Dopamine abnormalities in the neocortex of patients with temporal lobe epilepsy.

Experiments were designed to evaluate different variables of the dopaminergic system in the temporal cortex of surgically treated patients with temporal lobe epilepsy (TLE) associated with mesial sclerosis (MTLE, n=12) or with cerebral tumor or lesion (n=8). In addition, we sought to identify dopaminergic abnormalities in those patients with epilepsy that had comorbid anxiety and depression. Specifically, we investigated changes in dopamine and its metabolites, D1 and D2 receptors, tyrosine hydroxylase (TH) and dopamine transporter. Results obtained from patients with epilepsy were compared with those found in experiments using autopsy material. The neocortex of patients with MTLE demonstrated high D1 expression (1680%, p<0.05) and binding (layers I-II, 31%, p<0.05; layers V-VI, 28%, p<0.05), and decreased D2 expression (77%, p<0.05). The neocortex of patients with TLE secondary to cerebral tumor or lesion showed high expression of D1 receptors (1100%, p<0.05), and D2-like induced activation of G proteins (layers I-II, 503%; layers III-IV, 557%; layers V-VI, 964%, p<0.05). Both epileptic groups presented elevated binding to the dopamine transporter and low tissue content of dopamine and its metabolites. Analysis revealed the following correlations: a) D1 receptor binding correlated negatively with seizure onset age and seizure frequency, and positively with duration of epilepsy; b) D2 receptor binding correlated positively with age of seizure onset and negatively with duration of epilepsy; c) dopamine transporter binding correlated positively with duration of epilepsy and frequency of seizures; d) D2-like induced activation of G proteins correlated positively with the age of patients. When compared with autopsies and patients with anxiety and depression, patients without neuropsychiatric disorders showed high D2-like induced activation of G proteins, an effect that correlated positively with age of patient and seizure onset age, and negatively with duration of epilepsy. The present study suggests that alterations of the dopaminergic system result from epileptic activity and could be involved in the physiopathology of TLE and the comorbid anxiety and depression.

Safety and tolerability of dapsone for the treatment of patients with drug-resistant, partial-onset seizures: an open-label trial.

Dapsone has shown anti-convulsive properties in animal models of epilepsy. In the present study, we tested the safety and tolerability of dapsone as adjunctive therapy in adult patients with drug-resistant partial-onset seizures. Twenty-two adult patients with drug-resistant partial-onset seizures were included. After a 3-month baseline period, patients received dapsone 100 mg per day, for a 3-month evaluation period. Plasma concentrations of anti-epileptic drugs (AEDs) did not significantly change during the study. No alteration of mean clinical laboratory values was observed. The reported adverse events were: mild methemoglobinemia (50%), headache (31.8%), paleness (27.3%) and somnolence (4.5%).Sixteen of 22 patients reduced their seizure frequency in more than 50% as a result of dapsone treatment. Three subjects remained seizure-free during the entire dapsone treatment period. This open-label study of adjunctive dapsone therapy at 100 mg/day suggests that dapsone is safe, and well-tolerated in adults with drug-resistant partial-onset seizures.

Epithelial cell adhesion molecule expression in pituitary adenomas: an immunohistochemical study.

An important amount of data correlating the expression of epithelial cell adhesion molecule (Ep-CAM) with cellular proliferation and de-differentiation could directly contribute to carcinogenesis. The aim of this study is to evaluate prognosis relevance of Ep-CAM expression in a group of pituitary adenomas. Epithelial cell adhesion molecule, proliferating cell nuclear antigen, and microvascular density labeling indices in pituitary adenomas were determined by immunohistochemistry on tissue samples obtained from each adenoma after surgery. We evaluated 45 adenomas. Sixty-two percent were nonsecretor adenomas and 37.8% were secretor tumors. Immunohistochemistry was scored for immunoexpression of Ep-CAM (cytoplasmic, membrane, and mixed pattern). Proliferating cell nuclear antigen and vascular density (CD34) labeling indices were assessed. Statistical significance was observed between Ep-CAM cytoplasmic immunoreactions (P = .000) and higher proliferating cell nuclear antigen (P = .001) in secretor adenomas compared with nonsecretor tumors. Vascular density labeling indices did not show statistical significance. Therefore, Ep-CAM could be evaluated to distinguish secretor and nonsecretor pituitary adenomas. These suggest that the markers could predict the growth potential of individual pituitary adenomas.

[Metric properties of clinimetric indexes for non-motor dysfunction of Parkinson's disease in Mexican population]. / Propiedades métricas de instrumentos de disfunción no motora en enfermedad de Parkinson en población mexicana.

