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Arauz A.,National Institute of Neurology and Neurosurgery | Berge E.,University of Oslo | Sandercock P.,University of Edinburgh
Current Opinion in Neurology | Year: 2014

PURPOSE OF REVIEW: The third International Stroke Trial (IST-3) was a randomized controlled trial of thrombolysis with intravenous recombinant tissue plasminogen activator in patients with acute ischemic stroke within 6h of onset. It sought to determine whether a wider variety of patients might benefit from treatment than were eligible under the prevailing European Union approval for the drug, especially among those aged over 80 years. RECENT FINDINGS: The entry criteria were broad, and there was no upper age limit for inclusion; over half the 3035 patients were aged over 80 years. For the types of patient recruited in IST-3, despite the early hazards (chiefly of fatal intracerebral hemorrhage), thrombolysis within 6h did not affect longer-term survival and improved functional outcome. Benefit was greatest among patients treated within 3h, and benefit did not appear to be diminished among elderly patients or those with severe stroke. SUMMARY: These results should, therefore, encourage clinicians to: consider thrombolytic treatment for a wider variety of patients (particularly those aged over 80 years); treat those with more severe strokes; reinforce their efforts to increase the proportion of ischemic strokes treated within 3h; and, have greater confidence that mortality is not increased by treatment. © 2014 Wolters Kluwer Health Lippincott Williams & Wilkins.


Rojas P.,National Institute of Neurology and Neurosurgery | Montes P.,National Institute of Neurology and Neurosurgery | Rojas C.,National Autonomous University of Mexico | Serrano-Garcia N.,National Institute of Neurology and Neurosurgery | Rojas-Castaneda J.C.,National Institute of Pediatrics
Nutrition | Year: 2012

Ginkgo Biloba extract 761 (EGb 761) is a patented and well-defined mixture of active compounds extracted from Ginkgo biloba leaves. This extract contains two main groups of active compounds, flavonoids (24%) and terpenoids (6%). EGb 761 is used clinically to treat dementia and vaso-occlusive and cochleovestibular disorders. This extract has neuroprotective effects, exerted probably by means of its antioxidant function. Parkinson's disease (PD) is a neurodegenerative disorder that affects 2% of the population older than 60 y. It produces a progressive loss of dopaminergic neurons and depletion of dopamine (DA), leading to movement impairment. The production of reactive oxygen species, which act as mediators of oxidative damage, is linked to PD. This disease is routinely treated with the DA precursor, L-3,4-dihydroxyphenylalanine. However, this produces severe side effects, and its neurotoxic properties can be due to a free radical production. Thus, administration of antioxidant drugs might be used to prevent neuronal death produced by oxidative mechanisms. The use of synthetic antioxidants has decreased because of their suspected activity as carcinogenic promoters. We describe the studies related to the antioxidant effect of EGb 761 in an animal model of PD. It has been shown that EGb761 can provide a neuroprotective/neurorecovery effect against the damage to midbrain DA neurons in an animal model of PD. EGb 761 also has been found to lessen the impairment of locomotion, correlating with an increase of DA and other morphologic and biochemical parameters related to its antioxidant effect in an animal model of PD. These studies suggest it as an alternative in the future treatment of PD. © 2012 Elsevier Inc.


Roldan-Valadez E.,Medica sur Hospital and Clinic Foundation | Favila R.,General Electric | Martinez-Lopez M.,Medica sur Hospital and Clinic Foundation | Uribe M.,Medica sur Hospital and Clinic Foundation | And 2 more authors.
Journal of Hepatology | Year: 2010

