Abstract: Introduction: Quality of life (QoL) is a key aspect in the treatment of patients with Spinal Muscular Atrophy (SMA). International information regarding QoL in SMA is scarce, and is not available in our country. Objective: To characterize QoL in a sample of Chilean children and adolescents with SMA. Subjects and Method: Observational, cross-sectional study. A general questionnaire and the PedsQLTM 3.0 Neuromuscular Module Inventory were applied to parents of children with SMA aged 2 to 18 years. It has three areas: Disease, Communication, and Family. A score > 60 was considered as good QoL, 30-60 as regular, and < 30 as low. MINITAB-17« software was used, considering signifi cant a p < 0.05 value. Results: We recruited 38 patients, with median age 8 years (2-18), 52.63% were male, and 17 (44.7%) with SMA I. All had genetic confirmation. The total score of QoL was 51.92 ± 17, representing 31% good, 55% regular, and 14% low. Regarding SMA I, it was 46.5 ± 15.2 and SMA II-III, 56.3 ± 17.4 (p = 0.071). Concerning the area of Disease, it was 53.83 ± 18.1, Family 48.6 ± 23.14, and Communication 33.3 (IQR: 0.0; 83.33). In this last area, children with SMA II-III, older than 6 years., with non-invasive ventilatory support, or living out of the metropolitan area had hig her scores, however, in multivariate analysis, only SMA type was significant, which explained 40,9% of the variation in the communication area score. Conclusions: In this sample of SMA pediatric patients, the QoL was regular or good in most of them. The lowest area was communication, with a higher score in those children with higher motor function.

Resumen: Introducción: La calidad de vida (CV) es un aspecto fundamental del tratamiento en pacientes con Atrofia Muscular Espinal (AME). Existe escasa información a nivel local e internacional. Objeti vo: Caracterizar la CV en una muestra de niños y adolescentes chilenos con AME. Sujetos y Metodo: Estudio observacional, transversal. Se aplicó un cuestionario y el módulo neuromuscular 3.0 de la encuesta PedsQL™, a padres de niños con AME de 2-18 años. Ésta consta de 3 ámbitos: Enfermedad, Comunicación y Familia. Se consideró el puntaje >60 como CV buena, 30-60 regular y < 30, defi ciente. Se utilizó el programa MINITAB-17«, considerando significativo p ≤ 0,05. Resultados: Se re clutaron 38 pacientes, con edad mediana 8 años (2-18), 52,7% hombres, y 17 (44,7%) AME I. Todos con confirmación genética. El puntaje total fue 51,92 ± 17, correspondiendo 31% a CV buena, 55% regular y 14% baja. En AME I fue 46,5 ± 15,2 y en AME II-III, 56,3 ± 17,4 (p = 0,071). Para el ámbi to de Enfermedad fue 53,83 ± 18,1, de Familia 48,6 ± 23,14 y Comunicación 33,3 (RIC: 0,0-83,33). En este último, tuvieron mayor puntaje los pacientes con AME II o III, los mayores de 6 años, los con menor apoyo ventilatorio y los residentes en regiones. Sin embargo, en el análisis multivariado solamente el tipo de AME fue significativo, explicando 40,9% de la variación del puntaje del área de comunicación. Conclusiones: En esta muestra de pacientes con AME, la calidad de vida fue regular a buena en la mayoría. El área más baja fue la de Comunicación, con mayor puntaje en aquellos con mayor capacidad motora funcional.

ABSTRACT Spinal muscular atrophy (SMA) has gained much attention in the last few years because of the approval of the first intrathecal treatment for this neurodegenerative disease. Latin America needs to develop the demographics of SMA, timely access to diagnosis, and appropriate following of the standards of care recommendations for patients. These are essential steps to guide health policies. Methods This was a descriptive study of a cohort of SMA patients from all over Chile. We analyzed the clinical, motor functional, and social data, as well as the care status of nutritional, respiratory and skeletal conditions. We also measured the SMN2 copy number in this population. Results We recruited 92 patients: 50 male; 23 SMA type-1, 36 SMA type-2 and 33 SMA type-3. The median age at genetic diagnosis was 5, 24 and 132 months. We evaluated the SMN2 copy number in 57 patients. The SMA type-1 patients were tracheostomized and fed by gastrostomy in a 69.6 % of cases, 65% of SMA type-2 patients received nocturnal noninvasive ventilation, and 37% of the whole cohort underwent scoliosis surgery. Conclusion Ventilatory care for SMA type-1 is still based mainly on tracheostomy. This Chilean cohort of SMA patients had timely access to genetic diagnosis, ventilatory assistance, nutritional support, and scoliosis surgery. In this series, SMA type-1 is underrepresented, probably due to restrictions in access to early diagnosis and the high and early mortality rate.

