Enfermedad de Alzheimer y otras demencias

Libro que centra su atención en dar respuesta a una serie de preguntas relacionadas con el Alzheimer y otras demencias. El modo en que funciona el cerebro del paciente, cómo afecta a la actividad intelectual, cuáles con las causas o cómo se diagnostica el Alzheimer son algunas de las cuestiones resueltas en esta guía.

Valoración de la marcha mediante plantillas instrumentadas en pacientes con espasticidad de miembros inferiores tras infiltración con toxina botulínica / Walking assessment with instrumented insoles in patients with lower limb spasticity after botulinum toxin infiltration

Introducción: El objetivo del presente trabajo es la valoración funcional y cinemática en pacientes con espasticidad de miembros inferiores tras lesión encefálica o medular con indicación de infiltración con toxina botulínica (TBA). Material y métodos: Diez pacientes (11 extremidades inferiores) atendidos en unidad de neurorrehabilitación. Examen clínico, funcional (functional ambulation categories, valoración marcha del Hospital de Sagunto) y biomecánico (plantillas instrumentadas Biofoot/IBV versión 5,0) antes y 3 semanas después de la infiltración con TBA. Estadísticos: prueba de la t para muestras relacionadas de las variables clínicas, funcionales y biomecánicas antes y después dela infiltración. Nivel de significación inferior a 0,05. Modo cualitativo para valorar si los cambios en las variables biomecánicas orientan a una aproximación a los parámetros de normalidad. Resultados: La infiltración con TBA mejora el tono muscular, el arco articular y la frecuencia de espasmos (p < 0,01). La población infiltrada muestra un nivel alto de satisfacción con la mejora de los síntomas. No hay cambios funcionales en habilidad para la marcha tras la infiltración. En los parámetros biomecánicos mejora de la cadencia de marcha y la presión máxima en retropié se aproxima a la significación estadística cercana a 0,1. Conclusiones: Con la disminución del tono muscular tras infiltración con TBA, mejoran los síntomas clínicos derivados de esta sin cambios funcionales en escalas de marcha. Los cambios en los parámetros biomecánicos indican la necesidad de ampliar los estudios con plantillas instrumentadas en población con espasticidad tras lesión del sistema nervioso central tratada con infiltración de TBA (AU)

Introduction: Botulinum toxin A (BTA) improves the kinematic parameters of gait in patients with spasticity of lower limbs, but there are no studies in which kinetic parameters are measured with instrumented insoles. We therefore used instrumented insoles to perform a functional assessment of therapeutic results in patients with lower limb spasticity after brain injury or spinal cord infiltration indicating BTA. Material and methods: Ten patients (11 lower limbs) seen in a Neurorehabilitation Unit. The tests carried out included clinical examination, gait assessment (Functional Ambulation Categories (FAC); Hospital de Sagunto Gait Scale), and biomechanical assessment (Biofoot / IBV version 5.0), before and three weeks after infiltration with BTA. Statistics: t-test for related samples of clinical variables, functional variables and biomechanical variables before and after infiltration. Level of significance P< .05. Qualitative method to assess whether changes in the biomechanical variables tended toward normal values. Results: BTA improves muscle tone, joint arch and frequency of spasms (P<.01). The patient sample showed a high level of satisfaction with the improvement in symptoms. There were no changes in walking ability after injection. There were no statistically significant changes inbiomechanical parameters, but there was improved gait cadence. The relatively small statistical significance close to P=.1 of the peak pressure in the heel after injection indicates the need for further studies with instrumented insoles in people with spasticity due to central nervous system injury. Conclusions: With the decrease in muscle tone after infiltration with BTA the clinical symptoms associated with muscle tone improved without any functional changes in gait scales. The changes in the biomechanical parameters show that larger studies using instrumented insoles should be performed in the population with spasticity after a central nervous system injury treated with BTA infiltration (AU)

Walking assessment with instrumented insoles in patients with lower limb spasticity after botulinum toxin infiltration.

INTRODUCTION: Botulinum toxin A (BTA) improves the kinematic parameters of gait in patients with spasticity of lower limbs, but there are no studies in which kinetic parameters are measured with instrumented insoles. We therefore used instrumented insoles to perform a functional assessment of therapeutic results in patients with lower limb spasticity after brain injury or spinal cord infiltration indicating BTA. MATERIAL AND METHODS: Ten patients (11 lower limbs) seen in a Neurorehabilitation Unit. The tests carried out included clinical examination, gait assessment (Functional Ambulation Categories (FAC); Hospital de Sagunto Gait Scale), and biomechanical assessment (Biofoot / IBV version 5.0), before and three weeks after infiltration with BTA. STATISTICS: t-test for related samples of clinical variables, functional variables and biomechanical variables before and after infiltration. Level of significance P< .05. Qualitative method to assess whether changes in the biomechanical variables tended toward normal values. RESULTS: BTA improves muscle tone, joint arch and frequency of spasms (P<.01). The patient sample showed a high level of satisfaction with the improvement in symptoms. There were no changes in walking ability after injection. There were no statistically significant changes in biomechanical parameters, but there was improved gait cadence. The relatively small statistical significance close to P=.1 of the peak pressure in the heel after injection indicates the need for further studies with instrumented insoles in people with spasticity due to central nervous system injury. CONCLUSIONS: With the decrease in muscle tone after infiltration with BTA the clinical symptoms associated with muscle tone improved without any functional changes in gait scales. The changes in the biomechanical parameters show that larger studies using instrumented insoles should be performed in the population with spasticity after a central nervous system injury treated with BTA infiltration.

[Memory evaluation using functional magnetic resonance: applications in preoperative patients and in Alzheimer s disease]. / Evaluacion de la memoria mediante resonancia magnetica funcional: aplicaciones en pacientes prequirurgicos y en la enfermedad de Alzheimer.

The assessment of memory functions related to medial temporal lobe has become one of the most important issues on current neuropsychology. On this communication, we review the results which our research group has achieved using two functional magnetic resonance Image procedures to assess memory function: Hometown walking task and an encoding/retrieval task using complex images. Nine patients with tumoural temporal lesions performed the hometown walking task. The results of these patients showed either a bilateral or contralesional representation of memory function. These results confirm those obtained by Jokeit, Okujava y Woermann (2001), and they seem to prove that this protocol is useful to determine the preservation of memory function in the non damaged hemisphere. On the other hand, the images encoding/retrieval task has been run by two groups of four patients diagnosed as Alzheimer disease and mild cognitive impairment, and another group of five patients who participated as a control group. According to our hypothesis, the results have shown a lower activation at the left parahippocampal gyrus in mild cognitive impairment and Alzheimer disease patients than controls, just as a lower bilateral activation in the same structure for the Alzheimer group than the control group. As a whole, our results show how important may become functional magnetic resonance image for neuropsychological assessment of memory, and as a diagnostic tool for CNS diseases.

[Streptococcus suis meningitis]. / Meningitis por Streptococcus suis.

Human infection by Streptococcus suis (S. suis) is a zoonosis, with a known occupational risk and clinical presentation mainly as a purulent meningitis with low mortality and frequent hearing loss and ataxia sequela. Less than 150 human cases have been reported since original one thirty years ago. There is a geographical distribution most patients living in northern Europe and south Asia. S. suis disease in human has been reported in two patients in Spain the last years. We present two patients with S. suis meningitis, both were men with occupation related by pork meet, and good outcome. They come at our hospital in a lapse of one month. Both had neurosensorial hearing loss and walking ataxia. One patient had peripheral facial paralysis and diplopia because of paresia of contralateral sixth nerve, with complete resolution at three months. The rare presentation of S. suis meningitis in our country must not forget us to record the working risk at anamnesis.