[Botulin toxin as treatment for spasticity and dystonia in infantile cerebral paralysis]. / Toxina botulínica como tratamiento de la espasticidad y distonía en la parálisis cerebral infantil.

UNLABELLED: Treatment of spasticity and dystonía in PCI with Botulinum toxin A. BACKGROUND: Botulinum-A (NxTxBoA) toxin produce neuromuscular blockade, it has been effective with therapeutic purposes in strabismus, focal dystonias and spasticity. OBJECTIVE: Evaluate the therapeutically effects off NxTxBoA in cerebral palsy (CP) spastic and/or dystonic in children. Prospective study. MATERIAL AND METHODS: 12 CP patients (8 spastic and 4 spastic/dystonic) were treated with NxTxBoA in affected muscles at least for 2 doses by up 12 months. The indication was: improve limb function, to avoid surgical correction or improve hygienic or dressing. Ashworth Spasticity Scale (ASS), functional scale for Dystonic Sindou-Millet (SMS) and O'Brien Global Assessment Scale (OGAS) were used to evaluate improvement. STATISTICAL METHODS: No parametric tests, Wilcoxon's rang's test and sign test were used with p < 0.05. RESULTS: Total doses session was 3-10 U/kg. AAS showed muscle spasticity improvement in two grades in 8 patients, and one grade in the rest (p = 0.004). SMS showed the muscle dystonic improve up 60% in two patients improve 50% in others (p = 0.006). OGAS demonstrated a good correlation. Mean treatment effect during 4.8 months (rank 4 to 10 m). Two patients had side effects, general weakness, instability, and focal haematoma. CONCLUSIONS: Botulinum toxin type A proved a highly useful adjuvant therapy and conservative management in CP.

Interleukin levels in cerebrospinal fluid from children with neurocysticercosis.

No information about the levels of pro-inflammatory interleukins has been described in children with neurocysticercosis (NCC). The levels of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-5, IL-6, and IL-12 in the cerebrospinal fluid from children with NCC were determined by enzyme-linked immunosorbent assay (ELISA). Twelve children with NCC, six with active and six with inactive disease, and six children without NCC were studied. TNF-alpha was undetectable in CSF from controls and five children with inactive NCC, whereas the levels were significantly higher (median 22.1 pg/ml; P = 0.008) in all children with active NCC. Levels of IL-6 were low in active and inactive NCC patients but two subjects with active subarachnoid disease had high levels. IL-5 and IL-12 were not detected. This study shows that high levels of TNF-alpha are present in CSF from children with active NCC. IL-6 levels are higher when infection occurs in the subarachnoid space.

[Interferons in neurology]. / Interferones en neurología.

Interferon (INF) plays an important role in the immune response against viral infections. INF is part of the big cytokines family. It has also shown modulating activity on numerous components of the immune system; it inhibits cellular division, thus counteracting proliferation of cancerogenic cells. It has also the ability to reduce complications in multiple sclerosis by immunologic mechanism involving. Th2 responses. Recently, the utility of INF in neurological cases has been explored. Good results have been observed using recombinant INF beta-1a and glucosylated INF beta-1 in patients with active multiple sclerosis relapsing-remitting type (MS RR), in whom decreases the incidence and complications and possibly halts the progression of the disease. This manuscript will reviews the biologic activity of INF, the use, side effects and indications for using different INF's in neurological diseases specially in multiple sclerosis, particularly INF beta which are broadly accepted for clinical use in this pathology. We mention the Expanded Disability Status Scale (EDSS) to evaluate clinical involvement and recuperation after management.

[Giant aneurysms not amenable to direct treatment by ligation of the carotid artery]. / Aneurismas gigantes no susceptibles a tratamiento directo con ligadura de la arteria carótida.

Surgical treatment of giant aneurysms are a challenge. Optimal treatment for an intracranial aneurysm is the direct approach, and also clipping the neck of the aneurysm and preservation of the parent vessel. These surgical procedures are not always possible to carry out even with state-of-the-art in neurological surgery. This is the case for giant aneurysms. Carotid ligation remains a good alternative for ophthalmic, intercavernous sinus, and giant aneurysms of the internal carotid artery. We present two patients with unclippable carotid artery aneurysms, one in the intercavernous sinus, and the other in the internal carotid. These were treated by progressive ligature of the carotid artery at the neck. The ligation was done after angiographic and CT scan evaluation. Tolerance to carotid occlusion was evaluated by electroencephalogram and somatosensory evoked potential monitoring, and the procedure was undertaken gradually. Outcome of the two patients was gradual improvement of oculomotor nerve palsy and decrease of ocular pain. These results of treatment and favorable evolution suggest that this treatment is a useful alternative in the management of unclippable carotid aneurysm. Acute or long-term complications were not observed.

[Parinaud's syndrome in children]. / Síndrome de Parinaud en niños.

