RESUMEN
This study reviews the most recent (from 2000 to 2011) Clinical Controlled Trials (CCT) and Randomized Controlled Trials (RCT) concerning the use of music and music-therapy (MT) in the context of dementia and related issues. Studies which explored the efficacy of music and MT on behavioral and psychological symptoms of dementia (BPSD) are prevalent, while those aiming at assessing a potential effect of these approaches on cognitive and physiological aspects are scant. Although with some limitations, the results of these studies are consistent with the efficacy of MT approach on BPSD. In this context, the ability of the music therapist to directly interact with the patients appears to be crucial for the success of the intervention. This review was endorsed by the Italian Psychogeriatric Association (AIP) and represents its view about the criteria to select appropriate music and MT approaches in the field of dementia. Accordingly, we have developed a list of recommendations to facilitate the current use of these techniques in the context of non-pharmacological treatments for patients with dementia.
Asunto(s)
Trastornos del Conocimiento/terapia , Cognición , Demencia/terapia , Musicoterapia , Música , Guías de Práctica Clínica como Asunto , Relaciones Profesional-Paciente , Humanos , Italia , Organizaciones , Resultado del TratamientoRESUMEN
This contribution focuses on the definition of music therapy as a specific applicative context to be seen as distinct from the generic use of music in a variety of pathologies. Music therapy is presented as a discipline grounded both upon relationship and upon the theoretical-methodological principles peculiar to each applicative model. The therapeutic nature proper to music therapy is highlighted with specific reference to the domain of the dementias. Music therapy facilitates expression, communication and relationship in the non-verbal context. Such an opportunity allows persons with dementia to establish contact, to express, and even contrive an organisation/regulation of their emotions, through the sonorous-musical relationship with the music therapist. On the basis of a brief analysis of the relevant literature, attention is drawn to the importance of both evidence-based clinical practice and music therapy evaluations, aimed at proving the effectiveness of music therapy, while promoting its correct application.
Asunto(s)
Demencia/terapia , Musicoterapia/métodos , Investigación Biomédica , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/terapia , Comunicación , Demencia/complicaciones , Humanos , Teoría PsicológicaRESUMEN
OBJECTIVES: To explore the extent of variation in the detection of dementia in primary care across Europe, and the potential for the development of European guidelines. METHOD: A mixture of focus group and adapted nominal group methods involving 23 experts of different disciplines and from eight European countries. RESULTS: The diagnosis of dementia should be 'timely' rather than 'early'. Timeliness has an impact on the patient, on the caregiver, on healthcare professionals, and on society. Ethical and moral issues may interfere with the aim of timely diagnosis. Guidelines may be important for facilitating a timely diagnosis of dementia, but were infrequently used and not even available in three of the eight countries. Referral pathways often depended on health care system characteristics, differing throughout the eight European countries, whilst diagnostic strategies differed due to varied cultural influences. There was consensus that national variations can be reduced and timely diagnosis enhanced by combining simple tests using a systematic stepwise case-finding strategy, in conjunction with a strong infrastructure of multidisciplinary collaboration. CONCLUSIONS: This study identified three key themes that should be considered in harmonizing European approaches to the diagnosis of dementia in primary care: (1) a focus on timely diagnosis, (2) the need for the development and implementation of guidelines, and (3) the identification of appropriate referral pathways and diagnostic strategies including multi-professional collaboration. The content of guidelines may be determined by the perspectives of the guideline developers.
