[Effect of transcraneal magnetic stimulation on the motor recovery of the thoracic limb in cerebrovascular disease -a systematic review]. / Efecto de la estimulacion magnetica transcraneal sobre la recuperacion motora del miembro toracico en la enfermedad vascular cerebral. Revision sistematica.

INTRODUCTION: There have been studies in which contralesional inhibitory and ipsilesional excitatory transcranial magnetic stimulation (TMS) has been used as coadjuvant therapy in the motor rehabilitation of the thoracic limb in patients. However, there is no consensus regarding the stimulation variables or their clinical outcomes. AIM: To describe the results of clinical trials where TMS has been applied in rehabilitation in patients with cerebrovascular disease (CVD). PATIENTS AND METHODS: A systematic review of the PubMed database was performed. The articles cataloged as originals in English, whose population had limitation of thoracic limb after CVD were selected. Pilot studies, as well as studies in which patients under pharmacological treatment included any intervention other than physical or occupational therapy were excluded. Given their heterogeneity, it was not possible to apply inferential statistics, only descriptive statistics were use. RESULTS: Seven studies were identified; 259 cases with an age of 64.3 ± 4.28 years (range: 35-89 years) were reported. The TMS protocols, for the most part, were performed by contralesional inhibitory type stimulation. There were positive results in five studies. CONCLUSION: In accordance with the results obtained, we observed that TMS could contribute to the improvement of motor control of the thoracic limb in patients with sequelae due to CVD.

TITLE: Efecto de la estimulacion magnetica transcraneal sobre la recuperacion motora del miembro toracico en la enfermedad vascular cerebral. Revision sistematica.Introduccion. Existen estudios donde se ha utilizado la estimulacion magnetica transcraneal (EMT) inhibitoria contralesional y excitatoria ipsilesional como terapia coadyuvante en la rehabilitacion motora del miembro toracico; sin embargo, no existe un consenso respecto a las variables de estimulacion ni sobre sus resultados clinicos. Objetivo. Describir los resultados de los ensayos clinicos donde se ha aplicado EMT en la rehabilitacion en pacientes con enfermedad vascular cerebral (EVC). Pacientes y metodos. Se realizo la revision sistematica de la base de datos PubMed. Fueron seleccionados los estudios catalogados como originales en idioma ingles, cuya poblacion tuvo afectacion de miembro toracico tras una EVC. Se excluyeron todos los estudios piloto, ademas de estudios que incluyeran pacientes bajo tratamiento farmacologico o alguna intervencion diferente a terapia fisica u ocupacional. Dada la heterogeneidad percibida en los estudios, no fue posible aplicar estadistica inferencial, unicamente se empleo estadistica descriptiva. Resultados. Fueron seleccionados siete estudios. Se identificaron 259 casos con una edad media de 64,3 ± 4,28 años (rango: 35-89 años). Los protocolos de EMT, en su mayoria, se realizaron mediante estimulacion de tipo inhibitoria contralesional. Hubo resultados positivos en cinco estudios. Conclusion. De acuerdo con los resultados obtenidos, existen indicios de que la EMT podria contribuir a la mejoria del control motor del miembro toracico en los pacientes con secuelas por EVC.

[Treatment of refractory aggressiveness by amygdalotomy and posteromedial hypothalamotomy by radiofrequency]. / Tratamiento de la agresividad refractaria mediante amigdalotomia e hipotalamotomia posteromedial por radiofrecuencia.

INTRODUCTION: Since, under certain circumstances, defensive or attacking behaviours display a pattern of motor dominance, as observed in subjects who participate in contact or fighting sports, aggressive behaviour was considered to have a dominant motor pattern. With the aim of preventing the functional problems reported with bilateral lesion procedures involving both the central nucleus of the amygdala and the posteromedial hypothalamus, the decision was made to combine them; thus, an amygdalotomy of the central nucleus of the amygdala and a posteromedial hypothalamotomy were to be performed simultaneously and unilaterally, on the basis of the motor dominance of the patient determined by means of the Edinburgh test. PATIENTS AND METHODS: This study describes the surgical experience in a series of nine patients diagnosed with refractory neuroaggressive syndrome. As part of the study protocol, a magnetic resonance brain scan was performed to rule out the presence of neoplasms, vascular diseases, infections and degenerative disorders. The degree of aggressiveness was quantified using Yudofsky's Overt Aggression Scale. Additionally, manual dominance was determined by means of the Edinburgh test. RESULTS AND CONCLUSIONS: Good control of aggressiveness was seen immediately. In some cases it was necessary to reduce the antipsychotic or benzodiazepine medication, as it was seen to increase aggressiveness. Only one case required a second surgical intervention. Follow-up was achieved in 100% of the cases at 24 months and 78% at 36 months.

TITLE: Tratamiento de la agresividad refractaria mediante amigdalotomia e hipotalamotomia posteromedial por radiofrecuencia.Introduccion. Dado que, en algunas circunstancias, las conductas defensivas o de ataque muestran un patron de dominancia motora, tal como se observa en los sujetos dedicados a los deportes de contacto o de lucha, se considero que la conducta agresiva tiene un patron motor dominante. Con el fin de evitar los problemas funcionales descritos con los procedimientos de lesion bilateral tanto del nucleo central de la amigdala como del hipotalamo posteromedial, se decidio combinarlos; es decir, realizar amigdalotomia del nucleo central de la amigdala e hipotalamotomia posteromedial de manera unilateral y simultanea, basandose en la dominancia motora del paciente mediante la prueba de Edimburgo. Pacientes y metodos. Este estudio muestra la experiencia quirurgica en una serie de nueve pacientes con el diagnostico de sindrome neuroagresivo resistente al tratamiento farmacologico. Dentro del protocolo de estudio, se les realizo resonancia magnetica cerebral para descartar la presencia de neoplasias, enfermedades vasculares, infecciones y trastornos degenerativos. El grado de agresividad se cuantifico mediante la escala global de agresividad de Yudofsky. Adicionalmente, se determino la dominancia manual a traves de la prueba de Edimburgo. Resultados y conclusiones. El buen control de la agresividad se observo de modo inmediato. En algunos casos fue necesario reducir la medicacion de antipsicoticos o benzodiacepinas, ya que aumentaban la agresividad. Solo un caso requirio una segunda cirugia. Se logro seguimiento del 100% de los casos en 24 meses y del 78% en 36 meses.

[Cervantes and Shakespeare, two Renaissance neurologists]. / Cervantes y Shakespeare, dos neurologos renacentistas.

TITLE: Cervantes y Shakespeare, dos neurologos renacentistas.