Vitaminas B neurotrópicas y neuropatía periférica: estado del arte y acuerdo de expertos / Neurotropic B vitamins and peripheral neuropathy: State of the art and agreement of experts

Propósito: La neuropatía periférica tiene un espectro clínico inespecífico y multifactorial, con frecuente subdiagnóstico y terapéutica de eficacia variable. Existe una heterogénea prescripción de vitaminas B, las cuales pueden desempeñar un rol importante en el manejo de diferentes neuropatías; sin embargo, en Colombia no existen guías clínicas al respecto. El propósito de este trabajo es orientar en el reconocimiento temprano de las neuropatías periféricas y generar recomendaciones sobre el uso adecuado de vitaminas B neurotrópicas. Descripción de la metodología: Acuerdo de expertos sobre la neuropatía periférica y el rol terapéutico de las vitaminas B con énfasis en la epidemiología en Colombia, diagnóstico y tratamiento. Contenidos: En Colombia, la prevalencia de neuropatía periférica se estima cercana al 10 %, sin embargo, no hay datos recientes. Dentro de las etiologías más frecuentes se encuentran la neuropatía diabética, infecciosa, inflamatoria, carenciales, toxica y farmacológica. Se recomiendan las siguientes herramientas de tamizaje en población de riesgo: DN4, MNSI, test de monofilamento, test de vibración y valoración de reflejos. Las vitaminas B1, B6 y B12 son seguras, accesibles y pueden ser eficaces en neuropatía periférica, incluso cuando el déficit no ha sido demostrado, pero con requerimientos particulares en su administración conjunta. Conclusiones: Las neuropatías periféricas son un reto diagnóstico y terapéutico que requiere la identificación oportuna para el tratamiento de la etiología subyacente y el control de síntomas. El uso de vitaminas B neurotrópicas es efectivo y seguro en neuropatía periférica carencial, y también parece ser eficaz en el manejo de neuropatías periféricas de diferentes etiologías.

Purpose: Peripheral neuropathy has a nonspecific and multifactorial clinical spectrum, with frequent underdiagnosis and therapeutics of variable efficacy. There is a high but heterogeneous prescription of B vitamins, which can play an important role in the management of different neuropathies; however, in Colombia there are no clinical guidelines in this regard. The purpose of this article is to guide the early recognition of peripheral neuropathy and generate recommendations on the proper use of neurotropic B vitamins. Description of the methodology: Expert agreement on peripheral neuropathy and the therapeutic role of B vitamins with emphasis on epidemiology in Colombia, diagnosis and treatment. Contents: In Colombia, there are no recent data to estimate the prevalence of peripheral neuropathy; the main etiologies are: diabetes mellitus, nutritional deficiencies, herpes zoster and neuropathies due to chemotherapy. Given risk factors in the anamnesis, the use of DN4, MNSI, monofilament test, vibration test and assessment of reflexes is recommended. Vitamins B1, B6, and B12 are safe and can be effective in peripheral neuropathy, even when the deficit has not been demonstrated, but with special requirements in their joint administration. Conclusions: peripheral neuropathies are a diagnostic and therapeutic challenge, and require timely identification, for the treatment of the underlying etiology and symptom control. The use of neurotropic B vitamins is effective and safe in deficient peripheral neuropathy, and also appears to be effective in the management of peripheral neuropathies of different etiologies.

Development of Antiepileptic Drugs throughout History: From Serendipity to Artificial Intelligence.

This article provides a comprehensive narrative review of the history of antiepileptic drugs (AEDs) and their development over time. Firstly, it explores the significant role of serendipity in the discovery of essential AEDs that continue to be used today, such as phenobarbital and valproic acid. Subsequently, it delves into the historical progression of crucial preclinical models employed in the development of novel AEDs, including the maximal electroshock stimulation test, pentylenetetrazol-induced test, kindling models, and other animal models. Moving forward, a concise overview of the clinical advancement of major AEDs is provided, highlighting the initial milestones and the subsequent refinement of this process in recent decades, in line with the emergence of evidence-based medicine and the implementation of increasingly rigorous controlled clinical trials. Lastly, the article explores the contributions of artificial intelligence, while also offering recommendations and discussing future perspectives for the development of new AEDs.

