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1.
Swiss Dent J ; 131(4): 327-338, 2021 Apr 06.
Artículo en Alemán | MEDLINE | ID: mdl-33789417

RESUMEN

When a syndrome forms the background of a systemic involvement of periodontal disease, it is necessary to fully exploit the resources outside, which soon reaches its limits in private practice. In the patient's environment, it must be checked whether support for the patient can be guaranteed. Without support, as in this presented case, the patient's oral hygiene could hardly be maintained. This article reports on a female patient who was referred to the Center for Dental Medicine at the University of Zurich. In addition to various secondary carious lesions, an apical whitening, two carious wisdom teeth and two extremely mobile molars in the third quadrant, the patient had chronic, localized advanced (stage III, grade B) periodontitis associated with systemic disease (deafness and Sturge-Weber syndrome). For two years, the patient was treated at the Department of Periodontology. Due to the strong bleeding tendency on the left side, facial localization of the naevus flammeus, the patient was partially referred to the Polyclinic of Oral Surgery and treated there. Numerous oral hygiene sessions, scaling and root planing, restoration with composite fillings, a root filling, removal of wisdom teeth and finally removal of hypermobile molars 36 and 37 during corona lockdown were performed. In the meantime, the patient has been orally rehabilitated. Home oral hygiene was reorganized with the patient's family and the patient was discharged to a close supportive periodontal recall for the time being.


Asunto(s)
Epilepsia , Medicina , Mancha Vino de Oporto , Síndrome de Sturge-Weber , Femenino , Humanos , Aplanamiento de la Raíz , Síndrome de Sturge-Weber/complicaciones
2.
Nat Commun ; 12(1): 1423, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33658509

RESUMEN

In the mammalian hippocampus, adult-born granule cells (abGCs) contribute to the function of the dentate gyrus (DG). Disruption of the DG circuitry causes spontaneous recurrent seizures (SRS), which can lead to epilepsy. Although abGCs contribute to local inhibitory feedback circuitry, whether they are involved in epileptogenesis remains elusive. Here, we identify a critical window of activity associated with the aberrant maturation of abGCs characterized by abnormal dendrite morphology, ectopic migration, and SRS. Importantly, in a mouse model of temporal lobe epilepsy, silencing aberrant abGCs during this critical period reduces abnormal dendrite morphology, cell migration, and SRS. Using mono-synaptic tracers, we show silencing aberrant abGCs decreases recurrent CA3 back-projections and restores proper cortical connections to the hippocampus. Furthermore, we show that GABA-mediated amplification of intracellular calcium regulates the early critical period of activity. Our results demonstrate that aberrant neurogenesis rewires hippocampal circuitry aggravating epilepsy in mice.


Asunto(s)
Epilepsia/fisiopatología , Hipocampo/fisiopatología , Neurogénesis/fisiología , Animales , Calcio/metabolismo , Clozapina/análogos & derivados , Clozapina/farmacología , Modelos Animales de Enfermedad , Electroencefalografía , Epilepsia del Lóbulo Temporal/fisiopatología , Femenino , Ratones Endogámicos C57BL , Ratones Transgénicos , Neurogénesis/efectos de los fármacos , Neuronas/efectos de los fármacos , Neuronas/metabolismo , Neuronas/patología , Pilocarpina/farmacología , Retroviridae/genética , Convulsiones/fisiopatología , Ácido gamma-Aminobutírico/metabolismo
7.
Artículo en Ruso | MEDLINE | ID: mdl-33728858

