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lunes, 20 de febrero de 2017

Phenotypical variability in an Argentinian family, with history of frontotemporal lobar degeneration, caused by a mutation in the microtubule-associated protein tau 
Emilia M. Gatto a,b; Ricardo F. Allegri c,i,j; Gustavo Da Prat b; Patricio Chrem Méndez c David S. Hanna d,e; Michael O. Dorschner d,e; Ezequiel I. Surace f i; Ignacio F. Mata g,h 


a Departamento de trastornos del movimiento, Fundación INEBA, Buenos Aires, Argentina. b Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina. c Centro de la memoria y el envejecimiento, Instituto de Investigaciones Neurológicas Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina. d Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA. e Department of Pathology, University of Washington, Seattle, USA f Laboratorio de Biología Molecular, Instituto de Investigaciones Neurológicas Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina g Veterans Affairs Puget Sound Health Care System, Seattle, USA h Department of Neurology University of Washington, Seattle, WA USA i Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina j Universidad de la Costa (CUC), Colombia

OBJECTIVES:
To describe the first Argentinian family of Basque ancestry, with MAPT gene (p.P301L) mutation and intrafamilial phenotypical variability (Corticobasal Syndrome and Fronto Temporal Dementia).

BACKGROUND:
BackgroundbvFTD is a genetic disorder related with frontotemporal dementia (FTD), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). Gene mutations involving the microtubule-associated protein tau, progranulin and C9orf72 are related

METHODS
The pedigree consists of 26 family members over 6 generations presenting with a history of autosomal dominant bvFTD (previously mentioned as Pick disease). Two different phenotypes were identified among affected members in the living generation, CBS in the proband and FTD in one of his siblings. We performed neurological examination, neuropsychological tests and neuroimaging in 5 individuals. A whole-exome sequencing (WES) was conducted in 5 individuals (Proband, 3 brothers and a cousin). A Sanger sequence was performed to identify candidate variants in all 5 siblings to assess segregation.

RESULTS:
We identify a mutation in the exon 10 of the MAPT gene (p.P301L; rs63751273) in the proband and one affected brother, which was absent in the other three syblings analyzed. This mutation has often been assigned as the cause of FTD, particularly in French populations, but rarely of CBS. The proband and her affected brother presented a CBS and FTD phenotype respectively. This is the first report in Argentina and South America.

CONCLUSIONS:
Our findings contribute to support the wide distribution of this mutation and the high phenotypic variability presented among families, and also within families, carrying the MAPT-p.P301L mutation. This observation emphasize the concept that other environmental or genetic factors could modify the phenotype.




http://www.pascongress2017.org/MDS-PAS-2017-Files/PDFs/PASmiami-FP-v9.pdf

IMPULSE CONTROL DISORDER ON PARKINSON’S DISEASE. A new approach from art?

 Aldinio V., Persi G., Bres Bullrich M., Sánchez de Paz P., Da Prat G., Parisi V., Rojas G., Gatto E.
 Sanatorio de la Trinidad Mitre, Ciudad Autónoma de Buenos Aires, Argentina

Objectives To describe the characteristics of three PD patients, nonprofessional artists who developed an artistic hyper productivity on dopaminergic agonists treatment.

Background On Parkinson's disease (PD), the artistic productivity apparition has been reported with the use of dopaminergic agonists, as an unusual expression of impulse control disorder (ICD). Dopamine is involved into motivation and reward behaviors. The mesolimbic dopaminergic activity has been associated with creative impulse, search of the new and the sensibility for new stimulus.

Methods There were included three patients with PD on pramipexole treatment (2 cases) and ropinirole treatment (1 case): 2 women, 1 man. Literature review.

Results Male patient, 58 years old, 10 years PD, with pramipexole it develops ludopathy. Because of torpid evolution, it's been decided to implement a deep brain stimulator that had to be removed due to an infection. It starts with ropinirole, concomitantly it develops passion for painting. Female patient, 53 years old, 6 years PD, with pramipexole it develops hypersexuality, rotates to rotigotine with no results, restarts pramipexole, it develops skills for painting and dancing salsa. Female patient, 49 years old, 12 years PD, with pramipexole it develops compulsive shopping, and it develops hyper productivity for painting, implementing new artistic techniques.


Conclusion The ICD, related with dopaminergic agonists, is usually reported as a serious adverse event of the therapy, interfering on a negative manner with the quality of life of PD patients and their families. In our study the patients under dopaminergic agonists treatments developed skills for painting and increased their previous ability. This raises the question of whether artistic hyper productivity can be defined like an ICD, because it gave a beneficial effect on our patient’s quality of life.