Condiciones neuropsiquiátricas y probable causa de muerte de Maurice Ravel

El músico francés Maurice Ravel (1875-1937) presentó deterioro neurológico progresivo caracterizado por amnesia, afasia, apraxia, amusia y alexia que se inició a los 57 años, cinco antes de su muerte. Se le practicó lo que se conocía entonces como craneotomía exploratoria y falleció como consecuencia de ello. Hay múltiples publicaciones en las cuales su condición neurológica ha sido evaluada para intentar dilucidar qué enfermedad presentó. Se han considerado demencia tipo Alzheimer, enfermedad de Pick, afasia primaria progresiva, degeneración corticobasal o secuelas de trauma craneoencefálico, ya que tuvo un accidente automovilístico en 1932. Dado que no se practicó autopsia, no se ha podido confirmar el diagnóstico exacto. Se hace una revisión de la literatura y aportes originales sobre la condición neurológica y el impacto psicológico que tuvo en este gran genio musical.

Summary The renowned French composer and musician, Maurice Ravel (18751937) exhibited a perplexing case of progressive degenerative neurological symptoms, namely amnesia, aphasia, apraxia, amusia, and alexia. The symptoms started when Ravel was only fairly young, at 57, five years prior to his death in 1937. He was surgically intervened in what was known then as an exploratory craniotomy and passed away. There are a number of publications in which his life and known medical history were dissected and analyzed in an attempt to diagnose the ailment that Ravel suffered. Many diagnoses have been considered, among them Alzheimer's disease, Pick Disease, primary progressive aphasia, corticobasal degeneration, and complications of head injury following a car crash in 1932. Since an autopsy was not performed, an exact diagnosis is rather unlikely, and no one has been able to confirm or deny any of the aforementioned hypotheses. The authors conducted an extensive revision of existent literature and propose some original ideas regarding Ravel's neurological condition, mainly the psychological impact of Ravel's life and experiences and the way they may have influenced his musical genius.

Ivan Petrovich Pavlov and Santiago Ramón y Cajal, scientists and Nobel laureates of a new century.

Pavlov and Cajal were two influential scientists who developed their work in the late nineteenth and early twentieth centuries. Both won the Nobel Prize in Physiology or Medicine. The authors analyze the similarities between their life and work, delving into a single aspect: the Nobel prize obtained by both with only two years of difference: Pavlov in 1904 and Cajal in 1906, shared with Camilo Golgi. Both belonged to two declining empires when nationalism was still of some importance. The theories proposed by them more than 115 years ago are still valid in much of what they contributed in their respective disciplines.

Ivan Petrovich Pavlov and Santiago Ramón y Cajal, scientists and Nobel laureates of a new century / Iván Petrovich Pavlov y Santiago Ramón y Cajal, científicos y premios Nobel de un nuevo siglo

ABSTRACT Pavlov and Cajal were two influential scientists who developed their work in the late nineteenth and early twentieth centuries. Both won the Nobel Prize in Physiology or Medicine. The authors analyze the similarities between their life and work, delving into a single aspect: the Nobel prize obtained by both with only two years of difference: Pavlov in 1904 and Cajal in 1906, shared with Camilo Golgi. Both belonged to two declining empires when nationalism was still of some importance. The theories proposed by them more than 115 years ago are still valid in much of what they contributed in their respective disciplines.

RESUMEN Pavlov y Cajal fueron dos científicos influyentes que desarrollaron su trabajo a finales del siglo XIX y principios del XX. Ambos ganaron el premio Nobel de Fisiología o Medicina. Los autores analizan las similitudes entre su vida y obra, profundizando en un solo aspecto: el premio Nobel obtenido por ambos con tan solo dos años de diferencia: Pavlov en 1904 y Cajal en 1906, compartido con Camilo Golgi. Ambos pertenecían a dos imperios en decadencia, en un momento en que el nacionalismo todavía tenía cierta importancia. Las teorías propuestas por ellos, hace más de 115 años, siguen vigentes en lo fundamental de lo que aportaron en sus respectivas disciplinas.

