Search

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia. Catheter ablation aims to restore sinus rhythm. However, relapses occur in up to 30% of patients. A Mediterranean diet (MedDiet) enriched with extra-virgin olive oil (EVOO) substantially reduced the incidence of AF in the PREDIMED trial. The PREDIMAR will test a similar intervention in secondary prevention. Methods PREDIMAR is a multicenter, randomized, single-blind trial testing the effect of a MedDiet enriched with EVOO to reduce tachyarrhythmia relapses after AF ablation. The primary outcome is the recurrence of any sustained atrial tachyarrhythmia after ablation (excluding those occurring only during the first 3 months after ablation). The target final sample size is 720 patients (360 per group) recruited from 4 Spanish hospitals. A remote intervention, maintained for 2 years, is delivered to the active intervention group including periodic phone calls by a dietitian and free provision of EVOO. The control group will receive delayed intervention after trial completion. Routine electrocardiogram (ECG) and Holter ECG are performed, and a portable cardiac rhythm monitoring device is provided to be worn by participants during 15 months. Results Recruitment started in March 2017. Up to July 2019, 609 patients were randomized (average inclusion rate: 5.3 patients/wk). Retention rates after 18 months are >94%. Conclusions If our hypothesis is confirmed, the utility of the MedDiet enriched with EVOO in slowing the progression of AF will be proven, preventing recurrences and potentially reducing complications.

In 2011, the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of venous thromboembolism (VTE) and cancer. This guideline was updated in 2014, and since then, multiple studies and clinical trials have changed the landscape of the treatment and prophylaxis of VTE in cancer patients. To incorporate the most recent evidence, including data from direct oral anticoagulants (DOACs) randomized clinical trials, SEOM presents a new update of the guideline.

Resumen Objetivo Estudiar la duracion de los registros cerebrales multiunitarios (RCM) en 20 anos de neurocirugias en trastornos del movimiento, asi como las veces en que fue necesario explorar todos los trayectos de los electrodos en las posiciones registradas simultaneamente (PRS) por grupos que usan registros cerebrales unitarios (RCU). Material y metodo Analisis estadistico descriptivo retrospectivo de la duracion de los RCM en 4.296 trayectos en 952 cirugias. Los criterios de exclusion fueron: trayectos con menos de 5 senales grabadas, o con senales con duracion diferente de los 2 s habituales, o cuando existieron situaciones no usuales, ni relacionadas con los RCM, asi como las primeras 20 cirugias de cada blanco quirurgico, resultando asi un total de 3.448 trayectos en 805 cirugias. Del total de 952 cirugias, se analiza ademas en cuantas de ellas fueron explorados todos los trayectos en las PRS de RCU. Resultados La media y su intervalo de confianza (p = 0,05) del tiempo por trayecto de RCM es 5,49 ± 0,16 min en cirugia en nucleo subtalamico; 8,82 ± 0,24 min en globo palido medial o interno; y 18,51 ± 1,31 min en nucleo ventral intermedio del talamo. Para la suma total de trayectos por cirugia, en el 75% de los casos el tiempo total es de menos de 39 min en nucleo subtalamico, casi 42 min en globo palido medial o interno y menos de 1 h y 17 min en nucleo ventral intermedio del talamo. En solo el 4,2% de las cirugias fueron explorados todos los trayectos en las PRS de RCU. Conclusiones El impacto de los RCM en el tiempo quirurgico es aceptable para esta guia en la localizacion objetiva de los blancos quirurgicos, sin tener que usar varios electrodos simultaneos, no todos imprescindibles en la mayoria de los casos, con menor riesgo asi para el paciente.

Unilateral radiofrequency subthalamotomy has been shown to improve the cardinal features of Parkinson’s disease (PD).1 However, this approach has not been widely employed because most surgical candidates require bilateral treatment such as deep brain stimulation. Here, we evaluated to what extent the therapeutic impact of unilateral radiofrequency subthalamotomy on the treated body side is maintained years after surgery. This is particularly relevant nowadays because of the newly developed technique of MRI-guided high-intensity focused ultrasound (MRIgFUS). This has been shown to effectively improve essential and parkinsonian tremor by thalamotomy2 and all cardinal features of PD in asymmetrical patients by subthalamotomy.3 See table 1 for demographic characteristics of the sample (n=7). All patients were recruited and operated on in the Centro Internacional de Restauracion Neurologica (CIREN), Havana (Cuba), between 2008 and 2010. Details of the surgical procedure and clinical evaluation have been given previously.1 The Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III (Motor Part) was used for scoring. The specific impact of the lesion was evaluated by assessing the motor MDS-UPDRS score of the cardinal motor features for each body side (ie, 3.3 item for rigidity; 3.4–3.8 for bradykinesia and 3.15–3.17 for tremor). Patients were examined in the off medication state (12–18 hours of drug withdrawal) and subsequently re-evaluated after taking their usual levodopa dose. The same neurologists evaluated the patients reported here throughout the study period. View this table: Table 1 Baseline characteristics of patients with PD treated with unilateral subthalamotomy The …

Background Focal thalamic lesions have been associated with a variety of involuntary movements such as tremor, dystonia, and chorea-ballism. Methods We describe a patient with severe hyperkinesias of the right arm secondary to a thalamic infarction in the left postero-ventral region of the thalamus. Results The dystonia and tremor of the right upper limb were subsequently controlled with another surgical lesion of the ventralis intermedius nucleus of the thalamus. Conclusion This observation suggests that ablative surgery might be applied to treat a movement disorder induced by the lesion of the same nucleus, which in addition lead to interesting pathophysiological conjectures. © 2014 International Parkinson and Movement Disorder Society

Background: Stereotactic thermocoagulative lesions of the subthalamic nucleus (STN) have been shown to induce significant motor improvement in patients with Parkinson’s disease (PD). Patients and methods: 89 patients with PD were treated with unilateral subthalamotomy. 68 patients were available for evaluations after 12 months, 36 at 24 months and 25 at 36 months. Results: The Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores improved significantly contralaterally to the lesion in the “off” and “on” states throughout the follow-up, except for the “on” state at the last evaluation. Axial features and signs ipsilateral to the lesion progressed steadily throughout the study. Levodopa daily doses were significantly reduced by 45%, 36% and 28% at 12, 24 and 36 months post-surgery. 14 patients (15%) developed postoperative hemichorea-ballism which required pallidotomy in eight. These 14 patients had significantly higher dyskinesia scores (levodopa induced) preoperatively than the entire cohort. Conclusion: Unilateral subthalamotomy was associated with significant and sustained motor benefit contralateral to the lesion. Further work is needed to ascertain what factors led to severe, persistent chorea-ballism in a subset of patients. Subthalamotomy may be considered an option in circumstances when deep brain stimulation is not viable.

We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12-24 months ('staged surgery'). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day ('simultaneous surgery'). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the 'off' and 'on' drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the 'off' (49.5%) and 'on' (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the 'off' and 'on' medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3-6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3-6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.

OBJECTIVE To develop a method to place a lesion precisely in the subthalamic nucleus (STN) and evaluate its effectiveness. METHODS A retrospective study of targeting data collected during stereotactic planning to lesion the STN in 31 patients with Parkinson's disease and of results in more than 50 procedures was performed. The targeting method was based on computed tomographic imaging together with semimicroelectrode recording digital processing and electrical stimulation. Two statistical methods were used to correlate initial with final target coordinates and assess the efficacy of the targeting procedure. RESULTS The anatomic target based on computed tomographic imaging data showed electrical activity in the subthalamus in the first pass in 82% of the procedures. In the remaining 18%, the STN was an average of 1.93 mm away from the nearest trajectory that recorded the STN (range, 1.41-2.24 mm). The average number of trajectories per procedure was 7.2; the location of the first trajectory relative to the center of the nucleus determined by electrical and physiological means (P < 0.01, analysis of variance, Student's t test) was as follows: in the lateral direction, 1.25 +/- 1.15 mm; in the anteroposterior direction, 1.53 +/- 1.31 mm; and in the vertical direction, 0.67 +/- 0.51 mm. The average number of tracts necessary to lesion the STN was two. CONCLUSION The combination of computed tomographic imaging, semimicroelectrode recording, and microstimulation provides an effective method to identify the STN lesion in parkinsonian patients. The method used for anatomic localization and electrophysiological mapping of the subthalamus was found to be effective in reaching the sensorimotor region of the nucleus. We carried out an accurate determination of the subthalamus location and its volume in the lesioning.

This paper describes the automatic three-dimensional (3D) graphic possibilities that are supplied by the Neurosurgical Deep Recording System (NDRS) to facilitate anatomic-physiological targeting during stereotactic and functional neurosurgery using depth recording. This software has been developed to substitute the complex electronic equipment ordinarily used for deep brain electrical recording, display and processing by a personal computer. It may also help to improve on-line graphic analysis, automatic management of the recorded information and flexibility to implement different forms of signal analysis. It can automatically show a 2D or 3D representation of the electrode track, with the electrophysiological findings superimposed as well as the corresponding sagittal, coronal and axial views of a brain atlas using automatic scaling. The NDRS has already successfully been applied during more than 300 neurosurgeries in Spain and Cuba, enabling improved targeting accuracy and safety.

Introduction The association of neuromyelitis optica (NMO) and multiple sclerosis (MS) has been reported, but details of the cases were not described. We report two Venezuelan Caucasian sisters with human leukocyte antigen (HLA) typing. Results Patient 1 fulfilled McDonald, et al. criteria with HLA A*24; B*07,*15; DRB1*01,*16 (DR2 positive). Patient 2 fulfilled the NMO revised criteria of Wingerchuck, et al. with HLA A*02,*24; B*07,*40; DRB1*04,*08, similar to Canadian aboriginal NMO cases and the Yukpa population from Venezuela. Conclusion These cases confirmed the coexistence of NMO and MS in sisters, and further studies are needed to understand the genetic linkage between these diseases.

We have now applied the enzyme immunoassay using anti-NGF monoclonal antibody (MAb) 27/21 and a blocking test validating the specificity of the immunoreactivity for NGF in serum samples to examine NGF levels in normal rat sera, hemiparkinsonian rat sera, normal monkey sera, and MPTP-treated monkey sera. The levels of NGF in treated animals showed reductions when compared with serum from normal animals. The NGF level alterations observed in lesioned animals and in human parkinsonian patients evidence a relationship between this neurotrophic factor and the neurodegenerative changes observed in Parkinson disease (PD).

The “Neurosurgical Deep Recording System” (NDRS) is a software for physiological targeting during stereotactic and functional neurosurgery using deep brain recording [1]. It substitutes with a personal computer (PC) complex equipment for signal recording.

This paper summarizes the results of three controlled clinical trials related to the transplantation of embryonic ventral mesencephalic tissue into the striatum of 46 idiopathic parkinsonian patients exhibiting motor complications on standard levodopa therapy. From January 1988 to April 1990, 30 subjects with fluctuating Parkinson's disease received fetal dopaminergic tissue implants by the open microsurgical technique. In March 1992 the stereotactic approach was adopted for successive fetal mesencephalic cell suspension transplants (7 unilateral and 9 bilateral) into the caudate and putamen of parkinsonian patients with levodopa-induced complex fluctuations and dyskinesias. The neurological assessment performed 12 months before and 3-18 months after transplantation demonstrated a reduction of both the daily time spent in the 'off' condition and the number of daily 'off' periods, and a significant improvement of the motor scale. The stereotactic selective thalamotomy with microelectrode recording was introduced in January 1993, in order to provide a further potential treatment strategy; i.e., the combination of the two surgical trends in Parkinson's disease, the restorative neurotransplantation technique, and the selective lesional approach. In addition to that, microelectrode recording is also used for implantation site selection and functional characterization.

INTRODUCTION: The Neurosurgical Deep Recording System (NDRS) using a personal computer takes the place of complex electronic equipment for recording and processing deep cerebral electrical activity, as a guide in stereotaxic functional neurosurgery. It also permits increased possibilities of presenting information in direct graphic form with automatic management and sufficient flexibility to implement different analyses. OBJECTIVE: This paper describes the possibilities of automatic simultaneous graphic representation in three almost orthogonal planes, available with the new 5.1 version of NDRS so as to facilitate the analysis of anatomophysiological correlation in the localization of deep structures of the brain during minimal access surgery. MATERIAL AND METHODS: This new version can automatically show the spatial behaviour of signals registered throughout the path of the electrode inside the brain, superimposed simultaneously on sagittal, coronal and axial sections of an anatomical atlas of the brain, after adjusting the scale automatically according to the dimensions of the brain of each individual patient. This may also be shown in a tridimensional representation of the different planes themselves intercepting. RESULTS: The NDRS system has been successfully used in Spain and Cuba in over 300 functional neurosurgery operations. The new version further facilitates analysis of spatial anatomophysiological correlation for the localization of brain structures. CONCLUSION: This system has contributed to increase the precision and safety in selecting surgical targets in the control of Parkinson s disease and other disorders of movement.

INTRODUCTION Microtransplantation of fetal dopaminergic cells has been used over the past ten years with good results in models of Parkinson's disease. OBJECTIVE To evaluate the effect of microtransplantation of fetal dopaminergic cells 'seeded' in the substantia nigra pars reticulata (SNpr) and striate (St) simultaneously. MATERIAL AND METHODS The animals received a transplant or microtransplant of cells into the St and SNpr ipsilateral to the lesion in the substantia nigra pars compacta or to both regions. Depending on the site and technique used the following experimental groups were considered: I. Macrotransplantation to the St (n = 20); II. Microtransplant to the St (n = 20); III. Microtransplant to St + SNpr (n = 20); IV. Microtransplant to St + SNpr (n = 20); V. Macrotransplantation to SNpr (n = 20); VI. Microtransplantation to SNpr (n = 20); and VII. Control (lesion only) (n = 20). The rotations induced by D-amphetamine (5 mg/kg i.p.) and by apomorphine were studied 1, 2, 3 and 6 months and 3 and 6 months respectively after transplantation. Three months after transplantation we studied the motor asymmetry shown by the animals by means of the ladder test. RESULTS The rotations were reduced in the groups with intrastriate transplantation. Comparison between the surgical techniques showed nonsignificant differences between them. The ladder test showed significant differences in use of the limbs in all experimental groups. Use of the left limb was significantly reduced in all groups. CONCLUSIONS Modification of the rotations seems more sensitive to the site of transplant than to the technique used. It seems that the skills studied using the ladder test are not altered by the microtransplant technique.

INTRODUCTION Studies of neural transplants in experimental models of Parkinson's disease have concentrated their attention on ectopic transplants of foetal mesencephalic cells to denervated striatum. However, the external globus pallidus has recently been shown to play an important part in the physiopathology of this disease. OBJECTIVE Bearing in mind the importance of loss of extra-striatal dopamine in the genesis of the clinical signs found in parkinsonism, the objective of this study was to evaluate the effect of foetal mesencephalic transplantation to the globus pallidus of hemiparkinsonian rats. MATERIAL AND METHODS Following conventional transplantation methodolgy, suspensions of cells from the ventral mesencephalum of rat embryos (E-14) were implanted. The tissue was grafted into the striatum, pallidum-striatum and pallidum areas of rats with unilateral lesions of the striatonigral bundle. One, two, three and six months after transplantation, the rotatory activity induced by D-amphetamine was evaluated. The rotatory behaviour induced by apomorphine was evaluated at three months. Motor ability of the front legs was evaluated in all experimental groups three months after transplantation using the 'ladder test'. RESULTS In the experimental groups in which a transplant was made to the globus pallidus there was a significant reduction (p < 0.01) in rotatory activity induced by D-amphetamine and by apomorphine as compared with the non-transplanted groups. CONCLUSIONS Transplants of foetal dopaminergic cells survive in the globus pallidus of hemiparkinsonian rats and can improve the rotational activity induced by dopaminergic agonists.

Objective The objective of this paper was to review information related to the various factors which may trigger the mechanisms of cell death, induced or programmed, which take place in the nervous system and their relationship with the aetiopathogenesis of the neurodegenerative diseases. Development In recent years it has been recognized that cell death may be not only the consequence of accidental damage but also a sign of a suicide programme. This form of death is currently known as apoptosis. It is a process which is morphologically distinct from accidental cell death or necrosis. It does not cause an inflammatory response. This type of death is not only involved in the development and haemostasis of tissues, but also in setting off neuronal degeneration in experimental models of Parkinson's disease, Huntington's chorea, etc. Conclusions In the cell death occurring in neurodegenerative diseases there is more than one induction mechanisms. Understanding the factors which trigger cell death, and the chain of events leading to this, gives grounds for the design of new pharmacological strategies for the treatment of these diseases.

INTRODUCTION Transplantation of foetal dopaminergic cells has been extensively used as restorative treatment for Parkinson's disease. OBJECTIVE This study was carried out to determine the survival, modifications in rotatory activity induced by D-amphetamine and total content of dopamine in the striatal and nigra regions of hemiparkinsonian rats which had had foetal mesencephalic cells simultaneously transplanted to the striatum and pars reticularis of the substancia nigra. MATERIAL AND METHODS The study was done using adult male Wistar rats weighing 200-250 gms. The following experimental groups were formed, depending on the site of transplant: St: transplant to striatum (n = 2); SNr: transplant to SNr (n = 20), ST + Snr; transplant to striatum and SNr simultaneously n = 20; and control (lesion with no transplant) n = 20. We studied the rotatory activity induced by D-amphetamine 1, 2, 3 and 6 months after transplantation. After this time the rats were deeply anaesthetized and randomly allocated for morphological study or biochemical determination of the total dopamine content in the St and SNr using the HPLC technique. RESULTS Study of conduct showed no significant differences in rotatory activity induced by D-amphetamine between the groups with intrastriatal transplants, but there was a difference between these and the SNr and control groups. Biochemical analysis showed that striatal DA content was significantly greater in the ST for the groups with intrastriatal transplants. The content of substancia nigra DA was significantly greater in the SNr of the ST + SNr group, followed by the ST group. Morphometric study showed differences, which were not significant, between ST transplanted animals and significant differences between the SNr transplanted group with a significant increase in survival of the SNr of the ST + SNr group. CONCLUSIONS These results suggest a positive effect due to intrastriatal transplants compared to survival following intranigral transplants.

INTRODUCTION: Evaluation of rotatory activity induced by dopaminergic agonists is the most widely used test of conduct for the measurement of dopaminergic depletion of a unilateral lesion of the striatonigral pathway caused by 6-hydroxydopamine (6-OHDA) in rats, since it is quantitatively related to the extension of the dopaminergic denervation. OBJECTIVE: The objective of this study was to evaluate, from different angles, the changes in conduct seen in the model of unilateral lesion with 6-OHDA and to establish correlation with the rotation induced by D-amphetamine and by apomorphine and the ladder test. MATERIAL AND METHODS: Male Wistar rats were used. Lesions were produced in the SNpc by stereotactic injection of 6-OHDA into the right hemisphere and the effectiveness of the lesions was studied using the rotary conduct induced by D-amphetamine and apomorphine. The motor ability of the front legs was measured by the ladder test, carried out under standard and forced conditions. RESULTS: All the animals with lesions had difficulty in reaching food with both legs, although the most pronounced deficit was in the leg contralateral to the lesion. The ladder test correlated better with rotatory activity induced by apomorphine than by D-amphetamine. CONCLUSION: The animals with most dopamine loss showed most deficient use of their front legs. Language: es