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Teresa Corona

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Neurologist. President National Academy of Medicine of Mexico.Laboratory of Neurodegenerative diseases. Natiional Institute of Neurology and Neurosurgery. MexicoNational Research

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Mohd Tariq Salman

Integral University

Eric S . Kim (UBC)

University of British Columbia

Roma Siugzdaite

Ghent University

Annelise Barron

Stanford University

Matthew Gutmann

Brown University

Viacheslav Kuleshov

Stockholm University

University of Karachi

Hacettepe University

Jeffrey L Saver

University of California, Los Angeles

Kenneth Pakenham

The University of Queensland, Australia

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Papers by Teresa Corona

Charcot’s 1886 Preface to Sœur Jeanne des Anges: Autobiographie d’une hysterique possédée: An English Rendition (P4.9-059)

Marie-Foix Syndrome: A Classical Crossed Pontine Syndrome? (P4.9-046)

Anti‐aquaporin‐4 antibody‐positive neuromyelitis optica spectrum disorder associated with central nervous system tuberculosis

Clinical and Experimental Neuroimmunology, Nov 6, 2019

Background Neuromyelitis optica spectrum disorder (NMOsd) is an inflammatory astrocytopathy that ... more Background Neuromyelitis optica spectrum disorder (NMOsd) is an inflammatory astrocytopathy that has both genetic and environmental cause. The exact etiology and pathogenesis of NMOsd is partially known, complex interactions between genetic and environmental factors are thought to be involved in its development. Infectious diseases have received particular attention, as they have long been considered to be triggers of many autoimmune disorders. Case presentation Here, we report two cases of positive aquaporin-4 serostatus NMOsd in relation to granulomatous infection of the central nervous system. Both patients initially presented with active tuberculosis meningitis signs and symptoms with posterior development of longitudinally extensive transverse myelitis positive for anti-aquaporin-4 antibodies. Cerebral spinal fluid hypercellularity and elevated proteins were initially documented. The evolution was rather favorable, with clinical and radiological improvement based on antituberculous treatment and a cycle of i.v. steroids. Conclusions Although various cases of active pulmonary, renal and abdominal tuberculosis have been documented in association with NMOsd, no mechanism of association has been discovered; interestingly, the seropositive for NMOsd is variable. We theorized that a genetic background in our population might be associated with this uncommon phenotype. If this phenomenon corresponds to an immune dysfunction caused directly by the bacillus, direct tuberculosis infection or a cross-reaction is to be determined.

Histopathology and Antibodies

Vascular and Endovascular Surgery, Jan 16, 2018

We read with great interest the case reported by Jun and Jung in this journal, since acute aortic... more We read with great interest the case reported by Jun and Jung in this journal, since acute aortic aneurysm and myasthenia gravis (MG) have only been reported together very infrequently in the literature. However, it is important to note that some points that we consider relevant were not detailed enough. The first point that strikes us is the paucity of histopathological information, which is essential for the definite diagnosis of IgG4-related disease (IgG4-RD). The absence of perianeurysmal fibrosis is mentioned. Nevertheless, this is not the only histopathological feature described in these cases. So far, in this patient, the diagnosis of IgG4-RD could be considered only as possible. The second and last of these points is related to the diagnosis of MG. It would be quite valuable to know the specific antibodies involved in this particular case (anti-acetylcholine receptor antibodies or antimuscle-specific kinase [anti-MuSK] antibodies), since the case of a 54-year-old female patient with anti-MuSK MG associated with IgG4-RD was recently reported. The elucidation of the antibodies involved in the present case might possibly strengthen the association between IgG4-RD and anti-MuSK MG. ORCID iD

Silica Reservoirs for their Use in the Treatment of Demyelization

Interferon ® and Copaxone ® , two commercial drugs used to treat the demyelization diseases like ... more Interferon ® and Copaxone ® , two commercial drugs used to treat the demyelization diseases like multiple sclerosis, were adsorbed on nanostructured SBA-15 reservoir. SBA-15 is ordered mesoporous silica normally used as catalytic adsorbent powder, but in this work we occluded the drug in the solid from separate solutions of each drug and then released them in a controlled way. The resultant SBA15-Copaxone and SBA15-Interferone were characterized by means of Infrared spectroscopy, Electron Microscopy, N 2 adsorptiondesorption, Thermal-gravimetric analysis and X-ray diffraction techniques. Also, an "in vitro" drug release test was performed using an aqueous medium, the released drug was monitored by Ultraviolet-Visible spectroscopy. The resultant X-ray diffraction patterns and electron micrographs showed the characteristic ordered structures of mesoporous silica nanomaterials. The calculated surface area, pore diameter and pore volume values for the silica containing the drugs decreased approximately a 50% compared to SBA-15 reference values. These observations suggest that the drug molecules occupied the empty spaces inside and on the surface of the samples. The drug release profiles showed two stages, beginning with fast medicament liberation during the first hours, followed by a slow drug release until the end of the test.