HEMICHOREA INDUCED BY SERTRALINE
Case Report and Literature Review
Aldinio V., Persi G., Bres Bullrich M., Sánchez de Paz P., Da Prat G., Parisi V., Rojas G., Gatto E.
 Sanatorio de la Trinidad Mitre, Ciudad Autónoma de Buenos Aires, Argentina

Objectives To describe hemichorea in a patient with sertraline treatment

Background Hemichorea (HC) is a unilateral continuous, random and proximal movement on one side of the body. HC is associated with nonketotic hyperglycemia and is less frequently related to stroke involving striatum. Drug induced HC is a rare syndrome related to serotonin selective reuptake inhibitors (SSRIs).

Methods There was included a woman who developed HC after being treated with sertraline. Literature review.

Results A 65 years old woman, with personal history of irritable bowel and smoking, noticed a postural instability and irritability in December 2015. A depressive syndrome was diagnosed on March and she was started on sertraline 50 mg/day. One week later, she developed HC, diarrhea, stomatitis. An extensive investigation to exclude other causes was conducted. Brain MRI revealed no basal ganglia lesions. Laboratory tests, including complete blood count, renal, liver, and thyroid function, vitamin B12, folic acid, VDRL, HIV, prolactin, cortisol, carcinoembryonic antigen, CA 15.3, CA 19.9, CA 125, VSG, PCR, ceruloplasmine, anti-endomysium, Anti RI, Yo, Hu, FAN, P-ANCA , C-ANCA, rheumatoid factor, CSF protein, onconeural antibodies were normal/negative. Echocardiogram, Doppler ultrasound of neck vessels, CT scan of thorax, abdomen and pelvis, normal. High and low video endoscopy with biopsy: negative. Sertraline was withdraw with clinical improvement.


Conclusion The incidence of movement disorders caused by SSRIs is unknown. After a literature review, we failed to identify sertraline induced HC. Fluoxetine was reported associated with HC. In our patient temporal association and an extensive clinical assessment discarded other causes of HC and supported a drug induced involuntary movement. We hypothesized that a serotonergic transmission could impair striatum pathways and induce HC.




viernes, 10 de febrero de 2017


Resumen Las drogas sedativas se asocian con mayor deterioro cognitivo e incremento de la mortalidad. La carga sedativa (CS) es la exposición acumulativa a múltiples drogas con propiedades sedativas. Objetivo: Describir el uso de psicofármacos y la CS en pacientes ≥65 años con (PcD) y sin demencia (PsD). Material y métodos: Estudio descriptivo transversal entre 2014-2015 (Sanatorio Trinidad Mitre), en pacientes hospitalizados mayores de 65 años. Se emplearon el Sistema de Clasificación Anatómica, Química y Terapéutica de la OMS y el modelo de Linjakumpu. Resultados: Analizamos 152 PsD y 35 PcD, edad media 80.8±8.42 años. El 44.39% del total evidenció polifarmacia; 62.86% en PcD y 40.13% en PsD (p=0.0147). Al menos un psicotrópico/sedativo se identificó en 40.64% de la muestra; con mayor prevalencia en PcD respecto de PsD (60% vs 36.18%-p=0.0097). La CS global fue 1.32±1.59; 2.14 en PcD y 1.13 en PsD (p<0.001). Los antipsicóticos atípicos y benzodiazepinas fueron los psicofármacos más empleados en PcD (51.43% y 40%, respectivamente). Conclusiones: En nuestra muestra encontramos una alta prevalencia de polifarmacia, empleo de drogas psicotrópicas/sedativas y CS. Esta situación fue mayor en PcD. Estos hallazgos resaltan la importancia de implementar estrategias para racionalizar el uso de drogas sedativas en los pacientes añosos. 

RATIONAL USE OF PSYCHOTROPIC MEDICATIONS AND SEDATIVE LOAD IN OLDER ADULTS WITH AND WITHOUT DEMENTIA. 
Abstract Sedative drugs use has been associated with more cognitive impairment and increased mortality. Sedative load refers to cumulative exposure to multiple drugs with sedative properties. Objective: Describe the use of psychotropic drugs and sedative load in older adults with and without dementia. Material and methods: We conducted a cross–sectional study from 2014-2015 (Sanatorio Trinidad Mitre), in hospitalized patients older than 65 years old. Drugs were classified according to the WHO ATC system. The sedative load of drugs was calculated using the Linjakumpu model. Results: 152 PsD and 35 PcD patients were registered, mean age 80.8±8.42. Polypharmacy was present in 44.39% being higher in patients with dementia than without dementia (62.80% vs 40.13%, p=0.0147). In 40.64% at least one psychotropic/sedative medication was used, greater in PcD (60% vs 36.18%, p=0.0097). The CS was: 1.32±1.59; 2.14 in PcD and 1.13 in PsD (p<0.001). Atypical antipsychotics and benzodiazepines were the most common (51.43 and 40% respectively) in patients without dementias. Conclusion: we evidenced a high level of prescription psychotropic or sedative drugs, mostly in patients with dementia. In those, the sedative load was greater. This finding highlights the importance of implementing strategies to optimize sedative drug use among older people.