Asunto(s)
Demencia/diagnóstico , Testimonio de Experto , Medicina , Pautas de la Práctica en Medicina , Atención Primaria de Salud , Especialización , Europa (Continente) , Grupos Focales , HumanosRESUMEN
Subjects with anorexia nervosa (AN) present a number of changes in autonomic system functions, such as thermoregulation, vascular motility, heart rate and rhythm, and blood pressure. We evaluated the changes in the autonomic control of heart rate and blood pressure after postural variation by means of the spectral analysis of R-R interval variability (HRV in 13 female subjects with AN diagnosed on the basis of diagnostic statistical manual (DSM-IV) criteria, a mean age of 25 +/- 5.8 years and a mean body mass index (BMI) of 16.9 +/- 2.6. The controls were 16 healthy female subjects with a mean age of 25 +/- 2.3 years and a normal BMI. The data were statistically evaluated by means of one-way analysis of variance or Student's t test. The high frequency (HF) components of the spectral analysis did not significantly change when passing from clino- to orthostatism in the AN subjects, but there were significant changes in the controls. The changes in the low frequency (LF) components were similar in both groups, but smaller in the AN subjects. However, the difference between the two series was not statistically significant. The variance in the orthostatic R-R intervals recorded in the AN subjects was significantly less than the clinostatic intervals, the intervals recorded in the controls. These results indicate that AN subjects show signs of autonomic dysfunction. The increase in the HF component of the spectral analysis suggests that parasympathetic modulation is abnormally persistent during orthostatism, furthermore, the variability of the R-R intervals indicates that orthosympathetic regulation is also altered in AN.
Asunto(s)
Anorexia Nerviosa/fisiopatología , Sistema Nervioso Autónomo/fisiopatología , Adolescente , Adulto , Presión Sanguínea/fisiología , Electrocardiografía/métodos , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Postura , Análisis Espectral , Pruebas de Mesa InclinadaRESUMEN
The etiology of Alzheimer's disease (AD) has not been as yet completely defined. Genetic, environmental and neurophysiological aspects should all be taken into account. The disease has also neuroendocrine implications, some of which are discussed in this review. It is known that stress and glucocorticoids may affect neurone survival. On the contrary, some data indicate that DHEA and DHEAS exert a neuroprotective action. In AD, changes in hypothalamic-pituitary-adrenal axis function have been reported. Experimental and clinical evidence indicates that glucocorticoid hypersecretion and DHEAS levels decrement may add to hippocampal dysfunction in aging and in AD. Glucocorticoid and beta-amyloid concur in the mechanism of neurone damage, as well as excitatory amino acids (EAA), Ca++ and reactive oxygen species (ROS). The neuroprotective effects exerted by IGFs are also hindered in aging and even more in AD. Production and biological actions of IGFs are negatively influenced by cortisol hypersecretion and DHEAS decrease in patients with AD.
Asunto(s)
Enfermedad de Alzheimer/fisiopatología , Sistemas Neurosecretores/fisiopatología , Envejecimiento/fisiología , Envejecimiento/psicología , Hormonas/metabolismo , HumanosRESUMEN
Changes in the hypothalamus-pituitary-adrenal axis (HPAA) function, entailing elevated cortisol circulating titres, occur in aging and in some neurological conditions, such as Alzheimer's disease (AD). Excess cortisol has neurotoxic effects which affect hippocampal neurones. Dehydroepiandrosterone sulphate (DHEAS) has an antiglucocorticoid activity and neuroprotective effects, but its levels decrease with aging. Glucocorticoids influence the production of insulin-like growth factor-I (IGF-I) and modify its systemic and neurotrophic biological activity by inducing changes in IGF-binding proteins (IGFBPs). We looked for relationships between cortisol, DHEAS levels, and IGF-I - IGFBPs system in AD. Cortisol, DHEAS and GH levels at 02:00, 08:00, 14:00, 20:00 h, basal IGF-I, IGFBP-1 and IGFBP-3 levels were determined by RIAs or IRMA in 25 AD patients, aged 58-89 yr, and in 12 age-matched healthy controls. AD subjects had higher cortisol, lower DHEAS levels and increased cortisol/DHEAS ratio (C/Dr) than controls. In AD cases, total IGF-I, IGFBP-3, and IGF-I/IGFBP ratios were significantly lowered, while IGFBP-1 levels were significantly higher than in controls. We found a significant inverse correlation between IGF-I and IGFBP-3 levels vs C/Dr, and between both IGF-I/IGFBPs ratios vs mean cortisol levels. IGFBP-3 correlated directly with DHEAS. Cortisol was directly and IGF-I inversely correlated with cognitive impairment. In AD patients we found that alterations in HPAA function and elevated C/Dr are related to lowered total and free IGF-I levels. These findings and their relationship to cognitive impairment suggest that changes in hormonal set-up might influence the clinical presentation of the disease.