Background & Aims: The clinical application of liver fat quantification has increased in recent years, paralleling the epidemic increase in nonalcoholic fatty liver disease. The aim of this study was to perform a diagnostic evaluation of spectroscopy by comparing its measurement of total lipid content with that from liver biopsies and morphometry in normal subjects and patients with nonalcoholic fatty liver disease. Methods: Patients with symptomatic cholelithiasis underwent 3T MR cholangiography with spectroscopic quantification of TLC. A laparoscopic cholecystectomy was performed on the day of admission, with liver samples taken during surgery. Microcolorimetric assessment quantified lipid content in liver samples and morphometric evaluation in stained slides. Statistical analysis included bivariate correlation, regression, and ROC analysis. Results: The study was conducted in 18 patients, 5 men (mean age, 35.2 ± 11.03 years; range, 27-54 years) and 13 women (mean age, 46.77 ± 11.77 years; range, 21-61 years). Using a cut-off value >5% for fat content, 8 patients presented with steatosis and 10 patients presented with normal liver fat content. A significant correlation was observed between fat spectroscopy and lipid content (r = 0.876, p <0.001). A lower and non-significant correlation was observed between lipid content and morphometry (r = 0.190, p >0.05). Conclusions: The accuracy of spectroscopy in assessing fat concentration with a cut-off level of 7.48% was 100%. Spectroscopy showed a strong and significant correlation with lipid content. It may reliably replace liver biopsy for the assessment of liver fat content. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Montes P.,National Institute of Neurology and Neurosurgery | Ruiz-Sanchez E.,National Institute of Neurology and Neurosurgery | Rojas C.,National Autonomous University of Mexico | Rojas P.,National Institute of Neurology and Neurosurgery
CNS and Neurological Disorders - Drug Targets | Year: 2015

Ginkgo biloba extract 761 (EGb 761) is a well-defined extract obtained from Ginkgo biloba leaves according to a standardized method. It has been used extensively for the treatment of diseases related to the central nervous system including neurosensory disturbances, cerebrovascular insufficiency, peripheral vascular disturbances, and degenerative dementia. The potential use of EGb 761 has also been suggested for the treatment of psychiatric disorders such as anxiety and depression, which is discussed in the current review. These disorders constitute a global epidemic with serious economic and social consequences. Current available treatments with synthetic drugs may have some disadvantages and undesired side effects. There are diverse natural extracts that have been used for the treatment of psychiatric disorders due to their therapeutic action and low rate of side effects, such as EGb 761. EGb 761 has the ability to produce neuroprotection due to its chemical composition and the synergy of its components. We describe several neuroprotective mechanisms of action of EGb 761 such as antioxidant effects, modulation of neurotransmission, neuroendocrine regulation, and upregulation of neurotrophic factors, which underlie its potential therapeutic effect on psychiatric disorders. Furthermore, we discuss the therapeutic effects of EGb 761 both in animal models of psychiatric disorders and in clinical studies that include these pathologies. We focus on depression, anxiety, and schizophrenia, as well as the therapeutic action of EGb 761 on dementia in comorbidity with psychiatric disorders. In the current review, we propose the potential use of EGb 761, alone or combined with current medication treatment, for psychiatric disorders. © 2015 Bentham Science Publishers.


Roldan-Valadez E.,Coordination of Research and Innovation | Rios C.,National Institute of Neurology and Neurosurgery
European Journal of Gastroenterology and Hepatology | Year: 2015

INTRODUCTION: A deeper understanding of supplementary bibliometrics beyond the impact factor might provide researchers with a better understanding of the citation process. This study presents a multivariate analysis of gastroenterology and hepatology journals to evaluate the predictive ability of seven bibliometrics in the Web of Science to calculate total cites over a 2-year period. METHODS: Coincidentally, bibliometrics appearing during 2008, 2009, and 2010, with their corresponding cites in 2010, 2011, and 2012, were recorded from the Journal Citation Reports Science Edition. A linear mixed-effects design using random slopes and intercepts was performed on 51 out of 74 journals in the Gastroenterology and Hepatology category. RESULT: There was a significant global effect size (R=0.992; P<0.001), which yielded a total variance of 99.2%. The strongest predictors in the model were the Eigenfactor Score and Cited Half-life (P<0.001), followed by the Number of Articles (P=0.011) and the Immediacy Index (P=0.021). The impact factor was not a significant predictor. CONCLUSION: The Eigenfactor Score and Cited Half-life predictors might be the new standards to assess the influence and importance of scientific journals; this approach may help researchers select journals in which to publish their work. © 2015 Wolters Kluwer Health, Inc.


