Doping and sports endocrinology: growth hormone, IGF-1, insulin, and erythropoietin.

Among the substances prohibited by the World Anti-Doping Agency, "peptide hormones, growth factors, related substances, and mimetics" are classified as prohibited both in- and out-of-competition in section S2. This work reviews growth hormone and its releasing peptides, insulin-like growth factor 1 as the main growth factor, insulin, and erythropoietin and other agents that affect erythropoiesis. This review analyzes the prevalence of use among professional athletes and gym clients, the forms of use, dosing, ergogenic effects and effects on physical performance, as well as side effects and anti-doping detection methods.

Doping and sports endocrinology: anabolic-androgenic steroids.

The use of anabolic steroids affects not only professional athletes but also the general population (bodybuilders, gym clients, and adolescents). In the first case, its use is prohibited and sanctioned by the World Anti-Doping Agency and Olympic committees. For the other users, it is difficult to establish its prevalence since many obtain the products via the internet. The reasons for its use are varied and different forms of use and other types of users have been described. Among the side effects of steroid use, hypogonadism is the most frequent cause for endocrinological consultation. After a general introduction to doping, this review describes the historical background of anabolic-androgenic steroids, their classification, forms of use, physiological effects, adverse effects on different organs and systems, treatment of hypogonadism, as well as detection methods.

[Knowledge on stroke in Spanish population. A systematic review]. / Conocimiento sobre el ictus en la población española. Una revisión sistemática.

OBJECTIVES: To analyze by means of a systematic review the general knowledge about strokes of the Spanish population. MATERIALS AND METHODS: A systematic review is performed following PRISMA guidelines and with data from PubMed, Scopus and EMBASE. All studies carried out in Spain, centred around the knowledge of strokes are compiled (terminology, pathophysiology, signs and symptoms, risk factors, treatment, and willingness to make use of the Emergency Services). From the 4,627 articles collected, 21 were ultimately included in this review. RESULTS: In Spain, the term stroke is less known than others such as embolism or cerebrovascular accident. Loss of strength is the most widely recognized symptom, whereas arterial hypertension is the most widely identified risk factor. The least known symptom and risk factor are visual impairment and diabetes mellitus, respectively. When faced with a suspected stroke, the attitude of most respondents is adequate as they decide to go to the hospital or call the Emergency Services. However, in rural areas or in cases in which the symptoms suddenly stop, a greater number of participants choose to go to their family physician. The main sources of information of the participants are their family members and their doctors. CONCLUSIONS: General knowledge about strokes is scarce among the general population. Nonetheless, the attitude of most of the participants is adequate as they choose to contact specialized Emergency Services.

TITLE: Conocimiento sobre el ictus en la población española. Una revisión sistemática.Objetivos. Analizar mediante una revisión sistemática el estado de conocimiento sobre el ictus en la población española. Materiales y métodos. Se ha llevado a cabo una revisión sistemática siguiendo las directrices PRISMA en las bases de datos PubMed, Scopus y EMBASE. Se incorporaron todos los estudios realizados en España que versaran sobre el conocimiento del ictus (terminología, fisiopatología, síntomas y signos, factores de riesgo, tratamiento e intención de acudir a servicios de emergencias). Se identificaron 4.627 artículos, de los cuales 21 se incluyeron finalmente en la revisión. Resultados. El término ictus es menos reconocido que otros, como embolia o infarto cerebral. La pérdida de fuerza es el síntoma más reconocido y la hipertensión arterial es el factor de riesgo más identificado. El síntoma y el factor de riesgo menos reconocidos son los déficits visuales y la diabetes mellitus, respectivamente. Ante la sospecha de ictus, la actitud de la mayoría de los encuestados es adecuada, ya que eligen acudir al hospital o llamar a los servicios de emergencias. Sin embargo, en el medio rural, y ante síntomas que ceden espontáneamente, un mayor número de participantes elige acudir a su médico de familia. Las principales fuentes de información de los participantes son sus familiares y médicos. Conclusiones. El conocimiento global sobre el ictus es escaso entre la población española. Sin embargo, la actitud de la mayoría de los participantes es adecuada, ya que elige mayoritariamente contactar con servicios de emergencias especializados.