ASM Press eBooks, Apr 30, 2014

Bases moleculares de la esclerosis múltiple

Archivos de neurociencias (México, D.F.), 2001

The monetary burden of cysticercosis in Mexico

PLOS Neglected Tropical Diseases, Jul 10, 2019

Background Taenia solium cysticercosis is a public health and agricultural problem in many low an... more Background Taenia solium cysticercosis is a public health and agricultural problem in many low and middle-income countries where health education, sanitation, pig management practices and meat inspection infrastructure are insufficient. Cysticercosis affects both human and animal health and has important economic consequences. Very few studies have been conducted to evaluate the monetary burden of cysticercosis. This study aimed at estimating the 2015 costs associated with cysticercosis in humans and pigs in Mexico. Methods The monetary burden of human cysticercosis was estimated based on costs incurred by living with and treating epilepsy and severe chronic headaches associated with neurocysticercosis (NCC). The estimated cost of porcine cysticercosis took into consideration losses due to the reduction in the price of cysticercosis-infected animals. Epidemiologic and economic data were obtained from the published literature, government reports, and setting-specific questionnaires. Latin hypercube sampling methods were employed to sample the distributions of uncertain parameters and to estimate 95% credible regions (95% CRs). All results are reported in 2015 U.

Position paper: Impact on medical and health personnel in the SARS-CoV-2 pandemic

Gaceta Medica De Mexico, Mar 31, 2023

Diagnosis of reversible versus irreversible cerebral ischemia by the intravenous administration of naloxone

Stroke, Nov 1, 1985

Naloxone was given as an I. V. bolus of 0.8 mgs to four groups of patients with stroke: 1) 20 pat... more Naloxone was given as an I. V. bolus of 0.8 mgs to four groups of patients with stroke: 1) 20 patients with C.T. proven cerebral infarcts of longer than 7 days duration; 2) 20 patients with acute cerebral ischemia of less than 24 hours; 3) 5 patients with C.T. proven intracerebral hemorrhage of less than 24 hours, and; 4) 3 patients with hyperacute cerebral ischemia which occurred during the performance of a cerebral angiogram. The patients with established cerebral infarctions of more than 7 days duration and the patients with intracerebral hematomas had no response to intravenous naloxone. Of 20 patients with acute cerebral ischemia of less than 24 hours duration, 7 had prompt, complete and long-lasting recovery. These patients had no subsequent evidence of cerebral infarct by C.T. scanner 48 hours after the onset of the cerebral ischemia and were asymptomatic when discharged. The 3 patients with hyperacute cerebral ischemia secondary to cerebral angiography had a dramatic response to the injection of naloxone. These findings suggest that intravenous naloxone may differentiate reversible versus irreversible cerebral ischemia.

Ausencia de relación entre los genotipos de apolipoproteína E y la gravedad de la esclerosis múltiple en pacientes mexicanos

Revista De Neurologia, 2010

Introduccion. El curso clinico de la esclerosis multiple (EM) es muy variable. La historia natura... more Introduccion. El curso clinico de la esclerosis multiple (EM) es muy variable. La historia natural de la enfermedad ha ensenado que aproximadamente el 50% de los pacientes que inician con un curso clinico brote-remision tendra un curso progresivo despues de unos 10 anos de evolucion de la enfermedad y necesitara alguna ayuda para deambular. La expresion de la apolipoproteina E (ApoE) aumenta en el tejido nervioso en regeneracion, y el alelo ApoE epsilon-4 esta asociado con reparacion neural anomala. Diversas comunicaciones indican que el alelo ApoE epsilon4 se asocia a una mayor progresion de la discapacidad en pacientes con EM, aunque es controvertido. Pacientes y metodos. Analizamos las caracteristicas clinicas de 99 pacientes con diagnostico de EM, describimos la correlacion de la presencia o ausencia del alelo epsilon-4 de la ApoE con la edad de inicio, subtipo clinico, progresion de la enfermedad, puntuacion de la Expanded Disability Status Scale y tasa de recaidas. Exploramos el impacto de la presencia del alelo epsilon-2 con la evolucion de la enfermedad. Resultados. En pacientes menores de 21 anos observamos una mayor frecuencia de la presencia del alelo epsilon-4 (p = 0,057), pero no encontramos ninguna asociacion entre algun alelo de ApoE y los indices de progresion de la enfermedad. Conclusiones. Nuestros resultados no indican alguna asociacion entre la presencia del alelo ApoE epsilon-4 en la progresion de discapacidad en pacientes con EM en nuestra muestra.

