Marcos Serrano-Dueñas | Pontificia Universidad Católica del Ecuador (original) (raw)
Papers by Marcos Serrano-Dueñas
Neurology Research International, Dec 15, 2020
Arquivos de Neuro-Psiquiatria, 2021
Background: Parkinson’s disease (PD) is a chronic disease that presents a multitude of symptoms, ... more Background: Parkinson’s disease (PD) is a chronic disease that presents a multitude of symptoms, with symptoms of both motor and nonmotor nature. The Delphi method is widely used to create consensuses among experts in a field of knowledge. Objective: In order to reach a consensus on the values that should be assigned to the different motor and nonmotor manifestations of Parkinson’s disease, a linear evaluation index (LEI) was created. Subsequently, the metric properties of this index were studied. Methods: 120 consecutive patients with a Parkinson’s diagnosis were chosen in accordance with the UKPDSBB criteria. The Delphi method was used to reach a consensus among experts regarding the values of each of the manifestations included. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability, in terms of internal consistency, reliability index, Cronbach’s alpha and standard error of measurement; and validity, in terms of convergent validit...
Neurology Research International, 2020
Objective. This study has been designed with the aim of using optimal scaling to perform the allo... more Objective. This study has been designed with the aim of using optimal scaling to perform the allocation of scores and to be able to construct an indicator of the Parkinson’s Disease Gravity Index. Scores were assigned to interrelated dimensions that share information about the patient’s situation, to have an objective, holistic tool which integrates scores so that doctors can have a comprehensive idea of the patient’s situation. Patients and Methods. 120 consecutive patients with Parkinson’s diagnosis were chosen according to the United Kingdom Parkinson’s Disease Society Brain Bank criteria. Subsequently, all the chosen dimensions were transformed into interval variables for which the formula proposed by Sturges was used. Once the dimensions were transformed into interval variables, optimal scaling was carried out. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability: internal consistency, reliability index, Cronbach’s alpha, and ...
Clinical Neuropharmacology, 2017
Objectives Impulse control disorder (ICD) is a common adverse effect in patients with Parkinson d... more Objectives Impulse control disorder (ICD) is a common adverse effect in patients with Parkinson disease who receive dopamine agonists; however, other factors are involved in its manifestations. To study the frequency and factors involved in the development of this adverse effect in a Latin American population, we conducted a cross-sectional multicenter study. Methods Two hundred fifty-five patients in 3 Latin American centers were evaluated by examination and application of scales (Unified Parkinson’s Disease Rating Scale, Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale, Hoehn and Yahr, Clinical Impression of Severity Index for Parkinson’s Disease). Results Of the patients, 27.4% had ICD, most of whom were on dopamine agonists. Other associated risk factors included a younger age at onset of Parkinson disease, moderate symptoms, a shorter evolution of the clinical manifestations, rapid eye movement (REM) sleep disorder behavior, and the consumpti...
Annals of Neurology, 2016
![Research paper thumbnail of [Hemifacial spasm, quality of life and depression]](https://attachments.academia-assets.com/45332446/thumbnails/1.jpg)
](Revista de neurologia
Quality of life, a concept which has become increasingly important in recent years, refers to a p... more Quality of life, a concept which has become increasingly important in recent years, refers to a patient's perception of himself in relation to his illness and its treatment. This is compared with the concept of quantity of life or survival. This approach is in keeping with the concepts of health of the World Health Organization. Hemifacial spasm is a disorder of movement with a prevalence of 7.4 and 14.5 per 100,000 men and women respectively. To evaluate the quality of life of patients with hemifacial spasm, study the occurrence of depression and ascertain whether it correlates with the severity, response to treatment and muscle groups involved. We present a cohort of 57 patients (average age 53.4 years) with hemifacial spasm, in whom the disorder had been present for an average of 3.7 years. It was found that in these patients the quality of life and index of depression were worse when the severity of the disease was greater, response to treatment poorer and there was generali...
