Recent advances in controlling the internal and external properties of self-assembling cyclic peptide nanotubes and dimers.

One of the most powerful strategies for the preparation of nanotubes is based on the stacking of flat-shaped cyclic peptide components. This strategy allows precise control of the nanotube internal diameter, the external properties and, more recently, the structural characterisitics of the internal cavity. The recent advances in these technologies and the applications of the resulting materials are described.

Code stroke in Asturias.

BACKGROUND: Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. METHODS: We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. RESULTS: We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. CONCLUSIONS: Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible.

Sexual selection, sexual size dimorphism and Rensch's rule in Odonata.

Odonata (dragonflies and damselflies) exhibit a range of sexual size dimorphism (SSD) that includes species with male-biased (males > females) or female-biased SSD (males < females) and species exhibiting nonterritorial or territorial mating strategies. Here, we use phylogenetic comparative analyses to investigate the influence of sexual selection on SSD in both suborders: dragonflies (Anisoptera) and damselflies (Zygoptera). First, we show that damselflies have male-biased SSD, and exhibit an allometric relationship between body size and SSD, that is consistent with Rensch's rule. Second, SSD of dragonflies is not different from unit, and this suborder does not exhibit Rensch's rule. Third, we test the influence of sexual selection on SSD using proxy variables of territorial mating strategy and male agility. Using generalized least squares to account for phylogenetic relationships between species, we show that male-biased SSD increases with territoriality in damselflies, but not in dragonflies. Finally, we show that nonagile territorial odonates exhibit male-biased SSD, whereas male agility is not related to SSD in nonterritorial odonates. These results suggest that sexual selection acting on male sizes influences SSD in Odonata. Taken together, our results, along with avian studies (bustards and shorebirds), suggest that male agility influences SSD, although this influence is modulated by territorial mating strategy and thus the likely advantage of being large. Other evolutionary processes, such as fecundity selection and viability selection, however, need further investigation.

[Use of extra-hospital emergency systems in the treatment of acute stroke in the region of Murcia. Possible repercussions on the urgent care of stroke patients]. / Utilización del sistema de emergencias extrahospitalario en el tratamiento del ictus agudo en la región de Murcia. Posible repercusión en la asistencia sanitaria urgente del ictus.

AIM: To examine the use of extra-hospital emergency systems in the urgent care of stroke patients in our region and their influence on the time required to reach hospital, the time needed to perform an urgent computerised axial tomography (CAT) scan and the delay in receiving attention from the specialist. PATIENTS AND METHODS: Samples were collected from 232 stroke patients out of the total number admitted to our hospitals. Data about the stroke were collected prospectively, and included the arrival time, the time required to perform the CAT scan and the time the specialist devoted to attending the patient. Data were also gathered about the different extra-hospital transport and emergency systems. A statistical analysis was performed to determine the effect of using the extra-hospital emergency procedures on the different variables. RESULTS: A total of 53.6% of patients arrived within the first three hours. 38.7% went straight to hospital, 25% visited extra-hospital Emergency Services first, and 18.5% made a prior visit to Primary Care. 51.5% found their own way to the hospital and 46.7% arrived by ambulance. Mean time taken to perform an urgent CAT scan: 190.4 minutes; mean time required for specialist attention: 25.65 hours. The only statistically significant relation was the use of extra-hospital emergency systems and health care transport according to the type of stroke: both were more likely to be used in cases of haemorrhagic stroke. CONCLUSIONS: In hospitals in the Murcia region, the use of the extra-hospital emergency system and the means of transport utilised do not affect the time stroke patients take to reach hospital or the time needed to perform an urgent CAT scan or the delay in receiving attention from a specialist; the aetiology of the stroke does, however, influence the use of such services.

[Cerebellar hemorrhage after spinal anesthesia]. / Hemorragia cerebelosa tras anestesia subaracnoidea.