Involuntary Emotional Expression Disorder in a Patient With Toluene Leukoencephalopathy

Revista Colombiana De Psiquiatría (english Edition), Apr 1, 2022

To study the frequency of latent and overt involuntary emotional expression disorder (IEED) in po... more To study the frequency of latent and overt involuntary emotional expression disorder (IEED) in postural tachycardia syndrome (PoTS). Methods: We compared 51 PoTS patients with 15 neurally mediated hypotension (NMH) patients and 12 control subjects using the Center for Neurologic Study-Lability Scale (CNS-LS) for latent IEED and the PHQ-9 questionnaire for depression screening before head-up tilt (HUT). Overt IEED occurrence was observed during HUT. Results: HUT precipitated overt IEED in 11 (22%) PoTS patients but not in NMH patients or controls. CNS-LS identified latent IEED in 23 (45%) PoTS patients, 5 (33%) NMH patients, and no control subjects. The CNS-LS tearfulness subscale was elevated in PoTS patients compared with controls (P = 0.0006). The PHQ-9 questionnaire scores were elevated in 69% of PoTS patients and 47% of NMH patients. The PHQ-9 score was higher in PoTS (< 0.0001) and NMH (P = 0.0002) patients compared with controls. Conclusions: The study demonstrated frequent occurrence of latent IEED in PoTS and NMH and overt IEED in PoTS without "structural" involvement. HUT was a specific trigger for overt IEED in PoTS. Depression was comorbid with PoTS. Neurohumoral and cerebral blood flow changes in supine position along with reduced gray matter volume in the insula and cingulate gyrus may underlie susceptibility to IEED. During HUT, cerebral hypoperfusion, rising epinephrine levels, and augmented autonomic arousal provide underpinnings for overt IEED. Clinicians should recognize this entity and counsel PoTS patients and their families. Limiting the duration of orthostatic stress may reduce morbidity.

Comparación de los espectros de neuromielitis óptica según el seroestado del anticuerpo AQP4 en un centro de referencia mexicano

Revista De Neurologia, 2017

Introduccion. Estudios recientes describen que los pacientes con neuromielitis optica (NMO) o tra... more Introduccion. Estudios recientes describen que los pacientes con neuromielitis optica (NMO) o trastornos del espectro de NMO seronegativos exhiben caracteristicas clinicas diferentes a los pacientes seropositivos al anticuerpo acuaporina-4 (AQP4). Objetivo. Analizar las caracteristicas clinicas y paraclinicas de pacientes con NMO segun el estado serico del anticuerpo AQP4. Pacientes y metodos. Estudio retrospectivo de 100 pacientes con NMO que cumplian los criterios de Wingerchuk: 70 presentaron positividad al anticuerpo AQP4 y 30 fueron seronegativos. Resultados. Un 70% de los sujetos cumplio los criterios para la NMO, y un 30%, para los trastornos del espectro de NMO. Los pacientes seropositivos presentaron mayor discapacidad en las puntuaciones de la escala de la Asociacion Americana de Lesion de la Medula Espinal (ASIA) y la escala ampliada del estado de discapacidad (p = 0,034 y 0,004, respectivamente) comparados con los seronegativos durante el seguimiento; en este mismo grupo hubo mayor afectacion visual (p = 0,02), mayor numero de recaidas (p = 0,008) y mayor numero de segmentos medulares afectados (p = 0,003). Conclusion. Este estudio proporciona una vision general de las caracteristicas clinicas y paraclinicas de los pacientes con NMO segun el seroestado del anticuerpo AQP4. Los pacientes seropositivos al anticuerpo AQP4 presentan mayor afectacion clinica e imaginologica.

