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Resumen La neuromielitis optica (NMO), tambien llamada espectro de la neuromielitis optica (neuromyelitis optica spectrum disorders) se reconoce como una enfermedad inflamatoria, autoinmune, desmielinizante del sistema nervioso central, mediada por autoanticuerpos contra el receptor de acuaporina 4 (AQP4-IgG) que afecta predominantemente a los nervios opticos y la medula espinal 1 , 2 , 3 . Es conocido que los pacientes con trastornos inmunitarios tienen mas probabilidades de presentar otras enfermedades autoinmunes; sin embargo, no esta completamente descrita la asociacion entre artritis idiopatica juvenil y NMO 5 . En este escrito se reporta el caso de una paciente que cursa con artritis idiopatica juvenil, inicio con compromiso neurologico rapidamente progresivo, y es tratada con medicamentos biologicos 1 , 2 , 3 , 4 .

Resumen Antecedentes El bloqueo interatrial avanzado (BIA-a) es considerado un factor de riesgo independiente para infarto cerebral (IC). Nuestro objetivo fue analizar si el BIA-a predice recurrencia de IC en pacientes con infarto cerebral embolico de origen no determinado (ESUS). Metodos Ciento cuatro pacientes con diagnostico confirmado de ESUS fueron seguidos durante una mediana de 15 meses (RIQ 10-48). Los datos clinicos, las caracteristicas de la onda P y presencia de BIA en electrocardiograma realizado durante el evento indice, fueron registrados. La interpretacion de los electrocardiogramas se realizo de forma centralizada y ciega en (XXXX2). La recurrencia de ESUS fue el desenlace primario. Resultados La mediana de edad de los casos fue de 47 anos (rango 19-85); 50% fueron mujeres. Se encontro BIA en 36 casos (34,6%); parcial (BIA-p) en 29 (27,9%) y BIA-a en 7(6,7%). Dieciseis pacientes (15,4%) presentaron IC recurrente; de los cuales 5 tenian BIA-p y 4 BIA-a (p=0,01;OR 9,44:IC 95% 1,88-47,46). La mediana de duracion de la onda P fue mayor en pacientes con recurrencia (p=0,009). En el analisis multivariado de regresion logistica, los factores de riesgo independientes para recurrencia de IC fueron: el BIA-a (p Conclusiones El BIA-a y edad mayor a 50 anos predicen recurrencia de ESUS.

Resumen Introduccion La diana habitual empleada para el tratamiento quirurgico del temblor es el nucleo ventralis intermedius (Vim) del talamo. Su localizacion es compleja, ya que no se puede visualizar con metodos de imagen convencionales, por lo que para el procedimiento quirurgico se toman clasicamente medidas indirectas y se correlacionan con la clinica y neurofisiologia intraoperatorias. Sin embargo, procedimientos ablativos actuales como la talamotomia por gamma-knife o por ultrasonidos (MRgFUS) hacen que sea preciso buscar otras alternativas para su localizacion. El objetivo del presente trabajo es comparar la localizacion indirecta del Vim mediante tecnica esterotactica con la realizada directamente por tractografia para el tratamiento del temblor. Discusion La definicion citoarquitectonica mas empleada del Vim es la del atlas de Schaltenbrand-Wahren. Existe un limite claro entre el talamo motor y el sensitivo; las neuronas del Vim responden a movimientos pasivos articulares y su actividad es sincronica con el temblor periferico. Las coordenadas estereotacticas del Vim mas frecuentemente utilizadas se basan en mediciones indirectas respecto a la linea intercomisural y el III ventriculo, las cuales dependen de variaciones interindividuales. Estudios recientes han propuesto el haz dentatorrubrotalamico como una diana optima para el control del temblor, postulando que se asocia a una mejoria clinica; sin embargo, esto no ha sido corroborado por otros autores. Conclusiones La visualizacion de la via cerebelorrubrotalamica por tractografia puede ayudar a definir la localizacion del Vim. Esta tecnica tiene limitaciones inherentes y seria necesaria una estandarizacion del metodo para lograr resultados mas precisos. La posible mayor utilidad de la diana por tractografia, directa, sobre la indirecta queda por demostrar a largo plazo en pacientes con temblor.

Resumen Objetivos Evaluamos la presencia de trastornos del sueno en pacientes con epilepsia y analizamos su asociacion con el control de las crisis. Metodos Se realizo un estudio transversal de pacientes con epilepsia reclutados consecutivamente entre septiembre de 2017 y diciembre de 2018. Los pacientes se clasificaron en 2 grupos segun el control de crisis (buen control: pacientes sin crisis en las ultimas 4 semanas) o mal control (pacientes con una crisis o mas en las ultimas 4 semanas). Se compararon variables demograficas y clinicas; insomnio, medido por el Indice de Severidad del Insomnio (ISI); somnolencia diurna excesiva, medida por la Escala de Somnolencia de Epworth (ESS); calidad del sueno, medida por el Indice de Calidad del Sueno de Pittsburgh (PSQI); depresion, medida por el Inventario de Depresion de Beck-II (BDI-II); y calidad de vida, medida por el test de Calidad de Vida en Epilepsia (QOLIE-10). Resultados Se incluyeron 123 pacientes. El 31,7% tenia somnolencia diurna excesiva (ESS ≥ 10), el 50,4% insomnio (ISI ≥ 10) y el 53,6% mala calidad del sueno (PSQI ≥ 5). Los factores asociados con la presencia de crisis fueron el desempleo (odds ratio [OR] = 4,7; intervalo de confianza del 95% [IC 95%]: 1,36-19,2; p = 0,02), un mayor numero de farmacos antiepilepticos (OR = 5,87; IC 95%: 1,81-27,1; p Conclusiones Los trastornos del sueno son frecuentes en pacientes con epilepsia. El insomnio y la mala calidad del sueno se asociaron con un peor control de crisis. Estos hallazgos apoyan que los trastornos del sueno son una comorbilidad frecuente en epilepsia, especialmente en pacientes con peor control de crisis.

This article provides a description and discussion of the key equipment used by the British Defence Medical Services (DMS) to provide anaesthesia and critical care in the field. There is a need to balance equipment clinical capability against its suitability for use in the field. By necessity, military anaesthesia and critical care equipment should be robust, portable, compact, easy to use, easy to maintain and clean, and require minimal consumables.

Study Design Case report. Introduction Severe flexure contractures of the hand secondary to upper limb spasticity (ULS) cause pain, palmar hyperhidrosis, ulceration, and nail plate deformities. Nonoperative management includes traditional orthotic devices that can be very painful for severe contractures and Botox injections, which provide a temporary solution. Surgical treatment comprises of soft tissue releases, tendon transfers, and release of the flexor and intrinsic muscles, which can cause permanent functional problems. Case Description In a 28-year-old male, unfit for surgery, we present the first documented case report in literature of flexion contractures of the hand secondary to upper limb spasticity managed using the “Inflatable Carrot” orthosis, where other conservative measures failed. Results At 4 weeks, the pulp to palm distance improved from 0 to 2 cm. At 3 months, the patient regained normal nail plate architecture, improved hand hygiene, reduced infection and pain. The patient reported improved psychological well-being and motivation to engage further with our therapists. Conclusions The inflatable carrot provided an alternative nonsurgical solution for management of flexion contractures of the hand when surgical intervention was not considered in the patient’s best interests. Awareness of this orthosis among hand therapists and surgeons will broaden our armamentarium for this challenging clinical problem.

Retrospective cross-sectional case series.Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ.In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint.Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values.The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29 with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative).The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints.

