El ejercicio como estrategia terapéutica en la epilepsia: revisión bibliográfica / Exercise as a therapeutic strategy in epilepsy: a literature review

INTRODUCCIÓN: La epilepsia es una enfermedad neurológica común con consecuencias emocionales y físicas significativas. Hasta el 30% de los pacientes son refractarios a los fármacos antiepilépticos, por lo que se han planteado terapias no farmacológicas coadyuvantes, como la actividad física. OBJETIVO: Se realizó una búsqueda en la bibliografía sobre actividad física en personas con epilepsia, con el fin de evaluar los beneficios, potenciales efectos secundarios, el impacto en las comorbilidades, la clasificación de riesgo de cada deporte y las barreras existentes para su práctica. DESARROLLO: Múltiples modelos en animales y en humanos evalúan los beneficios del ejercicio en la epilepsia, explicados por efectos en neurotransmisores, hormonas y factores neurotróficos; además, demuestran efectos positivos en comorbilidades como la obesidad, las enfermedades cardiovasculares, la depresión y la osteoporosis. A pesar de ser una práctica que ha mostrado ser segura, las personas con epilepsia son menos activas físicamente debido a barreras que limitan su práctica. CONCLUSIONES: La actividad física es beneficiosa y segura para las personas con epilepsia. La bibliografía sugiere un mejor control de las crisis epilépticas, además de beneficios psicosociales y sobre las comorbilidades. Hay un bajo riesgo de lesiones asociadas con esta práctica. El ejercicio debería promoverse después de una evaluación clínica cuidadosa, considerando el control de crisis en el último año, posibles factores precipitantes y el tipo de deporte que se va a practicar

INTRODUCTION: Epilepsy is a common neurologic disease with emotional and physical consequences. Thirty percent of patients have drug-resistant epilepsy, therefore adjuvant non-pharmacological therapies, such as physical activity, have been proposed. AIM: This study reviews the literature about physical activity in people with epilepsy, to evaluate the benefits, potential side effects, impact on comorbidities, the risk classification of sports, and the barriers to their practice. DEVELOPMENT: Multiple animal and human models evaluate the benefits of exercise in epilepsy, explained by modulation on neurotransmitters, hormones, and neurotrophic factors. Furthermore, exercise demonstrates positive impact on comorbidities such as obesity, cardiovascular disease, depression, and osteoporosis. Despite being a practice that has been shown to be safe, people with epilepsy are less physically active due to barriers that limit their practice. CONCLUSIONS: Physical activity is beneficial and safe for people with epilepsy. Literature suggests better control of seizures, psychosocial benefits, and improvements on the comorbidities. There is a low risk of injury associated. Exercise should be promoted after a careful clinical evaluation, considering seizure control in the last year, potential triggering factors and the sport chosen

Diagnostic yield of the palmomental reflex in patients with suspected frontal lesion.

BACKGROUND: The purpose of this study was to determine the diagnostic value of the palmomental reflex in order to identify frontal lesions in neurological outpatients. METHODS: Two hundred twenty-six neurological patients with suspected intracranial lesion with an indication for magnetic resonance imaging (MRI) were included. All patients underwent the same MRI protocol. The reflex was elicited by trained and standardized nurses, and was evaluated by two neurologists. The evaluation was blind and independent. The test's accuracy was calculated. The Kappa coefficient was used to calculate the interobserver and intra-observer reliability. RESULTS: The interobserver reliability between neurologists was 0.53 with 93% of agreement (p<0.001). The diagnostic accuracy measures were as follow: sensitivity of 19%, specificity of 93%, positive predictive value of 30%, negative predictive value of 88%, positive likelihood ratio of 2.7 and negative likelihood ratio of 0.87. The area under the curve was 0.56. CONCLUSION: The palmomental reflex is associated with frontal structural lesions but the sensitivity is low, indicating a high percentage of frontal lesions with a negative reflex. When the test is used on its own, it is insufficient to detect frontal damage.

Descripción del rechazo celular en pacientes con trasplante hepático en el hospital Pablo Tobón Uribe (HPTU) en el periodo 2005-2010 / Description of cellular rejection in liver transplant patients at the Hospital Pablo Tobón Uribe 2005-2010

Introducción: El rechazo celular agudo es una complicación del trasplante ortotópico de hígado (TOH). Se presenta entre 30 y 70% de los pacientes trasplantados en el primer año del procedimiento. Objetivo: Describir las principales variables asociadas al rechazo celular en pacientes con trasplante hepático en el Hospital Pablo Tobón Uribe de la ciudad de Medellín, en el periodo 2005-2010. Metodología: De forma retrospectiva se evaluaron las historias clínicas de 248 pacientes a quienes se les realizó TOH con donante cadavérico y se identificaron aquellos pacientes que presentaron pruebas histológicas, clínicas y bioquímicas de rechazo celular según los criterios universalmente aceptados. Resultados: En los 248 trasplantes de hígado realizados en el periodo 2005-2010 se confirmaron 44 episodios de rechazo celular en 34 pacientes, para una incidencia de 13,7%; 30 pacientes (88,2%) presentaron un episodio de rechazo; 2 (5,8%) tres episodios y 2 (5,8%) cuatro episodios. Conclusión: Se describen las características principales del rechazo celular agudo en esta serie y se comparan con la literatura internacional ya que no encontramos reportes nacionales. La mayoría de casos fueron rechazo celular agudo leve y moderado con buena respuesta al manejo médico y sin repercusiones para la supervivencia del injerto o del paciente.