La Atrofia Muscular Espinal (AME) ha concitado mucha atención en los últimos 2 años debido a la aprobación del primer tratamiento intratecal para esta enfermedad neurodegenerativa. América Latina necesita desarrollar la demografía de AME, un acceso oportuno al diagnóstico y un seguimiento apropiado de los pacientes que incorporen los estándares de atención recomendados por expertos. Estos son pasos esenciales para orientar las futuras políticas de salud en esta enfermedad. Métodos Este es un estudio descriptivo de una cohorte de pacientes con AME de todo el país. Se analizaron los datos clínicos, motores, funcionales, sociales y el estado nutricional, respiratorio y esquelético de los pacientes. También medimos el número de copias del gen SMN2 en esta población. Resultados se reclutaron 92 pacientes, 50 varones; 23 AME tipo 1, 36 AME tipo 2 y 33 AME tipo 3. La edad media al diagnóstico genético fue de 5, 24 y 132 meses respectivamente. Evaluamos el número de copias de SMN2 en 57 pacientes. Un 69,6% de los pacientes con AME tipo 1 estaban traqueostomízados y gastrostomizados , un 65% de los pacientes con AME tipo 2 usaban ventilación nocturna no invasiva y el 37% de toda la cohorte presentaba una cirugía de escoliosis. Conclusión Esta cohorte chilena de pacientes con AME tuvo acceso oportuno al diagnóstico genético, asistencia ventilatoria, apoyo nutricional y cirugía de escoliosis, sin embargo, la atención ventilatoria para AME tipo 1 continúa aun basándose principalmente en la traqueostomía. En esta serie, AME tipo 1 está subrepresentada, probablemente debido a las restricciones en el acceso al diagnóstico temprano y la tasa de mortalidad alta y temprana.

Abstract: Spinal muscular atrophy (SMA) is the first inherited cause of mortality in infants, with four subtypes: SMA0 prenatal onset, SMA1 babies less than 3 months non sitters, SMA2 sitters and SMA3 walkers. Pneumonia and respiratory insufficiency are the most severe complications. Informed parental de cisions are relevant. Respiratory management includes cough assistance, prevention of lung under development due to chest deformity, prompt treatment of respiratory infections, hypoventilation, swallow problems, gastro esophageal reflux and malnutrition. In view of the FDA and EMA approval of the nonsense oligonucleotides nusinersen, the first specific treatment for SMA and the future with gene therapy and others under development, we need to optimize preventive respiratory manage ment with the new standard of care.

Resumen: La atrofia muscular espinal (AME) es la enfermedad genética mortal más frecuente en lactantes, con severidad variable. Se clasifica en cuatro subtipos: tipo 0 de inicio prenatal y recién nacido ya afecta do, con ausencia de esfuerzo respiratorio y ningún desarrollo motor, tipo 1 de inicio en menores de 3 meses que no logran sentarse, tipo 2 que logran sentarse, pero no caminar y tipo 3 que consiguen caminar. La causa más seria de morbimortalidad es la neumonía y la insuficiencia respiratoria. La información a los cuidadores debe contemplarse desde el diagnóstico, para la toma de decisiones anticipadas. Los objetivos del manejo incluyen el estímulo de la tos, evitar la deformación de la caja torácica, la hipoventilación, y tratar oportunamente las infecciones respiratorias, el trastorno de de glución, el reflujo gastroesofágico y la malnutrición. El objetivo de esta actualización es discutir los nuevos desafíos en cuidados respiratorios con un enfoque preventivo, considerando la reciente dis ponibilidad de tratamientos específicos -oligonucleótidos antisentido nusinersen- y otros que están en desarrollo, incluída la terapia génica.

Abstract: Myopathies secondary to collagen VI mutations (COLVI-M) are the most frequent in the northern hemisphere, affecting the adult and pediatric population. There are no data on its prevalence in Latin America. They are characterized by a great clinical variability, from severe phenotypes, such as Ullrich congenital muscular dystrophy (UCMD), to intermediate and mild ones such as Bethlem myopathy (BM). Its onset is also variable and extends from the neonatal period to adulthood. Given the presence of joint hypermobility, the differential diagnosis should be made with various connective tissue diseases. The classical diagnostic algorithm in many patients has been insufficient to guide the genetic study in an adequate way, and from this the muscular magnetic resonance imaging has emerged as a very useful tool for a better diagnostic approach of this and other muscular pathologies. This ob jective of this review is to study the forms of presentation, clinical characteristics, specific diagnostic study, differential diagnosis and management of one of the most frequent hereditary muscular patho logies, with emphasis on the contribution of muscle magnetic resonance imaging.

