Espasmo hemifacial desencadenado por migraña: un caso más / Migraine-triggered hemifacial spasm: another case study

No disponible

Estimulación cerebral profunda en los trastornos del humor: ¿tan fácil como parece? / Deep brain stimulation in mood disorders: is it as easy as it seems?

No disponible

No disponible

Estimulación eléctrica del nervio facial con función pronóstica en la cirugía de parótida / Electrical stimulationof the facial nerve with a prognostic function in parotid surgery

Introducción. La electromiografía continua durante la parotidectomía y la estimulación directa del nervio facial como técnica de identificación intraoperatoria disminuyen la morbilidad postoperatoria significativamente. Objetivo. Determinar la utilidad de los parámetros neurofisiológicos intraoperatorios obtenidos mediante estimulación eléctrica del nervio facial como valores predictivos del tipo de lesión y pronóstico funcional. Pacientes y métodos. Serie correlativa de 20 casos de parotidectomía monitorizada. Se compara la función facial postoperatoria, tipo de lesión y su pronóstico con las variaciones de latencia/amplitud de la respuesta muscular entre dos estimulaciones del nervio facial pre y posresección, además de la ausencia o presencia de respuesta muscular a la estimulación posresección. Resultados. Todos los pacientes menos uno presentaron potencial evocado motor (PEM) a la estimulación posresección. El 55% obtuvo indemnidad facial postoperatoria y el 45% presentó algún tipo de paresia. La caída de amplitud del PEM intraoperatorio del 21% y el aumento de la latencia media del 13,5% se corresponden con las lesiones axonales y desmielinizantes, respectivamente, con un tiempo medio de recuperación de tres y seis meses. El único caso de ausencia de respuesta a la estimulación posresección presentó una paresia permanente. Conclusiones. La presencia del PEM tras resección no asegura la indemnidad funcional del nervio. Sin embargo, puede considerarse un dato que sugiere menor grado de afectación en el caso de haberlo y mejor pronóstico. Las variaciones de latencia y amplitud de los PEM tienden a ser parámetros indicadores del grado de afectación intraoperatorios y del pronóstico funcional (AU)

Introduction. Continuous electromyography during parotidectomies and direct stimulation of the facial nerve as an intraoperative identification technique significantly lower the rate of post-operative morbidity. Aim. To determine the usefulness of intra-operative neurophysiological parameters registered by means of electrical stimulation of the facial nerve as values capable of predicting the type of lesion and the functional prognosis. Patients and methods. Our sample consisted of a correlative series of 20 cases of monitored parotidectomies. Post-operative facial functioning, type of lesion and its prognosis were compared with the variations in latency/amplitude of the muscle response between two stimulations of the facial nerve before and after resection, as well as in the absence or presence of muscle response to stimulation after resection. Results. All the patients except one presented motor evoked potentials (MEP) to stimulation after resection. There was no facial damage following the operation in 55% of patients and 45% presented some kind of paresis. The 21% drop in the amplitude of the intra-operative MEP and the mean increase in latency of 13.5% correspond to axonal and demyelinating insult, respectively, with a mean recovery time of three and six months. The only case of absence of response to the post-resection stimulation presented permanent paresis. Conclusions. The presence of MEP following resection does not ensure that functioning of the nerve remains undamaged. Nevertheless, it can be considered a piece of data that suggests a lower degree of compromise, if it is present, and a better prognosis. The variations in latency and amplitude of the MEP tend to be intra-operative parameters that indicate the degree of compromise and functional prognosis (AU)

[Electrical stimulation of the facial nerve with a prognostic function in parotid surgery]. / Estimulación eléctrica del nervio facial con función pronóstica en la cirugía de parótida.