Asunto(s)
Enfermedad de Alzheimer/sangre , Sulfato de Deshidroepiandrosterona/sangre , Hidrocortisona/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Glándulas Suprarrenales/fisiopatología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/fisiopatología , Ritmo Circadiano , Cognición , Femenino , Hormona de Crecimiento Humana/sangre , Humanos , Hipotálamo/fisiopatología , Proteína 1 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Masculino , Persona de Mediana Edad , Hipófisis/fisiopatologíaRESUMEN
The hippocampus is involved in Alzheimer's disease (AD) and regulates the hypothalamus-pituitary-adrenal axis (HPAA). Enhanced cortisol secretion has been reported in AD. Increased cortisol levels affect hippocampal neuron survival and potentiate beta-amyloid toxicity. Conversely, dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are believed to antagonize noxious glucocorticoid effects and exert a neuroprotective activity. The present study was aimed at investigating possible correlations between hippocampus perfusion - evaluated by SPECT - and HPAA function in AD. Fourteen patients with AD and 12 healthy age-matched controls were studied by (99m)Tc-HMPAO high-resolution brain SPECT. Plasma adrenocorticotropin, cortisol, and DHEAS levels were determined at 2.00, 8.00, 14.00, 20.00 h in all subjects and their mean values were computed. Cortisol/DHEAS ratios (C/Dr) were also calculated. Bilateral impairment of SPECT hippocampal perfusion was observed in AD patients as compared to controls. Mean cortisol levels were significantly increased and DHEAS titers were lowered in patients with AD, as compared with controls. C/Dr was also significantly higher in patients. Using a stepwise procedure for dependent SPECT variables, the variance of hippocampal perfusional data was accounted for by mean basal DHEAS levels. Moreover, hippocampal SPECT data correlated directly with mean DHEAS levels, and inversely with C/Dr. These data show a relationship between hippocampal perfusion and HPAA function in AD. Decreased DHEAS, rather than enhanced cortisol levels, appears to be correlated with changes of hippocampal perfusion in dementia.
Asunto(s)
Enfermedad de Alzheimer/fisiopatología , Circulación Cerebrovascular/fisiología , Hipocampo/irrigación sanguínea , Sistema Hipófiso-Suprarrenal/irrigación sanguínea , Hormona Adrenocorticotrópica/sangre , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico por imagen , Sulfato de Deshidroepiandrosterona/sangre , Femenino , Hipocampo/diagnóstico por imagen , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Sistema Hipófiso-Suprarrenal/diagnóstico por imagen , Radiofármacos , Exametazima de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Alterations in the hypothalamic-pituitary-adrenal axis (HPAA) and failure of dexamethasone (DXT) to suppress cortisol secretion occur in Alzheimer's disease (AD). This study was aimed to settle possible differences in some clinical (age, body weight, body mass index, dementia severity) and hormonal parameters in AD patients non-responders to overnight 1 mg-DXT suppression test compared with the responder subjects. ACTH, cortisol and dehydroepiandrosterone sulphate (DHEAS) day-time levels were assessed in 25 AD patients and in 12 age-matched healthy controls before DXT administration. In view of their neuroprotective effects, plasma levels of Insulin-like Growth Factor-I (IGF-I) and of IGF-Binding Proteins (IGFBPs) were also determined. After DXT, 8 AD subjects (32%) showed cortisol levels above the conventional cut-off of 140 nmol/L. No significant differences were found in clinical parameters in suppressor vs nonsuppressor patients. AD subjects showed higher cortisol, cortisol/DHEAS ratios, and lower DHEAS levels in comparison with controls. Both ACTH and cortisol levels were not different in suppressor and nonsuppressor patients, but DHEAS levels were significantly lower in nonsuppressor cases, who also exhibited ACTH and cortisol periodicities more altered than in suppressor and in control subjects. IGF-I and IGFBP-3 levels were lower and those of IGFBP-1 higher in nonsuppressor than in suppressor cases and in healthy controls. IGF-I/IGFBPs system data were correlated with cognitive impairment and adrenal steroid levels in AD patients.
