[Frontal dysfunction in idiopathic Parkinson's disease]. / Disfunción frontal en la enfermedad de Parkinson idiopática.

INTRODUCTION: In his description of the disease in his original work, James Parkinson claimed that the 'senses remained intact', but later reports began to identify cognitive impairment that ranged from dementia to barely identifiable subclinical deteriorations. Research carried out in recent decades has revealed that cognitive disorders form part of the clinical symptoms of Parkinson's disease (PD) and point to the frontal lobes as being the most affected areas; a great deal of controversy, however, still surrounds their definition, epidemiology and pathology. AIM: To determine and classify the frontal deficits associated to this disease and to relate this cognitive performance with certain characteristics of the disease. SUBJECTS AND METHODS: The sample utilised in the study was made up of 222 subjects divided into two groups according to their diagnosis: 111 subjects with idiopathic PD and 111 control subjects. The neuropsychological examination was performed using the Frontal Assessment Battery, the copy of the Rey-Osterrieth complex figure and the digit test for determining frontal functioning. RESULTS AND CONCLUSIONS: We prove the existence of a frontal dysfunction that is characterised by impaired working memory, with visuospatial and executive dysfunction, which suggests greater involvement of the dorsolateral prefrontal cortex and cingulate. According to our findings, because working memory and visuospatial functioning are correlated to the motor status and the time elapsed since the onset of the disease, they could share the same underlying neuroanatomical foundations--the nigrostriatal denervation. This is not the case of executive function, which was not found to be related to the characteristics of the disease under study.

[The effects of lesions in the compact part of the substantia nigra on glutamate and GABA release in the pedunculopontine nucleus]. / Efecto de la lesión de la sustancia negra pars compacta sobre la liberación de glutamato y GABA en el núcleo pedunculopontino.

INTRODUCTION: The pedunculopontine nucleus (PPN), co-localized with the mesencephalic locomotor region, has been proposed as a key structure in the physiopathology of Parkinson's disease. OBJECTIVES: The goal of the present study was to assess if the aminoacid neurotransmitter release in the PPN is modified by the degeneration of dopaminergic cells, from substantia nigra pars compacta in 6-hydroxidopamine (6-OHDA)-lesioned rats. In addition, it was studied the aminoacid neurotransmitter release in the PPN of rats with lesion of the subthalamic nucleus by quinolinic acid (QUIN) (100 nmol) intracerebral injection. MATERIALS AND METHODS: Rats were assigned to five groups: untreated rats (I) (n = 13), 6-OHDA lesion (II) (n = 11), 6-OHDA + QUIN lesion (III) (n = 9), sham-operated (IV) (n = 10), QUIN, STN (V) lesioned (n = 9). The extracellular concentrations of glutamic acid (GLU) and gamma-aminobutyric acid (GABA) were determined by brain microdialysis and high performance liquid chromatography (HPLC). RESULTS. GLU released in PPN from 6-OHDA lesioned rats (group II), was significantly increased in comparison with the others groups (F(4, 47) = 18.21, p < 0.001). GABA released shows significant differences between experimental groups (F(4, 45) = 12.75, p < 0.001). It was detected a higher valour (p < 0.05) in-group II. The groups III and IV exhibited intermeddle valour (p < 0.001) and groups I and IV (p < 0.001) showed the lower GABA extracellular concentrations. The infusion of artificial cerebrospinal fluid with higher potassium (100 mmol) induced an increase in the GLU and GABA released in all groups, which confirm the neuronal origin of the extracellular content. CONCLUSION: These results are in agreement with the current model of basal ganglia functioning and suggest the role of STN-PPN projection in the physiopathology of Parkinson's disease.

[A clinical and epidemiological description of a series of patients diagnosed as suffering from progressive supranuclear palsy]. / Descripción clínica y epidemiológica de una serie de pacientes con diagnóstico de parálisis supranuclear progresiva.

