Repositorio Institucional Fleni
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Migrainous Infarction: Case series in a neurological center of Buenos Aires
No full textFil: Wainberg, Florencia N. Fleni. Departamento de Neurología; Argentina.Fil: Castiglione, Juan Ignacio. Fleni. Departamento de Neurología; Argentina.Fil: Burdet, Luis. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Rodriguez Pérez, María Soledad. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Goicochea, María Teresa. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina
Neuromyelitis optica spectrum disorders: from pathophysiology to therapeutic strategies
No full textNeuromyelitis optica (NMO) is a chronic inflammatory autoimmune disease of the central nervous system (CNS) characterized by acute optic neuritis (ON) and transverse myelitis (TM). NMO is caused by a pathogenic serum IgG antibody against the water channel aquoporin 4 (AQP4) in the majority of patients. AQP4-antibody (AQP4-ab) presence is highly specific, and differentiates NMO from multiple sclerosis. It binds to AQP4 channels on astrocytes, triggering activation of the classical complement cascade, causing granulocyte, eosinophil, and lymphocyte infiltration, culminating in injury first to astrocyte, then oligodendrocytes followed by demyelination and neuronal loss. NMO spectrum disorder (NMOSD) has recently been defined and stratified based on AQP4-ab serology status. Most NMOSD patients experience severe relapses leading to permanent neurologic disability, making suppression of relapse frequency and severity, the primary objective in disease management. The most common treatments used for relapses are steroids and plasma exchange.Currently, long-term NMOSD relapse prevention includes off-label use of immunosuppressants, particularly rituximab. In the last 2 years however, three pivotal clinical trials have expanded the spectrum of drugs available for NMOSD patients. Phase III studies have shown significant relapse reduction compared to placebo in AQP4-ab-positive patients treated with satralizumab, an interleukin-6 receptor (IL-6R) inhibitor, inebilizumab, an antibody against CD19+ B cells; and eculizumab, an antibody blocking the C5 component of complement. In light of the new evidence on NMOSD pathophysiology and of preliminary results from ongoing trials with new drugs, we present this descriptive review, highlighting promising treatment modalities as well as auspicious preclinical and clinical studies.Fil: Carnero Contentti, Edgar. Hospital Aleman; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina
Connectivity and Patterns of Regional Cerebral Blood Flow, Cerebral Glucose Uptake, and Aβ-Amyloid Deposition in Alzheimer's Disease (Early and Late-Onset) Compared to Normal Ageing
No full textPurpose: The aim of this study was to investigate the differences in early (EOAD) and late (LOAD) onset of Alzheimer´s disease, as well as glucose uptake, regional cerebral blood flow (R1), amyloid depositions, and functional brain connectivity between normal young (YC) and Old Controls (OC).
Methodology: The study included 22 YC (37 ± 5 y), 22 OC (73 ± 5.9 y), 18 patients with EOAD (63 ± 9.5 y), and 18 with LOAD (70.6 ± 7.1 y). Patients underwent FDG and PIB PET/CT. R1 images were obtained from the compartmental analysis of the dynamic PIB acquisitions. Images were analyzed by a voxel-wise and a VOI-based approach. Functional connectivity was studied from the R1 and glucose uptake images.
Results: OC had a significant reduction of R1 and glucose uptake compared to YC, predominantly at the dorsolateral and mesial frontal cortex. EOAD and LOAD vs. OC showed a decreased R1 and glucose uptake at the posterior parietal cortex, precuneus, and posterior cingulum. EOAD vs. LOAD showed a reduction in glucose uptake and R1 at the occipital and parietal cortex and an increased at the mesial frontal and temporal cortex. There was a mild increase in an amyloid deposition at the frontal cortex in LOAD vs. EOAD. YC presented higher connectivity than OC in R1 but lower connectivity considering glucose uptake. Moreover, EOAD and LOAD showed a decreased connectivity compared to controls that were more pronounced in glucose uptake than R1.
Conclusion: Our results demonstrated differences in amyloid deposition and functional imaging between groups and a differential pattern of functional connectivity in R1 and glucose uptake in each clinical condition. These findings provide new insights into the pathophysiological processes of AD and may have an impact on patient diagnostic evaluation
Accumulative risk of clinical event in high-risk radiologically isolated syndrome in Argentina: data from the nationwide registry RelevarEM
No full textIntroduction: We aimed to analyze the accumulative risk of MRI and OB factors for evolution from RIS to MS in subjects included in the Argentinean MS registry (NCT03375177).
