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Hospital de Órbigo, Spain

Simo M.,Bellvitge Biomedical Research Institute IDIBELL | Simo M.,Hospital Universitari Of Bellvitge Hub | Ripolles P.,Bellvitge Biomedical Research Institute IDIBELL | Ripolles P.,University of Barcelona | And 8 more authors.
PLoS ONE | Year: 2015

The medial temporal lobe (MTL)-comprising hippocampus and the surrounding neocortical regions-is a targeted brain area sensitive to several neurological diseases. Although functional magnetic resonance imaging (fMRI) has been widely used to assess brain functional abnormalities, detecting MTL activation has been technically challenging. The aim of our study was to provide an fMRI paradigm that reliably activates MTL regions at the individual level, thus providing a useful tool for future research in clinical memory-related studies. Twenty young healthy adults underwent an event-related fMRI study consisting of three encoding conditions: word-pairs, face-name associations and complex visual scenes. A regionof-interest analysis at the individual level comparing novel and repeated stimuli independently for each task was performed. The results of this analysis yielded activations in the hippocampal and parahippocampal regions in most of the participants. Specifically, 95% and 100% of participants showed significant activations in the left hippocampus during the face-name encoding and in the right parahippocampus, respectively, during scene encoding. Additionally, a whole brain analysis, also comparing novel versus repeated stimuli at the group level, showed mainly left frontal activation during the word task. In this group analysis, the face-name association engaged the HP and fusiform gyri bilaterally, along with the left inferior frontal gyrus, and the complex visual scenes activated mainly the parahippocampus and hippocampus bilaterally. In sum, our task design represents a rapid and reliable manner to study and explore MTL activity at the individual level, thus providing a useful tool for future research in clinical memory-related fMRI studies. © 2015 Simó et al.

Miro J.,Bellvitge Biomedical Research Institute IDIBELL | Miro J.,Hospital Universitari Of Bellvitge Hub | Gurtubay-Antolin A.,Bellvitge Biomedical Research Institute IDIBELL | Ripolles P.,Bellvitge Biomedical Research Institute IDIBELL | And 11 more authors.
Cortex | Year: 2015

Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy. The most frequent pathologic finding in this condition is hippocampal sclerosis (HS). In addition, in a small proportion (14-23%) of refractory TLE patients, the presence of HS is bilateral. TLE involves grey matter (GM) and white matter (WM) abnormalities in a wide cortico-subcortical network. However, the impact of neuronal loss on specific WM fiber pathways and associated functional systems as well as seizure propagation pathways remains unclear. There is still much controversy regarding the role of the commissures (corpus callosum, hippocampal commissure and anterior commissure) in interhemispheric seizure propagation. This study aimed to investigate the integrity of WM interhemispheric connectivity in a singular sample of patients with TLE and bilateral HS using structural magnetic resonance imaging (MRI). We performed multimodal structural MRI [high resolution T1-weighted and diffusion tensor imaging (DTI)] analyses of seven patients with medically refractory TLE with bilateral HS, fourteen unilateral left TLE patients and fifteen matched healthy individuals. Whole-brain voxel-wise analysis techniques were used. These patients evidenced WM derangement [reduced fractional anisotropy (FA), increased mean diffusivity (MD) or reduced WM volume] in temporal and extratemporal tracks, but also in commissural pathways, compared to the unilateral left TLE patients and the control group. Presence of reduced FA or increased MD in the fornix, cingulum and uncinate fasciculus in addition to reduced WM volume in the fornix was also encountered. Neuropsychological assessment was performed without significant correlations with structural data. The current results support the idea that commissural pathways play a contributory role in interhemispheric TLE seizure propagation in bilateral HS and offer new perspectives about the long-term effects on interhemispheric connectivity associated with seizure propagation patterns in TLE patients. © 2015 Elsevier Ltd.

Garcia I.J.,Hospital Universitari Of Bellvitge Hub | Rodriguez M.V.H.,Hospital Universitari Of Bellvitge Hub | Casas M.N.V.,Hospital Universitari Of Bellvitge Hub
Nutricion Hospitalaria | Year: 2015

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease which has no cure, so the treatment will be symptomatic in a Multidisciplinary Unit. It is composed of professionals, experts in patient care, with an interdisciplinary vision in order to act in a coordinated manner depending on the different situations which may arise over the course of the disease. There are several studies showing improved survival in patients treated within the framework of a multidisciplinary team compared to treatment by isolated specialties. An ALS Multidisciplinary Unit was created in 2004 in the University Hospital of Bellvitge (HUB). It is composed of a neurologist, pulmonologist, nutritionist, endocrinologist, rehabilitation, physical therapist, psychologist, social worker, nurse manager, speech therapist and an administrative worker. To assess the impact of the multidisciplinary care of our program 418 patients diagnosed with ALS were evaluated, 84 patients who had been treated by general neurology and 334 who had been treated under a model of multidisciplinary care. Patients who were treated in the unit of multidisciplinary care had a median survival of 1246 days (IC 1109-1382), 104 days above the median 1148 days of those followed by a general neurology consultation (CI 998-1297). This difference was statistically significant (log-rank 10,8; p= 0.008). This benefit was independent of having received treatment with riluzole, non-invasive mechanical ventilation or percutaneous gastrostomy. Nutritional assessment was performed on the first visit and all subsequent controls. It is important to do anthropometric measurements and detect unintentional weight loss and its possible precipitating causes in order to establish the appropriate nutritional treatment. The exploration of dysphagia allows a determination of the appro- priate dietary advice, the introduction of thickeners to adjust the texture of food or nutritional supplementation with high-calorie formulas to prevent or correct weight loss. If these measures are not sufficient or there is the risk of failure of respiratory function, early gastrostomy placement will be indicated. The analysis of 140 ALS patients (92 controls and 48 with radiologic percutaneous gastrostomy) showed no difference in mean survival time between groups (32 vs 33.9 months, log Rank 1.86 p=0.39). Any patient had major complications. Despite not find changes in survival, the use of gastrostomy should be understood as a treatment to improve the quality of life and well-being of the patient. Psychosocial support of the person and the family environment is essential to integrate all the changes and situations that arise in the course of the disease. This should start from diagnosis as early intervention contributes to improved training, preventing situations of deterioration and helping coping with the dependency process. It is also possible to use technology and social media to complement the classic care model. In the case of the HUB ALS Multidisciplinary Unit, affected individuals and their families have the resources of the Aula Paciente and ALS blog, created with the objective of providing opportunities for dialogue between patients, families and caregivers. The satisfaction degree of the patients with the care provided by the ALS Multidisciplinary Unit on service accessibility, information received and the quality of care was assessed globally as good in 52.8% or very good in 29, 2% of patients. Conclusion: Attention for the ALS affected person must be considered within the framework of a multidisciplinary team made up of all the professionals who go to intervene throughout the disease process in order to provide increased survival with the best care and quality of life. © 2015, Grupo Aula Medica S.A. All rights reserved.

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