[Frontal dysfunction in idiopathic Parkinson's disease]. / Disfunción frontal en la enfermedad de Parkinson idiopática.

INTRODUCTION: In his description of the disease in his original work, James Parkinson claimed that the 'senses remained intact', but later reports began to identify cognitive impairment that ranged from dementia to barely identifiable subclinical deteriorations. Research carried out in recent decades has revealed that cognitive disorders form part of the clinical symptoms of Parkinson's disease (PD) and point to the frontal lobes as being the most affected areas; a great deal of controversy, however, still surrounds their definition, epidemiology and pathology. AIM: To determine and classify the frontal deficits associated to this disease and to relate this cognitive performance with certain characteristics of the disease. SUBJECTS AND METHODS: The sample utilised in the study was made up of 222 subjects divided into two groups according to their diagnosis: 111 subjects with idiopathic PD and 111 control subjects. The neuropsychological examination was performed using the Frontal Assessment Battery, the copy of the Rey-Osterrieth complex figure and the digit test for determining frontal functioning. RESULTS AND CONCLUSIONS: We prove the existence of a frontal dysfunction that is characterised by impaired working memory, with visuospatial and executive dysfunction, which suggests greater involvement of the dorsolateral prefrontal cortex and cingulate. According to our findings, because working memory and visuospatial functioning are correlated to the motor status and the time elapsed since the onset of the disease, they could share the same underlying neuroanatomical foundations--the nigrostriatal denervation. This is not the case of executive function, which was not found to be related to the characteristics of the disease under study.

Diagnóstico por la imagen del absceso intraperitoneal poscesárea / Imaging diagnosis of postcesarean intraperitoneal abscess

Se presentan 2 casos de absceso poscesárea en pacientes de bajo riesgo quirúrgico ilustrados con imágenes de tomografía no concluyentes, y se discuten sus posibles diagnósticos diferenciales. El diagnóstico por la imagen del absceso pelviano se puede confundir con la degeneración miomatosa

We report 2 cases of postcesarean pelvic abscess that presented in low surgical risk patients. Tomographic scans were inconclusive. The possible differential diagnoses are discussed. Imaging diagnosis of a pelvic abscess may lead to confusion with red degeneration of leiomyoma

Disfunciòn frontal en la enfermedad de Parkinson idiopàtica / Frontal dysfunction in idiopathic Parkinson's disease

In his description of the disease in his original work, James Parkinson claimed that the 'senses remained intact', but later reports began to identify cognitive impairment that ranged from dementia to barely identifiable subclinical deteriorations. Research carried out in recent decades has revealed that cognitive disorders form part of the clinical symptoms of Parkinson's disease (PD) and point to the frontal lobes as being the most affected areas; a great deal of controversy, however, still surrounds their definition, epidemiology and pathology. AIM: To determine and classify the frontal deficits associated to this disease and to relate this cognitive performance with certain characteristics of the disease. The sample utilised in the study was made up of 222 subjects divided into two groups according to their diagnosis: 111 subjects with idiopathic PD and 111 control subjects. The neuropsychological examination was performed using the Frontal Assessment Battery, the copy of the Rey-Osterrieth complex figure and the digit test for determining frontal functioning. We prove the existence of a frontal dysfunction that is characterised by impaired working memory, with visuospatial and executive dysfunction, which suggests greater involvement of the dorsolateral prefrontal cortex and cingulate. According to our findings, because working memory and visuospatial functioning are correlated to the motor status and the time elapsed since the onset of the disease, they could share the same underlying neuroanatomical foundations--the nigrostriatal denervation. This is not the case of executive function, which was not found to be related to the characteristics of the disease under study(AU)

Disfunción frontal en la enfermedad de Parkinson idiopática / Frontal dysfunction in idiopathic Parkinson’s disease

Introducción. Al describir la enfermedad, James Parkinson planteó en su obra original que los sentidos permanecían indemnes, pero descripciones posteriores comenzaron a identificar el deterioro cognitivo, que abarcaba desde una demencia hasta deterioros subclínicos apenas identificables. Las investigaciones realizadas en las últimas décadas han revelado que los trastornos cognitivos forman parte de la sintomatología clínica de la enfermedad de Parkinson (EP) y señalan a los lóbulos frontales como los más afectados; pero todavía es controvertida su definición, epidemiología y patología. Objetivo. Determinar y caracterizar los déficit frontales asociados a esta enfermedad y relacionar este rendimiento cognitivo con algunas características de la enfermedad. Sujetos y métodos. La muestra utilizada estaba compuesta por 222sujetos, divididos en dos grupos en función de su diagnóstico: 111 sujetos con EP idiopática y 111 sujetos controles. La exploración neuropsicológica se constituyó por la batería de evaluación frontal(FAB), la copia de la figura compleja del Rey-Osterrieth y el test de dígitos para determinar la función frontal. Resultados y conclusiones. Se demuestra una disfunción frontal que se caracteriza por disminución de la memoria de trabajo, disfunción visuoespacial y ejecutiva, lo que sugiere una mayor afectación de la corteza prefrontaldorsolateral y cingulada. Según nuestros resultados, la memoria de trabajo y la función visuoespacial, al correlacionarse con el estado motor y el tiempo de evolución de la enfermedad, podrían compartir un mismo sustrato neuroanatómico, la denervación nigroestriatal. No así la función ejecutiva, que no se relacionó con las características de la enfermedad estudiada (AU)

