Neuroimágenes sin evidencia de déficit dopaminérgico (SWEDD) / SWEDDs: scans without evidence of dopaminergic deficit

Introducción. Aproximadamente un 10% de los pacientes diagnosticados inicialmente de Enfermedad de Parkinson (E.P.), no presentan alteraciones en la vía dopaminérgica nigroestriatal en su vertiente presináptica; se engloban bajo el acrónimo SWEDDs (Scans without evidence of dopaminergic deficit) [1]. Objetivo. Revisar aquellos aspectos clínicos que pueden ayudar al diagnóstico diferencial de los SWEDDs, así como las bases del tratamiento. Desarrollo. Las técnicas complementarias empleadas en el diagnóstico de la E.P. como el DAT-SCAN, han favorecido que se establezca un diagnóstico diferencial entre estas dos entidades: E.P. y SWEDDs, cuya evolución, pronóstico y tratamiento será diferente. Conclusiones. El término SWEDDs incluye pacientes con temblor de reposo asimétrico y ausencia de disfunción de la vía dopaminérgica nigroestriatal. En casos dudosos la prueba complementaria a realizar es el DAT-SCAN. La hipótesis de que el temblor en SWEDDs pueda ser una forma de distonía primaria debe ser contrastada en futuros estudios [1]. El tratamiento de los pacientes con SWEDDs se basa en fármacos anticolinérgicos (AU)

Introduction. Approximately 10% of all patients initially diagnosed with Parkinson's disease (PD) do not present any alterations in the presynaptic nigrostriatal dopaminergic pathway; they are classified under the acronym SWEDDs (Scans without evidence of dopaminergic deficit). Aims. Our aim is to review those clinical aspects that can be of use in the differential diagnosis of the SWEDDs, as well as the bases of treatment. Development. The complementary techniques employed in the diagnosis of PD, like DAT-SCAN, have made a valuable contribution to establishing a differential diagnosis between these two conditions, i.e. PD and SWEDDs, whose development, prognosis and treatment will be different. Conclusions. The term SWEDDs includes patients with asymmetrical tremor at rest and absence of dysfunction of the nigrostriatal dopaminergic pathway. In doubtful cases, the complementary test to be conducted is DAT-SCAN. The hypothesis that claims that the tremor in SWEDDs may be a form of primary dystonia must be tested in future studies. The treatment of patients with SWEDDs is based on anticholinergic drugs (AU)

[Locomotion and gait disorders]. / Locomoción y trastornos de la marcha.

INTRODUCTION: Human beings are characterised by the specialisation of certain functions, such as language or the ability to walk. We have achieved this capacity thanks to the development of multiple connections among different areas of the central and peripheral nervous system, together with adaptation of the musculoskeletal system. These are all essential to be able to walk correctly and to keep our balance. DEVELOPMENT: Gait disorders are currently receiving a great deal of attention in neurology departments, and this fact is directly related to the phenomenon of the ageing of the population, since it is a pathology that is particularly prevalent among the elderly. One of the fundamental mainstays in the study of these disorders is being able to distinguish between the different clinical gait patterns and their classification according to the neural system that has been damaged. Observation, the use of different manoeuvres in the examination and the search for other associated clinical signs all enable us reach a good diagnostic approximation, which will later be confirmed with more specific complementary techniques. CONCLUSIONS: From the therapeutic point of view, an early multidisciplinary intervention by the neurologist, primary care, specialists in rehabilitation and physiotherapists improves patients' quality of life and lowers the rate of associated comorbidity and mortality, which also results in a reduction in spending on community health resources.

Locomoción y trastornos de la marcha / Locomotion and gait disorders

Resumen. Introducción. El ser humano se caracteriza por la especialización de determinadas funciones, como son el lenguaje o la marcha. Esta capacidad la hemos llevado a cabo gracias al desarrollo de múltiples interconexiones entre diferentes áreas del sistema nervioso central y periférico, así como a la adaptación musculoesquelética. Todas ellas son fundamentales para una correcta realización de la deambulación y el mantenimiento del equilibrio. Desarrollo. Los trastornos de la marcha, en la actualidad, están cobrando especial importancia en las consultas de neurología, hecho que está directamente relacionado con el fenómeno de envejecimiento de la población, dado que es una patología especialmente prevalente en la población anciana. Uno de los pilares básicos en el estudio de estos trastornos es la diferenciación de los distintos patrones clínicos de marcha y la clasificación según el sistema neuronal dañado. La observación, el empleo de diferentes maniobras en la exploración y la búsqueda de otros signos clínicos asociados nos permiten una buena aproximación diagnóstica, que posteriormente podremos confirmar con técnicas complementarias más específicas. Conclusiones. Desde el punto de vista terapéutico, una intervención multidisciplinar precoz por parte de neurólogo, atención primaria, rehabilitadores y fisioterapeutas mejora la calidad de vida de los pacientes y disminuye la comorbilidad y mortalidad asociada, lo que permite, además, la reducción de los recursos sociosanitarios (AU)

Summary. Introduction. Human beings are characterised by the specialisation of certain functions, such as language or the ability to walk. We have achieved this capacity thanks to the development of multiple connections among different areas of the central and peripheral nervous system, together with adaptation of the musculoskeletal system. These are all essential to be able to walk correctly and to keep our balance. Development. Gait disorders are currently receiving a great deal of attention in neurology departments, and this fact is directly related to the phenomenon of the ageing of the population, since it is a pathology that is particularly prevalent among the elderly. One of the fundamental mainstays in the study of these disorders is being able to distinguish between the different clinical gait patterns and their classification according to the neural system that has been damaged. Observation, the use of different manoeuvres in the examination and the search for other associated clinical signs all enable us reach a good diagnostic approximation, which will later be confirmed with more specific complementary techniques. Conclusions. From the therapeutic point of view, an early multidisciplinary intervention y the neurologist, primary care, specialists in rehabilitation and physiotherapists improves patients’ quality of life and lowers the rate of associated comorbidity and mortality, which also results in a reduction in spending on community health resources (AU)