Methods: RIS subjects were identified according to RIS diagnosis criteria. Subjects were longitudinally followed with clinical and MRI at intervals of 6 months. Time from RIS identification to the first clinical event was estimated using Kaplan-Meier. Multivariable Cox regression models were created to assess the independent predictive value of demographic characteristics, as well as clinical, OB and MRI data on time to the first clinical event. The single and increased risk factor of evolution of RIS was quantified.
Results: A total of 88 RIS subjects, mean follow-up time 42 ± 4 months were included. 39 (44.3%) and 23 (26.1%) had a new MRI lesion or a clinical event, respectively, during the follow-up. OB (HR 5.9, 95% CI 1.29-10.1, p = 0.004), infratentorial lesions (HR 3.7, 95% CI 1.09-7.5) and spinal cord lesions (HR 5.3, 95% CI 1.4-8.2, p = 0.01) at RIS identification were independent predictors associated with a subsequent clinical event. The accumulative risk showed that when two of the three factors (OB, infratentorial or spinal cord lesions) were present the HR was 10.4, 95% CI 4.4-22, p < 0.001, and when three factors were present, it was HR 15.6, 95% CI 5.7-28, p < 0.001 for a relapse.
Conclusion: The presence of three factors significantly increased the risk of clinical event; high-risk subjects should probably be managed by a different approach than those used for individuals without high-risk factors.Fil: Rojas, Juan I. Centro de Esclerosis Múltiple de Buenos Aires; Argentina.Fil: Pappolla, Agustín. Hospital Italiano de Buenos Aires, Buenos Aires; Argentina.Fil: Blaya, Patricio A. Neurocomp; Argentina.Fil: Marrodán, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Ysrraelit, Maria Célica. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Luetic, Geraldine. Instituto de Neurociencias de Rosario; Argentina.Fil: Liwacki, Susana. Clínica Universitaria Reina Fabiola; Argentina.Fil: Barboza, Andrés G. Hospital Central de Mendoza; Argentina.Fil: Burgos, Marcos. Hospital San Bernardo; Argentina.Fil: Cohen, Leila. Hospital Dr. J. M. Ramos Mejía; Argentina.Fil: Mainella, Carolina. Hospital Español de Rosario; Argentina.Fil: Zanga, Gisela. Unidad Asistencial César Milstein; Argentina.Fil: Menichini, María L. Sanatorio Británico; Argentina.Fil: Tavolini, Darío. Fundación INECO; Argentina.Fil: Tkachuk, Verónica. Hospital de Clínicas José de San Martín; Argentina.Fil: Lopez, Pablo. Hospital Aleman; Argentina.Fil: Lequizamon, Felisa. Hospital de Agudos Dr. Teodoro Álvarez; Argentina.Fil: Knorre, Eduardo. Hospital de Agudos Dr. Teodoro Álvarez; Argentina.Fil: Nofal, Pedro. Sanatorio Güemes; Argentina.Fil: Patrucco, Liliana. Hospital Italiano de Buenos Aires; Argentina
Utility of a Spanish version of Three Words-Three Shapes Test to detect memory impairment in primary progressive aphasia
No full textIntroduction: Three Words-Three Shapes (3W3S) is a bedside test that assesses verbal and non-verbal memory and has proven useful in staging memory decline in amnestic disorders and primary progressive aphasia. Given its simple structure, the 3W3S can be easily adapted to other languages maintaining the original shapes and only modifying the words. We aim to validate a Spanish version of the 3W3S test and establish whether memory loss patterns present in amnesic disorders associated with Alzheimer's etiology and PPA were correctly characterized. Method: The translation and adaptation of the 3W3S were performed according to standardized guidelines and applied to a cohort of patients with Dementia of Alzheimer's type (DAT = 20), mild cognitive impairment (aMCI= 20), primary progressive aphasia (PPA = 20), and healthy controls (HC = 20). Results: In verbal memory performance, PPA patients' score was lower than that of MCI and HC and similar to DAT's in the effortless encoding (p < 0.001), delayed recall (p < 0.001), and recognition (p < 0.012). For non-verbal performance, PPA patients performed better than DAT and similar to HC and MCI subjects (p < 0.001). Conclusions: Results show good applicability of 3W3S to determine memory function in PPA patients, independently from language ability. Visual and verbal components of memory are dissociated in PPA.Fil: Calandri, Ismael Luis. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Crivelli, Lucia. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Morello García, Florentina. Universidad de Buenos Aires. Instituto de Investigaciones en Psicología; Argentina. Consejo Nacional de investigaciones Científicas y Técnicas; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina
Spinal cord and brain MRI should be routinely performed during follow-up in patients with NMOSD - Yes
No full textFil: Carnero Contentti, Edgar. Hospital Alemán. Departamento de Neurociencias; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina
Neural and subjective effects of inhaled N,N-dimethyltryptamine in natural settings
No full textBackground: N,N-dimethyltryptamine is a short-acting psychedelic tryptamine found naturally in many plants and animals. Few studies to date have addressed the neural and psychological effects of N,N-dimethyltryptamine alone, either administered intravenously or inhaled in freebase form, and none have been conducted in natural settings.