[Resting state functional magnetic resonance imaging applications in the temporal lobe epilepsy surgery]. / Aplicaciones de la resonancia magnética funcional en estado de reposo en la cirugía de la epilepsia del lóbulo temporal.

INTRODUCTION: There is a growing interest in the functional magnetic resonance imaging (fMRI) and his clinical applications in the planning of the epilepsy surgery. The conventional method of using the fMRI require the cooperation of the patient. Currently it is being studied the possibility of using this technique without the performance of specific tasks by the patient in the modality of resting state. AIM: To study the clinical applications of the fMRI in resting state, in the planning of the temporal epilepsy surgery. DEVELOPMENT: We carried out a systematic review helped by a bibliographic research in different databases, including PubMed, Science Direct, Scopus and Cochrane. We included articles focused on the use of resting state fMRI written in Spanish and English, excluding studies exclusively focused on pediatric patients or related with the presence of epileptogenic tumors and other structural pathologies except for the temporal sclerosis. We found 11 articles which describe different clinical applications for the resting state fMRI in the context of epilepsy surgery. In five, the objective was to identify the epileptogenic hemisphere; in two, it was planned to predict the improvement of the disease; and in four of the articles, it has been studied the possibility of predicting worsening of cognitive functions that are frequently affected after the surgery. CONCLUSION: The resting state fMRI is a technique with a great potential of developing an useful tool in the context of planning the epilepsy surgery, as well as in the prediction of postsurgical morbidity.

TITLE: Aplicaciones de la resonancia magnética funcional en estado de reposo en la cirugía de la epilepsia del lóbulo temporal.Introducción. Existe un interés creciente en la aplicación de la resonancia magnética funcional (RMf) en el abordaje prequirúrgico de la cirugía de la epilepsia. Tradicionalmente, esta técnica precisa la colaboración del paciente en la realización de tareas concretas; sin embargo, en la actualidad, se estudia la posibilidad de realizarla sin necesidad de colaboración en la modalidad de estado de reposo. Objetivo. Estudiar las utilidades clínicas de la RMf en estado de reposo en la planificación de la cirugía de la epilepsia del lóbulo temporal. Desarrollo. Se realizó una revisión mediante la búsqueda bibliográfica en diferentes bases de datos: PubMed, Science Direct, Scopus y Cochrane. Se incluyeron estudios en inglés y castellano que utilizaron la RMf en estado de reposo, excluyendo los artículos de pacientes exclusivamente pediátricos o relacionados con la existencia de tumores u otras patologías estructurales diferentes a la esclerosis temporal. Se encontraron 11 artículos que estudiaron las utilidades clínicas en la aplicación de la RMf en estado de reposo en el contexto de la cirugía de la epilepsia. En cinco se intenta determinar el hemisferio epileptógeno, en dos se propone como objetivo la predicción pronóstica de la mejoría de las crisis epilépticas y en cuatro se estudia la posibilidad de predecir el deterioro de diversas funciones cognitivas tras la cirugía. Concusión. La RMf en estado de reposo es una técnica con un gran potencial para convertirse en una herramienta útil en el contexto de la planificación de la cirugía de la epilepsia y en la predicción de la morbilidad postoperatoria.

[State of the art in musicogenic epilepsy: a review of the scientific literature]. / Conocimiento actual de la epilepsia musicogena: revision de la literatura cientifica.

INTRODUCTION: Musicogenic epilepsy is a type of reflex complex epilepsy and is evoked by musical stimulus, specially music with high emotional content to the patient. AIM: To review the state of the art of the musicogenic epilepsy in the current literature. DEVELOPMENT: We have made an analysis of all the patients that have been described with musicogenic epilepsy. Among the most studied variables we have included: the nature of the sound that evoke the seizure, the musical education of the patients, the changes between the different neurophysiological and neuroimaging techniques, the most frequent location and the hemispheric side implication in seizures, and comparison between the different neuroimaging techniques. Most of the patients had seizures when they were listening to music with emotional content. The right temporal lobe is the most affected area in this type of epilepsy. In these studies the structural neuroimaging were normal in most of the patients. CONCLUSIONS: Musicogenic epilepsy is reflex and complex and music with emotional content to the patients is the most frequent stimulus that evoke this type of epilepsy. The right temporal lobe is the most affected area. It seems that exists a correlation between emotional and auditory cerebral processing networks.