Asunto(s)
Enfermedad de Alzheimer/metabolismo , Dexametasona , Glucocorticoides , Hidrocortisona/sangre , Anciano , Enfermedad de Alzheimer/psicología , Índice de Masa Corporal , Sulfato de Deshidroepiandrosterona/sangre , Femenino , Hormona de Crecimiento Humana/sangre , Humanos , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/metabolismo , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Escalas de Valoración Psiquiátrica , RadioinmunoensayoRESUMEN
UNLABELLED: In this study the neuropsychological status of patients with Alzheimer's disease (AD) was correlated with quantitative electroencephalography (qEEG) and regional cerebral blood flow (rCBF) both in the cortex and in deep gray matter structures. METHODS: Forty-three outpatients (mean age 72.4 +/- 7.5 y) with probable AD underwent 99mTc-hexamethyl propyleneamine oxime SPECT with a brain-dedicated gamma camera and qEEG (relative values) within 1 mo. Preliminary factorial analysis with promax rotation identified four qEEG bands (2-5.5, 6-7.5, 8-11.5 and 12-22.5 Hz, with no distinction as to topography) and six SPECT regions (the two thalami together, the two parietal cortices together, the right temporal cortex, the right hippocampus, the left hippocampus and the remaining cortical areas together) as the variables with highest statistical power. All these variables and the Mini-Mental Status Examination score (MMSE, a sensitive marker of neuropsychological deficit) were processed by a final factorial analysis and multivariate analysis of variance. RESULTS: Both the 2-5.5 Hz and the 8-11.5 Hz powers were correlated with the perfusion level in the parietal regions of interest (ROls) (P = 0.0009), whereas the 2-5.5 Hz power was correlated with the right hippocampal perfusion level (P = 0.007). The MMSE score was significantly correlated with the perfusion level, both in the right (P = 0.006) and in the left (P = 0.004) hippocampal ROls and in the parietal ROls (P = 0.01); moreover, it was correlated with both the 2-5.5 Hz (P = 0.0005) and the 8-11.5 Hz (P = 0.004) power. CONCLUSION: rCBF (bilateral parietal perfusion) and qEEG (especially the slowest frequencies, i.e., 2-5.5 Hz) are confirmed to be good descriptors of AD severity. It is especially noteworthy that bilateral hippocampal CBF was the perfusional index best correlated with the MMSE as well as being significantly correlated to qEEG. Hippocampal SPECT imaging appears to be a promising index to improve characterization of AD in respect to other forms of primary degenerative dementia and may be proposed as a marker for evaluating the effects of pharmacotherapy of AD at the neuronal level.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular/fisiología , Electroencefalografía/métodos , Exametazima de Tecnecio Tc 99m , Anciano , Enfermedad de Alzheimer/diagnóstico , Análisis Factorial , Femenino , Humanos , Masculino , Análisis Multivariante , Pruebas Neuropsicológicas , Radiofármacos , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Basal growth hormone (GH) and insulin-like growth factor I (IGF-I) as well as GH responses to GH-releasing hormone (GHRH) were studied in 22 subjects (7 females, 15 males), aged between 65 and 86 years. The study was aimed at investigating the possible correlations between the age-dependent GH-IGF-I axis decline and the cognitive function - assessed by the Mini Mental State Examination (MMSE). The relationship between hormonal data, cognition and age, body weight, body mass index (BMI), some nutritional indices (triceps skinfolds, TSF, mid-arm circumference, MAC), and physical activity - quantified by the physical functioning index (PFI)--were also analyzed. GH basal levels were within the normal range, while GH responses to GHRH were blunted in most cases. GH peaks after GHRH were directly correlated with GH basal values. IGF-I serum levels were found to be in the lower part of the reference range for adult subjects or below it. GH responses to GHRH, but not GH and IGF-I basal levels, were inversely correlated with subject age. GH secretion areas after GHRH were inversely correlated with BMI, but no further correlations between GH data and clinical or nutritional parameters were found. MMSE values directly correlated with MAC and PFI values. IGF-I levels were directly correlated with MMSE scores, being lowered in patients with more advanced cognitive deterioration, and with MAC values--the decrease of which is thought to reflect protein caloric malnutrition--but not with body weight, BMI, TSF and PFI. MMSE-related protein caloric malnutrition and decreased physical activity possibly take part in affecting IGF- I function in subjects with mild cognitive impairment and, reciprocally, IGF-I decrement might affect neuronal function.