Revista de neurologia
On average 40% of all patients suffering from Parkinson s disease (PD) undergo bouts of depressio... more On average 40% of all patients suffering from Parkinson s disease (PD) undergo bouts of depression. It is thought that this is due to a dysfunction in the orbitofrontal and dorsolateral circuits, together with hypometabolism in the orbital, caudate nucleus and frontal dorsolateral tract regions. The aim of this study is to compare the effectiveness of low doses of fluoxetin with that of low doses of amitriptyline in controlling depression in patients with PD. The study examined a total of 77 patients (34 females and 43 males), with an average age of 68.2 years, who had been suffering from PD (according to the diagnostic criteria of Calne et al, in stage II of Hoehn and Yahr) for an average of 6.9 years. They were divided randomly into two groups which received fluoxetin (37 patients, dosage: 20 40 mg/day) or amitriptyline (40 patients, dosage: between 25 and 75 mg/day). A basal evaluation and four others (at 3, 6, 9 and 12 months of treatment) were performed, including the STMS (Sho...
Commentary Chronic type-tensional headache can be understood using the Limbic Augmented Pain synd... more Commentary Chronic type-tensional headache can be understood using the Limbic Augmented Pain syndrome paradigm.1 The chronic pain is resistant to analgesic treatment and is associated with neuropsy- chiatric disturbance. This study suggests that a combination of amitriptiline and stress therapy is the best treatment, however, it has some weak- nesses. International Headache Society criteria are not used to classify tension headaches according to participation of the peri- cranial musculature. These criteria have been questioned,2 but Holroyd and colleagues believe that contracture is associated with anxiety that increments muscular contraction and the sen- sibility of trigeminal neurons.3 The neuropsychiatric profile of pa- tients is not considered, although a psychological stressor or psychiatric illness has been detected in 84% of tension headache sufferers.4 Lower response to treatment in patients with chronic tension headaches could indicate disturbed personality.5 Also, the stu...
![Research paper thumbnail of [Neuroleptic malignant syndrome in patients with non-herpetic viral encephalitis. Study of 7 cases]](https://attachments.academia-assets.com/45332449/thumbnails/1.jpg)
](Medicina Clínica
Our aim was to consider the possibility that patients with viral non-herpetic viral encephalitis ... more Our aim was to consider the possibility that patients with viral non-herpetic viral encephalitis develop the neuroleptic malignant syndrome (NMS) and determine the indispensable elements to diagnose it. Seven patients with this type of encephalitis whose clinical picture fulfilled the criteria for NMS were evaluated. The control group consisted of 17 patients with the same type of encephalitis who had been randomly selected from the Neurological Service of a 3rd level hospital. We compared blood leukocyte numbers, cerebrospinal fluid (CSF) findings, axilar temperature, creatine kinase (CK) values and number of days of hospitalisation. There were 5 males and 2 females with the mean age of 26 years. The control group consisted of 10 males and 7 females with an mean age of 37.52 years. Patients developed NMS after they were exposed to a mean doses of 17.85 mg of haloperidol with a latency (up to onset of symptoms) of 27.42 hours. In patients with NMS, the total number of leukocytes was...
Psiquiatria Biologica
BACKGROUND: The aim of this study was to observe the similarities and differences presented in th... more BACKGROUND: The aim of this study was to observe the similarities and differences presented in the malignant neuroleptic syndrome in psychiatric patients and previously healthy subjects. PATIENTS AND METHODS: A series of clinical cases evaluated by the author is presented. The following values were determined (comparison of means): leucocytosis, temperature, CPK, latency in hours from drug administration and the development of symptoms, drug and dose involved, days of hospital stay and CSF. Moreover, the following were compared (Chi square test, exact Fisher's test and Yates correction): level of alertness, rigidness, autonomic instability and the presence of movement disorders. A p value < 0.05 was significant in both cases. RESULTS: Thirteen males and eight females with a mean age of 41.5 years were studied. Eight were included in the healthy group and thirteen in the study group (12 patients diagnosed withschizophrenia). Seven patients in the first group consulted for acut...
