MERRF (epilepsia mioclónica con fibras rojas rasgadas) ha sido relacionado con las mutaciones A8344G y A8566G del tARN Lys. Se describe un lactante femenino de 7 meses de edad, con un cuadro de inicio temprano, que se acompañaba de una encefalopatía asociada a la mutación A3243G. En los exámenes de laboratorio destacaba una acidosis láctica y el estudio EEG mostraba signos compatibles con proceso encefalopático. Se administró ACTH durante un mes con mejoría clínica y encefalográfica. Actualmente recibe tratamiento a base de Vitaminas del complejo B, L-carnitina y alcalinizantes urinarios. Se concluye que en los lactantes que presentan convulsiones, retraso en su desarrollo psicomotor, acidosis láctica y el estudio encefalográfico compatible con una encefalopatía, debería realizarse análisis del ADN mt, para descartar una enfermedad mitocondrial.
Asunto(s)
Humanos , Femenino , Lactante , Síndrome MELAS , Encefalomiopatías Mitocondriales , Mutación , Convulsiones , Lesión Encefálica Crónica , Neurología , Pediatría , VenezuelaRESUMEN
Se revisó la utilización del electroencefalograma (EEG) en el manejo de las epilepsias y síndromes epilépticos, como una herramienta para el diagnóstico y pronóstico del paciente con crisis epilépticas en el área de la neuropediatría, correlacionando las manifestaciones clínicas, edad de inicio, frecuencia, pronóstico y características electroencefalográficas de los trazados de cada una de ellas. El electroencefalograma goza de una extraordinaria vigencia en las neurociencias, dado que es un instrumento del que disponemos para aproximarnos realmente al funcionamiento cerebral en tiempo reales decir, a escala de milisegundos. A pesar de que en el último decenio se ha producido un desarrollo espectacular de las técnicas de neuroimágenes y funcionales, como la tomografía axial computarizada (TAC), resonancia magnética cerebral (RM) con sus variantes funcionales, la tomografía de emisión de positrones (PET), la tomografía computarizada de emisión de fotones (SPECT) y la magnetoencefalografía (MEG), la llegada de esas técnicas no ha conseguido relegar al EEG a un papel secundario. La calidad del EEG va a depender de los datos obtenidos, de una evaluación adecuada para llegar a conclusiones valederas que se obtengan como producto de la habilidad, entrenamiento y experiencia de la persona a cargo de realizarlo. El EEG aporta el diagnóstico definitivo en muchas de las epilepsias y síndromes epilépticos de la infancia.
The utility of the electroencephalogram (EEG) in handling childhood epilepsies and epileptic syndromes was reviewed as a diagnosis and prognosis tool in the patient with epileptic crisis. Correlations were stablished between clinical manifestations, age of onset, frequency, prognosis and electroencephalographic characteristics of the layouts of each one of the different types. EEG is extremely useful in neurosciences; since it is the only instrument that we have to assess the brain´s function in real time, that is to say, at the scale of milliseconds. Although in the last decade a spectacular development of neuroimages and functional techniques has taken place, as with computerized axial tomography (CAT), cerebral magnetic resonance (MR) with its fuctional variants, positron emission tomography (PET), photon emission computerized tomography (SPECT) and magnetoencephalography (MEG), the arrival of those techniques has not been able to relegate EEG to a secondary place. The utility of the EEG depends on an adequate evaluation that will lead to valid conclusions. The accuracy of this evaluation is related to the ability, training and experience of the operator. The EEG contributes to the definite diagnosis in many of childhood epilepsies and epileptic syndromes.
Asunto(s)
Humanos , Masculino , Femenino , Electroencefalografía/métodos , Epilepsia/clasificación , Espasmos Infantiles/patología , Síndrome de Landau-Kleffner/fisiopatología , Convulsiones/etiología , Convulsiones/patología , Neurología , PediatríaRESUMEN
Se descubre un caso de afasia adquirida o sindrome de Landau-Kleffner, en un niño preescolar de 5 años de edad, quien presentaba episodios de ausencia atípicas y crisis atónicas, llegando a presentar status eléctrico durante el sueño lento. La TAC cerebral no presenta anormalidades. Se discuten las características de la enfermedad y el tratamiento de la misma
Asunto(s)
Preescolar , Humanos , Masculino , Anticonvulsivantes/estadística & datos numéricos , Afasia/diagnóstico , Afasia/tratamiento farmacológico , ElectroencefalografíaRESUMEN
Se describe un caso de dependencia a la piridoxina (Vit. B6) en una adolescencia de 13 años de edad con retardo mental. Hija de padres consanguíneos. Las convulsiones fueron observadas desde el período neonatal, siendo controladas con la administración diaria de piridoxina
Asunto(s)
Adolescente , Humanos , Femenino , Epilepsia Tónico-Clónica/etiología , Piridoxina/efectos adversos , Convulsiones/inducido químicamenteRESUMEN
Se realiza una revisión bibliográfica de esta entidad clínica, analizando los diversos aspectos que abarca la misma como son: importancia de su estudio, definición, características clínicas, etiología, factores genéticos, electroencefalografía, pronóstico, secuelas y tratamiento. Se destaca la utilidad del fenobarbital y ácido valproico en la prevención de las crisis febriles