[Intensities in the application of robotic technologies in upper extremity rehabilitation after a stroke: a systematic review of randomised controlled clinical trials]. / Intensidades en la aplicación de tecnologías robóticas en la rehabilitación de las extremidades superiores tras un ictus: revisión sistemática de ensayos clínicos controlados aleatorizados.

INTRODUCTION: In the vast majority of cases stroke entails long-term limitations in the use of the upper extremities that are affected. Robotic technologies provide beneficial results in motor rehabilitation, but the optimal levels of intensity are not known. AIMS: To review the scientific literature (over the last 10 years) on robotic therapies (intervention group) compared to conventional therapies (control group) in the chronic phase of stroke, and to study correlations between variables that characterise the interventions and intensity variables. SUBJECTS AND METHODS: A systematic review was conducted of randomised controlled clinical trials in PubMed, Web of Science, Cochrane Library and Google Scholar, with results assessed by the Fugl-Meyer Assessment-Upper Extremity Motor Score (mFMA-UE). The methodological quality was analysed using the Physiotherapy Evidence Database scale (PEDro). RESULTS: Thirteen studies from evidence level I (92%, excellent) were selected. Positive correlations between minutes per week and improvements in mFMA-UE are observed in the control group and in the intervention group, with a higher level of significance for the latter. Negative correlations are observed between the number of months since the lesion and improvements in the control and intervention groups. An exponential regression is included, which illustrates differences between the control group and the intervention group in favour of the latter. A negative correlation is observed between the total duration and the number of minutes per week. CONCLUSION: Significant correlations are observed between intensity (minutes per week) and mFMA-UE, with a higher level of significance in the intervention group.

TITLE: Intensidades en la aplicación de tecnologías robóticas en la rehabilitación de las extremidades superiores tras un ictus: revisión sistemática de ensayos clínicos controlados aleatorizados.Introducción. El ictus conlleva limitaciones a largo plazo en el uso de las extremidades superiores afectadas en la gran mayoría de los casos. Las tecnologías robóticas aportan resultados beneficiosos en rehabilitación motora, pero se desconocen los niveles óptimos de intensidad. Objetivos. Revisar la literatura científica (últimos diez años) sobre terapias robóticas (grupo de intervención) en comparación con las terapias convencionales (grupo control) en la fase crónica del ictus y estudiar correlaciones entre las variables que caracterizan a las intervenciones y las variables de intensidad. Sujetos y métodos. Se realizó una revisión sistemática de ensayos clínicos controlados aleatorizados en PubMed, Web of Science, Cochrane Library y Google Scholar, con resultados valorados mediante la Fugl-Meyer Assessment-Upper Extremity Motor Score (mFMA-UE). La calidad metodológica se analizó mediante la escala Physiotherapy Evidence Database (PEDro). Resultados. Se seleccionaron 13 estudios, de nivel de evidencia I (92% excelente). Se observan correlaciones positivas entre los minutos semanales y las mejoras en la mFMA-UE en el grupo control y el grupo de intervención, con mayor nivel de significación para este último. Se observan correlaciones negativas entre el número de meses desde la lesión y las mejoras en el grupo control y en el grupo de intervención. Se incluye una regresión exponencial, que ilustra diferencias entre el grupo control y el grupo de intervención en favor de éste. Se observa una correlación negativa entre la duración total y la cantidad de minutos semanales. Conclusión. Se observan correlaciones significativas entre la intensidad (minutos semanales) y la mFMA-UE, con un mayor nivel de significación en el grupo de intervención.

Behavioral scales used in severe and moderate traumatic brain injury.