INTRODUCTION: Continuous electromyography during parotidectomies and direct stimulation of the facial nerve as an intraoperative identification technique significantly lower the rate of post-operative morbidity. AIM: To determine the usefulness of intra-operative neurophysiological parameters registered by means of electrical stimulation of the facial nerve as values capable of predicting the type of lesion and the functional prognosis. PATIENTS AND METHODS: Our sample consisted of a correlative series of 20 cases of monitored parotidectomies. Post-operative facial functioning, type of lesion and its prognosis were compared with the variations in latency/amplitude of the muscle response between two stimulations of the facial nerve before and after resection, as well as in the absence or presence of muscle response to stimulation after resection. RESULTS: All the patients except one presented motor evoked potentials (MEP) to stimulation after resection. There was no facial damage following the operation in 55% of patients and 45% presented some kind of paresis. The 21% drop in the amplitude of the intra-operative MEP and the mean increase in latency of 13.5% correspond to axonal and demyelinating insult, respectively, with a mean recovery time of three and six months. The only case of absence of response to the post-resection stimulation presented permanent paresis. CONCLUSIONS: The presence of MEP following resection does not ensure that functioning of the nerve remains undamaged. Nevertheless, it can be considered a piece of data that suggests a lower degree of compromise, if it is present, and a better prognosis. The variations in latency and amplitude of the MEP tend to be intra-operative parameters that indicate the degree of compromise and functional prognosis.

[The usefulness of electromyographical monitoring with intraoperative brain mapping during motor lesionectomy]. / Utilidad de la monitorización electromiográfica durante la estimulación eléctrica cortical intraoperatoria en áreas motoras.

INTRODUCTION: Surgery for resection of supratentorial lesions near the motor areas and/or internal capsule carries an associated risk of damage to cortical or subcortical motor pathways. Intraoperative brain mapping, using direct cortical electric stimulation, is a surgical adjunct used during lesionectomy in functional cortex. The technique of observing movements elicited by electrical stimulation has proved useful for intraoperative localization of motor pathways but it is difficult observe the entire body at once. Thus, a small movement may be missed while attention is focused on another site. AIM: To determinate the usefulness of electromyographical monitoring in locating motor pathways during neurosurgery in functional cortex. PATIENTS AND METHODS: We recorded multichannel electromyography activity during cortical and subcortical electric stimulation in a consecutive series of 40 patients undergoing craniotomies for lesionectomy near motor cortex or subcortical motor tracts. Because the aim of the electromyography recordings was to sample as many muscles as possible, the two electrodes connected to each different amplifier input were placed in different muscles in the same region of the body. RESULTS: No motor responses were detected by either electromyographical monitoring or visual inspection in 20% patients. Electromyographical activity was the only indication of motor response in 17%. Motor responses were detected simultaneously by either electromyographical monitoring and visual inspection in 76%. CONCLUSIONS: Electromyography monitoring enhances the ability to detect the location of primary motor cortex and subcortical pathways with electrical stimulation during neurosurgery.

Utilidad de la monitorización electromiográfica durante la estimulación eléctrica cortical intraoperatoria en áreas motoras / The usefulness of electromyographical monitoring with intraoperative brain mapping during motor lesionectomy

Introducción. La resección de lesiones adyacentes a áreas sensitivomotoras conlleva el riesgo de lesionar las vías motoras corticosubcorticales. La realización de un mapa funcional de la corteza expuesta en la craneotomía mediante estimulación eléctrica cortical mejora notablemente los índices de resecabilidad lesional y reduce los riesgos de morbimortalidad. La valoración de la respuesta tras el estímulo consiste en detectar un movimiento o una contracción muscular en el paciente. En algunas ocasiones, debido a la posición del paciente, la iluminación o por tratarse de una contracción mínima, esta respuesta puede pasar desapercibida. Objetivo. Determinar la utilidad de la monitorización electromiográfica simultánea a la estimulación eléctrica corticosubcortical como ayuda a la localización de áreas motoras. Pacientes y métodos. Se registra la actividad electromiográfica simultánea en múltiples grupos musculares durante la estimulación eléctrica cortical y subcortical con electrodos de superficie en una serie consecutiva de 40 pacientes sometidos a craneotomías para resección de lesiones cercanas a áreas funcionales motoras. Al pretender monitorizar el mayor número posible de músculos, cada electrodo (activo e indiferente) se coloca en dos músculos adyacentes en la misma región del cuerpo por cada amplificador. Resultados. No se objetivaron respuestas motoras clínicas ni electromiográficas en el 20% de los pacientes. Se detectó sólo respuesta electromiográfica en el 17% de los pacientes. La respuesta motora clínica y electromiográfica fue simultánea en el 76% de los pacientes. Conclusiones. La utilización de monitorización electromiográfica durante el mapeo cortical con estimulación eléctrica facilita la localización de la corteza motora primaria y las vías motoras subcorticales (AU)