INTRODUCTION: Progressive supranuclear palsy is a disease that normally presents only sporadically in adults and courses in a progressive, chronic manner. It is characterised by the presence of supranuclear ophthalmoplegia, postural instability, a Parkinsonian syndrome, pseudobulbar affect, cervical dystonia and cognitive impairment. PATIENTS AND METHODS: We conducted a descriptive study of clinical and epidemiological features in a series of 18 patients who satisfied the mandatory NINDS-SPSP clinical eligibility criteria for the likely diagnosis of progressive supranuclear palsy, using the scale developed by Golbe et al. RESULTS AND CONCLUSIONS: The mean age of onset of the disease was 58.6 +/- 8.2 years, 55.5% of the patients were males, the average history of the disease at the time of diagnosis was 4.39 +/- 2.3 years, and there was a diagnostic subregister in the first 4 years of the disease. Gait disorders, falls and slowness were the most frequently observed presenting forms of the disease. During their first four years with the disease, 75% of the patients were totally independent when it came to carrying out activities of daily living, whereas after the fourth year there was a predominance of the need for aid and absolute dependence. Dysphagia was more frequent in the later stages of the disease. Ocular motility disorders and impaired cognitive functioning were obvious in the initial stages of the disease, and there was a strong correlation between the length of time the disease had been coursing and the severity of the ocular and cognitive disorders.

[Database application for information on post-surgical evolution after functional neurosurgery]. / Programa de base de datos sobre evolución posquirúrgica de la neurocirugía funcional.

INTRODUCTION: A series of quantitative scales have been established internationally to evaluate the functional state of patients affected by movement disorders, such as Parkinson s disease. The values of these parameters offered by each patient, measured at different moments during his or her illness, allow us to conduct studies into their evolution as well as perform statistical studies about the casuistics. AIM. To provide a tool that enables us to study this vast amount of material in an efficient, sure and, above all, automated manner. Materials and methods. We selected the most interesting variables from the international protocols. We also designed and developed a database application for use under the Windows environment using Delphi 3.0 language and compiler and Structured Query Language. RESULTS: We designed, developed and validated a database system so as to be able to handle automatically the information on the clinical evolution of patients who had undergone functional neurosurgery. This system not only enables us to collect all relevant pre and post surgical information but also allows fast searches and selection, data processing using descriptive statistical techniques and the exportation of the data in a standard format. The system, which also allows final double blind clinical evaluation of each patient to be performed, has been used successfully in the Movement Disorders Clinic at the CIREN for over three years. CONCLUSIONS: This system allows for a considerable saving in the amount of time and effort needed for the post surgical evolution of patients, while also increasing the reliability of the results obtained.

[Factors that lead to death of neurons in neurodegenerative diseases]. / Factores que desencadenan la muerte neuronal en enfermedades neurodegenerativas.

OBJECTIVE: The objective of this paper was to review information related to the various factors which may trigger the mechanisms of cell death, induced or programmed, which take place in the nervous system and their relationship with the aetiopathogenesis of the neurodegenerative diseases. DEVELOPMENT: In recent years it has been recognized that cell death may be not only the consequence of accidental damage but also a sign of a suicide programme. This form of death is currently known as apoptosis. It is a process which is morphologically distinct from accidental cell death or necrosis. It does not cause an inflammatory response. This type of death is not only involved in the development and haemostasis of tissues, but also in setting off neuronal degeneration in experimental models of Parkinson's disease, Huntington's chorea, etc. CONCLUSIONS: In the cell death occurring in neurodegenerative diseases there is more than one induction mechanisms. Understanding the factors which trigger cell death, and the chain of events leading to this, gives grounds for the design of new pharmacological strategies for the treatment of these diseases.

[Lesions in the pars compacta substantiae nigra and the subthalamic nucleus modify the density of muscarinic receptors in different nuclei of the basal ganglia]. / La lesión de la sustancia negra pars compacta y del núcleo subtalámico modifica la densidad de receptores muscarínicos en distintos núcleos de los ganglios basales.