UNLABELLED: Neurobehavioral disorders are common consequences of traumatic brain injury (TBI) that should be objectively assessed in this population. The use of scales allows us to unify terms both in clinical practice and investigative work; it also constitutes a useful guide in clinical interviews and makes it possible to see outcome changes in patients with or without intervention. The aim of this study is to review the most frequently neurobehavioral scales used to measure the non-cognitive disorders of conduct in TBI patients. METHOD: A systematic and descriptive literature review was done in Medline, without time limit, which focused on scales applied to behavioral disorders in moderate and severe TBI patients. RESULTS: Ninety articles were selected for the final review and thirty-seven different scales were identified. Seven of these instruments represent sixty-five percent of all behavioral scales applied in the studies collected and were selected for the present review. There are scales that are more general and include a wide range of neurobehavioral symptoms, like the Neurobehavioral Rating Scale and the Neuropsychiatric Inventory. On the opposite, there are questionnaires that focus on specific symptoms like aggressiveness, agitation and apathy such as the Agitated Behavior Scale or the Apathy Evaluation Scale. The forms for caregiver or staff were the most prevalent in our review. The most representative behavioral scales applied to moderate and severe TBI patients were analyzed using clinical useful, covered domains, item descriptions, administration procedures and psychometric properties.

[Pharmacotherapy of the cognitive sequelae secondary to traumatic brain injury]. / Farmacoterapia de las secuelas cognitivas secundarias a traumatismo craneoencefálico.

AIM: To review and correlate the most common cognitive disorders secondary to traumatic brain injuries (TBI), the neurobiology of these deficits and their possible modulation by neuropharmacological means. DEVELOPMENT: As of a complex cascade of injuries to the brain, patients with TBI may experience alterations that affect the cognitive domain on different levels and to varying degrees, the most common being alteration of the level of alertness; slowing of the speed at which information is processed; attention, memory and learning deficits; language and communication disorders; and impaired executive functions. Brain damage may be caused by a range of pathological mechanisms, such as focal bruising, diffuse axonal damage, cytotoxic damage and neurotransmitter excitotoxicity. Certain pharmacological agents have an effect on the cognitive functions. Pharmacological agents that improve cognitive performance include dopaminergic agents, psychostimulants, some antidepressants and cholinesterase inhibitors. CONCLUSIONS: Studies into the pharmacological neuromodulation of the cognitive disorders secondary to TBI are currently in the early stages. The information we have available on the neurochemical bases of cognition and cognitive disorders due to TBI suggest that the most important goals of pharmacological intervention in this group of patients are the stimulation of the catecholaminic and cholinergic functions.

Farmacoterapia de las secuelas cognitivas secundarias a traumatismo craneoencefálico / Pharmacotherapy of the cognitive sequelae secondary to traumatic brain injury

Revisar y correlacionar las alteraciones cognitivas más comunes secundarias al traumatismo craneoencefálico(TCE), la neurobiología de estos déficit y la posible modulación neurofarmacológica. Desarrollo. A partir de una compleja cascada de daños a nivel cerebral, el paciente con TCE puede experimentar alteraciones en diferentes niveles y grados del dominio cognitivo, de las cuales las más comunes son: alteración del nivel de alerta, disminución de la velocidad delprocesamiento de la información, déficit de atención, memoria y aprendizaje, alteraciones del lenguaje y de la comunicación, y alteración de la función ejecutiva. Los mecanismos patológicos causantes del daño cerebral son diversos, como contusiones focales, daño axonal difuso, daño citotóxico y excitotoxicidad neurotransmisora. Existen fármacos que interfieren en las funcionescognitivas. Entre los medicamentos que mejoran el rendimiento cognitivo están los dopaminérgicos, psicoestimulantes, algunos antidepresivos e inhibidores de la colinesterasa. Conclusiones. El estudio de la neuromodulación farmacológica delas alteraciones cognitivas secundarias al TCE se encuentra en una etapa inicial. La información de que disponemos sobre las bases neuroquímicas de la cognición y de las alteraciones cognitivas debidas al TCE sugieren que la estimulación de funciones catecolaminérgicas y colinérgicas son los objetivos más importantes en la intervención farmacológica en este grupo depacientes

