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Scalp-recorded evoked potentials elicited by applying afferent electrical stimulation at the tragus region of the human external ear have shown inconsistent results. We aim to disentangle discrepant findings and interpretations, and put forward novel physiological explanations on the origin of the vagus nerve somatosensory evoked potentials (VSEP).We systematically search and critically appraise in PubMed, Web of Science, and Scielo databases the scientific reports publishing VSEP findings elicited by afferent electrical stimulation at the tragus region from individuals without brain disorders. Eligible studies published from January 2000 to April 2020 were extracted. The following information was identified from each article: number of participants; age; gender; stimulating/recording and grounding electrodes as well as stimulus side, intensity, duration, frequency, and polarity. Information about physiological parameters and neurobiological variables was also extracted. Representative vignettes with novel scalp responses induced by stimulating the tragus were also included to add support to our conclusions.140 healthy participants were identified from six selected reports. Mean age ranged from 24.3 to 61.5 years. Stimulating and recording aspects were miscellaneous among studies. Scalp responses marked as the VSEP were recorded in 76% of participants, and showed high variability, low validity and poor reproducibility. Age correlated with response latencies. There were not gender differences in scalp response parameters. Cardiovascular function was unaltered by tragus stimulation. Vignettes showed that the VSEP was scalp muscle responses.VSEP did not fulfil evoked potential guidelines. VSEP corresponded to volume conduction propagating from muscles surrounding scalp recording sites.

The trigeminocardiac reflex (TCR) is a complex and, sometimes, fatal event triggered by overstimulation of the trigeminal nerve (TN) and its territorial and spinal cord branches. We reviewed and compiled for the neurosurgeon key aspects of the TCR that include a novel and straightforward classification, as well as morphophysiology, pathophysiology, neuromonitoring and neuromodulation features. Further, we present intraoperative data from a patient who developed extraterritorial, or type IV, TCR while undergoing a cervical surgery. TCR complexity, severity and unwanted outcomes indicate that this event should not be underestimated or overlooked in the surgical room. Timely TCR recognition in surgical settings is valuable for applying effective intraoperative management to prevent catastrophic outcomes.

5 p., Objective: Functional movement disorders (FMDs) mimic a range of movements, neuropsychiatric and neurodegenerative disorders known to have smell dysfunction, which has been neglected in terms of its application to FMD. We aim to determine the smell status in FMD patients tested by a non-invasive, reliable and validated olfactory test. Patients and methods: We quantitatively assessed in thirty-five FMD patients their smell status and compared it to that of healthy age- and sex-matched controls, and of patients with Parkinson’s disease (PD). All participants were administered the Brief Smell Identification Test (B-SIT), a standardized short version of the University of Pennsylvania Smell Identification Test (UPSIT). The Picture Identification Test (PIT), a visual test analogous in content and form to the UPSIT designed to control for non-olfactory cognitive confounds, was also administered. Results: The B-SIT scores of the FMD patients were higher than those from PD patients [respective means (standard deviations: SDs) = FMD, 9.54 (1.57); PD, 4.64 (1.05), p < 0.01)] but similar to the smell scores from healthy controls [9.97 (1.77), p=0.35]. Gender, age, time of disease onset, smoking status, and phenotypic expression did not influence the test scores. Fourteen FMD patients who mentioned having olfactory dysfunction before smell testing have their test results within normal range. PIT scores from patients and healthy controls were within normal range. Conclusions: These findings indicate that FMD patients have normal olfactory function. Olfactory testing may be helpful in identifying and differentiating FMD from other movement, neurodegenerative and neuropsychiatric diseases for which smell function is altered.

Motor nerve conduction studies (MNCS) and blink reflexes (BR) were done on a 42-year-old female patient who presented with peripheral facial nerve palsy (PFNP); these investigations were done while she had her facial muscles relaxed ("A"), and contracted ("B"). While in the "A" state, MNCS of the facial nerves had prolonged latency and low amplitude and R3 of the blink reflex was absent in the affected side; an early contralateral R1 response was recorded on the unaffected side. In state "B," the third silent period was "prolonged" on the affected side and absent on the unaffected one. This is an illustrative case of a variant of facial nerve palsy in humans.

