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INTRODUCTION/AIMS: Somatosensory evoked potentials (SSEPs) are described as a supportive tool to diagnose chronic inflammatory demyelinating polyradiculoneuropathy (CIDP); however, there is a lack of studies determining the effectiveness of SSEPs in monitoring the clinical course of individuals with this condition. The aims of this study are to evaluate the utility of SSEPs in monitoring patients with CIDP and to assess their association with clinical outcomes following immunomodulatory therapy. METHODS: This was a single-center retrospective observational study that included patients who met European Federation of Neurological Societies and Peripheral Nerve Society criteria for CIDP between 2018 and 2023. SSEPs were performed at diagnosis and during follow-up after the start of immunomodulatory treatment. Fisher's exact test was employed to assess the association between clinical improvement and SSEP improvement. RESULTS: Eighteen patients were included in the study. Ten patients had a typical CIDP pattern and 11 were male. In 17, SSEPs were abnormal prior to the start of immunomodulatory treatment. In patients who showed clinical improvement with immunomodulatory therapy, we observed that 15/17 had partial or complete improvement in SSEPs. Patients who showed no clinical improvement with first-line treatment exhibited worsening SSEPs. There was a significant association between clinical and SSEPs improvement (p = 0.009). DISCUSSION: We observed a positive association between improvement in SSEPs and clinical improvement in patients with CIDP. Our data suggest that SSEPs may be useful for monitoring the clinical course of patients with CIDP, but additional, larger studies are needed.

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BACKGROUND AND AIMS: Retinal sensitivity (RS) and gaze fixation (GF) assessed by retinal microperimetry are useful and complementary tools for identifying mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D). The hypothesis is that RS and GF examine different neural circuits: RS depends only on the visual pathway while GF reflects white matter complex connectivity networks. The aim of the study is to shed light to this issue by examining the relationship of these two parameters with visual evoked potentials (VEP), the current gold standard to examine the visual pathway. MATERIALS AND METHODS: Consecutive T2D patients > 65 years were recruited from the outpatient clinic. Retinal microperimetry (MAIA 3rd generation) and visual evoked potentials (VEP) (Nicolet Viking ED). RS (dB), GF (BCEA63%, BCEA95%) (MAIA) and VEP (Latency P100ms, Amplitude75-100 uV) were analyzed. RESULTS: Thirty three patients (45% women, 72.1 ± 4.6 years) were included. VEP parameters significantly correlated with RS but not with GF. CONCLUSIONS: These results confirm that RS but not GF depends on the visual pathway, reinforcing the concept that they are complementary diagnostic tools. Used together can further increase the value of microperimetry as screening test for identifying T2D population with cognitive impairment.

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Introducción: La debilidad es una complicación frecuente en el enfermo crítico por COVID-19. Se describen sus características, y los factores que pueden condicionarla y predecirla. Pacientes y métodos: Estudio observacional descriptivo prospectivo con pacientes ingresados en la unidad de cuidados intensivos (UCI) por COVID-19 entre abril y mayo de 2020 con debilidad muscular. Se consideró una afectación clínica grave un equilibrio motor igual o inferior a 3/5 según la escala de fuerza muscular modificada del Medical Research Council. Se han realizado 25 estudios analíticos, 16 estudios neurofisiológicos y una biopsia muscular; seguimiento telefónico al mes; análisis comparativo entre los grupos con y sin afectación grave, y determinación de puntos de corte de parámetros analíticos para predecir afectación grave mediante curvas ROC. Resultados: Se incluyó a 25 pacientes con 58 años (desviación estándar ± 9) de edad media. La mediana de estancia en la UCI fue de 27,5 días. Todos los electromiogramas mostraban un patrón miógeno y el 75%, también una neuropatía. El grupo con afectación clínica grave tenía mayores niveles de dímero-D (p = 0,08), lactato deshidrogenasa (p = 0,03) e interleucina 6 (p = 0,10), y la combinación de la alteración de dos cualquiera de estos tres parámetros pronosticaba la afectación grave con una sensibilidad del 100% y una especificidad del 76,9%. Al mes de seguimiento, el 36% no podía deambular autónomamente y el 92% seguía con debilidad muscular. Conclusiones: La debilidad en el enfermo por COVID-19 grave tiene una repercusión clínica importante. Su detección y estudio precoces mediante predictores de su desarrollo pueden permitir un mejor manejo. La ausencia en algunos casos de los factores de riesgo clásicos para la debilidad adquirida en la UCI sugiere una fisiopatología diferente.(AU)