Introduction. In his description of the disease in his original work, James Parkinson claimed that the 'senses remained intact', but later reports began to identify cognitive impairment that ranged from dementia to barely identifiable subclinical deteriorations. Research carried out in recent decades has revealed that cognitive disorders form part of the clinical symptoms of Parkinson’s disease (PD) and point to the frontal lobes as being the most affected areas; a great deal of controversy, however, still surrounds their definition, epidemiology and pathology. Aim. To determine and classify the frontal deficits associated to this disease and to relate this cognitive performance with certain characteristics of the disease. Subjects and methods. The sample utilised in the study was made up of 222 subjects divided into two groups according to their diagnosis: 111 subjects with idiopathic PD and 111 control subjects. The neuropsychological examination was performed using the Frontal Assessment Battery, the copy of the Rey-Osterrieth complex figure and the digit test for determining frontal functioning. Results and conclusions. We prove the existence of a frontal dysfunction that is characterised by impaired working memory, with visuospatial and executive dysfunction, which suggests greater involvement of the dorsolateral prefrontal cortex and cingulate. According to our findings, because working memory and visuospatial functioning are correlated to the motor status and the time elapsed since the onset of the disease, they could share the same underlying neuroanatomical foundations –the nigrostriatal denervation. This is not the case of executive function, which was not found to be related to the characteristics of the disease under study (AU)

[The effects of lesions in the compact part of the substantia nigra on glutamate and GABA release in the pedunculopontine nucleus]. / Efecto de la lesión de la sustancia negra pars compacta sobre la liberación de glutamato y GABA en el núcleo pedunculopontino.

INTRODUCTION: The pedunculopontine nucleus (PPN), co-localized with the mesencephalic locomotor region, has been proposed as a key structure in the physiopathology of Parkinson's disease. OBJECTIVES: The goal of the present study was to assess if the aminoacid neurotransmitter release in the PPN is modified by the degeneration of dopaminergic cells, from substantia nigra pars compacta in 6-hydroxidopamine (6-OHDA)-lesioned rats. In addition, it was studied the aminoacid neurotransmitter release in the PPN of rats with lesion of the subthalamic nucleus by quinolinic acid (QUIN) (100 nmol) intracerebral injection. MATERIALS AND METHODS: Rats were assigned to five groups: untreated rats (I) (n = 13), 6-OHDA lesion (II) (n = 11), 6-OHDA + QUIN lesion (III) (n = 9), sham-operated (IV) (n = 10), QUIN, STN (V) lesioned (n = 9). The extracellular concentrations of glutamic acid (GLU) and gamma-aminobutyric acid (GABA) were determined by brain microdialysis and high performance liquid chromatography (HPLC). RESULTS. GLU released in PPN from 6-OHDA lesioned rats (group II), was significantly increased in comparison with the others groups (F(4, 47) = 18.21, p < 0.001). GABA released shows significant differences between experimental groups (F(4, 45) = 12.75, p < 0.001). It was detected a higher valour (p < 0.05) in-group II. The groups III and IV exhibited intermeddle valour (p < 0.001) and groups I and IV (p < 0.001) showed the lower GABA extracellular concentrations. The infusion of artificial cerebrospinal fluid with higher potassium (100 mmol) induced an increase in the GLU and GABA released in all groups, which confirm the neuronal origin of the extracellular content. CONCLUSION: These results are in agreement with the current model of basal ganglia functioning and suggest the role of STN-PPN projection in the physiopathology of Parkinson's disease.

Efecto de la lesión de la sustancia negra parte compacta sobre la liberación de glutamato y GABA en el núcleo pedunculopontino / The effects of lesions in the compact part of the substantia nigra on glutamate and GABA release in the pedunculopontine nucleus

The pedunculopontine nucleus (PPN), co-localized with the mesencephalic locomotor region, has been proposed as a key structure in the physiopathology of Parkinson's disease. OBJECTIVES: The goal of the present study was to assess if the aminoacid neurotransmitter release in the PPN is modified by the degeneration of dopaminergic cells, from substantia nigra pars compacta in 6-hydroxidopamine (6-OHDA)-lesioned rats. In addition, it was studied the aminoacid neurotransmitter release in the PPN of rats with lesion of the subthalamic nucleus by quinolinic acid (QUIN) (100 nmol) intracerebral injection...(AU)

Efecto de la lesión de la sustancia negra pars compacta sobre la liberación de glutamato y GABA en el núcleo pedunculopontino / The effects of lesions in the compact part of the substantia nigra on glutamate and gaba release in the pedunculopontine nucleus