To review and correlate the most common cognitive disorders secondary to traumatic brain injuries (TBI), the neurobiology of these deficits and their possible modulation by neuropharmacological means. Development. As of a complex cascade of injuries to the brain, patients with TBI may experience alterations that affect the cognitive domain on different levels and to varying degrees, the most common being alteration of the level of alertness; slowing of the speed at which information is processed; attention, memory and learning deficits; language and communication disorders; and impaired executive functions. Brain damage may be caused by a range of pathological mechanisms, such as focal bruising, diffuse axonal damage, cytotoxic damage and neurotransmitter excitotoxicity. Certain pharmacological agents have an effect on the cognitive functions. Pharmacological agents that improve cognitive performance include dopaminergic agents, psychostimulants, some antidepressants and cholinesterase inhibitors. Conclusions. Studies into the pharmacological neuromodulation of the cognitive disorders secondary to TBI are currently in the early stages. The information we have available on the neurochemical bases of cognition and cognitive disorders due to TBI suggest that the most important goals of pharmacological intervention in this group of patients are the stimulation of the catecholaminic and cholinergic functions

Tratamiento neurorrehabilitador de la esclerosis lateral amiotrófica / Neurorehabilitation treatment of amyotrophic lateral sclerosis

Objetivo. Realizar una revisión bibliográfica con la ideade definir, valorar, contrastar y dar a conocer la utilidad del tratamientoneurorrehabilitador en las diferentes fases evolutivas de laesclerosis lateral amiotrófica (ELA), haciendo especial hincapié enla función que éste desempeña tanto a la hora de mejorar la supervivencia,como la independencia funcional y la calidad de vida deestos pacientes. Desarrollo. Aun siendo la ELA una enfermedadque sigue un curso inexorable, la calidad de vida de los pacientes,e incluso su tiempo de supervivencia, puede cambiar de forma significativacon una actuación médica adecuada. El tratamiento neurorrehabilitadorconsiste en un proceso integral realizado por unequipo multidisciplinar, que incluye el tratamiento farmacológicode base, el tratamiento sintomático de los problemas asociados y eltratamiento de rehabilitación, con el objetivo de prolongar la capacidadfuncional y promover la independencia de estos pacientesy que tiene como objetivo final el poder garantizar la mayor calidadde vida posible durante todo el proceso asistencial. Conclusiones.Es evidente que hasta que no se encuentre un tratamiento curativopara la ELA, el tratamiento neurorrehabilitador permaneceactualmente como la mejor esperanza terapéutica, de cara a mejorarla calidad de vida, la salud y la supervivencia de estos pacientes.Este tratamiento no sólo debe contemplar la atención médicadel paciente, sino también las ayudas técnicas oportunas y el soportedomiciliario, así como la formación y preparación tanto delcuidador principal como de la familia del paciente, abarcando desdeel momento en que se diagnostica la enfermedad, hasta su faseterminal

Aim. To carry out a review of the literature with the aim of defining, evaluating, establishing and making morewidely known the value of neurorehabilitation therapy in the different phases of the course of amyotrophic lateral sclerosis(ALS). Special emphasis will be given to the role this type of treatment plays in improving both survival rates and thesepatients’ functional independence and quality of life. Development. Although ALS is a disease that follows an unrelentingcourse, patients’ quality of life, and even their survival time, can be changed dramatically with suitable medical management.Neurorehabilitation therapy consists of an integral process carried out by an interdisciplinary team that includes the basicpharmacological treatment, symptomatic treatment of the associated problems and rehabilitation therapy, the aim being toprolong the functional capacity of these patients and to promote their independence. Its ultimate goal is to ensure the highestpossible quality of life throughout the whole health care process. Conclusions. Until a cure is found for ALS, neurorehabilitationtherapy is clearly today’s most promising therapeutic option as far as improving these patients’ quality of life,health and survival rates is concerned. This treatment should not only involve the medical care of the patient, but also providethe appropriate technical aids and home help, together with training and preparation of both the main caregiver and thepatient’s family. This instruction should cover the whole period from the moment the disease is diagnosed to its terminalphase

[Neurorehabilitation treatment of amyotrophic lateral sclerosis]. / Tratamiento neurorrehabilitador de la esclerosis lateral amiotrófica.