Background In 2019, the Hand Therapy Certification Commission (HTCC), in consultation with Scantron Corporation, performed a practice analysis study of hand therapy, the sixth in a series of similar studies performed byHTCC over a 35-year period. Purpose The primary goal of this study was to update and validate the definition and delineation of hand therapy and to ensure that the test content outline for the Hand Therapy Certification Examination (HTCE) reflects the critical tasks, knowledge, and skills required in the practice of hand therapy. Additionally, HTCC explored specific trends in hand therapy practice, compared findings with previous studies, and gathered data about the frequency, criticality, and performance expectations for the use and fabrication of orthoses by hand therapists. Study Design Quantitative Descriptive. Methods More than 40 subject matter experts from the United States and Canada, representing a broad range of experiences and perspectives, developed an updated delineation of the domains, tasks, knowledge, and techniques and tools used in hand therapy practice. A large-scale online survey of all certified hand therapists from the United States, Canada, and other countries was completed to test the profile within the practice of hand therapy. Results This large-scale online survey overwhelmingly validated the profile of hand therapy. The results affirmed the test specifications for the Hand Therapy Certification Examination; affirmed the definition of hand therapy; and refined the scope of hand therapy practice. New data was gathered regarding the use of orthotics in hand therapy. Conclusions This study establishes content validity for the HTCE. It highlights that the specialty of hand therapy is a mature and stable specialty field of occupational therapy and physical therapy. Certified Hand Therapists frequently issue pre-fabricated and fabricate custom orthoses in the course of rehabilitation for clients with hand and arm injuries, and overall consider this a highly critical task in hand therapy practice. Level of Evidence N/A

Objective We investigate if posttraumatic stress disorder (PTSD) symptoms mediate the effects of disaster severity or prior trauma on binge drinking following disaster exposure and test if support from caregiver moderates the relation between disaster severity and PTSD symptoms as well as prior trauma and PTSD symptoms. Method A population-based clinical trial used address-based sampling to enroll 1,804 adolescents and parents from communities affected by tornadoes in Missouri and Alabama. Data collection via baseline (averaging 8 months postdisaster), 4-month postbaseline, and 12-month postbaseline semistructured telephone interviews was completed between September 2011 and August 2013. Longitudinal analyses, testing the indirect effects of disaster severity and prior traumatic events on alcohol use through PTSD symptoms, as potentially moderated by support from caregiver, were conducted. Results PTSD symptoms mediated the effect of prior trauma, but not disaster severity, on binge drinking. Specifically, those with more prior traumas reported more PTSD symptoms, which in turn increased risk for binge drinking. Support from caregiver moderated the effect of disaster severity, but not prior trauma, on PTSD symptoms. Specifically, the effect of disaster severity on PTSD symptoms was significant for adolescents with average or below-average caregiver support. Conclusion Findings suggest that PTSD symptomatology is one mechanism by which prior trauma can impact binge drinking among adolescents following exposure to a natural disaster. Caregiver support can serve as a buffer for reducing PTSD symptomatology related to the severity of a natural disaster, which can decrease the likelihood of adolescent binge drinking. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Laboratory studies identified changes in the metabolism of halogens in the serum and cerebrospinal fluid (CSF) of patients with Parkinson's disease, which indicates the presence of «accelerated self-halogenation» of CSF and/or an increase in haloperoxidases, specifically serum thyroperoxidase and CSF lactoperoxidase. Furthermore, an excess of some halogenated derivatives, such as advanced oxygenation protein products (AOPP), has been detected in the CSF and serum. «Accelerated self-halogenation» and increased levels of haloperoxidases and AOPP proteins indicate that halogenative stress is present in Parkinson's disease. In addition, 3-iodo-L-tyrosine, a halogenated derivative, shows «parkinsonian» toxicity in experimental models, since it has been observed to induce α-synuclein aggregation and damage to dopaminergic neurons in the mouse brain and intestine. The hypothesis is that patients with Parkinson's disease display halogenative stress related to a haloenzymatic alteration of the synthesis or degradation of oxyacid of halogens and their halogenated derivatives. This halogenative stress would be related to nervous system damage.

Introduction Although delusional jealousy accounts for merely 10% of delusional disorders, it is associated to risk of serious violence and suicide. With this clinical case, we intend to explore the difficulties in the pharmacological approach of delusional jealousy disorder and to summarise the most recent findings in the treatment of this condition. Methods Case report. Case presentation A 76-year-old man involuntarily admitted to a psychiatric ward due to threats of physical aggression to his wife in the context of irreducible ideas of her infidelity. Initially, we observed an improvement of symptomatology with risperidone and its long-acting injectable formulation, but the emergence of hypotensive side effects required the off-label use of paliperidone palmitate 50 mg/ml. Conclusions Few studies, mainly case reports, look at the specific treatment of delusional jealousy. Given the negative consequences for patients and for their spouses, better scientific evidence to treat this condition is needed.

Background Acute flexor tendon injuries are challenging injuries for patients, surgeons, and therapists alike. There is ongoing debate about the optimal timing and amount of therapy after these injuries. Purpose We sought to investigate the relationship between hand therapy utilization and reoperation rates after flexor tendon repair and quantify reoperation rates and costs associated with flexor tendon repair. We hypothesize there will be an inverse relationship between the number of hand therapy visits and later reoperation rates and a positive correlation between reoperation rates and total cost of care. Study Design A retrospective cohort study of patients undergoing primary flexor tendon repair was pursued. Methods A commercially available database was utilized to access insurance claims data for 20.9 million patients in the US from 2007 to 2015. Patients undergoing primary flexor tendon repair were included and followed for one year. Patients with fractures, vascular injuries, or digit replantation were excluded. We studied post-operative rehabilitation utilization, reoperation rates, and costs. Chi-Square tests and multivariable logistic regressions were used to assess the relationship between therapy utilization and reoperation rates and costs. Results The one-year reoperation rate was 11.4 percent at a median time of 100.0 days amongst 1,129 patients undergoing primary tendon repair. In multivariable analysis, age between 30 and 59, male sex, and utilization of over 21 therapy sessions were associated with increased odds of reoperation. Mean insurance reimbursement one year following primary flexor repair was $14,533 per patient but $27,870 if patients went on to reoperation. Conclusion Continued therapy utilization after primary flexor tendon repair is an independent predictor of reoperation need. These findings may help surgeons counsel patients who require a large number of visits after flexor tendon repair on when to revisit surgical options.

Background Holt-Oram syndrome (HOS) is a rare, genetic condition characterized by the combination of congenital heart defect and hypoplasia in one or both upper extremities. Children with HOS commonly present with varied joint and limb involvement including radial longitudinal deficiency impacting hand function. Evidence-based guidelines regarding orthotic wear and therapeutic techniques are lacking. Purpose The aim of this case report was to present the results of a long-term occupational therapy program for a patient with HOS pre and post pollicization Study Design Case Report Methods A 4-month-old patient with bilateral radial longitudinal deficiencies began outpatient occupational therapy for custom orthosis fabrication and treatment which included long term clinic and home-based intervention. Techniques included passive range of motion, orthosis wear, therapeutic taping, and modified constraint induced movement therapy. Longitudinal assessment of musculoskeletal alignment and functional hand use was performed using goniometry for passive and active range of motion, the Assisting Hand Assessment (AHA), and The Thumb and Grasp Assessment of Pinch (T-GAP). Results Improvement in passive and active range of motion was achieved as well as improved activity level function as measured by the AHA and T-GAP post pollicization and intervention. Conclusions A combined clinic and home-based therapeutic approach can be effective for children with HOS to improve alignment and function pre and post pollicization to further enhance hand function. Comprehensive, long-term assessment is necessary to fully evaluate and communicate improvement.