Introduction: Weakness is a frequent complication in those critically ill due to COVID-19. This study describes its characteristics and the factors that can condition and predict it. Patients and methods: We conducted a prospective, descriptive, observational study of patients admitted to the intensive care unit (ICU) due to COVID-19 between April and May 2020 with muscle weakness. A motor balance equal to or lower than 3/5 according to the modified Medical Research Council muscle strength scale was considered to be severe clinical impairment. Altogether 25 analytical studies, 16 neurophysiological studies and one muscle biopsy were performed, with a telephone follow-up at one month, a comparative analysis between the groups with and without severe compromise, and determination of cut-off points for analytical parameters to predict severe involvement using ROC curves. Results: The sample consisted of 25 patients with a mean age of 58 years (standard deviation ± 9). The median length of stay in the ICU was 27.5 days. All the electromyograms exhibited a myogenic pattern and 75% also showed neuropathy. The group with severe clinical involvement had higher levels of D-dimer (p = 0.08), lactate dehydrogenase (p = 0.03) and interleukin-6 (p = 0.10), and the combination of the alteration of any two of these three parameters predicted severe involvement with a sensitivity of 100% and a specificity of 76.9%. At one month of follow-up, 36% were unable to walk autonomously and 92% continued with muscle weakness. Conclusions: Weakness in severe COVID-19 patients has a major clinical impact. Its early detection and study by means of predictors of its development may allow for better management. The absence in some cases of classical risk factors for ICU-acquired weakness suggests a different pathophysiology.(AU)

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INTRODUCTION: Weakness is a frequent complication in those critically ill due to COVID-19. This study describes its characteristics and the factors that can condition and predict it. PATIENTS AND METHODS: We conducted a prospective, descriptive, observational study of patients admitted to the intensive care unit (ICU) due to COVID-19 between April and May 2020 with muscle weakness. A motor balance equal to or lower than 3/5 according to the modified Medical Research Council muscle strength scale was considered to be severe clinical impairment. Altogether 25 analytical studies, 16 neurophysiological studies and one muscle biopsy were performed, with a telephone follow-up at one month, a comparative analysis between the groups with and without severe compromise, and determination of cut-off points for analytical parameters to predict severe involvement using ROC curves. RESULTS: The sample consisted of 25 patients with a mean age of 58 years (standard deviation ± 9). The median length of stay in the ICU was 27.5 days. All the electromyograms exhibited a myogenic pattern and 75% also showed neuropathy. The group with severe clinical involvement had higher levels of D-dimer (p = 0.08), lactate dehydrogenase (p = 0.03) and interleukin-6 (p = 0.10), and the combination of the alteration of any two of these three parameters predicted severe involvement with a sensitivity of 100% and a specificity of 76.9%. At one month of follow-up, 36% were unable to walk autonomously and 92% continued with muscle weakness. CONCLUSIONS: Weakness in severe COVID-19 patients has a major clinical impact. Its early detection and study by means of predictors of its development may allow for better management. The absence in some cases of classical risk factors for ICU-acquired weakness suggests a different pathophysiology.