El blefaroespasmo esencial benigno cursa con movimientos repetitivos anormales del cierre de los párpados y espasmo del músculo orbicular de los ojos. Modernas teorías postulan que este trastorno del movimiento se origina por alteraciones en el procesamiento de la información aferente, con posterior desintegración de dicha información a nivel del programa neural sensorimotor que existe en el sistema nervioso central, que se manifiesta luego como movimiento anormal en los individuos genéticamente susceptibles. Diferentes investigaciones que incluyen estudios imagenológicos, genéticos y neurofisiológicos han proporcionado nuevos hallazgos acerca de las áreas neurales involucradas en esta patología y la forma como se genera este trastorno. Dentro de estas investigaciones sobresale el estudio del reflejo del parpadeo obtenido eléctricamente, el cual consta de tres respuestas llamadas no-nociceptiva (R1), nociceptiva (R2) y ultranociceptiva (R3). Dicho reflejo y, principalmente, la respuesta refleja ultranociceptiva (R3) parece ser muy útil para entender más profundamente la fisiopatología de esta distonía focal y realizar la endofenotipificación funcional y seguimiento en la neuro rehabilitación correspondiente de este complejo problema neurológico.Benign essential blepharospasm is characterized by abnormal repetitive movements of lid closure and spasm of the orbiculari oculi muscles. Modern theories postulate that this movement disorder originates by abnormal processing of afferent information with further disintegration of the sensorimotor neural program at central levels of the nervous system all of which is seen as dystonic movements in genetically susceptible people. Different investigations including neuroimagin, genetic and neurophysiological studies have discovered new findings on what structures are involved and how this abnormal movement is generated. Among these research is noteworthy the study of electrically elicited blink reflex. It consists of three responses called non-nociceptive (R1), nociceptive (R2) and ultranociceptive (R3). Such blink reflexes, mostly the ultranociceptive response (R3), seem to be very useful to understand more deeply the pathophysiology of this focal dystonia, to perform the functional endophenotyping and to do a more appropriate follow-up of this complex neurological problem.

2 p.

La evaluación semiológica apropiada es uno de los aspectos más importantes para realizar un adecuado diagnóstico neurológico. Presentamos una paciente colombiana de 60 años de edad, quien padeció un infarto de la arteria cerebral media izquierda, originándole hemiplejía derecha, afasia motora, parálisis facial "central" derecha y atrofia del músculo platisma derecho. Este último hallazgo, originalmente descrito por Joseph Babinski, el cual es el verdadero signo de Babinski, no fue identificado sino hasta dos años y siete meses después de haberse presentado el ictus, aunque había sido evaluada, previamente, por diferentes especialistas en ciencias neurológicas. La no identificación de signos como el mencionado aquí lleva, en ocasiones, a realizar diagnósticos erróneos o incompletos afectando no sólo la localización apropiada de las lesiones sino, también, las eventuales medidas que se deben tomar en la neurorrehabilitación de estos pacientes.Neurological signs and symptoms are very important to establish a correct neurological diagnosis. We present here a Colombian female patient, 60 yearsold, who had ischaemic stroke in the left cerebral media artery. It produced right hemiplegia, motor aphasia, "central" facial palsy and atrophy of right platysma muscle. This latter finding, described originally by Joseph Babinski as "The Babinski Sign" was observed only two years and seven months after the ictus even when she had, previously, been evaluated by several neurologists. The underdiagnosis of clinical signs like the one described here may lead to erroneous diagnosis that will, ultimately, affect neurorehabilitation measures.

Olfaction is critical to the hedonic appreciation of foods, caloric regulation of food intake, quality of life and taste preferences since birth. However, malnutrition in newborns down-regulates chemosensory function. Thus, olfactory measures might be used as early markers of chemosensory dysfunction in malnutrition, and may also be useful in assessing feeding adjustments during nutritional rehabilitation. Olfactory anomalies originated by malnutrition would be reversed by nutritional rehabilitation following flavor-enhancing odorants.

Background and Aims The motor-evoked potential (MEP) induced by transcranial magnetic stimulation (TMS), its recruitment and the conditioning effects of weak stimuli in Parkinson's disease (PD) have shown contradictory results. The aim of this study is to definitively establish the influences of PD on the TMS-evoked MEP. Methods We investigated resting and active motor thresholds, resting and active recruitment curves, and short interval intracortical inhibition (ICI) and facilitation (ICF) in 39 PD patients and 40 age-matched healthy controls. The Unified Parkinson's Disease Rating Scale (UPDRS) motor score was used as a clinical measure. Results MEPs to single pulses were slightly, but significantly, larger in the PD patients at rest, but increased much less than controls with voluntary muscle activation. PD patients also showed clearly and consistently less ICI and ICF by the conditioning pulse. Both ICI and ICF correlated with MEP threshold in healthy subjects, but not in PD patients. None of the TMS measures correlated with the UPDRS. Conclusions This study strongly supports the view that PD-related MEPs reflect a disturbed signal-noise ratio of pyramidal neuron responses. Such disturbance may be due to a complex combination of altered presynaptic and surround inhibition that results in unbalanced excitatory/inhibitory input at the brain motor cortex level.