Resumen Introduccion El estatus epileptico (SE, por sus siglas en ingles) es una urgencia neurologica con altas tasas de mortalidad. En este estudio analizamos el manejo del SE e identificamos factores de riesgo de mortalidad en los que realizar intervenciones de mejora o modificaciones en los protocolos de actuacion hospitalarios. Metodos Retrospectivamente se analizaron los datos demograficos de tratamiento y pronostico de 65 pacientes (59 [44,5-77] anos, 53,8% mujeres) que ingresaron en un hospital terciario cumpliendo los criterios de SE de la ILAE 2015, durante un periodo de 18 meses. Resultados Treinta (46,2%) pacientes tenian antecedentes de epilepsia. Las causas mas frecuentes de SE fueron enfermedad cerebrovascular (27,7%) e infeccion sistemica (16,9%). Se registraron desviaciones respecto al tratamiento habitual: la administracion de las benzodiazepinas como primer farmaco solo en 33 (50,8%) pacientes, la combinacion de 2 benzodiazepinas en 7 (10,8%) pacientes y el uso off-label de lacosamida en 5 (7,7%) pacientes. El electroencefalograma (EEG) fue realizado unicamente en 26 (40%) pacientes y solo 5 EEG (7,7% de pacientes) en las primeras 12 h. La tasa de mortalidad fue del 21,5%. Ictus agudo y complicaciones cerebrovasculares se asociaron con mortalidad, mientras que epilepsia previa e ingreso en la unidad de cuidados intensivos (UCI) fueron factores de buen pronostico (p Conclusiones Para mejorar el manejo del SE y reducir la tasa de mortalidad, seria recomendable implementar actividades formativas dirigidas a los profesionales del departamento de urgencias, asi como el ingreso electivo en la UCI para pacientes con factores de riesgo (primera crisis epileptica, con ictus agudo o complicaciones cardiovasculares).

Background Smoking behavior during the first 24 hours of a quit attempt is a significant predictor of longer-term abstinence, yet little is known about the neurobiology of early tobacco abstinence. Specifically, the effects of acute tobacco deprivation and reinstatement on brain function—particularly at the level of large-scale network dynamics and assessed across the entire brain—remain incompletely understood. To address this gap, this study used a mixed within- and between-subjects design to assess the effects of smoking status (yes/no smoker) and state (deprived vs. satiated) on whole-brain patterns of intrinsic connectivity. Methods Participants included 42 tobacco smokers who underwent resting-state functional magnetic resonance imaging following overnight abstinence (deprived state) and following smoking reinstatement (satiated state, randomized order across participants). Sixty healthy control nonsmokers underwent a single resting-state scan using the same acquisition parameters. Functional connectivity data were analyzed using both a canonical network-of-interest approach and a whole-brain, data-driven approach, i.e., intrinsic connectivity distribution. Results Network-of-interest–based analyses indicated decreased functional connectivity within frontoparietal and salience networks among smokers relative to nonsmokers as well as effects of smoking state on default mode connectivity. In addition, intrinsic connectivity distribution analyses identified novel between-group differences in subcortical-cerebellar and corticocerebellar networks that were largely smoking state dependent. Conclusions These data demonstrate the importance of considering smoking state and the utility of using both theory- and data-driven analysis approaches. These data provide much-needed insight into the functional neurobiology of early abstinence, which may be used in the development of novel treatments.

Introduction Inadequate drooling can cause serious clinical, functional and social problems. Validated questionnaires to evaluate drooling impact on quality of life are lacking in Brazilian Portuguese. Objectives To translate and validate the drooling impact scale to Brazilian Portuguese. Methods The drooling impact scale was translated to Brazilian Portuguese and back- translated to English to assess potential conceptual differences. Brazilian Portuguese version of drooling impact scale was applied to a 40 patients’ sample of sialorrhea presenting pediatric patients (up to 20 years of age). Chronbach’s alpha, exploratory factorial analysis and confirmatory factorial analysis were then proceeded with data collected. Results The mean drooling impact scale value for the whole population was 51.77 (SD = 16.13). The internal consistency obtained with Cronbach’s alpha indicated a value of 0.72 for the entire sample. The Bartlett’s test of sphericity was significant (p< 0.0001), confirming correlation among variables tested. Kaiser-Meyer-Olkin measure of sampling adequacy revealed a value of 0.72, indicating that the correlation matrix was reasonably suitable for factor analysis. Regarding exploratory factorial analysis, parallel analysis suggested a two-factor solution that was used for confirmatory factorial analysis. The first factor was responsible for 33.78% of the variance with an Eigenvalue of 3.38. The second factor explained 16.1% of the variance with an Eigenvalue of 1.61. At confirmatory factorial analysis, the two-factor model showed consistently better adjustments parameters than the one-factor model. Conclusion The drooling impact scale has been successfully translated to Brazilian Portuguese language, showing adequate internal validity. Validation of this instrument allows physicians and other personnel involved in the care of these patients to perform a better management of patients experiencing drooling. With this tool, we are now able to guide routines and provide guidelines both before and after the different kinds of treatments in order to improve the general well-being of the patient and his family.

Resumen Introduccion La evaluacion del lenguaje en el contexto de las alteraciones neurologicas se fundamenta, tradicionalmente, en el uso de la lengua estandar de la comunidad en la que tiene lugar. Las variables dialectales constituyen un tema «olvidado». El objetivo de esta revision es aportar recursos y guias de trabajo para superar esta limitacion. Desarrollo (1) Revision de conceptos propios de la dialectologia (lengua, dialecto, lineas isoglosas, idiolecto, registro, «variante estandar», bilinguismo). (2) Caracterizacion fundamental de las dialectologias espanola y catalana y busqueda de recursos online para el desarrollo de instrumentos en neurologia. (3) Busqueda ad hoc en PubMed (palabras clave: dialect, aphasia, multilingual). Conclusiones (1) Se aportan recursos online para promover un adecuado desarrollo de instrumentos de evaluacion en lenguas castellana y catalana, considerando aspectos dialectales. (2) Se aportan unas guias de trabajo orientadas a la introduccion de variables dialectales en los test de lenguaje para asegurar su objetivo ultimo: evaluar el uso real de la lengua, y no el conocimiento cultural de la lengua estandar.

Resumen Objetivos Analizar los cambios en las tendencias de la mortalidad por enfermedades cerebrovasculares segun comunidad autonoma y sexo en Espana durante el periodo 1980-2016 utilizando modelos de regresion joinpoint. Metodos Los datos de mortalidad se obtuvieron del Instituto Nacional de Estadistica. Para cada comunidad autonoma y sexo se calcularon las tasas brutas y estandarizadas. El analisis de regresion joinpoint se utilizo para identificar los puntos mas adecuados donde se produjo un cambio estadisticamente significativo en la tendencia. Resultados El analisis joinpoint permite diferenciar comunidades en las que las tasas muestran un descenso continuado a lo largo de todo el periodo en ambos sexos (Asturias, Cantabria, Castilla y Leon, Ceuta y Melilla) o solo en los hombres (Extremadura). En los hombres, en las comunidades en las que se observan cambios en la tendencia se aprecia, en todas ellas (excepto en Aragon, Baleares y Murcia, donde las tasas permanecen estables), un primer periodo de descenso, que oscila entre el −3,4% en Cataluna y Extremadura y el −6,0% en Madrid, y un periodo final donde las tasas muestran tendencias divergentes: siguen descendiendo en Andalucia, Aragon, Baleares y Madrid, han comenzado a estabilizarse en Castilla-La Mancha y Murcia y aumentan en Canarias. En las mujeres, en las comunidades en que se observan cambios en la tendencia se aprecia, en todas ellas (excepto en Aragon, Murcia y Pais Vasco, donde las tasas permanecen estables), un primer periodo de descenso, que oscila entre el −3,1% en Cataluna y el −6,4% en Navarra, y un periodo final donde las tasas muestran tendencias divergentes: siguen descendiendo en Andalucia, Aragon, Cataluna, Galicia, Madrid y Pais Vasco, han comenzado a estabilizarse en Extremadura y Murcia, y aumentan en Canarias. Conclusiones Los datos actuales muestran que las tasas de mortalidad por enfermedades cerebrovasculares se han desacelerado (en mujeres en Andalucia), estancado (en ambos sexos en Murcia, en hombres en Castilla-La Mancha y en mujeres en Extremadura) e incluso se han revertido (en hombres y en mujeres en Canarias). Las causas de estas tendencias requieren mas estudios.

