Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology.

Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.

Opciones de monitorización neurofisiológica en la resección de tumoraciones cerebrales. Documento de consenso entre el Grupo de Trabajo de Neurooncología de la Sociedad Española de Neurocirugía (SENEC) y la Sociedad Española de Neurofisiología Clínica (SENFC) / Neurophysiological monitoring options in brain tumour resections. Consensus statement from the Spanish Society of Neurosurgery's (SENEC) Neuro-oncology Working Group and the Spanish Society of Clinical Neurophysiology (SENFC)

Las tumoraciones cerebrales que se encuentran cerca o en áreas elocuentes siguen siendo un importante reto neuroquirúrgico. Existe consenso en la literatura respecto a que la realización de este tipo de cirugías con monitorización neurofisiológica nos permite conseguir resecciones mayores con una mayor seguridad y menor presencia de focalidades neurológicas permanentes. Sin embargo, la forma de realizar este tipo de monitorización, la definición exacta de área elocuente, la forma de realizar la cirugía con el paciente despierto o dormido es objetivo de un gran debate a nivel científico. Miembros del Grupo de Trabajo de Neurooncología (GTNO) de la Sociedad Española de Neurocirugía (SENEC) y miembros de la Sociedad Española de Neurofisiología Clínica (SENFC) han elaborado un documento de consenso con el objetivo de exponer las diferentes opciones de monitorización neurofisiológica que tenemos a día de hoy, tanto en el paciente despierto como en el dormido, para obtener mejores resecciones quirúrgicas preservando la función neurológica del paciente y se ha realizado una exhaustiva revisión bibliográfica

Brain tumours located in or in proximity to eloquent areas are a significant neurosurgical challenge. Performing this kind of surgery with neurophysiological monitoring to improve resections with reduced permanent focal neurological deficit has become widely accepted in the literature. However, how to conduct this monitoring, the exact definition of an eloquent area and whether to perform this surgery with the patient awake or asleep are still subject to rigorous scientific debate. Members of the Neuro-oncology Working Group (GTNO) of the Spanish Society of Neurosurgery (SENEC) and members of the Spanish Society of Clinical Neurophysiology (SENFC) have published a consensus statement to explain the different neurophysiological monitoring options currently available in awake and asleep patients to obtain better surgical resection without neurological deficits. An exhaustive review of the literature has also been conducted

Anorgasmia masculina como síntoma inicial de mielitis transversa / Male anorgasmia as initial symptom of transverse myelitis

No disponible

Neurociencia cognitiva aplicada / Applied cognitive neuroscience

No disponible

Simulación en patología espinal / Simulation in spinal diseases

La columna es terreno abonado para la simulación, involucrando a diferentes Especialistas (traumatólogos, neurocirujanos, rehabilitadores, médicos de familia, etc.). La simulación requiere la producción intencional de síntomas exagerados o falsos respondiendo a un incentivo externo. Sin embargo, en la práctica, hay dificultades en la demostración de dichos requisitos. Esto origina que algunos simuladores no resulten identificados y que pacientes no simuladores con actitud incongruente sean etiquetados de rentistas, originando distrés iatrógeno y exposición a litigación. Se analiza la simulación en el raquis, proponiendo una modificación terminológica, así como una nueva estrategia de diagnóstico, para evitar errores y reducir tanto el distrés iatrógeno como la ligitabilidad. Basándonos en la experiencia clínico-forense de los autores, se analiza la bibliografía y se propone una semiología uniforme. El abordaje es multidimensional y la estrategia de diagnóstico basada en: anamnesis, exploración y pruebas complementarias, adaptando sus resultados a una terminología uniforme con significado preciso de signos y síntomas (AU)