Herpes Zoster and Multiple Sclerosis

The Journal of Infectious Diseases, Jul 15, 2011

Uncertainties in the diagnosis of brain cysticercosis

American Journal of Neuroradiology, 1995

Uncertainties in the Diagnosis of Brain Cysticercosis Recent advances in brain imaging present ne... more Uncertainties in the Diagnosis of Brain Cysticercosis Recent advances in brain imaging present new challenges for the diagnosis of brain cysticercosis, as illustrated by the following case. A 32-year-old woman was admitted to the neurology department with intracranial hypertension of 9 months duration, mild left hemiparesis (4/5), and a left babinski sign. Cerebrospinal fluid opening pressure was 300 mm H 2 O. The fluid contained 25 cells, 120 mg of protein, and 93 mg of glucose/ml. ELISA (enzyme-linked immunosorbent assay) test for cysticercus was positive. Plain and contrast-enhanced computed tomography (CT) findings were normal (Fig 1). Magnetic resonance (MR) study showed multiple parenchymatous and subarachnoid nodular lesions with diffuse inflammation around lesions, clearly suggestive of cysticercosis (Fig 2). The advantages of MR over CT for diagnosis of cerebral and subarachnoid cysticercosis have been reported (1-3). In our patient the CT scan was normal, although the MR showed multiple lesions of cysticercotic encephalitis. These findings have implications in regard not only to imaging studies but also to immunologic studies such as ELISA to detect antibodies against cysticerci. Until now CT has been used as the standard diagnostic test to determine sensitivity, specitivity, and predictive values for ELISA test for cysticercosis (4-5). If CT has limitations, the figures obtained by these have to be reassessed according to advances in MR imaging.

Vinpocetine Inhibits Oligodendroglial Precursor Cell Differentiation

Cellular Physiology and Biochemistry, 2012

Background: In multiple sclerosis during periods of remission a limited degree of myelin repair c... more Background: In multiple sclerosis during periods of remission a limited degree of myelin repair can be observed mediated by oligodendroglial precursor cells. Phosphodiesterase inhibitors act as anti-inflammatory agents and might hold promise for future multiple sclerosis treatment. Aims: To investigate whether phosphodiesterase inhibitors could also influence myelin repair. Methods: We stimulated primary oligodendroglial precursor cells with cilostazol, rolipram and vinpocetine and assessed their effects on repair related cellular processes. Results: We found that vinpocetine exerted a strong negative effect on myelin expression while cilostazol and rolipram did not show such effects. In addition, vinpocetine decreased morphological complexities suggesting an overall negative impact on oligodendroglial cell maturation. We provide evidence that this is not mediated via a blockade of phosphodiesterase-1 but rather by inhibition of IκB kinase. Conclusion: These findings suggest that vinpocetine via IκB inhibition exerts a strong negative impact on oligodendroglial cell maturation and may therefore provide the rationale to restrict its application during periods of remission in multiple sclerosis patients. This is of particular interest since vinpocetine is widely used as a health supplement thought to act as a cognitive and memory enhancer for healthy people and patients with neurological or muscle diseases.

Investigación sobre Cuidados Paliativos en México. Revisión Sistemática Exploratoria

Revista Mexicana de Neurociencia, Apr 26, 2018

The normative process initiated with the reforms to the General Health Law in 2009 has paralleled... more The normative process initiated with the reforms to the General Health Law in 2009 has paralleled the institutionalization of Palliative Care and the development of academic and research work in our country. With the objective of describing the scientific activity developed in the area of palliative care in Mexico in the last 25 years, a scoping review was carried out to describe the characteristics of research papers published in scientific journals. Descriptive statistics were calculated, and content analyzed. We found 608 articles, selected 81. The first report was publisher 1992; the year with the most publications was 2013 with 19. The national journal that most covered the subject was Gaceta Medica Oncologica, at the international level was Psicooncologia. The most recurrent themes are professional attitudes/decisions, endof-life care and activities of hospice teams. The most studied disease is cancer. Those who maintain the leadership in the publications are doctors with clinical and epidemiological perspectives, in journals of low impact and national distribution.

Palatal tremor and intact Guillain‐Mollaret triangle secondary to Hashimoto’s encephalopathy

Clinical and Experimental Neuroimmunology, 2020

BackgroundHashimoto’s encephalopathy, also known as steroid‐responsive encephalopathy associated ... more BackgroundHashimoto’s encephalopathy, also known as steroid‐responsive encephalopathy associated with autoimmune thyroiditis, is a rare association of neuropsychiatric symptoms and autoimmune thyroid disease. Among the movement disorders reported in Hashimoto’s encephalopathy, palatal tremor is relatively uncommon.Case presentationWe present the case of a 50‐year‐old woman with neuropsychiatric symptoms characterized by behavioral changes, cognitive impairment, epilepsy, parkinsonism, palatal tremor and ataxia with high levels of serum anti‐thyroid peroxidase and a clear response after steroid therapy.ConclusionsGiven the reversibility of clinical manifestations, Hashimoto’s encephalopathy should be in the differential diagnosis of patients with unexplained seizures or encephalopathy who present with these symptoms or other involuntary movements.