INTRODUCTION: Several studies that has focused to the dopaminergic transmission in the basal ganglia in parkinsonian condition, but only a few article has taking into account the imbalance between dopaminergic and cholinergic transmission. OBJECTIVE: To evaluate the muscarinic cholinergic receptors density in SNc and PPN in the 6-OHDA model. MATERIALS AND METHODS: Were organized five experimental groups in correspondence to the place of the lesion: I. Non treated rats, II. 6-OHDA lesion in SNc, III. 6-OHDA lesion in SNc + quinolinic acid lesion in NST, IV. Sham operated rats, V. Quinolinic acid in STN. Were obtained coronal sections of 20 microm thickness of SNc and PPN from rats and in these sections was evaluated the muscarinic receptors density through autoradiographic technique with [3H]quinuclidinylbenzilate (QNB) (1.23 nM). The muscarinic antagonist atropine (1 microM) was utilized as non-specific union. The density was evaluated in both hemispheres and the density optical was converted in fentomolas/mg of tissue with base to values obtained from tritium standards. RESULTS: Significant diminution of the muscarinic receptors density was found in the SNc ipsilateral to the 6-OHDA lesion from experimental groups II (t=2.76; p<0.05) and III (t=4.06; p<0.05). In the group V, was seen a significant increase of muscarinic receptor density in the SNc ipsilateral to the 6-OHDA lesion. The comparison between experimental groups evidenced significant differences among them (F=13.13; p<0.001) with a significant decrease in the density from SNc of groups II and III and significant increase in the density from SNc of group V in comparison of the others groups. In relation to PPN, muscarinic receptors density from right PPN ipsilateral to the 6-OHDA lesion, shown significant differences (F=3.93; p<0.01) between the experimental groups with a significant increase of this variable in the group II. CONCLUSIONS: These results signal a modification of cholinergic activity after 6-OHDA lesion. The changes in the muscarinic receptors populations located in SNc and PPN could be part of different compensatory mechanisms to attempt ameliorate the imbalance between dopaminergic and cholinergic transmission that it was installed after denervation of nigrostriatal forebrain bundle. The excitotoxic lesion of STN impose a new adjust mechanism for cell from PPN, which could be expressed in the changes of muscarinic cholinergic receptors population at the level of SNc.

[Effects of simultaneous transplant of foetal mesencephalic cells in the striatum and the subthalamic nucleus of hemiparkinsonian rats]. / Efectos del trasplante simultáneo de células mesencefálicas fetales en el estriado y el núcleo subtalámico de ratas hemiparkinsonianas.

INTRODUCTION: The main strategy followed in neural transplants as a method of treatment for Parkinson s disease, both experimental and clinical, has been to introduce foetal mesencephalic cells into the target area: the striatum. However, when the dopaminergic cells in the substantia nigra degenerate, not only is the dopaminergic innervation of the striatum affected but also other nuclei: globus pallidus, substantia nigra, substantia nigra pars reticulata and subthalamic nucleus. A series of data from pharmacological and physiological studies offer strong evidence that the dopamine released in these nuclei may play an important role in regulating the output nuclei of the basal ganglia. AIM: To evaluate the effect of transplanting foetal mesencephalic cells on the behaviour of 6 OH DA rats when introduced into the striatum and the subthalamic nucleus. MATERIALS AND METHODS: 6 OH DA was used to induce lesions in the substantia nigra of rats, which were divided into several experimental groups. The rotating activity induced by D amphetamine (5 mg/kg, intraperitoneally) and apomorphine (0.05 mg/kg, subcutaneously) was evaluated before and three months after the transplant in all the experimental groups, except in the control group of healthy rats. The hemiparkinsonian rats received a total of 350,000 foetal ventral mesencephalic cells, which were implanted within small deposits in the striatum (8) and in the subthalamic nucleus (4). RESULTS AND CONCLUSIONS: Rotation induced by both drugs was significantly lower (p= 0.05) in animals that had had dopaminergic cells transplanted into the striatum body. No significant improvement in this behaviour was to be found when transplants were limited to just the subthalamus or, simultaneously, also to the striatum. A significant increase in rotating behaviour induced by apomorphine was observed in the group which received a transplant in just the subthalamus.

[Subthalamic nucleus targeting and spatial variability]. / Localización bilateral y simetría del núcleo subtalámico.