OBJECTIVE: To determine the metric properties of the non-motor symptoms questionnaire (NMSQuest), non-motor symptoms scale (NMSSS) and SCOPA-AUT clinimetric instruments to assess non motor dysfunction in Mexican population. MATERIAL AND METHODS: After linguistic validation, the instruments were applied to 100 consecutive Parkinson's disease patients to analyze its metric properties in Mexican out-patients from the National Institute of Neurology and Neurosurgery. RESULTS: Internal consistency by Cronbach's alpha was above 0.80 for all instruments. Inter-item and item-total correlations were above 0.30 in the majority of the domains and inter-observer variability was acceptable. Total score did not correlate with any of the registered clinical variables. CONCLUSION: The metric properties of the three instruments were acceptable and similar to published data from other countries.

Chronic intermittent vagal nerve stimulation in the treatment of refractory epilepsy: experience in Mexico with 35 cases.

BACKGROUND: The role of vagal nerve stimulation (VNS) in the treatment of refractory epilepsy is still evolving and requires precision through extensive description of acute and chronic results, adverse effects and complications in specific populations. METHODS: We selected patients with refractory epilepsy subjected to VNS who had completed at least a 12-month followup. Descriptive and inferential statistics were used to review and assess the effects of VNS on seizure frequency/intensity, memory, alertness, mood, postictal recovery, and quality of life (subjective scale, QoL IE-31 inventory) as well as factors (gender, age, age of onset, time of surgery, stimulation parameters, seizure frequency and type) associated with clinical response. We describe stimulation parameters, complications and adverse effects compared to other series. RESULTS: We selected 35 patients with an age range of 5-48 years; 18 patients presented partial epilepsy and 17 generalized epilepsy. All procedures and wound healing were uneventful, and no infections were reported. Median reduction in seizure frequency was 55.65% (p <0.001). Four patients showed improvement of >90%. Two patients became seizure free, whereas seizure frequency increased in two patients. The subjectively qualified response to treatment was good in 33 patients. The mean global increase in the QoLIE-31 Scale was 12.6 (p = 0.020). Improvements in memory, mood, alertness and postictal recovery period were documented. Only seizure type showed statistically significant association with clinical response. Adverse effects were transitory and responded to changes in stimulation parameters. CONCLUSIONS: VNS is a safe, feasible, well-tolerated and effective palliative treatment in appropriately selected cases of refractory partial and multifocal generalized seizures.

Mental disorders in Mexican patients with multiple sclerosis.

The authors aim to explore psychiatric disorders in Mexican patients with multiple sclerosis. The Structured Clinical Interview for DSM-IV Axis I Disorders, the Montgomery-Asberg Depression Rating Scale, and the Hamilton Anxiety Rating Scale were administered to 37 consecutive multiple sclerosis patients and 37 healthy comparison subjects. The multiple sclerosis group had higher rates of any axis I disorder (OR 1.97; 95% CI=1.78-3.306). The most common comorbid diagnoses were depressive disorders (46% of the multiple sclerosis cases) with higher anxiety scores (p=0.001). No correlations between psychiatric variables, number of relapses, and clinical course of multiple sclerosis were found.

Estimulación crónica intermitente del nervio vago en el tratamiento de epilepsia refractaria: experiencia en México con 35 casos / Chronic intermittent vagal nerve stimulation in the treatment of refractory epilepsy: experience in Mexico with 35 cases

Introducción: El papel de la estimulación crónica intermitente del nervio vago (ECINV) en el tratamiento de la epilepsia refractaria está evolucionando y requiere precisarse mediante la descripción de resultados, efectos adversos y complicaciones en poblaciones específicas. Material y métodos: Se seleccionaron los pacientes con epilepsia refractaria sometidos a ECINV con mínimo 12 meses de seguimiento, utilizando estadística descriptiva e inferencial para valorar el efecto sobre la frecuencia e intensidad de las crisis, memoria, ánimo, estado de alerta, recuperación postictal y calidad de vida (escala subjetiva, cuestionario QoLIE-31), y los factores (sexo, edad, tiempo de evolución, número/tipo crisis, parámetros de estimulación) asociados a la respuesta clínica. Se describen los parámetros de estimulación usados, empleo del magneto, complicaciones y efectos adversos. Resultados: Se seleccionaron 35 pacientes, edad de cinco a 48 años, 18 con epilepsia parcial, 17 con generalizada. No hubo complicaciones, infección o alteración de la cicatrización en los procedimientos quirúrgicos. La reducción promedio en crisis fue de 55.65 % (p < 0.001). En epilepsias generalizadas hubo 58.8 % de respondedores y 88.9 % en parciales. Cuatro sujetos presentaron mejoría > 90 %, con control total; en dos pacientes aumentó la frecuencia de las crisis. La respuesta al tratamiento fue buena subjetivamente en 33 pacientes. La calificación global de QoLIE-31 aumentó 12.6 puntos (p = 0.020). Solo el tipo de crisis se asoció con la respuesta clínica. Los efectos adversos fueron transitorios y respondieron al cambio de parámetros de estimulación. Conclusiones: la ECINV es segura, bien tolerada y eficaz para el tratamiento paliativo en casos seleccionados de crisis parciales y generalizadas multifocales refractarias.

BACKGROUND: The role of vagal nerve stimulation (VNS) in the treatment of refractory epilepsy is still evolving and requires precision through extensive description of acute and chronic results, adverse effects and complications in specific populations. METHODS: We selected patients with refractory epilepsy subjected to VNS who had completed at least a 12-month followup. Descriptive and inferential statistics were used to review and assess the effects of VNS on seizure frequency/intensity, memory, alertness, mood, postictal recovery, and quality of life (subjective scale, QoL IE-31 inventory) as well as factors (gender, age, age of onset, time of surgery, stimulation parameters, seizure frequency and type) associated with clinical response. We describe stimulation parameters, complications and adverse effects compared to other series. RESULTS: We selected 35 patients with an age range of 5-48 years; 18 patients presented partial epilepsy and 17 generalized epilepsy. All procedures and wound healing were uneventful, and no infections were reported. Median reduction in seizure frequency was 55.65% (p <0.001). Four patients showed improvement of >90%. Two patients became seizure free, whereas seizure frequency increased in two patients. The subjectively qualified response to treatment was good in 33 patients. The mean global increase in the QoLIE-31 Scale was 12.6 (p = 0.020). Improvements in memory, mood, alertness and postictal recovery period were documented. Only seizure type showed statistically significant association with clinical response. Adverse effects were transitory and responded to changes in stimulation parameters. CONCLUSIONS: VNS is a safe, feasible, well-tolerated and effective palliative treatment in appropriately selected cases of refractory partial and multifocal generalized seizures.

Study of the telomerase hTERT fraction, PCNA and CD34 expression on pituitary adenomas. Association with clinical and demographic characteristics.

To determine the frequency of human telomerase reverse transcriptase (hTERT) catalytic fraction expression and its association with clinical and demographic characteristics of the patient, as well as with the expression of CD34 and proliferating cell nuclear antigen (PCNA) indexes on adenohypophyseal hormone tissues. A transverse study was realized with 49 cases of hypophyseal adenoma with analysis type cases and controls. The different adenohypophyseal hormones [prolactin (PRL), growth hormone (GH), follicle stimulating hormone, luteinizing hormone, thyroid gland stimulant hormone, adrenocorticotropic hormone (ACTH)], the catalytic fraction of the telomerase hTERT, the PCNA index and the CD34 density were determined by means of immunohistochemical techniques. The clinical, demographic and histopathological characteristics of the patients with and without hTERT expression were compared by means of Pearson's Chi-squared, Fisher's exact test and Mann-Whitney's U. Twenty-eight point six percent of the adenomas had positive expression for hTERT. The variables significantly correlated with hTERT's expression were younger age of presentation, diagnostic of adenoma producer, higher PCNA index, higher CD34 density, increased GH on serum and the expression on PRL tissue, GH and ACTH. Tobacco history had a negative association with hTERT's expression. The telomerase could be a marker of cellular proliferation associated with angiogenesis and hormonal activity. Evaluation of these variables could provide information about their biological behavior.

[Excessive daytime sleepiness in Mexico city]. / Somnolencia excesiva diurna en la ciudad de México.

OBJECTIVE: To determine the prevalence of excessive daytime somnolence (EDS) in a sample of residents from Mexico City. METHODS: A cross-sectional survey was done using a randomized telephone survey. A structured questionnaire (including demographic and clinical data) and Epworth Sleepiness Scale, a valid and reliable instrument for the detection of EDS, were administered. RESULTS: A total sample of 200 subjects was obtained, with a mean age of 37 +/- 16.24 years. EDS was found in 31.5% of the subjects; 12.5% considered that EDS interfered in a significant way with daily activities, and 9% with work related abilities. Subjects with EDS were older, came from lower socio-economic status, and had a significantly higher body mass index. DISCUSSION: Our results indicate that EDS is more frequent in Mexico City residents than in other populations. Notwithstanding, the association between EDS with advanced age, lower socio-economic status and high body mass index requires further investigation.