Aims: Our primary aim was to study the acute effects of inhaled N,N-dimethyltryptamine in natural settings, focusing on questions tuned to the advantages of conducting field research, including the effects of contextual factors (i.e. "set" and "setting"), the possibility of studying a comparatively large number of subjects, and the relaxed mental state of participants consuming N,N-dimethyltryptamine in familiar and comfortable settings.
Methods: We combined state-of-the-art wireless electroencephalography with psychometric questionnaires to study the neural and subjective effects of naturalistic N,N-dimethyltryptamine use in 35 healthy and experienced participants.
Results: We observed that N,N-dimethyltryptamine significantly decreased the power of alpha (8-12 Hz) oscillations throughout all scalp locations, while simultaneously increasing power of delta (1-4 Hz) and gamma (30-40 Hz) oscillations. Gamma power increases correlated with subjective reports indicative of some features of mystical-type experiences. N,N-dimethyltryptamine also increased global synchrony and metastability in the gamma band while decreasing those measures in the alpha band.
Conclusions: Our results are consistent with previous studies of psychedelic action in the human brain, while at the same time the results suggest potential electroencephalography markers of mystical-type experiences in natural settings, thus highlighting the importance of investigating these compounds in the contexts where they are naturally consumed.Fil: Pallavicini, Carla. Fleni. Instituto de Neurociencias FLENI-CONICET; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina.Fil: Cavanna, Federico. Fleni. Instituto de Neurociencias FLENI-CONICET; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina.Fil: Zamberlan, Federico. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina.Fil: de la Fuente, Laura A. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina.Fil: Ilksoy, Yayla. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina.Fil: Perl, Yonatan S. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina.Fil: Arias, Mauricio. Hospital General de Agudos Francisco Santojanni, Buenos Aires, Argentina.Fil: Romero, Celeste. Centro de Estudios de la Cultura Cannábica; Argentina.Fil: Carhart-Harris, Robin. Imperial College London; Reino Unido.Fil: Timmermann, Christopher. Imperial College London; Reino Unido.Fil: Tagliazucchi, Enzo. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina
COVID-19 y adultos mayores con deterioro cognitivo: ¿puede influir el aislamiento social en la enfermedad?
No full textIntroducción y objetivo
En Argentina, la calidad del cuidado que los adultos mayores con cuadros crónicos de deterioro cognitivo reciben, está siendo afectada por la pandemia de COVID-19. Nuestro objetivo fue estudiar en qué medida la cuarentena afectó el bienestar y los síntomas conductuales de sujetos con demencia que viven en la comunidad y sus cuidadores luego de las 8 semanas iniciales de aislamiento obligatorio.
Métodos
Familiares de 119 pacientes con demencia tipo Alzheimer (DTA) o trastornos relacionados que viven en la comunidad fueron invitados a participar de forma anónima y voluntaria de una encuesta exploratoria, de tipo transversal o sincrónica, y con formato electrónico. Se utilizó estadística descriptiva y el test de Chi-cuadrado con un valor de significación de p < 0,05 para analizar las diferencias según la severidad de la demencia.
Resultados
La edad media de los sujetos con demencia fue de 81,16 años (± 7,03), el 35% tenían > 85. El 67% tenía DTA y el 26% demencia mixta. El 34,5% tenían demencia leve, 32% moderada y 33% severa. En el 67% de los casos, el cuidador principal era familiar. Se observó un aumento de ansiedad (43%), insomnio (28%), depresión (29%), empeoramiento de la marcha (41%) y aumento del uso de psicofármacos. La frecuencia de síntomas conductuales fue mayor en sujetos con demencia leve (p < 0,05). En casi todos los casos la rehabilitación fue suspendida durante la cuarentena. Hubo un aumento significativo de la sobrecarga del cuidador durante la pandemia (t = −8,657; p < 0,001).