Sotelo J.,National Institute of Neurology and Neurosurgery
Surgical Neurology International | Year: 2012

Long-term treatment of hydrocephalus continues to be dismal. Shunting is the neurosurgical procedure more frequently associated with complications, which are mostly related with dysfunctions of the shunting device, rather than to mishaps of the rather simple surgical procedure. Overdrainage and underdrainage are the most common dysfunctions; of them, overdrainage is a conspicuous companion of most devices. Even when literally hundreds of different models have been proposed, developed, and tested, overdrainage has plagued all shunts for the last 60 years. Several investigations have demonstrated that changes in the posture of the subject induce unavoidable and drastic differences of intraventricular hydrokinetic pressure and cerebrospinal fluid (CSF) drainage through the shunt. Of all the parameters that participate in the pathophysiology of hydrocephalus, the only invariable one is cerebrospinal fluid production at a constant rate of approximately 0.35 ml/min. However, this feature has not been considered in the design of currently available shunts. Our experimental and clinical studies have shown that a simple shunt, whose drainage capacity complies with this unique parameter, would prevent most complications of shunting for hydrocephalus. Copyright © 2012 Sotelo J.


Boll M.-C.,National Institute of Neurology and Neurosurgery | Alcaraz-Zubeldia M.,National Institute of Neurology and Neurosurgery | Rios C.,National Institute of Neurology and Neurosurgery
Current Neuropharmacology | Year: 2011

Neuroprotection refers to the protection of neurons from excitotoxicity, oxidative stress and apoptosis as principal mechanisms of cell loss in a variety of diseases of the central nervous system. Our interest in Parkinson's disease (PD) treatment is focused on drugs with neuroprotective properties in preclinical experiments and evidence-based efficacy in human subjects. To this date, neuroprotection has never been solidly proven in clinical trials but recent adequate markers and/or strategies to study and promote this important goal are described. A myriad of compounds with protective properties in cell cultures and animal models yield to few treatments in clinical practice. At present, markers of neuronal vitality, disease modifying effects and long term clinical stability are the elements searched for in clinical trials. This review highlights new strategies to monitor patients with PD. Currently, neuroprotection in subjects has not been solidly achieved for selegiline and pramipexole; however, a recent rasagiline trial design is showing new indications of disease course modifying effects. In neurological practice, it is of utmost importance to take into account the potential neuroprotection exerted by a treatment in conjunction with its symptomatic efficacy. © 2011 Bentham Science Publishers Ltd.


Montes S.,National Institute of Neurology and Neurosurgery | Rivera-Mancia S.,National Institute of Neurology and Neurosurgery | Diaz-Ruiz A.,National Institute of Neurology and Neurosurgery | Tristan-Lopez L.,National Institute of Neurology and Neurosurgery | Rios C.,National Institute of Neurology and Neurosurgery
Oxidative Medicine and Cellular Longevity | Year: 2014

Copper is a transition metal that has been linked to pathological and beneficial effects in neurodegenerative diseases. In Parkinson's disease, free copper is related to increased oxidative stress, alpha-synuclein oligomerization, and Lewy body formation. Decreased copper along with increased iron has been found in substantia nigra and caudate nucleus of Parkinson's disease patients. Copper influences iron content in the brain through ferroxidase ceruloplasmin activity; therefore decreased protein-bound copper in brain may enhance iron accumulation and the associated oxidative stress. The function of other copper-binding proteins such as Cu/Zn-SOD and metallothioneins is also beneficial to prevent neurodegeneration. Copper may regulate neurotransmission since it is released after neuronal stimulus and the metal is able to modulate the function of NMDA and GABA A receptors. Some of the proteins involved in copper transport are the transporters CTR1, ATP7A, and ATP7B and the chaperone ATOX1. There is limited information about the role of those biomolecules in the pathophysiology of Parkinson's disease; for instance, it is known that CTR1 is decreased in substantia nigra pars compacta in Parkinson's disease and that a mutation in ATP7B could be associated with Parkinson's disease. Regarding copper-related therapies, copper supplementation can represent a plausible alternative, while copper chelation may even aggravate the pathology. © 2014 Sergio Montes et al.