Asunto(s)
Envejecimiento/sangre , Cognición/fisiología , Hormona de Crecimiento Humana/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Anciano , Anciano de 80 o más Años , Antropometría , Área Bajo la Curva , Distribución de Chi-Cuadrado , Trastornos del Conocimiento/sangre , Femenino , Hormona Liberadora de Hormona del Crecimiento , Hormona de Crecimiento Humana/efectos de los fármacos , Humanos , Estilo de Vida , Masculino , Trastornos de la Memoria/sangre , Escala del Estado Mental , Índice de Severidad de la Enfermedad , Estadísticas no ParamétricasRESUMEN
Forty-two patients with probable Alzheimer's disease (AD) and 18 elderly healthy controls underwent quantitative EEG (qEEG) and regional cerebral blood flow (rCBF; 133Xe clearance) examinations. Correlations were sought between relative qEEG band powers and percent rCBF values in a posterior temporoparietal region of interest in either hemisphere. Moreover, stepwise discriminant analysis was applied to study the accuracy of the two techniques in differentiating AD from healthy ageing. rCBF and qEEG were correlated with one another, especially in the right hemisphere (p values ranging from <0.001 to <0.01). Significant correlations were found between Mini Mental State Examination (MMSE) and relative power of both the 2- to 6-Hz and the 6.5- to 12-Hz bands on either side (p < 0.001), and between MMSE and left rCBF (p < 0.005), while the correlation with right rCBF was poorer (p < 0.02). The statistical procedure identified the right values of both examinations for the discriminant analysis. Sensitivity of qEEG and rCBF employed together was 88% and specificity 89%, with a total accuracy of 88.3%. The unrecognized patients (n = 5) were affected by mild AD (4 scoring 3 at the Global Deterioration Scale and 1 scoring 4). qEEG alone showed an accuracy of 77% in the whole group and of 69% in mild AD, and rCBF alone an accuracy of 75% in the whole group and of 71% in mild AD. It is concluded that qEEG and rCBF examinations employed together are accurate tools to differentiate AD from normal ageing, although a lower degree of accuracy is achieved in mildly demented patients.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/fisiopatología , Circulación Cerebrovascular , Electroencefalografía , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Análisis Discriminante , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radioisótopos de XenónRESUMEN
Data obtained in our laboratory had suggested that acute ethanol administration (6 g/kg body weight) selectively and rapidly affects the intracellular system of protein glycosylation at the level of the Golgi apparatus. Dolichols are important membrane components, and dolichyl phosphate is a glycosyl sugar carrier for N-glycosylation of proteins in endoplasmic reticulum and is considered rate-limiting for this process. In this study, modifications in the concentration and distribution of liver microsomal dolichols after acute ethanol administration were investigated. Between 3 and 24 hr after ethanol administration, the microsomal dolichyl phosphate concentration was significantly lower than in control animals. The highest reduction was observed at 12 hr (-52%). An earlier and more marked reduction of total dolichol was observed in the Golgi apparatus, and, in particular, in the secretory fraction F1 (-70% at 6 hr). Ethanol treatment of isolated hepatocytes led to a significant reduction of the de novo synthesis of both dolichyl phosphate and free dolichol. Moreover, in vitro experiments have demonstrated that pro-oxidant agents lead to a significant decrease of both free dolichol and dolichyl phosphate. Our results suggest that acute ethanol administration induces a marked decrease of dolichols, probably by increasing the degradation and impairing the biosynthetic pathway of these molecules.