Introducción. El núcleo pedunculopontino (NPP), colocalizado con el área locomotora mesencefálica, se ha señalado como una estructura clave en la fisiopatología de la enfermedad de Parkinson. Objetivos. 1. Estudiar el efecto de la lesión de la sustancia negra pars compacta -por inyección de 6-hidroxidopamina (6-OHDA)- sobre la liberación de aminoácidos neurotransmisores en el NPP. 2. Estudiar el efecto de la lesión del núcleo subtalámico (NST), por inyección intracerebral de 100 nmol de ácido quinolínico (QUIN), sobre la liberación de aminoácidos neurotransmisores en el NPP. Materiales y métodos. Se organizaron cinco grupos experimentales: ratas sanas (I; n = 13), lesión con 6-OHDA (II; n = 11), lesión simultánea de 6-OHDA + QUIN (III; n = 9), falsa lesión de 6-OHDA (IV; n = 10), y lesión del NST con QUIN (V; n = 9). Las concentraciones extracelulares de ácido glutámico (GLU) y GABA se determinaron por medio de cromatografía líquida de alta resolución (HPLC) con detección fluorimétrica. Resultados. Se detectaron diferencias significativas en la liberación de GLU entre todos los grupos experimentales (F(4, 47) = 18,21, p < 0,001), con un aumento significativo de esta variable en el grupo II. La liberación de GABA en el NPP mostró diferencias significativas entre los grupos en estudio (F(4, 45) = 12,75, p < 0,001). Para esta variable se produjo una separación entre los grupos, con un aumento significativo (p < 0,05) en el grupo II, valores intermedios y significativamente diferentes para los grupos III y V (p < 0,001) y valores menores para los grupos I y IV. La infusión de una solución de líquido cefalorraquídeo artificial con mayor concentración de potasio (100 mmol) produjo un incremento en la liberación de los aminoácidos neurotransmisores en todos los grupos experimentales, lo cual confirma el origen neuronal del contenido extracelular estudiado. Conclusiones. Estos resultados concuerdan con el ‘modelo’ actual de funcionamiento de los ganglios basales y sugieren un papel importante a la proyección STN-NPP en la fisiopatología de la enfermedad de Parkinson

Introduction. The pedunculopontine nucleus (PPN), co-localized with the mesencephalic locomotor region, has been proposed as a key structure in the physiopathology of Parkinson’s disease. Objectives. The goal of the present study was to assess if the aminoacid neurotransmitter release in the PPN is modified by the degeneration of dopaminergic cells, from substantia nigra pars compacta in 6-hydroxidopamine (6-OHDA)-lesioned rats. In addition, it was studied the aminoacid neurotransmitter release in the PPN of rats with lesion of the subthalamic nucleus by quinolinic acid (QUIN) (100 nmol) intracerebral injection. Materials and methods. Rats were assigned to five groups: untreated rats (I) (n = 13), 6-OHDA lesion (II) (n = 11), 6-OHDA + QUIN lesion (III) (n = 9), sham-operated (IV) (n = 10), QUIN, STN (V) lesioned (n = 9). The extracellular concentrations of glutamic acid (GLU) and gamma-aminobutyric acid (GABA) were determined by brain microdialysis and high performance liquid chromatography (HPLC). Results. GLU released in PPN from 6-OHDA lesioned rats (group II), was significantly increased in comparison with the others groups (F(4, 47) = 18.21, p < 0.001). GABA released shows significant differences between experimental groups (F(4, 45) = 12.75, p < 0.001). It was detected a higher valour (p < 0.05) in-group II. The groups III and IV exhibited intermeddle valour (p < 0.001) and groups I and IV (p < 0.001) showed the lower GABA extracellular concentrations. The infusion of artificial cerebrospinal fluid with higher potassium (100 mmol) induced an increase in the GLU and GABA released in all groups, which confirm the neuronal origin of the extracellular content. Conclusion. These results are in agreement with the current model of basal ganglia functioning and suggest the role of STN-PPN projection in the physiopathology of Parkinson’s disease

[A clinical and epidemiological description of a series of patients diagnosed as suffering from progressive supranuclear palsy]. / Descripción clínica y epidemiológica de una serie de pacientes con diagnóstico de parálisis supranuclear progresiva.

INTRODUCTION: Progressive supranuclear palsy is a disease that normally presents only sporadically in adults and courses in a progressive, chronic manner. It is characterised by the presence of supranuclear ophthalmoplegia, postural instability, a Parkinsonian syndrome, pseudobulbar affect, cervical dystonia and cognitive impairment. PATIENTS AND METHODS: We conducted a descriptive study of clinical and epidemiological features in a series of 18 patients who satisfied the mandatory NINDS-SPSP clinical eligibility criteria for the likely diagnosis of progressive supranuclear palsy, using the scale developed by Golbe et al. RESULTS AND CONCLUSIONS: The mean age of onset of the disease was 58.6 +/- 8.2 years, 55.5% of the patients were males, the average history of the disease at the time of diagnosis was 4.39 +/- 2.3 years, and there was a diagnostic subregister in the first 4 years of the disease. Gait disorders, falls and slowness were the most frequently observed presenting forms of the disease. During their first four years with the disease, 75% of the patients were totally independent when it came to carrying out activities of daily living, whereas after the fourth year there was a predominance of the need for aid and absolute dependence. Dysphagia was more frequent in the later stages of the disease. Ocular motility disorders and impaired cognitive functioning were obvious in the initial stages of the disease, and there was a strong correlation between the length of time the disease had been coursing and the severity of the ocular and cognitive disorders.