RESUMEN

OBJECTIVE: To describe the spectrum of being detected gene mutations in patients with epilepsy in clinical practice of neurologists specializing in epilepsy with an analysis of diagnosed epileptic syndromes, the characteristics of seizures, the timing of a genetic diagnosis, options and treatment effectiveness. PATIENTS AND METHODS: The study included 100 patients (40 boys, 60 girls) with epilepsy and/or epileptic encephalopathy and a gene mutation identified. The average age was 6.9±5.1 years. Through remote access, epilepsy specialists filled out a specially designed unified table containing information from outpatient case history. RESULTS AND DISCUSSION: There are patients with a wide range of gene mutations, the leading of which is a mutation in the SCN1A gene (15%). The main method (85%) of detection remains the sequencing of the last generation in the «Hereditary Epilepsy¼ panel. Years pass from the onset of the disease to the genetic diagnosis (Me - 3 years). In most cases, patients with severe (52% have epileptic encephalopathy, 88% have developmental disorders) and pharmacoresistant (mean amount of anti-epileptic drugs - 3.8±2.2, multitherapy - 70%) syndromes have undergone genetic testing. In the treatment of these patients epileptologists are increasingly (52%) use alternative methods: steroids, ketogenic diet and others. The absence of seizures was observed only in 46% of patients. CONCLUSION: Thus, in the outpatient practice of epileptologists, patients with a wide range of gene mutations are found. As a rule, these are patients with severe, therapy-resistant epileptic syndromes.


Asunto(s)
Epilepsia Generalizada , Epilepsia , Síndromes Epilépticos , Niño , Preescolar , Epilepsia/tratamiento farmacológico , Epilepsia/genética , Femenino , Humanos , Lactante , Masculino , Mutación , Pacientes Ambulatorios , Convulsiones
8.
J Pediatr Nurs ; 57: e52-e58, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33750569

RESUMEN

PURPOSE: Epilepsy affects both children and their parents, as it is a chronic disease with recurrent seizures. Parents play a key role in acceptance of the diagnosis of epilepsy by the child and compliance of the child with its treatment. Therefore, the perceptions and experiences of parents about this process are critical. The Epilepsy-Related Fears in Parents Questionnaire is one such instrument, and it has been used to measure the epilepsy-related fear experienced by parents who had children with epilepsy in Germany. This study aimed to analyze the psychometric properties of the Epilepsy-Related Fears in the Parents Questionnaire in Turkey. DESIGN AND METHODS: The study was conducted on 403 parents using a descriptive correlational method. The Sociodemographic Information Form and Epilepsy-Related Fears in Parents Questionnaire were used to gather data. Data analysis and evaluation were performed using factor analysis, Cronbach's alpha, and item-total score correlation. RESULTS: Seventeen items were recorded on the main scale and other items on two subscales. The two subscales recorded a variance of 55.695%. Turkish Cronbach's alpha coefficient recorded a total of 0.929. Because of confirmatory factor analysis, the model fit index results were recorded as follows: 0.94 as the Goodness-of-Fit Index and 0.92 as the Comparative Fit Index. CONCLUSIONS: The study determined that the Turkish version of the Epilepsy-Related Fears in Parents Questionnaire was a valid and reliable measurement tool. PRACTICE IMPLICATIONS: All health professionals can use this scale to evaluate fears of parents who have children diagnosed with epilepsy.


Asunto(s)
Epilepsia/psicología , Miedo , Padres/psicología , Psicometría/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Adulto , Niño , Epilepsia/diagnóstico , Alemania , Humanos , Reproducibilidad de los Resultados , Turquia
9.
Arq Neuropsiquiatr ; 79(2): 133-138, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33759980

RESUMEN

INTRODUCTION: People with epilepsy frequently complain of poor memory. OBJECTIVE: To assess the occurrence of memory complaints in older adults with epilepsy (OAE) and whether it is associated with clinical variables, objective cognitive performance, and quality of life (QoL). METHODS: The Memory Complaint Questionnaire (MAC-Q) was related to objective cognitive performance, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Quality of Life in Epilepsy Inventory (QOLIE-31), and the clinical characteristics of 83 OAE. RESULTS: OAE showed worse cognitive performance and higher MAC-Q scores when compared to a similar control group (n=40). Impairment in multiple cognitive domains occurred in 34 (41%) OAE and was associated with older age and lower educational level. Memory complaints (MAC-Q≥25) were reported by 45 (54.2%) OAE and associated with older age, lower educational level, onset at ≥60 years, higher NDDI-E scores, lower QOLIE-31 scores, and impairment in multiple cognitive domains. CONCLUSIONS: OAE presented worse cognitive performance and greater memory complaints. Episode onset at ≥60 years of age was associated with complaints, but not with objective cognitive deficit. We found an association between subjective and objective cognitive performance, with aspects of epilepsy and worse QoL scores.


