Phases in the decision to request euthanasia and brain structures involved. / Fases en la decisión de solicitar la eutanasia y estructuras cerebrales involucradas.

INTRODUCTION: Euthanasia laws do not mention as an obstacle brain diseases other than dementia that damage circuits involved in decision-making. DEVELOPMENT: Narrative review of the stages of the decision to request euthanasia and the brain areas involved. The amygdala, the cingulate and insular cortex, and different parts of the prefrontal lobes are activated during decisions with similarities to that of requesting euthanasia. CONCLUSIONS: When an injury or malfunction of any of the structures involved in making decisions is known, a specific evaluation should be made of the influence it may have on the competence of the patient to request euthanasia.

TITLE: Fases en la decisión de solicitar la eutanasia y estructuras cerebrales involucradas.Introducción. Las leyes de eutanasia no mencionan como obstáculo las enfermedades cerebrales diferentes de la demencia, pero que dañan los circuitos involucrados en la toma de decisiones. Desarrollo. Revisión narrativa de las etapas de la decisión de solicitar la eutanasia y las áreas cerebrales involucradas. La amígdala, la corteza cingulada, la ínsula y distintas partes de los lóbulos prefrontales se activan durante decisiones con similitudes a la de solicitar la eutanasia. Conclusiones. Cuando se conoce una lesión o mal funcionamiento de alguna de las estructuras involucradas en la toma de decisiones, se debe realizar una evaluación específica de la influencia que pueda tener en la competencia del paciente para solicitar la eutanasia.

Fases en la decisión de solicitar la eutanasia y estructuras cerebrales involucradas / Phases in the decision to request euthanasia and brain structures involved

Introducción: Las leyes de eutanasia no mencionan como obstáculo las enfermedades cerebrales diferentes de la demencia, pero que dañan los circuitos involucrados en la toma de decisiones. Desarrollo: Revisión narrativa de las etapas de la decisión de solicitar la eutanasia y las áreas cerebrales involucradas. La amígdala, la corteza cingulada, la ínsula y distintas partes de los lóbulos prefrontales se activan durante decisiones con similitudes a la de solicitar la eutanasia. Conclusiones: Cuando se conoce una lesión o mal funcionamiento de alguna de las estructuras involucradas en la toma de decisiones, se debe realizar una evaluación específica de la influencia que pueda tener en la competencia del paciente para solicitar la eutanasia.(AU)

Introduction: Euthanasia laws do not mention as an obstacle brain diseases other than dementia that damage circuits involved in decision-making. Development: Narrative review of the stages of the decision to request euthanasia and the brain areas involved. The amygdala, the cingulate and insular cortex, and different parts of the prefrontal lobes are activated during decisions with similarities to that of requesting euthanasia. Conclusions: When an injury or malfunction of any of the structures involved in making decisions is known, a specific evaluation should be made of the influence it may have on the competence of the patient to request euthanasia.(AU)

[Validation study of the Spanish version of the Fahn-Tolosa-Marin scale for essential tremor]. / Estudio de validacion de la version española de la escala Fahn-Tolosa-Marin para el temblor esencial.

INTRODUCTION: The Fahn-Tolosa-Marin (FTM) tremor rating scale has been widely used in clinics for the estimation of tremor severity. However, a Spanish language version of this scale has still not been formally validated. AIM: To provide support to the validity and reliability of this version of FTM Scale. PATIENTS AND METHODS: A cross-sectional study was conducted on essential tremor patients. Severity was rated using the FTM scale. Upper limb disability was evaluated by terms of Disabilities of the Arm, Shoulder and Hand Scale (DASH), and to health-related quality of life using the Short Form-36 Health Survey (SF-36). Statistical analysis included sample description, reliability (Cronbach's alpha), convergent validity, and discrimination capacity tests (ROC curves). RESULTS: Forty patients with essential tremor (22 women, 18 men) were included, with a mean age of 65.8 ± 14.7 years (range: 21-90 years). Internal consistency of the FTM was high: Cronbach's alpha: 0,90 (subscale A: 0.85; subscale B: 0.91; subscale C: 0.77), and the floor and ceiling effects were negligible. The FTM (subscale C) showed high correlations with DASH, and acceptable diagnostic capacity, with an area under the curve of 0.86 (95% CI: 0.67-1.00), sensitivity 78% and specificity 75% for a cut-off score > 5.5. CONCLUSION: The Spanish version of FTM the rating scale is a reliable and valid tool to evaluate disability in patients with essential tremor, and a suitable instrument for use in medical research, as well as in clinical practice.

