Cognición Social: Conceptos y Bases Neurales / Social Cognition: Concepts and Neural Bases

Resumen El creciente interés en los mecanismos que determinan el funcionamiento social de los seres humanos ha emergido como un desafío a la hora de obtener un concepto adecuado de cognición social y sus mecanismos relacionados, debido a que diversas patologías neurológicas y psiquiátricas se relacionan con deterioros de estas funciones desde etapas tempranas. Cognición Social se define como la integración de procesos mentales que permiten la interacción entre sujetos, incluyendo fenómenos como el de la Percepción Social, la Teoría de la Mente y la Empatía (o respuesta afectiva a los estados mentales de otros sujetos). En este artículo, como objetivo principal, exponemos los principales conceptos y las bases neurales para facilitar una primera aproximación de quienes busquen una aplicación con poblaciones clínicas.

The growing interest in the mechanisms determining the social functioning of human beings has raised the challenge of obtaining an accurate concept of social cognition and its related mechanisms, because several neurologic and psychiatric diseases exhibit related impairments since earliest stages. Social Cognition is defined as the integration of mental processes allowing the interaction among subjects and it includes phenomena as Social Perception, Theory of Mind and Empathy (or the affective response to the mental state of other people). In this article, as the primary aim, we expose the main concepts and neural basis in order to make easier the first approach for those who are looking for an application in the research with clinical populations.

Practical Issues Concerning the Approval and Use of Biosimilar Drugs for the Treatment of Multiple Sclerosis in Latin America.

The use of biosimilar drugs for multiple sclerosis (MS) has become widespread in Latin America, with the goal of reducing costs of treatments, promoting the sustainability of healthcare systems, and improving patient access to these therapies. There is currently a need to define and comply with requirements to guarantee the efficacy, safety, and quality of these drugs. Thus, the objective of the present study was to compile up-to-date information from each Latin American country assessed on (a) approval of biosimilar drugs by regulatory agencies; (b) use of biosimilar drugs, pharmacovigilance plans, risk management; and (c) update in the knowledge on different molecules. To do so, a group of experts from Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Peru, Uruguay, and Venezuela met to discuss the current situation regarding good practices and risks associated with the use of biosimilar drugs in their respective countries. Regulation, risk management plans, and pharmacovigilance in the whole continent must guide the strategies on the commercialization and access of biosimilar drugs and copies of complex molecules. Current regulations must be implemented for the registration of biosimilar drug products and complex molecules. It is paramount to ensure that new products follow the best quality standards at all stages beyond being safe and efficient. Uncontrolled interchangeability between original biological and biosimilar should be avoided. Latin America requires the implementation and full use of strong pharmacovigilance programs. National and multinational clinical studies are required to demonstrate the similarity in safety, efficacy, and immunogenicity profiles of complex molecules, as well as biological and biosimilar products. Plain language summary available for this article.

Ensayo pictórico: diagnóstico diferencial radiológico en esclerosis múltiple / Pictory essay: radiological differential diagnosis of multiple sclerosis

La esclerosis múltiple (EM) es la enfermedad inflamatorio-desmielinizante del Sistema nervioso central más prevalente en adultos. La resonancia magnética (RM) juega un rol cada vez más importante en el estudio de esta patología, en especial en su diagnóstico precoz, por lo que la diferenciación imagenológica de variantes frecuentes e infrecuentes de EM con otras patologías de sustancia blanca que comprometen encéfalo y médula espinal es esencial. Mediante una revisión pictórica se ilustrarán características típicas en RM del compromiso por EM y de variantes menos habituales de lesión desmielinizante, y se ilustrarán hallazgos característicos de lesiones relacionadas a vasculopatías inflamatorias y no inflamatorias, encefalomielitis diseminada aguda (ADEM), neuromielitis óptica (NMO) y enfermedades vasculares de la médula espinal que pueden simular EM, con énfasis en el diagnóstico diferencial radiológico.

Multiple sclerosis (MS) is the most prevalent inflammatory-demyelinating disease of the central nervous system in adult population. Magnetic resonance imaging (MRI) has an increasingly important role, especially in early diagnosis, so the imaging differentiation of frequent and infrequent variants of MS with other white matter diseases of brain and spinal cord is essential. Through a pictorial essay we show typical MR features of MS and more infrequent variants of demyelinating lesions and illustrate characteristic imaging findings of inflammatory and non-inflammatory vasculopathies, acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO) and vascular diseases of spinal cord that may simulate MS, with emphasis on imaging differential diagnosis.

Secondary paroxysmal dyskinesia in multiple sclerosis: Clinical-radiological features and treatment. Case report of seven patients.

Secondary paroxysmal dyskinesias (SPDs) are short, episodic, and recurrent movement disorders, classically related to multiple sclerosis (MS). Carbamazepine is effective, but with risk of adverse reactions. We identified 7 patients with SPD among 457 MS patients (1.53%). SPD occurred in face ( n = 1), leg ( n = 2), or arm +leg ( n = 4) several times during the day. Magnetic resonance imaging (MRI) showed new or enhancing lesions in thalamus ( n = 1), mesencephalic tegmentum ( n = 1), and cerebellar peduncles ( n = 5). Patients were treated with clonazepam and then acetazolamide ( n = 1), acetazolamide ( n = 5), or levetiracetam ( n = 1) with response within hours (acetazolamide) to days (levetiracetam). No recurrences or adverse events were reported after a median follow-up of 33 months.

Biological and nonbiological complex drugs for multiple sclerosis in Latin America: regulations and risk management.

Biological drugs and nonbiological complex drugs with expired patents are followed by biosimilars and follow-on drugs that are supposedly similar and comparable with the reference product in terms of quality, safety and efficacy. Unlike simple molecules that can be copied and reproduced, biosimilars and follow-on complex drugs are heterogeneous and need specific regulations from health and pharmacovigilance agencies. A panel of 14 Latin American experts on multiple sclerosis from nine different countries met to discuss the recommendations regarding biosimilars and follow-on complex drugs for treating multiple sclerosis. Specific measures relating to manufacturing, therapeutic equivalence assessment and pharmacovigilance reports need to be implemented before commercialization. Physical, chemical, biological and immunogenic characterizations of the new product need to be available before clinical trials start. The new product must maintain the same immunogenicity as the original. Automatic substitution of biological and complex drugs poses unacceptable risks to the patient.

Prevalence of epilepsy in a cohort of patients with multiple sclerosis.

INTRODUCTION: Epilepsy prevalence is 0.27-1.7% in general population. However, higher figures have been reported in Multiple Sclerosis (MS) patients, suggesting this association is not coincidental. METHODS: We retrospectively reviewed the records of MS patients seen between 2009 and 2012 at Pontificia Universidad Católica of Chile's Multiple Sclerosis Center. RESULTS: Of 310 MS patients, ten had the diagnosis of epilepsy (3.2%). These patients were younger, and had an earlier onset of symptoms of MS compared to the group without epilepsy (32 vs. 40 years, p=0.04 and 25 vs. 32 years, p=0.02, respectively). In 4 patients, seizures were the first MS symptom and the most frequent seizure type was partial secondary generalized (6 patients). MRI showed cortical lesions in all patients. Patients with poor epilepsy control (frequent seizures or development of status epilepticus) had lower brain volumes and worse cognitive performance. All patients received antiepileptic drugs as well as immunomodulatory therapy. CONCLUSION: Patients with epilepsy and MS are younger and have an earlier onset of symptoms. Since most seizures were partial, the presence of cortical lesions and progressive brain atrophy could probably be the pathophysiological mechanism underlying this association.