Simulation is frequent in spinal disease, resulting in problems for specialists like Orthopedic Surgeons, Neurosurgeons, Reumatologists, etc. Simulation requires demonstration of the intentional production of false or exaggerated symptoms following an external incentive. The clinician has difficulties in demonstrating these criteria, resulting in misdiagnosis of simulation or misinterpretation of the normal patient as a simulator, with the possibility of iatrogenic distress and litigation. We review simulation-related problems in spine, proposing a terminological, as well as a diagnostic strategy including clinical and complementary diagnosis, as a way to avoid misinterpretation and minimize the iatrogenic distress and liability. Based on the clinical-forensic author's expertise, the literature is analyzed and the terminology readdressed to develop new terms (inconsistencies, incongruences, discrepancies and contradictions). Clinical semiology and complementary test are adapted to the new scenario. Diagnostic strategy relies on anamnesis, clinical and complementary tests, and adapting them to a uniform terminology with clear meaning of signs and symptoms (AU)

Trastorno por estrés postraumático y cerebro / Posttraumatic stress disorder and brain

En la actualidad, encontramos numerosa bibliografía sobre las alteraciones estructurales y funcionales cerebrales en el Trastorno por Estrés Postraumático (TEPT). En este trabajo se presenta una revisión bibliográfica no sistemática de los artículos publicados en los últimos años sobre la neuroanatomía y la neurofisiología del Trastorno por Estrés Postraumático. Los objetivos son: describir las hipótesis que relacionan las alteraciones neuroanatómicas y la sintomatología característica del TEPT; y describir el perfil neuropsicológico y los tratamientos con base en las neurociencias, partiendo de la premisa de que las limitaciones metodológicas de los estudios no permiten generalizar estos resultados. Finalmente se propone que la rehabilitación neuropsicológica de los déficits cognitivos mostrados por estos pacientes potenciaría la eficacia de los tratamientos psicológicos (AU)

Currently, we have enough literature about brain findings in posttraumatic stress disorder (PTSD). A bibliographical review of the articles published in the last years related to neuroanatomy and neurophysiology of Posttraumatic Stress Disorder is presented. The aims of this review are: to describe the hypotheses that relate the neuroanatomics disorders and the typical symptomatology of the TEPT, and to describe the neuropsychological profile and the treatments based in Neuroscience, taking into account that the methodological limitations of the studies do not allow to generalize these results. Finally, we raise the rehabilitation of the neuropsychological cognitive deficits shown by these patients, with a view to enhancing the effectiveness of psychological treatments (AU)

Guías visuales como herramienta terapéutica en la enfermedad de Parkinson. Una revisión sistemática / Visual cues as a therapeutic tool in Parkinson's disease. A systematic review

Los estímulos o guías sensoriales se están utilizando como una herramienta terapéutica para la mejora de los trastornos de la marcha en los pacientes con enfermedad de Parkinson, pero la mayoría de los estudios parecen centrarse en el uso de estímulos auditivos. El objetivo del presente estudio fue realizar una revisión sistemática referente al uso de estímulos visuales sobre los trastornos de la marcha y la ejecución de tareas duales durante la misma, su influencia sobre los bloqueos motores y la incidencia de caídas en los pacientes con enfermedad de Parkinson, al objeto de poder extraer implicaciones terapéuticas. Se realizó una búsqueda bibliográfica sistemática en las principales bases de datos, como Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE, y Physiotherapy Evidence Database, durante el periodo 2005 al 2012, de acuerdo con las recomendaciones de la Consolidated Standards of Reporting Trials, valorando la calidad de los trabajos con el Quality Index de Downs y Black. Fueron incluidos 21 artículos en la presente revisión sistemática (con un total de 892 participantes), con calidad metodológica variable, obteniendo una puntuación media en el Quality Index de 17,27 puntos (rango: 11-21). Los estímulos visuales producen mejoras en parámetros temporoespaciales de la marcha, la ejecución de giros, disminuyendo la aparición de freezing y caídas en la enfermedad de Parkinson. Las tareas duales durante la marcha parecen beneficiarse mediante su uso, disminuyendo la interferencia de esta segunda tarea. Existe una necesidad de mayores estudios que determinen el tipo de estímulo preferente para cada estadio de la enfermedad(AU)