Análisis retrospectivo de pacientes diagnosticados con hipertensión intracraneal idiopática al ingreso. Evaluación del abordaje diagnóstico

Subdirección de neurología Análisis retrospectivo de pacientes diagnosticados con hipertensión in... more

PND4 El Impacto Economico Del Tabaquismo En El Desarrollo De La Enfermedad Vascular Cerebral En Un Centro Neurologico De Tercer Nivel

Value in Health, 2011

Charcot’s 1886 Preface to Sœur Jeanne des Anges: Autobiographie d’une hysterique possédée: An English Rendition (P4.9-059)

Marie-Foix Syndrome: A Classical Crossed Pontine Syndrome? (P4.9-046)

Anti‐aquaporin‐4 antibody‐positive neuromyelitis optica spectrum disorder associated with central nervous system tuberculosis

Clinical and Experimental Neuroimmunology, Nov 6, 2019

Background Neuromyelitis optica spectrum disorder (NMOsd) is an inflammatory astrocytopathy that ... more Background Neuromyelitis optica spectrum disorder (NMOsd) is an inflammatory astrocytopathy that has both genetic and environmental cause. The exact etiology and pathogenesis of NMOsd is partially known, complex interactions between genetic and environmental factors are thought to be involved in its development. Infectious diseases have received particular attention, as they have long been considered to be triggers of many autoimmune disorders. Case presentation Here, we report two cases of positive aquaporin-4 serostatus NMOsd in relation to granulomatous infection of the central nervous system. Both patients initially presented with active tuberculosis meningitis signs and symptoms with posterior development of longitudinally extensive transverse myelitis positive for anti-aquaporin-4 antibodies. Cerebral spinal fluid hypercellularity and elevated proteins were initially documented. The evolution was rather favorable, with clinical and radiological improvement based on antituberculous treatment and a cycle of i.v. steroids. Conclusions Although various cases of active pulmonary, renal and abdominal tuberculosis have been documented in association with NMOsd, no mechanism of association has been discovered; interestingly, the seropositive for NMOsd is variable. We theorized that a genetic background in our population might be associated with this uncommon phenotype. If this phenomenon corresponds to an immune dysfunction caused directly by the bacillus, direct tuberculosis infection or a cross-reaction is to be determined.

Histopathology and Antibodies

Vascular and Endovascular Surgery, Jan 16, 2018

We read with great interest the case reported by Jun and Jung in this journal, since acute aortic... more We read with great interest the case reported by Jun and Jung in this journal, since acute aortic aneurysm and myasthenia gravis (MG) have only been reported together very infrequently in the literature. However, it is important to note that some points that we consider relevant were not detailed enough. The first point that strikes us is the paucity of histopathological information, which is essential for the definite diagnosis of IgG4-related disease (IgG4-RD). The absence of perianeurysmal fibrosis is mentioned. Nevertheless, this is not the only histopathological feature described in these cases. So far, in this patient, the diagnosis of IgG4-RD could be considered only as possible. The second and last of these points is related to the diagnosis of MG. It would be quite valuable to know the specific antibodies involved in this particular case (anti-acetylcholine receptor antibodies or antimuscle-specific kinase [anti-MuSK] antibodies), since the case of a 54-year-old female patient with anti-MuSK MG associated with IgG4-RD was recently reported. The elucidation of the antibodies involved in the present case might possibly strengthen the association between IgG4-RD and anti-MuSK MG. ORCID iD

Silica Reservoirs for their Use in the Treatment of Demyelization

Interferon ® and Copaxone ® , two commercial drugs used to treat the demyelization diseases like ... more Interferon ® and Copaxone ® , two commercial drugs used to treat the demyelization diseases like multiple sclerosis, were adsorbed on nanostructured SBA-15 reservoir. SBA-15 is ordered mesoporous silica normally used as catalytic adsorbent powder, but in this work we occluded the drug in the solid from separate solutions of each drug and then released them in a controlled way. The resultant SBA15-Copaxone and SBA15-Interferone were characterized by means of Infrared spectroscopy, Electron Microscopy, N 2 adsorptiondesorption, Thermal-gravimetric analysis and X-ray diffraction techniques. Also, an "in vitro" drug release test was performed using an aqueous medium, the released drug was monitored by Ultraviolet-Visible spectroscopy. The resultant X-ray diffraction patterns and electron micrographs showed the characteristic ordered structures of mesoporous silica nanomaterials. The calculated surface area, pore diameter and pore volume values for the silica containing the drugs decreased approximately a 50% compared to SBA-15 reference values. These observations suggest that the drug molecules occupied the empty spaces inside and on the surface of the samples. The drug release profiles showed two stages, beginning with fast medicament liberation during the first hours, followed by a slow drug release until the end of the test.

