When aphasia is due to aphasic status epilepticus: a diagnostic challenge.

Aphasic status epilepticus is an uncommon entity that should be included in the differential diagnosis of persistent and sudden language disorders. In our study, we describe seven patients admitted with clinical and electroencephalographic diagnosis of aphasic status, who were studied with both neuroimaging and electroencephalogram. The mean age was 65.9 years (range of 39-89). Three of the patients had previously been diagnosed of epilepsy. The aphasia was global in six patients. In one case, we found foci of the left hemorrhagic contusions. The initial electroencephalogram (EEG) was not conclusive of status in two patients. In one patient, neuroimaging showed left hemispheric hypoperfusion, compatible with postictal changes. Six out of seven patients required at least two antiepileptic drugs. Three patients died of systemic complications (infectious causes), whereas the other four cases had a complete recovery. Our study highlights that a second EEG study might be necessary to confirm epileptiform activity, when clinical features and other tests suggest an epileptic origin. An early and specific treatment, avoiding or diminishing comorbidities, might significantly improve the prognosis of these patients.

Depresión y otros trastornos afectivos en la enfermedad de Parkinson / Depression and other affective disorders in Parkinson's disease

RESUMEN Los síntomas no motores son frecuentes en la enfermedad de Parkinson (EP). La depresión, la ansiedad y la apatía son síntomas muy prevalentes en la población afectada. Estos síntomas han demostrado ser determinantes en el deterioro de la calidad de vida de los pacientes con EP y el resultado es un empeoramiento de su estado funcional y cognitivo, además de aumento en la mortalidad. Diversos sistemas de neurotransmisión, como el dopaminérgico y las vías serotoninérgicas y noradrenérgicas, pueden contribuir a la alta aparición de depresión en la EP. Existen varias escalas que sirven como herramientas para monitorizar cambios a lo largo del tiempo y determinar el efecto de las estrategias terapéuticas en estos pacientes. El abordaje terapéutico se puede enfocar desde el punto de vista farmacológico y no farmacológico. Antidepresivos tricíclicos, inhibidores de la recaptación de serotonina e inhibidores mixtos de serotonina y noradrenalina han demostrado efectividad. También hay reportes positivos de opciones no farmacológicas como la estimulación magnética transcraneal, la terapia cognitiva conductual y la cirugía de estimulación cerebral profunda. Sin embargo, estas últimas requieren más evidencia. La ansiedad se relaciona con empeoramiento de la sintomatología motora y frecuentemente se asocia a síndrome depresivo. Como tratamiento se utilizan habitualmente antidepresivos con perfil ansiolítico y benzodiazepinas. La apatía se asocia con edad avanzada, peor función cognitiva, aumento de los síntomas motores, discapacidad más grave y menor calidad de vida, con una mayor carga para el cuidador.

SUMMARY Non-motor symptoms are frequent in Parkinson's disease (PD), being depression, anxiety and apathy symptoms very prevalent in this population. These symptoms have been shown to be determinants of quality of life in patients with PD, resulting in reduced quality of life, poorer functional status and worse cognitive function, and have been associated with an increase in mortality. Various neurotransmitters systems, such as dopaminergic, serotonergic and noradrenergic pathways, may contribute to the high onset of depression in PD. There are several scales that serve as tools to monitor changes over time and determine the effect of therapeutic strategies in these patients. The therapeutic strategy can be approached from the pharmacological and non-pharmacological point of view. Tricyclic antidepressants, serotonin reuptake inhibitors and mixed serotonin and norepinephrine inhibitors have shown effectiveness. There are also positive reports of non-pharmacological options such as transcranial magnetic stimulation, cognitive behavioral therapy, and deep brain stimulation surgery, however the latter require more evidence. Anxiety is related to worsening of motor symptoms and is frequently associated with depressive symptoms. As a treatment, antidepressants with anxiolytic profile and benzodiazepines are commonly used. Apathy is associated with advanced age, worse cognitive function, increased motor symptoms, more disability and lower quality of life with a greater burden for the caregiver.