Genetic characterization of Parkinson's disease patients in Ecuador and Colombia.

To help address the scarcity of studies on the genetics of Parkinson's disease (PD) in Latin America, we screened 426 Ecuadorians with PD and 80 Colombians (PD = 55, Control = 26) for mutations within several PD-related genes. Among Colombians, we identified several variants within PARKIN and PINK1 genes.

Motor Dysfunction as a Prodrome of Parkinson's Disease.

BACKGROUND: Recognition of motor signs in the prodromal stage could help identify those at risk of developing Parkinson's disease (PD). OBJECTIVE: This study identified motor symptoms and signs in individuals suspected of having PD but who did not have a progressive reduction in the speed and amplitude of finger tapping or other physical signs indicative of bradykinesia. METHODS: 146 patients, who had symptoms or signs suggestive of PD, were serially evaluated by a movement disorder specialist, using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and video recordings. If the patients 'converted' to PD during follow-up, they were categorized as cases and compared with those who did not meet PD criteria during follow-up (non-cases). RESULTS: The 82 cases were more likely to have action dystonia or postural/action/rest tremor of a limb (OR 2.8; 95% CI 1.1-7.1; p = 0.02), a reduced blink rate at rest (OR 2.3; 95% CI 1.2-4.6; p = 0.01), anxiety (OR 8.9; 95% CI 2.6-31.1; p < 0.001), depression (OR 7.0; 95% CI 2.9-17.2; p < 0.001), or a frozen shoulder (OR 3.1; 95% CI 1.6-6.2) than the 64 'non-cases'.A reduction of the fast blink rate was common in patients who met the criteria for PD (p < 0.001). CONCLUSIONS: This study emphasizes that motor dysfunction is a component of the clinical prodrome seen in some patients with PD.

Tuberculous meningitis: do modern diagnostic tools offer better prognosis prediction?

BACKGROUND: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis. AIMS: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging. METHODS: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve. RESULTS: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101 (32.5%) survived with sequelae. The associated predictors were consciousness impairment (p = 0.010), motor deficit (p = 0.003), cisternal effacement (p = 0.006) and infarcts (p = 0.015). The new score based on these predictors yielded a larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI: 0.65-0.77). CONCLUSIONS: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability of modern tests did not improve the ability to predict a bad outcome.

Neuroimmunological findings of Angiostrongylus cantonensis meningitis in Ecuadorian patients.

UNLABELLED: Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5% and 26% in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.

Neuroimmunological findings of Angiostrongylus cantonensis meningitis in ecuadorian patients / Hallazgos neuroinmunologicos en meningitis por Angiostrongylus cantonesis en pacientes ecuatorianos

Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5 percent and 26 percent in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.

La meningitis provocada por Angiostrongylus cantonensis ha sido reportada recientemente en pacientes procedentes de los primeros brotes reportados en regiones subtropicales de Ecuador. MÉTODO: Ocho adultos jóvenes procedentes de dos brotes fueron estudiados. Se cuantificó IgA, IgM, IgG y albúmina en suero y líquido cefalorraquídeo y fueron colocados en los gráficos de las razones líquido cefalorraquídeo/suero (reibergramas). La anamnesia incluía ingestión de caracoles crudos, los síntomas y los daños provocados. RESULTADOS: Una eosinofílica promedio de 7,5 y 26 por ciento en suero y líquido cefalorraquídeo fue observada al igual que un moderado incremento en las proteínas totales. El patrón de síntesis intratecal predominante fue de tres clases de inmunoglobulinas. La síntesis intratecal de IgM se observó en todos los casos a las dos semanas después del inicio de los síntomas. CONCLUSIÓN: El patrón de síntesis intratecal de la meningitis eosinofílica por Angiostrongylus cantonensis facilitado por el análisis del líquido cefalorraquídeo fue similar a los casos previos reportados fuera del país.

Comparison of major immunoglobulins intrathecal synthesis patterns in Ecuadorian and Cuban patients with angiostrongyliasis.