Conclusiones
Tanto los sujetos con demencia que viven en la comunidad como sus cuidadores mostraron un empeoramiento de su bienestar y estado de salud durante la pandemia de COVID-19, debido a una combinación multifactorial de aislamiento social, ausencia de rehabilitación, aumento del estrés del cuidador, miedo de contraer la enfermedad entre otras causas. Es necesario desarrollar un plan de acción coordinado y urgente que involucre a las familias de los pacientes, las autoridades sanitarias y el personal de salud que habitualmente atiende a estos pacientes para mitigar el impacto negativo de la cuarentena y epidemia en la salud de los sujetos con demencia que viven en la comunidad.Fil: Russo, María Julieta. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Cohen, Gabriela. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Campos, Jorge. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina
Aggressive multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM
No full textThe objectives of the present study were to describe the frequency of aggressive multiple sclerosis (aMS) as well as to compare clinical and radiological characteristics in aMS and non-aMS patients included in RelevarEM (NCT 03375177).
Methods
The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥ 6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥ 6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-aMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset.
Results
A total of 2158 patients with MS were included: 74 aMS and 2084 non-aMS. The prevalence of aMS in our cohort was 3.4% (95%CI 2.7–4.2). AMS were more likely to be male (p = 0.003), older at MS onset (p < 0.001), have primary progressive MS (PPMS) phenotype (p = 0.03), multifocal presentation (p < 0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p = 0.004 and p = 0.002, respectively).
Conclusion
3.4% of our patient population could be considered aMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesions on MRI at clinical presentation all had higher odds of having aMS.Fil: Kohler, Matías. Fundación Sinapsis Santa Rosa; Argentina.Fil: Kohler, Eduardo. Fundación Sinapsis Santa Rosa; Argentina.Fil: Vrech, Carlos. Sanatorio Allende; Argentina.Fil: Pappolla, Agustín. Hospital Italiano de Buenos Aires; Argentina.Fil: Miguez, Jimena. Hospital Italiano de Buenos Aires; Argentina.Fil: Patrucco, Liliana. Hospital Italiano de Buenos Aires; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; ArgentinaFil: Marrodan, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; ArgentinaFil: Gaitán, María Inés. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Fiol, Marcela. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Negrotto, Laura. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Ysrraelit, María Célica. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Cristiano, Edgardo. Centro de esclerosis múltiple de Buenos Aires; Argentina.Fil: Carrá, Adriana. Hospital Británico; Argentina.Fil: Steinberg, Judith. Hospital Británico; Argentina.Fil: Martinez, Alejandra D. Hospital Británico; Argentina.Fil: Curbelo, María Celeste. Hospital Británico; Argentina.Fil: Cohen, Leila. Hospital Dr. J. M. Ramos Mejía; Argentina.Fil: Alonso, Ricardo. Hospital Dr. J. M. Ramos Mejía; Argentina.Fil: Garcea, Orlando. Hospital Dr. J. M. Ramos Mejía; Argentina
Impact of Andropause on Multiple Sclerosis
No full textAndropause results from the natural decrease in testosterone levels that occurs with age. In contrast to menopause, which is a universal, well-characterized process associated with absolute gonadal failure, andropause ensues after gradual decline of both hypothalamic-pituitary-gonadal axis activity, as well as of testicular function, a process which usually develops over a period of many years. Increasing evidence on greater risk of Multiple sclerosis (MS) associated with lower testosterone levels is being reported. Likewise, epidemiological studies have shown a later age of onset of MS in men, relative to women, which could perhaps respond to the decline in protective testosterone levels. In this review, we will discuss the role of androgens in the development and function of the innate and adaptive immune response, as well as in neuroprotective mechanisms relevant to MS. Testosterone effects observed in different animal models and in epidemiological studies in humans will be discussed, as well as their correlation with physical disability and cognitive function levels. Finally, published and ongoing clinical trials exploring the role of androgens, particularly at key stages of sexual maturation, will be reviewed.Fil: Ysrraelit, Maria Célica. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina