Peripheral levels of brain-derived neurotrophic factor and S100B in neuropsychiatric systemic lupus erythematous.

BACKGROUND: The aim of this study was to investigate serum S100B and brain-derived neurotrophic factor (BDNF) in systemic lupus erythematous (SLE) patients, with and without neuropsychiatric (NP) manifestation activity. METHODS: We assessed 47 SLE patients and 20 selected healthy individuals. Disease activity was assessed according to the SLE disease activity index (SLEDAI). Serum BDNF and S100B were measured by enzyme-linked immunosorbent assay. RESULTS: Serum S100B protein was significantly higher in SLE patients. BDNF levels were significantly decreased in active SLE, when compared with inactive SLE, but not when compared with controls. S100B was clearly higher in the NPSLE group, when compared with the non-NPSLE or control groups. Receiver operating characteristic analysis of S100B revealed an area under the curve of 0.706 that discriminated NPSLE patients with peripheral polyneuropathy. CONCLUSIONS: Our findings reinforce the use of serum S100B as a biomarker in SLE, particularly for NPSLE. Moreover, we found a strong association between serum S100B and peripheral neuropathy, indicating a specific utility for this biomarker in SLE that warrants clinical investigation.

The tropical fowl mite, Ornithonyssus bursa (Acari: Macronyssidae): environmental and host factors associated with its occurrence in Argentine passerine communities.

The tropical fowl mite, Ornithonyssus bursa, is a common avian parasite found on diverse bird species worldwide. In the Neotropical region, O. bursa is present in wild birds, but it may also infect poultry and bite humans. Little is known about the ecology and epidemiology of this parasite. We conducted a thorough longitudinal study in passerine assemblages from central Argentina, gathering data from six reproductive seasons, with the aim of identifying factors that have a role in driving the occurrence and distribution of O. bursa in its natural hosts. We focused on the brood and microhabitat levels, accounting for potential confounders of higher levels. The results hereby presented contribute to our knowledge on the eco-epidemiology of O. bursa in natural hosts of the Neotropical region. Among the many variables assessed, nest material and host species appeared to be the most important correlates of O. bursa prevalence. Nonetheless, supplementary analyses showed that host species is a stronger predictor than nest material. Moreover, mite burden (parasite intensity) was found to depend on host species, but not on nest material. The association with species depended on nestling age, suggesting that resistance builds up as the nestling develop, but at a different pace depending on the bird species. Brood size was inversely correlated with intensity of parasitism, suggesting a dilution of the parasite burden on each nestling.

Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: a systematic review of the literature.

INTRODUCTION: A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS: We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS: Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.

Pulmonary involvement of systemic lupus erythematosus: analysis of 90 necropsies.

Pleuropulmonary manifestations of systemic lupus erythematosus (SLE) have been reported to be of variable prevalence, depending on the diagnostic methods used. The objective of this study was to determine the anatomopathological prevalence and the nature of lung involvement associated with SLE and to define if there were differences in the grade and type of pulmonary involvement in patients who had died at different time periods, before or after 1996. Complete autopsy studies of 90 patients with SLE diagnosis carried out between 1958 and 2006 and their clinical records were studied. All patients fulfilled the American College of Rheumathology (ACR) diagnostic criteria for SLE. Two groups of patients were analyzed: patients who had died before 1996 and those deceased in 1996-2006. Some pleuropulmonary involvement was detected in 97.8% of the autopsies. The most frequent findings were pleuritis (77.8%), bacterial infections (57.8%), primary and secondary alveolar haemorrhages (25.6%), followed by distal airway alterations (21.1%), opportunistic infections (14.4%) and pulmonary thromboembolism (7.8%), both acute and chronic. No cases of acute or chronic lupus pneumonitis were found. Opportunistic lung infections were invasive aspergillosis, disseminated strongyloidiasis, mucormicosis and Pneumocystis carinii. Only three of 23 patients with alveolar haemorrhage showed capillaritis. The four patients with primary pulmonary hypertension (PHT) had plexiform lesions. Deceased patients' age at death (46.09 +/- 11.01 vs 30.3 +/- 11.5 years, P < 0.0001) as well as survival time from diagnosis date (11.8 +/- 11.2 vs 4.4 +/- 4.9 years, P < 0.0001) in the second time period evaluated were significantly higher. However, there were no statistically significant differences in the prevalence of any of the pulmonary manifestations. Sepsis was considered the major cause of death without significant differences in both groups. Our results show that pulmonary manifestations directly caused by systemic lupus erythematosus are very uncommon and that their prevalence has not changed in the past 10 years. Pulmonary infection is still the most frequent affection, and it is an important cause of death in patients with lupus.

Central drive and ventilatory failure in late-onset Pompe disease: At the gates of a new phenotype.