Breve historia de las lágrimas y el llanto

Las lágrimas y el llanto son fenómenos biológicos enmarcados en diferentes contextos sociales, culturales y de conocimiento a lo largo de los años. Este artículo es una revisión sobre la construcción de las concepciones alrededor de las lágrimas y el llanto. Se exploran las formulaciones en el tema desde las civilizaciones más antiguas, pasando por la discusión alrededor del origen de las lágrimas (corazón vs. cerebro), así como los hallazgos con la introducción de la disección anatómica y la experimentación fisiológica. Finalmente, se exponen las posturas evolucionistas y psicológicas del llanto para estudiar su funcionalidad en la supervivencia y su papel en las relaciones sociales. El objetivo de este es presentar, en forma sucinta, los aspectos históricos de las lágrimas y el llanto.

SUMMARY Tears and crying are biological phenomena framed in different social and cultural contexts throughout the years. This article is a review of the construction of different conceptions around tears and crying. We explore proposals on the subject from the oldest civilizations, going through the discussion around the origin of tears (heart vs. brain), and the findings with the introduction of anatomical dissection and physiological experimentation. Finally, the evolutionary and psychological positions of crying are exposed, to study its functionality in survival and its role in social relations. The aim of this article is to present, succinctly, what have been the tears and crying through the history.

Jean Martin Charcot, padre de la neurología moderna / Jean Martin Charcot, father of modern neurology

RESUMEN Jean Martin Charcot (1825-1893) es considerado el mayor exponente del nacimiento de la neurología en el mundo. Fundó y dirigió el servicio de neurología más grande de Europa en el hospital de la Salpétriére en París y, en 1882, dirigió la primera cátedra universitaria en el mundo sobre enfermedades del sistema nervioso. Existen por los menos 14 epónimos en medicina que recuerdan sus aportes en diferentes disciplinas. Fue un gran pintor, un afamado profesor universitario y demostró grandes habilidades en gestión hospitalaria. Fue uno de los fundadores de la revista Archives de Neurologie, junto con su discípulo Pierre Marie en 1872, y director de la publicación Iconographie de la Salpétriére, inmensa obra que contiene material visual, dibujos y fotos de gran valor para la enseñanza de la neurología. Por este y otros múltiples aportes a esta disciplina, es considerado el padre de la neurología.

SUMMARY Jean Martin Charcot (1825-1893) is considered the greatest exponent of the origin of Neurology in the world. He founded and directed the largest neurology service in Europe at the Salpétriére hospital in Paris, and in 1882 he directed the first ever university chair on diseases of the nervous system. There are at least 14 eponyms in medicine that recall his contributions in different disciplines. He was a great painter, a famous university professor, and demonstrated great skills in hospital management. He was one of the founders of the magazine Archives de Neurologie together with his disciple Pierre Marie in 1872, and director of the publication Iconographie de la Salpétriére, immense work containing visual material, drawings, and photos of great value for the teaching of Neurology. For this and many other contributions to this discipline, he is considered the father of modern Neurology.

Caligula: a neuropsychiatric explanation of his madness.

Gaius Julius Caesar Augustus Germanicus, better known as Caligula, (12 CE to 41 CE) was the third Roman emperor and ruled only four years. Throughout his life he experienced several traumatic events, and, in addition, historians mention some premorbid conditions that could cause him to become the monster that most historians know today. When Caligula was 25 years old, he suffered a near-fatal illness that turned his story around. One possible cause was lead poisoning due to the high consumption of wine, which contained lead, by Roman patricians. On the other hand, it is plausible that Caligula experienced epilepsy that began in childhood, later experienced status epilepticus in 37 CE, which triggered an epileptic psychosis with the consequent psychopathic and paranoid changes that led him to the madness noted by historians.

Caligula: a neuropsychiatric explanation of his madness / Calígula: una explicación neuropsiquiátrica de su locura

ABSTRACT Gaius Julius Caesar Augustus Germanicus, better known as Caligula, (12 CE to 41 CE) was the third Roman emperor and ruled only four years. Throughout his life he experienced several traumatic events, and, in addition, historians mention some premorbid conditions that could cause him to become the monster that most historians know today. When Caligula was 25 years old, he suffered a near-fatal illness that turned his story around. One possible cause was lead poisoning due to the high consumption of wine, which contained lead, by Roman patricians. On the other hand, it is plausible that Caligula experienced epilepsy that began in childhood, later experienced status epilepticus in 37 CE, which triggered an epileptic psychosis with the consequent psychopathic and paranoid changes that led him to the madness noted by historians.