![Research paper thumbnail of [Sialorrhea in patients with Parkinson. A six year prospective study]](https://attachments.academia-assets.com/45332442/thumbnails/1.jpg)
](Revista de neurologia
The sialorrhea has been recognised as one of the manifestations of Parkinson's disease, with ... more The sialorrhea has been recognised as one of the manifestations of Parkinson's disease, with a frequency of up to 80%. The evolution of patients with sialorrhea is unknown. We study 26 male and 17 female patients with Parkinson's disease and sialorrhea. Evaluation at three years showed that sialorrhea had persisting in 18 of them, at six years showed that persisted in 8 patients. We found significant impairment in the sialorrhea group. If we accept the principle, that sialorrhea are levodopa-resistant disorders as non nigrostriatal symptoms, secondary to a diffuser and more extended cerebral stem degeneration, we could assume that in these patients with sialorrhea cortical-sub cortical circuits are more widely involved leading to motor and cognitive impairment and depression.
Neurologia (Barcelona, Spain)
sialorrhea is one of the common nonmotor, non-neuropsychiatric symptoms in Parkinson's diseas... more sialorrhea is one of the common nonmotor, non-neuropsychiatric symptoms in Parkinson's disease and its pre-sence can cause limitation in the patient's social life. The traditional treatment with anticholinergic medication is capable of triggering important neuropsychiatric complications. this is a prospective, double-blind, placebo compared study, which follow-up Parkinson's disease patients for 3 months. we measured the efficacy of clonidine in the management of sialorrhea. The study was performed in 32 patients (20 males and 12 females), with a mean age of 70.75 years and mean duration of the disease of 8.84 years. Randomly, 17 patients received clonidine 0.15 mg/day and the remaining 15 patients received placebo. Both groups were made up of subjects with similar characteristics, age, years of illness, sex, stage of disease (H and Y), disability (S and C) and motor score (UPDRS). Likewise, salivation affected both groups in the same intensity. We used the variable anal...
![Research paper thumbnail of [Clonidine versus propranolol in the treatment of essential tremor. A double-blind trial with a one-year follow-up]](https://attachments.academia-assets.com/45332452/thumbnails/1.jpg)
](Neurologia (Barcelona, Spain)
To compare the efficacy of clonidine vs propranolol in the control of essential tremor, a double-... more To compare the efficacy of clonidine vs propranolol in the control of essential tremor, a double-blind randomized controlled trial with a one year follow-up was designed to obtain 80 % power and 95 % confidence level. The participants (186 patients with the essential tremor diagnosis) were recruited from the community, 122 (65.6 %) of these patients completed the trial. They were assessed using a Clinical-Evaluation Scale for Tremor and were examined 5 times, once at baseline and 4 times during the treatment phase. We used ANOVA with Bonferroni corrections, a p> value of 0.01 was considered significant. Dropouts due to side effects were compared using the Fisher's exact X (2) test for two tails, a p>value of 0.05 was considered statistically significant. Propranolol as well as clonidine (p> = 0.005) proved to be statistically efficacious (p> = 0.0005). Propranolol was not more efficacious than clonidine (p> = 0.4). Dropouts were significantly higher in the clonidi...
Revista Ecuatoriana de Neurologia
Entre el 20 al 40% de los pacientes tratados por los neurólogos presentan síntomas inexplicables ... more Entre el 20 al 40% de los pacientes tratados por los neurólogos presentan síntomas inexplicables que terminan en muchos casos etiquetados como histéricos. La histeria ha sido prácticamente eliminada de los manuales de clasificación de las enfermedades psiquiátricas; en su lugar se emplean términos tales como: trastornos somatomorfes, de somatización o de conversión. Curiosamente hay enfermos que presentan síntomas y signos claramente psicogénicos y en quienes no puede ser establecido el diagnóstico de trastorno somatomorfe o de conversión; por otro lado bajo el título de Trastorno de somatización se incluyen –erróneamente- a entidades como la cefalea tipo tensional. Si recordamos que la histeria no es un término que involucre necesariamente una enfermedad categorial, es una palabra descriptiva; que no es obligatoriamente un sustantivo, que puede ser la mayoría de veces un adjetivo, y que, existe una clara influencia de lo psicológico sobre la funcionalidad neuronal; probablemente te...