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Since ancient times, several cultures including those from China, Egypt, India and Rome gave rigid solutions to improve physical problems of affected people by several neurological disorders. These measures were applied, at that time, by individuals prepared for doing such task. It evolved throughout the years supported by the discovery and comprehension of the so-called neural plasticity as well as the current evidences that the nervous system is able of remodelating itself even in adult times. It is known today that synaptic modulation is the base of neurorehabilitation improved by use and application of specific protocols to each neurological disorder. Among these, we have to consider not only all of the already known on rehabilitation measures but also on neurorobotic, neurorestauration, neuromodulation, neurostimulation as well as virtual reality, among others interventions. Neurorehabilitation has been able to put together modern science with ancient manual therapies helping to change, in a positive way, the attitude toward people with disabilities in the twenty one century; likewise, it offers new hopes for functional recovery where before was nothing. Further, it gives opportunities to get a better quality of life to affected people and its corresponding families. It is very interesting to know that the modern concepts of neurorehabilitation performed in a multidisciplinary approach are very useful for humans on the Earth and people interested in conquer Space.

In this study we demonstrate that myasthenia gravis, an autoimmune disease strongly identified with deficient acetylcholine receptor transmission at the post-synaptic neuromuscular junction, is accompanied by a profound loss of olfactory function. Twenty-seven MG patients, 27 matched healthy controls, and 11 patients with polymiositis, a disease with peripheral neuromuscular symptoms analogous to myasthenia gravis with no known central nervous system involvement, were tested. All were administered the University of Pennsylvania Smell Identification Test (UPSIT) and the Picture Identification Test (PIT), a test analogous in content and form to the UPSIT designed to control for non-olfactory cognitive confounds. The UPSIT scores of the myasthenia gravis patients were markedly lower than those of the age- and sex-matched normal controls [respective means (SDs) = 20.15 (6.40) & 35.67 (4.95); p

Resumen El sistema nervioso es un sistema cerrado pero, a la vez, muy dinámico, que asimila, reorganiza, y modifica los mecanismos biológicos, bioquímicos y fisiológicos que posee. Esta capacidad se denomina neuroplasticidad e implica cambios en el tejido neural que incluye regeneración axonal, colateralización, neurogénesis, sinaptogénesis y reorganización funcional, entre otros mecanismos. Dichos mecanismos emplean neurotrasmisores como el N-metil-D-apartato (NMDA), el acido gama-aminobutirico (GABA), la acetilcolina o la serotonina, involucrados en la potenciación o depresión sináptica a corto o largo plazo, la cual puede durar horas o días, sostenida por segundos mensajeros como el AMP cíclico, cuyos efectos pueden ser transitorios o permanentes. Estos efectos son la base de la neuromodulación. Esta última genera cambios a largo plazo en la actividad metabólica neuronal y su respuesta a diversos estímulos eléctricos, magnéticos o químicos, empleados en la neurorehabilitación clínica. Dicha neurorehabilitación es una intervención necesaria en, al menos, el 75% de los pacientes que han padecido un insulto neural, cuyo fundamento es la recuperación funcional del paciente. Por esto, la responsabilidad de los neurólogos clínicos, los neurocirujanos, los pediatras, los neuropediatras, los ortopedistas, los siquiatras y los cirujanos en general, entre otros profesionales de la salud debería no solo proveer un diagnóstico y suministrar un tratamiento médico o quirúrgico, sino reorientar al paciente hacia un programa formal de neurorehabilitación, liderado por especialistas en el área, donde le ayudaran a alcanzar una apropiada funcionabilidad, una óptima neurorestauración y una adecuada calidad de vida, incluyendo la de sus correspondientes familias. Palabras claves: neuroplasticidad, neuromodulación, neurorehabilitación, integración sensorimotora, neurofisiatria Abstract The nervous system is a closed system but, at the same time, is very dynamic and able to adapt, reorganize and modify the biological, biochemical and physiological mechanisms that it poses. This ability is called neuroplasticity and implies changes in neural structures such as axonal regeneration, collateralization, neurogenesis, synaptogenesis and functional reorganization, among other mechanisms. These mechanisms involve different neurotramsitters such as N-metil-D-apartate (NMDA), gama-amynobutiric acid (GABA), acetilcholine or serotonine; they are involved in short-term depression and potentiation which may last hours or days, maintained by second messengers such as cyclic AMP; its effects may be transient or permanents, and they are the basis of neuromodulation. This latter concept involves long term changes on the neuronal metabolism and its responses to electrical, magnetic or chemical stimuli are employed for neurorehabilitation. Neurorehabilitation is an intervention that must be apply in, at least, seventy five percent of patients suffering neural injuries being its main goal the functional recovery of patients. Accordingly, clinical neurologist, neurosurgeons, pediatricians, neuropediatricians, orthopedic surgeons, psychiatrist and general surgeons, among others health care professionals should offer not only a diagnosis and its corresponding medical or surgical treatment but also to reorient patients toward neurorehabilitation programs leaded by specialist properly trained in this area. This will help patients to obtain optimal functioning, better neurorestaurative condition and a more appropriate quality of life of patients and their relatives. Key Words: neuroplasticity, neuromodulation, neurorehabilitation, sensori-motor integration, neurophysiatrist

