Constitutional risk factors for focal neuropathies in patients referred for electromyography.

BACKGROUND AND PURPOSE: It is well established that patient-related constitutional features predispose to focal peripheral neuropathies. Some of these risk factors were investigated in common focal neuropathies encountered in patients referred for electromyography. METHODS: Gender, age, height and body mass index (BMI) were analysed retrospectively as risk factors for 11 focal neuropathies. In all, 9686 patients (age range 18-96 years; 58% women) were included from three different centres, with identical methods and equipment. RESULTS: High BMI was related to carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), combined CTS and UNE, meralgia paraesthetica and lumbar radiculopathy. In women, CTS and Morton's metatarsalgia were more common, whilst long thoracic neuropathies, suprascapular neuropathies and UNE were more common in men. Older age increased the risk for CTS, UNE, Morton's metatarsalgia and radiculopathies. CONCLUSIONS: Age, gender and BMI are important risk factors for many common focal neuropathies.

Estudio videopolisomnográfico en un paciente con sospecha de insomnio familiar fatal / Video-polisomnografic monitoring in a fatal familial insomnia clinical suspect case

Objetivo. Demostrar las alteraciones neurofisiológicas y del comportamiento del ciclo vigilia-sueño características del insomnio familiar fatal (IFF), en un paciente con sospecha clínica y posterior diagnóstico genético. Paciente y método. Varón de 39 años. Presenta historia familiar compatible con IFF. En el curso de 5 meses manifiesta impotencia, insomnio progresivo y episodios diurnos de sueño con apneas, mioclonías, automatismos y gesticulaciones. Al ingreso, presenta diplopía, hipertensión arterial e hiperhidrosis. Se realizó una monitorización videopolisomnográfica durante 24 h. Cada segundo de registro fue clasificado según los criterios de Sforza (1995). Resultados. Vigilia: ojos cerrados, actividad motora en miembros inferiores. Ritmo alfa posterior reactivo a 8-9 Hz. Sueño: breves episodios de sueño no REM y REM, de características atípicas, con ausencia de sueño profundo y disminución de actividad spindle, en asociación con mioclonías, gesticulaciones y apneas. Insomnio de conciliación. Tras indicar alprazolam (1 mg por vía oral y 0,5 mg sublingual), presentó patrón no REM durante 3,5 h, sin actividad motora y sin apneas. Discusión y conclusiones. Los hallazgos polisomnográficos se caracterizaron por grave alteración de la organización cíclica del sueño, disminución del tiempo total de sueño y patrones no REM y REM atípicos. La administración de alprazolam permitió aumentar el sueño nocturno, con desaparición de las sacudidas motoras y las apneas (AU)

Objective. To demonstrate the neurophysiologic and behavior disorders in the wake-sleep cycle typical of fatal familial insomnia (IFF), in a case with clinical suspect and latter genetic diagnostic. Patient and method. Male 39 year old. Family history of an IFF syndrome. Within 5 months he developed impotence, progressive insomnia and episodes of daytime somnolence associated with apneas, myoclonus and anormal motor behavior. He was hospitalized with diplopia, high blood pressure and hyperhidrosis. We carried out a video-polisomnografic long-term monitoring during 24 hours. Each second of the record was classified according to the de Sforza criterium (1995). Results. Waking: closed eyes, restless movements of legs. Responsive posterior alpha rhythm at 8-9 Hz. Sleep: brief episodes of "NREM" and "REM" sleep of atipical features, such as absence of slow wave sleep and marked reduction of spindle frequency activity, with myoclonus, gesturing and apneas. At night, impossibility in falling asleep. After alprazolam, "NREM" sleep during 3,5 hours, without motor activity nor apneas. Discussion and conclusions. The polisomnografic findings characterized by severe alteration of the cyclic sleep organization, reduction in total sleep time and atipical patterns of "NREM" and "REM" sleep. Administration of alprazolam (1 mg orally and 0.5 mg sublingually) allowed increasing night-time sleep, dissapearing jerks and apneas (AU)

XIV Reunión Anual de la Asociación Ibérica de Patología del Sueño. Sueño y dolor / No disponible

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[Disorders affecting the digestive system during sleep]. / Alteraciones del sistema digestivo durante el sueño.

