Brain MR patterns in inherited disorders of monoamine neurotransmitters: An analysis of 70 patients.

Inherited monoamine neurotransmitter disorders (iMNDs) are rare disorders with clinical manifestations ranging from mild infantile hypotonia, movement disorders to early infantile severe encephalopathy. Neuroimaging has been reported as non-specific. We systematically analyzed brain MRIs in order to characterize and better understand neuroimaging changes and to re-evaluate the diagnostic role of brain MRI in iMNDs. 81 MRIs of 70 patients (0.1-52.9 years, 39 patients with tetrahydrobiopterin deficiencies, 31 with primary disorders of monoamine metabolism) were retrospectively analyzed and clinical records reviewed. 33/70 patients had MRI changes, most commonly atrophy (n = 24). Eight patients, six with dihydropteridine reductase deficiency (DHPR), had a common pattern of bilateral parieto-occipital and to a lesser extent frontal and/or cerebellar changes in arterial watershed zones. Two patients imaged after acute severe encephalopathy had signs of profound hypoxic-ischemic injury and a combination of deep gray matter and watershed injury (aromatic l-amino acid decarboxylase (AADCD), tyrosine hydroxylase deficiency (THD)). Four patients had myelination delay (AADCD; THD); two had changes characteristic of post-infantile onset neuronal disease (AADCD, monoamine oxidase A deficiency), and nine T2-hyperintensity of central tegmental tracts. iMNDs are associated with MRI patterns consistent with chronic effects of a neuronal disorder and signs of repetitive injury to cerebral and cerebellar watershed areas, in particular in DHPRD. These will be helpful in the (neuroradiological) differential diagnosis of children with unknown disorders and monitoring of iMNDs. We hypothesize that deficiency of catecholamines and/or tetrahydrobiopterin increase the incidence of and the CNS susceptibility to vascular dysfunction.

Etomidate improves seizure adequacy during electroconvulsive therapy.

The purpose of this study was to assess whether switching propofol to etomidate during an electroconvulsive therapy course improves seizure quality in convulsion-resistant patients. A retrospective study of paired cases included thirty-three patients. Seizure variables for each agent were assessed. A generalized linear mixed model (GLMM) for repeated measures was used for the analysis. Anesthesia with etomidate leads to greater seizure duration, improved seizure quality in the EEG register, and prevents further need for restimulation; although did not differ from propofol in the amount of energy delivered or in other automated parameters. These results suggest that this procedure appears to be an adequate strategy to improve seizure quality.

Mejora de la efectividad de la terapia electroconvulsiva mediante la determinación de la profundidad anestésica. Resultados preliminares / Improving the effectiveness of electroconvulsive therapy through the determination of anesthetic depth. Preliminary results

No disponible

Terapia electroconvulsiva en psicogeriatría / No disponible

La Terapia Electroconvulsiva (TEC) constituye el tratamiento de referencia para las depresiones graves. Los ancianos representan una población en la que se aplica con frecuencia, posiblemente por padecer enfermedades psiquiátricas que responden mejor a esta técnica junto con la necesidad de una respuesta más rápida o la intolerancia a tratamientos farmacológicos. Se revisan aspectos técnicos de su realización, los predictores de respuesta, las indicaciones habituales y las situaciones especiales en ancianos, así como los efectos adversos más frecuentes además de los cognitivos. En general, se puede concluir que la TEC es un tratamiento eficaz y seguro en el anciano

Electroconvulsive therapy (ECT) is the standard treatment for severe depression. The elderly represent a population in which it is applied frequently, possibly suffering from psychiatric illnesses that respond better to this technique along with the need for faster response or intolerance to drug treatments. Technical aspects of implementation, response predictors, usual clinical applications and special situations in the elderly, and frequent adverse effects (including cognitive effects) are reviewed. In general , it can be concluded that ECT is an effective and safe treatment in the elderly

Factores predictivos de respuesta a la terapia electroconvulsiva en la depresión / Response predictive factors for electroconvulsive therapy in depression

La terapia electroconvulsiva (TEC) es uno de los principales tratamientos en la depresión. No obstante, existe una falta de consenso respecto a las variables que determinan la respuesta satisfactoria a TEC. Esta revisión se centra en los estudios actuales de los factores predictivos de respuesta a TEC en pacientesdiagnosticados de trastorno depresivo. Se realizó una búsqueda sistemática en la base de datos Medline y en las referencias bibliográficas de las revisiones previas. Se seleccionaron 25 artículos relevantes publicados entre 1996 y 2013. Se identificaron como factores predictivos positivos: la edad mayor de 65 a˜nos, homocigosis Val/Val para la enzima catecol-O-metiltransferasa, la severidad del episodio depresivo, la ideación suicida y puntuaciones pretratamiento elevadas en ítems de disforia en la Montgomery and Asberg Depression Rating Scale. La resistencia al tratamiento, la cronicidad del trastorno y la comorbilidad con desórdenes de personalidad serían factores predictivos negativos de respuesta a TEC. Esta revisión no puede concluir que haya asociación respecto a la sintomatología psicótica, la melancólica o a determinados polimorfismos de la enzima convertidora de angiontensina (AU)

Electroconvulsive therapy (ECT) is one of the main treatments for depression. However, there is a lack of consensus on the variables that determine the successful response to ECT. This review focuses on current studies of the predictive factors of ECT response in depressed patients. A systematic search was conducted using the Medline database and the references of previous reviews. A total of 25 relevant articles published between 1996 and 2013 were selected. As positive predictors were identified: ageover 65 years, homozygous Val/Val for the enzyme catechol-O-methyltransferase, the severity of the episode, suicidal ideation, and increased baseline scores in items of dysphoria on the Montgomery and Asberg Depression Rating Scale. Treatment resistance, chronic state of the disorder, and comorbidity with personality disorders would be negative response predictors to ECT. This review was unable to demonstrate the association with psychotic symptoms, melancholic symptoms or angiotensin converting enzyme polymorphisms (AU)

Resistencia primaria a antipsicóticos / Primary resistance to antipsychotic agents

La resistencia al tratamiento antipsicótico en la esquizofrenia suele aparecer en el curso de la enfermedad, generalmente años después de iniciarlo. No hay estudios que comparen los fármacos antipsicóticos de nueva generación entre sí para el tratamiento de un episodio inicial de esquizofrenia, y los datos referentes a las alternativas en caso de resistencia al tratamiento también son muy escasos. A continuación se describe el caso clínico de un paciente con un primer episodio psicótico de difícil manejo farmacológico, tanto por la escasa respuesta inicial al tratamiento como por la aparición de importantes efectos secundarios, que limitaron el perfil de los posibles antipsicóticos utilizables y sus dosis. Finalmente se instauró tratamiento con clozapina

Resistance to antipsychotic treatment in schizophrenia usually develops throughout the course of the disease, generally years after the start of treatment. There are no trials comparing the new generation of antipsychotic agents in the treatment of first-episode schizophrenia, and data on the various options available in cases of treatment resistance are limited. We describe the case of a patient with difficult pharmacological management of a first psychotic episode, due to poor initial treatment response and the presence of serious adverse effects. These factors limited the possible antipsychotic drugs that could be used as well as their doses. Finally, clozapine therapy was started (AU)