Recomendaciones sobre estudios neurofisiológicos en tiempos de pandemia de COVID-19 / Recommendations on neurophysiological studies during the COVID-19 pandemic

A finales de enero, la Organización Mundial de la Salud declaró el brote actual de la enfermedad por coronavirus COVID-19 como emergencia de salud pública de importancia internacional. En España, desde que el 14 de marzo de 2020 el Gobierno decretase el estado de alarma, los médicos encargados de las pruebas neurofisiológicas las hemos estado realizando sin tener un criterio consensuado ni unas pautas adecuadas de seguridad claras para los facultativos, los técnicos ni los pacientes. Las siguientes recomendaciones, basadas en el actual conocimiento de la enfermedad y, por tanto, susceptibles de variaciones en el futuro, se proponen cuando la pandemia parece que ha entrado en un proceso de disminución de la virulencia y, con ello, las medidas estrictas de confinamiento hasta ahora mantenidas; sin embargo, ante la posibilidad de una segunda oleada de rebrotes de la pandemia, parece necesario establecer unas recomendaciones básicas y de mínimos para respetar el derecho del paciente a una atención adecuada, similar a la previa a la pandemia, y mantener unos mínimos de seguridad para los propios pacientes y los médicos, técnicos y personal sanitario que realizan estas pruebas. Se trata de recomendaciones sobre el establecimiento de una prioridad basándose en el motivo de consulta, el establecimiento de llamadas de comprobación de la situación clínica del paciente antes de acudir a la consulta externa y las normas de ejecución de las pruebas neurofisiológicas, que se basan, en general, en la preservación de circuitos hospitalarios, el respeto y el cuidado de las barreras de contagio conocidas de esta enfermedad, y la utilización de material desechable. Estas recomendaciones son de especial interés, sobre todo por la incertidumbre de no saber la evolución de la infección por el SARS-CoV-2 en las próximas semanas o meses

At the end of January, the current outbreak of COVID-19 coronavirus disease was declared an important international public health emergency. In Spain, since the government declared the state of alarm on 14 March 2020, doctors responsible for carrying out neurophysiological tests have been performing them without any consensus criterion or clear safety guidelines for doctors, technicians or patients. The following recommendations, based on current knowledge of the disease and therefore liable to change in the future, are proposed when the pandemic appears to have entered a process of decreasing virulence and, with it, the strict containment measures established to date. However, in view of the possibility of a second wave of the pandemic, it seems necessary to establish basic and minimum recommendations to respect the patient's right to appropriate care, similar to that provided prior to the pandemic, and to maintain minimum safety standards for the patients themselves and for the doctors, technicians and health personnel carrying out these tests. These recommendations concern the constitution of a priority based on the reason for consultation, the establishment of calls to check the patient's clinical situation before going to the outpatient department and the rules for carrying out neurophysiological tests, which are generally based on the preservation of hospital circuits, respect for and observation of the known barriers to contagion of this disease, and the use of disposable material. These recommendations are of particular interest, especially given the uncertainty of not knowing the evolution of the SARS-CoV-2 infection in the coming weeks or months

Evaluación prequirúrgica mediante resonancia magnética funcional en pacientes con tumores neuroepiteliales disembrioplásicos: una serie de casos / Preoperative evaluation by functional magnetic resonance imaging in patients with dysembryoplastic neuroepithelial tumours: A case series