Melatonin is the main hormone involved in the control of the sleep-wake cycle. It is easily synthesisable and can be administered orally, which has led to interest in its use as a treatment for insomnia. Moreover, as production of the hormone decreases with age, in inverse correlation with the frequency of poor sleep quality, it has been suggested that melatonin deficit is at least partly responsible for sleep disorders. Treating this age-related deficit would therefore appear to be a natural way of restoring sleep quality, which is lost as patients age. However, despite the undeniable theoretical appeal of this approach to insomnia, little scientific evidence is available that supports any benefit of this substitutive therapy. Furthermore, the most suitable dose ranges and pharmaceutical preparations for melatonin administration are yet to be clearly defined. This review addresses the physiology of melatonin, the different pharmaceutical preparations, and data on its clinical usefulness.

The growing number of people living with dementia will result in increased costs of dementia worldwide. The e-Health intervention 'Exergaming' may improve health and quality of life of people with dementia, but the cost-effectiveness is unknown. We assessed the cost-effectiveness of exergaming compared to regular activities from a societal perspective in day-care centres (DCC) for people with dementia and their informal caregivers (IC) alongside a cluster randomised controlled trial. We included 112 dyads (person with dementia and IC) from 20 psychogeriatric DCCs (11 exergaming, 9 control) across the Netherlands. Exergaming consisted of interactive cycling at least twice a week for 6 months. Measurements were conducted at baseline (T0), after 3 (T1) and 6 (T2) months. Primary outcomes were minutes of physical activity, mobility of the participants with dementia (Short Physical Performances Battery, SPPB), and Quality-Adjusted Life-Years (QALYs) of participants with dementia and ICs. ICs filled out cost diaries to measure healthcare and informal care utilisation during the study. There were no statistically significant differences in outcomes or costs between the groups at the level of participants with dementia, the ICs or the dyad. With regard to QALYs and SPPB, the probability that exergaming is cost-effective compared to control was low for all possible willingness-to-pay (WTP) thresholds. However, for physical activity at WTP thresholds of 0, 50 and 250 Euros per additional minute of physical activity, the probability of cost-effectiveness is 0.46, 0.84 and 0.87, respectively. Exergaming in DCC was not cost-effective compared to usual activities. However, considering the small sample size and the large number of missing observations, findings should be interpreted with caution. Future studies with larger samples are recommended to obtain definitive answers on the cost-effectiveness of exergaming. This trial was registered in the Netherlands Trial Register (NTR5537/NL5420).

Choline, folic acid, and Vitamin D are essential for fetal brain development that may be the first steps in the pathogenesis of the psychotic spectrum. Micronutrient deficiencies have been associated with changes in fetal brain development, manifest as early problems in childhood behavior, and cognition, and later as increased incidence of psychotic and autism spectrum disorders. Micronutrient supplements may not only prevent deficiency, but they may also positively affect brain development in the context of other maternal risk factors, including maternal infection, stress, inflammation, and substance abuse. Many genes associated with later psychotic illness are highly expressed in the fetal brain, where they are responsible for various neurodevelopmental mechanisms. Interaction of micronutrient vitamins with these genetically programmed mechanisms to prevent pathological brain development associated with later psychosis is under active investigation. In addition to their effects on brain development, micronutrient vitamins have effects on other aspects of gestation and fetal development, including the prevention of premature delivery and other developmental abnormalities. Supplemental micronutrient vitamins should be part of good prenatal care, as has already happened for folic acid and Vitamin D and is now advocated by the American Medical Association for choline. The benefits of these micronutrient supplements include protection of brain development and the possibility of decreased risk for future psychotic disorders in those children who are either genetically or environmentally vulnerable. The purpose of this review is to present the current evidence supporting the safety and effectiveness of micronutrients in gestation and to suggest areas for future research.

Objectives Emerging evidence implicates atypical plasticity in the neurophysiology of autism spectrum disorder (ASD). Specifically, autistic people demonstrated hyperplasticity in response to theta-burst stimulation (TBS). We hypothesized that autistic adults would display hyperplasticity to TBS and that repetitive transcranial magnetic stimulation (rTMS) – which potentiates brain inhibitory mechanisms – would ‘stabilize’ hyperplasticity. Methods Using a randomized, cross-over design, plasticity was assessed using TBS in the left motor cortex (M1) in 31 autistic adults and 30 sex-, intelligence quotient-, and age-matched controls. Autistic adults (n = 29) were further randomized (1:1) to receive a single session of active (n = 14) or sham (n = 15) rTMS (6000 pulses at 20 Hz) over left M1 and plasticity was reassessed on the next day following rTMS. Results Both long-term potentiation (LTP) and long-term depression (LTD) were significantly increased in the ASD group, indicating hyperplasticity. Active, but not sham rTMS, attenuated LTD in autistic adults. Conclusions We provided further evidence for the presence of brain hyperplasticity in ASD. To our knowledge, this is the first study to show preliminary evidence that an excessive LTD in ASD can be ‘stabilized’ using rTMS. Such ‘stabilizing’ effect of rTMS on LTP was not observed, likely due to small sample size or a more specific ‘attenuating’ effect of rTMS on LTD, compared to LTP. Significance These findings indicate atypical brain inhibitory mechanisms behind hyperplasticity in ASD. Utilizing a larger sample, future replication studies could investigate therapeutic opportunities of ‘mechanism-driven’ rTMS.

Resumen Introduccion La guardia de neurologia es frecuentemente presencial; es decir, con el neurologo presente en el centro hospitalario; pero en algunos centros, puede ser localizada o mixta. La fibrinolisis intravenosa (FIV) es uno de los principales tratamientos reperfusores en el ictus isquemico agudo (IIA). El objetivo del siguiente trabajo es comparar el tiempo puerta-aguja (TPA) durante la guardia presencial y la guardia localizada. Material y metodos Estudio prospectivo, observacional, desde el ano 2012 hasta el ano 2017 en el que se incluyeron pacientes con IIA y FIV. Se recogieron datos como sexo, edad, hora del inicio de los sintomas, hora de llegada al hospital, hora de la tomografia axial computarizada (TAC), hora de inicio de la FIV. Se considero guardia de «Presencia» desde las 8:00 hasta las 20:00 y «Localizada» desde las 20:00 hasta las 08:00, divido en 3 grupos: guardia «Presencial», guardia «Localizada» y guardia «Localizada con residente». Resultados N.° = 138; edad media 69,7 anos; mujeres 45,7%. Pacientes en guardia de «Presencia» 96, «Localizada» 42, de los cuales 17 con residente. Ambos grupos presentaban caracteristicas basales similares. Los TPA de los grupos «Presencia» y «Localizada» fueron 59 y 72 min, respectivamente (p = 0,003). Los TPA de grupos «Presencia», «Localizada» y «Localizada con residente», respectivamente 59, 74 y 68 min (p = 0,001), con significacion entre «Presencia» y «Localizada». No se observaron diferentes entre el TPA dependiendo de la franja horaria de manana, tarde y noche ni entre dias laborales y dias de fin de semana. Conclusion La presencia o ausencia del neurologo en el centro hospitalario en el momento del codigo ictus, influye en la demora de administracion del tratamiento fibrinolitico. La presencia del residente de neurologia puede acelerar la realizacion del proceso.