Cited By (since 1996): 2, Export Date: 23 July 2009, Source: Scopus
Revista Ecuatoriana de Neurologia
Objective: To examine the concurrent validity of the Hamilton Depression Rating Scale and the Bec... more Objective: To examine the concurrent validity of the Hamilton Depression Rating Scale and the Beck Depression Inventory for quantifying depression in patients with Parkinson's disease, using the ICD-10 Diagnostic Criteria as the gold standard, and to determine if the somatization items considered are pertinent. Methods: The study involved one hundred and forty consecutive PD patients -102 men and 38 women- with a mean age of 68.7 years and mean disease duration of 6.7 years. Sensitivity, specificity, positive and negative predictive values and likelihood ratios were obtained with a 95% CI. ROC Curves (AUC) were also performed. Results: Based on ROC measurement of discriminative ability, our results suggest that both scales were poor at recognizing mild de- pression, somewhat better at recognizing moderate depression and adequate for distinguishing severe depression, though with poor specific - ity. Comparisons of HDRS-21, HDRS-12, BDI-21 and BDI-16 to determine concurrent validi...
Revista Ecuatoriana de Neurologia
Abstract Background: Study to investigate the concurrent validity of the Beck Depression Inventor... more Abstract Background: Study to investigate the concurrent validity of the Beck Depression Inventory and Beck Anxiety Inventory evaluation scales against the ICD-10. Methods: A K2 factorial design for studying the metrics properties of the BDI and BAI in parkinsonian outpatients. Results: 147 parkinsonian patients were included; 44 patients has anxiety and depression; only depression 19; only anxiety 31; finally 53 subjects don’t have depression or anxiety. The BDI AUC was [0.858]. The BAI AUC was of [0.907]. The cut score was of 14/15 for the BDI and 13/14 for the BAI. The factorial design resulted in the two factors (depression and anxiety) has the best functional correlation in the regression. Conclusions: The results we present bear out this lack of dimensionality, since we found that the BDI AUC-measured discriminative ability for anxiety was [0.739]. With regard to the BAI, this is employed to discriminate the depressed, AUC values of [0.771]. Keywords: Parkinson’s disease, Depr...
Revista Ecuatoriana de Neurologia
Abstract Background: Neuropsychiatric symptomatology frequently accompanies Parkinson’s disease. ... more Abstract Background: Neuropsychiatric symptomatology frequently accompanies Parkinson’s disease. Purpose: In this work (a one point time analytical study), we wished to explorer the Neuropsychiatric Inventory in its shorter format (NPI–Q) in seventy consecutive patients. To find out in what way information obtained from the caregiver (CG) is correlated with that which the patients provide. If this tool, designed to evaluate patients with dementia, can be applied to non-demented subjects with Parkinson’s disease (NDP). Method: The study, the NPI–Q Spanish version was employed, first with the CG alone and subsequently, with the individual patient alone by a researcher with no knowledge of the previous result from the CG. The weighted kappa correlation coefficient was measured to evaluate the CG–NDP consistency rate (Test–retest reliability; obtained by judging the reproductibility or stability of a instrument over time; two or more observers; or two or more times); a value of 0.7 or h...
![Research paper thumbnail of [Transitory cranial dyskinesias and tubercular meningitis. Report of three cases]](https://a.academia-assets.com/images/blank-paper.jpg)
](Neurología (Barcelona, Spain), 1997
Three patients who suffered transitory (from 18 to 49 days) cranial dyskinesias during the course... more Three patients who suffered transitory (from 18 to 49 days) cranial dyskinesias during the course of tubercular meningitis are described. The diagnosis was confirmed by the presence of acid-alcohol resistant bacilli in spinal fluid. Cranial tomography or magnetic resonance images failed to demonstrate anatomical lesions. The blink reflex and brain stem auditory evoked potentials were abnormal, indicating dysfunction of motor nuclei of the cranial nerves, possibly secondary to changes in their regulation by basal ganglia. No recurrences have been observed during follow-up (from 3 to 7 years).