RESUMEN Gaius Julius Caesar Augustus Germanicus, mejor conocido como Calígula, (12 C.E. - 41 C.E.), fue el tercer emperador romano y gobernó durante apenas cuatro años. A lo largo de su vida, experimentó diferentes eventos traumáticos y, adicionalmente, algunos historiadores mencionan condiciones premórbidas que pudieron causar que se convirtiera en el monstruo que los historiadores conocen hoy. Cuando Calígula tenía 25 años, sufrió una enfermedad casi fatal que le dio un giro considerable a su historia. Una posible causa es intoxicación por plomo, debido al excesivo consumo de vino, el cual contenía considerables niveles de este metal. Por otro lado, es posible que Calígula cursara con crisis epilépticas de inicio en la infancia. Posteriormente, en el año 37 C.E. experimentara un estado epiléptico, el cual desencadenaría una psicosis epiléptica, dejando secuelas que iban a desencadenar la locura de la que muchos historiadores hablan.

Notas para una investigación futura sobre la historia del internado médico en Colombia. Segunda parte: el internado en los siglos XX y XXI / Notes for a future research on the history of the internship in medicine, in Colombia. Second part: The Internship in Colombia (20th and 21st centuries)

RESUMEN Este artículo es la segunda parte de una serie que explora la trayectoria histórica de la configuración del internado en la educación y en la práctica médica. En el artículo anterior se estudió el surgimiento del internado en la Francia napoleónica y su posterior consolidación bajo la reforma flexneriana estadounidense en la educación médica. Esta segunda parte explora, en cinco apartados, el proceso de constitución del internado en el contexto colombiano. El primero empieza analizando la influencia francesa a inicios del siglo xx; el segundo revisa el cambio hacia el modelo flexneriano que se dio con la llegada de varias misiones médicas estadounidenses y por sus sugerencias sobre la educación médica; el tercero estudia el proceso de ensamblaje de estos modelos en el país, su regulación y la crisis de esta; el cuarto recoge las propuestas actuales; en el epílogo se reflexiona sobre el futuro del internado en la coyuntura de la pandemia de la COVID-19.

SUMMARY This article is the second part of a series that explores the historical process of the configuration of the intern-ship in medical education and practice. In a previous article, we studied the emergence of the internship in Napoleonic France and its latter configuration trough the North American Flexnerian reforms to medical education. This second part deals with the process by which the internship was constituted in Colombia through five sections. The first one analyses the French influence at the beginning of the 20th century; the second part, the change towards the North American flexnerian model, which was motivated by the arrival of multiple medical missions and their suggestions regarding medical education; the third part studies the process by which these models assembled in the country, their regulation and its crisis; the fourth discusses the actual proposals; and the epilogue talks about the future of the internship in the COVID-19 pandemics.

Heracles and epilepsy: the sacred disease.

Epilepsy is one of the most dreaded and terrifying human afflictions. One of the many names it has received was Sacred Disease, during Greek times. Heracles served as a source of the divine connotation that epilepsy received in ancient times, as he was one of the most important demigods in Greek mythology. However, several authors have attributed Heracles' actions to a seizure, including Hippocrates, who described the sacred disease on his "Corpus Hippocraticum." This paper reviewed some of the publications on the myth and content of the text of Hippocrates, in relation to the current knowledge of the disease.

Heracles and epilepsy: the sacred disease / Hércules y la epilepsia: la enfermedad sagrada

ABSTRACT Epilepsy is one of the most dreaded and terrifying human afflictions. One of the many names it has received was Sacred Disease, during Greek times. Heracles served as a source of the divine connotation that epilepsy received in ancient times, as he was one of the most important demigods in Greek mythology. However, several authors have attributed Heracles' actions to a seizure, including Hippocrates, who described the sacred disease on his "Corpus Hippocraticum." This paper reviewed some of the publications on the myth and content of the text of Hippocrates, in relation to the current knowledge of the disease.