Associated risk of damage to cortical or subcortical motor pathways. Intraoperative brain mapping, using direct cortical electric stimulation, is a surgical adjunct used during lesionectomy in functional cortex. The technique of observing movements elicited by electrical stimulation has proved useful for intraoperative localization of motor pathways but it is difficult observe the entire body at onces. Thus, a small movement may be missed while attention is focused on another site. Aim. To determinate the usefulness of electromyographical monitoring in locating motor pathways during neurosurgery in functional cortex. Patients and methods. We recorded multichannel electromyography activity during cortical and subcortical electric stimulation in a consecutive series of 40 patients undergoing craniotomies for lesionectomy near motor cortex or subcortical motor tracts. Because the aim of the electromyography recordings was to sample as many muscles as possible, the two electrodes connected to each different amplifier input were placed in different muscles in the same region of the body. Results. No motor responses were detected by either electromyographical monitoring or visual inspection in 20% patients. Electromyographical activity was the only indication of motor response in 17%. Motor responses were detected simultaneously by either electromyographical monitoring and visual inspection in 76%. Conclusions. Electromyography monitoring enhances the ability to detect the location of primary motor cortex and subcortical pathways with electrical stimulation during neurosurgery (AU)

[Indications of neurophysiological studies in lower back pain]. / Indicaciones de los estudios neurofisiológicos en el dolor lumbar.

INTRODUCTION: Between 60% and 90% of people in developed countries experience lower back pain at some time in their life and it is therefore one of the most frequent reasons for visiting the specialist in neurology. On many occasions there is no correlation between the symptoms, the clinical pathology and the radiological features. AIM. To determine suitable indications and the appropriate time to conduct neurophysiological studies in lower back pain. DEVELOPMENT: We review the neurophysiological techniques that are most commonly used today and the most frequent findings in patients with acute, subacute or chronic lower back pain, and acute or chronic lumbar-radicular pain. CONCLUSIONS: There is no scientific evidence to prove that neurophysiological studies provide information that modifies the conservative treatment that must be established in patients with acute, subacute or chronic lower back pain, and acute lumbar-radicular pain. In patients with subacute or chronic lumbar-radicular pain, the first neurophysiological studies must be conducted between three weeks and six months after the onset of symptoms. Electromyography is the most sensitive neurophysiological test. Neurophysiological studies are carried out provided that their findings involve changes in the patient's therapeutic attitude, in the pre-operative evaluation and to confirm the extent of injury; they therefore offer prognostic data.

Indicaciones de los estudios neurofisiológicos en el dolor lumbar / Indications of neurophysiological studies in lower back pain

Introducción. Alrededor del 60-90% de las personas depaíses desarrollados experimenta dolor lumbar en algún momentode su vida y éste es una de las causas más frecuentes de consulta enneurología. En numerosas ocasiones, los síntomas, la anatomía patológicay el aspecto radiológico no se correlacionan. Objetivo. Establecerlas indicaciones adecuadas y el momento cronológico apropiadopara la realización de los estudios neurofisiológicos en eldolor lumbar. Desarrollo. Se revisan las técnicas neurofisiológicasmás utilizadas en la actualidad y los hallazgos más frecuentes enpacientes con lumbalgia aguda, subaguda o crónica, y lumbociáticaaguda o crónica. Conclusiones. No hay evidencia científica de quelos estudios neurofisiológicos aporten información que modifique eltratamiento conservador que debe hacerse en pacientes con lumbalgiaaguda, lumbalgia subaguda o crónica, y lumbociática aguda.En pacientes con lumbociática subaguda o crónica, los primerosestudios neurofisiológicos deben realizarse entre las tres semanas ylos seis meses del inicio de la sintomatología. La electromiografía esel test neurofisiológico con mayor sensibilidad. Los estudios neurofisiológicosse realizan siempre que sus resultados impliquen cambiosen la actitud terapéutica del paciente, en la evaluación prequirúrgicay para confirmar el nivel de la lesión, de manera que aportaninformación pronóstica