![Research paper thumbnail of [Parkinson's disease, side affected and depression]](https://attachments.academia-assets.com/45332443/thumbnails/1.jpg)
](Revista de neurologia
Depression is a state of mind often associated with Parkinson's disease, which is not correla... more Depression is a state of mind often associated with Parkinson's disease, which is not correlated with the stage of the disease or the response to treatment with L-dopa. It has been suggested that patients with right-sided Parkinsonism have more depression than those with left-sided. To assess whether patients whose dominant side is affected primarily have more depression than those whose non-dominant side is affected; and to evaluate whether when the dominant side is more affected this is accompanied by greater deterioration on the scale of everyday activities (ADLS) and on the motor part of the unified scale for evaluation of Parkinsonism (UPDRSm). The study group was formed of 63 patients with Parkinsonism at stage 1 or 1.5 (Hoehn and Yahr), with an average age of 66.17 years. They were divided into two groups. Those who received L-dopa (Dopa group) and those who were newly-diagnosed patients (Naive group). They were evaluated on the Hamilton test, UPDRSm and ADLs scale. We us...
Neurology Research International, Dec 15, 2020
Arquivos de Neuro-Psiquiatria, 2021
Background: Parkinson’s disease (PD) is a chronic disease that presents a multitude of symptoms, ... more Background: Parkinson’s disease (PD) is a chronic disease that presents a multitude of symptoms, with symptoms of both motor and nonmotor nature. The Delphi method is widely used to create consensuses among experts in a field of knowledge. Objective: In order to reach a consensus on the values that should be assigned to the different motor and nonmotor manifestations of Parkinson’s disease, a linear evaluation index (LEI) was created. Subsequently, the metric properties of this index were studied. Methods: 120 consecutive patients with a Parkinson’s diagnosis were chosen in accordance with the UKPDSBB criteria. The Delphi method was used to reach a consensus among experts regarding the values of each of the manifestations included. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability, in terms of internal consistency, reliability index, Cronbach’s alpha and standard error of measurement; and validity, in terms of convergent validit...
Neurology Research International, 2020
Objective. This study has been designed with the aim of using optimal scaling to perform the allo... more Objective. This study has been designed with the aim of using optimal scaling to perform the allocation of scores and to be able to construct an indicator of the Parkinson’s Disease Gravity Index. Scores were assigned to interrelated dimensions that share information about the patient’s situation, to have an objective, holistic tool which integrates scores so that doctors can have a comprehensive idea of the patient’s situation. Patients and Methods. 120 consecutive patients with Parkinson’s diagnosis were chosen according to the United Kingdom Parkinson’s Disease Society Brain Bank criteria. Subsequently, all the chosen dimensions were transformed into interval variables for which the formula proposed by Sturges was used. Once the dimensions were transformed into interval variables, optimal scaling was carried out. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability: internal consistency, reliability index, Cronbach’s alpha, and ...
Clinical Neuropharmacology, 2017
Objectives Impulse control disorder (ICD) is a common adverse effect in patients with Parkinson d... more Objectives Impulse control disorder (ICD) is a common adverse effect in patients with Parkinson disease who receive dopamine agonists; however, other factors are involved in its manifestations. To study the frequency and factors involved in the development of this adverse effect in a Latin American population, we conducted a cross-sectional multicenter study. Methods Two hundred fifty-five patients in 3 Latin American centers were evaluated by examination and application of scales (Unified Parkinson’s Disease Rating Scale, Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale, Hoehn and Yahr, Clinical Impression of Severity Index for Parkinson’s Disease). Results Of the patients, 27.4% had ICD, most of whom were on dopamine agonists. Other associated risk factors included a younger age at onset of Parkinson disease, moderate symptoms, a shorter evolution of the clinical manifestations, rapid eye movement (REM) sleep disorder behavior, and the consumpti...
Annals of Neurology, 2016
Revista de neurologia
Quality of life, a concept which has become increasingly important in recent years, refers to a p... more Quality of life, a concept which has become increasingly important in recent years, refers to a patient's perception of himself in relation to his illness and its treatment. This is compared with the concept of quantity of life or survival. This approach is in keeping with the concepts of health of the World Health Organization. Hemifacial spasm is a disorder of movement with a prevalence of 7.4 and 14.5 per 100,000 men and women respectively. To evaluate the quality of life of patients with hemifacial spasm, study the occurrence of depression and ascertain whether it correlates with the severity, response to treatment and muscle groups involved. We present a cohort of 57 patients (average age 53.4 years) with hemifacial spasm, in whom the disorder had been present for an average of 3.7 years. It was found that in these patients the quality of life and index of depression were worse when the severity of the disease was greater, response to treatment poorer and there was generali...