Asunto(s)
Dolicoles/metabolismo , Etanol/toxicidad , Aparato de Golgi/efectos de los fármacos , Hígado/efectos de los fármacos , Microsomas Hepáticos/efectos de los fármacos , Animales , Femenino , Glicosilación/efectos de los fármacos , Humanos , Ratas , Ratas Sprague-DawleyRESUMEN
Serum levels of sex-hormones, sex-hormone binding globulin, gonadotropin, and prolactin were evaluated during the follicular and the luteal phases in 65 women with epilepsy and in 20 healthy controls. Twenty-one patients were treated with sodium valproate (VPA), 21 with phenobarbital (PB), and 23 with carbamazepine (CBZ). VPA does not stimulate liver microsome enzymes, whereas PB and CBZ do. Patients on VPA therapy showed higher body weight and body mass index, but no significant differences in hirsutism score, or in ovary volume or polycystic ovary prevalence (at ultrasound examination). Estradiol levels were lower in all patient groups than in healthy controls in the follicular but not in the luteal phases. VPA affected luteal progesterone surge in 63.6% of cases. This effect was significantly lower in the CBZ and PB groups. Furthermore, increases in testosterone and delta 4-androstenedione levels and in free androgen index, along with a higher luteinizing hormone-follicle-stimulating hormone ratio in the luteal phase, were observed in women treated with VPA. Although sex-hormone binding globulin levels were higher in CBZ and PB than in VPA-treated patients, the differences were not significant because of the wide dispersion of the carrier protein levels. Inducer antiepileptic drugs decreased dehydroepiandrosterone sulfate levels, which remained unchanged during VPA treatment. No significant differences occurred in basal gonadotropin and prolactin levels.
Asunto(s)
Anticonvulsivantes/efectos adversos , Carbamazepina/efectos adversos , Epilepsia/sangre , Hormonas Esteroides Gonadales/sangre , Fenobarbital/efectos adversos , Ácido Valproico/efectos adversos , Adolescente , Adulto , Anticonvulsivantes/uso terapéutico , Índice de Masa Corporal , Carbamazepina/uso terapéutico , Epilepsia/tratamiento farmacológico , Femenino , Fase Folicular/sangre , Gonadotropinas/sangre , Hirsutismo/inducido químicamente , Humanos , Fase Luteínica/sangre , Persona de Mediana Edad , Ovario/anatomía & histología , Ovario/diagnóstico por imagen , Ovario/fisiología , Fenobarbital/uso terapéutico , Prolactina/sangre , Ultrasonografía , Ácido Valproico/uso terapéuticoRESUMEN
Impaired reproductive function is thought to frequently affect women with epilepsy, mainly when seizures originate in the temporal lobe. In this study, we evaluated menstrual cycle features and assessed ovulation by determining luteal progesterone (Pg) levels in 101 consecutive women with epilepsy (36 with idiopathic generalized epilepsy -IGE; 65 with partial epilepsy -PE), aged between 16 and 50 years, treated with various antiepileptic drugs (AED). PE originated in the temporal lobe (TLE) in 40 subjects, in the frontal lobe in 13, in the parietal lobe in 2, while the origin of focal seizures remained undetermined in 10 patients. In all patients, menstrual and reproductive history, body mass index, hair distribution and hormonal pattern were assessed. Suprapubic ovary ultrasound (US) examination was carried out in 83 patients (28 with IGE, 55 with PE). Three patients with IGE and one with PE were amenorrheic. Oligomenorrhea occurred in 16 patients, polymenorrhea in 2. Changes in menstrual cyclicity were independent from epilepsy type (19.4% in IGE; 23.1% in PE) and from origin of focal discharges (22.5% of patients with TLE; 20.0% with origin in other brain areas). Luteal Pg levels remained below 2 ng/ml in 30 patients independently of epilepsy type. Corpus luteum