Introduction SARS-CoV-2 is the pathogen of COVID-19. The virus is composed of the spike, membrane and envelope. On physiological smell, odoriferous substances bind to proteins secreted by sustentacular cells in order to be processed by olfactory receptor neurons. Olfactory disorder is one of the main manifestations of COVID-19, however, research is still required to clarify the mechanism involved in SARS-CoV-2 induced anosmia. Objective This article aims to analyze current scientific evidence intended to elucidate the pathophysiological relationship between COVID-19 and the cause of olfactory disorders. Methods Pubmed, Embase, Scopus and ScienceDirect were used to compose this article. The research was conducted on November 24th, 2020. Original articles with experimental studies in human, animal and in vitro, short communications, viewpoint, published in the English language and between 2019 and 2020 were included, all related to the pathophysiological relationship between olfactory disorders and COVID-19 infection. Results Both human cell receptors ACE2 and TMPRSS2 are essential for the SARS-CoV-2 entrance. These receptors are mostly present in the olfactory epithelium cells, therefore, the main hypothesis is that anosmia is caused due to damage to non-neuronal cells which, thereafter, affects the normal olfactory metabolism. Furthermore, magnetic resonance imaging studies exhibit a relationship between a reduction on the neuronal epithelium and the olfactory bulb atrophy. Damage to non-neuronal cells explains the average recovery lasting a few weeks. This injury can be exacerbated by an aggressive immune response, which leads to damage to neuronal cells and stem cells inducing a persistent anosmia. Conductive anosmia is not sufficient to explain most cases of COVID-19 induced anosmia. Conclusion Olfactory disorders such as anosmia and hyposmia can be caused by COVID-19, the main mechanism is associated with olfactory epithelium damage, targeting predominantly non-neuronal cells. However, neuronal cells can also be affected, worsening the condition of olfactory loss.

Resumen Presentamos 3 casos de mesotelioma deciduoide pleural: 3 mujeres de 75, 74 y 23 anos. Las pacientes debutaron con disnea, vomitos y dolor pelvico. Los hallazgos en sus estudios de imagen fueron, respectivamente, engrosamiento nodular pleuropericardico, masas solidas pleuropericardicas parietales y gran masa toracica derecha. Solo una de ellas pudo ser tratada mediante quimioterapia, cirugia y radioterapia. La supervivencia desde el diagnostico fue 24 dias, un mes y 17 meses (media de 6,2 meses). Tras el estudio de los 3 casos de mesotelioma deciduoide, una infrecuente variante histologica con marcada agresividad clinica, describimos los hallazgos clinicopatologicos e inmunohistoquimicos, ademas de incluir una revision de la bibliografia publicada mas relevante al respecto.

Objective To evaluate the incidence of significant intraoperative electrophysiological signal changes during surgical positioning, and to assess the effectiveness of head and neck repositioning on the restoration of signals, among patients undergoing surgery for cervical myelopathy. Material and methods We used multimodal intraoperative monitoring (somatosensory [SEP] and motor evoked potentials [MEP] and spontaneous electromyography) before and after patients’ positioning in a consecutive cohort of 103 patients operated for symptomatic cervical myelopathy. Significant changes were defined as > 50% attenuation in amplitude or > 10% increase in latency of SEP, or abolishment or 50–80% attenuation of MEP. Results Out of 103 patients (34.9% female, median age 54.5 years) 88 underwent laminectomy (85.4%) and 15 (14.6%) anterior approach. At the time of positioning, signal alterations occurred in 44 patients (42.7%), yet only 11 patients (10.7%) showed alarming changes. Immediate neck repositioning of these resulted in complete (n = 6) or partial (n = 4) restoration of potentials, yielding no postoperative deficits. The patient in which signals could not be restored after repositioning resulted in added postoperative deficit. The accuracy (true positives plus true negatives) of monitoring to detect new neurological deficits was 99.0% (102/103) for the entire cohort, and 100% (11/11) for those showing significant changes at the moment of positioning. Overall, only 1 patient, with non-significant SEP attenuation, experienced a new postoperative deficit, yielding a 0.97% rate of false negatives. Conclusion Among patients undergoing surgery for cervical myelopathy, 10.7% showed alarming electrophysiological signal changes at the time of positioning. Immediate repositioning of the neck resulted in near always restoration of potentials and avoidance of added neurological damage. Complete or partial restoration of potentials after repositioning yielded no postoperative deficits.

Objective Studies have indicated that trauma exposure is a common factor in posttraumatic stress symptoms (PTSSs) and posttraumatic growth (PTG), but it is unclear whether PTSSs and PTG share a common underlying mechanism related to trauma exposure. To explore this issue, this study examined the mediating role of feelings of safety, hope, and coping strategies between trauma exposure and both PTSSs and PTG to elucidate differences in their underlying mechanisms. Method One year following the Jiuzhaigou earthquake in Sichuan province, China, 620 adolescents were selected to answer self-report questionnaires, and a structural equation model was used to test the hypotheses. Results Trauma exposure was positively associated with PTSSs by two 1-step indirect paths of feelings of safety and emotion-focused coping strategies, and by two 2-step indirect paths of feelings of safety to both hope and emotion-focused coping strategies. Trauma exposure was positively associated with PTG by a 1-step indirect path of problem-focused coping strategies but negatively associated with PTG by two 2-step indirect paths of feelings of safety to both hope and problem-focused coping strategies, and by one 3-step indirect path of feelings of safety to hope to problem-focused coping strategies. Conclusions Trauma exposure is common to PTSSs and PTG but affects these differently via feelings of safety, feelings of hope, and coping strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objectives Cure for severe depression in elderly patients with psychotic symptoms should consider not only the results of major depression but also the nature of antidepressants and their side effects. Psychiatric disability is higher in patients who have greater deterioration in neurological function. Methods In addition to reviewing antidepressant discontinuation syndrome and depressive disorder, this study describes an elderly woman with mild depression that developed into major depression, related to high suspicion of delirium, diagnosed based on patient history, physical health examination, neurological examinations, family history, and laboratory data, with subsequent treatment plan. Results The treatment results and prognosis indicate that patients with paroxetine antidepressant deactivation may enable early use of low-dose quetiapine with less anticholinergic and extrapyramidal side effects for the treatment of depression in elderly patients with psychotic symptoms. The poor prognostic factors for patients were chronic environmental stress (poverty) and lack of a social support system. Although the patient lived with her children and grandchildren, she rarely received care. Hence, it was not possible to monitor her condition and medication intake. Conclusions The consensus is that the abrupt discontinuation of short half-life selective serotonin reuptake inhibitors (SSRIs), such as paroxetine can be associated with transient symptomatology, much of which is of a serotonergic nature. Psychotic-like symptoms have also been reported in both controlled trials and large patient databases.

Objective To investigate whether epileptiform discharge burden can identify those at risk for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). Methods Retrospective analysis of 113 moderate to severe grade SAH patients who had continuous EEG (cEEG) recordings during their hospitalization. We calculated the burden of epileptiform discharges (ED), measured as number of ED per hour. Results We find that many SAH patients have an increase in ED burden during the first 3–10 days following rupture, the major risk period for DCI. However, those who develop DCI have a significantly higher hourly burden from days 3.5–6 after SAH vs. those who do not. ED burden is higher in DCI patients when assessed in relation to the onset of DCI (area under the receiver operator curve 0.72). Finally, specific trends of ED burden over time, assessed by group-based trajectory analysis, also help stratify DCI risk. Conclusions These results suggest that ED burden is a useful parameter for identifying those at higher risk of developing DCI after SAH. The higher burden rate associated with DCI supports the theory of metabolic supply-demand mismatch which contributes to this complication. Significance ED burden is a novel biomarker for predicting those at high risk of DCI.