Angiostrongylus cantonensis meningitis was first reported in Cuba in 1981, and it was recently reported in South America. The aim of this paper is to evaluate the intrathecal immunoglobulin synthesis patterns from Cuba's and Ecuador's patients with angiostrongyliasis; 8 Ecuadorian patients from two different outbreaks and 28 Cuban patients were studied. Simultaneous blood and cerebrospinal fluid samples were taken. Immunoglobulin (Ig) A, IgM, IgG, and albumin were quantified by radial immunodiffusion. Corresponding Reibergrams were applied. A three-Ig pattern was the most frequent in the two groups, but IgM was presented in all Ecuadorian young mature patients; however, in the Cuban children, only 12 of 28 patients had intrathecal IgM, but about 90% had an IgA and IgG synthesis at time of later puncture. This indicates that, with a larger amount of parasites ingested, clinical symptoms are more severe, and a higher frequency of intrathecal IgM synthesis could be observed. This is discussed as a similarity with the intrathecal IgM synthesis in African trypanosomiasis.

Postpartum follicular development in Brahman cows under two stocking rates.

The aim was to study postpartum follicular population dynamics in Brahman cows in the Mexican humid tropics and under different stocking rates. Lactating adult cows (n = 104) grazed native grammas (Paspalum spp., Axonopus spp.) under two stocking rates: 2.8 (high) or 1.7 (low) cows/ha. Follicle numbers and their size (millimetres) were measured by ovarian ultrasound scanning. Animals detected in oestrus and inseminated were taken out of the study. Both stocking rates produced similar (P < 0.05) body condition scores (BCS) and follicular dynamics. The percent of follicles, averaged over stocking rates, of <4 mm diminished and those of 5-8 mm increased with time, whilst those of >9 mm remained constant; respective values for the previously mentioned sizes were 60 days postpartum (n = 101), 49%, 56% and 5%; 120 days (n = 70), 28%, 66% and 6%; and 180 days (n = 15), 9%, 79% and 12%. There was a positive correlation between BCS and follicle number for size <4 mm (r = 0.73, P < 0.01), whilst for size 5-8 mm, this was negative (r = -0.51, P < 0.05), for follicles >9 mm, no difference was found (r = -0.08, P > 0.05). It was concluded that stocking rate did not affect follicular population dynamics of Brahman cows, but BCS dictated the number and categories of follicles present regardless of the stocking rate utilised.

Tuberculous meningitis: does lowering the treatment threshold result in many more treated patients?

OBJECTIVE: To determine how many more patients would be treated when lowering the treatment threshold for tuberculous meningitis. METHODS: From 1989 to 2004 findings of patients with symptoms lasting more than 1 week and inflammatory changes of cerebrospinal fluid (CSF) were collected. Several models of latent class analysis were tested. Cumulative numbers of cases were plotted against different cut-offs for post-test probability. RESULTS: In a cohort of 232 patients the prevalence of tuberculous meningitis (TBM) was estimated at 79.8% (95% CI. 67,0-88,1); probabilities above 80% were reached in 73% of patients. Lowering this threshold from 80% to 20% would add 14% more patients to be treated, for a total of 87%. A further lowering of the threshold to 5% would imply 5% more patients to be treated, bringing the cumulative number to 92%. The difference of lowering the threshold from 80% to 5% was 19%. CONCLUSION: In this setting, at least 75% of patients showing suggestive symptoms for more than a week and CSF changes very probably had TBM. The number of patients that should be treated does not increase linearly when lowering the threshold.

Prevalence of migraine in Latin America.

OBJECTIVE: To determine the 1-year point prevalence of migraine among residents > or =15 years old in 12 Latin American urban communities, and record medical consultation preferences of the identified migraineurs. BACKGROUND: Prevalence of migraine with or without aura in Latin American urban communities has not been established by large-scale population studies. METHODS: A validated face-to-face interview questionnaire based on International Headache Society criteria was completed for all headache sufferers within selected households, in a cross-sectional study. The randomly selected populations were representative of urban communities from the six participating Latin American countries. The questionnaire used was identical in each of the six participating countries. RESULTS: Of the 8618 people available for screening, 62% reported headache and 2637 completed interview questionnaires. Age-adjusted 1-year prevalence of migraine with or without aura for each country was (female/male, %): Argentina 6.1/3.8, Brazil 17.4/7.8, Colombia 13.8/4.8, Ecuador 13.5/2.9, Mexico 12.1/3.9, and Venezuela 12.2/4.7. Migraine prevalence was highest in women aged 30 to 50 years. In the year prior to the study, 42% of individuals interviewed and identified with migraine reported consulting a health professional about their headaches, most frequently (14%) a general practitioner. No previous diagnosis of migraine was reported by 65% of individuals with headache. CONCLUSIONS: In agreement with previous epidemiologic reports, migraine is also a common disorder in Latin American urban communities and predominantly affects women aged 30 to 50 years. Consultation preferences are also similar to those of previous reports.

Clinical characteristics and patterns of medication use of migraneurs in Latin America from 12 cities in 6 countries.

OBJECTIVE: The objective of this study was to document the clinical characteristics of migraine and patterns of medication use in residents > or =15 years old in 12 Latin American urban communities. BACKGROUND: Few large-scale population studies have established the symptoms and disability associated with migraine with or without aura in Latin American urban communities or the pattern of medication use in these regions. METHODS: In this study, subjects in 12 urban communities, from 6 Latin American countries, were surveyed with a validated face-to-face interview questionnaire based on International Headache Society criteria for migraine. The questionnaire was completed during face-to-face interviews with headache sufferers within selected households and included questions about migraine symptoms, migraine-related disability, and the use of health-care resources and medications to treat migraines. RESULTS: Of the 8618 people available for screening, 62% suffered from headaches. Of individuals with migraine, 42% reported consulting a health-care professional about their headaches. Of the migraineurs, 94.2% reported moderate to severe pain. Associated symptoms of nausea or vomiting, photophobia, phonophobia, and osmophobia were common during migraine attacks in 30.3, 76.4, 85.1, and 47.7% of subjects, respectively. The majority of subjects suffered between one and eight migraines each month. Although no previous diagnosis of migraine was reported by 65% of headache sufferers, migraineurs lost an average of 8 days in the preceding 3 months in any of the following areas: school, work, household chores, and/or social, family, or leisure activities. The agents used most widely to treat migraine were paracetamol and salicylates, while nonsteroidal anti-inflammatory drugs, dypirone, and ergotamines were also commonly used. Medication use varied widely among countries, but was predominantly nonprescription. CONCLUSIONS: Migraine is a common disorder in Latin American urban communities imposing significant burden on individuals, families, and communities. The magnitude of the impact and the range of activities affected by migraine are similar to those of previous reports in other regions. The preponderance of nonprescription medications and the scarcity of migraine-specific triptans from the study findings are especially striking.

Systemic diseases that cause movement disorders.

The present review is aimed at providing practical assistance to the clinical neurologist in reaching a diagnosis, understanding the pathogenic mechanisms of movement disorders associated with systemic diseases, and determining appropriate therapy. Infectious disease by direct effect or as an acquired autoimmune neurological disease, stroke, hypoxia-ischemia, paraneoplastic syndromes, collagen disorders, endocrine, liver and kidney diseases that may cause hypokinetic or hyperkinetic abnormal movement are considered separately. The type and evolution of abnormal movement caused by systemic disease vary with age and underlying pathology. Therapy for abnormal movements should include a primary treatment for the systemic disease.

Tratamiento de la Corea Reumática con ácido valproico

Antecedentes y propósito.- La corea es una manifestación infrecuente de la fiebre reumática. En su tratamiento han sido utilizados diversos fármacos. el propósito de este estudio es establecer en nuestros pacientes con corea reumática la respueta al Acido Valproico. Pacientes y Métodos.- Se realizó un estudio simple abierto en el que se incluyeron quince pacientes que reunieron los criterios de corea reumática del protocolo estandar establecido en nuestro servicio. Evaluamos la severidad de la corea antes y durante el tratamiento. Todos los pacientes fueron tratados unicamente con Acido Valproico en dosis progresivas hasta lograr el control de los movimientos coreicos. Resultados.- Un alto porcentaje (73por ciento) de los pacientes fueron adolescentes. Predominó el sexo femenino (67por ciento) y la distribución unilateral de la corea (60 porciento). Los movimientos coreicos tuvieron una evolución promedio de 28 días antes del inicio del tratamiento. en trece pacientes (86 porciento) los movimientos coreicos remitieron y en uno (7 porciento) disminuyeron de severidad. En dos pacientes (13 porciento) los movimientos coreicos recurrieron. Conclusiones.- Nuestros resultados sugieren que el Acido Valproico podría ser el medicamento de primera elección en el tratamiento de la corea reumática.