Sensory stimuli or sensory cues are being used as a therapeutic tool for improving gait disorders in Parkinson's disease patients, but most studies seem to focus on auditory stimuli. The aim of this study was to conduct a systematic review regarding the use of visual cues over gait disorders, dual tasks during gait, freezing and the incidence of falls in patients with Parkinson to obtain therapeutic implications. We conducted a systematic review in main databases such as Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE and Physiotherapy Evidence Database, during 2005 to 2012, according to the recommendations of the Consolidated Standards of Reporting Trials, evaluating the quality of the papers included with the Downs & Black Quality Index. 21 articles were finally included in this systematic review (with a total of 892 participants) with variable methodological quality, achieving an average of 17.27 points in the Downs and Black Quality Index (range: 11-21). Visual cues produce improvements over temporal-spatial parameters in gait, turning execution, reducing the appearance of freezing and falls in Parkinson's disease patients. Visual cues appear to benefit dual tasks during gait, reducing the interference of the second task. Further studies are needed to determine the preferred type of stimuli for each stage of the disease(AU)

Validación de la cordancia electroencefálica en la evaluación, pronóstico y tipología de fibromialgia / Validation of electroencephalic cordance for evaluation, prognosis and classification of fibromyalgia

Objetivo: Determinar los indicadores específicos para mejorar el diagnóstico y la evaluación de la gravedad de la fibromialgia, buscando la relación con distintos aspectos psíquicos. Material y método: En el primer estudio se comparó un grupo de 13 pacientes de fibromialgia con un grupo control de 13 individuos. En el segundo estudio se analizaron 56 pacientes antes y después del tratamiento psicoterapéutico ACT. Se calcularon los valores de intensidad de cordancia y se les evaluó mediante diversos cuestionarios psicológicos. Se obtuvieron, mediante el EEG cuantitativo, los valores de cordancia para los distintos electrodos y bandas de frecuencias, así como las correlaciones con los resultados de las pruebas psicológicas. Resultados: Los pacientes con mayor gravedad clínica mostraron valores de la cordancia prefrontal en la banda theta significativamente mayores que los enfermos menos graves. Encontramos una correlación negativa entre los valores prefrontal izquierdo y derecho de la cordancia en la banda theta (Fp1 y Fp2) y el estado global de salud (SF-36). Tras la terapia se observó una disminución significativa de la cordancia de los pacientes en varias regiones, fundamentalmente en prefrontales. Conclusión: Este estudio pone de manifiesto el interés de estudiar la cordancia como método de diagnóstico y tipificación de la fibromialgia (AU)

Objective: The main goal has been to determine specific indicators and to contribute to the diagnosis and assessment of severity of fibromyalgia, also looking for establishing its relationship with several psychological and neuropsychiatric tests. Material and method: In the first study a group of 13 patients with fibromyalgia was compared with a control group of 13 subjects. In the second study, we compared a group of 56 patients before and after Psychotherapy ACT. We calculated the intensity values of cordance and the correlations with various psychological questionnaires. The values of cordance for the different electrodes and frequency bands, as well as the correlations with the results of psychological tests, were obtained from EEG recordings. Results: Patients with clinical severity showed higher values of the prefrontal cordances in the theta band, significantly higher than less severe patients. There is also a strong negative correlation between left and right prefrontal values of concordance in the theta band (Fp1 and Fp2) and global health status (SF-36). After therapy, there was a significant decrease in the cordance of patients in several regions, particularly in the prefrontal regions. Conclusion: This study is the first step for the acceptance of cordance as a new tool for diagnostic and classification of fibromyalgia and other neuropsychiatric disorders (AU)

Anestesia para la craneotomía en el paciente consciente / Anesthesia for craniotomy in the conscious patient