AIM: The effectiveness of anatomic localization of the subthalamic nucleus (EAL) was assessed and the mapping method is described here. The symmetry of contralateral nuclei (SCN) was analyzed on 11 parkinsonian patients submitted to bilateral subthalamotomy with ablative lesioning. PATIENTS AND METHODS: To assess EAL the percentage so much of first trajectory (p1) as the total of trajectories (pt) that hit the target and the rest of subthalamic nucleus average distance (d) was calculated. The anatomic localization error (epsilon) is determined as a difference between first trajectory coordinates with those of medial determined nucleus point, through electrophysiological data as to the statistical significance of this error. SCN is analyzed by contrasting equality hypothesis at the nucleus maximum height alongside a trajectory, average electrophysiological position center and spatial distribution of all intranuclear recordings found in each hemisphere in all patients. RESULTS: The pi, pt and d obtained values were 86.36%, 86.13% and 1.41 +/- 1.01 mm respectively. The epsilon value was greater in anteroposterior direction of 1.11 +/- 0.83 mm without statistical significance. The average number of recorded trajectories for the first procedure was 6.45 and 6 for the second. The asymmetry of contralateral nucleus was not significant. CONCLUSIONS: An indirect method with CT brain images and a new electrophysiological mapping method with a multiunitary recording for first and second nucleus is safe enough and it yields a high effectiveness in anatomofunctional nucleus localization. The nucleus of a same patient are symmetrical. There is little space variability among patient non related to the differences in the intercommissural distance.

[Giant evoked potentials]. / Potenciales evocados gigantes.

INTRODUCTION: There are many, diverse nosological entities with the common factor of the genesis of cortical evoked potentials of great amplitude, commonly known as giant evoked potentials. In most cases they are conditions with the common clinical condition of myoclonic of cortical origin, such as progressive myoclonic epilepsy, generalized idiopathic epilepsy, myoclonias of toxic, infectious or postanoxic origin. Giant potentials have been shown both in studies of focal hemisphere lesions and in some cases of patients with corticobasal degeneration. OBJECTIVE: The aim of this paper was to show, by presenting interesting cases, some of the conditions mentioned and to review some concepts concerning the mechanisms which may be involved in the production of these electrophysiological responses. PATIENTS AND METHODS: We studied 6 patients aged between 2 and 22 years, in whom multimodal evoked potentials, electroencephalograms and imaging studies had been done. RESULTS: Giant somatosensory potentials were shown in the patients with obvious myoclonia. Visual potentials of great amplitude were common to the other patients presented, with or without myoclonia. CONCLUSION: Giant evoked potentials respond to a state of cortical hyperexcitability which may have various causes.

[The efficacy of the school health exam at the Molina de la Vega Health Center of Huelva]. / Rendimiento del examen de salud escolar en el Centro de Salud "Molino de la Vega" de Huelva.

BACKGROUND: To evaluate the efficiency of the school health test, by studying; the number of unknown anomalies detected; the number of children who went to confirm the anomalies; and the number of anomalies confirmed. METHODS: A descriptive observational study, with a subsequent followup, aimed at all students tested from the first, fifth and eighth years of EGB from the six schools in the basic area of "Molino de la Vega" in Huelva (714 in total). RESULTS: A total of 172 anomalies were detected (24% of the examined). Of those, 133 (77.3%) were followed and 112 (84.2%) came back to confirm the diagnosis, being the highest percentage (100%) for empty scrotum and the lowest (75%) for somatometric anomalies. A number of 73 (79.76%) of the anomalies detected were confirmed, reaching the maximum for visual alterations (86.48%) and the minimum for raquis deviations (65.21%). Of the children examined a 10.22% had anomalies not detected before. CONCLUSIONS: The school test proved highly efficient. Given the high number of anomalies detected in our basic health area, the percentage of children who went to confirm the diagnosis together with the high percentage of anomalies confirmed.

[Automatic anatomic-physiologic correspondence of deep structures of the central nervous system in stereotaxic functional neurosurgery]. / Automatización de la correlación anatomofisiológica de las estructuras profundas del sistema nervioso central en la neurocirugía funcional estereotáxica.