Espinola-Nadurille M.,National Institute of Neurology and Neurosurgery | Crail-Melendez D.,National Institute of Neurology and Neurosurgery | Sanchez-Guzman M.A.,National Institute of Neurology and Neurosurgery
Epilepsy and Behavior | Year: 2014

Epilepsy is a neurological disorder with neurobiological, cognitive, psychological, and social consequences. Epilepsy stigma is a social determinant of ill health that affects the quality of life of people who suffer from epilepsy and that renders a poor social prognosis even worse than the clinical one. From a phenomenological approach, between January and July 2011, we explored the experience of epilepsy stigma through 25 in-depth qualitative interviews with 10 persons with temporal lobe epilepsy (PWE) (we avoided terms such as "epileptics" or "epileptic patients" because they can be labeling and stigmatizing), 10 carers (CEs) of PWE who attended the epilepsy clinic of the Institute of Neurology and Neurosurgery of Mexico, and 5 physicians specialized in epilepsy. The objective of the study was to identify the following: perceptions that could indicate any form of discrimination due to having epilepsy, reactions of people in front of a person having seizures, and social functioning of PWE since epilepsy onset, particularly their interpersonal relationships and participation in educational or working activities. Through the health providers' narratives, we explored the mainstream care practices, their perspectives on epilepsy, and their views about how the disease should be addressed. Thematic guidelines were elaborated for each type of participant. All information was processed with the use of the computer-assisted data analysis, Atlas.ti5. We made a codification of broad themes that corresponded to the main topics of the interview guidelines and then proceeded to finer categorization to elaborate the analytical categories. Epilepsy was attached to a powerful stereotype that includes notions of contamination, danger, sin, divine punishment, supernatural forces, and madness. Internalized, interpersonal, and institutional stigma prevents PWE from participating in school and employment and reduces their opportunities to establish peer and couple relationships. Mexican's overt impunity of structural discrimination towards PWE shows a lack of available legal resources that protect their human rights. The narrow biomedical concept that physicians have of epilepsy is consistent with the limited medical practices that are offered to treat epilepsy at the health services in Mexico. Comprehensive treatment and integrated services for epilepsy must incorporate psychosocial programs that include epilepsy stigma as a major component of the disease. © 2013 Elsevier Inc.


Ramirez-Crescencio M.A.,National Institute of Neurology and Neurosurgery | Velasquez-Perez L.,National Institute of Neurology and Neurosurgery
Clinical Neurology and Neurosurgery | Year: 2013

Objective: The aim of this study was to identify the main neurological conditions associated with HIV/AIDS in Mexican patients treated at the National Institute of Neurology and Neurosurgery (NINN) in Mexico city, the main referral center for patients with disorders of the central and peripheral nervous system. Methods: An observational, transversal and descriptive analysis was performed. We reviewed the databases from the Department of Epidemiology and the medical records of patients with AIDS seen during the period from January 1st, 1995 to December 31, 2009. Results: 320 patients were detected, the main conditions related to HIV/AIDS were brain toxoplasmosis (42%), cerebral criptoccocosis (28%), tuberculous meningitis (8.7%), linfoma no Hodking (3.75%), acute HIV infection (3.4%) and AIDS dementia complex (3%). No specific trend on morbility and mortality were detected during the period of study. Conclusions: In Mexico the most common neurological complications of HIV/AIDS are opportunistic infections. © 2013 Elsevier B.V.

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