BOLD Activation During the Application of MOXO-CPT in School Patients With and Without Attention Deficit Hyperactivity Disorder.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 3% of children in the world. OBJECTIVE: In this work, we seek to compare the different brain activations of pediatric patients with and without ADHD. METHODS: A functional resonance examination with BOLD contrast was applied using the MOXO-CPT test (Continuous Performance test with single and double visual-auditory distractors). RESULTS: Differences in BOLD activation were observed indicating that control children regularly presented negative BOLD activations that were not found in children with ADHD. Inhibitory activity in audiovisual association zones in control patients was greater than in patients with ADHD. The inhibition in the frontal and motor regions in the controls contrasted with the overactivation of the motor areas in patients with ADHD, this, together with the detection of cerebellar activation which attempted to modulate the responses of the different areas that lead to executive failure in patients with ADHD. CONCLUSIONS: In view of these results, it can be argued that the lack of inhibition of ADHD patients in their executive functions led to a disorganization of the different brain systems.

Compassionate use of Quantum Magnetic Resonance Therapy for treatment of children with Diffuse Brainstem Glioma in Mexico City: a single institutional experience.

PURPOSE: Diffuse Brainstem Glioma (DBG) is a catastrophic brain tumor with a survival rate of less than 10% two years after diagnosis despite the existence of different treatment protocols. Among the devices that use magnetic fields generated by Magnetic Resonance Imaging is Quantum Magnetic Resonance Therapy (QMRT). METHODS: Five children diagnosed with DBG in our institution in Mexico City underwent treatment of compassionate use with QMRT between December 2018 and July 2019. A survival analysis was performed with previously reported historical data (n = 15). RESULTS: Two patients (40%) survived after three years of follow-up; the log-rank test showed a statistically significant difference in overall survival between both groups (p = 0.032). All patients tolerated the treatment adequately without reporting any severe clinical or neuroradiological adverse effects. Of the patients included, all showed a decrease in the tumor one month after the end of the treatment, although there was great variability in the response and the difference was not statistically significant (p = 0.06). CONCLUSIONS: Although future investigations are needed to confirm the findings reported in the present study, the improvement in survival is promising for a group of patients whose prognosis has been catastrophic over the years. Trial registration NCT03577600.

Midiendo el espectro de los trastornos del lenguaje a los trastornos del espectro autista: Consenso Latinoamericano Delphi Modificado / Measuring the spectrum from language disorders to autism spectrum disorders: modified Delphi Latin American Consensus

INTRODUCCIÓN: Existen diferentes posturas en cuanto a la delimitación entre los trastornos del lenguaje y de la comunicación; sobre todo al acuñar las definiciones, sus limitantes y particularmente poder medir los pronósticos y diferentes procesos a lo largo del neurodesarrollo. El presente consenso busca unir las diferentes visiones de la región latinoamericana sobre los Trastornos del Desarrollo del Lenguaje (TDL) y Trastornos del Espectro Autista (TEA), homologar taxonomías y evolución a lo largo de los primeros años de vida. MÉTODO: Se realizó un estudio Delphi Modificado para llegar a un consenso sobre la definición más adecuada y diagnóstico temprano de los TDL y TEA. RESULTADOS: Un total de 34 profesionales de 11 países de la región aceptaron la invitación para participar en el consenso e incluyó a distintos especialistas a cargo del cuidado de estos pacientes. Se realizaron dos rondas de evaluación llegando a un acuerdo y consenso en todos los ítems. CONCLUSIONES: El término "Riesgo para Trastornos de la Comunicación y del Lenguaje" es creado para referirse a los niños que no caen en ninguna categoría diagnóstica en etapas tempranas del desarrollo. Consideramos que tanto el uso de este término como el del resto de los mismos, alcanzados por consenso, permitirá coincidir en distintos puntos para la caracterización del TDL y TEA, todo ello contribuirá a evaluar de forma más específica cuáles son las intervenciones adecuadas que mejoren el pronóstico y modifiquen las trayectorias del desarrollo de esta población en nuestra región.

INTRODUCTION: There are different points of view regarding the delimitation between language and communication disorders; especially when establishing the definitions, their limitations and above all being able to measure prognoses and different processes throughout neurodevelopment. The present consensus seeks to unify the different points of view of the Latin American region on Language Development Disorders (LDD) and Autism Spectrum Disorders (ASD), standardize the taxonomies and evolution throughout the first years of life. METHOD: A Modified Delphi study was carried out to reach a consensus on the most adequate definition and early diagnosis of TDL and ASD. RESULTS: A total of 34 professionals from 11 countries in the region accepted the invitation to participate in the consensus and included different specialists in charge of the care of these patients. Two rounds of evaluation were carried out, reaching an agreement and consensus on all items. CONCLUSIONS: The term "Risk for Communication and Language Disorders" is created to refer to children who do not fall into any diagnostic category in early stages of development. We consider that using this term as well as the rest of the terms reached by consensus in the present work will allow to match in different points for the characterization of TDL and ASD, this will contribute to a more specific evaluation regarding the appropriate interventions to improve prognosis and modify development trajectories of this population in our region.

