[Mismatch negativity and conscience level in severe traumatic brain injury]. / Mismatch negativity y nivel de conciencia en el traumatismo craneoencefálico grave.

INTRODUCTION: The mismatch negativity (MMN) is a component of the long-latency auditory evoked potentials, that are used to check the functionality of automatic attentional processes of attentive information processing. Vegetative state diagnosis is frequent following severe traumatic brain injury (TBI). Eventually, some patients improve their condition to another one called minimal conscientious state. AIM: To evaluate the diagnostic usefulness of MMN in severe TBI patients during the subacute phase after leaving the neurological intensive care unit. PATIENTS AND METHODS: We gathered MMN results from 19 patients (12 males and 7 females; 8 vegetative state and 11 minimal conscientious state) with ages between 17 and 59 years (mean: 27.3 years). The delay between TBI onset and MMN recordings were greater than 2 months (mean: 181 days). During the recording session, patients were evaluated by means of the Multisociety Task Force on Persistent Vegetative State scale. RESULTS: All the minimal conscientious state patients (100%) showed MMN potential. In seven of the vegetative state patients (87.5%) the MMN was not found. The remaining MMN potential positive vegetative state patient improved to MCS 16 days after testing. CONCLUSIONS: MMN is a valid tool for differentiating vegetative state from MCS during the subacute phase of severe TBI. Hence it is a useful aid to the clinical evaluation. This would diminish the impact of a possible diagnostic error and its prognosis on therapeutical management, family and health costs. It can also be used for evaluating other brain disorders with altered consciousness.

Mismatch negativity y nivel de conciencia en el traumatismo craneoencefálico grave / Mismatch negativity and conscience level in severe traumatic brain injury

Introducción. El componente mismatch negativity (MMN) es un potencial evocado de larga latencia que refleja el funcionamiento de un mecanismo automático y preatencional del procesamiento de estímulos. El estado vegetativo es un diagnóstico muy frecuente tras un traumatismo craneoencefálico (TCE) grave que, en ocasiones, evoluciona hacia un nivel de conciencia superior denominado estado de respuesta mínima. Objetivo. Evaluar la utilidad diagnóstica de la MMN en pacientes que han sufrido un TCE grave en fase subaguda tras la salida de la Unidad de Cuidados Intensivos. Pacientes y métodos. Se ha realizado MMN auditiva a 19 pacientes (12 hombres y 7 mujeres), con edades comprendidas entre 17 y 59 años (media: 27,3 años), que sufrieron TCE grave hacía más de dos meses (media: 181 días). En el momento de la prueba, ocho se encontraban en estado vegetativo, y 11, en estado de respuesta mínima. Resultados. El 100% (11/11) de los pacientes en estado de respuesta mínima presentaron potencial MMN. En siete de los pacientes en estado vegetativo no se recogió el potencial (87,5%). El paciente vegetativo en el que se obtuvo MMN pasó a estado de respuesta mínima a los 16 días. Conclusiones. La MMN es una herramienta de gran utilidad en la fase subaguda de un TCE grave para el diagnóstico diferencial entre estado vegetativo y estado de respuesta mínima, refrendando el juicio clínico y minimizando las consecuencias familiares, sanitarias, sociales y económicas derivadas de un posible error, y abriendo la posibilidad de ser aplicada a otras patologías cerebrales adquiridas

Introduction. The mismatch negativity (MMN) is a component of the long-latency auditory evoked potentials, that are used to check the functionality of automatic attentional processes of attentive information processing. Vegetative state diagnosis is frequent following severe traumatic brain injury (TBI). Eventually, some patients improve their condition to another one called minimal conscientious state. Aim. To evaluate the diagnostic usefulness of MMN in severe TBI patients during the subacute phase after leaving the neurological intensive care unit. Patients and methods. We gathered MMN results from 19 patients (12 males and 7 females; 8 vegetative state and 11 minimal conscientious state) with ages between 17 and 59 years (mean: 27.3 years). The delay between TBI onset and MMN recordings were greater than 2 months (mean: 181 days). During the recording session, patients were evaluated by means of the Multisociety Task Force on Persistent Vegetative State scale. Results. All the minimal conscientious state patients (100%) showed MMN potential. In seven of the vegetative state patients (87.5%) the MMN was not found. The remaining MMN potential positive vegetative state patient improved to MCS 16 days after testing. Conclusions. MMN is a valid tool for differentiating vegetative state from MCS during the subacute phase of severe TBI. Hence it is a useful aid to the clinical evaluation. This would diminish the impact of a possible diagnostic error and its prognosis on therapeutical management, family and health costs. It can also be used for evaluating other brain disorders with altered consciousness