Revista de neurologia
On average 40% of all patients suffering from Parkinson s disease (PD) undergo bouts of depressio... more On average 40% of all patients suffering from Parkinson s disease (PD) undergo bouts of depression. It is thought that this is due to a dysfunction in the orbitofrontal and dorsolateral circuits, together with hypometabolism in the orbital, caudate nucleus and frontal dorsolateral tract regions. The aim of this study is to compare the effectiveness of low doses of fluoxetin with that of low doses of amitriptyline in controlling depression in patients with PD. The study examined a total of 77 patients (34 females and 43 males), with an average age of 68.2 years, who had been suffering from PD (according to the diagnostic criteria of Calne et al, in stage II of Hoehn and Yahr) for an average of 6.9 years. They were divided randomly into two groups which received fluoxetin (37 patients, dosage: 20 40 mg/day) or amitriptyline (40 patients, dosage: between 25 and 75 mg/day). A basal evaluation and four others (at 3, 6, 9 and 12 months of treatment) were performed, including the STMS (Sho...
Commentary Chronic type-tensional headache can be understood using the Limbic Augmented Pain synd... more Commentary Chronic type-tensional headache can be understood using the Limbic Augmented Pain syndrome paradigm.1 The chronic pain is resistant to analgesic treatment and is associated with neuropsy- chiatric disturbance. This study suggests that a combination of amitriptiline and stress therapy is the best treatment, however, it has some weak- nesses. International Headache Society criteria are not used to classify tension headaches according to participation of the peri- cranial musculature. These criteria have been questioned,2 but Holroyd and colleagues believe that contracture is associated with anxiety that increments muscular contraction and the sen- sibility of trigeminal neurons.3 The neuropsychiatric profile of pa- tients is not considered, although a psychological stressor or psychiatric illness has been detected in 84% of tension headache sufferers.4 Lower response to treatment in patients with chronic tension headaches could indicate disturbed personality.5 Also, the stu...
Medicina Clínica
Our aim was to consider the possibility that patients with viral non-herpetic viral encephalitis ... more Our aim was to consider the possibility that patients with viral non-herpetic viral encephalitis develop the neuroleptic malignant syndrome (NMS) and determine the indispensable elements to diagnose it. Seven patients with this type of encephalitis whose clinical picture fulfilled the criteria for NMS were evaluated. The control group consisted of 17 patients with the same type of encephalitis who had been randomly selected from the Neurological Service of a 3rd level hospital. We compared blood leukocyte numbers, cerebrospinal fluid (CSF) findings, axilar temperature, creatine kinase (CK) values and number of days of hospitalisation. There were 5 males and 2 females with the mean age of 26 years. The control group consisted of 10 males and 7 females with an mean age of 37.52 years. Patients developed NMS after they were exposed to a mean doses of 17.85 mg of haloperidol with a latency (up to onset of symptoms) of 27.42 hours. In patients with NMS, the total number of leukocytes was...
Psiquiatria Biologica
BACKGROUND: The aim of this study was to observe the similarities and differences presented in th... more BACKGROUND: The aim of this study was to observe the similarities and differences presented in the malignant neuroleptic syndrome in psychiatric patients and previously healthy subjects. PATIENTS AND METHODS: A series of clinical cases evaluated by the author is presented. The following values were determined (comparison of means): leucocytosis, temperature, CPK, latency in hours from drug administration and the development of symptoms, drug and dose involved, days of hospital stay and CSF. Moreover, the following were compared (Chi square test, exact Fisher's test and Yates correction): level of alertness, rigidness, autonomic instability and the presence of movement disorders. A p value < 0.05 was significant in both cases. RESULTS: Thirteen males and eight females with a mean age of 41.5 years were studied. Eight were included in the healthy group and thirteen in the study group (12 patients diagnosed withschizophrenia). Seven patients in the first group consulted for acut...
