RESUMO
Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) is an autoimmune disorder with neurological and psychiatric features. The disease presents with a viral prodrome, followed by psychiatric manifestations. In the next phase, movement disorders or/and seizures occur. Finally, in the last phase, there is a decrease in the level of consciousness. Central hypoventilation and autonomic dysfunction can occur. Recently a unique EEG (electroencephalogram) pattern has been associated with anti-NMDA receptor encephalitis, the extreme delta brush (EDB). Although the association of the EDB with ANMDARE is known by the medical community, its significance is mainly unknown. A systematic review on NMDARE is also scarce. We decided to conduct a systematic review on this topic to consolidate the knowledge and establish the importance of the EDB as a prognostic factor. To conduct this systematic review, we used only studies conducted in humans, written in English, and published in the last 20 years. We used PubMed as a database and searched the following search terms: ("NMDA encephalitis"[Title/Abstract] AND "Epilepsy"[Title/Abstract]) OR (NMDA encephalitis"[Title/Abstract] AND "seizures" [Title/Abstract]) OR ("NMDA encephalitis"[Title/Abstract] AND "extreme delta brush"[Title/Abstract]). The protocol used for this systematic review was the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) protocol, and to analyze the bias of the studies, we used the ROBINS-1 tool. Eight studies were collected from our search strategy. Our data pulling showed that seizures were present in 178/249 (71.48%) patients. Status Epilepticus was reported in 29/96 (30.20%), and the EBD was seen in 30.89% (55/178) patients with seizures. The range of EDB was 5.9%-33% among the studies. Because the sample size was small, the statistical power was decreased. We had a low overall risk of bias. The wide range in the results could be related to the timing of the EEG recording. EDB was associated overall with increased length of hospital stay, increased ICU admission, and incidence of status epilepticus. The etiology of the EDB remains mainly unknown. However, it has been postulated that in NMDAR encephalitis, there is a disruption of the rhythmic neuronal activity. When antibodies block/target the NMDAR, the rhythmic neuronal activity is disrupted, leading to the unique EDB pattern. Another theory suggests that delta activity is caused because of focal abnormalities in the brain, and the superimposition of the beta waves is related to the alterations of the NMDA receptors.
RESUMO
La presente investigación trata sobre la evaluación clínica de las disgnacias y la postura de la columna vertebral en 45 niños de 6 a 12 años de edad que asistieron a la clínica de Odontología infantil y Ortodoncia de la Facultad de Odontología de la Universidad de El Salvador, durante el mes de Octubre del 2006. Donde se evaluó la postura de la columna vertebral en base a su curvatura, se observo las desarmonías del aparato estomatognático y estableció la asociación entre dichas alteraciones antes mencionadas con la postura de la columna vertebral. Para realizar el examen físico se elaboró una guía de observación, con la cual se observó la morfología y desviación de la columna vertebral, ejecutadas por dos examinadores (un Ortodoncista y un Odontopediatra) haciéndola en forma individual, una vez que se realizaron las evaluaciones físicas, se procedió a la evaluación clínica intra y extraoral de los pacientes en el sillón dental. Entre los resultados y conclusiones obtenidas en esta investigación fueron que la alteración más predominante fue la cifosis en 23 niños (51.10%), seguida de la lordosis en 12 niños (22.20%) y en una minoría escápula u omoplatos salientes en 15 niños (33.30%), la Maloclusión clase I de Angle se encontró con mayor alteración de la postura de la columna vertebral en 18 sujetos (75%), seguida de la clase II de Angle en 8 sujetos (73%), siendo irrelevante en la clase III de Angle en 5 sujetos (63%) y la relación molar no evaluable en 2 sujetos (100%).
The present research deals with the clinical evaluation of the disgnancies and the posture of the spine in 45 children from 6 to 12 years of age who attended the Children's Dentistry and Orthodontics clinic of the Faculty of Dentistry of the University of El Salvador, during the month of October 2006. Where the posture of the spine was evaluated based on its curvature, the disharmonies of the stomatognathic apparatus were observed and the association between the aforementioned alterations with the posture of the spine was established. To perform the physical examination, an observation guide was developed, with which the morphology and deviation of the spine were observed, executed by two examiners (an Orthodontist and a Pediatric Dentist) doing it individually, once the physical evaluations were performed. , we proceeded to the intraoral and extraoral clinical evaluation of the patients in the dental chair. Among the results and conclusions obtained in this research were that the most predominant alteration was kyphosis in 23 children (51.10%), followed by lordosis in 12 children (22.20%) and in a minority scapula or protruding shoulder blades in 15 children (33.30 %), Angle's class I malocclusion was found with a greater alteration of the posture of the spine in 18 subjects (75%), followed by Angle's class II in 8 subjects (73%), being irrelevant in class III of Angle in 5 subjects (63%) and the molar ratio was not evaluable in 2 subjects (100%).