Somnolencia excesiva diurna en la ciudad de México / Excessive daytime sleepiness in Mexico city

Objetivo: Determinar la prevalencia de somnolencia excesiva diurna (SED) en una muestra de habitantes de la ciudad de México. Material y métodos: Se realizó un estudio transversal analítico mediante una encuesta telefónica al azar; la entrevista estructurada se aplicó con la finalidad de obtener datos demográficos y clínicos. Así mismo se utilizó la escala de Epworth, que es un instrumento confiable y válido para el diagnóstico de la SED. Resultados: Se estudiaron 200 habitantes de la ciudad de México, con una media de edad de 37±16 años. De ellos 31.5% cursaba con SED. En 12.5% de los sujetos la SED interfería de manera significativa con sus actividades cotidianas y 9% admitía que interfería con sus actividades laborales. Los sujetos con SED tenían mayor edad, pertenecían con mayor frecuencia al nivel socioeconómico bajo y presentaban un índice de masa corporal significativamente más alto. Discusión: Estos resultados indican que la SED es más frecuente en la ciudad de México que en otras poblaciones estudiadas. Se requieren estudios posteriores que permitan establecer la participación de la edad, nivel socioeconómico y el índice de masa corporal en el desarrollo de la SED.

OBJECTIVE: To determine the prevalence of excessive daytime somnolence (EDS) in a sample of residents from Mexico City. METHODS: A cross-sectional survey was done using a randomized telephone survey. A structured questionnaire (including demographic and clinical data) and Epworth Sleepiness Scale, a valid and reliable instrument for the detection of EDS, were administered. RESULTS: A total sample of 200 subjects was obtained, with a mean age of 37 +/- 16.24 years. EDS was found in 31.5% of the subjects; 12.5% considered that EDS interfered in a significant way with daily activities, and 9% with work related abilities. Subjects with EDS were older, came from lower socio-economic status, and had a significantly higher body mass index. DISCUSSION: Our results indicate that EDS is more frequent in Mexico City residents than in other populations. Notwithstanding, the association between EDS with advanced age, lower socio-economic status and high body mass index requires further investigation.

Psammomatous choroid plexus papilloma: three cases with atypical characteristics.

BACKGROUND: Intravertricular papillary neoplasms are derived from choroid plexus epithelium. Although choroid plexus tumors account for 0.4% to 0.6% of all brain tumors, they represent 2% to 4%. Approximately 80% of choroid plexus carcinomas arise in children. CASES DESCRIPTION: We describe 3 cases of choroid plexus papilloma (CPP) with profuse psammomatous bodies and calcifications that have lost their normal papillary architecture. Immunohistochemistry was positive for glial fibrillary acidic protein in 2 cases, and proliferating cellular nuclear antigen index was higher compared with regular CPPs. All 3 patients were female and were 12, 40, and 48 years old, respectively. CONCLUSION: We describe psammomatous CPPs and suggest a difference from CPPs because of the more aggressive clinical course, and higher nuclear proliferation index (proliferating cellular nuclear antigen) than the CPPs that lack psammoma bodies.

Frequency of delirium in a neurological emergency room.

The authors present a cross-sectional survey designed to evaluate the presence of delirium in patients with neurological emergencies. Two hundred and two patients were included in the study: 14.9% of subjects had delirium; 62.4% had no arousal disturbances; and 22.7% presented a coma or stupor state. Findings revealed that the presence of a cerebral infection, the presence of multiple etiologies, and the location of lesions in the frontal and temporal lobes were all associated with delirium. Results substantiate that delirium is a frequent occurrence in neurological patients and that the presence of multiple etiologies must be investigated in each patient.

Aplicaciones neuropsiquiátricas de la terapia electroconvulsiva / Neuropsichiatric applications of electroconvulsive therapy

El presente trabajo revisa la utilidad de la terapia electroconvulsiva ( T EC) en los padecimientos neurológicos. En primer lugar, se presentan las evidencias actuales de la posible eficacia y la TEC en el manejo de las enfermedades neurológicas sin comorbilidad psiquiátrica (indicaciones poco convencionales), incluyendo algunos de los mecanismos neurobiológicos relacionados con las respuestas a esta a este tipo de tratamiento; y en segundo término, se resume la información más actualizada del uso de la TEC en trastornos psiquiátricos, como depresión, psicosis y catatonia; entre los pacientes con enfermedades neurológicas coexistentes o de base, que anteriormente se consideraban contraindicaciones para su utilización.