Revista de neurologia
The sialorrhea has been recognised as one of the manifestations of Parkinson's disease, with ... more The sialorrhea has been recognised as one of the manifestations of Parkinson's disease, with a frequency of up to 80%. The evolution of patients with sialorrhea is unknown. We study 26 male and 17 female patients with Parkinson's disease and sialorrhea. Evaluation at three years showed that sialorrhea had persisting in 18 of them, at six years showed that persisted in 8 patients. We found significant impairment in the sialorrhea group. If we accept the principle, that sialorrhea are levodopa-resistant disorders as non nigrostriatal symptoms, secondary to a diffuser and more extended cerebral stem degeneration, we could assume that in these patients with sialorrhea cortical-sub cortical circuits are more widely involved leading to motor and cognitive impairment and depression.
Neurologia (Barcelona, Spain)
sialorrhea is one of the common nonmotor, non-neuropsychiatric symptoms in Parkinson's diseas... more sialorrhea is one of the common nonmotor, non-neuropsychiatric symptoms in Parkinson's disease and its pre-sence can cause limitation in the patient's social life. The traditional treatment with anticholinergic medication is capable of triggering important neuropsychiatric complications. this is a prospective, double-blind, placebo compared study, which follow-up Parkinson's disease patients for 3 months. we measured the efficacy of clonidine in the management of sialorrhea. The study was performed in 32 patients (20 males and 12 females), with a mean age of 70.75 years and mean duration of the disease of 8.84 years. Randomly, 17 patients received clonidine 0.15 mg/day and the remaining 15 patients received placebo. Both groups were made up of subjects with similar characteristics, age, years of illness, sex, stage of disease (H and Y), disability (S and C) and motor score (UPDRS). Likewise, salivation affected both groups in the same intensity. We used the variable anal...
Neurologia (Barcelona, Spain)
To compare the efficacy of clonidine vs propranolol in the control of essential tremor, a double-... more To compare the efficacy of clonidine vs propranolol in the control of essential tremor, a double-blind randomized controlled trial with a one year follow-up was designed to obtain 80 % power and 95 % confidence level. The participants (186 patients with the essential tremor diagnosis) were recruited from the community, 122 (65.6 %) of these patients completed the trial. They were assessed using a Clinical-Evaluation Scale for Tremor and were examined 5 times, once at baseline and 4 times during the treatment phase. We used ANOVA with Bonferroni corrections, a p> value of 0.01 was considered significant. Dropouts due to side effects were compared using the Fisher's exact X (2) test for two tails, a p>value of 0.05 was considered statistically significant. Propranolol as well as clonidine (p> = 0.005) proved to be statistically efficacious (p> = 0.0005). Propranolol was not more efficacious than clonidine (p> = 0.4). Dropouts were significantly higher in the clonidi...
Revista Ecuatoriana de Neurologia
Entre el 20 al 40% de los pacientes tratados por los neurólogos presentan síntomas inexplicables ... more Entre el 20 al 40% de los pacientes tratados por los neurólogos presentan síntomas inexplicables que terminan en muchos casos etiquetados como histéricos. La histeria ha sido prácticamente eliminada de los manuales de clasificación de las enfermedades psiquiátricas; en su lugar se emplean términos tales como: trastornos somatomorfes, de somatización o de conversión. Curiosamente hay enfermos que presentan síntomas y signos claramente psicogénicos y en quienes no puede ser establecido el diagnóstico de trastorno somatomorfe o de conversión; por otro lado bajo el título de Trastorno de somatización se incluyen –erróneamente- a entidades como la cefalea tipo tensional. Si recordamos que la histeria no es un término que involucre necesariamente una enfermedad categorial, es una palabra descriptiva; que no es obligatoriamente un sustantivo, que puede ser la mayoría de veces un adjetivo, y que, existe una clara influencia de lo psicológico sobre la funcionalidad neuronal; probablemente te...
Cited By (since 1996): 2, Export Date: 23 July 2009, Source: Scopus
Revista Ecuatoriana de Neurologia
Objective: To examine the concurrent validity of the Hamilton Depression Rating Scale and the Bec... more Objective: To examine the concurrent validity of the Hamilton Depression Rating Scale and the Beck Depression Inventory for quantifying depression in patients with Parkinson's disease, using the ICD-10 Diagnostic Criteria as the gold standard, and to determine if the somatization items considered are pertinent. Methods: The study involved one hundred and forty consecutive PD patients -102 men and 38 women- with a mean age of 68.7 years and mean disease duration of 6.7 years. Sensitivity, specificity, positive and negative predictive values and likelihood ratios were obtained with a 95% CI. ROC Curves (AUC) were also performed. Results: Based on ROC measurement of discriminative ability, our results suggest that both scales were poor at recognizing mild de- pression, somewhat better at recognizing moderate depression and adequate for distinguishing severe depression, though with poor specific - ity. Comparisons of HDRS-21, HDRS-12, BDI-21 and BDI-16 to determine concurrent validi...