Cerebellar hemorrhage is a rare complication of spinal anesthesia. We report a case in a 51-year-old woman with a history of hypertension who underwent uterine dilatation and curettage with spinal anesthesia. During recovery she vomited and complained of headache. Postdural puncture headache was diagnosed. When there was no response to conventional treatment, computed tomography and magnetic resonance scans of the head were performed. The scans confirmed cerebellar hemorrhage due to rupture of a cavernous angioma. The patient recovered fully without surgical decompression. We review the pathogenesis of headache and cerebral hemorrhage after spinal anesthesia and propose differential diagnosis between spontaneous rupture related to hypertension and cerebrospinal fluid hypotension syndrome caused by trauma from lumbar spinal puncture. Patients with prolonged severe headache after spinal anesthesia require neurologic and radiologic monitoring to rule out the possibility of intracranial complications.

Pindolol, not propranolol, reverses cardiac hypertrophy in renal hypertensive rats.

Reversal of cardiac hypertrophy has been obtained by treatment with some antihypertensive drugs but has not been achieved consistently with beta blockers. To investigate whether this difference might be explained by the distinct hemodynamic actions of the drugs, we studied the effects of propranolol and pindolol, beta blockers with distinct modes of action, on cardiac hypertrophy of hypertensive male Wistar rats, two-kidney, one clip (2K1C) Goldblatt model (n = 33) and sham-operated control rats (n = 34). We also assessed the effects of such therapies on the ventricular pumping ability during open-chest, transient aortic occlusion. Four weeks after surgery, propranolol (5 mg/kg/day p.o.) was given to hypertensive (n = 8) and control rats (n = 11); pindolol was also given orally (1 mg/kg/day) to similar groups (n = 7 and n = 5, respectively). Untreated animals served as controls for both groups. Cardiac hypertrophy developed with hypertension in the untreated rats of the propranolol (3.38 +/- 0.18 vs 2.60 +/- 0.08 mg/g; p less than 0.01) and pindolol groups (3.93 +/- 0.21 vs 2.40 +/- 0.03 mg/g; p less than 0.001). Treatment reversed cardiac hypertrophy in the pindolol-treated (3.01 +/- 0.19 vs 3.93 +/- 0.21 mg/g; p less than 0.001, NS) but not in the propranolol-treated rats (3.24 +/- 0.18 vs 3.38 +/- 0.21 mg/g, NS). The maximal pressure that developed during aortic occlusion in the propranolol group was similar to that observed in the pindolol group. These results indicate that cardiac hypertrophy is reversed by pindolol but not by propranolol, and that this reversal does not interfere with left ventricular pumping ability.

[The use of the potential years of life between the ages of 1 and 64 as an indicator of premature mortality in Aragón during 1987]. / Utilización de los años potenciales de vida perdidos entre las edades de 1 y 64 años como un indicador de la mortalidad prematura ocurrida en Aragón durante 1987.

BACKGROUND: Years of potential life lost (YPLL) are a health indicator which allows to discriminate the main causes of premature mortality weighting up the deaths according to the age of dead person. METHODS: Premature mortality in Aragón during 1987 is analysed by means of the indicator YPLL between the ages 1 and 64 years. The information given by this indicator along with that supplied by the mortality rates is used to obtain a more complete information of the role and relative importance of each one of the main groups of diseases of the International Classification of Diseases (ICD-9th revision) within the mortality in Aragón during that whole year. RESULTS: The biggest rates of YPLL by one thousand population were due to tumours (9.87), traumatisms and poisonings (8.84), vascular diseases (5.65) and digestive diseases (1.96). Mortality and YPLL rates were higher for males than for females and statistically significant differences were also observed when comparing the provinces of Zaragoza and Huesca with the province of Teruel (higher rates in the first ones) and when comparing rural with urban areas (higher rates in the second case). CONCLUSIONS: According to this indicator the preventive programs in Aragón should lead to the prevention of tumors, traumatisms, vascular diseases and digestive diseases, without forgetting that these illnesses have a bigger effect on male population and on urban areas.

[Reflex epilepsies]. / Epilepsias reflejas.

INTRODUCTION: Reflex seizures are provoked by a specific sensory stimulus. Approximately 6% of all epileptic patients have reflex seizures. For identification of these seizures it is necessary to take a directed history and make an EEG study whilst the patient is being exposed to the stimulus, which will confirm the diagnosis. DEVELOPMENT: Many stimuli are effective in provoking reflex seizures, the commonest are visual. Amongst the various epileptic syndromes there are different types of epilepsies with reflex seizures which generally correspond to idiopathic generalized epilepsies. The physiopathogenic mechanisms are usually complex. The cerebral cortex corresponding to the function which induces the epileptic crisis is hyperexcitable, and is the cause of an identifiable lesion or dysfunction without an underlying lesion. CONCLUSION: The diagnostic importance of reflex seizures is that when some formerly drug-resistant patients can control the mechanism which triggers off their seizures they attain good control of them.

Estrogenic regulation of NADPH-diaphorase in the supraoptic and paraventricular nuclei under acute osmotic stress.

Estrogen receptors (ERs) α and ß are involved in the regulation of the nitrergic system in the supraoptic (SON) and paraventricular (PVN) nuclei under basal conditions. In this study we have assessed whether ERs are also involved in the modulation of the nitrergic system in the SON and PVN under acute systemic hypertonic conditions. Adult ovariectomized rats received a single injection of either estradiol, a selective ERα agonist, a selective ERß agonist, a selective ERα antagonist, a selective ERß antagonist or vehicle. Twenty-four hours later, animals received one i.p. injection of 1.5M NaCl to induce osmotic stress and were sacrificed after two additional hours. The number of NADPH-diaphorase-positive cells in the SON and PVN was determined. Their number in the SON was not affected by NaCl administration, whereas in the four PVN subdivisions it was decreased after NaCl administration. Estradiol and the ERα agonist prevented the action of NaCl in the four subdivisions of the PVN. In contrast, the inhibition of ERα enhanced the effect of NaCl, inducing a further decrease in the number of NADPH-diaphorase-positive cells. Moreover, the ERß agonist enhanced and the ERß antagonist blocked the effect of NaCl on the number of NADPH-diaphorase-positive neurons in the SON and in the medial magnocellular subdivision of the PVN. These findings indicate that estradiol regulates the nitrergic system in the SON and PVN under acute osmotic stress conditions, but the effects specifically depend on the anatomical subregions and different ERs.

El código ictus de Asturias / Code stroke in Asturias

Introducción: La trombólisis intravenosa con alteplasa es un tratamiento efectivo para el ictus isquémico si se aplica dentro de las primeras 4,5 horas, pero al que acceden <15% de los pacientes. La trombectomía mecánica recanaliza más obstrucciones proximales en las grandes arterias, pero necesita una infraestructura que la hace menos disponible. Métodos: Se detalla la evolución del código ictus en el Principado de Asturias y la adaptación del mismo a los sucesivos recursos para la atención urgente al ictus en la región. Teniendo en cuenta dichos recursos, las circunstancias poblacionales y geográficas de nuestra región, se plantea la reorganización del código ictus buscando la optimización del tiempo y la adecuación a cada paciente. Resultados: Reparto de las ocho áreas sanitarias de Asturias para derivar los pacientes candidatos a tratamientos de reperfusión hacia los dos hospitales donde se dispone de Unidad de Ictus y guardia de Neurología, con posibilidad de aplicar la fibrinólisis IV. Este reparto se realizó en función de la proximidad y la gravedad de los mismos, derivando todos los casos más graves directamente al hospital que dispone de guardia de Neurorradiología Intervencionista. El cribado del paciente se realizó por los Servicios de Emergencias Extrahospitalarias según la escala NIHSS. Conclusiones: Las modificaciones en el código ictus de Asturias permiten ofrecer tratamientos recanalizadores con buenos resultados, buscando la equidad y optimizando el manejo del binomio gravedad-tiempo para ofrecer a cada paciente el tratamiento óptimo en el menor plazo de tiempo posible y en condiciones de seguridad

Background: Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. Methods: We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. Results: We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. Conclusions: Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible

[Rational choice of antiepileptic treatment]. / Elección racional del tratamiento antiepiléptico.

The choice of the adequate antiepileptic treatment is based on the clinical experience more than rationality. During some decades, the combination of two antiepileptic drugs was considered the initial treatment but monotherapy showed more advantages (effectiveness, fewer adverse events, fewer teratogenic effects and better compliance). New antiepileptic drugs have increased our interest and knowledge of the epilepsies. They have changed some of our therapeutical schemes. Sodium valproate continues to be considered the choice treatment for all the idiopathic, cryptogenic and symptomatic generalized epilepsies. Lamotrigine and topiramate are two valid alternatives in these epileptic syndromes. In West's syndrome vigabatrin is considered the initial treatment. Carbamacepine, vigabatrine and tiagabine are not indicated in the treatment of generalized idiopathic epilepsies especially in patients with absence seizures. In focal epilepsies, both cryptogenic and symptomatic all the antiepileptic drugs have shown efficacy and the choice treatment is based on the adverse events and the teratogenic power. Prospective studies in patients with the same type of seizures and epileptic syndromes will allow us to determine the more adequate antiepileptic treatment.

[Drop attacks in patients with partial epilepsy]. / Crisis de caída brusca en pacientes con epilepsia focal.

BACKGROUND: It is known the presence of sudden falls or epileptic drop-attacks (DA) in patients with partial epilepsy. OBJECTIVE: To review the clinical and electroencephalographic manifestations in our patients with partial epilepsy and DA. PATIENTS AND METHODS: Fifteen patients (9 males/6 females) over 18 years with partial epilepsy and epileptic falls were selected. RESULTS: The mean age was 39 years (24-56 years). The mean age at seizure onset were 13 years (8 months-49 years) for partial seizures and 26 years (2-54 years) for DA. Secondary generalized or not, all patients had complex partial seizures, associated with simple partial seizures in five (34%). All were treated with politherapy, but a good control was not achieved. EEG recordings showed frontal focus in 7, temporal focus in 8, secondary bilateral synchrony in 9, and increase of electroencephalographic abnormalities during sleep in 9. Cognitive and emotional disorders were observed in 8 and 6 patients, respectively. Nine patients suffered from status epilepticus. The causal lesions were connatal encephalopathy in 8 and criptogenic in the other 7. The main consequence of DA was recurrent craneal trauma in 9 patients. CONCLUSIONS: The presence of DA is considered an ominous change in the evolution of a partial epilepsy. It's associated with mental deterioration and emotional disturbances and with drug resistance.

Líquido cefalorraqueano em 50 pacientes com AIDS / Cerebrospinal fluid in 50 AIDS patients

Foram estudados 50 pacientes com AIDS, todos estes pacientes apresentavam anticorpos ant-HIV1 (ELISA) e preenchiam os critérios de pontuaçao OPAS/Caracas de definiçao de casos de AIDS em adultos. A análise do liquido cefalorraqueano (LCR) incluiu: pressao; citologia (número de células e aspectos citomorfológicos); proteína total e eletroforese; concentraçoes de glicose, cloretos e testes imunológicos para sífilis, toxoplasmose e infecçoes virais (citomegalovírus, varicela-zoster, Herpes simplex, e HIV1). Investigaçoes bacteriológicas e micológicas (pesquisa direta e cultura), além de teste de aglutinaçao (látex) paracryptococcus foram também realizados. Os testes imunológicos usados foram fixaçao do complemento, imunofluorescência indireta, hemaglutinaçao passiva e/ou ELISA. Todos os LCR foram analisados no mesmo laboratório seguindo sempre a mesma metodologia. O LCR esteve alterado em 45 pacientes (90,0 por cento) dos 50 pacientes estudados. As principais alteraçoes encontradas no LCR foram: aumento de gamaglobulina em 25 casos (55,5 por cento); aumento da proteína total em 23 (51,1 por cento); hipercitose em 22 (48,9 por cento) e diminuiçao dos cloretos em 18(40,0 por cento). A detecçao de anticorpos anti- HIV1 estiveram presentes em 42 pacientes (93,3 por cento). Toxoplasmose isolada ou associada a outros agentes foi a infecçao oportunista mais frequente, detectada em 26 casos (57,7 por cento). O LCR deverá ser sempre analisado em todos os pacientes com AIDS, com ou sem sintomas neurológicos.