AIMS: In this work we review the major publications dealing with disorders that affect the digestive system and how they are related to sleep. Development. Sleep disorders occur in 12-25% of the general population and a large percentage of these pathologies are related to disorders of the digestive system. We review the different pathologies and symptoms linked to the digestive tract that give rise to sleep disorders. The study first examined the upper digestive tract, that is, the teeth and teeth grinding, and we then went on to look at gastroesophageal reflux, esophageal motility disorders, peptic ulcer disease, cholelithiasis, gastric ulcer, irritable bowel, proctalgia, the extent to which the disorders are related to pregnancy, disorders at the paediatric age and eating disorders. CONCLUSIONS: Digestive pains during sleep form a heterogeneous clinical picture that disrupts patients' sleep and exerts an influence on their quality of daily living, which in turn may affect sleep and favour the appearance of pains. To date these symptoms have received relatively little attention, but in the few studies that have been carried out, it has not been possible to establish with any degree of accuracy whether sleep and the digestive system share common control mechanisms or not. Research into this type of disorders could help to prevent the appearance of the complications that appear in these clinical pictures.

Alteraciones del sistema digestivo durante el sueño / Disorders affecting the digestive system during sleep

Objetivo. En el presente trabajo se revisan las principales publicaciones que tratan sobre alteraciones del sistema digestivo y su relación con el sueño. Desarrollo. Los trastornos del sueño se dan en el 12-25 por ciento de la población general; una gran parte de esta patología tiene relación con alteraciones del sistema digestivo; realizamos una revisión de las distintas patologías digestivas y los cuadros relacionados con el tubo digestivo que acarrean trastornos de sueño. Comenzamos por el sistema digestivo superior, en los dientes, con el bruxismo, y continuamos con la enfermedad por reflujo gastroesofágico, los trastornos de la motilidad esofágica, la enfermedad ulcerosa péptica, la colelitiasis, la úlcera gástrica, el intestino irritable, la proctalgia, la relación de los trastornos con el embarazo, las alteraciones en la edad pediátrica y los trastornos de la alimentación. Conclusiones. Los dolores digestivos durante el sueño forman un cuadro heterogéneo de patologías que interrumpen el sueño del paciente e influyen sobre su calidad de vida diurna; ésta, a su vez, puede influir sobre el sueño y favorecer la aparición de dolores. Estos cuadros se han estudiado hasta ahora relativamente poco; cuando sí se han estudiado, no se ha llegado a establecer con precisión si existen mecanismos de control comunes entre el sueño y el aparato digestivo. La investigación de este tipo de trastornos podría llevar a evitar muchas de las complicaciones que aparecen en estos cuadros (AU)

Aims. In this work we review the major publications dealing with disorders that affect the digestive system and how they are related to sleep. Development. Sleep disorders occur in 12-25% of the general population and a large percentage of these pathologies are related to disorders of the digestive system. We review the different pathologies and symptoms linked to the digestive tract that give rise to sleep disorders. The study first examined the upper digestive tract, that is, the teeth and teeth grinding, and we then went on to look at gastroesophageal reflux, esophageal motility disorders, peptic ulcer disease, cholelithiasis, gastric ulcer, irritable bowel, proctalgia, the extent to which the disorders are related to pregnancy, disorders at the paediatric age and eating disorders. Conclusions. Digestive pains during sleep form a heterogeneous clinical picture that disrupts patients’ sleep and exerts an influence on their quality of daily living, which in turn may affect sleep and favour the appearance of pains. To date these symptoms have received relatively little attention, but in the few studies that have been carried out, it has not been possible to establish with any degree of accuracy whether sleep and the digestive system share common control mechanisms or not. Research into this type of disorders could help to prevent the appearance of the complications that appear in these clinical pictures (AU)