AIM: To carry out a review of the literature with the aim of defining, evaluating, establishing and making more widely known the value of neurorehabilitation therapy in the different phases of the course of amyotrophic lateral sclerosis (ALS). Special emphasis will be given to the role this type of treatment plays in improving both survival rates and these patients' functional independence and quality of life. DEVELOPMENT: Although ALS is a disease that follows an unrelenting course, patients' quality of life, and even their survival time, can be changed dramatically with suitable medical management. Neurorehabilitation therapy consists of an integral process carried out by an interdisciplinary team that includes the basic pharmacological treatment, symptomatic treatment of the associated problems and rehabilitation therapy, the aim being to prolong the functional capacity of these patients and to promote their independence. Its ultimate goal is to ensure the highest possible quality of life throughout the whole health care process. CONCLUSIONS: Until a cure is found for ALS, neurorehabilitation therapy is clearly today's most promising therapeutic option as far as improving these patients' quality of life, health and survival rates is concerned. This treatment should not only involve the medical care of the patient, but also provide the appropriate technical aids and home help, together with training and preparation of both the main caregiver and the patient's family. This instruction should cover the whole period from the moment the disease is diagnosed to its terminal phase.

[Functional outcome at discharge of patients with severe traumatic brain injury admitted to a brain damage unit]. / Resultado funcional al alta de los traumatismos craneoencefálicos graves ingresados en una unidad de daño cerebral.

INTRODUCTION: Severe traumatic brain injuries (TBI) are linked to high morbidity and mortality rates and have important individual and social costs, not only because of the high incidence of deaths they cause but also owing to the large number of individuals who are left with some kind of disability. AIMS: The purpose of this study was to analyse the epidemiological, clinical, functional and rehabilitational aspects of patients with severe TBI admitted to a brain damage unit for neurorehabilitation therapy with special emphasis on the functional outcome at discharge. PATIENTS AND METHODS: We carried out a descriptive study of patients suffering from TBI admitted to the Brain Damage Unit of the Institut Guttmann hospital between January 2000 and June 2002. We analysed epidemiological (age, sex, cause of the TBI), clinical (aetiology, initial Glasgow Coma Scale --GCS--, motor deficit, type of injury, duration of post-traumatic amnesia), functional (Glasgow Outcome Scale --GOS--, Level of Cognitive Functioning Scale --LCFS-- and Disability Rating Scale --DRS--) variables, in addition to patients' destination on discharge. RESULTS: Of a total of 174 hospitalised patients, 88.52% were cases of serious TBI, 80% of which involved males, with a mean age of 29.72 years (standard deviation: 12.63), and an average of 99.28 days' hospitalisation (standard deviation: 60.72). Road accidents were the chief cause of the TBI (78%). The most frequent neurological injuries were parenchymatous (68.05%), followed by subarachnoid haemorrhages (40.58%). 87.58% of the patients presented TBI-related complications. Functional improvement at discharge was statistically significant (p < 0.001) as regards the GOS, LCFS and DSR scales, and 87.5% of the patients were able to reintegrate into their home life. CONCLUSIONS: Despite the severity of the sequelae left by serious TBI, the functional outcome at discharge, associated with the high rate of reintegration into home life, justifies admission of these patients to a brain damage unit for neurorehabilitation therapy.

Resultado funcional al alta de los traumatismos craneoencefálicos graves ingresados en una unidad de daño cerebral / Functional outcome at discharge of patients with severe traumatic brain injury admitted to a brain damage unit

Introducción. Los traumatismos craneoencefálicos (TCE) graves se asocian a una elevada morbimortalidad con elevados costos individuales y sociales, no sólo por la alta incidencia de fallecimientos que ocasionan, sino también por el gran número de individuos que quedan con algún tipo de discapacidad. Objetivo. Analizar los aspectos epidemiológicos, clínicos, funcionales y de reinserción, haciendo especial hincapié en el resultado funcional al alta, de los pacientes con TCE grave ingresados en una unidad de daño cerebral para tratamiento neurorrehabilitador. Pacientes y métodos. Estudio descriptivo de pacientes afectados de TCE ingresados en la Unidad de Daño Cerebral del hospital Institut Guttmann entre enero de 2000 y junio de 2002. Se analizan variables epidemiológicas (edad, sexo, causa del TCE), clínicas -etiología, Glasgow Coma Scale (GCS) inicial, déficit motor, tipo de lesión, tiempo de amnesia postraumática-, funcionales -Glasgow Outcome Scale (GOS), Level of Cognitive Functioning Scale (LCFS) y Disability Rating Scale (DRS)-, y el destino al alta hospitalaria. Resultados. De 174 pacientes ingresados, el 88,52 por ciento tenían TCE graves, el 80 por ciento correspondía a varones, la media de edad era 29,72 años (desviación estándar: 12,63), con una estancia media de 99,28 días (DE: 60,72).La principal causa del TCE fueron los accidentes de tráfico (78 por ciento).Las lesiones neurológicas más frecuentes fueron las parenquimatosas (68,05 por ciento), seguidas de las hemorragias subaracnoideas (40,58 por ciento). El 87,58 por ciento de los pacientes presentaba complicaciones asociadas al TCE. La mejora funcional al alta fue estadísticamente significativa (p < 0,001) en lo que respecta a las escalas GOS, LCFS y DSR, y se consiguió la reinserción domiciliaria en un 87,5 por ciento de los pacientes. Conclusiones. A pesar de la gravedad de las secuelas en las TCE graves, el resultado funcional al alta, asociado al elevado índice de reinserción domiciliaria, justifica el ingreso de estos pacientes en una unidad de daño cerebral, para realizar un tratamiento neurorrehabilitador (AU)

[Oropharyngeal dysphagia in patients with multiple sclerosis]. / Disfagia orofaríngea en pacientes afectados de esclerosis múltiple.

AIMS: The aim of this study is to evaluate the prevalence of the clinical and videofluoroscopic (VDF) symptoms of oropharyngeal dysphagia in patients with multiple sclerosis, and to describe its therapeutic management. PATIENTS AND METHODS: We studied 23 patients suffering from multiple sclerosis to evaluate the characteristics of the disease, the VDF exploration of swallowing and therapeutic strategies. The VDF exploration enables us to define the VDF symptoms that assess the safety and efficiency of swallowing for the oral and pharyngeal phases. The therapeutic strategies include: changes in the characteristics of the diet, changes of posture and active manoeuvres. RESULTS: The patients studied presented a mean EDSS score 7.4 (4-9). There were alterations in swallowing efficiency and/or safety in more than 80% of the patients. In 52% there was some change in the swallowing safety. 40% of them were silent aspirators. All these patients were fed orally without any complications, in 78% the volume of the bolus has been modified and changes have taken place in the consistency (thickening for liquids); in 43%, moreover, postural strategies were employed and active manoeuvres (supraglottic swallow) were introduced in 13% in order to improve swallowing safety. CONCLUSIONS: There is a high prevalence of clinical and VDF symptoms of oropharyngeal dysphagia in patients with advanced multiple sclerosis. VDF enables us to diagnose the pathophysiological mechanism of aspiration and the existence of silent aspirators, and helps us to introduce specific therapeutic interventions for each patient, thereby achieving safe and efficient swallowing, while prolonging oral feeding.

Accidente vascular cerebral isquémico secundario a displasia fibromuscular: a propósito de un caso / Ischemic stroke, secondary to fibromuscular dysplasia: a case report

Introducción. La displasia fibromuscular es una angiopatía poco común, que se presenta con mayor frecuencia en mujeres jóvenes de mediana edad. Consiste en cambios histológicos heterogéneos que conducen finalmente a un estrechamiento arterial. Las manifestaciones clínicas dependen del vaso afectado; la hipertensión (afectación de las arterias renales) y el accidente vascular cerebral (afectación de las carótidas) son las más comunes. Se ha publicado poco en los últimos años acerca de este proceso. Caso clínico. Mujer de 30 años, con un infarto extenso de la arteria cerebral media derecha por oclusión de la carótida interna. La arteriografía evidenció la disección de los cuatro troncos supraórticos, junto con alteraciones de la arteria renal. La edad de la paciente y la afectación de las cuatro arterias cerebrales con estenosis irregulares hicieron pensar, como primera opción diagnóstica, en una displasia fibromuscular (DFM). Se adoptó una actitud conservadora ante las lesiones vasculares y se realizó un tratamiento rehabilitador de los déficit neurológicos. Discusión. La DFM cefálica puede ser asintomática, y se diagnostica de manera casual. La presentación clínica habitual es la de un ictus isquémico en relación con la estenosis u obstrucción arterial o un tromboembolismo arterioarterial. La arteriografía o la angiorresonancia magnética son útiles para el diagnóstico; es característica la afectación de diversos vasos supraaórticos. Pese a los buenos resultados que muestra la angioplastia transluminal percutánea, se requieren estudios prospectivos que determinen el tratamiento óptimo de esta patología (AU)

[Ischemic stroke, secondary to fibromuscular dysplasia: a case report]. / Accidente vascular cerebral isquémico secundario a displasia fibromuscular: a propósito de un caso.

INTRODUCTION: Fibromuscular dysplasia is an infrequent angiopathy that occurs more often in young women. It consists in a series of heterogeneous histological changes that finally lead to the narrowing of arteries. Clinical manifestations depend on the vessel involved, but high blood pressure (renal artery involvement) and stroke (carotid artery involvement) are the most common. Little has been published about this process in recent years. CASE REPORT: A 30-year-old female with extensive infarction of the right middle cerebral artery caused by obstruction of the internal carotid artery. Arteriographical examination revealed the dissection of the four supra-aortic trunks together with alterations to the renal artery. The patient's age and the involvement of the four cerebral arteries with irregular stenoses led us to consider a fibromuscular dysplasia (FMD) as the first diagnostic option. A conservative attitude was adopted towards the vascular lesions and therapy was carried out with a view to rehabilitating the neurological deficits. DISCUSSION: Brain FMD can be asymptomatic and is often diagnosed by chance. The usual clinical presentation is a stenosis-related ischemic stroke, arterial obstruction or arterio-arterial thromboembolism. Arteriography or magnetic resonance angiography are useful for diagnosis; the involvement of different supra-aortic vessels is characteristic. Despite the good results shown by percutaneous transluminal angioplasty, there is still a need for prospective studies that determine the optimal treatment for this pathology.

Accidente vascular cerebral isquémico secundario a displasia fibromuscular: a propósito de un caso / Ischemic stroke, secondary to fibromuscular dysplasia: a case report

Introducción. La displasia fibromuscular es una angiopatía poco común, que se presenta con mayor frecuencia en mujeres jóvenes de mediana edad. Consiste en cambios histológicos heterogéneos que conducen finalmente a un estrechamiento arterial. Las manifestaciones clínicas dependen del vaso afectado; la hipertensión (afectación de las arterias renales) y el accidente vascular cerebral (afectación de las carótidas) son las más comunes. Se ha publicado poco en los últimos años acerca de este proceso. Caso clínico. Mujer de 30 años, con un infarto extenso de la arteria cerebral media derecha por oclusión de la carótida interna. La arteriografía evidenció la disección de los cuatro troncos supraórticos, junto con alteraciones de la arteria renal. La edad de la paciente y la afectación de las cuatro arterias cerebrales con estenosis irregulares hicieron pensar, como primera opción diagnóstica, en una displasia fibromuscular (DFM). Se adoptó una actitud conservadora ante las lesiones vasculares y se realizó un tratamiento rehabilitador de los déficit neurológicos. Discusión. La DFM cefálica puede ser asintomática, y se diagnostica de manera casual. La presentación clínica habitual es la de un ictus isquémico en relación con la estenosis u obstrucción arterial o un tromboembolismo arterioarterial. La arteriografía o la angiorresonancia magnética son útiles para el diagnóstico; es característica la afectación de diversos vasos supraaórticos. Pese a los buenos resultados que muestra la angioplastia transluminal percutánea, se requieren estudios prospectivos que determinen el tratamiento óptimo de esta patología (AU)

