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Daniela Chinchilla-Ochoa,1 Paola Barriguete-Chávez Peón,1 Blanca Eugenia Farfán-Labonne,1 Saúl Garza-Morales,1 Philippe Leff-Gelman,1 Mónica Flores-Ramos21Neuroscience Department, National Institute of Perinatology “Isidro Espinosa de los Reyes”, C.P.11000 Del. Miguel Hidalgo, México; 2CONACYT Research fellow, National Institute of Psychiatry “Ramón de la Fuente Muñiz” 14370 Ciudad de México, CDMX, MéxicoBackground: Depression and anxiety are frequent during pregnancy, and epidemiological studies demonstrate high rates of co-morbidity.Aims: To evaluate the association between the trait and state anxiety and depressive symptoms in women during the perinatal period.Method: A transversal study was conducted at the National Institute of Perinatology (INPer, Mexico City) from 2012 and 2015. Pregnant women diagnosed with Major Depressive Disorder (MDD) were included (N=128). Depressive and anxiety symptoms were evaluated using CES-D and STAI, respectively. Patients were sub-classified according to percentile 75 for Low and High Trait Anxiety (LTA, HTA) and Low and High State Anxiety (LSA, HSA); depressive symptoms were compared between pregnant women and women in the postpartum, by state and trait levels.Results: CES-D scores differed according to state and trait anxiety levels: while we observed that depressive scores (CES-D) were higher in HTA patients compared to LTA prenatally (35.9±9,5 vs 21.2±10,8 respectively; p=0.001), this finding was not observed in the postpartum period. In the case of state anxiety depressive scores were elevated among HSA versus LSA groups before delivery (33.0±11.3 vs 14.0±6.7 respectively; p=0.008) and after partum (35.1±8.06 vs 10.0±6.0; p=0.005).Conclusions: Patients showed higher scores of depressive symptoms when high trait or state anxiety comorbidity is present during the perinatal period. In the postpartum period, even low trait anxiety scores were associated with high depressive scores.Keywords: perinatal depression, perinatal anxiety, women, major depressive disorder

Background: Extended-release vinpocetine is effective to control focal onset epileptic seizures with a low rate of adverse events. A clinical study was performed to evaluate the efficacy and tolerability of vinpocetine as an adjuvant treatment in patients with this condition., Methods: A double-blind clinical study of parallel groups was conducted, in which 87 patients with a diagnosis of focal epilepsy treated with one to three antiepileptic drugs were recruited. Patients were randomized to receive vinpocetine (n = 41) or placebo (n = 46) adjuvant to their treatment. Patients entered the baseline phase (4 weeks), the titration phase (4 weeks) and the evaluation phase (8 weeks), maintaining stable doses of vinpocetine and their respective antiepileptic drug treatment., Results: Vinpocetine was more effective than placebo in reducing seizures at the end of the evaluation phase (p < 0.0001). Sixty-nine percent of the vinpocetine-treated patients had a 50% reduction in seizures compared to 13% of placebo-treated patients. No significant differences in the presence of adverse effects in patients treated with vinpocetine compared to those treated with placebo were observed. The most frequent adverse events observed with vinpocetine were headache (7.9%) and diplopia (5.2%)., Conclusions: As an adjuvant treatment, vinpocetine (2 mg/kg/day) effectively reduced the frequency of epileptic seizures and proved to be well tolerated. Vinpocetine has a wide safety profile and well-known adverse events, which are transient and with no sequelae., (Copyright: © 2019 Permanyer.)

Objective: To compare performance of children with attention deficit hyperactivity disorders-combined (ADHD-C) type with control children in multi-source interference task (MSIT) evaluated by means of error related negativity (ERN)., Method: We studied 12 children with ADHD-C type with a median age of 7 years, control children were age- and gender-matched. Children performed MSIT and simultaneous recording of ERN., Results: We found no differences in MSIT parameters among groups. We found no differences in ERN variables between groups. We found a significant association of ERN amplitude with MSIT in children with ADHD-C type. Some correlation went in positive direction (frequency of hits and MSIT amplitude), and others in negative direction (frequency of errors and RT in MSIT)., Conclusion: Children with ADHD-C type exhibited a significant association between ERN amplitude with MSIT. These results underline participation of a cingulo-fronto-parietal network and could help in the comprehension of pathophysiological mechanisms of ADHD.

Introduction: In some studies in children, topiramate showed efficacy., Aim: To evaluate efficacy, tolerability and safety of topiramate in monotherapy in newly diagnosed epilepsy vs carbamazepine in children., Patients and Methods: In a multicentre, open-label, comparative and randomized study patients with partial epilepsy, were randomized to received topiramate or carbamazepine treatment. Patients with degenerative disease were excluded. Data were analysed by SPSS statistical program v. 11.0, and non parametric test. Comparisons between groups were made with chi square test and t Student's test., Results: In total were included 88 patients, 33 in group 1 (topiramate), 32 group 2 (carbamazepine), 23 were drop-outs because adverse events and lost in follow-up (13 in group 1 y 10 group 2). In both groups were observed good efficacy, in month 6 and 9 of follow-up, the average of seizures in group 1 were better than group 2 (p = 0.01, t Student's test). The percentage of free seizure patients was greater in group 1 than group 2 (statistical significance p = 0.02 chi square test). The adverse events were similar in both groups and mild, somnolence 9%, weight loss 6% in group 1 and somnolence 19%, dizziness 3% and seizure discontrol 3% in group 2., Conclusions: Good efficacy in both groups, and topiramate in good treatment choice in newly diagnosed epilepsy in children because it's the efficacy and tolerability in comparison with the gold standard carbamazepine.