TITLE: Estudio de validacion de la version española de la escala Fahn-Tolosa-Marin para el temblor esencial.Introduccion. Hasta ahora no existe una validacion formal de la version española de la escala Fahn-Tolosa-Marin (FTM), usada ampliamente para valorar la gravedad del temblor. Objetivo. Analizar la validez y la fiabilidad de la version en castellano de la escala FTM. Pacientes y metodos. Estudio observacional transversal en pacientes diagnosticados de temblor esencial. Se evaluo la gravedad del temblor con la escala FTM; la discapacidad en el miembro superior, con la escala Disabilities of the Arm, Shoulder and Hand (DASH), y la calidad de vida relacionada con la salud, con el cuestionario Short Form-36 Health Survey (SF-36). El analisis estadistico incluyo descripcion de la muestra, fiabilidad (alfa de Cronbach), validez convergente y capacidad discriminatoria (curvas ROC). Resultados. Se incluyo a 40 pacientes (22 mujeres y 18 hombres con temblor esencial), con una edad media de 65,8 ± 14,7 años (rango: 21-90 años). La fiabilidad de la FTM fue alta, con un alfa de Cronbach de 0,90 (subescala A: 0,85; subescala B: 0,91; subescala C: 0,77). Para evaluar la discapacidad originada por el temblor esencial, la validez convergente entre las escalas DAHS y FTM (subescala C) fue adecuada, con una capacidad diagnostica aceptable: area bajo la curva de 0,86 (intervalo de confianza al 95%: 0,67-1,00), sensibilidad del 78% y especificidad del 75%, para un punto de corte mayor de 5,5. Conclusion. La escala FTM es un instrumento fiable, valido y preciso para la valoracion del temblor esencial en la poblacion española adulta.

[Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia]. / Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.

INTRODUCTION: Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity. AIM: To analyze and summarize different questions about the use of BTA in our clinical practice. DEVELOPMENT: A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc. CONCLUSION: This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.

TITLE: Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.Introduccion. La toxina botulinica de tipo A (TBA) ha supuesto una verdadera revolucion terapeutica en neurologia, y en la actualidad es el tratamiento rutinario en las distonias focales y la espasticidad. Objetivo. Plantear, revisar y responder cuestiones controvertidas en relacion con la neurofarmacologia de la TBA y su uso en las distonias en la practica clinica habitual. Desarrollo. Un grupo de expertos en trastornos del movimiento reviso una lista de temas controvertidos relacionados con la farmacologia de la TBA y su uso en las distonias. Revisamos la bibliografia e incluimos articulos relevantes especialmente en ingles, pero tambien, si su importancia lo merece, en castellano y en frances, hasta junio de 2016. El documento se estructuro como un cuestionario que incluyo las preguntas que podrian generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. Incluimos preguntas sobre diferentes aspectos de la neurofarmacologia, especialmente el mecanismo de accion, la bioequivalencia de los diferentes preparados y la inmunogenicidad. En relacion con el subapartado de las distonias, se incluyeron aspectos sobre la evaluacion y el tratamiento de las distonias focales. Conclusiones. Esta revision no pretende ser una guia, sino una herramienta practica destinada a neurologos y medicos internos residentes interesados en esta area, dentro de diferentes ambitos especificos del manejo de la TBA.

Posible origen en la arteria carótida de un infarto vertebrobasilar / No disponible

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Atributos psicométricos de la versión española de la escala de cribado A-TAC para trastornos del espectro autista / Psychometric attributes of the spanish version of A-TAC screening scale for autism spectrum disorders