TITLE: Debilidad como complicación del paciente crítico por COVID-19: características clínicas y factores pronósticos en una serie de casos.Introducción. La debilidad es una complicación frecuente en el enfermo crítico por COVID-19. Se describen sus características, y los factores que pueden condicionarla y predecirla. Pacientes y métodos. Estudio observacional descriptivo prospectivo con pacientes ingresados en la unidad de cuidados intensivos (UCI) por COVID-19 entre abril y mayo de 2020 con debilidad muscular. Se consideró una afectación clínica grave un equilibrio motor igual o inferior a 3/5 según la escala de fuerza muscular modificada del Medical Research Council. Se han realizado 25 estudios analíticos, 16 estudios neurofisiológicos y una biopsia muscular; seguimiento telefónico al mes; análisis comparativo entre los grupos con y sin afectación grave, y determinación de puntos de corte de parámetros analíticos para predecir afectación grave mediante curvas ROC. Resultados. Se incluyó a 25 pacientes con 58 años (desviación estándar ± 9) de edad media. La mediana de estancia en la UCI fue de 27,5 días. Todos los electromiogramas mostraban un patrón miógeno y el 75%, también una neuropatía. El grupo con afectación clínica grave tenía mayores niveles de dímero-D (p = 0,08), lactato deshidrogenasa (p = 0,03) e interleucina 6 (p = 0,10), y la combinación de la alteración de dos cualquiera de estos tres parámetros pronosticaba la afectación grave con una sensibilidad del 100% y una especificidad del 76,9%. Al mes de seguimiento, el 36% no podía deambular autónomamente y el 92% seguía con debilidad muscular. Conclusiones. La debilidad en el enfermo por COVID-19 grave tiene una repercusión clínica importante. Su detección y estudio precoces mediante predictores de su desarrollo pueden permitir un mejor manejo. La ausencia en algunos casos de los factores de riesgo clásicos para la debilidad adquirida en la UCI sugiere una fisiopatología diferente.

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Fetal alcohol spectrum disorders (FASD) cause neurodevelopmental abnormalities. However, publications about epilepsy and electroencephalographic features are scarce. In this study, we prospectively performed electroencephalography (EEG) and brain magnetic resonance (MR) imaging in 61 patients with diagnosis of FASD. One patient had multiple febrile seizures with normal EEGs. Fourteen children showed EEG anomalies, including slow background activity and interictal epileptiform discharges, focal and/or generalized, and 3 of them had epilepsy. In one patient, seizures were first detected during the EEG recording and one case had an encephalopathy with electrical status epilepticus during slow sleep (ESES). Focal interictal discharges in our patients did not imply the presence of underlying visible focal brain lesions in the neuroimaging studies, such as cortical dysplasia or polymicrogyria. However, they had nonspecific brain MR abnormalities, including corpus callosum hypoplasia, vermis hypoplasia or cavum septum pellucidum. The latter was significantly more frequent in the group with EEG abnormal findings (p < 0.01).

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Evoked Potentials (EP) are a neurophysiological tool that makes it possible for us to make an extensive study of the cerebral cortex, the brainstem and the spinal cord. Different techniques can be applied while performing the EPs, such as Visual Evoked Potentials (VEPs), Somatosensory Evoked Potentials (SSEPs), Long Latency Somatosensory Evoked Potentials (LLSEPs), Brainstem Auditory Evoked Potentials (BAEPs), Middle Latency Auditory Evoked Potentials (MLAEPs), Long Latency Auditory Evoked Potentials (LLAEP) and Mismatch Negativity (MMN). The combination of the different techniques of Evoked Potentials (EP) allows us to make a neurofunctional evaluation of comatose patients in the Intensive Care Units (ICU). It is also a useful tool in the diagnosis of the origin of coma, to confirm brain death, and as an evolutive prognosis value of the different central nervous system diseases (SNC). There are also studies that propose using EPs as a monitoring tool of the SNC. We present an up-dated review on the principal aspects of EP neuromonitoring in Intensive Care Unit (ICU) patients.