Background: Minor facial anomalies in 14-33% of exposed fetuses have been associated with the teratogenic effect of antiepileptic drugs (AED) since 1968. The purpose of this article is to describe the facial characteristics of offspring of epileptic mothers with and without exposure to AED by means of 22 anthropometric measurements, for the purpose of comparison with the measurements of offspring of non-epileptic women previously described in the literature, and to correlate the facial anomalies with the specific drug., Methods: An interval was defined where 95% of the central values were considered as "common values" and the remaining 5% as "uncommon values" (UV) or as being in the "alert zone"; the odds ratio with Wolf modification was used and then Fisher's test for comparison with healthy newborns. Full-term eutrophic newborns of epileptic mothers who received attention at the epilepsy clinic of a gyneco-obstetric center were included., Results: During the study period, 72 eutrophic, full-term newborns were included; in 70 cases at least one measurement was found in the alert zone, with a predominance of the mid-line area. No differences were found between neonates who received monotherapy vs. polytherapy. The groups exposed to phenobarbital, clonazepam and multiple AED showed more uncommon values (p < 0.05), identified as minor dysmorphisms by other authors. It seems to be a particular susceptibility of the mid-line of the face to show the effects of AED and, additionally, of environmental agents., Conclusions: No differences were found in the facial values among the different AED used in monotherapy form. It is suggested that the choice of drug used during pregnancy must be decided on according to the clinical diagnosis of each mother's epilepsy, and not on the basis of potential teratogenic risk.

Background: Subependymal/intraventricular hemorrhage (SE/IVH) is a frequent cause of disability and mortality., Methods: This is a prospective, randomized, double-blind study which included 100 pregnant Mexican women who need to interrupt their pregnancy within 28-32 weeks of gestation. One group was given a single dose of intravenous (IV) phenobarbital 10 micrograms/kg (phenobarbital group, n = 50), and the other was provided with diluted distilled water (control group). Measurements of phenobarbital serum concentrations were taken by both mother and newborn, and head sonograms were applied during the first 24 hours, at the 3rd and 7th days of life., Results: The sample was made up of 42 newborns in the phenobarbital group, and 46 in the control group; the newborns had phenobarbital levels of 11.5 5.7 g/microliter at birth, and of 9.5 +/- 5.9 g/microliter 24 hours later. SE/IVH was found in 12 patients from the phenobarbital group and in 29 from the control group (p < 0.005), the first group were 11 mild SE/IVH (2 grade I, and 9 grade II), and 26 in the control group (4 grade I, and 22 grade II), p < 0.005. Severe hemorrhages were similar between groups. A larger frequency of SE/IVH was found in the newborn group which received mechanical ventilation (p = 0.0008)., Conclusions: Prenatal phenobarbital can reduce the SE/IVH frequency in premature infants younger than 32 weeks at birth. Its main effect could be shown in patients with mechanical ventilation.

During pregnancy, there are several physiological changes that influence the kinetics of medication administrated during this time. These physiological changes are not reestablished immediately during delivery; so, its concentration in biologic fluids is different when is administered immediately after delivery, than several weeks after. The purpose in this work was to identify the changes of pharmacocinetics constants for fenitoin and carbamacepine, in epileptic patients. When the same dose is maintained, during different times of postpartum. In 20 Mexican epileptic women, the plasma and milk concentrations of fenitoina during 60 day postpartum and in 14 carbamacepine was determined. In all the patients pharmakocinetics of anticonvulsivant, in each study period (5, 15, 30, 45 y 60 days postpartum). Excretion index of maternal milk was determined. Maximal plasmatic concentration of fentoine had no variation; however, carbamacepine was higher during the late period. There were no differences in the areas under curve and life all the middle of elimination and in excretion index.

Auditory evoked potentials of the brain stem (AEPBS) provide a simple noninvasive method of evaluating hearing function and have been widely used for early detection of hypoacusis in children. Between April 1992 and May 1994, a study was done of 400 Mexican children who presented at least one neonatal risk factor for hearing impairment. The average age of the children studied was 6.6 months and their average gestational age at birth was 35.1 weeks. Just over half of them (51%) had been treated with amikacin. The study found 1427 risk factors (3.5 per child), the most common ones being exposure to ototoxic substances, hyperbilirubinemia, and birthweight of less that 1500 g. In 27% of the children, peripheral auditory changes were found, and 13% did not respond to auditory stimuli. Low birthweight and young gestational age at birth, high serum concentration of bilirubin, sepsis, subependymal or intraventricular hemorrhage, mechanical ventilation, and exposure to ototoxic substances were significantly associated with the presence of severe or profound hypoacusis.