Benign essential blepharospasm is characterized by abnormal repetitive movements of lid closure and spasm of the orbiculari oculi muscles. Modern theories postulate that this movement disorder originates by abnormal processing of afferent information with further disintegration of the sensorimotor neural program at central levels of the nervous system all of which is seen as dystonic movements in genetically susceptible people. Different investigations including neuroimagin, genetic and neurophysiological studies have discovered new findings on what structures are involved and how this abnormal movement is generated. Among these research is noteworthy the study of electrically elicited blink reflex. It consists of three responses called non-nociceptive (R1), nociceptive (R2) and ultranociceptive (R3). Such blink reflexes, mostly the ultranociceptive response (R3), seem to be very useful to understand more deeply the pathophysiology of this focal dystonia, to perform the functional endophenotyping and to do a more appropriate follow-up of this complex neurological problem.

Neurological signs and symptoms are very important to establish a correct neurological diagnosis. We present here a Colombian female patient, 60 years-old, who had ischaemic stroke in the left cerebral media artery. It produced right hemiplegia, motor aphasia, "central" facial palsy and atrophy of right platysma muscle. This latter finding, described originally by Joseph Babinski as "The Babinski Sign" was observed only two years and seven months after the ictus even when she had, previously, been evaluated by several neurologists. The underdiagnosis of clinical signs like the one described here may lead to erroneous diagnosis that will, ultimately, affect neurorehabilitation measures.

Los esfuerzos que realizan los científicos latinoamericanos para desarrollar investigaciones de calidad, dignas de ser publicadas a nivel internacional son enormes. Sin embargo, Colciencias, ente creado para apoyar dichas investigaciones en Colombia, introdujo evaluaciones cienciométricas revaluadas hace tiempo en otras latitudes, basándose entre otras medidas en aspectos como el mal llamado factor de impacto. Más grave aún es que dicha entidad gubernamental desconoce que tales medidas se basan en principios matemáticos discutidos, poniendo así a la ciencia colombiana en riesgo inminente de padecer una iatrogenia académica de irreparables consecuencias. Por tal razón, una reestructuración urgente de la forma como se debe evaluar la producción científica colombiana se hace mandatoria, antes de que estas medidas terminen afectando aún más la apenas incipiente materialización de las investigaciones científicas en Colombia. Latin American scientists are making tremendous efforts to conduct good-quality research worthy of being published internationally. However, Colciencias, an entity created to support this research in Colombia, introduced scienciometric evaluations which had been re-evaluated elsewhere some time ago, based on measurements of aspects such as the ill-termed "impact factor". Even more serious is that the aforementioned government office is unaware that measures are based on debated mathematical principles, placing Colombian science at imminent risk of suffering from an academic yatrogeny of irreparable consequences. Therefore, an urgent restructuring of the way in which Colombia’s scientific production is to be evaluated is thus mandatory before these measures have a negative impact thereon.