Idiopathic hypersomnia (IH) is characterized by excessive daytime sleepiness despite normal or prolonged sleep. IH is distinguished from narcolepsy by the female predominance, severe morning inertia, continuous drowsiness (rather than sleep attacks), unrefreshing naps, absence of cataplexy, sleep onset in REM periods, and hypocretin deficiency. In IH, the multiple sleep latency test demonstrates low sensitivity, specificity, and reproducibility, compared with prolonged sleep monitoring. In some IH cases, an endogenous hypnotic peptide stimulating GABA receptors during wakefulness is suspected, which are improved by anti-GABA drugs. The benefits of modafinil, sodium oxybate, mazindol, and pitolisant were found in mostly retrospective studies.

Epidemiologic studies have provided evidence that prenatal exposure to maternal infection is associated with an increased risk of developing schizophrenia in the offspring. Research over the past decade has added further to our understanding of the role of prenatal infection in schizophrenia risk. These investigations include several well-powered designs, and like some earlier studies, measured maternal antibodies to specific infectious agents in stored serum samples and large registers to identify clinically diagnosed infections during pregnancy. Convergent findings from antibody studies suggest that prenatal maternal infection with Toxoplasma gondii is associated with increased schizophrenia risk in the offspring, while associations with HSV-2 infection are likely attributable to confounding. Maternal influenza infection remains a viable candidate for schizophrenia, based on an early serological study, though there has been only one attempt to replicate this finding, with a differing methodology. A prior association between maternal serologically confirmed cytomegalovirus infections require further study. Clinically diagnosed maternal infection, particularly bacterial infection, also appears to be associated with increased risk of offspring schizophrenia, and heterogeneity in these findings is likely due to methodological differences between studies. Further clarification may be provided by future studies that address the timing, type, and clinical features of infections. Important insight may be gained by examining the long-term offspring outcomes in emerging epidemics such as Zika virus and COVID-19, and by investigating the interaction between exposure to prenatal infection and other risk or protective factors.

Resumen Introduccion y objetivo Se han notificado resultados contradictorios sobre un aumento en la intensidad de la senal (IS) en las imagenes de resonancia magnetica (RM) ponderadas en T1 no realzadas en el globo palido y/o el nucleo dentado (ND) despues de la exposicion a varios agentes de contraste con gadolinio (ACG). Este cambio en la senal varia en funcion del ACG especifico. Nuestro objetivo fue investigar si existe un aumento en la IS del ND en imagenes ponderadas en T1 no realzadas en pacientes sometidos a multiples administraciones del ACG macrociclico gadoterato de meglumina. Se realizo una revision exhaustiva de la bibliografia para corroborar nuestros resultados. Materiales y metodos Se incluyeron pacientes que se habian sometido a mas de 10 estudios de RM con contraste y administracion exclusiva de gadoterato de meglumina. Se llevo a cabo un analisis cuantitativo mediante el uso de mediciones de regiones de interes en el ND y el puente en imagenes no realzadas ponderadas en T1. Se calcularon las proporciones ND-puente y las diferencias en las proporciones entre el inicio y la ultima RM realizada. Se utilizo una prueba de la t de una muestra para evaluar si las diferencias en la proporcion de la IS difieren de 0. Se realizo un analisis de subgrupos de pacientes con Resultados 54 pacientes (26 hombres) recibieron una media de 13,8 dosis ± 3,47 (desviacion estandar [DE]) (rango, 10-23 dosis). La diferencia en la proporcion de la IS ND-puente entre la primera y la ultima exploracion de RM fue de -0,0275 ± 0,1917 y no difirio significativamente de 0 P = 0,2968) en el analisis general y en el analisis de subgrupos [( Conclusiones Mas de 10 administraciones de gadoterato de meglumina no se asociaron a un aumento de la IS en el ND.

Olfactory dysfunction is manifested in a wide range of neurological and psychiatric diseases, and often emerges prior to the onset of more classical symptoms and signs. From a behavioral perspective, olfactory deficits typically arise in conjunction with impairments of cognition, motivation, memory, and emotion. However, a conceptual framework for explaining the impact of olfactory processing on higher brain functions in health and disease remains lacking. Here we aim to provide circuit-level insights into this question by synthesizing recent advances in olfactory network connectivity with other cortical brain regions such as the prefrontal cortex. We will focus on social cognition as a representative model for exploring and critically evaluating the relationship between olfactory cortices and higher-order cortical regions in rodent models. Although rodents do not recapitulate all dimensions of human social cognition, they have experimentally accessible neural circuits and well-established behavioral tests for social motivation, memory/recognition, and hierarchy, which can be extrapolated to other species including humans. In particular, the medial prefrontal cortex (mPFC) has been recognized as a key brain region in mediating social cognition in both rodents and humans. This review will highlight the underappreciated connectivity, both anatomical and functional, between the olfactory system and mPFC circuitry, which together provide a neural substrate for olfactory modulation of social cognition and social behaviors. We will provide future perspectives on the functional investigation of the olfactory-mPFC circuit in rodent models and discuss how to translate such animal research to human studies.

Radiofrequency techniques are minimally invasive procedures used to provide prolonged pain relief compared to local anaesthetic blocks and forms part of a multidisciplinary approach in managing chronic pain. A generator produces a high-frequency current that passes from an electrode to an earthing plate. The electromagnetic field created around the tip of the electrode then has an effect on the surrounding nervous tissue resulting in pain relief.

Resumen Introduccion La descripcion de la teoria de la compuerta del dolor fue el punto de partida para el desarrollo de la estimulacion de la medula espinal (EME). El presente articulo describe las indicaciones para el tratamiento del dolor y otros usos no relacionados con este. Desarrollo En la actualidad existen diversos paradigmas de EME: tonica, de alta frecuencia en rafaga o simplemente de alta frecuencia. Estas se distinguen por la presencia de parestesias. La EME ha mostrado beneficio sobre todo en dolor de tipo neuropatico. El sindrome de cirugia espinal fallida muestra las mejores tasas de respuesta, aunque en casos de sindrome doloroso regional complejo y neuropatia diabetica, asi como de radiculopatia y lumbago sin cirugia espinal previa, tambien se logra una reduccion importante del dolor. Aunque su aplicacion en el dolor de tipo fantasma y en el asociado a enfermedad vascular periferica o cardiovascular parece util, no existe una evidencia solida para generalizar su empleo. Por otra parte, la EME tambien reduce el dolor neuropatico secundario a tumor, a pesar de que esta linea ha sido poco explorada. Otras indicaciones no relacionadas con el dolor son trastornos de movimiento, espasticidad y secuelas de trauma medular. Sin embargo, el uso de la EME se ve limitado por dos factores principales: las complicaciones mecanicas y el costo de la terapia. Conclusion Durante los 50 anos de aplicacion, la EME ha mostrado grandes avances. Asimismo, a medida que se perfeccione el hardware y el software relacionados con esta, se podra mejorar la efectividad y reducir el rango de complicaciones. La indicacion para la EME se podria extender a otras enfermedades y su uso se expandiria si, ademas, se lograra disenar una tecnologia asequible.

