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RESUMEN El término ataxias cerebelosas hereditarias comprende un amplio espectro de trastornos neurológicos en los cuales la ataxia es el síntoma principal. Conforman un complejo grupo de entidades cuyo reconocimiento es esencial para el correcto asesoramiento genético, el adecuado control clínico y, en algunos casos, el apropiado abordaje terapéutico. La riqueza clínico-semiológica y los avances en la biología molecular han convertido a las ataxias hereditarias en uno de los temas más apasionantes de la neurología. El diagnóstico clínico de los subtipos de ataxias es complicado, por la prominente superposición de fenotipos entre los subtipos genéticos. En este artículo abordamos los principales avances neurofisiológicos, clínicos y genéticos de las ataxias cerebelosas hereditarias.
ABSTRACT The term "Hereditary cerebellar ataxia" comprises a wide spectrum of neurological disorders where ataxia is the main symptom. Hereditary ataxias are a complex group of entities, in which detection is essential for an adequate genetic assessment, satisfactory clinical control and in some cases, a suitable therapeutic approach. Clinical semiology variety and molecular biology advanceshave become hereditary ataxias one of the most interesting subjects inside neurology. Subtypes clinical diagnosis of ataxias is complicated by the salient overlap of phenotypes between genetic subtypes. In this article, we refer to the most important neurophysiological, clinical and genetics advances of hereditary cerebellar ataxias.
RESUMO
OBJECTIVE: To evaluate the biodistribution, internal radiation dosimetry and safety of the 188Re-labelled humanized monoclonal antibody nimotuzumab in the locoregional treatment of malignant gliomas. METHODS: Single doses of 370 or 555 MBq of 188Re-labelled nimotuzumab were locoregionally administered to nine patients with recurrent high-grade gliomas, according to an approved dose-escalation study. SPECT, planar scintigraphy and magnetic resonance images were combined for dosimetric and pharmacokinetic studies. Blood and urine samples were collected to evaluate clinical laboratory parameters and for absorbed doses calculations. Biodistribution, internal dosimetry, human anti-mouse antibody response and toxicity were evaluated and reported. RESULTS: The 188Re-nimotuzumab showed a high retention in the surgically created resection cavity with a mean value of 85.5+/-10.3%ID 1 h post-injection. It produced mean absorbed doses in the tumour region of approximately 24.1+/-2.9 Gy in group I (patients receiving 370 MBq) and 31.1+/-6.4 Gy in group II (patients receiving 555 MBq); the normal organs receiving the highest absorbed doses were the kidneys, liver and urinary bladder. About 6.2+/-0.8%ID was excreted by the urinary pathway. The maximum tolerated dose was 370 MBq because two patients showed severe adverse effects after they received 555 MBq of 188Re-nimotuzumab. No patient developed human anti-mouse antibody response. CONCLUSIONS: A locoregional single dose of 188Re-labelled nimotuzumab of approximately 370 MBq could be used safely in the routine treatment of patients suffering with high-grade gliomas. The efficacy of this therapy needs to be evaluated in a phase II clinical trial.