This work describes in detail the graphic facilities of a neurosurgical deep recording system for the anatomic-physiologic analysis of central nervous system deep structures in stereotaxic function neurosurgery guided by deep semi-microrecordings of the brain, as developed by the International Center of Neurologic Restoration in Cuba. This system for digitization of electrical activity in the brain uses an IBM-compatible 80386/80486 microprocessor in place of analog equipment for the visualization and recording of signals, thereby providing easier manipulation of recorded data and greater flexibility of analysis. The system automatically integrates each pulse recorded and quantifies its average amplitude. For each brain region explored, the behavior of the integrated activity recorded can be displayed on the corresponding sagittal view from the cerebral atlas of Schaltenbrand-Wahren, and then automatically scaled to the anatomic dimensions of each patient. The picture, with its different options, Facilitates analysis of anatomic correspondence of deep electrophysiologic signals so the various structures, nuclei and specific neuronal groups can be precisely located in the patient's brain. To date the system has been used successfully in over 110 neurosurgical procedures ventral intermedios (vim)-thalamotomy, pallidotomy, subthalotomy and neurotransplantation, providing more certain location of lesions or grafting sites for managing symptoms in Parkinson's disease and other movement disorders.

Disfunciòn frontal en la enfermedad de Parkinson idiopàtica / Frontal dysfunction in idiopathic Parkinson's disease

In his description of the disease in his original work, James Parkinson claimed that the 'senses remained intact', but later reports began to identify cognitive impairment that ranged from dementia to barely identifiable subclinical deteriorations. Research carried out in recent decades has revealed that cognitive disorders form part of the clinical symptoms of Parkinson's disease (PD) and point to the frontal lobes as being the most affected areas; a great deal of controversy, however, still surrounds their definition, epidemiology and pathology. AIM: To determine and classify the frontal deficits associated to this disease and to relate this cognitive performance with certain characteristics of the disease. The sample utilised in the study was made up of 222 subjects divided into two groups according to their diagnosis: 111 subjects with idiopathic PD and 111 control subjects. The neuropsychological examination was performed using the Frontal Assessment Battery, the copy of the Rey-Osterrieth complex figure and the digit test for determining frontal functioning. We prove the existence of a frontal dysfunction that is characterised by impaired working memory, with visuospatial and executive dysfunction, which suggests greater involvement of the dorsolateral prefrontal cortex and cingulate. According to our findings, because working memory and visuospatial functioning are correlated to the motor status and the time elapsed since the onset of the disease, they could share the same underlying neuroanatomical foundations--the nigrostriatal denervation. This is not the case of executive function, which was not found to be related to the characteristics of the disease under study(AU)

Efecto de la lesión de la sustancia negra parte compacta sobre la liberación de glutamato y GABA en el núcleo pedunculopontino / The effects of lesions in the compact part of the substantia nigra on glutamate and GABA release in the pedunculopontine nucleus

The pedunculopontine nucleus (PPN), co-localized with the mesencephalic locomotor region, has been proposed as a key structure in the physiopathology of Parkinson's disease. OBJECTIVES: The goal of the present study was to assess if the aminoacid neurotransmitter release in the PPN is modified by the degeneration of dopaminergic cells, from substantia nigra pars compacta in 6-hydroxidopamine (6-OHDA)-lesioned rats. In addition, it was studied the aminoacid neurotransmitter release in the PPN of rats with lesion of the subthalamic nucleus by quinolinic acid (QUIN) (100 nmol) intracerebral injection...(AU)

Diagnóstico por la imagen del absceso intraperitoneal poscesárea / Imaging diagnosis of postcesarean intraperitoneal abscess

Se presentan 2 casos de absceso poscesárea en pacientes de bajo riesgo quirúrgico ilustrados con imágenes de tomografía no concluyentes, y se discuten sus posibles diagnósticos diferenciales. El diagnóstico por la imagen del absceso pelviano se puede confundir con la degeneración miomatosa

We report 2 cases of postcesarean pelvic abscess that presented in low surgical risk patients. Tomographic scans were inconclusive. The possible differential diagnoses are discussed. Imaging diagnosis of a pelvic abscess may lead to confusion with red degeneration of leiomyoma

Disfunción frontal en la enfermedad de Parkinson idiopática / Frontal dysfunction in idiopathic Parkinson’s disease