Introduction. Fibromuscular dysplasia is an infrequent angiopathy that occurs more often in young women. It consists in a series of heterogeneous histological changes that finally lead to the narrowing of arteries. Clinical manifestations depend on the vessel involved, but high blood pressure (renal artery involvement) and stroke (carotid artery involvement) are the most common. Little has been published about this process in recent years. Case report. A 30-year-old female with extensive infarction of the right middle cerebral artery caused by obstruction of the internal carotid artery. Arteriographical examination revealed the dissection of the four supra-aortic trunks together with alterations to the renal artery. The patient’s age and the involvement of the four cerebral arteries with irregular stenoses led us to consider a fibromuscular dysplasia (FMD) as the first diagnostic option. A conservative attitude was adopted towards the vascular lesions and therapy was carried out with a view to rehabilitating the neurological deficits. Discussion. Brain FMD can be asymptomatic and is often diagnosed by chance. The usual clinical presentation is a stenosis-related ischemic stroke, arterial obstruction or arterio-arterial thromboembolism. Arteriography or magnetic resonance angiography are useful for diagnosis; the involvement of different supra-aortic vessels is characteristic. Despite the good results shown by percutaneous transluminal angioplasty, there is still a need for prospective studies that determine the optimal treatment for this pathology (AU)

[The usefulness of dopaminergic drugs in traumatic brain injury]. / Utilidad de los fármacos dopaminérgicos en el daño cerebral de origen traumático.

OBJECTIVE: To review the bibliography indexed in MEDLINE so as to assess and/or compare the usefulness and indications of dopaminergic drugs in both cognitive and motor disorders due to head injuries (traumatic brain injury). DEVELOPMENT: Lesions due to head injuries cause both focal and diffuse cerebral damage which lead to neuropsychological and motor deficit. It is clear that motor alterations cause major physical disability, but neuropsychological alterations affect cognitive behaviour and emotional aspects which are very disabling and seriously affect both the patient and his family and also his return to social, family and working life. There is a wide range of drugs available to assist in the improvement or recovery of the patient. Some of the most important of these drugs are the dopaminergic agents, due to the importance of dopamine for proper frontal cerebral area function. CONCLUSIONS: This study confirms the indications for the use of dopaminergeric drugs when trying to improve or accelerate recovery from cognitive deficits in patients with traumatic cerebral damage. However, it is important to note that, in view of the complexity of cognitive function and the mechanisms of their recovery, it will be necessary to make randomized, double blind, prospective studies with a control group (if possible) so as to determine the real part played by these drugs in the recovery process of patients with traumatic brain damage.

Utilidad de los fármacos dopaminérgicosen el daño cerebral de origen traumático / The usefulness of dopaminergic drugs in traumatic brain injury

Objetivo. Realizar una revisión bibliográfica de los artículos indexados en MEDLINE, con el fin de valorar y contrastar la utilidad e indicaciones de los fármacos dopaminérgicos en los trastornos, tanto cognitivos como motores, derivados del traumatismo craneoencefálico (TCE). Desarrollo. Las lesiones producidas por el TCE oca sionan daños cerebrales, tanto focales como difusos, que se traducen principalmente en déficit neuropsicológicos y motores. Es evidente que las alteraciones motoras provocan importantes discapacidades físicas, pero las alteraciones neuropsicológicas afectan a aspectos cognitivos, conductuales y emocionales, que son altamente discapacitantes y que tienen un importante impacto, tanto en el mismo afectado como en su familia, así como en su reinserción sociofamiliar y laboral. Para el manejo de estos déficit disponemos de un arsenal farmacológico, que puede contribuir a la mejoría o recuperación del paciente. De este grupo de neurofármacos cabe destacar los fármacos dopaminérgicos, con la importante base de la dopamina en el correcto funcionamiento de las áreas cerebrales frontales. Conclusiones. Este trabajo confirma las indicaciones que el uso de fármacos dopaminérgicos tiene a la hora de intentar mejorar o acelerar la recuperación de los déficit cognitivos en pacientes con daño cerebral de origen traumático. Sin embargo, es importante destacar que, dada la complejidad de las funciones cognitivas y de sus mecanismos de recuperación, sería preciso la realización de estudios prospectivos, aleatorios, a doble-ciego y, a ser posible, con grupo control, para poder determinar el auténtico papel que desempeñan estos fármacos en el proceso de recuperación de los pacientes con daño cerebral de origen traumático (AU)