Blinking is a normal human phenomenom involving trigeminal and facial patways. To gain understanding on the neurobiology of blinking, five normal subjects were investigated before and after application of transdermal capsaicin at the forehead for two weeks. No effects of topical capsaicin were detected in eye blink rates. However, when capsaicin was applied to a female subject with blepharospasm, she showed a dramatic restoration of her vision subsequent to blinking modification. Deactivation of abnormal A-to-C fibers cross talks at the trigeminal-facial pathways seems to be the most likely mechanism of such improvement. El parpadeo es un fenómeno normal en los humanos que involucra las vías trigéminas faciales. Con el fin de conocer un poco más la neurobiología de este fenómeno estudiamos cinco individuos normales antes y después de aplicar capsaicina trasdérmica en la frente de cada uno de ellos, por dos semanas. La frecuencia de parpadeo no se alteró con la aplicación de capsaicina tópica. Sin embargo, cuando la misma sustancia se aplicó a una paciente con blefaroespasmo hubo dramática restauración de su visión, la cual fue secundaria a la modificación de la actividad muscular palpebral. La desactivación del cruce patológico de información que pasa de las fibras A a las fibras C, pertenecientes a las vías trigémino-faciales, parece ser el mecanismo de acción relacionado con la aplicación de capsaicina, el que estaría directamente relacionado con la recuperación clínica observada en la paciente con blefaroespasmo.

En 1985, Baker y cols estimularon la corteza cerebral humana intacta de manera trascraneal utilizando campos magnéticos, registrando tales estímulos en la musculatora axial. Desde entonces, una gran cantidad de estudios se realizan en diversas partes del mundo, encontrándose múltiples usos clínicos y experimentales.

Durante años se consideró que los músculos de la cara de los humanos, no poseían husos neuromusculares, llevando esto a distorcionar hallazgos que a nivel de fisiología sensorimotora se obtuvieron durante gran parte del siglo XX.

Trypanosoma cruzi, causative agent of Chagas disease, affects not only cardiac and intestinal structures but also neurological structures. A high prevalence of T. cruzi infection occurs in Colombia, prompting the present study. First, a qualitative metaanalysis was undertaken using the PubMed database, the electronic internet engine Altavista, Colombian journals indexed by Colciencias, and three relevant textbooks. The following key words were used: Trypanosoma, Chagas disease, nervous system, spinal cord, central nervous system, peripheral nervous system, neuromuscular junction, autonomic nervous system, muscle, muscle disorders, neuromuscular disease, neuromuscular disorders, synapticopathies and dysautonomia. The documents analyzed numbered 116 and included original papers, reviews, case reports, editorials, brief communications, conferences and book chapters. At minimum, each document included data involving ELISA testing, indirect immunofluorescense, or parasitemia levels in the clinical, serological or histopathological studies. Polymerase chain reaction (PCR) studies were not included because of the recent introduction of PCR as a confirmatory technique for Chagas disease in Colombia. Chagas disease affects the central, the peripheral and the autonomic nervous system in humans, although its effects on the antonomic system is most commonly investigated in Colombia. Neurological lesions must be evaluated carefully, because patients may be misdiagnosed and treated as carriers of 'idiopathic' diseases. Neurological pathologies poses a serious threat in Colombia due to the prevalence of Chagas disease.

Trypanosoma cruzi infection is a common cause of cardiopathy in South America leading it eventually to an established stroke; however, the association between T. cruzi infection itself and cerebrovascular disease is still unknown. We did a case-control study at Eastern Colombia and found that T. cruzi infection was more frequent and statistically significant in stroke cases (24.4%) than controls (1.9%), (Chi square: 21.72; OR: 16.13; 95% confidence interval (CI): 3.64-71.4; p