TITLE: Conocimiento actual de la epilepsia musicogena: revision de la literatura cientifica.Introduccion. La epilepsia musicogena se clasifica dentro del grupo de las epilepsias reflejas complejas y se caracteriza por desencadenarse con estimulos musicales, especialmente con fragmentos musicales con alta emotividad en la melodia. Objetivo. Revisar el conocimiento actual de las epilepsias musicogenas en la literatura cientifica. Desarrollo. Se ha realizado una revision detallada de los articulos que versan sobre epilepsia musicogena. Para ello se ha llevado a cabo un analisis de todos los casos clinicos descritos en la bibliografia hasta febrero de 2019. Entre las variables mas frecuentes se han estudiado: el tipo de estimulo sonoro desencadenante de las crisis, la presencia o no de educacion musical del paciente, los cambios en las diferentes pruebas complementarias neurofisiologicas y de neuroimagen, y la localizacion y lateralidad hemisferica implicada en este fenomeno. La mayoria de los pacientes tiene crisis evocadas por musica con contenido emocional para ellos. El lobulo temporal derecho es el mas frecuentemente implicado en este tipo de crisis, pero en la mayoria de los casos no se han observado alteraciones estructurales en las pruebas de neuroimagen. Conclusiones. La epilepsia musicogena es refleja y compleja y se caracteriza por desencadenarse con estimulos musicales. La zona que mas se afecta en las pruebas funcionales es el lobulo temporal derecho. Se piensa que existe una relacion entre las redes cerebrales que se encargan del procesamiento de las emociones a traves del estimulo auditivo y el desarrollo de este tipo de epilepsia.

Memory assessment in patients with temporal lobe epilepsy to predict memory impairment after surgery: A systematic review. / Evaluación de la memoria en la epilepsia del lóbulo temporal para predecir sus cambios tras la cirugía. Una revisión sistemática.

INTRODUCTION: Given that surgical treatment of refractory mesial temporal lobe epilepsy may cause memory impairment, determining which patients are eligible for surgery is essential. However, there is little agreement on which presurgical memory assessment methods are best able to predict memory outcome after surgery and identify those patients with a greater risk of surgery-induced memory decline. OBJECTIVE: We conducted a systematic literature review to determine which presurgical memory assessment methods best predict memory outcome. MATERIAL AND METHODS: The literature search of PubMed gathered articles published between January 2005 and December 2015 addressing pre- and postsurgical memory assessment in mesial temporal lobe epilepsy patients by means of neuropsychological testing, functional MRI, and other neuroimaging techniques. We obtained 178 articles, 31 of which were included in our review. RESULTS: Most of the studies used neuropsychological tests and fMRI; these methods are considered to have the greatest predictive ability for memory impairment. Other less frequently used techniques included the Wada test and FDG-PET. CONCLUSIONS: Current evidence supports performing a presurgical assessment of memory function using both neuropsychological tests and functional MRI to predict memory outcome after surgery.

[Music therapy as a non-pharmacological treatment in Alzheimer's disease. A systematic review]. / Efecto de la musicoterapia como terapia no farmacologica en la enfermedad de Alzheimer. Revision sistematica.

INTRODUCTION: Alzheimer's disease (AD) is a neurodegenerative disease which involves, among other manifestations, a progressive deterioration of memory and language, as well as behavioral disorders. In addition to non-curative pharmacological therapies, for the last years, music therapy has been developed as an effective non-pharmacological therapy in order to relieve many of these manifestations. AIM: To analyze the recent scientific evidence about the effect of music therapy on cognitive and behavioral symptoms in patients with AD. PATIENTS AND METHODS: A systematic review has been carried out by means of a bibliographical research using the database PubMed and Science Direct. The key words used for this search were 'Alzheimer's disease' and 'music therapy', as well as the boolean operator 'AND'. We selected those publications between January 2006 and December 2016 and after inclusion criteria, 21 publications were selected. RESULTS: This systematic review has demonstrated the beneficial impact of music therapy on cognition (memory, attention, language), emotion and behavior (anxiety, depression and agitation) in AD patients. CONCLUSIONS: Music therapy constitutes a non-pharmacological therapy effective for some cognitive, emotional and behavioral symptoms in patients with AD. However, further investigations and more evidence in this field are needed to claim conclusively the impact of music therapy on this disease.