INTRODUCCIÓN: Los tumores neuroepiteliales disembrioplásicos (DNET) son un tipo de neoplasia glioneuronal benigna de localización típicamente temporal que producen crisis epilépticas resistentes al tratamiento farmacológico en niños y adultos jóvenes. OBJETIVO: Se muestran 4 casos valorando la utilidad de la resonancia magnética funcional en el estudio prequirúrgico de pacientes con tumores neuroepiteliales disembrionarios. Para la obtención de imágenes se utilizó un equipo de resonancia magnética Philipps Intera de 3.0 Tesla y la técnica Blood Oxygenation Level-Dependent, permitiendo localizar las áreas elocuentes de lenguaje y motora mediante la aplicación de paradigmas específicos. RESULTADOS: En un caso el tumor se encontraba adyacente al área de Broca, en 2 casos coincidía con Wernicke, en un paciente estaba menos de 1cm del área motora de la mano y en otro próximo a la memoria. Solo 2 de los pacientes fueron operados, no produciéndose déficit funcional postoperatorio. Se observó activación hemisférica contralateral al tumor sugestivo de neuroplasticidad en uno de los pacientes. CONCLUSIONES: La resonancia magnética funcional supone un método no invasivo que permite evaluar la proximidad de las lesiones a las áreas elocuentes, clave en la evaluación del riesgo quirúrgico. Además, ha permitido detectar probable neuroplasticidad en un caso, la cual ha garantizado el éxito de la cirugía

INTRODUCTION: Dysembryoplastic neuroepithelial tumours (DNET) are a type of benign glioneuronal neoplasia of typically temporal location that produce drug-resistant epileptic seizures in children and young adults. OBJECTIVE: This work aims to assess the usefulness of functional magnetic resonance imaging (fMRI) in the preoperative study in four patients with DNET. A Philips Intera 3.0 Tesla magnetic resonance imaging scanner and the Blood-Oxygen-Level-Dependent (BOLD) technique were used to obtain the images, making it possible to locate the eloquent areas for language and motor areas through the application of specific paradigms. RESULTS: In one case the tumour was adjacent to Broca's area, in two cases it coincided with Wernicke's area, in one patient it was < 1cm from the motor area for the hand and in another close to memory. Only two of the patients were operated on, without postoperative functional deficit. Hemispheric activation contralateral to the tumour suggestive of neuroplasticity was observed in one of the patients. CONCLUSIONS: fMRI is a non-invasive method that allows us to assess the proximity of lesions to eloquent areas, which is key in the evaluation of surgical risk. In addition, it allowed the detection of probable neuroplasticity in one case, which guaranteed the success of the surgery

Preoperative evaluation by functional magnetic resonance imaging in patients with dysembryoplastic neuroepithelial tumours: A case series. / Evaluación prequirúrgica mediante resonancia magnética funcional en pacientes con tumores neuroepiteliales disembrioplásicos: una serie de casos.

INTRODUCTION: Dysembryoplastic neuroepithelial tumours (DNET) are a type of benign glioneuronal neoplasia of typically temporal location that produce drug-resistant epileptic seizures in children and young adults. OBJECTIVE: This work aims to assess the usefulness of functional magnetic resonance imaging (fMRI) in the preoperative study in four patients with DNET. A Philips Intera 3.0 Tesla magnetic resonance imaging scanner and the Blood-Oxygen-Level-Dependent (BOLD) technique were used to obtain the images, making it possible to locate the eloquent areas for language and motor areas through the application of specific paradigms. RESULTS: In one case the tumour was adjacent to Broca's area, in two cases it coincided with Wernicke's area, in one patient it was<1cm from the motor area for the hand and in another close to memory. Only two of the patients were operated on, without postoperative functional deficit. Hemispheric activation contralateral to the tumour suggestive of neuroplasticity was observed in one of the patients. CONCLUSIONS: fMRI is a non-invasive method that allows us to assess the proximity of lesions to eloquent areas, which is key in the evaluation of surgical risk. In addition, it allowed the detection of probable neuroplasticity in one case, which guaranteed the success of the surgery.

Validación transcultural al castellano del Actionable Bladder Symptoms Screening Tool / Transcultural validation in Spanish of the Actionable Bladder Symptoms Screening Tool