Asunto(s)
Disfunción Cognitiva , Epilepsia , Anciano , Disfunción Cognitiva/etiología , Epilepsia/complicaciones , Humanos , Memoria , Trastornos de la Memoria/etiología , Pruebas Neuropsicológicas , Calidad de Vida
10.
Medicine (Baltimore) ; 100(9): e24989, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655969

RESUMEN

RATIONALE: Tacrolimus-associated neurologic disorders can be found in some cases, mainly in organ transplantation patients. However, epilepsy induced by tacrolimus in primary membranous nephropathy (PMN) patient is scare. PATIENT CONCERNS: A 63-year-old man experienced 1-year history of foamy urine, and edema of lower extremity. DIAGNOSIS: The patient had proteinuria, hypoalbuminemia, which indicated nephrotic syndrome. Further, we performed renal biopsy for this patient. Combined with the renal biopsy result, the diagnosis of primary membranous nephropathy was established. INTERVENTION: At first, irbesartan was administrated for 6 months. However, the proteinuria had no obvious improvement. Tacrolimus was administrated afterwards. OUTCOMES: Twenty-two days after tacrolimus treatment, epilepsy occurred. Sodium valproate and carbamazepine were successively given to control epilepsy. However, the epileptic symptoms were not effectively controlled. During the treatment, the concentration of tacrolimus fluctuated greatly. At last, levetiracetam was given to maintain the curative effect. Fortunately, the patient did not suffer from epilepsy again. The concentration of temporary tacrolimus was stable, whereas proteinuria gradually decreased. LESSONS: Tacrolimus-induced epilepsy should be considered in patients exhibiting acute neurological symptoms. Early diagnosis and effective treatment play a vital role for favorable prognosis.


Asunto(s)
Epilepsia/inducido químicamente , Glomerulonefritis Membranosa/tratamiento farmacológico , Tacrolimus/efectos adversos , Electroencefalografía , Epilepsia/diagnóstico , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Tacrolimus/uso terapéutico
11.
Medicine (Baltimore) ; 100(10): e23571, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725809

RESUMEN

ABSTRACT: This study investigated the epidemiological status of depression and its influencing factors among caregivers of children with epilepsy in southwestern China.This was a cross-sectional study. Caregivers of children with epilepsy were recruited from February to June 2018 at the Pediatric Neurology Department of the West China Second Hospital. Depression status was assessed using the Zung Self-Rating Depression Scale. Multiple linear regression analysis was used to assess correlations between depression status and its influencing factors.A total of 319 participants were included. The mean Zung Self-Rating Depression Scale score was 36.37 ±â€Š10.178 and 5.3% (17/319) of participants were classified as depressed. Regression analysis showed that place of residence (B = 0.114; standard error = 0.643; P = .039), attitude towards seizures (B = -0.121; standard error = 1.215; P = .029), medical expenses payment (B = -0.111; standard error = 2.002; P = .044), and children's medication adherence (B = -0.124; standard error = 0.393; P = .025) were related to depression.Some caregivers of children with epilepsy in southwestern China experience depression. Health care providers should pay particular attention to caregivers who live in rural areas, who fear seizures, who experience difficulty paying medical expenses, and whose children show low medication adherence.


Asunto(s)
Cuidadores/estadística & datos numéricos , Depresión/epidemiología , Epilepsia/terapia , Adolescente , Adulto , Anticonvulsivantes/uso terapéutico , Cuidadores/psicología , Niño , China/epidemiología , Estudios Transversales , Depresión/diagnóstico , Depresión/psicología , Epilepsia/psicología , Miedo/psicología , Femenino , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Población Rural/estadística & datos numéricos , Autoinforme/estadística & datos numéricos
12.
Medicine (Baltimore) ; 100(10): e25134, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725915

RESUMEN

BACKGROUND: Epilepsy is 1 of the common neurodevelopmental diseases. It can affect about 0.5% to 1.0% of the population regardless of their race and social class. Despite the development of a wide range of treatments, there remaining about one-third of patients still experience seizures. Chinese herbal compounds containing scorpion (CHCCS) have shown an outstanding curative effect on nerve protection and epilepsy. But there's no study to assess its clinical efficacy and safety. METHODS: Each data of CHCCS in treating epilepsy from related English and Chinese databases will be searched. The primary outcome is the efficacy of the CHCCS on epilepsy. And the secondary outcomes include recurrence rate and side effects. The risk of bias will be assessed, and RevMan5.3 and Stata14.0 will be performed for meta-analysis. Finally, we will assess the level of the resulting evidence. RESULTS: The results of the study will be combined with current evidence and published in a peer-reviewed journal. CONCLUSIONS: This study will specifically investigate the effectiveness and safety of CHCCS in treating epilepsy. INPLASY REGISTRATION NUMBER: INPLASY202120056.


Asunto(s)
Medicamentos Herbarios Chinos/administración & dosificación , Epilepsia/tratamiento farmacológico , Escorpiones/química , Animales , Medicamentos Herbarios Chinos/efectos adversos , Medicamentos Herbarios Chinos/química , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
13.
Am J Med Qual ; 36(1): 5-16, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33764917

RESUMEN

Routine outpatient epilepsy care has shifted from in-person to telemedicine visits in response to safety concerns posed by the coronavirus disease 2019 (COVID-19) pandemic. But whether telemedicine can support and maintain standardized documentation of high-quality epilepsy care remains unknown. In response, the authors conducted a quality improvement study at a level 4 epilepsy center between January 20, 2019, and May 31, 2020. Weekly average completion proportion of standardized documentation used by a team of neurologists for adult patients for the diagnosis of epilepsy, seizure classification, and frequency were analyzed. By December 15, 2019, a 94% average weekly completion proportion of standardized epilepsy care documentation was achieved that was maintained through May 31, 2020. Moreover, during the period of predominately telemedicine encounters in response to the pandemic, the completion proportion was 90%. This study indicates that high completion of standardized documentation of seizure-related information can be sustained during telemedicine appointments for routine outpatient epilepsy care at a level 4 epilepsy center.


Asunto(s)
/epidemiología , Epilepsia/terapia , Telemedicina , Adulto , Femenino , Humanos , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Calidad de la Atención de Salud , Telemedicina/métodos , Telemedicina/normas
14.
Lancet Neurol ; 20(4): 316-326, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33743240

RESUMEN

China has approximately 10 million people with epilepsy. There is a vast epilepsy treatment gap in China, mainly driven by deficiencies in health-care delivery and social discrimination resulting from cultural beliefs about epilepsy. WHO's Global Campaign Against Epilepsy project in China showed that it was possible to treat epilepsy in primary care settings, which was a notable milestone. The China Association Against Epilepsy has been a necessary force to stimulate interest in epilepsy care and research by the medical and scientific community. Nearly 20 different anti-seizure medications are now available in China. Non-pharmacological options are also available, but there are still unmet needs for epilepsy management. The Chinese epilepsy research portfolio is varied, but the areas in which there are the most concentrated focus and expertise are epidemiology and clinical research. The challenges for further improvement in delivering care for people with epilepsy in China are primarily related to public health and reducing inequalities within this vast country.


Asunto(s)
Epilepsia/epidemiología , China/epidemiología , Humanos
15.
Nat Commun ; 12(1): 1539, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33750784

RESUMEN

Vagus nerve stimulation (VNS) is thought to affect neural activity by recruiting brain-wide release of neuromodulators. VNS is used in treatment-resistant epilepsy, and is increasingly being explored for other disorders, such as depression, and as a cognitive enhancer. However, the promise of VNS is only partially fulfilled due to a lack of mechanistic understanding of the transfer function between stimulation parameters and neuromodulatory response, together with a lack of biosensors for assaying stimulation efficacy in real time. We here develop an approach to VNS in head-fixed mice on a treadmill and show that pupil dilation is a reliable and convenient biosensor for VNS-evoked cortical neuromodulation. In an 'optimal' zone of stimulation parameters, current leakage and off-target effects are minimized and the extent of pupil dilation tracks VNS-evoked basal-forebrain cholinergic axon activity in neocortex. Thus, pupil dilation is a sensitive readout of the moment-by-moment, titratable effects of VNS on brain state.


Asunto(s)
Pupila/fisiología , Nervio Vago/fisiología , Animales , Encéfalo , Corteza Cerebelosa/fisiología , Epilepsia/fisiopatología , Femenino , Locus Coeruleus/patología , Masculino , Ratones , Ratones Endogámicos C57BL , Estimulación del Nervio Vago , Vigilia/fisiología
16.
Epilepsy Behav ; 116: 107791, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33578223

RESUMEN

Climate change is with us. As professionals who place value on evidence-based practice, climate change is something we cannot ignore. The current pandemic of the novel coronavirus, SARS-CoV-2, has demonstrated how global crises can arise suddenly and have a significant impact on public health. Global warming, a chronic process punctuated by acute episodes of extreme weather events, is an insidious global health crisis needing at least as much attention. Many neurological diseases are complex chronic conditions influenced at many levels by changes in the environment. This review aimed to collate and evaluate reports from clinical and basic science about the relationship between climate change and epilepsy. The keywords climate change, seasonal variation, temperature, humidity, thermoregulation, biorhythm, gene, circadian rhythm, heat, and weather were used to search the published evidence. A number of climatic variables are associated with increased seizure frequency in people with epilepsy. Climate change-induced increase in seizure precipitants such as fevers, stress, and sleep deprivation (e.g. as a result of more frequent extreme weather events) or vector-borne infections may trigger or exacerbate seizures, lead to deterioration of seizure control, and affect neurological, cerebrovascular, or cardiovascular comorbidities and risk of sudden unexpected death in epilepsy. Risks are likely to be modified by many factors, ranging from individual genetic variation and temperature-dependent channel function, to housing quality and global supply chains. According to the results of the limited number of experimental studies with animal models of seizures or epilepsy, different seizure types appear to have distinct susceptibility to seasonal influences. Increased body temperature, whether in the context of fever or not, has a critical role in seizure threshold and seizure-related brain damage. Links between climate change and epilepsy are likely to be multifactorial, complex, and often indirect, which makes predictions difficult. We need more data on possible climate-driven altered risks for seizures, epilepsy, and epileptogenesis, to identify underlying mechanisms at systems, cellular, and molecular levels for better understanding of the impact of climate change on epilepsy. Further focussed data would help us to develop evidence for mitigation methods to do more to protect people with epilepsy from the effects of climate change.


Asunto(s)
/epidemiología , Cambio Climático , Epilepsia/epidemiología , Salud Global/tendencias , Salud Pública/tendencias , Animales , Muerte Súbita , Epilepsia/terapia , Calor/efectos adversos , Humanos , Humedad/efectos adversos , Privación de Sueño/epidemiología , Privación de Sueño/terapia , Tiempo (Meteorología)
17.
Artículo en Inglés | MEDLINE | ID: mdl-33530431

RESUMEN

Background: Epilepsy associated with strokes is a significant clinical and public health problem and has a negative impact on prognosis and clinical outcome. A late epileptic seizure occurring seven days after stroke is actually equated with poststroke epilepsy due to the high risk of recurrence. Predictive models evaluated in the acute phase of stroke would allow for the stratification and early selection of patients at higher risk of developing late seizures. Methods: The most relevant papers in this field were reviewed to establish multifactorial predictors of late seizures and attempt to standardize and unify them into a common prognostic model. Results: Clinical and radiological factors have become the most valuable and reproducible predictors in many reports, while data on electroencephalographic, genetic, and blood biomarkers were limited. The existing prognostic models, CAVE and SeLECT, based on relevant, readily available, and routinely assessed predictors, should be validated and improved in multicenter studies for widespread use in stroke units. Conclusions: Due to contradictory reports, a common and reliable model covering all factors is currently not available. Further research might refine forecasting models by incorporating advanced radiological neuroimaging or quantitative electroencephalographic analysis.