Descripción clínica y epidemiológica de una serie de pacientes con diagnóstico de parálisis supranuclear progresiva / A clinical and epidemiological description of a series of patients diagnosed as suffering from progressive supranuclear palsy

Introducción. La parálisis supranuclear progresiva es una enfermedad de curso crónico progresivo, de presentación fundamentalmente esporádica en el adulto, que se caracteriza por la presencia de oftalmoplejía supranuclear, inestabilidad postural, síndrome parkinsoniano, afectación seudobulbar, distonía cervical y deterioro cognitivo. Pacientes y métodos. Realizamos un estudio descriptivo sobre aspectos clínicos y epidemiológicos en una serie de 18 pacientes que cumplían los criterios clínicos mandatarios de inclusión (NINDS-SPSP) para el diagnóstico probable de parálisis supranuclear progresiva, utilizando la escala de Golbe et al. Resultados y conclusiones. La edad de inicio promedio de la enfermedad fue de 58,6 ñ 8,2 años, el 55,5 por ciento de los pacientes pertenecen son varones, el tiempo medio de evolución de la enfermedad hasta el momento del diagnóstico fue de 4,39 ñ 2,3 años, y existía un subregistro diagnóstico en los primeros cuatro años de la enfermedad. Los trastornos de la marcha, las caídas y la lentitud constituyeron las formas más frecuente de debut de la enfermedad. El 75 por ciento de los pacientes en los primeros cuatro años de evolución era totalmente independiente para realizar las actividades de la vida cotidiana, mientras que después de los cuatro años predominaba la necesidad de asistencia y la dependencia absoluta. La disfagia fue más frecuente en etapas tardías de la enfermedad. La afectación de la motilidad ocular y la función cognitiva fue evidente en las etapas iniciales de la enfermedad, y existió una alta correlación entre el tiempo de evolución de la enfermedad y la gravedad de la afectación ocular y cognitiva (AU)

y. Introduction. Progressive supranuclear palsy is a disease that normally presents only sporadically in adults and courses in a progressive, chronic manner. It is characterised by the presence of supranuclear ophthalmoplegia, postural instability, a Parkinsonian syndrome, pseudobulbar affect, cervical dystonia and cognitive impairment. Patients and methods. We conducted a descriptive study of clinical and epidemiological features in a series of 18 patients who satisfied the mandatory NINDS-SPSP clinical eligibility criteria for the likely diagnosis of progressive supranuclear palsy, using the scale developed by Golbe et al. Results and conclusions. The mean age of onset of the disease was 58.6 ± 8.2 years, 55.5% of the patients were males, the average history of the disease at the time of diagnosis was 4.39 ± 2.3 years, and there was a diagnostic subregister in the first 4 years of the disease. Gait disorders, falls and slowness were the most frequently observed presenting forms of the disease. During their first four years with the disease, 75% of the patients were totally independent when it came to carrying out activities of daily living, whereas after the fourth year there was a predominance of the need for aid and absolute dependence. Dysphagia was more frequent in the later stages of the disease. Ocular motility disorders and impaired cognitive functioning were obvious in the initial stages of the disease, and there was a strong correlation between the length of time the disease had been coursing and the severity of the ocular and cognitive disorders (AU)

[Lesions in the pars compacta substantiae nigra and the subthalamic nucleus modify the density of muscarinic receptors in different nuclei of the basal ganglia]. / La lesión de la sustancia negra pars compacta y del núcleo subtalámico modifica la densidad de receptores muscarínicos en distintos núcleos de los ganglios basales.

INTRODUCTION: Several studies that has focused to the dopaminergic transmission in the basal ganglia in parkinsonian condition, but only a few article has taking into account the imbalance between dopaminergic and cholinergic transmission. OBJECTIVE: To evaluate the muscarinic cholinergic receptors density in SNc and PPN in the 6-OHDA model. MATERIALS AND METHODS: Were organized five experimental groups in correspondence to the place of the lesion: I. Non treated rats, II. 6-OHDA lesion in SNc, III. 6-OHDA lesion in SNc + quinolinic acid lesion in NST, IV. Sham operated rats, V. Quinolinic acid in STN. Were obtained coronal sections of 20 microm thickness of SNc and PPN from rats and in these sections was evaluated the muscarinic receptors density through autoradiographic technique with [3H]quinuclidinylbenzilate (QNB) (1.23 nM). The muscarinic antagonist atropine (1 microM) was utilized as non-specific union. The density was evaluated in both hemispheres and the density optical was converted in fentomolas/mg of tissue with base to values obtained from tritium standards. RESULTS: Significant diminution of the muscarinic receptors density was found in the SNc ipsilateral to the 6-OHDA lesion from experimental groups II (t=2.76; p<0.05) and III (t=4.06; p<0.05). In the group V, was seen a significant increase of muscarinic receptor density in the SNc ipsilateral to the 6-OHDA lesion. The comparison between experimental groups evidenced significant differences among them (F=13.13; p<0.001) with a significant decrease in the density from SNc of groups II and III and significant increase in the density from SNc of group V in comparison of the others groups. In relation to PPN, muscarinic receptors density from right PPN ipsilateral to the 6-OHDA lesion, shown significant differences (F=3.93; p<0.01) between the experimental groups with a significant increase of this variable in the group II. CONCLUSIONS: These results signal a modification of cholinergic activity after 6-OHDA lesion. The changes in the muscarinic receptors populations located in SNc and PPN could be part of different compensatory mechanisms to attempt ameliorate the imbalance between dopaminergic and cholinergic transmission that it was installed after denervation of nigrostriatal forebrain bundle. The excitotoxic lesion of STN impose a new adjust mechanism for cell from PPN, which could be expressed in the changes of muscarinic cholinergic receptors population at the level of SNc.