La craneotomía en el paciente consciente (CPC) permite valorar los cambios neurológicos durante la obtención de mapas neurológicos en la cirugía de la epilepsia, la localización de los electrodos durante la cirugía de estimulación cerebral profunda y la extirpación tumoral en áreas elocuentes del cerebro. La CPC consciente es útil para realizar cirugía radical, minimizando el daño en las zonas funcionales del cerebro. El anestesiólogo debe asegurar un adecuado bienestar al paciente, una óptima analgesia y garantizar su colaboración. Se debe realizar una adecuada selección conjunta de los posibles candidatos con todos los profesionales implicados en el caso. El conocimiento de las distintas fases de esta forma de craneotomía, la coordinación y comunicación entre los especialistas, el dominio de la farmacología y de las técnicas anestésicas específicas, junto con la capacidad de comunicación psicoemocional con el paciente, son los determinantes del éxito del procedimiento, que debe someterse, además, a la cultura de seguridad. El objetivo de esta revisión es describir el tratamiento anestésico integral, las consideraciones neurofisiológicas y las complicaciones intraoperatorias de la CPC(AU)

Craniotomy in the conscious patient (CPC) enables the neurological changes to be assessed during the mapping in epilepsy surgery, the location of the electrodes during deep brain stimulation surgery, and tumor resection in eloquent areas of the brain. CPC is a useful technique for radical surgery in order to minimize the damage to the functional areas of the brain. The anesthesiologist must ensure, adequate patient comfort, analgesia and ensure optimal collaboration. The appropriate selection of potential candidates for CPC should be made jointly with all professionals involved in the case. Knowledge of the different phases of CPC, coordination and communication among specialists, the right management of the pharmacology, and anesthetic techniques specific to CPC, along with the ability of psycho-emotional communication with the patient, determine the success of the procedure to be performed in the culture of patient safety. The aim of this review was to describe the anesthetic management, comprehensive considerations, and intraoperative neurophysiological tests for CPC(AU)

Figures and institutions of the neurological sciences in Paris from 1800 to 1950. Part II: Neurophysiology.

We present a short historical review of the major figures and institutions that contributed to make Paris a renowned centre of physiology and neurology during the xixth and the first half of the xxth century. We purposely chose to focus on the period 1800-1950, as 1800 corresponds to the actual beginning of experimental physiology of the nervous system - what is here referred to as "neuroscience"-and 1950 marks its exponential rise. Our presentation is divided into four chapters, matching the main disciplines which have progressed and contributed the most to the knowledge we have of the brain sciences: anatomy, physiology, neurology, and psychiatry-psychology. The present article is the second of four parts of this review which includes the chapter on neurophysiology with selected biographical sketches of François Magendie, Marie Jean-Pierre Flourens, Claude Bernard, Charles-Édouard Brown-Séquard, Étienne-Jules Marey, Alfred Fessard and Denise Albe-Fessard.

EEG departments in Great Britain: a survey of practice.

OBJECTIVE: Guidelines have been published recently on when an electroencephalogram (EEG) should be undertaken and the expected waiting time for a routine EEG, but have not included recommendations on how an EEG should be undertaken or who should undertake and report EEGs. The purpose of this survey was to obtain background information on the composition and practice of EEG departments throughout Great Britain that might form the basis for additional recommendations and guidelines. METHODS: A postal questionnaire was sent to all EEG departments in Great Britain in 2001/2002; non-responders were sent a further copy of the questionnaire. RESULTS: Fifty-two departments responded, representing a response rate of 48%. The reasons for this relatively poor response rate are not known. Findings indicated that a single doctor reported EEGs in 44% of all departments. The speciality of doctor reporting EEGs included neurophysiologists (59%), neurologists (22%), paediatric neurologists (PNs) (13%), psychiatrists (5%) and one general practitioner (GP). EEG recordists from 28 departments (54%) and medical staff in 21 departments (40%) stated that they had not received any formal training in, respectively, undertaking and reporting EEGs in children. In 29 departments (55%), medical staff report EEGs independently from the recordists. Fourteen departments (27%) undertake less than 500 EEGs per year. Ten of the 42 departments providing a paediatric service perform less than 100 paediatric EEGs per year. Eighteen (35%) and eight (15%) units have a waiting time of 2-4 and over 12 weeks, respectively, for a routine EEG. CONCLUSIONS: This survey has identified a range of practice and operational procedures in 52 EEG departments throughout Great Britain. These findings may have implications on the investigation and management of people with non-epileptic seizures and epilepsy.

