Neurotoxicidad secundaria a metronidazol: un efecto adverso reversible. Caso clínico / Reversible neurotoxicity secondary to metronidazole report of one case

Metronidazole can cause adverse effects both in the central and peripheral nervous system. We report a 34-year-old female who presented a reversible cerebellar syndrome and peripheral neuropathy as an adverse effect associated with the use of metronidazole. Brain magnetic resonance imaging (MRI) showed hyperintense T2 and FLAIR bilateral symmetrical cerebellar lesions, without contrast enhancement or mass effect, isointense in diffusion-weighted imaging and hypointense in apparent diffusion coefficient sequences. Also, electrophysiological evaluation was consistent with axonal polyneuropathy. She had received metronidazole for a liver abscess during 49 days. After discontinuation of metronidazole, she had rapid regression of cerebellar symptoms and normalization of MRI, with subsequent disappearance of peripheral symptoms. The brain MRI, electromyography and nerve conduction studies performed at 35 months later showed complete resolution of the lesions. Although metronidazole neurotoxicity is a rare event, it must be borne in mind because the prognosis is usually favorable after stopping the drug.

Panencefalitis esclerosante subaguda de inicio en edad adulta: presentación atípica en 2 pacientes / Adult onset subacute sclerosing panencephalitis: atypical presentation in 2 cases

Subacute sclerosing panencephalitis is an infrequent central nervous system viral disease and is a late manifestation of persistent infection by a mutant form of measles virus. Since it affects mainly children and teenagers, the diagnosis in older ages is difficult. Its main clinical symptoms are cognitive impairment, behavioral disturbances and myoclonia. We report two males, aged 21 and 22 years old, presenting with the disease with atypical manifestations. One had a catatonic syndrome and the other, amaurosis. The recognition of the different presentation forms of the disease, endemic in developing countries, allows an earlier diagnosis and a more efficient treatment, when available

Accesibilidad a la farmacoterapia específica de la enfermedad de Parkinson, en Santiago de Chile / Accessibility of patients with Parkinson disease to specific pharmacotherapy in Chile

Background: The high costs of adequate pharmacological treatment for Parkinson disease preclude the universal access of patients to this medication. Aim: To assess the accessibility to pharmacological treatment of Chilean patients with Parkinson disease. Patients and methods: An inquiry about socioeconomic stratification, medical controls, disease features and costs of pharmacological therapy, was applied to 95 patients (56 male, aged 32 to 89 years old) attending the Chilean League Against Parkinson Disease. Results: Among studied patients, the disease had a mean duration of 7.9ñ6 years. There was a direct relationship between family income, the frequency of visits to physicians and the dose and cost of pharmacological therapy. Conclusions: The accessibility to pharmacological therapy among patients with Parkinson disease, depends on their socioeconomic level. Measures to correct this situation and improve the quality of life of these patients should be undertaken by health services

La epilepsia refractaria del adulto y los antiepilépticos nóveles: el rol de la gabapentina / Refractary epilepsy in adults and new antiepileptic drugs: role of gabapentin

The features of refractory epilepsies and the role of functional surgery and new antiepileptic drugs is reviewed. Among the latter, gabapentin, a drug with peculiar pharmacokinetic properties, is highlighted as a therapeutic alternative in refractory epilepsies and eventually for epileptic patients without previous treatment. A new type of relationship between the pharmaceutical industry and physicians, that privileges clinical research is discussed

Carbamazepina: consideraciones prácticas / Carbamazepine: practical considerations

Se revisan las características farmacológicas clínicas de la Carbamazepina y se hace hincapié en las dificultades de índole práctica que ocasiona el uso de este fármaco antiepiléptico