-In order to compare and contrast the efficacy of haloperidol, carbamazepine, and valproic acid in the treatment of Sydenham´s chorea a prospective study including 18 cases of this disorder was undertaken. Age of patients ranged from 7 to 15 years. Ten children were female and 8 were male. All but one had generalized, either symmetric or asymmetric chorea. The patients were divided in three equal groups, and were given a standardized dose of each of the drugs built-up over a week. Following therapy, the six children receiving valproic acid showed remarkable improvement, without side effects. Five patients receiving carbamazepine showed improvement without side effects. Only three of the patients that received haloperidol improved. In the 4 cases that did not show clinical improvement after one week of treatment, therapy with valproic acid led to disappearance of the symptoms in a lapse that ranged from 4 to 7 days. Recurrence related to discontinuation of treatment was observed in two patients. In view of the present results we recommend valproic acid as the first choice drug to treat Sydenham chorea.KEY WORDS: Sydenham´s chorea, carbamazepine, haloperidol, valproic acid.Comparación de la eficacia de carbamazepina, haloperidol y acido valproico en el tratamiento de niños Comparación de la eficacia de carbamazepina, haloperidol y acido valproico en el tratamiento de niños Comparación de la eficacia de carbamazepina, haloperidol y acido valproico en el tratamiento de niños Comparación de la eficacia de carbamazepina, haloperidol y acido valproico en el tratamiento de niños Comparación de la eficacia de carbamazepina, haloperidol y acido valproico en el tratamiento de niños con corea de Sydenham: seguimiento clínico de 18 pacientes con corea de Sydenham: seguimiento clínico de 18 pacientes con corea de Sydenham: seguimiento clínico de 18 pacientes con corea de Sydenham: seguimiento clínico de 18 pacientes con corea de Sydenham: seguimiento clínico de 18 pacientes RESUMEN -A fin de comparar y contrastar la eficacia de haloperidol, carbamazepina y ácido valproico en el tratamiento de la corea de Sydenham, se realizó un estudio prospectivo que incluyó 18 casos de esta patología. La edad de los pacientes varió de 7 a 15 años. Diez de los niños eran varones y el resto hembras. A excepción de uno de ellos, todos tenían corea generalizada, simétrica ó asimétrica. Los pacientes fueron divididos en tres grupos iguales, a cada uno de los cuales se le administró una dosis estandarizada de los medicamentos mencionados durante una semana. Luego del tratamiento, los seis pacientes que recibieron ácido valproico mostraron mejoría notable sin efectos colaterales. Cinco de los seis pacientes que recibieron carbamazepina exhibieron mejoría sin efectos colaterales. Solo tres de los pacientes que recibieron haloperidol mejoraron. En los cuatro casos que luego de recibir estas dos últimas drogas sin experimentar mejoría clínica luego de una semana, se instaló terapia con ácido valproico, lo que llevó a desaparición de la sinto...

Objectives-Several lines of evidence suggest that the endothelial constitutive nitric oxide synthase (ecNOS) and angiotensin converting enzyme (ACE) may have a role in Alzheimer's disease. ACE is widely expressed in the brain, and a DNA polymorphism at the ACE gene has been linked to the risk for late onset Alzheimer's disease. Nitric oxide (NO) production by microglial cells, astrocytes, and brain microvessels is enhanced in patients with Alzheimer's disease. There is a growing evidence that NO is involved in neuronal death in Alzheimer's disease, and the oxidative stress caused by NO in the brain could be a pathogenic mechanism in Alzheimer's disease. The objective was to determine if two DNA polymorphisms at the ecNOS and ACE genes that have been linked with diVerent levels of enzyme expression, have some eVect on the risk of developing late onset Alzheimer disease. Methods-A total of 400 healthy controls younger than 65 years and 350 patients with Alzheimer's disease (average age 72 years) were genotyped for the ACE and ecNOS polymorphisms. To define a possible role for these polymorphisms in longevity 117 healthy controls older than 85 years were also analysed. Genomic DNA was obtained and amplified by polymerase chain reaction, and genotypes were defined following a previously described procedure. Gene and genotype frequencies between patients and controls were compared statistically. Results-Gene and genotype frequencies for the ecNOS and ACE polymorphisms did not diVer between both groups of healthy controls (<65 years and >85 years). EcNOS gene and genotype frequencies were similar between patients and controls. There was a slight but significantly increased frequency of the ACE-I allele among patients with Alzheimer's disease compared with controls (p=0.03; OR=1.28, 95%CI= 1.04;1.58). Conclusions-The ACE-I allele was associated with a slightly increased risk of developing late onset Alzheimer's disease. (J Neurol Neurosurg Psychiatry 1999;67:733-736) Keywords: angiotensin converting enzyme, nitric oxide synthase DNA polymorphisms; Alzheimer's disease Angiotensin converting enzyme (ACE) is a major component of the renin-angiotensin system. The enzyme catalyses the conversion of angiotensin I to angiotensin II (Agt II). Agt II exerts its biological functions through binding to two receptors, AT1R and AT2R. A polymorphism at intron 16 of the ACE gene (also known as the DCP1 gene), consisting in an insertion/deletion (I/D) of a 287 base pair sequence, is associated with ACE concentrations in blood, and the DD genotype has been linked to an increased risk for myocardial infarction and left ventricular hypertrophy.

