Laboratory evaluations in HIV-1-associated cognitive/motor complex.

Laboratory tests can provide useful information about the presence and effects of HIV-1 in the CNS, but have thus far not yielded definitive diagnostic or prognostic markers of HIV-1-related cognitive and motor complex. The most clinically useful laboratory procedures are MR imaging and CSF examinations. The routine clinical use of MR imaging and CSF examinations, however, is still restricted to providing information for detecting and excluding secondary effects of HIV-1 infection. MR imaging and CT do not appear to be sensitive enough at current resolutions to provide early detection of HIV-1 CNS effects nor to follow disease progression. Several CSF variables are extremely promising as early markers of primary HIV-1 infection of the brain, and may provide preclinical indications for onset of treatment and for evaluation of treatment efficacy. These include CSF quinolinic acid levels, acid dissociated p24 antigen levels, neopterin or beta 2m, intrathecal IgG synthesis rate, and possibly quantitated PCR levels of HIV-1 viral load. Procedures such as nuclear magnetic resonance spectroscopy, SPECT, PET, computerized EEG, EP, and ERPs are all promising candidates for early detection or localization of HIV-1-related brain dysfunction, but at this time all must still be considered primarily research tools. Before any of these procedures can provide reliable diagnostic and prognostic information about primary HIV-1 neurologic disease, currently on-going longitudinal evaluations of large numbers of asymptomatic HIV-1-infected individuals as they progress to neurologically symptomatic disease must be completed. There is currently no laboratory marker in blood or CSF that definitively predicts the risk for HIV-1-associated cognitive/motor complex. HIV-1-associated cognitive/motor complex remains a clinical diagnosis, which is made on the basis of positive neurologic signs and symptoms and abnormal neuropsychological findings after other causes of neurologic disease are excluded. Laboratory measures, such as the electrophysiologic methods and some CSF variables, are likely to remain adjuncts to the diagnosis because, with few exceptions, they provide data that are nonspecific as to etiopathogenesis. Dynamic imaging, electrophysiologic methods, and CSF indices provide presumptive evidence for the presence of HIV-1-associated CNS damage, and with clinical and neuropsychological evidence, could be used to establish a new definition of primary HIV-1-associated CNS disease along the lines used in establishing a diagnosis of multiple sclerosis.(ABSTRACT TRUNCATED AT 400 WORDS)

[LACTRIMS consensus document for the pharmacological treatment of the multiple sclerosis and its clinical variants]. / Documento de consenso de LACTRIMS para el tratamiento farmacologico de la esclerosis multiple y sus variantes clinicas.

INTRODUCTION. Multiple sclerosis (MS) it is not considered any more a rare disease in Latin America. Most of the Latin American countries have reported moderate or lower prevalence data. However only very few countries have developed therapeutic guidelines. LACTRIMS prepared this consensus document with specific recommendations for the treatment of the disease. DEVELOPMENT. Experts on treatment and clinical research on MS were invited by LACTRIMS in order to generate a initial document to be discussed in Quito, Ecuador. Several groups were organized in relation of the different clinical variants. These groups were coordinated by experts leaders and prepared a preliminary document that was discussed in Quito during July 8th and 9th, 2011. Finally the final version was submitted to the members and delegates of LACTRIMS in most of the Latin American countries who were able to make modifications and suggest changes to the final manuscript. CONCLUSIONS. Based on the different evidence levels and the AGREE criteria, the clinical variants were reviewed and recommendations were made for the use of drugs and different modifying disease therapeutic agents.

[Neurology and HIV/AIDS infection: ethical problems]. / Neurologia e infección por el VIH-SIDA: problemas éticos.

Human immunodeficiency virus infection raises ethical issues in medical practice. This work presents several problems with ethical connotations related to HIV infections, observed by a neurologist during his medical practice. Patient-physician relationships, confidentiality, the request of patient consent to perform diagnostic procedures and reports to third parties are analyzed. The need for education and patient counseling about risk factors for infections is emphasized. Some features of clinical research in HIV infection such as the urging by the patients to simplify study protocols and limit sample sizes in clinical trials, are mentioned. Finally the possible solutions to these problems are discussed.

[Migraine caused by ergotamine tartrate dependence]. / Jaqueca por dependencia al tartrato de ergotamina.

A 37-year-old patient had migraine without aura over a six year period. He developed tolerance and dependency to ergotamine tartrate defined as the irresistible and dependable use of the drug. This is contingent upon a self-sustaining, rhythmic headache/medication cycle. The diagnosis of this entity is clinical and is supported by the typical and expected evolution of the migraine in response to the sudden interruption of ergotamine tartrate use.

[Treatment of multiple sclerosis with interferons]. / Tratamiento de la esclerosis múltiple con interferones.

Despite the important achievements in clinical and experimental aspects of demylinating diseases and multiple sclerosis (MS), its pathogenesis still remains unknown. The most commonly held view is that it is an autoimmune disease, related in some way to a viral infection, that occurs in genetically susceptible basis. Based on this, many current treatments for MS are designed to modulate the immune response and interferons are an example. Only beta interferon (out of delta and gamma interferon) has a dose dependent efficacy in phase III clinical trials, as treatment for remitting-relapsing forms. It produces a reduction in exacerbation rates and in the burden of the disease, measured by Magnetic Resonance imaging. The clinical use of beta interferon considering the cost and large treatment period, must be cautious, reserving it only for confirmed remitting-relapsing modalities of MS. There is no clear cut evidence that beta interferon is useful for chronic-progressive MS.

Cerebrospinal fluid (CSF) analyses in HIV-1 primary neurological disease.

This paper will focus on CSF findings in HIV-1 Neurological Disease (ND). Why use CSF as exploration window of the HIV-CNS involvement? Traditionally, CSF analysis has been an effective diagnostic method as well as a means of monitoring treatment in several infectious and immune pathologies of the CNS. Consequently there is an abundance of mature background information [113, 145, 147] particularly in terms of detecting infectious agents, using IgG findings as immunological indexes, and utilizing CSF findings to map the evolution of ND. We will explore the papers that utilize CSF variables as dependent measures to explore the effects of HIV disease, particularly HIV ND, cited in Index Medicus and MEDLINE data base, and published in Spanish, Italian and English, between 1985 to 1991. We will restrict our review to those studies that exclude HIV cases with CNS opportunistic infections or neoplasms, and thus focus on what the CSF can tell us about the primary effects of HIV on the brain as defined above. The primary long-term goal is to find some elements of the CSF that would lead to an understanding of the etiopathogenesis of HIV ND. However, an almost equally important aim is to determine which CSF variables may be clinically predictive of HIV ND occurrence and progression. The latter variables can also be expected to provide the best measures of HIV ND treatment efficacy. This is particularly important since it is our contention that treatment of HIV ND will eventually be initiated and monitored on the basis of laboratory markers of HIV ND, most likely from the CSF. Finally, this summarized information would be useful in drafting a CSF profile in order to have a reference pattern for cases with complications. The data of this review will be broken down, when the information permits, according to clinical stage and presence or absence of clinical manifestations of ND.

[Clinical characterization of 450 patients with cerebrovascular disease admitted to a public hospital during 1997]. / Caracterización clínica de 450 pacientes con enfermedad cerebrovascular ingresados a un hospital público durante 1997.

BACKGROUND: In Chile, cerebrovascular diseases are the fifth cause of death among men and the third cause among women. AIM: To assess the clinical features and management of patients with cerebrovascular disease admitted to a public hospital during 1997. PATIENTS AND METHODS: A retrospective analysis of clinical records of patients discharged with a diagnosis of cerebrovascular disease. Those records in which there was discordance between the discharge diagnosis and the clinical picture were not considered in the analysis. RESULTS: Of the 563 discharges from the hospital with the diagnosis of cerebrovascular disease, 487 records were located and 450 were considered in the analysis. Fifty four percent of patients were male and ages ranged from 17 to 96 years old. Fifty-one percent of patients had an ischemic stroke, 34% a cerebral hemorrhage, 12% a subarachnoidal hemorrhage and 3% a transient ischemic attack. There was a history of hypertension in 64% patients and 20% had an adequate treatment. Eighteen percent were diabetics, 34% had a heart disease and 20% had a previous episode of stroke. Mean hospital stay was 6.3 days in the emergency room and 11 days in the neurology ward. Hospital infections appeared in 21% of patients (respiratory in 68% and urinary in 22%), lethality was 30.5% and a CAT scan was done in 94%. At the moment of admission, 10% of patients had an evolution of less than 2 hours, 27% had an evolution between 2 and 6 hours and nine cases were potential eligible for thrombolysis. CONCLUSION: This is a picture of the local features of patients with cerebrovascular diseases that can be used as a reference for future studies.

Epilepsia y embarazo. / Epilepsy and pregnancy

Se analizan tanto los efectos de la epilepsia sobre el embarazo, parto, puerperio y producto como los efectos del embarazo sobre la evolucion de la epilepsia.En termino generales, la epilepsia condiciona potencialmente mayores riesgos tanto para la embarazada como para el nino. Como normas basicas se pueden plantear: 1. El embarazo en si mismo no es indicacion de suspender el tratamiento anticonvulsivante pero es preferible que en los casos nuevos o de abandono previo, este no se inicie o retablezca en el primer trimestre de gestacion. 2. Durante el embarazo debe intentarse siempre la monoterapia antiepileptica. No debe utilizarse la trimetadiona que es toxica y teratogenica. Hay escasa experiencia con el empleo de acido valproico y de carbamazepina. 3. Los niveles plasmaticos de anticonvulsivantes deben ser monitorizados periodicamente durante el embazo. 4. Las embarazadas epilepticas deben ser referidas a las unidades de alto riesgo obsterico y controladas en ellas. 5.Los tratamientos anticonculsivantes no obligan a suspender o evitar la lactancia ya que el paso de droga a la leche es escaso