Introduction: Acute cellular rejection is a complication of orthotopic liver transplantation (OLT) which occurs in between 30% and 70% of transplant patients in the first year after the procedure. Objective: The objective of this study was to describe the main variables associated with cellular rejection in liver transplant patients at the Hospital Pablo Tobon Uribe in Medellin from 2005 to 2010. Methods: Medical records of 248 patients who had undergone OLTs with cadaveric donor grafts were evaluated retrospectively. Patients with histological, clinical and biochemical evidence of cellular rejection were identified in accordance with universally accepted criteria. Results: 44 episodes of cellular rejection in 34 patients were confirmed from among 248 liver transplantations performed in from 2005 to 2010. The incidence of rejection was 13.7%. Thirty patients (88.2%) had one episode of rejection, two (5.8%) had three episodes and two others (5.8%) had four episodes. Conclusions: We describe the main features of acute cellular rejection in this series and compare them with reports in the international literature. No other reports from Colombia were found. Most cases were mild to moderate acute cellular rejection which responded well to medical management without implications for graft or patient survival.

[Correlation between the magnetic resonance imaging morphometry and the clinical and electroencephalographic findings in patients diagnosed with ulegyria and epilepsy]. / Correlación de la morfometría por resonancia magnética con los hallazgos clínicos y electroencefalográficos de pacientes con diagnóstico de ulegiria y epilepsia.

INTRODUCTION: Ulegyria is a cortical lesion affecting neighbouring vascular zones, which gives the convolutions a mushroom-like appearance. It is an important cause of occipital epilepsy. AIM. To correlate patients diagnosed clinically, electrically and morphometrically with ulegyria and epilepsy by comparing the thickness of the cortex in the zones affected by ulegyria with the normal cortical thickness reported in the literature and the average cortical thickness of healthy subjects. PATIENTS AND METHODS: Ten patients with ulegyria confirmed by magnetic resonance imaging were included in the study; all of them were submitted to a clinical interview, an electroencephalographic study and cortical morphometric analysis based on volumetric T1 sequences. RESULTS: Findings included a predominance in males, neurodevelopmental retardation and epilepsy. Ulegyria was mainly parietooccipital, frequently bilateral, with statistically significant thinning of the cortical thickness in the site of the lesion and an increase in the thickness of the cortex in the areas surrounding the lesion. CONCLUSIONS: We report on a series of patients with ulegyria with characteristics similar to those existing in the literature and by means of morphometry we detected an increase in the thickness of the cortex around the areas affected by ulegyria. These findings could point to the presence of adaptive neuroplasticity in the neurons that surround the scar tissue or they may be the result of mechanical changes of normal tissue in response to the loss of volume of the ulegyria-affected area, although these data need to be replicated in a study with a greater number of patients.

Correlación de la morfometría por resonancia magnética con los hallazgos clínicos y electroencefalográficos de pacientes con diagnóstico de ulegiria y epilepsia / Correlation between the magnetic resonance imaging morphometry and the clinical and electroencephalographic findings in patients diagnosed with ulegyria and epilepsy

Introducción. La ulegiria es una lesión cortical propia de zonas vasculares limítrofe, que da a las circunvoluciones unaspecto de hongo. Es una causa importante de epilepsia occipital. Objetivo. Correlacionar clínica, eléctrica y morfométricamente a los pacientes con diagnóstico de ulegiria y epilepsia comparando el espesor cortical de las zonas ulegíricas con el espesor cortical normal comunicado en la bibliografía y el promediodel espesor cortical de sujetos sanos.Pacientes y métodos. Se incluyeron diez pacientes con ulegiria comprobada imaginológicamente con resonancia magnética,los cuales se sometieron a una entrevista clínica, un estudio electroencefalográfico y un análisis morfométrico cortical a partir de secuencias T1 volumétricas. Resultados. Encontramos un predominio del sexo masculino, retraso en el neurodesarrollo y epilepsia. La ulegiria fueen su mayoría parietooccipital, frecuentemente bilateral, con adelgazamiento del espesor cortical en el sitio de la lesiónsignificativamente estadístico y aumento del grosor de la corteza en las zonas periféricas a la lesión.Conclusión. Describimos una serie de pacientes con ulegiria con características similares a las existentes en la bibliografíay detectamos en morfometría un aumento en el espesor cortical que rodea las zonas ulegíricas. Estos hallazgos podrían indicar bien la presencia de neuroplasticidad adaptativa en las neuronas que rodean el tejido cicatricial o el resultado de cambios mecánicos del tejido normal en respuesta a la pérdida de volumen de la zona ulegírica, datos que se deben replicaren un estudio con un mayor número de pacientes (AU)

Introduction. Ulegyria is a cortical lesion affecting neighbouring vascular zones, which gives the convolutions a mushroomlikeappearance. It is an important cause of occipital epilepsy. Aim. To correlate patients diagnosed clinically, electrically and morphometrically with ulegyria and epilepsy by comparing the thickness of the cortex in the zones affected by ulegyria with the normal cortical thickness reported in the literatureand the average cortical thickness of healthy subjects. Patients and methods. Ten patients with ulegyria confirmed by magnetic resonance imaging were included in the study;all of them were submitted to a clinical interview, an electroencephalographic study and cortical morphometric analysisbased on volumetric T1 sequences.Results. Findings included a predominance in males, neurodevelopmental retardation and epilepsy. Ulegyria was mainlyparietooccipital, frequently bilateral, with statistically significant thinning of the cortical thickness in the site of the lesion and an increase in the thickness of the cortex in the areas surrounding the lesion. Conclusions. We report on a series of patients with ulegyria with characteristics similar to those existing in the literature and by means of morphometry we detected an increase in the thickness of the cortex around the areas affected byulegyria. These findings could point to the presence of adaptive neuroplasticity in the neurons that surround the scar tissue or they may be the result of mechanical changes of normal tissue in response to the loss of volume of the legyriaaffectedarea, although these data need to be replicated in a study with a greater number of patients (AU)