OBJECTIVE: To describe the clinical and ethiologic findings of children with Parinaud's syndrome. MATERIAL AND METHODS: 11 children fulfilling the clinical criteria for Parinaud's syndrome were studied. The mean age was 10 years with a range of 10 months to 14 years. RESULTS: Seven cases were tumors (pineal germinoma in four and one each with teratoma, astrocytoma, and an undefined tumor); the remaining 4 cases corresponded to arachnoid cyst in the III ventricule, cysticercosis, tuberculoma and multiple sclerosis. The main treatment was surgical including ventriculoperitoneal shunt because of hydrocephalous secondary to mechanical obstruction. Chemotherapy and radiotherapy were also used for the tumor cases, and steroids for the multiple sclerosis patient. CONCLUSIONS: In contrast to adults, Parinaud's syndrome in our children was associated with a mass, mainly tumoral, which interrupted the afferent and efferent connections of the midbrain structures, such as posterior commissure, riMLF or the interstitial nucleus of Cajal.

[Pain in the Guillain-Barré syndrome in children]. / El dolor en el síndrome de Guillain-Barré en niños.

In Guillain-Barré syndrome (GBS) painful involvement has not been considered as a major clinical manifestation for diagnostic criteria among children. Was to evaluate whether clinical our purpose painful sensations are the main manifestations in pediatric patients with GBS. Twenty patients that fulfilled the Asbury criteria for diagnosis of GBS were studied prospectively from January, 1992 to June, 1994. Painful sensations were evaluated considering segmentary level with special focus in intensity, modality, topography distribution from the beginning to the resolution of the paralysis and effect to analgesic therapy every day for the first week and weekly thereafter. Patients had a mean age of 9.6 years (SD 5.4). Twelve patients were males and eight were females. All the patients but one complained of pain during some time of the course of illness, (19/20, 95%). At the illness onset, pain sensations were spontaneously referred in 12/20 (60%) of the cases, after anamnesis in 3/20 (15%) and physical exam in 4/20 (20%). Pain distribution during acme occurred in feet, thighs and legs in 95% of patients; back, arms and forearms in 65%, buttocks, shoulders and hands in 35%. The highest intensity of pain took place the first week of the illness course, and the mean time of decreasing occurred with a median of three days after onset with complete resolution three weeks later. We report that pain was an early and main clinical manifestation of GBS in children. We suggest that pain must be considered as a relevant criterium for GBS diagnosis in pediatric patients.

[SPECT-99mTc-HMPAO in a case of epilepsia partialis continua and focal encephalitis]. / SPECT-99mTc-HMPAO en un caso de epilepsia parcial continua y encefalitis focal.

A case of epilepsia partialis continua (EPC) in a eight year old girl is presented. The episode EPC involved the left side of the face and the left arm and leg with progressive neurologic deficit and mental impairment. The focal seizures did not respond to treatment with a wide variety of antiepileptic drugs. The patient was studied with a 99mTc HMPAO-SPECT in addition to EEG, CT and MRI procedures. During the ictal period the SPECT showed an increased cerebral blood flow in the right hemisphere especially in the Rolandic area and the temporal lobe; during the interictal period a decreased flow was seen in the same regions. The EEG showed marked epileptogenic activity consisting of continued spike and slow wave discharges over the right brain hemisphere; the CT scan was normal and the MRI showed an increased signal intensity in the white and gray matter in the right hemisphere, especially in the frontal and temporal lobes. A temporal lobectomy and a frontal corticectomy were done. The pathologic specimens showed changes consistent with viral encephalitis (Rasmussen's syndrome). The patient has not had seizures in the ten months after surgery. She returned to school three months after surgery, and her IQ was normal. This report illustrates the usefulness of the 99mTc HMPAO-SPECT technique for the diagnosis and the management of EPC cases.

[Should computed axial tomography of the skull be done in all pediatric patients with epilepsy?]. / Se debe realizar tomografía axial computada de cráneo en todos los pacientes pediátricos con epilepsia?

The charts of 118 children with epilepsy (64 boys and 54 girls) from the Pediatric Hospital of the National Medical Center, Mexican Institute of Social Security, were surveyed. Results are as follow: 21% had a family history of epilepsy; 15.3% had pathological findings in simple skull x-ray. In 50% of the cases there were a normal CT scan and in the remaining 50% there were pathological findings, such as cerebral atrophy (12.7%) and neurocysticercosis (10%). The CT scan was abnormal in 51% of partial seizures cases and in 41.8% of those with generalized seizures. Electroencephalogram (EEG) was abnormal in 85.7% of both simple and complex seizures cases. EEG was abnormal in 85.4% of cases with generalized seizures. We do not intend to establish a comparison between EEG and CT scan, but to show the usefulness of CT scan in children with epilepsy. Finally an algorithm for correct CT scan prescription in children with epilepsy is proposed.