Introducción. Al describir la enfermedad, James Parkinson planteó en su obra original que los sentidos permanecían indemnes, pero descripciones posteriores comenzaron a identificar el deterioro cognitivo, que abarcaba desde una demencia hasta deterioros subclínicos apenas identificables. Las investigaciones realizadas en las últimas décadas han revelado que los trastornos cognitivos forman parte de la sintomatología clínica de la enfermedad de Parkinson (EP) y señalan a los lóbulos frontales como los más afectados; pero todavía es controvertida su definición, epidemiología y patología. Objetivo. Determinar y caracterizar los déficit frontales asociados a esta enfermedad y relacionar este rendimiento cognitivo con algunas características de la enfermedad. Sujetos y métodos. La muestra utilizada estaba compuesta por 222sujetos, divididos en dos grupos en función de su diagnóstico: 111 sujetos con EP idiopática y 111 sujetos controles. La exploración neuropsicológica se constituyó por la batería de evaluación frontal(FAB), la copia de la figura compleja del Rey-Osterrieth y el test de dígitos para determinar la función frontal. Resultados y conclusiones. Se demuestra una disfunción frontal que se caracteriza por disminución de la memoria de trabajo, disfunción visuoespacial y ejecutiva, lo que sugiere una mayor afectación de la corteza prefrontaldorsolateral y cingulada. Según nuestros resultados, la memoria de trabajo y la función visuoespacial, al correlacionarse con el estado motor y el tiempo de evolución de la enfermedad, podrían compartir un mismo sustrato neuroanatómico, la denervación nigroestriatal. No así la función ejecutiva, que no se relacionó con las características de la enfermedad estudiada (AU)

Introduction. In his description of the disease in his original work, James Parkinson claimed that the 'senses remained intact', but later reports began to identify cognitive impairment that ranged from dementia to barely identifiable subclinical deteriorations. Research carried out in recent decades has revealed that cognitive disorders form part of the clinical symptoms of Parkinson’s disease (PD) and point to the frontal lobes as being the most affected areas; a great deal of controversy, however, still surrounds their definition, epidemiology and pathology. Aim. To determine and classify the frontal deficits associated to this disease and to relate this cognitive performance with certain characteristics of the disease. Subjects and methods. The sample utilised in the study was made up of 222 subjects divided into two groups according to their diagnosis: 111 subjects with idiopathic PD and 111 control subjects. The neuropsychological examination was performed using the Frontal Assessment Battery, the copy of the Rey-Osterrieth complex figure and the digit test for determining frontal functioning. Results and conclusions. We prove the existence of a frontal dysfunction that is characterised by impaired working memory, with visuospatial and executive dysfunction, which suggests greater involvement of the dorsolateral prefrontal cortex and cingulate. According to our findings, because working memory and visuospatial functioning are correlated to the motor status and the time elapsed since the onset of the disease, they could share the same underlying neuroanatomical foundations –the nigrostriatal denervation. This is not the case of executive function, which was not found to be related to the characteristics of the disease under study (AU)

Efecto de la lesión de la sustancia negra pars compacta sobre la liberación de glutamato y GABA en el núcleo pedunculopontino / The effects of lesions in the compact part of the substantia nigra on glutamate and gaba release in the pedunculopontine nucleus

Introducción. El núcleo pedunculopontino (NPP), colocalizado con el área locomotora mesencefálica, se ha señalado como una estructura clave en la fisiopatología de la enfermedad de Parkinson. Objetivos. 1. Estudiar el efecto de la lesión de la sustancia negra pars compacta -por inyección de 6-hidroxidopamina (6-OHDA)- sobre la liberación de aminoácidos neurotransmisores en el NPP. 2. Estudiar el efecto de la lesión del núcleo subtalámico (NST), por inyección intracerebral de 100 nmol de ácido quinolínico (QUIN), sobre la liberación de aminoácidos neurotransmisores en el NPP. Materiales y métodos. Se organizaron cinco grupos experimentales: ratas sanas (I; n = 13), lesión con 6-OHDA (II; n = 11), lesión simultánea de 6-OHDA + QUIN (III; n = 9), falsa lesión de 6-OHDA (IV; n = 10), y lesión del NST con QUIN (V; n = 9). Las concentraciones extracelulares de ácido glutámico (GLU) y GABA se determinaron por medio de cromatografía líquida de alta resolución (HPLC) con detección fluorimétrica. Resultados. Se detectaron diferencias significativas en la liberación de GLU entre todos los grupos experimentales (F(4, 47) = 18,21, p < 0,001), con un aumento significativo de esta variable en el grupo II. La liberación de GABA en el NPP mostró diferencias significativas entre los grupos en estudio (F(4, 45) = 12,75, p < 0,001). Para esta variable se produjo una separación entre los grupos, con un aumento significativo (p < 0,05) en el grupo II, valores intermedios y significativamente diferentes para los grupos III y V (p < 0,001) y valores menores para los grupos I y IV. La infusión de una solución de líquido cefalorraquídeo artificial con mayor concentración de potasio (100 mmol) produjo un incremento en la liberación de los aminoácidos neurotransmisores en todos los grupos experimentales, lo cual confirma el origen neuronal del contenido extracelular estudiado. Conclusiones. Estos resultados concuerdan con el ‘modelo’ actual de funcionamiento de los ganglios basales y sugieren un papel importante a la proyección STN-NPP en la fisiopatología de la enfermedad de Parkinson