ASM Press eBooks, Apr 30, 2014

Bases moleculares de la esclerosis múltiple

Archivos de neurociencias (México, D.F.), 2001

The monetary burden of cysticercosis in Mexico

PLOS Neglected Tropical Diseases, Jul 10, 2019

Background Taenia solium cysticercosis is a public health and agricultural problem in many low an... more Background Taenia solium cysticercosis is a public health and agricultural problem in many low and middle-income countries where health education, sanitation, pig management practices and meat inspection infrastructure are insufficient. Cysticercosis affects both human and animal health and has important economic consequences. Very few studies have been conducted to evaluate the monetary burden of cysticercosis. This study aimed at estimating the 2015 costs associated with cysticercosis in humans and pigs in Mexico. Methods The monetary burden of human cysticercosis was estimated based on costs incurred by living with and treating epilepsy and severe chronic headaches associated with neurocysticercosis (NCC). The estimated cost of porcine cysticercosis took into consideration losses due to the reduction in the price of cysticercosis-infected animals. Epidemiologic and economic data were obtained from the published literature, government reports, and setting-specific questionnaires. Latin hypercube sampling methods were employed to sample the distributions of uncertain parameters and to estimate 95% credible regions (95% CRs). All results are reported in 2015 U.

Position paper: Impact on medical and health personnel in the SARS-CoV-2 pandemic

Gaceta Medica De Mexico, Mar 31, 2023

Diagnosis of reversible versus irreversible cerebral ischemia by the intravenous administration of naloxone

Stroke, Nov 1, 1985

Naloxone was given as an I. V. bolus of 0.8 mgs to four groups of patients with stroke: 1) 20 pat... more Naloxone was given as an I. V. bolus of 0.8 mgs to four groups of patients with stroke: 1) 20 patients with C.T. proven cerebral infarcts of longer than 7 days duration; 2) 20 patients with acute cerebral ischemia of less than 24 hours; 3) 5 patients with C.T. proven intracerebral hemorrhage of less than 24 hours, and; 4) 3 patients with hyperacute cerebral ischemia which occurred during the performance of a cerebral angiogram. The patients with established cerebral infarctions of more than 7 days duration and the patients with intracerebral hematomas had no response to intravenous naloxone. Of 20 patients with acute cerebral ischemia of less than 24 hours duration, 7 had prompt, complete and long-lasting recovery. These patients had no subsequent evidence of cerebral infarct by C.T. scanner 48 hours after the onset of the cerebral ischemia and were asymptomatic when discharged. The 3 patients with hyperacute cerebral ischemia secondary to cerebral angiography had a dramatic response to the injection of naloxone. These findings suggest that intravenous naloxone may differentiate reversible versus irreversible cerebral ischemia.

Ausencia de relación entre los genotipos de apolipoproteína E y la gravedad de la esclerosis múltiple en pacientes mexicanos

Revista De Neurologia, 2010

Introduccion. El curso clinico de la esclerosis multiple (EM) es muy variable. La historia natura... more Introduccion. El curso clinico de la esclerosis multiple (EM) es muy variable. La historia natural de la enfermedad ha ensenado que aproximadamente el 50% de los pacientes que inician con un curso clinico brote-remision tendra un curso progresivo despues de unos 10 anos de evolucion de la enfermedad y necesitara alguna ayuda para deambular. La expresion de la apolipoproteina E (ApoE) aumenta en el tejido nervioso en regeneracion, y el alelo ApoE epsilon-4 esta asociado con reparacion neural anomala. Diversas comunicaciones indican que el alelo ApoE epsilon4 se asocia a una mayor progresion de la discapacidad en pacientes con EM, aunque es controvertido. Pacientes y metodos. Analizamos las caracteristicas clinicas de 99 pacientes con diagnostico de EM, describimos la correlacion de la presencia o ausencia del alelo epsilon-4 de la ApoE con la edad de inicio, subtipo clinico, progresion de la enfermedad, puntuacion de la Expanded Disability Status Scale y tasa de recaidas. Exploramos el impacto de la presencia del alelo epsilon-2 con la evolucion de la enfermedad. Resultados. En pacientes menores de 21 anos observamos una mayor frecuencia de la presencia del alelo epsilon-4 (p = 0,057), pero no encontramos ninguna asociacion entre algun alelo de ApoE y los indices de progresion de la enfermedad. Conclusiones. Nuestros resultados no indican alguna asociacion entre la presencia del alelo ApoE epsilon-4 en la progresion de discapacidad en pacientes con EM en nuestra muestra.