La lesión de la sustancia negra pars compacta y del núcleo subtalámico modifica la densidad de receptores muscarínicos en distintos núcleos de los ganglios basales / Lesions in the pars compacta substantiae nigrae and the subthalamic nucleus modify the density of muscarinic receptors in different nuclei of the basal ganglia

Introducción. Numerosos estudios han abordado el papel de la neurotransmisión dopaminérgica en los ganglios basales en condiciones de parkinsonismo, pero pocos se han encaminado hacia el desequilibrio entre la trasmisión dopaminérgica y colinérgica. Objetivo. Evaluar la densidad de receptores colinérgicos muscarínicos en sustancia negra pars compacta (SNc) y núcleo pedunculopontino (NPP) en el modelo de 6-OHDA. Materiales y métodos. Se organizaron cinco grupos experimentales según la lesión de SNcyNST: 1. Animales sanos; 2. Ratas lesionadas con 6-OHDA; 3. Ratas con lesión simultánea de SNcyNST; 4. Ratas Sham del modelo de 6-OHDA; 5. Ratas con lesión de NST. Se obtuvieron cortes de 20 µm de grosor de SNc y NPP de ratas, en los cuales se evaluó la densidad de receptores colinérgicos muscarínicos por autorradiografía con [3H]quinuclidinilbencilato (QNB) (1,23 nM). Como unión no específica se usó el antagonista muscarínico atropina (1 µM). Se realizaron lecturas en los dos hemisferios y la densidad óptica se convirtió en fentomolas por mg de tejido con base en los valores obtenidos de los estándares de tritio. Resultados. En los grupos 2 (t = 2,76; p < 0,05) y 3 (t = 4,06; p < 0,05) se evidenció una disminución significativa de la densidad de receptores muscarínicos en la SNc ipsilateral a la lesión de 6-OHDA. El grupo 5 mostró un aumento significativo de la densidad de receptores muscarínicos en la SNc lesionada con 6-OHDA (t = 2,69; p < 0,05). La comparación entre grupos experimentales arrojó diferencias significativas entre éstos (F=13,13;p<0,001), con una disminución en los grupos 2 y 3 y un aumento significativo en el grupo 5, en relación con los restantes grupos. La densidad de receptores muscarínicos para el NPP derecho ipsilateral a la lesión de SNc mostró diferencias significativas entre los grupos experimentales (F=3,93;p<0,01), con un aumento significativo de esta variable en el grupo 2. Conclusiones. Estos resultados apuntan hacia una modificación de la actividad colinérgica posterior a la denervación de la SNc por inyección de 6-OHDA. Los cambios en las poblaciones de receptores muscarínicos distribuidos en SNc y NPP pueden ser parte de distintos mecanismos compensatorios que intentan atenuar el desequilibrio entre las transmisiones dopaminérgica y colinérgica, que se instala después de la degeneración de la vía negroestriatal. La lesión excitotóxica de lNST impone un nuevo mecanismo de ajuste a las células del NPP, que pudiera expresarse en los cambios en las poblaciones de receptores colinérgicos de la SNc (AU)

Introduction. Several studies that has focused to the dopaminergic transmission in the basal ganglia in parkinsonian condition, but only a few article has taking into account the imbalance between dopaminergic and cholinergic transmission. Objective. To evaluate the muscarinic cholinergic receptors density in SNc and PPN in the 6-OHDA model. Materials and methods. Were organized five experimental groups in correspondence to the place of the lesion: I. Non treated rats, II. 6-OHDA lesion in SNc, III. 6-OHDA lesion in SNc + quinolinic acid lesion in NST, IV. Sham operated rats, V. Quinolinic acid in STN. Were obtained coronal sections of 20 µm thickness of SNc and PPN from rats and in these sections was evaluated the muscarinic receptors density through autoradiographic technique with [3H]quinuclidinylbenzilate (QNB) (1.23 nM). The muscarinic antagonist atropine (1 µM) was utilized as non-specific union. The density was evaluated in both hemispheres and the density optical was converted in fentomolas/mg of tissue with base to values obtained from tritium standards. Results. Significant diminution of the muscarinic receptors density was found in the SNc ipsilateral to the 6-OHDA lesion from experimental groups II (t = 2.76; p < 0.05) and III (t = 4.06; p < 0.05). In the group V, was seen a significant increase of muscarinic receptor density in the SNc ipsilateral to the 6-OHDA lesion. The comparison between experimental groups evidenced significant differences among them (F = 13.13; p < 0.001) with a significant decrease in the density from SNc of groups II and III and significant increase in the density from SNc of group V in comparison of the others groups. In relation to PPN, muscarinic receptors density from right PPN ipsilateral to the 6-OHDA lesion, shown significant differences (F = 3.93; p < 0.01) between the experimental groups with a significant increase of this variable in the group II. Conclusions. These results signal a modification of cholinergic activity after 6-OHDA lesion. The changes in the muscarinic receptors populations located in SNc and PPN could be part of different compensatory mechanisms to attempt ameliorate the imbalance between dopaminergic and cholinergic transmission that it was installed after denervation of nigrostriatal forebrain bundle. The excitotoxic lesion of STN impose a new adjust mechanism for cell from PPN, which could be expressed in the changes of muscarinic cholinergic receptors population at the level of SNc (AU)

[Subthalamic nucleus targeting and spatial variability]. / Localización bilateral y simetría del núcleo subtalámico.