Subjects with late-onset Pompe disease (LOPD) typically present as slowly progressive proximal muscle weakness. Respiratory muscle weakness and diaphragmatic paralysis are common features, and may be the initial manifestation of the disease. There is often a poor correlation between the severity of limb and respiratory muscle weakness. Early clinical observations about disproportionate hypercapnia to the respiratory muscular weakness in late-onset Pompe disease were recognized and will be discussed with special reference to blunted respiratory drive, and the connections between early clinical observations, respiratory functional studies and anatomical findings. According to new evidence about blunted respiratory drive in Pompe disease, it is necessary to rethink what is meant by "asymptomatic Pompe disease" and propose a new phenotype with its therapeutic implications. The conceptual model of the mechanisms leading to respiratory failure in this disease could be considered according to these new findings. It may broaden the diagnostic spectrum of the adult forms and warrants a closer interaction between neurologists and pulmonologists. The recognition of this new phenotype of predominant central alveolar hypoventilation in Pompe disease will improve the understanding of the underlying mechanisms of ventilatory failure and could lead to improved future therapeutic strategies.

Guidelines for seizure management in palliative care: Proposal for an updated clinical practice model based on a systematic literature review. / Guía para el manejo de las crisis epilépticas en cuidados paliativos: propuesta de un modelo actualizado de práctica clínica basado en una revisión sistemática de la literatura.

INTRODUCTION: Very little has been written on seizure management in palliative care (PC). Given this situation, and considering the forthcoming setting up of the Palliative Care Unit at our neurorehabilitation centre, the Clínica San Vicente, we decided to establish a series of guidelines on the use of antiepileptic drugs (AEDs) for handling seizures in PC. METHODS: We conducted a literature search in PubMed to identify articles, recent manuals, and clinical practice guidelines on seizure management in PC published by the most relevant scientific societies. RESULTS: Clinical practice guidelines are essential to identify patients eligible for PC, manage seizures adequately, and avoid unnecessary distress to these patients and their families. Given the profile of these patients, we recommend choosing AEDs with a low interaction potential and which can be administered by the parenteral route, preferably intravenously. Diazepam and midazolam appear to be the most suitable AEDs during the acute phase whereas levetiracetam, valproic acid, and lacosamide are recommended for refractory cases and long-term treatment. CONCLUSIONS: These guidelines provide general recommendations that must be adapted to each particular clinical case. Nevertheless, we will require further well-designed randomised controlled clinical trials including large samples of patients eligible for PC to draft a consensus document recommending adequate, rational, and effective use of AEDs, based on a high level of evidence, in this highly complex area of medical care.

[Current evidence on virtual reality and its potential usefulness in post-stroke neurorehabilitation]. / Evidencias actuales sobre la realidad virtual y su utilidad potencial en la neurorrehabilitación postictus.

INTRODUCTION: Virtual reality therapy (VRT) constitutes a powerful and motivating tool for stroke patients to actively participate in the process of neurorehabilitation, providing augmented performance feedback, with the aim of achieving better therapeutic results owing to the enhancing of neuroplasticity mechanisms. AIM: To report the most relevant data about the applications of VRT in the post-stroke neurorehabilitation. DEVELOPMENT: We conducted a PubMed search for articles, latest books, leading clinical practice guidelines, and scientific societies, regarding such applications. CONCLUSIONS: Different performed randomized clinical trials (RCT) show that VRT safely facilitates in a statistically significant way motor and functional recovery of upper limb, gait, balance, quality of life related to health, and activities of daily living, together with conventional therapy, but have no clearly demonstrated overall superiority to conventional therapy. In this regard, underlying specific mechanisms remain elusive at this stage. Future RCT should define the good responder stroke patient profile based on the VRT used in conjunction with conventional therapy, allowing the generation of neurorehabilitation approaches that combine a customized immersive VRT with the clinical experience of the therapists, to maximize the results. It is necessary to carry out well-designed RCT, including larger samples of appropriately selected stroke subjects, to draft a consensus document that allows recommending, with a greater level of evidence and on a widespread basis, the implementation of VRT as add-on therapy in post-stroke neurorehabilitation. As well as to determine if the beneficial effects are maintained in the long term and to clarify the most suitable treatment schedule.