Introduction. The pedunculopontine nucleus (PPN), co-localized with the mesencephalic locomotor region, has been proposed as a key structure in the physiopathology of Parkinson’s disease. Objectives. The goal of the present study was to assess if the aminoacid neurotransmitter release in the PPN is modified by the degeneration of dopaminergic cells, from substantia nigra pars compacta in 6-hydroxidopamine (6-OHDA)-lesioned rats. In addition, it was studied the aminoacid neurotransmitter release in the PPN of rats with lesion of the subthalamic nucleus by quinolinic acid (QUIN) (100 nmol) intracerebral injection. Materials and methods. Rats were assigned to five groups: untreated rats (I) (n = 13), 6-OHDA lesion (II) (n = 11), 6-OHDA + QUIN lesion (III) (n = 9), sham-operated (IV) (n = 10), QUIN, STN (V) lesioned (n = 9). The extracellular concentrations of glutamic acid (GLU) and gamma-aminobutyric acid (GABA) were determined by brain microdialysis and high performance liquid chromatography (HPLC). Results. GLU released in PPN from 6-OHDA lesioned rats (group II), was significantly increased in comparison with the others groups (F(4, 47) = 18.21, p < 0.001). GABA released shows significant differences between experimental groups (F(4, 45) = 12.75, p < 0.001). It was detected a higher valour (p < 0.05) in-group II. The groups III and IV exhibited intermeddle valour (p < 0.001) and groups I and IV (p < 0.001) showed the lower GABA extracellular concentrations. The infusion of artificial cerebrospinal fluid with higher potassium (100 mmol) induced an increase in the GLU and GABA released in all groups, which confirm the neuronal origin of the extracellular content. Conclusion. These results are in agreement with the current model of basal ganglia functioning and suggest the role of STN-PPN projection in the physiopathology of Parkinson’s disease

Degeneración corticobasal. Descripción de un caso con sanguíneo / Corticobasal degeneration. Description of a consanguineous case

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Descripción clínica y epidemiológica de una serie de pacientes con diagnóstico de parálisis supranuclear progresiva / A clinical and epidemiological description of a series of patients diagnosed as suffering from progressive supranuclear palsy

Introducción. La parálisis supranuclear progresiva es una enfermedad de curso crónico progresivo, de presentación fundamentalmente esporádica en el adulto, que se caracteriza por la presencia de oftalmoplejía supranuclear, inestabilidad postural, síndrome parkinsoniano, afectación seudobulbar, distonía cervical y deterioro cognitivo. Pacientes y métodos. Realizamos un estudio descriptivo sobre aspectos clínicos y epidemiológicos en una serie de 18 pacientes que cumplían los criterios clínicos mandatarios de inclusión (NINDS-SPSP) para el diagnóstico probable de parálisis supranuclear progresiva, utilizando la escala de Golbe et al. Resultados y conclusiones. La edad de inicio promedio de la enfermedad fue de 58,6 ñ 8,2 años, el 55,5 por ciento de los pacientes pertenecen son varones, el tiempo medio de evolución de la enfermedad hasta el momento del diagnóstico fue de 4,39 ñ 2,3 años, y existía un subregistro diagnóstico en los primeros cuatro años de la enfermedad. Los trastornos de la marcha, las caídas y la lentitud constituyeron las formas más frecuente de debut de la enfermedad. El 75 por ciento de los pacientes en los primeros cuatro años de evolución era totalmente independiente para realizar las actividades de la vida cotidiana, mientras que después de los cuatro años predominaba la necesidad de asistencia y la dependencia absoluta. La disfagia fue más frecuente en etapas tardías de la enfermedad. La afectación de la motilidad ocular y la función cognitiva fue evidente en las etapas iniciales de la enfermedad, y existió una alta correlación entre el tiempo de evolución de la enfermedad y la gravedad de la afectación ocular y cognitiva (AU)