TITLE: Efecto de la musicoterapia como terapia no farmacologica en la enfermedad de Alzheimer. Revision sistematica.Introduccion. La enfermedad de Alzheimer (EA) es un trastorno neurodegenerativo que conlleva, entre otras manifestaciones, una afectacion progresiva de alteraciones cognitivas, como la memoria y el lenguaje, asi como de alteraciones conductuales. Ademas de las terapias farmacologicas no curativas, la terapia con musica viene asentandose en los ultimos anos como una terapia no farmacologica eficaz para paliar muchas de las manifestaciones clinicas de la enfermedad. Objetivo. Analizar la evidencia cientifica reciente sobre el efecto de la musicoterapia en los sintomas cognitivos y conductuales en pacientes con EA. Pacientes y metodos. Se ha realizado una revision sistematica mediante una busqueda bibliografica en las bases de datos PubMed y Science Direct, empleando como palabras clave 'Alzheimer's disease' y 'music therapy', y el operador booleano 'AND'. Se consideraron los trabajos publicados entre enero de 2006 y diciembre de 2016 y, tras los criterios de inclusion, se seleccionaron 21 estudios. Resultados. Esta revision sistematica demuestra el efecto beneficioso de la musicoterapia sobre el estado cognitivo (memoria, atencion, lenguaje), emocional y conductual (ansiedad, depresion y agitacion) de los pacientes con EA. Conclusiones. La musicoterapia constituye una terapia no farmacologica eficaz para determinados sintomas cognitivos, emocionales y conductuales de pacientes con EA. No obstante, se necesitan mas investigaciones en este campo para poder definir de forma mas concluyente el efecto que produce la musicoterapia en esta patologia.

An assessesment of telephone assistance systems for caregivers of patients with Alzheimer's disease. / Evaluación de la asistencia telefónica a demanda en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. PATIENTS AND METHODS: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. RESULTS: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. CONCLUSIONS: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services.

Health-related quality of life in caregivers of patients with Alzheimer's disease. / Calidad de vida relacionada con la salud en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Informal caregivers of patients with Alzheimer's disease (AD) have a poor health-related quality of life (HRQOL). HRQOL is an increasingly common user-focused outcome measure. We have evaluated HRQOL longitudinally in caregivers of AD patients at baseline and at 12 months. METHODS: Ninety-seven patients diagnosed with AD according to the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke, and Alzheimer's Disease and Related Disorders Association) and their 97 respective primary caregivers were included in the study. We analysed the following data at the baseline visit: sociodemographic data of both patients and carers, patients' clinical variables, and data related to the healthcare provided to patients by carers. HRQOL of caregivers was measured with the SF-36 questionnaire at baseline and 12 months later. RESULTS: At 12 months, primary caregivers scored lower in the 8 subscales of the SF-36 questionnaire; differences were statistically significant in all dimensions except for 'physical function' and 'social function'. Baseline scores in our sample were lower than those of the general population. 'Vitality' is the dimension that presented the lowest scores. CONCLUSION: HRQOL in caregivers of patients with Alzheimer's disease deteriorates over time and is poorer than that of the age- and sex-matched general population.

Model of music cognition and amusia.

INTRODUCTION: The study of the neural networks involved in music processing has received less attention than work researching the brain's language networks. For the last two decades there has been a growing interest in discovering the functional mechanisms of the musical brain and understanding those disorders in which brain regions linked with perception and production of music are damaged. DISCUSSION: Congenital and acquired musical deficits in their various forms (perception, execution, music-memory) are grouped together under the generic term amusia. In this selective review we present the "cutting edge" studies on the cognitive and neural processes implicated in music and the various forms of amusia. CONCLUSIONS: Musical processing requires a large cortico-subcortical network which is distributed throughout both cerebral hemispheres and the cerebellum. The analysis of healthy subjects using functional neuroimaging and examination of selective deficits (e.g., tone, rhythm, timbre, melodic contours) in patients will improve our knowledge of the mechanisms involved in musical processing and the latter's relationship with other cognitive processes.

[Miller Fisher syndrome as the presenting symptom of Wernicke's encephalopathy]. / Síndrome de Miller Fisher como presentación de una encefalopatía de Wernicke.

