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Humanos , Cateterismo Periférico/efeitos adversos , Coma/etiologia , Embolia Aérea/complicações , Remoção de Dispositivo/efeitos adversosRESUMO
Introducción: Dada la escasez de directrices abordando este tema y con motivo de la futura creación de la Unidad de Cuidados Paliativos (CP) en nuestro centro de neurorrehabilitación, los miembros del equipo médico de la Clínica San Vicente hemos decidido proponer una serie de sugerencias sobre el empleo de fármacos antiepilépticos (FAEs) en el manejo de las crisis epilépticas (CEs) en CP. Métodos: Búsqueda de artículos en PubMed, últimos libros y recomendaciones de las guías de práctica clínica y sociedades científicas publicadas más relevantes, referentes al manejo de las CEs en CP. Resultados: La confección de este tipo de guías, además de identificar pacientes candidatos a recibir CP, es fundamental para garantizar un buen control sintomático de las CEs y evitar el sufrimiento innecesario de estos enfermos y sus familiares. Dadas las características de estos pacientes, se recomienda usar FAEs con presentación vía parenteral (preferiblemente intravenosa) y un perfil bajo de interacciones. Diazepam y/o midazolam serían los más idóneos para la fase aguda, y levetiracetam, ácido valproico y/o lacosamida para casos refractarios y/o como tratamiento crónico. Conclusiones: Estas recomendaciones deben considerarse una guía de abordaje integral, debiendo adaptarse a la idiosincrasia de cada caso clínico en particular. Sin embargo, se necesitan ensayos clínicos controlados, aleatorizados, bien diseñados, que incluyan muestras amplias de pacientes subsidiarios de CP, para redactar un documento de consenso que permita recomendar con un mayor nivel de evidencia y de forma generalizada, la utilización adecuada, racional y efectiva de FAEs en este ámbito médico-asistencial de elevada complejidad
Introduction: Very little has been written on seizure management in palliative care (PC). Given this situation, and considering the forthcoming setting up of the Palliative Care Unit at our neurorehabilitation centre, the Clínica San Vicente, we decided to establish a series of guidelines on the use of antiepileptic drugs (AEDs) for handling seizures in PC. Methods: We conducted a literature search in PubMed to identify articles, recent manuals, and clinical practice guidelines on seizure management in PC published by the most relevant scientific societies. Results: Clinical practice guidelines are essential to identify patients eligible for PC, manage seizures adequately, and avoid unnecessary distress to these patients and their families. Given the profile of these patients, we recommend choosing AEDs with a low interaction potential and which can be administered by the parenteral route, preferably intravenously. Diazepam and midazolam appear to be the most suitable AEDs during the acute phase whereas levetiracetam, valproic acid, and lacosamide are recommended for refractory cases and long-term treatment. Conclusions: These guidelines provide general recommendations that must be adapted to each particular clinical case. Nevertheless, we will require further well-designed randomised controlled clinical trials including large samples of patients eligible for PC to draft a consensus document recommending adequate, rational, and effective use of AEDs, based on a high level of evidence, in this highly complex area of medical care
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Humanos , Convulsões/tratamento farmacológico , Epilepsia/tratamento farmacológico , Cuidados Paliativos na Terminalidade da Vida/métodos , Anticonvulsivantes/uso terapêutico , Neoplasias/complicaçõesRESUMO
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Humanos , Feminino , Idoso , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Artéria Cerebral Anterior/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Artéria Cerebral Anterior/patologia , Fibrinolíticos/uso terapêuticoAssuntos
Artéria Cerebral Anterior , Fibrilação Atrial/complicações , Infarto do Miocárdio , Acidente Vascular Cerebral/complicações , Idoso , Anticoagulantes/administração & dosagem , Dispneia/etiologia , Evolução Fatal , Feminino , Heparina/administração & dosagem , Humanos , Extremidade Inferior , Debilidade Muscular/etiologia , EspanhaRESUMO
INTRODUCTION: Very little has been written on seizure management in palliative care (PC). Given this situation, and considering the forthcoming setting up of the Palliative Care Unit at our neurorehabilitation centre, the Clínica San Vicente, we decided to establish a series of guidelines on the use of antiepileptic drugs (AEDs) for handling seizures in PC. METHODS: We conducted a literature search in PubMed to identify articles, recent manuals, and clinical practice guidelines on seizure management in PC published by the most relevant scientific societies. RESULTS: Clinical practice guidelines are essential to identify patients eligible for PC, manage seizures adequately, and avoid unnecessary distress to these patients and their families. Given the profile of these patients, we recommend choosing AEDs with a low interaction potential and which can be administered by the parenteral route, preferably intravenously. Diazepam and midazolam appear to be the most suitable AEDs during the acute phase whereas levetiracetam, valproic acid, and lacosamide are recommended for refractory cases and long-term treatment. CONCLUSIONS: These guidelines provide general recommendations that must be adapted to each particular clinical case. Nevertheless, we will require further well-designed randomised controlled clinical trials including large samples of patients eligible for PC to draft a consensus document recommending adequate, rational, and effective use of AEDs, based on a high level of evidence, in this highly complex area of medical care.