Introduction. Between 60% and 90% of people in developed countries experience lower back pain at some time intheir life and it is therefore one of the most frequent reasons for visiting the specialist in neurology. On many occasions thereis no correlation between the symptoms, the clinical pathology and the radiological features. Aim. To determine suitableindications and the appropriate time to conduct neurophysiological studies in lower back pain. Development. We review theneurophysiological techniques that are most commonly used today and the most frequent findings in patients with acute,subacute or chronic lower back pain, and acute or chronic lumbar-radicular pain. Conclusions. There is no scientific evidenceto prove that neurophysiological studies provide information that modifies the conservative treatment that must be establishedin patients with acute, subacute or chronic lower back pain, and acute lumbar-radicular pain. In patients with subacute orchronic lumbar-radicular pain, the first neurophysiological studies must be conducted between three weeks and six monthsafter the onset of symptoms. Electromyography is the most sensitive neurophysiological test. Neurophysiological studies arecarried out provided that their findings involve changes in the patient’s therapeutic attitude, in the pre-operative evaluationand to confirm the extent of injury; they therefore offer prognostic data

Estudios neurofisiológicos de la unión neuromuscular / Neurophysiological studies of the neuromuscular junction

Introducción. El papel de los estudios neurofisiológicos (ENF) en el diagnóstico de las enfermedades de la transmisión neuromuscular (TNM) se fundamenta en el estudio del fallo de la fibra muscular para alcanzar una despolarización suficiente para que el potencial de placa alcance el umbral adecuado y conseguir un potencial de acción muscular. Este impulso bloqueado total o parcialmente originará los distintos tipos de respuestas en los tests neurofisiológicos. Objetivo. Analizar los distintos ENF aplicados como método diagnóstico en las enfermedades que alteran la TNM. Desarrollo. Se revisa el concepto de margen de seguridad de la placa motora y se describen las técnicas neurofisiológicas más utilizadas en la actualidad –estimulación repetitiva, electromiografía (EMG) convencional, de fibra aislada con activación voluntaria y con activación eléctrica axonal– y los hallazgos más frecuentes en las enfermedades de la TNM. Conclusiones. Los ENF servirán para confirmar o no el diagnóstico clínico, excluir otras enfermedades neuromusculares concomitantes, determinar si el proceso es pre o postsináptico, monitorizar el curso clínico de la enfermedad, tanto si es natural o en respuesta al tratamiento médico o quirúrgico, y permiten, además, determinar el estado de la TNM en los casos de remisión clínica, así como detectar trastornos subclínicos. Los estudios de EMG de fibra aislada son el diagnóstico neurofisiológico que muestra una mayor sensibilidad en el diagnóstico de estas enfermedades (AU)

Introduction. The role played by neurophysiological studies (NPS) in the diagnosis of diseases affecting neuromuscular transmission (NMT) is based on the study of the failure of muscle fibres to achieve a sufficient degree of depolarisation for the junction potential to reach the appropriate threshold and attain a muscular action potential. This totally or partially blocked impulse will give rise to different types of responses in neurophysiological tests. Aims. To analyse the different NPS as diagnostic methods in diseases that affect NMT. Development. The article offers a review of the concept of the safety margin at the neuromuscular junction and a description of the most common neurophysiological techniques currently in use –repetitive stimulation, as well as conventional or single fibre electromyography (EMG) with voluntary activation or axonal electrical activation–. The most frequent findings in diseases affecting NMT are also discussed. Conclusions. NPS will be useful to confirm or reject the clinical diagnosis, to exclude other concomitant neuromuscular diseases, to establish whether the process is pre- or post-synaptic, to monitor the clinical course of the disease (when it is both natural or in response to the medical or surgical treatment) and also to enable the physician to determine the status of NMT in cases of clinical remission, as well as to detect subclinical disorders. Single fibre EMG studies are the most sensitive method of neurophysiological diagnosis when dealing with these diseases (AU)

[Neurophysiological studies of the neuromuscular junction]. / Estudios neurofisiológicos de la unión neuromuscular.