Asunto(s)
Epilepsia , Accidente Cerebrovascular , Electroencefalografía , Epilepsia/diagnóstico , Epilepsia/epidemiología , Epilepsia/etiología , Humanos , Pronóstico , Factores de Riesgo , Convulsiones/diagnóstico , Convulsiones/epidemiología , Convulsiones/etiología
19.
Nat Commun ; 12(1): 1027, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33589639

RESUMEN

Sleep spindles facilitate memory consolidation in the cortex during mammalian non-rapid eye movement sleep. In rodents, phase-locked firing during spindles may facilitate spike-timing-dependent plasticity by grouping pre-then-post-synaptic cell firing within ~25 ms. Currently, microphysiological evidence in humans for conditions conducive for spike-timing-dependent plasticity during spindles is absent. Here, we analyze field potentials and unit firing from middle/upper layers during spindles from 10 × 10 microelectrode arrays at 400 µm pitch in humans. We report strong tonic and phase-locked increases in firing and co-firing within 25 ms during spindles, especially those co-occurring with down-to-upstate transitions. Co-firing, spindle co-occurrence, and spindle coherence are greatest within ~2 mm, and high co-firing of units on different contacts depends on high spindle coherence between those contacts. Spindles propagate at ~0.28 m/s in distinct patterns, with correlated cell co-firing sequences. Spindles hence organize spatiotemporal patterns of neuronal co-firing in ways that may provide pre-conditions for plasticity during non-rapid eye movement sleep.


Asunto(s)
Potenciales de Acción/fisiología , Corteza Cerebral/fisiología , Consolidación de la Memoria/fisiología , Plasticidad Neuronal/fisiología , Neuronas/fisiología , Sueño REM/fisiología , Adulto , Corteza Cerebral/anatomía & histología , Electrodos Implantados , Electroencefalografía , Epilepsia/patología , Epilepsia/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuronas/citología , Técnicas Estereotáxicas
20.
Nat Commun ; 12(1): 1080, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33597538

RESUMEN

Clinicians have long been interested in functional brain monitoring, as reversible functional losses often precedes observable irreversible structural insults. By characterizing neonatal functional cerebral networks, resting-state functional connectivity is envisioned to provide early markers of cognitive impairments. Here we present a pioneering bedside deep brain resting-state functional connectivity imaging at 250-µm resolution on human neonates using functional ultrasound. Signal correlations between cerebral regions unveil interhemispheric connectivity in very preterm newborns. Furthermore, fine-grain correlations between homologous pixels are consistent with white/grey matter organization. Finally, dynamic resting-state connectivity reveals a significant occurrence decrease of thalamo-cortical networks for very preterm neonates as compared to control term newborns. The same method also shows abnormal patterns in a congenital seizure disorder case compared with the control group. These results pave the way to infants' brain continuous monitoring and may enable the identification of abnormal brain development at the bedside.


Asunto(s)
Encéfalo/diagnóstico por imagen , Corteza Cerebral/diagnóstico por imagen , Epilepsia/diagnóstico por imagen , Sustancia Gris/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Algoritmos , Encéfalo/fisiopatología , Corteza Cerebral/fisiopatología , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Femenino , Sustancia Gris/fisiopatología , Humanos , Recién Nacido , Recien Nacido Prematuro , Imagen por Resonancia Magnética/métodos , Masculino , Modelos Neurológicos , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Ultrasonografía Doppler/métodos , Sustancia Blanca/fisiopatología
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