Involuntary Emotional Expression Disorder in a Patient With Toluene Leukoencephalopathy

Revista Colombiana De Psiquiatría (english Edition), Apr 1, 2022

To study the frequency of latent and overt involuntary emotional expression disorder (IEED) in po... more To study the frequency of latent and overt involuntary emotional expression disorder (IEED) in postural tachycardia syndrome (PoTS). Methods: We compared 51 PoTS patients with 15 neurally mediated hypotension (NMH) patients and 12 control subjects using the Center for Neurologic Study-Lability Scale (CNS-LS) for latent IEED and the PHQ-9 questionnaire for depression screening before head-up tilt (HUT). Overt IEED occurrence was observed during HUT. Results: HUT precipitated overt IEED in 11 (22%) PoTS patients but not in NMH patients or controls. CNS-LS identified latent IEED in 23 (45%) PoTS patients, 5 (33%) NMH patients, and no control subjects. The CNS-LS tearfulness subscale was elevated in PoTS patients compared with controls (P = 0.0006). The PHQ-9 questionnaire scores were elevated in 69% of PoTS patients and 47% of NMH patients. The PHQ-9 score was higher in PoTS (< 0.0001) and NMH (P = 0.0002) patients compared with controls. Conclusions: The study demonstrated frequent occurrence of latent IEED in PoTS and NMH and overt IEED in PoTS without "structural" involvement. HUT was a specific trigger for overt IEED in PoTS. Depression was comorbid with PoTS. Neurohumoral and cerebral blood flow changes in supine position along with reduced gray matter volume in the insula and cingulate gyrus may underlie susceptibility to IEED. During HUT, cerebral hypoperfusion, rising epinephrine levels, and augmented autonomic arousal provide underpinnings for overt IEED. Clinicians should recognize this entity and counsel PoTS patients and their families. Limiting the duration of orthostatic stress may reduce morbidity.

Comparación de los espectros de neuromielitis óptica según el seroestado del anticuerpo AQP4 en un centro de referencia mexicano

Revista De Neurologia, 2017

Introduccion. Estudios recientes describen que los pacientes con neuromielitis optica (NMO) o tra... more Introduccion. Estudios recientes describen que los pacientes con neuromielitis optica (NMO) o trastornos del espectro de NMO seronegativos exhiben caracteristicas clinicas diferentes a los pacientes seropositivos al anticuerpo acuaporina-4 (AQP4). Objetivo. Analizar las caracteristicas clinicas y paraclinicas de pacientes con NMO segun el estado serico del anticuerpo AQP4. Pacientes y metodos. Estudio retrospectivo de 100 pacientes con NMO que cumplian los criterios de Wingerchuk: 70 presentaron positividad al anticuerpo AQP4 y 30 fueron seronegativos. Resultados. Un 70% de los sujetos cumplio los criterios para la NMO, y un 30%, para los trastornos del espectro de NMO. Los pacientes seropositivos presentaron mayor discapacidad en las puntuaciones de la escala de la Asociacion Americana de Lesion de la Medula Espinal (ASIA) y la escala ampliada del estado de discapacidad (p = 0,034 y 0,004, respectivamente) comparados con los seronegativos durante el seguimiento; en este mismo grupo hubo mayor afectacion visual (p = 0,02), mayor numero de recaidas (p = 0,008) y mayor numero de segmentos medulares afectados (p = 0,003). Conclusion. Este estudio proporciona una vision general de las caracteristicas clinicas y paraclinicas de los pacientes con NMO segun el seroestado del anticuerpo AQP4. Los pacientes seropositivos al anticuerpo AQP4 presentan mayor afectacion clinica e imaginologica.

Herpes Zoster and Multiple Sclerosis

The Journal of Infectious Diseases, Jul 15, 2011

Uncertainties in the diagnosis of brain cysticercosis

American Journal of Neuroradiology, 1995

Uncertainties in the Diagnosis of Brain Cysticercosis Recent advances in brain imaging present ne... more Uncertainties in the Diagnosis of Brain Cysticercosis Recent advances in brain imaging present new challenges for the diagnosis of brain cysticercosis, as illustrated by the following case. A 32-year-old woman was admitted to the neurology department with intracranial hypertension of 9 months duration, mild left hemiparesis (4/5), and a left babinski sign. Cerebrospinal fluid opening pressure was 300 mm H 2 O. The fluid contained 25 cells, 120 mg of protein, and 93 mg of glucose/ml. ELISA (enzyme-linked immunosorbent assay) test for cysticercus was positive. Plain and contrast-enhanced computed tomography (CT) findings were normal (Fig 1). Magnetic resonance (MR) study showed multiple parenchymatous and subarachnoid nodular lesions with diffuse inflammation around lesions, clearly suggestive of cysticercosis (Fig 2). The advantages of MR over CT for diagnosis of cerebral and subarachnoid cysticercosis have been reported (1-3). In our patient the CT scan was normal, although the MR showed multiple lesions of cysticercotic encephalitis. These findings have implications in regard not only to imaging studies but also to immunologic studies such as ELISA to detect antibodies against cysticerci. Until now CT has been used as the standard diagnostic test to determine sensitivity, specitivity, and predictive values for ELISA test for cysticercosis (4-5). If CT has limitations, the figures obtained by these have to be reassessed according to advances in MR imaging.