INTRODUCTION: The role played by neurophysiological studies (NPS) in the diagnosis of diseases affecting neuromuscular transmission (NMT) is based on the study of the failure of muscle fibres to achieve a sufficient degree of depolarisation for the junction potential to reach the appropriate threshold and attain a muscular action potential. This totally or partially blocked impulse will give rise to different types of responses in neurophysiological tests. AIMS: To analyse the different NPS as diagnostic methods in diseases that affect NMT. DEVELOPMENT: The article offers a review of the concept of the safety margin at the neuromuscular junction and a description of the most common neurophysiological techniques currently in use--repetitive stimulation, as well as conventional or single fibre electromyography (EMG) with voluntary activation or axonal electrical activation. The most frequent findings in diseases affecting NMT are also discussed. CONCLUSIONS: NPS will be useful to confirm or reject the clinical diagnosis, to exclude other concomitant neuromuscular diseases, to establish whether the process is pre- or post-synaptic, to monitor the clinical course of the disease (when it is both natural or in response to the medical or surgical treatment) and also to enable the physician to determine the status of NMT in cases of clinical remission, as well as to detect subclinical disorders. Single fibre EMG studies are the most sensitive method of neurophysiological diagnosis when dealing with these diseases.

[Diagnosis of peripheral neuropathies: a clinical and neurophysiological study]. / Sobre el diagnóstico de las neuropatías periféricas: estudio clínico y neurofisiológico.

INTRODUCTION: The diagnosis of peripheral neuropathy is based on clinical and neurophysiological features. This study aims to establish the diagnostic validity of different symptoms and clinical signs, as well as its correlation with electroneurography (ENG), to determine its sensitivity (SE), specificity (SP), positive (PLR) and negative likelihood ratio (NLR) for every peripheral neuropathies type. PATIENTS AND METHODS: A sample of 108 patients with clinical suspicion of peripheral neuropathy (pain, paresthesias, loss of strength, areflexia) was studied. ENG (nerve conduction velocity and response amplitude values in 208 nerves [Median and Posterior Tibial]) was used to confirm the diagnosis, classifying the sample in axonal group (A), demyelinating (D) and normal (N). It was made descriptive statistics of this sample, studies of SE, SP, PLR and NLR of symptoms, and association (contingency tables [Chi square] and Odds Ratio) between symptoms and clinical features. RESULTS: The patients with paresthesias, loss of strength or pathologic reflexes have larger motor latency (p< 0.01). Those with paresthesias, areflexia or pain have fewer sensitive conduction velocity (p< 0.05). Symptoms's value for sensory damage's diagnosis is (SE= 0.92, SP= 0.48, PLR= 1.78, NLR= 0.14). For motor damage (SE= 0.72, SP= 0.68, PLR= 2.25, NLR= 0.41). For axonal damage (SE= 0.83, SP= 0.44, PLR= 1.49, NLR= 0.37). And for demyelinating damage (SE= 0.92, SP= 0.44, PLR= 1.66, NLR= 0.16). CONCLUSIONS: The symptoms's combination is much more sensitive and has fewer NLR than each isolated symptom in all neuropathic damage's types. Paresthesias's presence is more indicative of sensory damage and loss of strength of motor damage. Pain is the only symptom that can aim for axonal damage than demyelinating.

Consumo de derivados de Cocaína en pacientes incluidos en un programa de mantenimiento con Metadona / Consumption of cocaine derived in patients included in methadone treatment