AIM: The effectiveness of anatomic localization of the subthalamic nucleus (EAL) was assessed and the mapping method is described here. The symmetry of contralateral nuclei (SCN) was analyzed on 11 parkinsonian patients submitted to bilateral subthalamotomy with ablative lesioning. PATIENTS AND METHODS: To assess EAL the percentage so much of first trajectory (p1) as the total of trajectories (pt) that hit the target and the rest of subthalamic nucleus average distance (d) was calculated. The anatomic localization error (epsilon) is determined as a difference between first trajectory coordinates with those of medial determined nucleus point, through electrophysiological data as to the statistical significance of this error. SCN is analyzed by contrasting equality hypothesis at the nucleus maximum height alongside a trajectory, average electrophysiological position center and spatial distribution of all intranuclear recordings found in each hemisphere in all patients. RESULTS: The pi, pt and d obtained values were 86.36%, 86.13% and 1.41 +/- 1.01 mm respectively. The epsilon value was greater in anteroposterior direction of 1.11 +/- 0.83 mm without statistical significance. The average number of recorded trajectories for the first procedure was 6.45 and 6 for the second. The asymmetry of contralateral nucleus was not significant. CONCLUSIONS: An indirect method with CT brain images and a new electrophysiological mapping method with a multiunitary recording for first and second nucleus is safe enough and it yields a high effectiveness in anatomofunctional nucleus localization. The nucleus of a same patient are symmetrical. There is little space variability among patient non related to the differences in the intercommissural distance.

Localización bilateral y simetría del núcleo subtalámico / subthalamic nucleus targeting and spatial variability

Objetivos. Se evalúa la efectividad de localización anatómica (ELAN) bilateral del núcleo subtalámico (NST), se describe el método de cartografiado electrofisiológico y se analiza la simetría de los núcleos contralaterales (SC) en 11 pacientes con enfermedad de Parkinson, sometidos a subtalamotomía bilateral. Pacientes y métodos. Para evaluar la ELAN se calcula el porcentaje tanto de los primeros trayectos (p1) como del total de trayectos (pt) que hicieron blanco, así como la distancia promedio (d) del resto al NST. Se define el error de localización anatómica ( Epsilon ) como la diferencia entre las coordenadas del primer trayecto y las del punto medio del núcleo, determinado por la información electrofisiológica, así como la significación estadística de este error. La SC se analiza con el contraste de la hipótesis de igualdad en la máxima altura del núcleo a lo largo de un trayecto, la posición promedio del centro electrofisiológico y la distribución espacial de todos los registros intranucleares en todos los pacientes encontrado en cada hemisferio. Resultados. Los valores de p1, pt y d obtenidos fueron 86,36 por ciento, 86,13 por ciento y 1,41 ñ 1,01 mm, respectivamente. El valor de fue mayor en la dirección anteroposterior (1,11 ñ 0,83 mm), aunque sin significación estadística (test ANOVA de Kruskal Wallis para la mediana y test de Wilcoxon para muestras apareadas; p = 0,05). El número promedio de trayectos de registros para el primer proceder fue 6,45, y para el segundo, 6. La asimetría de los núcleos contralaterales no fue significativa (test ANOVA de Kruskal Wallis para la mediana y test de Wilcoxon para muestras apareadas; p = 0,05). Conclusiones. Un método indirecto con imágenes de TAC y un novedoso método de cartografiado electrofisiológico con registro multiunitario, para el primer y el segundo núcleo, son seguros y brindan una alta efectividad en la localización anatomofuncional del núcleo. Los núcleos de un mismo paciente son simétricos. Se observó poca variabilidad espacial entre pacientes, no relacionada con las diferencias en la distancia intercomisural (AU)

Aim. The effectiveness of anatomic localization of the subthalamic nucleus (EAL) was assessed and the mapping method is described here. The symmetry of contralateral nuclei (SCN) was analyzed on 11 parkinsonian patients submitted to bilateral subthalamotomy with ablative lesioning. Patients and methods. To assess EAL the percentage so much of first trajectory (p1) as the total of trajectories (pt) that hit the target and the rest of subthalamic nucleus average distance (d) was calculated. The anatomic localization error (ε) is determined as a difference between first trajectory coordinates with those of medial determined nucleus point, through electrophysiological data as to the statistical significance of this error. SCN is analyzed by contrasting equality hypothesis at the nucleus maximum height alongside a trajectory, average electrophysiological position center and spatial distribution of all intranuclear recordings found in each hemisphere in all patients. Results. The pi, pt and d obtained values were 86.36%, 86.13% and 1.41±1.01 mm respectively. The ε value was greater in anteroposterior direction of 1.11±0.83mm without statistical significance. The average number of recorded trajectories for the first procedure was 6.45 and 6 for the second. The asymmetry of contralateral nucleus was not significant. Conclusions. An indirect method with CT brain images and a new electrophysiological mapping method with a multiunitary recording for first and second nucleus is safe enough and it yields a high effectiveness in anatomofunctional nucleus localization. The nucleus of a same patient are symmetrical. There is little space variability among patient non related to the differences in the intercomisural distance (AU)

[Database application for information on post-surgical evolution after functional neurosurgery]. / Programa de base de datos sobre evolución posquirúrgica de la neurocirugía funcional.