TITLE: Evidencias actuales sobre la realidad virtual y su utilidad potencial en la neurorrehabilitación postictus.Introducción. La terapia con realidad virtual (TRV) constituye una herramienta poderosa que motiva a los pacientes con ictus a participar activamente en su neurorrehabilitación, y proporciona retroalimentación aumentada del rendimiento, con objeto de obtener mejores resultados terapéuticos gracias a la potenciación de los mecanismos de neuroplasticidad. Objetivo. Exponer los datos más relevantes sobre las aplicaciones de la TRV en la neurorrehabilitación postictus. Desarrollo. Búsqueda de artículos en PubMed, últimos libros y principales guías de práctica clínica y sociedades científicas publicados con respecto a dichas aplicaciones. Conclusiones. Los diferentes ensayos clínicos aleatorizados (ECA) realizados demuestran que la TRV facilita, de forma segura y estadísticamente significativa, la recuperación motora y funcional del miembro superior, la marcha, el equilibrio, la calidad de vida relacionada con la salud y las actividades de la vida diaria, junto con la terapia convencional, sin ser globalmente superior a la terapia convencional. Aún no se conocen los mecanismos específicos subyacentes. Los ECA futuros deberán definir el perfil de paciente respondedor según la TRV empleada, permitiendo generar enfoques de neurorrehabilitación que conjuguen una TRV personalizada inmersiva y la experiencia clínica de los terapeutas para maximizar los resultados. Son precisos ECA bien diseñados, incluyendo muestras amplias de pacientes adecuadamente seleccionados, para redactar un documento de consenso que permita recomendar, con un mayor nivel de evidencia y de forma generalizada, la implementación de la TRV como terapia complementaria en la neurorrehabilitación postictus, determinar si los efectos beneficiosos se mantienen a largo plazo y clarificar qué esquema de tratamiento es el más apropiado.

Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: A systematic review of the literature. / Evidencias actuales sobre las potenciales aplicaciones terapéuticas de la estimulación magnética transcraneal en la esclerosis múltiple: revisión sistemática de la literatura.

INTRODUCTION: A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS: We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS: Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.

Current evidence on transcranial magnetic stimulation and its potential usefulness in post-stroke neurorehabilitation: Opening new doors to the treatment of cerebrovascular disease. / Evidencias actuales sobre la estimulación magnética transcraneal y su utilidad potencial en la neurorrehabilitación postictus: Ampliando horizontes en el tratamiento de la enfermedad cerebrovascular.

INTRODUCTION: Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic reality in post-stroke rehabilitation. It has a neuroprotective effect on the modulation of neuroplasticity, improving the brain's capacity to retrain neural circuits and promoting restoration and acquisition of new compensatory skills. DEVELOPMENT: We conducted a literature search on PubMed and also gathered the latest books, clinical practice guidelines, and recommendations published by the most prominent scientific societies concerning the therapeutic use of rTMS in the rehabilitation of stroke patients. The criteria of the International Federation of Clinical Neurophysiology (2014) were followed regarding the inclusion of all evidence and recommendations. CONCLUSIONS: Identifying stroke patients who are eligible for rTMS is essential to accelerate their recovery. rTMS has proven to be safe and effective for treating stroke complications. Functional brain activity can be optimised by applying excitatory or inhibitory electromagnetic pulses to the hemisphere ipsilateral or contralateral to the lesion, respectively, as well as at the level of the transcallosal pathway to regulate interhemispheric communication. Different studies of rTMS in these patients have resulted in improvements in motor disorders, aphasia, dysarthria, oropharyngeal dysphagia, depression, and perceptual-cognitive deficits. However, further well-designed randomized controlled clinical trials with larger sample size are needed to recommend with a higher level of evidence, proper implementation of rTMS use in stroke subjects on a widespread basis.

[Mismatch negativity and conscience level in severe traumatic brain injury]. / Mismatch negativity y nivel de conciencia en el traumatismo craneoencefálico grave.

INTRODUCTION: The mismatch negativity (MMN) is a component of the long-latency auditory evoked potentials, that are used to check the functionality of automatic attentional processes of attentive information processing. Vegetative state diagnosis is frequent following severe traumatic brain injury (TBI). Eventually, some patients improve their condition to another one called minimal conscientious state. AIM: To evaluate the diagnostic usefulness of MMN in severe TBI patients during the subacute phase after leaving the neurological intensive care unit. PATIENTS AND METHODS: We gathered MMN results from 19 patients (12 males and 7 females; 8 vegetative state and 11 minimal conscientious state) with ages between 17 and 59 years (mean: 27.3 years). The delay between TBI onset and MMN recordings were greater than 2 months (mean: 181 days). During the recording session, patients were evaluated by means of the Multisociety Task Force on Persistent Vegetative State scale. RESULTS: All the minimal conscientious state patients (100%) showed MMN potential. In seven of the vegetative state patients (87.5%) the MMN was not found. The remaining MMN potential positive vegetative state patient improved to MCS 16 days after testing. CONCLUSIONS: MMN is a valid tool for differentiating vegetative state from MCS during the subacute phase of severe TBI. Hence it is a useful aid to the clinical evaluation. This would diminish the impact of a possible diagnostic error and its prognosis on therapeutical management, family and health costs. It can also be used for evaluating other brain disorders with altered consciousness.