Resumen Introduccion Estudios recientes en Europa y Estados Unidos muestran un posible aumento de la incidencia y la hospitalizacion por ictus isquemico en adultos jovenes, sin embargo, en Espana la informacion disponible de la tendencia es escasa. Por ello planteamos analizar la tendencia de hospitalizacion por ictus isquemico en adultos menores de 50 anos en la Region de Murcia entre 2006 y 2014. Metodo Se realizo un estudio retrospectivo de las altas de hospitalizacion por enfermedad cerebrovascular (ECV) extraidas del Registro del conjunto minimo de datos al alta hospitalaria. Se obtuvieron las tasas estandarizadas, desagregadas segun edad y subtipo de ECV. La tendencia de los episodios fue analizada mediante regresion de joinpoint, obteniendo la tasa estandarizada anual calculada y el porcentaje de cambio anual (PCA). Resultados Se identificaron un total de 27.064 altas por ECV en los 9 anos del estudio. Los episodios generados por ictus isquemico fueron los mas numerosos (61,0%), en pacientes entre 18 y 49 anos; entre los anos extremos, se registro un aumento del 26% de los episodios por ictus isquemico y del 29,2% de las tasas, mientras que en la regresion de joinpoint no se observo tendencia (PCA = 2,74%, p ≥ 0,05). Por el contrario, en mayores de 49 anos esta tendencia fue descendente (PCA = –1,24%, p Conclusiones No se ha identificado una tendencia en la hospitalizacion por ictus isquemico en adultos jovenes a pesar del descenso en adultos de mayor edad. Seria importante identificar las causas de este comportamiento desigual para desarrollar medidas especificas dirigidas al grupo de menor edad.

The aim of this study was to estimate a potential beneficial influence of N-acetylcysteine (NAC) in the treatment of cisplatin-induced motor impairment. We included 32 male Wistar albino rats, divided into 4 equal groups: control (received saline on the 1st and 5th day), cisplatin – CIS (received saline on the 1st and cisplatin 7.5 mg/kg i.p. on the 5th day), NAC (received NAC on the 1st and 5th day, 500 mg/kg i.p.), and CIS+NAC (received NAC on the 1st and 5th day, 500 mg/kg i.p. and cisplatin 7.5 mg/kg i.p. on the 5th day) group. Motor performance was estimated by rotarod, grip wire, open field (OF), elevated plus maze (EPM) and beamwalking (BW) tests on the 10th day. Cisplatin administration resulted in decreased motor performance in all tests, except for BW test, compared to the control group. NAC supplementation on its own had no significant effect on motor performance parameters. However, simultaneous administration of NAC along with cisplatin reversed negative impact of cisplatin in rotarod, OF and EPM tests, with no significant effect on the results obtained in grip wire test. The results of this study confirmed numerous motoric manifestations of cisplatin-induced neurotoxicity in rats. However, the decline in most of the estimated parameters was successfully prevented by antioxidant supplementation with NAC.

Background The differential risk of incident dementia associated with receiving various overactive bladder (OAB) drugs is unknown. Objective To estimate the association of antimuscarinic OAB drug (exposure), compared with a β-3 agonist (mirabegron), and incident dementia. Design, setting, and participants A population-based nested case-control study was conducted in patients treated with OAB medications in Ontario, Canada. A total of 11 392 patients aged ≥66 yr with a new diagnosis of dementia between 2010 and 2017, and 29 881 age- and sex-matched controls without dementia were included in the study. Intervention Receipt of an antimuscarinic OAB drug or receipt of mirabegron, within the previous 6–12 mo. Outcome measurements and statistical analysis Cases developed dementia and Alzheimer’s disease. Controls were derived from the general population and matched to cases based on important baseline characteristics. Odds ratios (ORs) for incident dementia, adjusted for demographic and health-related characteristics, were determined. Results and limitations Patients receiving solifenacin (OR 1.24; 95% confidence interval 1.08–1.43) and darifenacin (OR 1.30; 95% CI 1.08–1.56) in the prior 6 mo had increased odds of incident dementia compared with those receiving mirabegron. In the 6 mo to 1 yr prior to diagnosis, receipt of solifenacin (OR 1.34; 95% CI 1.11–1.60), darifenacin (OR 1.49; 95% CI 1.19–1.86), tolterodine (OR 1.21; 95% CI 1.02–1.45), and fesoterodine (OR 1.39; 95% CI 1.14–1.71) was associated with increased odds of incident dementia compared with receipt of mirabegron. No effect was seen with oxybutynin or trospium. Limitations included misclassification of the outcome and residual confounding associated with the use of health administrative databases. Conclusions Older adults receiving solifenacin and darifenacin in the 6 mo prior to diagnosis, and those receiving solifenacin, darifenacin, tolterodine, or fesoterodine in the year prior to diagnosis, have increased odds of incident dementia, compared with those receiving mirabegron. Oxybutynin and trospium were not associated with dementia, likely due to a protopathic bias. Careful drug selection is warranted when treating patients with OAB. Patient summary In a large Canadian cohort of patients who developed dementia after starting an overactive bladder (OAB) medication, those taking some anticholinergic medications for OAB have an increased risk of dementia compared with those taking mirabegron.

Narcolepsy and idiopathic hypersomnia cannot be cured; all available treatments are symptomatic. It is of paramount importance for patients, and their relatives, to be informed about the consequences of these chronic diseases and to become ready to accept the consequences of the diagnosis before starting any treatment. This facilitates the implementation of behavioral modifications and the proper use of medication to decrease the disease burden. A supportive social environment (eg, family members, friends, employer, colleagues, and patient support groups) is instrumental. Current treatment options are discussed with a focus on pharmacologic treatment, including future directions.

To assess the utility of interictal magnetic and electric source imaging (MSI and ESI) using dipole clustering in magnetic resonance imaging (MRI)-negative patients with drug resistant epilepsy (DRE).We localized spikes in low-density (LD-EEG) and high-density (HD-EEG) electroencephalography as well as magnetoencephalography (MEG) recordings using dipoles from 11 pediatric patients. We computed each dipole's level of clustering and used it to discriminate between clustered and scattered dipoles. For each dipole, we computed the distance from seizure onset zone (SOZ) and irritative zone (IZ) defined by intracranial EEG. Finally, we assessed whether dipoles proximity to resection was predictive of outcome.LD-EEG had lower clusterness compared to HD-EEG and MEG (p 0.05). For all modalities, clustered dipoles showed higher proximity to SOZ and IZ than scattered (p 0.001). Resection percentage was higher in optimal vs. suboptimal outcome patients (p 0.001); their proximity to resection was correlated to outcome (p 0.001). No difference in resection percentage was seen for scattered dipoles between groups.MSI and ESI dipole clustering helps to localize the SOZ and IZ and facilitate the prognostic assessment of MRI-negative patients with DRE.Assessing the MSI and ESI clustering allows recognizing epileptogenic areas whose removal is associated with optimal outcome.

The differential diagnosis of bilateral lower extremity weakness is broad. We present a very rare case of a 48-year old male patient, with walking difficulties due to Bing-Neel syndrome. On clinical examination, there was a significant loss of muscle power in all his lower extremities key-muscle groups. The lumbar spine magnetic resonance imaging (MRI) showed only mild degenerative changes, whereas the MRI of the head indicated a diffuse meningeal thickening at the right temporal region, characterized by significant enhancement after contrast administration. Serum protein electrophoresis detected an IgM-kappa monoclonal protein. The patient received intrathecal chemotherapy with methotrexate and cytarabine, and was started on oral ibrutinib 420mg daily. In conclusion, a past medical history of Waldenstrom macroglobulinemia in conjunction with neurological manifestations should alert the treating physician for Bing-Neel syndrome. A complete diagnostic imaging and serologic protocol helps in setting the final diagnosis. Steroids are part of the treatment, but should be given after the diagnosis is set. Neurosurgical intervention is indicated for histologic confirmation in the case of diagnostic uncertainty.