INTRODUCTION: A series of quantitative scales have been established internationally to evaluate the functional state of patients affected by movement disorders, such as Parkinson s disease. The values of these parameters offered by each patient, measured at different moments during his or her illness, allow us to conduct studies into their evolution as well as perform statistical studies about the casuistics. AIM. To provide a tool that enables us to study this vast amount of material in an efficient, sure and, above all, automated manner. Materials and methods. We selected the most interesting variables from the international protocols. We also designed and developed a database application for use under the Windows environment using Delphi 3.0 language and compiler and Structured Query Language. RESULTS: We designed, developed and validated a database system so as to be able to handle automatically the information on the clinical evolution of patients who had undergone functional neurosurgery. This system not only enables us to collect all relevant pre and post surgical information but also allows fast searches and selection, data processing using descriptive statistical techniques and the exportation of the data in a standard format. The system, which also allows final double blind clinical evaluation of each patient to be performed, has been used successfully in the Movement Disorders Clinic at the CIREN for over three years. CONCLUSIONS: This system allows for a considerable saving in the amount of time and effort needed for the post surgical evolution of patients, while also increasing the reliability of the results obtained.

Programa de base de datos sobre evolución posquirúrgicade la neurocirugía funcional / Database application for information on post-surgical evolution after functional neurosurgery

Introducción. Internacionalmente se han establecido una serie de escalas cuantitativas de evaluación del estado funcional de pacientes afectados por trastornos del movimiento, como la enfermedad de Parkinson. Los valores de estos parámetros en cada paciente, medidos en diferentes momentos de su enfermedad, permiten realizar estudios evolutivos en cada uno de ellos, así como estudios estadísticos de la casuística. Objetivo. Contar con una herramienta automatizada para el estudio de todo este volumen de información de forma eficiente y segura. Materiales y métodos. Se seleccionaron las variables de mayor interés de los protocolos internacionales, además de diseñar y desarrollar un programa de base de datos en entorno Windows, utilizando el lenguaje y compilador Delphi 3.0. y el lenguaje estructurado de consultas. Resultados. Se diseñó, desarrolló y validó un sistema de base de datos para el manejo automatizado de la información de la evolución clínica de los pacientes de la neurocirugía funcional, que no sólo permite la recogida de toda la información pre y posquirúrgica de relevancia, sino también su rápida búsqueda y selección, su procesamiento estadístico descriptivo y su exportación en formato estándar. El sistema, que posibilita además la realización de una evaluación clínica final doble a ciegas de cada paciente, se utiliza con éxito en la Clínica de Trastornos del Movimiento del CIREN, desde hace más de tres años. Conclusiones. Este sistema permite un considerable ahorro de tiempo y esfuerzo para el estudio de la evolución posquirúrgica de los pacientes, así como un aumento de la fiabilidad de los resultados (AU)

[Effects of simultaneous transplant of foetal mesencephalic cells in the striatum and the subthalamic nucleus of hemiparkinsonian rats]. / Efectos del trasplante simultáneo de células mesencefálicas fetales en el estriado y el núcleo subtalámico de ratas hemiparkinsonianas.

INTRODUCTION: The main strategy followed in neural transplants as a method of treatment for Parkinson s disease, both experimental and clinical, has been to introduce foetal mesencephalic cells into the target area: the striatum. However, when the dopaminergic cells in the substantia nigra degenerate, not only is the dopaminergic innervation of the striatum affected but also other nuclei: globus pallidus, substantia nigra, substantia nigra pars reticulata and subthalamic nucleus. A series of data from pharmacological and physiological studies offer strong evidence that the dopamine released in these nuclei may play an important role in regulating the output nuclei of the basal ganglia. AIM: To evaluate the effect of transplanting foetal mesencephalic cells on the behaviour of 6 OH DA rats when introduced into the striatum and the subthalamic nucleus. MATERIALS AND METHODS: 6 OH DA was used to induce lesions in the substantia nigra of rats, which were divided into several experimental groups. The rotating activity induced by D amphetamine (5 mg/kg, intraperitoneally) and apomorphine (0.05 mg/kg, subcutaneously) was evaluated before and three months after the transplant in all the experimental groups, except in the control group of healthy rats. The hemiparkinsonian rats received a total of 350,000 foetal ventral mesencephalic cells, which were implanted within small deposits in the striatum (8) and in the subthalamic nucleus (4). RESULTS AND CONCLUSIONS: Rotation induced by both drugs was significantly lower (p= 0.05) in animals that had had dopaminergic cells transplanted into the striatum body. No significant improvement in this behaviour was to be found when transplants were limited to just the subthalamus or, simultaneously, also to the striatum. A significant increase in rotating behaviour induced by apomorphine was observed in the group which received a transplant in just the subthalamus.