RESUMEN La epilepsia es una de las enfermedades más temidas y terroríficas de la humanidad. Durante el periodo griego, recibió uno de sus muchos nombres, el de enfermedad sagrada. Hércules sirvió como una de las fuentes para la connotación divina que la epilepsia recibió en tiempos antiguos, debido a que fue uno de los semidioses más importantes de la mitología griega. Sin embargo, muchos autores atribuyeron las acciones de Hércules a convulsiones, incluyendo Hipócrates, quien describió la enfermedad sagrada en su "Corpus Hippocraticum". Este artículo revisa algunas de las publicaciones sobre el mito y el contenido del texto de Hipócrates, en relación al conocimiento actual de la enfermedad.

Considerations about the Neuropsychiatric Conditions of Quixote of La Mancha. / Consideraciones sobre las condiciones neuropsiquiátricas del Quijote de la Mancha.

Don Quixote of La Mancha, the picturesque character created by Miguel de Cervantes Saavedra in his immortal book The Ingenious Nobleman Sir Quixote of La Mancha, presents several neuropsychiatric conditions, including tremor, sleep disturbances, neuropsychiatric symptoms, syncope, perception disorders and traumatic brain injury. Throughout the masterpiece, there are episodes where the aforementioned disorders are evident. This paper makes a list of them and analyses them in the light of the current knowledge of those conditions.

Consideraciones sobre las condiciones neuropsiquiátricas del Quijote de la Mancha / Considerations about the Neuropsychiatry Conditions of Quixote of La Mancha

RESUMEN Don Quijote de la Mancha, el pintoresco personaje creado por Miguel de Cervantes Saavedra en su obra inmortal El Ingenioso Hidalgo Don Quijote de la Mancha, presenta varias condiciones neuropsiquiátricas que incluyen tremor, trastornos del sueño, síntomas neuropsiquiátricos, síncope, trastornos de la percepción y traumatismo craneoencefálico. A lo largo de la obra, se presentan episodios en los que se hacen evidentes los diferentes trastornos mencionados. El artículo hace un recuento de ellos a través de la novela y un análisis a la luz de los conocimientos actuales sobre dichas condiciones.

ABSTRACT Don Quixote of La Mancha, the picturesque character created by Miguel de Cervantes Saavedra in his immortal book The Ingenious Nobleman Sir Quixote of La Mancha, presents several neuropsychiatric conditions, including tremor, sleep disturbances, neuropsychiatric symptoms, syncope, perception disorders and traumatic brain injury. Throughout the masterpiece, there are episodes where the aforementioned disorders are evident. This paper makes a list of them and analyses them in the light of the current knowledge of those conditions.

Désiré-Magloire Bourneville and his contributions to pediatric neurology.

Désiré-Magloire Bourneville ought to be thought of as the father of Pediatric Neurology for his significant contributions to the field. He worked as a physician, politician, writer, and editor. He was the first to describe the autosomal dominant genetic condition known as "tuberous sclerosis complex", after conducting an autopsy on a young female patient, where the main finding in the central nervous system was multiple dense tubers. The patient had refractory epilepsy and intellectual disability. His work was based on the study of epilepsy and idiocy, and he was also an advocate of public health and social medicine education; creating day hospital programs for children with this type of neurologic disease.

Désiré-Magloire Bourneville and his contributions to pediatric neurology / Désiré-Magloire Bourneville y sus aportes a la neurología pediátrica

ABSTRACT Désiré-Magloire Bourneville ought to be thought of as the father of Pediatric Neurology for his significant contributions to the field. He worked as a physician, politician, writer, and editor. He was the first to describe the autosomal dominant genetic condition known as "tuberous sclerosis complex", after conducting an autopsy on a young female patient, where the main finding in the central nervous system was multiple dense tubers. The patient had refractory epilepsy and intellectual disability. His work was based on the study of epilepsy and idiocy, and he was also an advocate of public health and social medicine education; creating day hospital programs for children with this type of neurologic disease.