Malária cerebral e AIDS: relato de caso / Cerebral malaria and AIDS: case report

Embora nao esteja definitivamente comprovada que a severidade da malária esteja associada com o vírus da imunodeficiência humana (HIV), sabe-se que a infecçao pelo Plasmodium falciparum pode favorece uma rápida evoluçao da infecçao pelo HIV. Além disso a associaçao da malária com HIV/AIDS, do ponto de vista clínico, pode ser extremamente grave face a ocorrência de outros microorganismos e/ou neoplasias, o que piora a evoluçao e prognóstico dos pacientes. A concomitância do vírus HIV com o Plasmodium em zonas endêmicas de malária, é uma possibilidade que deve ser sempre pensada, visto que a sua transmissao está relacionada a fatores de risco ligados aos comportamentos das pessoas, que nem sempre sao logo revelados e/ou identificados. Os autores descrevem um caso de malária cerebral Plasmodium vivax e Plasmodium falciparum em um paciente com AIDS. Descrevem sua evoluçao clínica e terapêutica.

Hemorragia cerebelosa tras anestesia subaracnoidea / Cerebellar hemorrhage after spinal anesthesia

La hemorragia cerebelosa es una complicación rarade la anestesia subaracnoidea. Presentamos el caso deuna mujer de 51 años, con antecedentes de hipertensiónarterial, que fue anestesiada por vía subaracnoidea paralegrado uterino. En el postoperatorio desarrolló cefaleay vómitos, diagnosticándose de cefalea postpuncióndural. Al no responder al tratamiento convencional, serealizó tomografía computarizada craneal y resonanciacerebral, que confirmó el cuadro de hemorragia cerebelosapor ruptura de angioma cavernoso. La paciente serecuperó completamente sin precisar medidas quirúrgicasdescompresivas.Revisamos la patogénesis de la cefalea y la hemorragiaintracerebral tras anestesia subaracnoidea, planteandoel diagnóstico diferencial etiológico entre la roturaespontánea por hipertensión arterial y el síndromede hipotensión de líquido cefalorraquídeo de causatraumática tras punción lumbar. Pacientes con cefaleasevera y prolongada tras anestesia subaracnoidearequieren un cuidadoso seguimiento neurológico yradiológico para excluir una posible complicaciónintracraneal

Cerebellar hemorrhage is a rare complication of spinalanesthesia. We report a case in a 51-year-old womanwith a history of hypertension who underwent uterinedilatation and curettage with spinal anesthesia. Duringrecovery she vomited and complained of headache. Postduralpuncture headache was diagnosed. When therewas no response to conventional treatment, computedtomography and magnetic resonance scans of the headwere performed. The scans confirmed cerebellar hemorrhagedue to rupture of a cavernous angioma. Thepatient recovered fully without surgical decompression.We review the pathogenesis of headache and cerebralhemorrhage after spinal anesthesia and propose differentialdiagnosis between spontaneous rupture related tohypertension and cerebrospinal fluid hypotension syndromecaused by trauma from lumbar spinal puncture.Patients with prolonged severe headache after spinalanesthesia require neurologic and radiologic monitoringto rule out the possibility of intracranial complications

Utilización del sistema de emergencias extrahospitalario en el tratamiento del ictus agudo en la región de Murcia. Posible repercusión en la asistencia sanitaria urgente del ictus / Use of extra-hospital emergency system in the treatment of acute stroke in the region of murcia. Possible repercussions on the urgent care of stroke patients