dysfunction was combined with hyperandrogenism in 15 of these patients. In the other cases different alterations of hypothalamus-pituitary-ovary axis were observed. Valproic acid blunted luteal Pg surge more frequently than other AED. Polycystic ovaries (PCO) were observed in 14 (16.9%) patients (21.0% with IGE: 14.5% with PE). These prevalences are not higher than those reported in the general population. Among PE patients, PCO was found in 1 case with undetermined focal origin and in 7 TLE cases, who also had ovary volume significantly larger than patients with seizures originating from the frontal or parietal lobe. Epileptic women exhibited an increased occurrence of multifollicular ovaries (MFO) found in 12 cases (14.4% vs 5% in the general population). However, no defined hormonal or clinical pictures were associated with this US alteration in most patients. These findings reappraise the impact of ovary alterations in women mainly affected by mild to moderate epilepsy, on differing AED regimens, with the exception of more frequent ovulatory dysfunction and PCO occurrence in patients taking VPA.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Epilepsia/tratamiento farmacológico , Epilepsia/fisiopatología , Trastornos de la Menstruación/complicaciones , Ovario/fisiopatología , Adolescente , Adulto , Anovulación/complicaciones , Anovulación/diagnóstico por imagen , Cuerpo Lúteo/metabolismo , Epilepsia/complicaciones , Femenino , Humanos , Trastornos de la Menstruación/diagnóstico por imagen , Persona de Mediana Edad , Ovario/diagnóstico por imagen , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/diagnóstico por imagen , Progesterona/metabolismo , Ultrasonografía , Ácido Valproico/uso terapéuticoRESUMEN
In order to obtain data regarding peripheral levels of beta-endorphin in head pain syndromes, we evaluated the plasma beta-endorphin secretory pattern in 12 adult male patients suffering from cluster headache. Blood samples were drawn every 2 hours for a 24-hour period, and in addition at 30-minute intervals for 120 minutes during cluster attacks. The same sampling was repeated during an asymptomatic period. Cluster headache patients showed no significant beta-endorphin circadian rhythm and a delayed acrophase during cluster periods compared with that recorded in the remission period and in normal subjects. Eighteen cluster headache attacks were recorded during the study day, 13 (72%) of which were followed by a significant increase in beta-endorphin levels. No correlation was found between beta-endorphin maximum net increase and intensity and/or duration of pain. These data suggest the hypothesis of a temporary alteration of beta-endorphin circadian secretion, probably related to involvement of neural structures controlling biorhythm pacemakers.
Asunto(s)
Ritmo Circadiano , Cefalalgia Histamínica/fisiopatología , betaendorfina/metabolismo , Adulto , Cefalalgia Histamínica/sangre , Humanos , Masculino , Persona de Mediana Edad , betaendorfina/sangreRESUMEN
Aphasia due to simple partial status epilepticus is rare. We report a case of prolonged mixed aphasia without clouding of consciousness in a patient with an old history (10 years) of multiple sclerosis (MS). We found a clear clinical-EEG correlation with a continuous epileptic pattern in the shape of periodic lateralized epileptiform discharges (PLEDs). Clinical, laboratory and neuroradiological data ruled out possible etiological conditions other than MS and suggested that the development of new subcortical demyelinating lesions might play a critical role in seizure production. These findings, besides the role of PLEDs as an intrinsic feature of the status epilepticus condition, are discussed in relation to the literature.