RESUMEN Désiré-Magloire Bourneville debería ser considerado como el padre de la Neurología Pediátrica por sus importantes contribuciones en este campo. Trabajó como médico, político, escritor y editor. Hizo las primeras descripciones de la condición genética autosómica dominante conocida como "Complejo de esclerosis tuberosa", después de realizar una autopsia en una paciente joven, en la que el principal hallazgo en el sistema nervioso central fueron múltiples lesiones tipo tubérculos. La paciente tenía epilepsia refractaria y discapacidad intelectual como síntomas asociados. Su trabajo se basó en el estudio de la epilepsia y la idiotez, a su vez fue un defensor de salud pública y la educación en medicina social; creando programas de hospital diurno para niños con diferentes tipos de enfermedades neurológicas.

Notas para una investigación futura sobre la historia del internado médico en Colombia, siglo XX. Primera parte: antecedentes europeos y norteamericanos, (siglo XIX e inicios del XX) / Notes for a future research on the history of the internship in medicine in Colombia during the 20th century. First part: International background: Europe and North America (19th and 20th centuries)

RESUMEN Este artículo recoge la primera parte de un estudio sobre el desarrollo del internado en la educación médica colombiana. En esta se presenta un panorama histórico-cronológico de los antecedentes europeos y norteamericanos de la aparición y desarrollo de la figura del médico interno en la práctica médica. Cubre el periodo comprendido entre el surgimiento del internado durante el gobierno de Napoleón en Francia en el siglo XIX y su transformación al modelo propuesto por la reforma flexneriana en los Estados Unidos al iniciarse el siglo XX, como punto de partida para la comprensión de dicho proceso en el caso colombiano.

SUMMARY This article presents the results of the first part of a study about the development of the internship in Colombian medical education. This first part offers a historical-chronological overview of the birth and development of the "internship" in European and North American medical practice, covering the period of time that begins with its appearance during Napoleonian government in France during the 19th century, and its transformation with the model proposed during the flexnerian reform in the United States at the beginning of the 20th century, as a starting point for the understanding of the Colombian case.

Oxytocin and chronic pain in humans / Oxitocina y dolor crónico en humanos

Oxytocin (OT) is a long known neuropeptide, and it's uses in clinical practice, mainly those regarding obstetrics have been thoroughly studied. However, there's been an increasing interest in identifying other roles OT plays in emotion, cognition, perception and higher cognitive processing. OT is also believed o have a mayor role in the physiology and physiopathology of pain. We have reviewed existent literature and current human studies on the relationship between OT and chronic pain. The present work compiles a significant number of research papers and may cast some light on a remarkably interesting and promising matter

La oxitocina (OT) es un neuropéptido conocido desde hace mucho tiempo, y sus usos en la práctica clínica, principalmente los relacionados con la obstetricia, se han estudiado en múltiples ocasiones. Sin embargo, ha habido un creciente interés en la identificación de otros roles que la OT pudiera tener en la emoción, la cognición, la percepción y otras funciones cognitivas superiores. También se cree que la OT es de gran importancia en la fisiología y la fisiopatología del dolor. Hemos revisado la literatura existente y los estudios actuales en humanos sobre la relación entre la OT y el dolor crónico. El presente trabajo compila un número significativo de trabajos de investigación y pudiera arrojar alguna luz sobre un asunto sumamente interesante y prometedor

Síndrome de Alicia en el país de las maravillas (AIWS). Reflexión / Alice in Wonderland Syndrome (AIWS). A reflection

Abstract The Alice in Wonderland syndrome is a rare clinical neurological condition, defined by the presence of perception disorders usually interpreted by the affected patient as rare metamorphosing and depersonalization phenomena. Due to its extremely rare occurrence and its surreal and sometimes psychedelic character, the syndrome has been associated with the phenomena experienced by Alice, the character in the classic and world-famous story by Lewis Carroll.

Resumen El Síndrome de Alicia en el País de las Maravillas es una condición clínica neurológica de rara aparición, definida por la aparición de alteraciones en la percepción usualmente interpretadas por el paciente que las experimenta, como fenómenos extraños de metamorfosis y despersonalización. Por su naturaleza altamente inusual y su carácter surreal e incluso en ocasiones psicodélico, se ha relacionado al cuadro con los fenómenos experimentados por el personaje de Alicia, en la clásica y mundialmente reconocida historia de Lewis Carroll.