Exploraciones complementarias que apoyan el diagnóstico de estado vegetativo persistente. Estudios electrofisiológicos / Complementary investigations that support a diagnosis of persistent vegetative state. Electrophysiological studies

Los datos obtenidos del electroencefalograma y de los potenciales evocados somestésicos han sido utilizados para estimar su potencia predictiva en los pacientes en coma anóxico. Los estudios de metaanálisis, prospectivos, retrospectivos, series de casos y opiniones de experto han demostrado que estas pruebas pueden ser indicadores pronósticos fiables en los pacientes en coma anóxico. La mayoría de los trabajos analizados presenta una recomendación clase B con niveles de evidencia II-III, y hay dos publicaciones con recomendación A y nivel I (AU)

[Neurophysiological monitoring during scoliosis surgery using controlled hypotension]. / Monitorización neurofisiológica en la cirugía de escoliosis con hipotensión controlada.

Controlled arterial hypotension understood to be a mean arterial pressure (MAP) between 55 and 60 mmHg is often used as a complementary technique in anesthesia even though it is not without complications and associated mortality even in young patients. During surgery to reduce scoliosis in a young boy, MAP fell to 60 mmHg accompanied by bilateral loss of sensory and motor evoked potentials (SEP and MEP). Detecting the absence of SEP and MEP allowed us to prevent medullar injury due to ischemia secondary to hypotension, once possible surgical or technical causes had been ruled out. We believe that monitoring SEP and MEP is useful not only to the surgeon but also to the anesthesiologist.

Monitorización neurofisiológica en la cirugía de escoliosis con hipotensión controlada / Neurophysiological monitoring during surgery for scoliosis with controlled hypotension

La hipotensión arterial controlada, entendida como cifras de presión arterial media (PAM) límite de 5560 mmHg, se emplea frecuentemente como técnica anestésica coadyuvante, aunque no está exenta de morbimortalidad incluso en sujetos jóvenes. En el intraoperatorio de una reducción de escoliosis de un varón joven aconteció una caída de la PAM a 60 mmHg acompañada de una pérdida bilateral de los potenciales evocados somestésicos y motores (PES y PEM). Tras descartar la posibilidad de que la ausencia de PES y PEM fuera debida a causas quirúrgicas o técnicas, su alteración permitió prevenir una lesión medular por isquemia secundaria a una hipotensión arterial. Creemos que la monitorización de PES y PEM se convierte en una técnica de ayuda no sólo para el cirujano, sino también para el anestesiólogo (AU)

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Muerte encefálica: ¿cuál es el valor diagnóstico de los potenciales evocados multimodales? / Brain death: what is the diagnostic value of multimodality evoked potentials?

Los multipotenciales evocados [somestésicos (PES), acústicos troncoencefálicos (PEAT) y visuales (PEV)] son resistentes a depresores centrales e hipotermia. Exploran diferentes vías sensoriales periféricas y centrales, y aportan información útil para diagnosticar la muerte encefálica (ME). Esto se demuestra ampliamente en la bibliografía. Los PES se obtienen estimulando en nervio mediano en la muñeca y registrando en C'3/C'4-Fz y C7-Fz, los PEAT con estímulo click en el oído y registro en A1/A2-Cz y los PEV tras estimulación ocular y recepción Oz-Fz. Los multipotenciales evocados tienen un comportamiento muy constante en la ME, con ausencia de respuestas por encima de la unión bulbomedular. Los PEAT muestran ausencia bilateral de ondas III, IV y V, persistiendo a veces I y/o II uni o bilateralmente. Los somestésicos corticales están siempre ausentes y los espinales originados por debajo de la unión bulbomedular se conservan. Los PEV están ausentes. Los multipotenciales evocados confirman orechazan el diagnóstico clínico-electroencefalográfico (EEG) de ME en circunstancias donde la valoración de estos factores está limitada, como la hipotermia, que retrasa las latencias pero se conservan hasta los 25 ºC, comenzando entonces a desaparecer, y la impregnación por depresores centrales, como barbitúricos, que modifican latencias y amplitudes a ciertas dosis pero únicamente desaparecen con cifras muy superiores a las habituales. Los multipotenciales evocados constituyen una prueba diagnóstica segura, fiable, rápida, repetible, accesible, de bajo coste y disponible en casi todos los hospitales. La combinación de criterios clínicos y estudios neurofisiológicos (EEG y multipotenciales evocados) garantizan una seguridad diagnóstica en la ME (AU)