Objetivo. Utilización en nuestra región de los sistemas de urgencias extrahospitalarias en la atención urgente del ictus y su influencia en el tiempo de llegada al hospital, el de realización de la tomografía axial computarizada (TAC) urgente y demora de la atención por el especialista. Pacientes y métodos. Se recogieron muestras de 232 pacientes con ictus del total de los ingresados en nuestros hospitales. Prospectivamente se recogieron datos sobre el ictus, con inclusión de los tiempos de llegada, tiempo de realización de la TAC y tiempo de atención por el especialista. Se recogió el uso delos distintos sistemas de urgencias y transporte extrahospitalarios. Estadísticamente se analizó la influencia del uso de los dispositivos de urgencia extrahospitalarios en las distintas variables recogidas. Resultados. 53,6% de los pacientes llegaron en las tres primeras horas. 38,7% acudieron directamente al hospital, el 25% acude primero al Servicio de Urgencias extrahospitalarias y 18,5% consulta previamente con Asistencia Primaria. El 51,5% llegaron por sus propios medios y el 46,7% en ambulancia. Tiempo medio de TAC urgente: 190,4 minutos; tiempo medio de atención por el especialista:25,65 horas. La única relación estadísticamente significativa fue el uso del sistema de urgencias extrahospitalarias y transporte sanitario según el tipo de ictus, con más tendencia a utilizarlos en los ictus hemorrágicos. Conclusiones. En los hospitales de Murcia, el uso del sistema de urgencias extrahospitalarias y el medio de transporte empleado no influyen en el tiempo de llegada del ictus al hospital, en el tiempo de realización de TAC urgente ni en la demora de atención por el especialista, y sí influye en la utilización de dichos servicios la etiología del ictus (AU)

Aim. To examine the use of extra-hospital emergency systems in the urgent care of stroke patients in our region and their influence on the time required to reach hospital, the time needed to perform an urgent computerised axial tomography(CAT) scan and the delay in receiving attention from the specialist. Patients and methods. Samples were collected from 232stroke patients out of the total number admitted to our hospitals. Data about the stroke were collected prospectively, and included the arrival time, the time required to perform the CAT scan and the time the specialist devoted to attending the patient. Data were also gathered about the different extra-hospital transport and emergency systems. A statistical analysis was performed to determine the effect of using the extra-hospital emergency procedures on the different variables. Results. A total of 53.6% of patients arrived within the first three hours. 38.7% went straight to hospital, 25% visited extra-hospital Emergency Services first, and 18.5% made a prior visit to Primary Care. 51.5% found their own way to the hospital and 46.7% arrived by ambulance. Mean time taken to perform an urgent CAT scan: 190.4 minutes; mean time required for specialist attention: 25.65hours. The only statistically significant relation was the use of extra-hospital emergency systems and health care transport according to the type of stroke: both were more likely to be used in cases of haemorrhagic stroke. Conclusions. In hospitals in the Murcia region, the use of the extra-hospital emergency system and the means of transport utilised do not affect the time stroke patients take to reach hospital or the time needed to perform an urgent CAT scan or the delay in receiving attention from a specialist; the aetiology of the stroke does, however, influence the use of such services (AU)

Epilepsias reflejas / Reflex epilepsies

Introducción. Las crisis reflejas son las provocadas por un estímulo sensorial específico. Aproximadamente el 6 por ciento de los pacientes epilépticos sufren crisis reflejas. Su identificación necesita una anamnesis dirigida y un estudio EEG con exposición al estímulo que confirme el diagnóstico. Desarrollo. Los estímulos eficaces para provocar crisis reflejas son numerosos; los más frecuentes son los visuales. Dentro de los diferentes síndromes epilépticos existen distintos tipos de epilepsias con crisis reflejas que corresponden, la mayoría, a las epilepsias generalizadas idiopáticas. Los mecanismos fisiopatogénicos suelen ser complejos. La corteza cerebral correspondiente a la función capaz de inducir una crisis epiléptica es hiperexcitable siendo la causa una lesión demostrable o una disfunción sin lesión subyacente. Conclusión. La importancia diagnóstica de las crisis reflejas se traduce en el hecho de que algunos pacientes previamente farmacorresistentes alcanzan un buen control de las crisis al poder controlar el mecanismo desencadenante de las mismas (AU)