Efectos del trasplante simultáneo de células mesencefálicas fetales en el estriado y el núcleo subtalámico de ratas hemiparkinsonianas / Effects of simultaneous transplant of foetal mesencephalic cells in the striatum and the subthalamic nucleus of hemiparkinsonian rats

Introducción. La principal estrategia de trasplante neural como tratamiento de la enfermedad de Parkinson, tanto experimental como clínico, ha sido colocar las células mesencefálicas fetales en su principal blanco: el estriado. Sin embargo, cuando las células dopaminérgicas de la sustancia negra degeneran, no sólo se afecta la inervación dopaminérgica del estriado; por el contrario, la inervación de otros núcleos, como el globo pálido, sustancia negra parte reticulada y núcleo subtalámico, también se afectan. Una serie de datos provenientes de estudios farmacológicos y fisiológicos proveen de fuertes evidencias acerca de que la dopamina liberada en estos núcleos puede desempeñar un papel importante en la regulación de los núcleos de salida de los ganglios basales. Objetivo. El objetivo principal de este estudio fue evaluar el efecto del trasplante de células mesencefálicas fetales sobre la conducta de ratas-6-OH-DA, cuando el mismo se coloca en el estriado y el núcleo subtalámico. Materiales y métodos. Se utilizaron ratas con lesión de la sustancia negra inducida por la 6-OHDA, divididas en varios grupos experimentales. La actividad rotatoria inducida por D-anfetamina (5 mg/kg, intraperitonealmente) y apomorfina (0,05 mg/kg, subcutáneamente) se evaluó antes y en los tres meses posteriores al trasplante en todos los grupos experimentales, excepto en el grupo de controles sanos. Las ratas hemiparkinsonianas recibieron un total de 350.000 células de mesencéfalo ventral fetal, que se implantaron en pequeños depósitos en el estriado (8) y en el núcleo subtalámico (4). Resultados y conclusiones. Los animales con trasplante de células dopaminérgicas en el cuerpo estriado redujeron significativamente el número de vueltas inducido por ambas drogas (p= 0,05). No fue posible demostrar mejoría significativa de estas conductas cuando los trasplantes se colocaron sólo en el subtálamo o en este núcleo, simultáneamente al estriado. Se observó un incremento significativo en la conducta de giro inducida por apomorfina en el grupo con trasplante aislado en subtálamo (AU)

Efectos del trasplante simultáneo de células mesencefálicas fetales en el estriado y el núcleo subtalámico de ratas hemiparkinsonianas / EFFECTS OF SIMULTANEOUS TRANSPLANT OF FOETAL MESENCEPHALIC CELLS IN THE STRIATUM AND THE SUBTHALAMIC NUCLEUS OF HEMIPARKINSONIAN RATS

Introducción. La principal estrategia de trasplante neural como tratamiento de la enfermedad de Parkinson, tanto experimental como clínico, ha sido colocar las células mesencefálicas fetales en su principal blanco: el estriado. Sin embargo, cuando las células dopaminérgicas de la sustancia negra degeneran, no sólo se afecta la inervación dopaminérgica del estriado; por el contrario, la inervación de otros núcleos, como el globo pálido, sustancia negra parte reticulada y núcleo subtalámico, también se afectan. Una serie de datos provenientes de estudios farmacológicos y fisiológicos proveen de fuertes evidencias acerca de que la dopamina liberada en estos núcleos puede desempeñar un papel importante en la regulación de los núcleos de salida de los ganglios basales. Objetivo. El objetivo principal de este estudio fue evaluar el efecto del trasplante de células mesencefálicas fetales sobre la conducta de ratas-6-OH-DA, cuando el mismo se coloca en el estriado y el núcleo subtalámico. Materiales y métodos. Se utilizaron ratas con lesión de la sustancia negra inducida por la 6-OHDA,divididas en varios grupos experimentales. La actividad rotatoria inducida por D-anfetamina (5 mg/kg, intraperitonealmente) y apomorfina (0,05 mg/kg, subcutáneamente) se evaluó antes y en los tres meses posteriores al trasplante en todos los grupos experimentales, excepto en el grupo de controles sanos. Las ratas hemiparkinsonianas recibieron un total de 350.000 células de mesencéfalo ventral fetal, que se implantaron en pequeños depósitos en el estriado (8) y en el núcleo subtalámico (4). Resultados y conclusiones. Los animales con trasplante de células dopaminérgicas en el cuerpo estriado redujeron significativamente el número de vueltas inducido por ambas drogas (p=0,05). No fue posible demostrar mejoría significativa de estas conductas cuando los trasplantes se colocaron sólo en el subtálamo o en este núcleo, simultáneamente al estriado. Se observó un incremento significativo en la conducta de giro inducida por apomorfina en el grupo con trasplante aislado en subtálamo neural(AU)

Degeneración corticobasal. Descripción de un caso con sanguíneo / Corticobasal degeneration. Description of a consanguineous case

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