[Protocol of pre-surgical neurophysiological evaluation in epilepsy resistant to treatment]. / Protocolo de evaluación neurofisiológica prequirúrgica en epilepsia resistente a tratamiento.

INTRODUCTION: Nowadays approximately twenty per cent of epileptic patients who are on a pharmacological treatment carry on their fits. Their instability can be eliminated with an operation in any center that is specialized in epileptic surgery. The center must have a cross disciplinary team. DEVELOPMENT: The ideal operation is one that only eliminates the tissue needed to end up with the fits The main goal of the neurophysiological evaluation is to delimit the cerebral area that generates an epileptogenic activity so as to be able to eliminate it without causing further damage. We present a medical record of pre-surgical neurophysiological evaluation that we would like to put into practice in our department in coordination with the services of neurology, radiodiagnosis, and neurosurgery. This medical record contains the following sections: 1. Selection of patients. 2. Non invasive pre-surgical evaluation. 3. Invasive pre-surgical evaluation. 4. Postsurgical evaluation. The invasive pre-surgical evaluation constitutes the most interesting part of the whole process, it allows thanks to intracranial registers to locate accurately epileptogenic focuses; what is more, it allows to carry out a functional mapping of areas that cannot be explored with surface techniques; and finally this evaluation allows to open new fields of investigation about the way in which the encephalon works. CONCLUSION: Epilepsy surgery is a subject to develop in Spain in which the neurophysiologic exploration is something essential.

[Treatment of sleep apnea syndrome with CPAP: compliance with treatment, its efficacy and secondary effects]. / Tratamiento con CPAP del síndrome de apneas del sueño: cumplimiento, efectividad y efectos secundarios.

INTRODUCTION: Continuous positive pressure via the nose (nasal-CPAP) is the first line of treatment in the sleep apnea syndrome (SAS). Long term compliance with treatment is essential for success and this may depend on the relation of benefit to side-effects. OBJECTIVE: To study the improvement in symptoms of SAS patients treated with CPAP, side-effects and compliance with treatment. MATERIAL AND METHODS: In accordance with the objectives a 10 question questionnaire was given to 65 patients diagnosed as having SAS after polysomnographic studies (PSG) who were being treated with CPAP. RESULTS: Eighty per cent of the patients complied with the treatment prescribed and 82% of these considered it to be effective. Ninety per cent of the patients noticed improvement of 50% of their symptoms and 48% noticed improvement of more than 80%. The daytime symptoms which showed most improvement were the feeling of tiredness on waking (94.1%) and of excessive somnolence during the day. The nocturnal symptoms which most improved were snoring and inability to breathe whilst asleep (100% and 95.1% respectively). Ninety per cent of the patients complained of a side-effect and/or problem with the equipment. The commonest complaints were related to nasal problems (dryness, congestion, rhinorrhea, etc), which affected 61.5%. The main complaint about the equipment was of the noise it made (46%). However, only 6% of the patients gave up the treatment because of side-effects. CONCLUSION: CPAP is an effective treatment which is well tolerated in spite of its drawbacks.