Se ha realizado un estudio sobre el consumo de cocaína y derivados, en pacientes incluidos en el Programa de Mantenimiento con Metadona (P.M.M.) de los centros de la Asociación de Cooperación Juvenil San Miguel. Se ha comprobado que prácticamente la mitad (45,7 por ciento) consumen habitualmente este tipo de drogas. Asimismo se ha detectado un progresivo aumento de la frecuencia de consumo y cantidades consumidas por estos pacientes durante los últimos tres años. La forma de consumo preferente (90,4 por ciento) en la actualidad es el 'crack', lo cual se debe, entre otros factores, a la mayor facilidad para la obtención de este tipo de droga en la calle. El 66,6 por ciento de los pacientes refiere consumo de, además de cocaína y derivados, otras drogas como cannabis, benzodiacepinas y alcohol. El 69,5 por ciento de los encuestados han iniciado el consumo de este tipo de drogas antes de ser atendidos en los P.M.M., siendo la edad media de inicio para el clorhidrato de cocaína y 'crack', 18,3 y 25,6 años respectivamente. Sólo un 23,7 por ciento confiesan consumir cocaína por sus efectos estimulantes, señalando como principal causa (52,5 por ciento) de consumo los efectos 'placenteros' de la misma. El 53,3 por ciento de los encuestados consideran el 'crack' más peligroso, incluso que la heroína, aunque esta última es considerada la más adictiva (67,6 por ciento). La práctica totalidad (93,8 por ciento) manifiesta que el 'crack' afecta a su salud, sin embargo paradójicamente el 26,7 por ciento de los pacientes consideran que no necesitan dejar de consumirlo. El 29,5 por ciento declara haber intentado, sin éxito, dejar el consumo. Los efectos predominantes que manifiestan como consecuencia del consumo del 'crack' son: pérdida de apetito (88,7 por ciento),pérdida de peso (84,5 por ciento), taquicardias (84,5 por ciento), pupilar dilatadas (76,3 por ciento), cambios de ánimo (84,5 por ciento), pérdida de memoria (59,7 por ciento), falta de concentración (78,3 por ciento), irritabilidad (71,1 por ciento) (AU)

Sobre el diagnóstico de las neuropatías periféricas: estudio clínico y neurofisiológico / About peripheral neuropathies diagnosis: a clinical and neurophysiological study

Introducción. El diagnóstico de neuropatía periférica está basado en los hallazgos clínicos y neurofisiológicos. Objetivo. Establecer la validez diagnóstica de los síntomas y signos clínicos, así como su correlación con los estudios de electroneurografía (ENG), para determinar su sensibilidad (S), especificidad (E), y cociente de probabilidad positivo (CPP) y negativo (CPN) en cada tipo de neuropatía. Pacientes y métodos. Muestra de 108 pacientes con sospecha clínica de neuropatía periférica (dolor, parestesias, pérdida de fuerza, arreflexia). La ENG (estudios de conducción nerviosa y valores de respuesta en amplitud de 208 nervios [mediano y tibial posterior]) se usó para confirmar el diagnóstico, clasificando la muestra en grupo axonal (A), desmielinizante (D) y normal (N). Se realizó estadística descriptiva de la muestra, estudio de S, E, CPP y CPN de los síntomas, y asociación (tablas de contingencia con ji al cuadrado y odds ratio) entre síntomas y hallazgos clínicos. Resultados. Los pacientes con parestesias, pérdida de fuerza o arreflexia tienen mayor latencia motora (p< 0,01), y aquellos con parestesias, arreflexia o dolor tienen menor velocidad de conducción sensitiva (p< 0,05). El valor de los síntomas para el diagnóstico de afección sensitiva es (S= 0,92, E= 0,48, CPP= 1,78, CPN= 0,14). Para afección motora es (S= 0,72, E= 0,68, CPP= 2,25, CPN= 0,41). Para afección axonal (S= 0,83, E= 0,44, CPP= 1,49, CPN= 0,37). Y para afección desmielinizante (S= 0,92, E= 0,44, CPP= 1,66, CPN= 0,16). Conclusiones. La combinación de los síntomas es mucho más sensible y tiene menor CPN que los síntomas aislados en todos los tipos de neuropatía. La presencia de parestesias es más indicativa de lesión sensitiva y la pérdida de fuerza de lesión motora.El dolor es el único síntoma que puede orientar más al diagnóstico de lesión axonal que desmielinizante (AU)

[Protocol of intraoperative neurophysiological spinal cord monitoring]. / Protocolo de monitorizacion neurofisiológica intraoperatoria de la médula espinal.