A 14-year-old Colombian girl developed sudden spastic paraparesis 2 days before going to a rural hospital in northeast Colombia where a diagnosis of multiple sclerosis was made. A battery of neurological tests was suggested to confirm the multiple sclerosis diagnosis, which could not be afforded by the patient’s family. Due to the lack of facilities in her hometown, she was sent to the closest university hospital. Upon arrival at the emergency unit, she was found with spastic paraparesis, absent cutaneous reflex below the thoracic vertebra T10, loss of proprioception in her lower limbs, exaggerated knee and Achilles tendon reflexes, bilateral feet extensor responses, and urinary continence. Familial and personal past medical history was unremarkable. She emphasized that the medical problem came on suddenly 3 days before visiting the university hospital after feeling a knife-like pain at the mid-thoracic level. Beevor’s sign1 was present (Figure 1 ▶). A myelovascular disease was considered and magnetic resonance imaging (MRI) performed to the spinal cord. MRI showed a medullary infarction from T10 to T12, and anterior spinal artery syndrome was considered. Medical and neurorehabilitation measures were started immediately. The patient was lost in follow-up. Multiple sclerosis in Colombia has lower prevalence than neurovascular disorders in general.2,3 However, to consider a myelovascular attack requires clinical expertise that falls short during rural medical training, which takes place during the last year of mentoring before getting a full practitioner’s license in Colombia. The sudden onset, the accompanying signs and symptoms including pain, as well as the Beevor’s sign, suggested a vascular lesion inside the spinal cord at around T10 which was confirmed by MRI. Figure 1. Diagnosis of a spinal cord vascular lesion via Beevor’s sign. (A) Position of the umbilicus at rest. (B) Upward movement of the umbilicus (~1 cm) when the patient contracts the abdominal muscles while trying to sit up. Normally, the umbilicus does not change the position after rectus abdominus contraction. Beevor commented that in spinal cord lesions at the T10 level and below, “When a patient sits up or raises the head from a recumbent position, the umbilicus is displaced toward the head. This is the result of paralysis of the inferior portion of the rectus abdominal muscle, so that the upper fibers predominate pulling upwards the umbilicus.”4 Less commonly, downward movement of the umbilicus due to weakness of the upper part of the rectus abdominus muscle is called inverted Beevor’s sign.1 Beevor’s sign has also been described in amyotrophic lateral sclerosis and in some myopathies becoming a very consistent neurological sign in facioscapulohumeral muscular dystrophy.1,5 In fact, it has been said that in this latter disease, Beevor’s sign has 95% sensitivity and 93% specificity in neuromuscular diseases.5 Neurological signs are still of utmost importance to localized lesions despite novel laboratory techniques.6 Curiously, Beevor’s most important investigation was on the cerebral blood supply.7

Trypanosoma cruzi es el agente causal de la enfermedad de Chagas, patología que afecta principalmente estructuras cardiacas e intestinales. Sin embargo, las complicaciones neurológicas no han sido adecuadamente identificadas y estudiadas en Colombia, a pesar de existir allí áreas geográficas que presentan prevalencias de infección iguales o mayores de las informadas en otras latitudes, en donde se le ha dado una mayor atención a este tipo de complicaciones, desde hace ya varios años. Realizamos un metanálisis cualitativo sobre el tema, en la base de datos PubMed, en el motor de búsqueda Altavista y en las revistas colombianas indexadas por Colciencias, así como en tres libros que trataban el tópico de manera específica. Usamos las palabras claves: Trypanosoma, Chagas? disease, nervous system, spinal cord, central nervous system, peripheral nervous system, neuromuscular junction, autonomic nervous system, muscle, muscle disorders, neuromuscular disease, neuromuscular disorders, synapticopathies y dysautonomia. Como criterio de inclusión se debía haber realizado e informado la prueba de ELISA, inmunofluorescencia indirecta, presencia de parasitemia o presencia de parásitos en los tejidos, dependiendo de si se trataba de un estudio clínicoserológico o histopatólogico. No tuvimos en cuenta como criterio de inclusión la realización de la prueba de reacción en cadena de la polimerasa, dado que sólo hasta épocas recientes se introdujo esta técnica en el estudio de esta patología en Colombia. Encontramos 116 manuscritos con los términos antes descritos; éstos incluían artículos originales, revisiones, informe de casos, editoriales y comunicaciones breves, así como conferencias y capítulos de libros que cumplieron con los requisitos planteados. En ellos se apreció claramente cómo la enfermedad de Chagas afecta todos los niveles del sistema nervioso central, periférico y autonómico, siendo este último sistema el que se ha estudiado con mayor profundidad en nuestro país. Consideramos que el compromiso neurosistémico producido por T. cruzi debe ser evaluado de una manera más profunda a partir de la fecha, dado que muchos de los pacientes pueden estar siendo diagnosticados, tratados y seguidos como portadores de enfermedades ?idiopáticas?. Dichas patologías pueden llegar a convertirse en una seria amenaza para la salud de muchos colombianos si no se toman las medidas de prevención y control adecuadas. Por tanto, es necesario que actuemos en consecuencia, de acuerdo con el espectro de anormalidades neurológicas que se presentan en estos pacientes, como lo demostramos en el presente trabajo.