The association between epilepsy and pregnancy trace a problem for possible complications for the mother and the foetus by toxicity of antiepileptic drugs (AED) on the epilepsy itself. A group of 100 pregnant epileptic women were prospectively studied (clinically and by measurement of serum levels (SL) of AED. Mothers participating lived in the Valley of Mexico, 61 patients received monotherapy and 18 received no drugs. The most commonly used were phenytoin (41), carbamazepine (35) and valproate. The SL of AED were into or under the range recommended for seizures control, only 10 patients have increased their seizures (sleepless and AED medication were common causes). Obstetric complications in our patients do not differ from healthy pregnant women. The 50% of deliveries were resolved by cesarean section (only by neurologic recommendation). No major malformations were observed and the 12% showed minor dysmorphic features. This work show the Obstetric and Neurologic follow-up of 100 mexican women with epilepsy during pregnancy, treated in a third level attention hospital, their complications, pharmacologic recommendations and risk of teratogenicity.

The objective was to make the confirmation-exclusion diagnosis of fetal hydrocephaly, to study its etiology and identify associated anomalies. 67 cases with suspected fetal hydrocephaly were studied at 30 weeks of mean gestational age. Serial studies of ultrasonography, TORCH serology and fetal karyotype were made. Postnatal correlation was made. 14 cases were not confirm and 53 were. 6 cases (11.3%) were classified as isolated hydrocephaly and 47 (88.7%) with associated anomalies. In this group, 15 with only intracranial anomalies and 32 intracranial and extracranial anomalies. All chromosomic anomalies were found in this latter group. Proved in all the cases of hydrocephaly and most of its associated anomalies were documented. Fetal hydrocephaly can be accurately diagnosed with the technology presently available. The diagnosis of associated anomalies is more difficult to obtain, but can be reached using serial studies and multidisciplinary approach.

Thirty preschool children who survived from a neonatal intensive care unit were studied with pure tone audiometry between 125 to 8000 Hertz. Examinations were performed in a cross-sectional study at 36 to 72 postnatal months of age. Hypoacusis was found in three patients. Risk factors most frequently found in hypoacusic children were hyperbilirubinemia, hypoxia neonatorum and ototoxic exposure. All hypoacusic children had a history of preterm birth, one suffered hypoxia neonatorum, and two hyperbilirubinemia. The patients' group had an average of 2.26 risk factors. These data suggest that perinatal auditory damage occurs in the presence of additional hearing damage risk factors leading to hypoacusis.

Wave III latency and the III-V interpeak interval of brainstem auditory evoked responses in infants in the first weeks of life decreased and increased, respectively, in association with mid-pregnancy maternal blood lead levels (2.5-35 micrograms/dl) in a group of 30 prospectively followed healthy pregnancies and deliveries. The rapid myelination of brainstem auditory pathways occurring around mid-pregnancy and the lengthening of the III-V interpeak interval with increased mid-pregnancy maternal lead suggest that brain structures involved in spatial localization of sound may be compromised by prenatal lead exposure. The data also indicate that maternal blood lead measurements during pregnancy provide an adequate surrogate index of fetal exposure.

Subependymal/intraventricular hemorrhage (SE/IVH) is the most frequently encountered type of hemorrhage in the neonatal period. Premature infants often develop SE/IVH which remains is one of most serious neonatal events. We studied a group of 96 premature newborn infants: half of which were diagnosed with SE/IVH. We evaluated the babies at six and 12 months of age which++ a battery of neurobehavioral exams, including neurological, psychological, motor an audiological test. In 52 of infants with SE/IVH showed some type of neurobehavioral abnormality, compared with 13% of non-SE/IVH infants. In 56% of SE/IVH infants had neurological abnormalities at 12 months (P < 0.0001) difference with non-SE/IVH), predominantly in areas of muscle tone and reflex. Motor abnormalities were encountered in 42% of SE/IVH children, and in 4% of non-SE/IVH children at 12 months. Psychometric abnormalities at 12 months were noted in 53% of the SE/IVH group. Hypocusis were noted in 38% of the SE/IVH group and in 15% of the non-SE/IVH group.

The infants with low weight at birth have great chance of exhibiting early death or neurodevelopmental sequelae. We prospectively evaluated the neurological and psychological development during the first year of life in 118 infants who weighted less than 2,000 g at birth. All patients were examined with the Amiel Tison and Grenier test (neurologic evaluation), Gesell test (psychological) and Brunette-Lezine test (Psychomotor scale). Mean gestational age was 33 weeks (SD = 3.1) and birth mean weight was 1495 g (SD = 291). Seventy per cent were delivered by cesarean section. Neurological abnormalities were found in 20 infants (alteration of muscular tone in all and motor deficit in 50%). Twenty five per cent had abnormal Gesell test and 17% psychomotor retardation (13% mild and 4% severe).