INTRODUCTION: Wernicke's encephalopathy is an acute neuropsychiatric syndrome resulting from a thiamine deficit, which is defined by the characteristic triad of confusion, ophthalmoparesis and ataxia, although rare presentations have been reported that delay its diagnosis. Miller Fisher syndrome is characterised by the triad ophthalmoparesis, ataxia and areflexia and is considered to be a variant of Guillain-Barré syndrome; its differential diagnosis includes Wernicke's encephalopathy. CASE REPORT: A 75-year-old female with chronic digestive disorders, who developed an acute picture of bilateral internuclear ophthalmoplegia, ataxia and areflexia, with proteinocytologic dissociation in cerebrospinal fluid; accordingly, an initial diagnosis of Miller Fisher syndrome was proposed. Results of the neurophysiological studies were normal; anti-GQ1b antibodies were negative; and magnetic resonance imaging of the brain suggested Wernicke's encephalopathy. The response to thiamine was spectacular. CONCLUSIONS: The similarities in the distribution of the lesions of the two conditions, in the signs and symptoms and the lab findings, as well as the influence of certain misleading factors (hyponatremia, advanced age), went to make up a typical syndrome that favoured a wrong presumptive aetiological diagnosis. This was corrected at an early stage, however, in light of the results of certain diagnostic tests and after observing the therapeutic response. In addition to being an atypical presentation for Wernicke's encephalopathy, this case highlights the fact that for there to be an agreement between the syndromic and aetiological diagnoses it is necessary to carry out a correct differential diagnosis based on details from the patient's history, on appropriate complementary tests and on the follow-up study of how the patients progress, even when we come across typical syndromes that are usually related to a predominant aetiopathogenesis.

[Thalamic dementia secondary to acute bilateral paramedian thalamic infarcts after occlusion of the artery of Percheron]. / Demencia talámica secundaria a infarto agudo paramediano talámico bilateral por oclusión de la arteria de Percheron.

INTRODUCTION: The anterior and medial part of the thalamus is the responsible of multiples cognitive functions through the thalamus-cortical connections. A bilateral thalamic infarction can cause a secondary dementia and these are related to a thalamocortical deafferentation with a partial recovery. We report a case of sudden onset dementia caused by bilateral thalamus lesions. CASE REPORT: A 42 smoker male, that suddenly had an acute confusional syndrome with altered language, bradypsychia, right hemiparesis and right hemisensory loss. Cranial magnetic resonance imaging showed a bilateral thalamic stroke probably due to a variant talamus irrigation (artery of Percheron type 2). From this date, in three months, the patient had attention deficit, impairment of memory retention, apathy, initiative deficit, depressive syndrome and mood changes. All these symptoms improving partially in the following six months. CONCLUSIONS: The thalamic stroke can cause a thalamic dementia, commonly bilateral and preferable located in the anterior and medial nuclei. In our case, cranial SPECT showed frontal hypocaptation for diaschisis phenomenon.

[Moya-moya syndrome and arterial dysplasia associated to Down syndrome]. / Síndrome de Moyamoya y displasia arterial asociados a síndrome de Down.

INTRODUCTION: Ischemic vascular pathologies are predominant among the neurological processes associated to Down syndrome. Thrombosis of the venous sinuses, Moya-moya syndrome and arterial dysplasia, among others, stand out for their association with this syndrome. CASE REPORT: We describe the case of a 19-year-old female patient suffering from Down syndrome who visited because of deficiency symptoms of an ischemic origin; diagnosis was based on angiographic disorders compatible with Moya-moya syndrome in the left carotid tree and arterial dysplasia in the right carotid tree. Data concerning the medical history, physical examination, complementary tests, treatment applied and evaluation of the patient's clinical progress are reported. At the same time, the patient was also diagnosed as suffering from Graves-Basedow disease, which is contemplated in the aetiological study carried out on these and other vascular anomalies and which have often been described in relation to Down syndrome. CONCLUSIONS: The particular interest of our case lies in the fact that the two pathological processes occur in the same patient, although only one of them was symptomatic. Both of these vascular anomalies have been described in association with Down syndrome separately, but the simultaneous presence of both of them in the same patient is infrequent. We suggest the possibility of a common aetiological link between the two processes, which in turn accounts for their association with Down syndrome.