Kathleen Mears Memorial Lecture: ASET and OSET, patterns and parallels.

OSET is the international Organisation of Societies for Electrophysiological Technology, a federation of professional societies from around the world. Just as ASET grew out of the national physicians' society, OSET grew out of an international physicians' consortium. Both ASET and OSET are independent groups that address the many issues specific to technologists, from entry-level education to standards of practice and legal conditions of practice. The present "members" of OSET are the technologist societies of Australia, Canada, Denmark, Finland, France, Germany, Italy, Netherlands, Norway, Sweden, Switzerland, the U.K., and the U.S.; the individual members of those societies are members of OSET by extension. OSET holds a week-long Congress every four years, hosted by one of the member societies. Technologists from all over the world gather to share information via platform papers and posters. Just as ASET meetings provide an opportunity for technologists to learn from each other, formally and informally, so the OSET Congresses extend that sharing beyond national borders. Between Congresses, OSET work is done by committees. Some of the published results of this committee work are statements of minimal and optimal standards of training in EEG and evoked potentials, guidelines for digital EEG, guidelines for infection control, and guidelines for intraoperative monitoring. The last two Congresses have had sessions on education in the OSET countries; present committee work is continuing to study this issue to develop a truly international statement of competencies, i.e., what technologists must be able to do to perform electrophysiologic studies anywhere in the world.

Small bits to big bites.

The Department of Clinical Neurophysiology in Uppsala, Sweden, has reached a high degree of computerization. Patient booking, administration, recording equipment, reporting, and telemedicine are linked components forming an integrated laboratory. Today's configuration is a result of the continuous development and implementation of new technologies. During the 1960s and 1970s, the focus was set on the development of signal analysis procedures. The introduction of personal computers and a local network was the main interest during the 1980s. The 1990s were devoted to the Internet and the development of Keypoint electromyography/evoked potential equipment.

¿Es posible un tratamiento diferente de las adicciones? / No disponible

Los tratamientos de los trastornos adictivos siguen la inercia de los criterios asistenciales de la segunda mitad del siglo XX. Aunque estos han dado una respuesta satisfactoria a ciertas personas, hay un numeroso grupo de alcohólicos y drogodependientes con repetidas experinecias terapéuticas fracasadas, expuestos en las recaídas a severos procesoso de marginación. EStos hechos junto con las modernas hipótesis sustentadas en los resultados de las investigaciones y en las relaciones observadas entre drogas y trastornos mentales, animan a revisar los objetivos y medios del tratamiento de los drogodependientes(AU)

Drug addiction has today almost the same therapeutica approach that it had in the first sixties. The therapeutic models prevailing now adays have had success in some patients, although some others have repeted failures and relapses with margination problems associated. This facts plus the moder hypothesis about the drug dependence make necessary addictives disorders treatment(AU

The autonomic laboratory.

The autonomic nervous system can now be studied quantitatively, noninvasively, and reproducibly in a clinical autonomic laboratory. The approach at the Mayo Clinic is to study the postganglionic sympathetic nerve fibers of peripheral nerve (using the quantitative sudomotor axon reflex test [QSART]), the parasympathetic nerves to the heart (cardiovagal tests), and the regulation of blood pressure by the baroreflexes (adrenergic tests). Patient preparation is extremely important, since the state of the patient influences the results of autonomic function tests. The autonomic technologist in this evolving field needs to have a solid core of knowledge of autonomic physiology and autonomic function tests, followed by training in the performance of these tests in a standardized fashion. The range and utilization of tests of autonomic function will likely continue to evolve.