Introducción: Actualmente debido a la ausencia de marcadores biológicos, el cribado de trastornos del espectro autista (TEA) se centra fundamentalmente en la presencia de alteraciones conductuales caracterizadas por alteraciones en la interacción social y comunicación verbal y no verbal. Objetivo: Evaluar los atributos psicométricos de la versión española de la escala de autismo Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC), como medida de cribado de TEA. Material y métodos: Se incluyó en el estudio a 140 escolares (43% niños, 57% niñas), de edades comprendidas entre los 6 y los 16 años, con TEA (n = 15), discapacidad intelectual (n = 40), enfermedades psiquiátricas (n = 22), tics (n = 12) y participantes controles (n = 51). Se analizaron los principales atributos psicométricos como la fiabilidad, asunción escalar, la consistencia interna, la precisión y la validez predictiva. Resultados: La consistencia interna de la A-TAC fue alta (α = 0,93) y el error estándar de medida fue adecuado (1,13 [intervalo de confianza del 95%, —1,08 a 3,34]). Las puntuaciones medias de la escala A-TAC fueron más altas en participantes diagnosticados con TEA y discapacidad intelectual comparadas con el resto de participantes (p < 0,001), siendo el área bajo la curva de 0,96 para el grupo de TEA. Conclusión: La subescala de autismo de la escala A-TAC es un instrumento fiable, válido y preciso para el cribado de TEA en la población escolar española (AU)

Background: As there are no biological markers for Autism Spectrum Disorders (ASD), screening must focus on behaviour and the presence of a markedly abnormal development or a deficiency in verbal and non-verbal social interaction and communication. Objective: To evaluate the psychometric attributes of a Spanish version of the autism domain of the Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC) scale for ASD screening. Material and methods: A total of 140 subjects (43% male, 57% female) aged 6-16, with ASD (n = 15), Mental Retardation (n = 40), Psychiatric Illness (n = 22), Tics (n = 12) and controls (n = 51), were included for ASD screening. The predictive validity, acceptability, scale assumptions, Internal consistency, and precision were analysed. Results: The internal consistency was high (α = 0.93), and the standard error was adequate (1.13 [95% CI, -1.08 a 3.34]). The mean scores of the Autism module were higher in patients diagnosed with ASD and mental disability compared to the rest of the patients (P < 0.001). The area under the curve was 0.96 for the ASD group. Conclusion: The autism domain of the A-TAC scale seems to be a reliable, valid and precise tool for ASD screening in the Spanish school population (AU)

[Psychometric attributes of the Spanish version of A-TAC screening scale for autism spectrum disorders]. / Atributos psicométricos de la versión española de la escala de cribado A-TAC para trastornos del espectro autista.

BACKGROUND: As there are no biological markers for Autism Spectrum Disorders (ASD), screening must focus on behaviour and the presence of a markedly abnormal development or a deficiency in verbal and non-verbal social interaction and communication. OBJECTIVE: To evaluate the psychometric attributes of a Spanish version of the autism domain of the Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC) scale for ASD screening. MATERIAL AND METHODS: A total of 140 subjects (43% male, 57% female) aged 6-16, with ASD (n=15), Mental Retardation (n=40), Psychiatric Illness (n=22), Tics (n=12) and controls (n=51), were included for ASD screening. The predictive validity, acceptability, scale assumptions, internal consistency, and precision were analysed. RESULTS: The internal consistency was high (α=0.93), and the standard error was adequate (1.13 [95% CI, -1.08 a 3.34]). The mean scores of the Autism module were higher in patients diagnosed with ASD and mental disability compared to the rest of the patients (P<.001). The area under the curve was 0.96 for the ASD group. CONCLUSION: The autism domain of the A-TAC scale seems to be a reliable, valid and precise tool for ASD screening in the Spanish school population.

Hemorragia de núcleo caudado por anestesia dental / Caudal nucleus haemorrhage due to dental anaesthesia

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[Treatment of medical complications: hypertension/hypotension, hyperglycemia, hyperthermia, hypoxia, cardiac complications and pulmonary embolism]. / Tratamiento de las complicaciones médicas: hipertensión/hipotensión, hiperglucemia, hipertermia, hipoxia, complicaciones cardíacas y embolismo pulmonar.

The stroke patient often suffers additional medical complications related to age, heart and artery damage and immobility. Pulmonary embolism is one condition that can sometimes be prevented. Heart disease must be detected and treated, as it is the principal cause of death after stroke. Recent data describing the physiology of stroke suggest that hypotension, hyperglycemia and hyperthermia should be prevented, as these conditions increase the likelihood of death or sequelae. Stroke is no longer a "wait and see" disease.