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Anticonvulsivantes/uso terapêutico , Carbamazepina/uso terapêutico , Guias como Assunto , Cuidados Paliativos/métodos , Convulsões/tratamento farmacológico , Humanos , Levetiracetam , Ácido Valproico/uso terapêuticoRESUMO
INTRODUCCIÓN: La estimulación magnética transcraneal repetitiva (EMTr) constituye una realidad terapéutica en la rehabilitación postictus, ya que confiere efectos neuroprotectores incidiendo favorablemente en la modulación de la neuroplasticidad (NP), ayudando así al cerebro en su capacidad para readaptar circuitos neuronales y, con ello, la restauración y adquisición de nuevas habilidades compensatorias. DESARROLLO: Búsqueda de artículos en PubMed, últimos libros y recomendaciones de las guías de práctica clínica y sociedades científicas publicadas más relevantes, referentes al uso terapéutico de la EMTr en la rehabilitación de pacientes con ictus. Se incluyen las evidencias y recomendaciones según los criterios de la International Federation of Clinical Neurophysiology (2014) al respecto. CONCLUSIONES: La identificación de pacientes con ictus subsidiarios de recibir EMTr es importante para acelerar la fase de recuperación. La EMTr ha demostrado ser segura y efectiva para tratar los déficits que aparecen tras un ictus. Los pulsos electromagnéticos excitatorios e inhibitorios aplicados en el hemisferio cerebral ipsolateral o contralateral a la lesión, respectivamente, así como a nivel transcalloso para regular la comunicación interhemisférica cerebral, nos brindan la posibilidad de optimizar la actividad cerebral funcional. Los diferentes estudios realizados sobre EMTr han demostrado la mejoría de los trastornos motores, la afasia, la disartria, la disfagia orofaríngea, la depresión y las dificultades perceptivo-cognitivas que aparecen en estos pacientes. Sin embargo, se necesitan ensayos clínicos controlados, aleatorizados, bien diseñados, que incluyan a un mayor número de pacientes, para poder recomendar con un mayor nivel de evidencia y de forma generalizada, la utilización adecuada de la EMTr en los enfermos afectados por un ictus
INTRODUCTION: Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic reality in post-stroke rehabilitation. It has a neuroprotective effect on the modulation of neuroplasticity, improving the brain's capacity to retrain neural circuits and promoting restoration and acquisition of new compensatory skills. DEVELOPMENT: We conducted a literature search on PubMed and also gathered the latest books, clinical practice guidelines, and recommendations published by the most prominent scientific societies concerning the therapeutic use of rTMS in the rehabilitation of stroke patients. The criteria of the International Federation of Clinical Neurophysiology (2014) were followed regarding the inclusion of all evidence and recommendations. CONCLUSIONS: Identifying stroke patients who are eligible for rTMS is essential to accelerate their recovery. rTMS has proven to be safe and effective for treating stroke complications. Functional brain activity can be optimised by applying excitatory or inhibitory electromagnetic pulses to the hemisphere ipsilateral or contralateral to the lesion, respectively, as well as at the level of the transcallosal pathway to regulate interhemispheric communication. Different studies of rTMS in these patients have resulted in improvements in motor disorders, aphasia, dysarthria, oropharyngeal dysphagia, depression, and perceptual-cognitive deficits. However, further well-designed randomized controlled clinical trials with larger sample size are needed to recommend with a higher level of evidence, proper implementation of rTMS use in stroke subjects on a widespread basis
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Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Estimulação Magnética Transcraniana/métodos , Reabilitação Neurológica/métodos , Recuperação de Função Fisiológica , Estimulação Magnética Transcraniana/instrumentação , Estimulação Magnética Transcraniana/estatística & dados numéricosRESUMO