Epilepsia y Embarazo

Los embarazos que se producen en mujeres con epilepsia son considerados de alto riesgo. Estas pacientes tienen un riesgo mayor de presentar crisis en el curso del embarazo, asi como complicaciones durante el embarazo y el parto. En las pacientes con epilepsia existe un riesgo mayor que en la población general de presentar malformaciones congénitas , no sólo por el efecto de los anticonvulsivantes sino también por la epilepsia "per se" estas malformaciones se presentan con todos los anticonvulsivantes conocidos y el riesgo es mayor si se las utiliza en politerapia. Principalmente se presentan malformaciones cardíacas y hendiduras faciales. Con el uso de ácido valproico y carbamacepina existe un riesgo 20 veces mayor de presentar defectos del tubo neural. En el control del embarazo se debe realizar mediciones frecuentes de niveles séricos de los anticonvulsivantes para disminuir el riego de toxicidad. también mediciones de niveles de folato en suero y hematies, medición de alfa-feto proteína y un ecosonograma para estudiar la existencia de una malformación congénita. Se deve dar suplemento de ácido fólico y hacia el final del embarazo administrar vitamina K a la madre para disminuir el riesgo que el recien nacido presente malformaciones y hemorragias neonatal, respectivamente. Todos los anticonvulsivantes, excepto el ácido valproico se presentan en la leche materna produciendo un cuadro de irritabilidad o sedación en el niño, que cuando se presenta tiene indicacion de suspender la lactancia. El médico debe tratar de proteger a la madre y al feto del riesgo de presentar crisis durante el embarazo y de la toxicidad de los medicamentos. A pesar de todas estas complicaciones, más del 90 porciento de madres con epilepsia tienen hijos sanos.

Mielinolisis central pontina: reporte de un caso

La mielinólisis Central Pontina (MCP) fue descrita por primera vez Adams, Victor y Mancall en 1959 en cuatro pacientes alcohólicos y desnutridos (1,2,3,4,5). La etiología de la MCP es desconocida; en la mayoría de reportes se la relaciona con la corrección rápida de la hiponatremia y enfermedades crónicas (3,4,5,6,7,8,9). Reportamos un paciente alcoholico que ingresó al Hospital Eugenio Espejo con diagnóstico de colera y desarrolló una mielinólisis Central Pontina luego de la corrección de su hiponatremia.

Tratamiento de quistes de cisticerco por punción, mediante métodos estereotáxicos y tomografía computada / Cysticer cyst treatment by stereotaxic TC punction

Presentamos siete pacientes con quistes de cisticerco cuyo diagnóstico fue efectuado en base al cuadro clínico, a pruebas de inmunofluorescencia en el suero y al estudio tomográfico axial. Mediante pequeños agujeros de trépano y con control de tomografía computada (TC) succionamos el contenido quístico. El líquido se sometió a estudio citoquímico y examen microscópico posterior al secado del mismo; estableciendo comparación con muestras similares de quistes localizados en otros órganos. Controles posteriores de TC demostraron la desaparición completa de los quistes, en cinco pacienets pese a que en dos la extracción del líquido no fue total. En un enfermo, con un quiste pequeño, no se consiguió absorver el líquido y en otro, de un quiste grande, puncionando directamente vía transcutánea y transósea, se produjo contaminación por bacterias de la epidermis y se presentó un absceso, el mismo que fue drenado quirúrgicamente.

Epilepsia mioclonica de la adolescencia: un estudio de 39 pacientes

Teinta e nueve pacientes fueron diagnosticados de epilepsia mioclónica de la adolescencia, de un grupo de 65 pacientes con epilepsias y síndromes epilépticos generalizados, constituyendo el 60% de éstos. Ninguno de los pacientes había sido diagnosticado como portador de este síndrome y el promdedio de años desde el inicio de la enfermedad hasta el diagnóstico fue de 7 años. El Promedio de edad de inciio fue de 14 años, con una variación de 8 a 22 años. En 56% de los pacientes se presentó el síndrome con ausencias, mioclonías y crisis clónico-tónico-clónicas generalizadas. El 31% de los pacientes tuvieron antecedentes de epilespia en sus padres o hermanos. Se analizaron los hallazgos electroencefalográficos, los factores desencadenantes de crisis y la respuesta terapéutica. La epilepsia miclónica de la adolescencia de Janz ha constituído el 15% de todos los pacientes con crisis epilépticas que han acudido a un servicio de neurología de un hospital general por lo que reconocerlo es indispensable para el manejo adecuado de la epilelpsia