Antidepressant effect r TMS during pregnancy in a case of Major Depression Resistant to Pharmacological Treatment.

Major depressive disorder (MDD) is a common complication of pregnancy and the postpartum period. Approximately 5% of women who have MDD during pregnancy or the postpartum period meet criteria for resistant depression, associated with increased morbidity in both the newborn and the pregnant woman. Currently we have different therapeutic options for the treatment of MDD during pregnancy, although in cases of resistance during that period the treatment criteria are not that well established.

Nota clínica: Efecto antidepresivo de la EMTrdurante el embarazo en un caso de Depresión Mayor Resistente al Tratamiento Farmacológico / Clinical note: Antidepressant effect of rTMS during pregnancy in a case of drug-resistant major depression. during pregnancy in a case of Medication-Resistant Major Depression

El trastorno depresivo mayor (TDM) constituye una complicación común del embarazo y el período posparto. Aproximadamente un 5% de mujeres que presentan un TDM durante la gestación o el periodo postparto cumplen criterios paradepresión resistente, asociándose con un incremento de lamorbilidad tanto en el recién nacido como en la propia gestante. En la actualidad disponemos de diferentes opcionesterapéuticas para el tratamiento del TDM durante el embarazo si bien en los casos de resistencia durante el embarazolos criterios de tratamiento no se encuentran tan bien establecidos.Presentamos el caso de una mujer de 36 años de edadque desarrolló un episodio de depresión mayor resistente altratamiento farmacológico. Durante el episodio actual y trascuatro ciclos de tratamiento farmacológico fallido se quedóembarazada. A las 16 semanas de gestación fue tratada conestimulación magnética transcraneal repetitiva (EMTr) debaja frecuencia. Tras 30 sesiones de tratamiento, con buenatolerancia, la paciente presentó una recuperación completade la sintomatología depresiva, dando a luz a un recién nacido sano. La EMTr constituye una buena alternativa frente a laTerapia Electroconvulsiva en algunos casos de TDM resistentedurante la gestación. A pesar de estos hallazgos prometedores, se requiere de un mayor número de estudios controlados,doble ciego que incluyan muestras amplias de pacientes embarazadas, con parámetros EMTr bien diseñados, e inclusoestudios prospectivos (siguiendo a mujeres embarazadas ysus descendientes) para confirmar la ausencia de efectos secundarios a largo plazo. (AU)

Major depressive disorder (MDD) is a common complication of pregnancy and the postpartum period. Approximately 5% of women who have MDD during pregnancy orthe postpartum period meet criteria for resistant depression,associated with increased morbidity in both the newbornand the pregnant woman. Currently we have different therapeutic options for the treatment of MDD during pregnancy,although in cases of resistance during that period the treatment criteria are not that well established.We set out the case of a 36-year-old woman who presents an episode of major depression resistant to pharmacotherapy. During the current episode and after four cycles offailed pharmacological treatment she became pregnant. Inthe 16th week of gestation, she was treated with low-frequency repetitive transcranial magnetic stimulation (rTMS).After 30 treatment sessions, with good tolerance, the patient presented a complete recovery from the depressivesymptoms, giving birth to a healthy newborn. rTMS is a goodalternative to Electroconvulsive Therapy in some cases ofresistant MDD during pregnancy. Despite these promisingfindings, further double-blind controlled studies with broadsamples of pregnant women are required, with well-designed rTMS parameters, and even prospective studies (following pregnant women and their offspring) to confirm theabsence of long-term side effects. (AU)

Neuropsychophysiological Measures of Alcohol Dependence: Can We Use EEG in the Clinical Assessment?

Addiction management is complex, and it requires a bio-psycho-social perspective, that ought to consider the multiple etiological and developmental factors. Because of this, a large amount of resources has been allocated to assess the vulnerability to dependence, i.e., to identify the processes underlying the transition from substance use to dependence, as well as its course, in order to determine the key points in its prevention, treatment, and recovery. Consequently, knowledge \from neuroscience must be taken into account, which is why different initiatives have emerged with this objective, such as the "Research Domain Criteria" (RDoC), and the "Addiction Neuroclinical Assessment" (ANA). Particularly, neuropsychophysiological measures could be used as markers of cognitive and behavioral attributes or traits in alcohol dependence, and even trace clinical change. In this way, the aim of this narrative review is to provide an overview following ANA clinical framework, to the most robust findings in neuropsychophysiological changes in alcohol dependence, that underlie the main cognitive domains implicated in addiction: incentive salience, negative emotionality, and executive functioning. The most consistent results have been found in event-related potential (ERP) analysis, especially in the P3 component, that could show a wide clinical utility, mainly for the executive functions. The review also shows the usefulness of other components, implicated in affective and substance-related processing (P1, N1, or the late positive potential LPP), as well as event-related oscillations, such as theta power, with a possible use as vulnerability or clinical marker in alcohol dependence. Finally, new tools emerging from psychophysiology research, based on functional connectivity or brain graph analysis could help toward a better understanding of altered circuits in alcohol dependence, as well as communication efficiency and effort during mental operations. This review concludes with an examination of these tools as possible markers in the clinical field and discusses methodological differences, the need for more replicability studies and incipient lines of work. It also uses consistent findings in psychophysiology to draw possible treatment targets and cognitive profiles in alcohol dependence.

