Diseño de la tarjeta de habilidades prácticas de electroencefalografía para el técnico en Neurofisiología Clínica

Introducción: El programa de formación del Técnico Superior de Ciclo Corto en Neurofisiología Clínica incorpora en la educación en el trabajo la rotación por electroencefalografía. En ella el estudiante adquiere habilidades esenciales, desarrolla su pensamiento creador e independiente. No obstante, las habilidades prácticas desarrolladas en la misma no están establecidas. Objetivo: Diseñar la tarjeta de habilidades prácticas de electroencefalografía para el técnico en Neurofisiología Clínica. Materiales y métodos: Se realizó un estudio descriptivo transversal entre enero y julio de 2022. Fueron entrevistados seis profesores que impartieron la asignatura Electroencefalografía en el Técnico Superior de Ciclo Corto en Neurofisiología Clínica, cuatro de la Facultad de Ciencias Médicas Juan Guiteras Gener, de Matanzas, y dos de la Facultad de Ciencias Médicas Victoria de Girón, de La Habana. Resultados: Los profesores entrevistados, de modo general, apuntaron habilidades prácticas muy similares para el diseño de la tarjeta. La misma fue validada por el criterio de especialistas. Conclusiones: El diseño de la tarjeta de habilidades prácticas contiene los elementos fundamentales para la rotación de electroencefalografía aplicada en la educación al trabajo. Esta organiza y orienta en el estudiante su aprendizaje.

Introduction: The training program of the Short Cycle High Education Technician in Clinical Neurophysiology includes electroencephalography rotation into on-the-job education. In it, the student acquires essential skills, develops his creative and independent thinking. However, the practical skills developed in it are not established. Objective: To design the practical skills card of electroencephalography for the Technician in Clinical Neurophysiology. Materials and methods: A cross sectional, descriptive study was carried out in the period from January to July 2022. Six professors who taught the subject Electroencephalography in the Short Cycle course High Education Technician in Clinical Neurophysiology were interviewed; four from the Faculty of Medical Sciences Juan Guiteras Gener, from Matanzas, and two from the Faculty of Medical Sciences Victoria de Giron, from Havana. Results: The teachers interviewed, in general, pointed out very similar practical skills for the design of the card. It was validated by the criteria of specialists. Conclusions: The design of the practical skills card contains the fundamental elements for the electroencephalography rotation applied in on-the-job education. It organizes and guides the student's learning.

Neuromodulación eléctrica en el tratamiento del dolor neuropático refractario. Colocación del primer estimulador medular en Cuba / Electric neuromodulation in the treatment of refractory pain. Placement of the first spinal stimulator in Cuba

El dolor es una causa importante de sufrimiento físico y emocional. El tratamiento médico de los pacientes con dolor crónico refractario es un gran reto. Se presenta el caso de una paciente de 19 años con un cuadro radicular compresivo secundario a Hernia discal L5-S1 derecha, que se le aplicó una discectomía L5-S1 por técnica de Caspar. Al mes de evolución regresa con igual sintomatología. A pesar de múltiples terapias farmacológicas y procederes intervencionistas, el dolor neuropático no mejora, después de múltiples estudios y discusiones en colectivo se determina la posibilidad de la colocación de un neuroestimulador medular, proceder que se lleva a cabo con mejoría considerable de su cuadro doloroso(AU)

Pain is a major cause of physical and emotional suffering. The management of patients with refractory chronic pain is a great challenge. The case is presented of a 19-year-old female patient with compressive radicular symptoms secondary to right L5-S1 disc herniation, who underwent L5-S1 discectomy with Caspar technique. After one month of evolution, she returned with the same symptoms. Despite multiple pharmacological therapies and interventional procedures, the neuropathic pain did not improve. After multiple studies and collective discussions, the possibility of placing a spinal neurostimulator was decided. After the procedure, the patient improved considerably with respect to her painful symptoms(AU)

EEG-Derived Functional Connectivity Patterns Associated with Mild Cognitive Impairment in Parkinson's Disease.

OBJECTIVE: To evaluate EEG-derived functional connectivity (FC) patterns associated with mild cognitive impairment (MCI) in Parkinson's disease (PD). METHODS: A sample of 15 patients without cognitive impairment (PD-WCI), 15 with MCI (PD-MCI), and 26 healthy subjects were studied. The EEG was performed in the waking functional state with eyes closed, for the functional analysis it was used the synchronization likelihood (SL) and graph theory (GT). RESULTS: PD-MCI patients showed decreased FC in frequencies alpha, in posterior regions, and delta with a generalized distribution. Patients, compared to the healthy people, presented a decrease in segregation (lower clustering coefficient in alpha p = 0.003 in PD-MCI patients) and increased integration (shorter mean path length in delta (p = 0.004) and theta (p = 0.002) in PD-MCI patients). There were no significant differences in the network topology between the parkinsonian groups. In PD-MCI patients, executive dysfunction correlated positively with global connectivity in beta (r = 0.47) and negatively with the mean path length at beta (r = -0.45); alterations in working memory were negatively correlated with the mean path length at beta r = -0.45. CONCLUSIONS: PD patients present alterations in the FC in all frequencies, those with MCI show less connectivity in the alpha and delta frequencies. The neural networks of the patients show a random topology, with a similar organization between patients with and without MCI. In PD-MCI patients, alterations in executive function and working memory are related to beta integration.