The Role of Time as a Prognostic Factor in Pediatric Brain Tumors: a Multivariate Survival Analysis.

There is no evidence that prolonged pre diagnostic symptomatic intervals (PSI) increases the risk of death in pediatric brain tumors. When investigating the role of time previous research had not controlled for confounding variables or measured the pretreatment interval (PTI). We use the term global delay interval (GDI) to describe the sum of PSI and PTI. The aim of this research was to evaluate whether there was a decrease in the probability of survival in children with brain tumors due to a prolonged PSI, PTI and GDI, using a multivariate survival analysis. We retrospective review 127 clinical records labeled with the diagnosis of CNS tumors attended at a specialized pediatric center in Mexico City from January 2008 to December 2012. Patients with PSI and GDI diagnosed between 3 and 6 months showed statistical lower probability of surviving that those with intervals <3 months even when adjusting for age, sex, localization and tumor grade. When stratified for the place of residency and adjusted for sex, age, localization, grade of tumor, type of surgery and coadjuvant therapy, a GDI between 3 and 6 months showed to be a risk factor for the overall survival of brain tumors compared with an interval < 3 months. When analyzing the interaction, high grade tumors are at more risk of dying when GDI was between 3 and 6 months compared to <3 months. Prolonged PSI and GDI showed to be a potential prognostic factor for survival in CNS tumors, especially in high grade tumors. Future prospective research should measure the PSI, PTI and GDI and adjust for covariates in order to properly infer the effect of time in pediatric brain tumors.

Evaluation of the response of lisdexamfetamine in children and adolescents with ADHD: quasi-experimental study / Evaluación de la respuesta de la lisdexanfetamina en niños y adolescentes con TDAH: estudio cuasiexperimental

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. Although lisdexamfetamine dimesylate (LDX) offers a treatment alternative, clinical evidence of LDX for ADHD has not been explored in Latin American pediatric population. Objective To evaluate the LDX response in Mexican pediatric patients with ADHD. Method We designed a quasi-experimental, uncontrolled before and after study to evaluate the LDX response in patients with severe ADHD. We established a diagnosis of ADHD according to DSM-5 criteria. We formed three groups: without previous treatment (group A), in treatment with stimulant drugs (group B) or in treatment with non-stimulant drugs (group C). Prior to the start of the study, letters of consent and informed consent were signed. We evaluated the effect of LDX based on the difference between ADHD-RS scores at the beginning and after six months. Results We recruited a total of 144 patients (group A: 48 patients, group B: 57 patients, group C: 39 patients). All the groups showed a significant decrease in the mean score of ADHD-RS (Attention Deficit Hyperactivity Disorder Rating Scale) at six months (group A 37.57 vs. 22.34, p <.01), (group B 36.72 vs. 24.45; p <. 01), (group C 38.54 vs. 24.3, p <.01). Fewer than 30% of the subjects showed a significant adverse reaction, the most frequent ones being: sleep disturbance (primary insomnia) 24% and decreased appetite in 20%. Discussion and conclusion Treatment with LDX is an effective, well-tolerated pharmacological option for Mexican pediatric patients with ADHD.

Resumen Introducción El trastorno por déficit de atención con hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo más comunes. Aunque el dimesilato de lisdexanfetamina (LDX) ofrece una alternativa de tratamiento, la evidencia clínica de LDX para TDAH no se ha explorado en población pediátrica latinoamericana. Objetivo Evaluar la respuesta de LDX en pacientes pediátricos mexicanos con TDAH. Método Diseñamos un estudio cuasiexperimental no controlado de antes y después para evaluar la respuesta de LDX en pacientes con TDAH grave. Establecimos el diagnóstico de TDAH de acuerdo con criterios del DSM-5. Conformamos tres grupos: sin tratamiento previo (grupo A), en tratamiento con fármacos estimulantes (grupo B) o en tratamiento con fármacos no estimulantes (grupo C). Previo al inicio del estudio se firmaron las cartas de consentimiento y asentimiento informado. Evaluamos el efecto de LDX con base en la diferencia de los puntajes de ADHD-RS al inicio y posterior a seis meses. Resultados Reclutamos un total de 144 pacientes (grupo A: 48 pacientes, grupo B: 57 pacientes, grupo C: 39 pacientes). Todos los grupos mostraron una disminución significativa en la media de puntaje de ADHD-RS (Attention Deficit Hyperactivity Disorder Rating Scale) a los seis meses (grupo A 37.57 vs. 22.34; p < .01), (grupo B 36.72 vs. 24.45; p < .01), (grupo C 38.54 vs. 24.3; p < .01). Menos del 30% de los sujetos presentó alguna reacción adversa importante, siendo las más frecuentes: alteraciones del sueño (insomnio primario) 24% y disminución del apetito en 20%. Discusión y conclusión El tratamiento con LDX es una opción farmacológica efectiva y bien tolerada para pacientes pediátricos mexicanos con TDAH.