Introducción. Los trastornos del tracto urinario inferior son frecuentes en pacientes con esclerosis múltiple a lo largo del transcurso de la enfermedad y alcanzan prevalencias variables cercanas al 75%. Es primordial realizar un diagnóstico precoz en fases tempranas y un abordaje terapéutico óptimo. Burks et al elaboraron el Actionable Bladder Symptoms Screening Tool (ABSST) como herramienta de cribado útil de dichos trastornos. Posteriormente, Bates et al desarrollaron una versión corta del ABSST con el objetivo de minimizar el tiempo de realización y facilitar su manejo. Objetivo. Realizar la validación transcultural al castellano de la versión breve del ABSST. Pacientes y métodos. Se realizó la traducción al castellano del ABSST y una posterior retrotraducción al inglés que confirmaba su equivalencia semántica. Se llevó a cabo una prueba de campo en 40 pacientes con esclerosis múltiple, incluyendo dos preguntas finales para comprobar la comprensión y aceptabilidad de la herramienta y un último ítem que recogía el tiempo empleado para su realización. Resultados: Se seleccionaron 40 pacientes conforme a los criterios de inclusión y exclusión; el 67,5% eran mujeres y la media global de edad era de 46,2 años. La comprensión del test fue del 100%, y la aceptabilidad, del 97,5%. El 57,5% obtuvo puntuaciones >= 3, y se emplearon 5,33 minutos de media. Conclusiones. El ABSST como cuestionario de cribado breve de trastornos urinarios en la esclerosis múltiple es una herramienta útil para su detección temprana y queda validado para su uso en castellano (AU)

Introduction. Disorders of the lower urinary tract are frequent in patients with multiple sclerosis throughout the course of the disease and reach variable prevalences close to 75%. It is essential to obtain an early diagnosis in the initial phases and to implement an optimal therapeutic management. Burks et al developed the Actionable Bladder Symptoms Screening Tool (ABSST) as a useful screening test in such disorders. Later, Bates et al developed a short version of the ABSST with the objective of minimising the time required to complete it and making it easier to use. AIMS. To carry out the transcultural validation into Spanish of the short version of the ABSST. Patients and Methods: The ABSST was translated into Spanish and then back-translated into English, which confirmed the semantic equivalence. A field test was conducted on 40 patients with multiple sclerosis, with two extra questions being included at the end in order to check the comprehension and acceptability of the tool, together with a final item that asked for the time spent on completing it. Results: Forty patients were selected In accordance with the eligibility and exclusion criteria; 67.5% of them were females and the overall mean age was 46.2 years. The rate of comprehension of the test was 100%, and that of acceptability was 97.5%. Results showed that 57.5% obtained scores >= 3, and an average of 5.33 minutes were spent on completing it. Conclusions: As a brief screening questionnaire for urinary disorders in multiple sclerosis, the ABSST is a useful tool for detecting them at an early stage and has now been validated for use in Spanish (AU)

Biomarkers in multiple sclerosis: an update for 2014.

Multiple sclerosis is a chronic, demyelinating and inflammatory disease of the central nervous system that mainly affects young adults. It is characterised by processes involving inflammation, demyelination and axonal destruction, and as a result the pathogenic aspects and response to treatment of the disease vary widely. It is therefore difficult to establish a prognosis for these patients or to determine the effectiveness of the different drugs that are employed. Current clinical research into the development of new biomarkers has advanced a great deal in recent years, especially in the early stages of the disease. Yet, it is essential to further our knowledge about novel markers of the disease, and not only in the more advanced stages, so as to be able to stop disability from progressing and to establish new therapy regimens in these patients. This review presents an update on the information available about the biomarkers that are currently validated and used in multiple sclerosis, together with the possible candidates for utilisation in routine clinical practice.

TITLE: Biomarcadores en la esclerosis multiple: puesta al dia 2014.La esclerosis multiple es una enfermedad cronica, desmielinizante e inflamatoria del sistema nervioso central, que afecta principalmente a adultos jovenes. Se caracteriza por procesos de inflamacion, desmielinizacion y destruccion axonal, que confieren a esta enfermedad una gran variabilidad en los aspectos patogenicos y de respuesta al tratamiento. Por ello es muy dificil establecer el pronostico de estos pacientes, asi como la eficacia de los diferentes farmacos. La investigacion clinica actual en el desarrollo de nuevos biomarcadores ha experimentado un gran avance en los ultimos años, especialmente al inicio de la enfermedad. Sin embargo, es prioritario avanzar en el conocimiento de nuevos marcadores de la enfermedad, no solo en la fase mas avanzada, con el objetivo de prevenir la progresion de la discapacidad y establecer nuevas pautas terapeuticas en estos pacientes. Esta revision presenta una actualizacion de la informacion acerca de los biomarcadores actualmente validados y utilizados en la esclerosis multiple, asi como de los posibles candidatos de utilizacion en la practica clinica habitual.