Epilepsia y embarazo / Epilepsy and pregnancy

Introducción. El tratamiento de la paciente con epilepsia durante la gestación constituye un importante dilema clínico. Por un lado, hay que mantener a la paciente libre de crisis, y por otro, procurar mantener a la paciente en monoterapia y con la menor dosis posible, por los efectos que éstos pueden tener sobre la descendencia. Desarrollo. Existe un síndrome relacionado con la exposición intraútero de fármacos epilépticos clásicos, que no se puede asociar a un determinado fármaco. Sin embargo, todavía hay una gran incógnita sobre los efectos de los nuevos fármacos antiepilépticos sobre los futuros hijos. Hasta el momento no se ha descrito ningún patrón de malformaciones específico para ninguno de estos fármacos. Entre ellos, la lamotrigina es con el que se tiene una experiencia clínica más amplia, y aunque el número de casos registrados hasta la actualidad es insuficiente para obtener conclusiones definitivas, de momento no se ha observado que haya una mayor incidencia de anomalías congénitas en comparación con la población normal. Conclusiones. Los nuevos fármacos antiepilépticos presentan una importante ventaja terapéutica, no sólo en el manejo de la epilepsia en diferentes situaciones clínicas, sino con los buenos resultados que se han observado con la utilización de lamotrigina en la paciente epiléptica en edad reproductiva (AU)

[Epilepsy and pregnancy]. / Epilepsia y embarazo.

INTRODUCTION: Treatment of the epileptic patient during pregnancy poses a major clinical dilemma. For one thing the patient has to be kept free of seizures, but she also should be kept on monotherapy at the lowest possible dose, due to the effect such medication may have on the unborn child. DEVELOPMENT: There is a syndrome related to intra uterine exposure to the classical antiepileptic drugs, but which is not associated with any particular drug. However, the effect of the new antiepileptic drugs on unborn children is still unknown. To date, no specific pattern of malformations has been described in relation to any of these drugs. Lamotrigine is the one with which there is most clinical experience. Although there are still not enough cases studied to permit definite conclusions to be drawn, at the moment the incidence of congenital anomalies is the same as in the general population. CONCLUSIONS: The new anti-epileptic drugs have a major therapeutic advantage, not only in the management of epilepsy in different clinical situations, but also in the good results observed when using lamotrigine in patients of fertile age.

Genomic and cDNA structures of the gene encoding the chicken ZF5 DNA binding protein.

Genomic and cDNA clones encoding the chicken ZF5 transcription factor were isolated and sequenced. Conceptual translation of the cDNAs indicates that chicken ZF5 has five zinc fingers at its C-terminal end and a POZ/BTB protein-interaction domain at its N-terminal end. These two functional domains are more than 99% identical in amino acid sequence between the chicken and mouse proteins, whereas the region separating the POZ/BTB and DNA binding domains is only 74% identical. The entire 458 amino acid open reading frame is contained within a single exon, except for the initiator methionine codon which alone is supplied from an upstream exon by mRNA splicing.

Identification of proximal sequence element nucleotides contributing to the differential expression of variant U4 small nuclear RNA genes.

The two U4 genes in the chicken genome code for distinct sequence variants of U4 small nuclear RNA that are differentially expressed during development. Whereas U4B RNA is constitutively expressed, U4X RNA is specifically down-regulated relative to U4B in a tissue-specific manner during development. To investigate mechanisms controlling the differential expression of the U4B and U4X genes, chimeric U4 genes were constructed and their transcriptional activities assayed by injection into Xenopus oocytes or by transfection of CV-1 cells. The proximal regulatory region of the U4B gene and the enhancers of both the U4B and U4X genes functioned efficiently in each expression system. However, the proximal region of the U4X gene was inactive. To localize and identify the responsible nucleotides, reciprocal point mutations were introduced into the U4X and U4B proximal regulatory regions. The results indicate that the U4X gene contains a suboptimal proximal sequence element, and that this results primarily from the identities of the nucleotides at positions -61 and -57 relative to the transcription start site.