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Local inflammatory processes associated with amyloid plaques would contribute to the progression of late-onset Alzheimer disease (LOAD). Tumor necrosis factors alpha (TNF(alpha)) and beta (LT(alpha)) are inflammatory cytokines involved in the local immune response occurring in the central nervous system of LOAD patients. Genetic variation at these genes could contribute to the risk of developing AD or influence the age at the onset of the disease. We genotyped 315 LOAD patients and 400 healthy controls for DNA-polymorphisms in the genes encoding TNF(alpha) (-308 G/A, -238G/A) and LT(alpha) (Asn26Thr). Carriers of -308A showed a mean age at onset 3 years younger than noncarriers of this allele (P = 0.019). Our data suggest an effect of the TNF(alpha)-308 polymorphism on the age at onset of late AD. This represents additional evidence of the importance of genetic variation at the proinflammatory components in the origin and progression of this common neurodegenerative disease.

A total of 1,535 4-12 year-old children were screened with the Conners' rating scales, followed by diagnostic confirmation by the diagnostic interview schedule for children-IV-parent version. The prevalence of ADHD was estimated to be 10.03%, and only 3.9% of children had received medication for the treatment of ADHD symptoms. Prevalence rates and demographic profile of Venezuelan children with ADHD are very similar to those found in samples from other countries. Authorities need to develop public health policies to correctly identify and treat affected subjects. Furthermore, clinicians must actively search for children with ADHD in order to provide the best-available treatment.

Multiple sclerosis (MS), a chronic inflammatory autoimmune disease of the central nervous system (CNS) commonly diagnosed in adults, is being recognized increasingly in children. An estimated 1.7%–5.6% of all patients with MS have clinical symptoms before reaching the age of 18 years. In comparison with adults, the diagnosis of MS in children can be more difficult, being dismissed or misdiagnosed as other clinical disorders. Although adults and children share basic aspects of the disorder, children have distinctive clinical features, neuroimaging, laboratory, and courses of the disease. The 2010 McDonald criteria have simplified the requirements for establishing the diagnosis of MS and have been proposed to be applicable for the diagnosis of pediatric MS, mainly in children 12 years and older. This paper describes the distinctive features of common pediatric demyelinating disorders, including MS, and summarizes the most recent advances based on the available literature.

The study aims to determine the prevalence of autism spectrum disorders (ASDs) for children receiving services in Maracaibo County, Venezuela. Children aged 3-9 with diagnosis of any ASD were recruited. We ascertained area, referral process, and definitions of ASD for each patient. A total of 430 children were identified, and 76.5 percent were boys. Prevalences were 1.7 per 1000 for all ASD, 1.1 per 1000 for autism, and 0.6 per 1000 for PDD-NOS and Asperger syndrome combined. These prevalences are lower than current reports in the literature. Differences in case-finding methods, diagnostic criteria, and lack of awareness in the general population may have influenced the number of cases identified. An ASD prevalence of 1.7 per 1000 should alert the health and education authorities to the need to reassess the services available for children with these disorders and their families.

The distribution of apolipoprotein E (apo E) polymorphism was examined in 11 population groups not previously studied for this system. There is a marked difference in phenotype and gene frequency between the populations of England and Spain. The south European populations of Basques and Spanish non-Basques showed greater similarity to the populations of South Asia. The study clearly indicates that the distribution of apo E alleles does match with regions showing a high mortality rate of coronary heart disease. The data presented also indicate that authochthon groups such as Basques in Europe and tribals in India may throw better light on the role of apolipoproteins in the regulation of lipid levels in disease.