Biomarcadores en la esclerosis múltiple: puesta al día 2014 / Biomarkers in multiple sclerosis: an update for 2014

La esclerosis múltiple es una enfermedad crónica, desmielinizante e inflamatoria del sistema nervioso central, que afecta principalmente a adultos jóvenes. Se caracteriza por procesos de inflamación, desmielinización y destrucción axonal, que confieren a esta enfermedad una gran variabilidad en los aspectos patogénicos y de respuesta al tratamiento. Por ello es muy difícil establecer el pronóstico de estos pacientes, así como la eficacia de los diferentes fármacos. La investigación clínica actual en el desarrollo de nuevos biomarcadores ha experimentado un gran avance en los últimos años, especialmente al inicio de la enfermedad. Sin embargo, es prioritario avanzar en el conocimiento de nuevos marcadores de la enfermedad, no sólo en la fase más avanzada, con el objetivo de prevenir la progresión de la discapacidad y establecer nuevas pautas terapéuticas en estos pacientes. Esta revisión presenta una actualización de la información acerca de los biomarcadores actualmente validados y utilizados en la esclerosis múltiple, así como de los posibles candidatos de utilización en la práctica clínica habitual (AU)

Multiple sclerosis is a chronic, demyelinating and inflammatory disease of the central nervous system that mainly affects young adults. It is characterised by processes involving inflammation, demyelination and axonal destruction, and as a result the pathogenic aspects and response to treatment of the disease vary widely. It is therefore difficult to establish a prognosis for these patients or to determine the effectiveness of the different drugs that are employed. Current clinical research into the development of new biomarkers has advanced a great deal in recent years, especially in the early stages of the disease. Yet, it is essential to further our knowledge about novel markers of the disease, and not only in the more advanced stages, so as to be able to stop disability from progressing and to establish new therapy regimens in these patients. This review presents an update on the information available about the biomarkers that are currently validated and used in multiple sclerosis, together with the possible candidates for utilisation in routine clinical practice (AU)

The effectiveness of glatiramer acetate in clinical practice: an observational study.

AIM: To evaluate the clinical effectiveness and safety of glatiramer acetate for use in routine clinical practice. PATIENTS AND METHODS: A retrospective, observational study was conducted on patients with multiple sclerosis who were treated with glatiramer acetate in clinical practice. The primary outcome was the clinical effectiveness of glatiramer acetate treatment. RESULTS: The study included a total of 104 patients (women, 59.6%; age at onset of glatiramer acetate treatment, 39.9 ± 10.9 years; prior treatment for multiple sclerosis, 30.8%). The patients had received glatiramer acetate treatment for an average of 3.6 ± 1.9 years. During the first year of glatiramer acetate treatment, the relapse rate decreased by 60%. At this time, the number of relapses had decreased for 47 patients (45.1%), 67 patients (68.4%) had not suffered a relapse and 78 patients (75.0%) showed no signs of progression. During the second year of glatiramer acetate treatment, the relapse rate decreased by 70%. At this time, the number of relapses had decreased for 43 patients (41.3%), 63 patients (75.9%) had not suffered a relapse and 59 patients (56.7%) showed no signs of progression. There were no reported relapses or progression in 56 patients (53.8%) and 41 patients (39.4%) during the first and second years of treatment, respectively. Discontinuation of glatiramer acetate was necessary in only three patients. The most common adverse effects included fatigue (28.9%) and spasticity (7.7%). CONCLUSION: This evaluation of glatiramer acetate use in clinical practice supports the effectiveness and the safety profile observed in previously published clinical trial studies.