Vinpocetine Inhibits Oligodendroglial Precursor Cell Differentiation

Cellular Physiology and Biochemistry, 2012

Background: In multiple sclerosis during periods of remission a limited degree of myelin repair c... more Background: In multiple sclerosis during periods of remission a limited degree of myelin repair can be observed mediated by oligodendroglial precursor cells. Phosphodiesterase inhibitors act as anti-inflammatory agents and might hold promise for future multiple sclerosis treatment. Aims: To investigate whether phosphodiesterase inhibitors could also influence myelin repair. Methods: We stimulated primary oligodendroglial precursor cells with cilostazol, rolipram and vinpocetine and assessed their effects on repair related cellular processes. Results: We found that vinpocetine exerted a strong negative effect on myelin expression while cilostazol and rolipram did not show such effects. In addition, vinpocetine decreased morphological complexities suggesting an overall negative impact on oligodendroglial cell maturation. We provide evidence that this is not mediated via a blockade of phosphodiesterase-1 but rather by inhibition of IκB kinase. Conclusion: These findings suggest that vinpocetine via IκB inhibition exerts a strong negative impact on oligodendroglial cell maturation and may therefore provide the rationale to restrict its application during periods of remission in multiple sclerosis patients. This is of particular interest since vinpocetine is widely used as a health supplement thought to act as a cognitive and memory enhancer for healthy people and patients with neurological or muscle diseases.

Investigación sobre Cuidados Paliativos en México. Revisión Sistemática Exploratoria

Revista Mexicana de Neurociencia, Apr 26, 2018

The normative process initiated with the reforms to the General Health Law in 2009 has paralleled... more The normative process initiated with the reforms to the General Health Law in 2009 has paralleled the institutionalization of Palliative Care and the development of academic and research work in our country. With the objective of describing the scientific activity developed in the area of palliative care in Mexico in the last 25 years, a scoping review was carried out to describe the characteristics of research papers published in scientific journals. Descriptive statistics were calculated, and content analyzed. We found 608 articles, selected 81. The first report was publisher 1992; the year with the most publications was 2013 with 19. The national journal that most covered the subject was Gaceta Medica Oncologica, at the international level was Psicooncologia. The most recurrent themes are professional attitudes/decisions, endof-life care and activities of hospice teams. The most studied disease is cancer. Those who maintain the leadership in the publications are doctors with clinical and epidemiological perspectives, in journals of low impact and national distribution.

Palatal tremor and intact Guillain‐Mollaret triangle secondary to Hashimoto’s encephalopathy

Clinical and Experimental Neuroimmunology, 2020

BackgroundHashimoto’s encephalopathy, also known as steroid‐responsive encephalopathy associated ... more BackgroundHashimoto’s encephalopathy, also known as steroid‐responsive encephalopathy associated with autoimmune thyroiditis, is a rare association of neuropsychiatric symptoms and autoimmune thyroid disease. Among the movement disorders reported in Hashimoto’s encephalopathy, palatal tremor is relatively uncommon.Case presentationWe present the case of a 50‐year‐old woman with neuropsychiatric symptoms characterized by behavioral changes, cognitive impairment, epilepsy, parkinsonism, palatal tremor and ataxia with high levels of serum anti‐thyroid peroxidase and a clear response after steroid therapy.ConclusionsGiven the reversibility of clinical manifestations, Hashimoto’s encephalopathy should be in the differential diagnosis of patients with unexplained seizures or encephalopathy who present with these symptoms or other involuntary movements.

Análisis retrospectivo de pacientes diagnosticados con hipertensión intracraneal idiopática al ingreso. Evaluación del abordaje diagnóstico

Subdirección de neurología Análisis retrospectivo de pacientes diagnosticados con hipertensión in... more

PND4 El Impacto Economico Del Tabaquismo En El Desarrollo De La Enfermedad Vascular Cerebral En Un Centro Neurologico De Tercer Nivel

Value in Health, 2011