y. Introduction. Progressive supranuclear palsy is a disease that normally presents only sporadically in adults and courses in a progressive, chronic manner. It is characterised by the presence of supranuclear ophthalmoplegia, postural instability, a Parkinsonian syndrome, pseudobulbar affect, cervical dystonia and cognitive impairment. Patients and methods. We conducted a descriptive study of clinical and epidemiological features in a series of 18 patients who satisfied the mandatory NINDS-SPSP clinical eligibility criteria for the likely diagnosis of progressive supranuclear palsy, using the scale developed by Golbe et al. Results and conclusions. The mean age of onset of the disease was 58.6 ± 8.2 years, 55.5% of the patients were males, the average history of the disease at the time of diagnosis was 4.39 ± 2.3 years, and there was a diagnostic subregister in the first 4 years of the disease. Gait disorders, falls and slowness were the most frequently observed presenting forms of the disease. During their first four years with the disease, 75% of the patients were totally independent when it came to carrying out activities of daily living, whereas after the fourth year there was a predominance of the need for aid and absolute dependence. Dysphagia was more frequent in the later stages of the disease. Ocular motility disorders and impaired cognitive functioning were obvious in the initial stages of the disease, and there was a strong correlation between the length of time the disease had been coursing and the severity of the ocular and cognitive disorders (AU)

Efectos del trasplante simultáneo de células mesencefálicas fetales en el estriado y el núcleo subtalámico de ratas hemiparkinsonianas / Effects of simultaneous transplant of foetal mesencephalic cells in the striatum and the subthalamic nucleus of hemiparkinsonian rats

Introducción. La principal estrategia de trasplante neural como tratamiento de la enfermedad de Parkinson, tanto experimental como clínico, ha sido colocar las células mesencefálicas fetales en su principal blanco: el estriado. Sin embargo, cuando las células dopaminérgicas de la sustancia negra degeneran, no sólo se afecta la inervación dopaminérgica del estriado; por el contrario, la inervación de otros núcleos, como el globo pálido, sustancia negra parte reticulada y núcleo subtalámico, también se afectan. Una serie de datos provenientes de estudios farmacológicos y fisiológicos proveen de fuertes evidencias acerca de que la dopamina liberada en estos núcleos puede desempeñar un papel importante en la regulación de los núcleos de salida de los ganglios basales. Objetivo. El objetivo principal de este estudio fue evaluar el efecto del trasplante de células mesencefálicas fetales sobre la conducta de ratas-6-OH-DA, cuando el mismo se coloca en el estriado y el núcleo subtalámico. Materiales y métodos. Se utilizaron ratas con lesión de la sustancia negra inducida por la 6-OHDA, divididas en varios grupos experimentales. La actividad rotatoria inducida por D-anfetamina (5 mg/kg, intraperitonealmente) y apomorfina (0,05 mg/kg, subcutáneamente) se evaluó antes y en los tres meses posteriores al trasplante en todos los grupos experimentales, excepto en el grupo de controles sanos. Las ratas hemiparkinsonianas recibieron un total de 350.000 células de mesencéfalo ventral fetal, que se implantaron en pequeños depósitos en el estriado (8) y en el núcleo subtalámico (4). Resultados y conclusiones. Los animales con trasplante de células dopaminérgicas en el cuerpo estriado redujeron significativamente el número de vueltas inducido por ambas drogas (p= 0,05). No fue posible demostrar mejoría significativa de estas conductas cuando los trasplantes se colocaron sólo en el subtálamo o en este núcleo, simultáneamente al estriado. Se observó un incremento significativo en la conducta de giro inducida por apomorfina en el grupo con trasplante aislado en subtálamo (AU)