Brain functional connectivity after cognitive-bias modification and behavioral changes in abstinent alcohol-use disorder patients.

The use of the cognitive-bias modification (CBM) method has emerged as a therapeutic complement in the treatment of alcoholism, producing changes at behavioral and brain level. Nevertheless, the impact of the CBM procedure could be improved by the memory retrieval-extinction process (REP). Different studies have demonstrated that the retrieval of drug memories before extinction training later reduced the reinstatement of drug-seeking behavior. The main aim of this work was to study the effect of the CBM procedure itself, as well as in combination with the activation of alcohol-related memories, on the brain oscillatory activity of abstinent patients with alcohol-use disorder. The study sample comprised 33 patients divided into three groups: A-CBM (alcohol-related memory activation + CBM), N-CBM (neutral memory activation + CBM) and N-INT (no-intervention) groups. A resting-state EEG was obtained before and after each protocol, along with the assessment of the automatic action tendencies. A-CBM group showed a general alpha synchronization increase after the protocol, while the other groups did not show any significant change. Besides, A-CBM group showed significant intra and inter-group differences in the automatic action tendencies after the protocol, reflected in higher avoidance bias toward appetitive, aversive and without context alcohol-related stimuli. The alpha phase synchronization increase could be the neural manifestation of the conditioning produced between the alcohol-related stimuli and the automatic avoidance response. Moreover, the activation of the alcohol-related memories favors this conditioning with those alcohol-related stimuli associated with the activated memories, because it increases their threat level for the abstinence maintenance.

Epilepsia temporal farmacorresistente. Análisis de 33 casos intervenidos quirúrgicamente / Refractory temporal epilepsy. An analysis of 33 cases submitted to surgery

Objetivo. Analizar las manifestaciones clínicas, monitorización mediante electroencefalograma (EEG) de la actividad ictal,interictal e intraoperatoria en pacientes refractarios al tratamiento médico de la epilepsia temporal mesial, controladacon éxito quirúrgicamente.Pacientes y métodos. Análisis retrospectivo de 33 pacientes. Edad media: 36 ± 11,40 años; número de crisis al mes: 9 ± 14,23;media de duración de la enfermedad: 22 años; número de fármacos antiepilépticos: 3 ± 0,93; media de duración demonitorización en la Unidad de Monitorización Intensiva de Video-EEG: 6,42 ± 3,61 días. El EEG de superficie se registrómediante electrodos dispuestos según el sistema internacional 10-20.Resultados. Hubo un total de 158 crisis, la mayor parte de ellas focales complejas. El 82% de los pacientes presentó aura.La alteración del nivel de conciencia tuvo lugar en el 94,3% de los casos, en la mayoría más precoz que los automatismos.El automatismo más frecuente y precoz fue el oromandibular. En el 87,9% de los pacientes se registró actividad bioeléctricaintercrítica; ondas agudas en el 93,1%; aumento de la actividad con el sueño en el 97%; polipuntas durante el sueñoREM en el 21,2% y actividad epileptiforme bilateral en el 21,1%. Actividad ictal: cambios en el EEG antes de cualquier manifestaciónclínica en el 69% de los pacientes. Tipo de presentación ictal: aplanamiento del trazado en el 46%, actividadrítmica lenta en el 41,7%. Presentación ictal: focal en el 48,9%.Conclusiones. Un conocimiento detallado de las manifestaciones clínicas y eléctricas de las epilepsias del lóbulo temporalpermitiría un diagnóstico más precoz y una reducción en el tiempo de acceso de estos pacientes al tratamiento quirúrgicoen aquellos casos de farmacorresistencia (AU)

Aim. To analyze clinical manifestations, ictal, interictal and intraoperative EEG monitoring in patients with medical treatment refractory temporal epilepsy successfully controlled surgically. Patients and methods. Retrospective analysis, 33 patients. Mean age: 36 � 11.40; number of monthly seizures: 9 � 14.23; mean duration of disease: 22 years; number of anti-epileptic drugs: 3 � 0.93; average monitoring duration on Intensive Video-EEG Monitoring Unit: 6.42 � 3.61 days. Scalp EEG was recorded with surface electrodes placed according to the 10-20 international system Results. 158 seizures were recorded, most of them focal complex. 82% of patients presented aura. Disturbances of consciousness appeared in 94.3%, being more precocious than the automatisms in the majority of the sample. The most frequent and precocious automatisms were oromandibular. Intercritical: epileptiform activity was observed in 87.9% of cases; sharp waves in 93.1%, increasing with sleepiness in 97%. Polyspikes during REM sleep in 21.2%. Bilateral epileptiform activity in 21.1%. Ictal activity: changes on EEG activity was observed previous to clinical manifestation in more than 69%. Type of ictal onset: flattening (46%), rhythmic slow activity (41.7%). Ictal onset was focal in 48.9%. Conclusions. Detailed knowledge of clinical and electrical manifestations of temporal lobe epilepsies would allow a precocious diagnosis and a reduction of accessing time of these patients to surgical treatment in case of pharmacoresistance (AU)