INTRODUCTION: Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic reality in post-stroke rehabilitation. It has a neuroprotective effect on the modulation of neuroplasticity, improving the brain's capacity to retrain neural circuits and promoting restoration and acquisition of new compensatory skills. DEVELOPMENT: We conducted a literature search on PubMed and also gathered the latest books, clinical practice guidelines, and recommendations published by the most prominent scientific societies concerning the therapeutic use of rTMS in the rehabilitation of stroke patients. The criteria of the International Federation of Clinical Neurophysiology (2014) were followed regarding the inclusion of all evidence and recommendations. CONCLUSIONS: Identifying stroke patients who are eligible for rTMS is essential to accelerate their recovery. rTMS has proven to be safe and effective for treating stroke complications. Functional brain activity can be optimised by applying excitatory or inhibitory electromagnetic pulses to the hemisphere ipsilateral or contralateral to the lesion, respectively, as well as at the level of the transcallosal pathway to regulate interhemispheric communication. Different studies of rTMS in these patients have resulted in improvements in motor disorders, aphasia, dysarthria, oropharyngeal dysphagia, depression, and perceptual-cognitive deficits. However, further well-designed randomized controlled clinical trials with larger sample size are needed to recommend with a higher level of evidence, proper implementation of rTMS use in stroke subjects on a widespread basis.
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Reabilitação Neurológica/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Estimulação Magnética Transcraniana/métodos , Humanos , Recuperação de Função Fisiológica , Estimulação Magnética Transcraniana/instrumentação , Estimulação Magnética Transcraniana/estatística & dados numéricosRESUMO
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Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Opsoclonia-Mioclonia/patologia , Síndrome de Opsoclonia-Mioclonia/terapia , Síndrome de Opsoclonia-Mioclonia , Imunossupressores/uso terapêutico , Terapia Combinada/métodos , Síndrome de Opsoclonia-Mioclonia/etiologia , Tomografia por Emissão de Pósitrons/métodos , Fluordesoxiglucose F18/administração & dosagem , Fluordesoxiglucose F18/efeitos da radiação , Imuno-Histoquímica , Pleura/citologiaRESUMO
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Humanos , Feminino , Idoso , Diplopia/induzido quimicamente , Diplopia/complicações , Diplopia/fisiopatologia , Gentamicinas/administração & dosagem , Gentamicinas/efeitos adversos , Audiometria/instrumentação , Audiometria/métodos , Audiometria , Orelha Interna , Orelha Interna/fisiopatologia , Acuidade Visual , Acuidade Visual/fisiologia , Diplopia/etiologia , Estudos ProspectivosRESUMO
No disponible
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Humanos , Feminino , Idoso , Coma/complicações , Embolia Aérea/complicações , Embolia Aérea/diagnóstico , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Oxigênio/uso terapêutico , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico , Escala de Coma de Glasgow , Acidose Respiratória/complicações , Eletrocardiografia , Tomografia Computadorizada por Raios XRESUMO
No disponible
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Humanos , Masculino , Adulto , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/patologia , Cefaleia/complicações , Cefaleia/diagnóstico , Cefaleia/terapia , Tomografia/instrumentação , Tomografia/métodos , TomografiaAssuntos
Aneurisma Roto/complicações , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/etiologia , Adulto , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Digital , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Masculino , Procedimentos Neurocirúrgicos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: During the 'scientific revolution' that took place in the 18th century, a complex and poorly completed theory on the functioning of the nervous system, neural circulation, was to draw the attention of the European vanguards and, although it came up against a number of important obstacles, it also attempted to renew the traditional gallenic knowledge that had prevailed until then. In Spain, the field of medical knowledge was to flourish and the neurosciences presented their credentials with the introduction and development of the concept of neural circulation by the novator Martin Martinez. DEVELOPMENT: This work attempts to evoke that historic time and to summarise the elements that go to make up the neural or 'spirituous' circulation, as well as reviewing the figure of Martin Martinez. CONCLUSIONS: Neural circulation was a speculative theoretical deviation that tried, unsuccessfully, to offer a better explanation for empirical facts. In Spain, led by Martin Martinez, it was at least an attempt to modernise thinking by introducing the new ideas about neurological anatomy that were going round Europe.
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Fenômenos Fisiológicos do Sistema Nervoso , Neurociências/história , História do Século XVII , História do Século XVIII , EspanhaRESUMO
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