INTRODUCTION: The consequences derived from medullar harm caused during several spinal cord surgical interventions can often be catastrophic for the patient, even more taking into consideration that many of them are young. DEVELOPMENT: This problem is observed specially at interventions of spinal malformations (kyphoscoliosis), but also during other surgical techniques like fractures, degenerations, spinal tumors and aortic lesions. The use of somatosensory evoked potentials (SEP) began at late 70's, as a method to monitorize spinal cord function during surgery; years later, motor evoked potentials (MEP) joined this option, giving us direct information about the functioning of posterior spinothalamic tract (posterior column) and lateral corticospinal tract (pyramidal tract), respectively. This has motivated that, although the degree of surgical difficulty and complexity of spinal instrumentation have raised, the actual percentage of neurological complications derived from them has decreased. CONCLUSIONS: This article describes the intraoperative spinal cord monitoring protocol followed at Hospital Clínico San Carlos of Madrid, Spain, which includes the making of SEP and MEP, the latest according to the translaminar stimulation technique.

[Intraoperative electrical cortical stimulation in cerebral lesions]. / Estimulación eléctrica cortical intraoperatoria en lesiones cerebrales.

INTRODUCTION: Intraoperative brain mapping is used during neurosurgery in functional cortex to facilitate the extent of cortical resection and to identify nonfunctional tissue to remove subcortical lesions. OBJECTIVE: To describe the intraoperative brain mapping protocol that has been utilized in the Hospital Clínico San Carlos of Madrid, Spain. Detailed somatotopic motor, sensitive and language localization is possible using direct cortical electric stimulation in the awake patient. CONCLUSIONS: Intraoperative brain mapping is a surgical adjunct used during lesionectomy in functional cortex. In addition to preserving functions, the other essential goal is to achieve a radical removal while attempting to minimize the associated morbidity.

[Carpal tunnel syndrome: clinical and neurophysiological correlation: review of 100 cases]. / Síndrome del túnel del carpo. Correlación clínica y neurofisiológica: revisión de 100 casos.

INTRODUCTION: The diagnosis of carpal tunnel syndrome (CTS) continues to be neurophysiologically and clinically controversial. This study attempts to find the correlation between the subjective symptomatology and the neurophysiological affectation, establishing a diagnostic guide for the family doctor in order to recognize early CTS for referral to the specialist doctor. PATIENTS AND METHODS: After a sample of 100 cases with clinical suspicion of CTS, a clinical evaluation was made with the symptoms (paresthesias, pain, loss of strength), signs (Tinel, Phalen), and the neurophysiological evaluation with electroneurography (ENG) of the median and cubital nerve (sensory velocity (SV), motor distal latency (MDL)), and electromyography (EMG) of tenar eminence muscles. With this data an epidemiological study was made with correlation between the clinical and neurophysiological parameters. RESULTS: The patients with pain, loss of strength and Tinel's sign had significant alteration of the parameters of ENG and EMG. Tinel's sign had a sensitivity (SE) = 30.1% and a specificity (SP) = 73% for MDL, a SE = 32.5% and a SP = 88.2% for SV. Phalen's sign had a SE = 22.2% and a SP = 94.6% for MDL, a SE = 18.1% and a SP = 94.1% for SV. CONCLUSIONS: The guide to recognize clinically the patients which must be studied neurophysiologically that have a high probability to suffer CTS is: diagnosis for motor alteration, pain (SE = 79%), loss of strength (SP = 86%) and Phalen's sign (SP = 94.6%). Sensory alteration: paresthesias (SE = 97%), Tinel's sign (SP = 88.2%) and Phalen's sign (SP = 94.1%).

[Neurophysiological evaluation of the pelvic floor]. / Exploración neurofisiológica del suelo de la pelvis.

INTRODUCTION: Methods for investigating the pelvic floor neurophysiological means are described. These include recording electromyographic activity of pelvic muscles and sphincter, under urodynamics studies or to assess the integrity of innervation of the muscle, pudendal and dorsal nerve of the penis conduction velocity, sacral reflexes and afferent and efferent conduction studies between the cortex and the pelvic floor, under our hospital protocol and a description of the major method from published reports and the clinical applications (Neurogenic bladder, faecal incontinence, male impotence) are discussed.