Revista Ecuatoriana de Neurologia
Abstract Background: Study to investigate the concurrent validity of the Beck Depression Inventor... more Abstract Background: Study to investigate the concurrent validity of the Beck Depression Inventory and Beck Anxiety Inventory evaluation scales against the ICD-10. Methods: A K2 factorial design for studying the metrics properties of the BDI and BAI in parkinsonian outpatients. Results: 147 parkinsonian patients were included; 44 patients has anxiety and depression; only depression 19; only anxiety 31; finally 53 subjects don’t have depression or anxiety. The BDI AUC was [0.858]. The BAI AUC was of [0.907]. The cut score was of 14/15 for the BDI and 13/14 for the BAI. The factorial design resulted in the two factors (depression and anxiety) has the best functional correlation in the regression. Conclusions: The results we present bear out this lack of dimensionality, since we found that the BDI AUC-measured discriminative ability for anxiety was [0.739]. With regard to the BAI, this is employed to discriminate the depressed, AUC values of [0.771]. Keywords: Parkinson’s disease, Depr...
Revista Ecuatoriana de Neurologia
Abstract Background: Neuropsychiatric symptomatology frequently accompanies Parkinson’s disease. ... more Abstract Background: Neuropsychiatric symptomatology frequently accompanies Parkinson’s disease. Purpose: In this work (a one point time analytical study), we wished to explorer the Neuropsychiatric Inventory in its shorter format (NPI–Q) in seventy consecutive patients. To find out in what way information obtained from the caregiver (CG) is correlated with that which the patients provide. If this tool, designed to evaluate patients with dementia, can be applied to non-demented subjects with Parkinson’s disease (NDP). Method: The study, the NPI–Q Spanish version was employed, first with the CG alone and subsequently, with the individual patient alone by a researcher with no knowledge of the previous result from the CG. The weighted kappa correlation coefficient was measured to evaluate the CG–NDP consistency rate (Test–retest reliability; obtained by judging the reproductibility or stability of a instrument over time; two or more observers; or two or more times); a value of 0.7 or h...
Neurología (Barcelona, Spain), 1997
Three patients who suffered transitory (from 18 to 49 days) cranial dyskinesias during the course... more Three patients who suffered transitory (from 18 to 49 days) cranial dyskinesias during the course of tubercular meningitis are described. The diagnosis was confirmed by the presence of acid-alcohol resistant bacilli in spinal fluid. Cranial tomography or magnetic resonance images failed to demonstrate anatomical lesions. The blink reflex and brain stem auditory evoked potentials were abnormal, indicating dysfunction of motor nuclei of the cranial nerves, possibly secondary to changes in their regulation by basal ganglia. No recurrences have been observed during follow-up (from 3 to 7 years).
Revista de neurologia
Depression is a state of mind often associated with Parkinson's disease, which is not correla... more Depression is a state of mind often associated with Parkinson's disease, which is not correlated with the stage of the disease or the response to treatment with L-dopa. It has been suggested that patients with right-sided Parkinsonism have more depression than those with left-sided. To assess whether patients whose dominant side is affected primarily have more depression than those whose non-dominant side is affected; and to evaluate whether when the dominant side is more affected this is accompanied by greater deterioration on the scale of everyday activities (ADLS) and on the motor part of the unified scale for evaluation of Parkinsonism (UPDRSm). The study group was formed of 63 patients with Parkinsonism at stage 1 or 1.5 (Hoehn and Yahr), with an average age of 66.17 years. They were divided into two groups. Those who received L-dopa (Dopa group) and those who were newly-diagnosed patients (Naive group). They were evaluated on the Hamilton test, UPDRSm and ADLs scale. We us...