Resumen Antecedentes El tronco encefalico, situado en la fosa posterior, conecta el cerebro con la medula espinal. Debido a su ubicacion, sus componentes nerviosos guardan una estrecha relacion con estructuras vasculares. Objetivos Describir una relacion clinico-radiologica del asa vascular del angulo pontocerebeloso en pacientes con sintomas indicativos de afectacion vestibulococlear mediante evaluacion por neuroimagen. Materiales y metodos Se realizo un estudio retrospectivo y descriptivo. Se incluyeron todos los pacientes evaluados entre 2011 y 2017 con indicios de asa vascular del angulo pontocerebeloso e historial clinico y estudios de diagnostico por imagen disponibles. Resultados 102 pacientes (63 mujeres y 39 hombres) presentaban afectacion vestibulococlear. La indicacion clinica mas frecuente fue mareos (41,18%). Se hallo asa vascular unilateral en 43 pacientes (derecho: 21,57%, izquierdo: 20,59%) y bilateral en 59 pacientes (57,84%). El tipo de asa vascular mas frecuente fue el tipo II (derecho: 69,14%; izquierdo: 58,75%). El origen mas frecuente fue la arteria cerebelosa anteroinferior (ACAI) (derecha: 66,67%, izquierda: 65,00%). No se observo ninguna asociacion entre asas vasculares y perdida de audicion neurosensitiva, nistagmo o vertigo. Se hallo una asociacion con acufenos. Conclusiones y significacion La presencia de asas vasculares no se asocia a la mayoria de los sintomas auditivos. No obstante, deben notificarse todos los hallazgos de los estudios por imagen. La interpretacion de los hallazgos de los estudios por imagen debe correlacionarse con los sintomas clinicos despues de excluir otras causas mas frecuentes que puedan explicar la sintomatologia.

Primary intracranial malignant fibrous histiocytoma (MFH), or myxofibrosarcoma, is an extremely rare condition, with only a few cases reported in the literature. We report a case of a dural-based myxofibrosarcoma in a previously healthy 42-year-old man that was initially presumed to be an atypical meningioma. The findings based on conventional and advanced magnetic resonance sequences, including diffusion-weighted imaging, perfusion weighted imaging and proton magnetic resonance spectroscopy, as well as histopathological aspects, are discussed.

Introduction The Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers. Objective To diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver. Methods 171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix–Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix–Hallpike maneuver again. If the repeated Dix–Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver. Results Approximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix–Hallpike maneuvers, and were diagnosed with short-arm lithiasis. Conclusion The short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.

Background Neurofibromas are benign peripheral nerve sheath tumours. Hypoglossal nerve neurofibromas in cervical region are relatively rare, bilateral occurrence is extremely rare. Methods A 32-year-old man with type 1 neurofibromatosis presented with bilateral neck masses. Magnetic resonance imaging showed parapharyngeal masses consistent with neurogenic tumours, most likely neurofibromas. Results Surgical exploration through lateral cervical approach revealed unexpected finding of the tumour that arose from the hypoglossal nerve. The tumour had totally engulfed the nerve with no normal nerve fascicles identifiable, thus resected in toto. In the postoperative course, the patient developed right hypoglossal palsy and vocal fold palsy treated with augmentation of the paralysed vocal fold with temporary injection material. Conclusions The authors described a patient with type 1 neurofibromatosis with neurofibroma originating from cervical part of hypoglossal nerve. This paper discussed this rare condition and the management on how to improve the treatment outcome.

Introduction In patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them. Objective To propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV). Methods A prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization. Results Twenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV. Conclusion This new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV.

Resumen Introduccion La Escala de Impulsividad de Barratt (BIS) es un instrumento de autoinforme disenado para evaluar la construccion de personalidad y comportamiento de la impulsividad. La impulsividad se ha asociado con varios trastornos psiquiatricos, como el trastorno por deficit de atencion e hiperactividad (TDAH). Este estudio evalua el progreso de la conducta de impulsividad en ninos con TDAH despues de una intervencion dietetica de 8 semanas con dieta mediterranea y/o suplemento de acidos grasos omega-3, mediante el uso de la BIS-11 adaptada para ninos (BIS-11c). Metodos Este estudio transversal incluyo a 60 ninos espanoles con TDAH de la provincia de Madrid, Espana. Los participantes se dividieron en 4 grupos, un grupo de control (G1) y 3 grupos de intervencion (dieta mediterranea [G2], suplemento de omega-3 [G3] y dieta mediterranea + suplemento de omega-3 [G4]). Se diseno una dieta mediterranea personalizada para los grupos 2 y 4. Se administro BIS-11c para determinar los niveles de impulsividad y se uso el KIDMED para evaluar la adherencia a la dieta mediterranea. Resultados El grupo suplemento mostro una caida bastante significativa (p = 0,049) en la puntuacion total de Barratt despues del seguimiento. La puntuacion cognitiva total disminuyo ligeramente en los grupos de dieta y suplemento. Solo el grupo control tuvo una disminucion notable con respecto a la puntuacion total de la impulsividad motora. Las puntuaciones totales de «falta de planificacion» fueron menores en todos los grupos tras la intervencion. Las asociaciones entre las puntuaciones iniciales y finales del BIS-11c y los tratamientos presentaron una correlacion positiva (r > 0,9). Conclusion Una ingesta de 550 mg de EPA y 225 mg de DHA por dia durante 8 semanas se asocia con niveles mas bajos de conductas impulsivas en ninos con TDAH. Un patron dietetico mediterraneo podria mejorar las puntuaciones de la BIS, pero los resultados de este estudio no son concluyentes en esta poblacion.

Background The purpose of this study is to assess the incidence and clinical characteristics of adolescent tibial tubercle fractures (TTFs) during the COVID-19 pandemic by sharing our experiences. Methods Pediatric patients aged between 0 and 18 years old with confirmed diagnosis of TTFs who were treated at our center between April 2020 and May 2020 were included in the study. In addition to demographics, mechanism injury, treatment modalities, complications were also noted. Results Sixteen patients were included in the study. The mean age was 14.8 ± 0.9 years (range: 13–16 years). The mean BMI of patients was 26.3 ± 2.3 kg/m2 (range: 23.2–30.4 kg/m2). According to the BMI-for-age percentiles growth chart, eight patients (50%) were overweight, and eight patients (50%) were at a risk of being categorized as overweight. The most common cause for the injury was jumping due to basketball (50%). Twelve of 16 patients were treated operatively by open reduction and internal fixation. The remaining 4 patients were treated non-operatively with long leg cast. Conclusion The incidence of TTFs was 16 cases over about two months during the pandemic isolation period. Our results demonstrated that all adolescent TTFs occurred during periods when outdoor activities were permitted. This finding may be explained by sudden athletic activity after prolonged immobilization. We observed that all of our patients were male and either overweight or at risk of being overweight.

OBJECTIVE High numbers of adolescents today are exposed to conflict-related trauma, with trauma-exposure being associated with adverse biopsychosocial outcomes. Here we investigated the influence of trauma-exposure and high levels of posttraumatic stress disorder (PTSD) symptoms on cognitive functioning in trauma-related compared to neutral contexts. METHOD Afghan adolescent refugees with high levels of PTSD symptomatology and non-trauma-exposed Afghan adolescent refugee controls (N = 47; 43% female; aged 13-19 years, M = 15.49, SD = 1.40) completed a visual working memory task including affective (trauma-related) and neutral distractors. RESULTS Working memory capacity in the context of trauma-related distractors (and not neutral distractors) was significantly poorer in trauma-exposed refugees with high levels of PTSD when compared to non-trauma-exposed controls. CONCLUSIONS The findings highlight the importance of investigating posttraumatic cognitive functioning within affective contexts and suggest that affective working memory capacity may constitute a promising target for intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The persistent sciatic artery is an uncommon disease, considered an axial congenital vascular malformation due to the lack of involution of the sciatic artery during embryonic development. It may be associated with abnormalities in the development of the iliac, common femoral and superficial femoral arteries. Patients may be asymptomatic, or they could present chronic pain, such as sciatic neuralgia, caused by nerve damage, since it is close to the abnormal persistent vessel, or due to ischemic pain, as a result of a thrombosis or embolism of an aneurysm, which could compromise the viability of the limb.