Surgical Outcome in Extratemporal Epilepsies Based on Multimodal Pre-Surgical Evaluation and Sequential Intraoperative Electrocorticography.

OBJECTIVE: to present the postsurgical outcome of extratemporal epilepsy (ExTLE) patients submitted to preoperative multimodal evaluation and intraoperative sequential electrocorticography (ECoG). SUBJECTS AND METHODS: thirty-four pharmaco-resistant patients with lesional and non-lesional ExTLE underwent comprehensive pre-surgical evaluation including multimodal neuroimaging such as ictal and interictal perfusion single photon emission computed tomography (SPECT) scans, subtraction of ictal and interictal SPECT co-registered with magnetic resonance imaging (SISCOM) and electroencephalography (EEG) source imaging (ESI) of ictal epileptic activity. Surgical procedures were tailored by sequential intraoperative ECoG, and absolute spike frequency (ASF) was calculated in the pre- and post-resection ECoG. Postoperative clinical outcome assessment for each patient was carried out one year after surgery using Engel scores. RESULTS: frontal and occipital resection were the most common surgical techniques applied. In addition, surgical resection encroaching upon eloquent cortex was accomplished in 41% of the ExTLE patients. Pre-surgical magnetic resonance imaging (MRI) did not indicate a distinct lesion in 47% of the cases. In the latter number of subjects, SISCOM and ESI of ictal epileptic activity made it possible to estimate the epileptogenic zone. After one- year follow up, 55.8% of the patients was categorized as Engel class I-II. In this study, there was no difference in the clinical outcome between lesional and non lesional ExTLE patients. About 43.7% of patients without lesion were also seizure- free, p = 0.15 (Fischer exact test). Patients with satisfactory seizure outcome showed lower absolute spike frequency in the pre-resection intraoperative ECoG than those with unsatisfactory seizure outcome, (Mann- Whitney U test, p = 0.005). CONCLUSIONS: this study has shown that multimodal pre-surgical evaluation based, particularly, on data from SISCOM and ESI alongside sequential intraoperative ECoG, allow seizure control to be achieved in patients with pharmacoresistant ExTLE epilepsy.

Conectividad funcional derivada del electroencefalograma durante el sueño no REM en los trastornos del espectro autista / Functional connectivity derived from an electroencephalogram during non-REM sleep in autism spectrum disorders

Objetivo. Conocer las diferencias en los patrones de conectividad funcional, las características topológicas de la red y la relación de éstas con las anomalías epileptiformes interictales en niños con trastorno del espectro autista (TEA) primario y secundario. Pacientes y métodos. Se realizó un estudio retrospectivo con 27 niños de 3-13 años diagnosticados con TEA, a los que se les realizó un electroencefalograma en estado funcional de sueño espontáneo. Se analizó la conectividad funcional y las propiedades de la red a partir de los datos obtenidos del electroencefalograma durante la etapa N2 del sueño no REM. Se determinó la frecuencia de descarga de la actividad epileptiforme interictal (FDAEI) y se correlacionó con las propiedades topológicas de la red. Resultados. Los pacientes con TEA secundario tenían una disminución de la sincronización para la frecuencia alfa y un incremento para la frecuencia theta y delta en comparación con los pacientes con TEA primario. La eficiencia local alfa fue mayor en los pacientes que presentaban actividad epileptiforme interictal. Además, en los pacientes con TEA secundario, existía una correlación positiva y negativa estadísticamente significativa entre la FDAEI y las propiedades topológicas de red. Conclusiones. Los pacientes con TEA secundario muestran patrones de conectividad funcional más débiles para la frecuencia alfa y más fuerte para la theta y delta que los pacientes con TEA primario. En pacientes con TEA secundario, la actividad epileptiforme interictal se relaciona con la conectividad local y global de la red para las bandas de frecuencia alfa y beta durante el sueño no REM

Aim. To know the differences in the patterns of functional connectivity, the topological characteristics of the network and the relationship between these latter and the interictal epileptiform anomalies in children with primary and secondary autism spectrum disorder (ASD). Patients and methods. A retrospective study was conducted with 27 children aged between 3 and 13 years diagnosed with ASD. Subjects were submitted to an electroencephalogram in a functional state of spontaneous sleep. Functional connectivity and the properties of the network were analysed using data obtained from the electroencephalogram during the N2 stage of non-REM sleep. The frequency of discharge of the interictal epileptiform activity (FDIEA) was determined and was correlated with the topological properties of the network. Results. Synchronisation was diminished in patients with secondary ASD for the alpha frequency and increased for the theta and delta frequency compared with patients with primary ASD. Local alpha efficiency was higher in patients who presented interictal epileptiform activity. Additionally, in patients with secondary ASD there was a statistically significant positive and negative correlation between FDIEA and the topological properties of the network. Conclusions. Patients with secondary ASD display patterns of functional connectivity that are weaker for the alpha frequency and stronger for theta and delta than patients with primary ASD. In patients with secondary ASD, the interictal epileptiform activity is related to local and global connectivity of the network for the alpha and beta bands during non-REM sleep