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Los potenciales evocados (PEs) son una herramienta neurofisiológicaque nos permite un estudio amplio de la función del córtex cerebral,el tronco cerebral y la médula espinal. Durante la realización de losPEs se pueden aplicar diferentes técnicas, como son: potenciales evocadosvisuales (PEV), potenciales evocados somatosensoriales de cortalatencia (PESS), potenciales evocados somatosensoriales de medialatencia (PESSML), potenciales acústicos de tronco cerebral (PEATC),potenciales acústicos de media latencia (PEAML), potenciales acústicosde larga latencia (PEALL) y los potenciales de disparidad (MMN).La combinación de las diferentes técnicas de los PEs permite lavaloración neurofuncional de los pacientes en coma de las unidadesde cuidados intensivos (UCI), siendo una herramienta útil en el diagnósticodel origen del coma, en la confirmación de muerte cerebral ycomo valor pronóstico evolutivo de diferentes patologías del sistemanervioso central (SNC). También existen estudios en los que se proponela realización de PEs como herramienta de monitorización del SNC.Presentamos una revisión actualizada de los principales aspectosde los PEs en pacientes ingresados en unidades de cuidados intensivos(UCI) (AU)

Evoked Potentials (EP) are a neurophysiological tool thatmakes it possible for us to make an extensive study of the cerebralcortex, the brainstem and the spinal cord. Different techniques canbe applied while performing the EPs, such as Visual EvokedPotentials (VEPs), Somatosensory Evoked Potentials (SSEPs), LongLatency Somatosensory Evoked Potentials (LLSEPs), BrainstemAuditory Evoked Potentials (BAEPs), Middle Latency AuditoryEvoked Potentials (MLAEPs), Long Latency Auditory EvokedPotentials (LLAEP) and Mismatch Negativity (MMN).The combination of the different techniques of EvokedPotentials (EP) allows us to make a neurofunctional evaluation ofcomatose patients in the Intensive Care Units (ICU). It is also auseful tool in the diagnosis of the origin of coma, to confirm braindeath, and as an evolutive prognosis value of the different centralnervous system diseases (SNC). There are also studies that proposeusing EPs as a monitoring tool of the SNC.We present an up-dated review on the principal aspects of EPneuromonitoring in Intensive Care Unit (ICU) patients (AU)

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Fundamento. No se conoce cuál es el efecto que produce la administración crónica de estrógenos en el metabolismo mineral óseo del varón. Por otra parte, en algunos estudios se ha informado que un determinado polimorfismo del receptor de la vitamina D podría condicionar una mayor densidad mineral ósea. Estos estudios a menudo han mostrado resultados contradictorios y la mayor parte de ellos se han efectuado en mujeres. Por todo ello hemos realizado este trabajo en un grupo de varones transexuales que habían recibido estrógenos durante un mínimo de tres años, con el fin de analizar si un determinado polimorfismo del receptor de la vitamina D condiciona en ellos diferencias en el metabolismo mineral óseo. Método. Estudio transversal de casos y controles. Hemos estudiado marcadores bioquímicos de remodelado óseo, la densidad mineral ósea, así como varias hormonas sexuales y calciotropas. Resultados. Comparados con los controles, los transexuales mostraron menores valores de testosterona libre en sangre y mayores valores de estradiol y de densidad mineral ósea, tanto en la columna lumbar como en la cadera. La bioquímica general, los marcadores bioquímicos de remodelado óseo y las hormonas calciotropas no mostraron diferencias estadísticamente significativas entre ambos grupos. El polimorfismo del receptor de la vitamina D no condicionó ninguna diferencia en estas variables, ni en los transexuales ni en los controles. Conclusiones. No hemos encontrado asociación alguna entre el fenotipo transexual y la distribución del polimorfismo del receptor de la vitamina D. La administración crónica de estrógenos en el varón produce un aumento en los niveles de estradiol sérico, y un incremento en la densidad mineral ósea tanto en la columna lumbar como en la cadera, que no guarda relación con la presencia de un determinado polimorfismo del receptor de la Vitamina D, a pesar de existir una marcada reducción en la concentración de testosterona libre (AU)

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