Resumen: Las miopatías secundarias a mutaciones en el colágeno VI (M-COLVI) son las más frecuentes en el hemisferio norte, afectando población adulta y pediátrica. No existen datos de su prevalencia en Latinoamérica. Se caracterizan por presentar una gran variabilidad clínica, desde fenotipos severos, como la distrofia muscular congénita de Ullrich (DMCU), a intermedios y leves como la Miopatía de Bethlem (MB). Su inicio también es variable y se extiende desde el período de recién nacido hasta la vida adulta. Dada la presencia de hiperlaxitud articular, el diagnóstico diferencial se debe realizar con diversas enfermedades del tejido conectivo. El algoritmo diagnóstico clásico en muchos pacientes ha sido insuficiente para orientar el estudio genético de forma adecuada, y a partir de esto la resonancia magnética muscular ha emergido como una herramienta de gran utilidad para una mejor aproxima ción diagnóstica de ésta y otras patologías musculares. Esta revisión tiene como objetivo examinar las formas de presentación, características clínicas, estudio diagnóstico específico, diagnóstico dife rencial y manejo de una de las patologías musculares herediatarias más frecuentes, con énfasis en el aporte de la resonancia magnética muscular.

RESUMO: Vaccinia bovina (VB) é uma doença vesicular induzida pelo Vaccinia virus (VACV) que afeta a produção de leite e é uma zoonose ocupacional. Este trabalho teve os seguintes objetivos: (i) detecção de VACV por qPCR em bovinos com suspeita clínica de doença vesicular; (ii) caracterização dos sintomas apresentados por animais e ordenhadores com suspeita clínica da doença e detecção do vírus em humanos; e (iii) identificação de fatores de risco para infecção por VACV em rebanhos de vários estados brasileiros. Um total de 471 amostras de epitélio bovino de fazendas leiteiras, em 15 estados brasileiros, foram avaliados entre 2007 e 2012. As amostras foram testadas por PCR quantitativa (qPCR) usando reagentes SYBR Green®, validados com um limite inferior de detecção de 100TCID50 / 50μL (1,7x100 partículas virais) e 45,1% das amostras positivas de VACV foram detectadas. Usando formulários oficiais de investigação epidemiológica (FORM-IN), os fatores de risco para infecções por VACV em bovinos foram determinados como fazendas com falta de instalações tecnológicas (P= 0,029) e presença de roedores (P= 0,001). Houve um efeito da sazonalidade no gado com maior ocorrência de VB durante a estação seca. Um total de 420 questionários epidemiológicos foram aplicados nos centros públicos de saúde, onde 100% dos ordenhadores apresentaram lesões vesiculares nas mãos (98,1%) e nos braços (6,9%). Os sintomas clínicos mais frequentes em humanos foram: inchaço local (74,2%), cefaleia (20,7%), febre (10,4%) e linfadenopatia inguinal (74,2%). Apenas 19,98% dos produtores de leite com idade entre 39 e 58 anos foram sororreagentes ao VACV e foram imunizados com a vacina contra a varíola humana. Houve um aumento na frequência de BV em indivíduos mais velhos devido à sua diminuição natural na imunidade específica. Demonstrou-se que a implementação de técnicas de gestão zootécnica e planejamento sanitário são importantes para a prevenção da VB em animais e seres humanos.

ABSTRACT: Bovine vaccinia (BV) is a vesicular disease induced by the Vaccinia virus (VACV) that affects milk production and is an occupational zoonosis. This research had the following objectives: (i) detection of VACV by qPCR in cattle with clinical suspicion of vesicular disease; (ii) symptoms characterization in animals and milkers with clinical suspicion of the disease and virus detection in humans; and (iii) identification of risk factors for infections of VACV in herds from several Brazilian states. A total of 471 bovine epithelial samples from dairy farms, in 15 Brazilian states, were evaluated between 2007 and 2012. The samples were tested by quantitative PCR (qPCR) using SYBR Green® reagents, validated with a lower limit of detection of 100TCID50/50µL (1.7x100 viral particles), and 45.1% of VACV positive samples were detected. Using official forms for epidemiological investigation (FORM-IN), the risk factors for VACV infections in cattle were determined to be farms with a lack of technological facilities (P= 0.029) and the presence of rodents (P= 0.001). There was an effect of seasonality in cattle with a higher occurrence of BV during the dry season. A total of 420 epidemiological questionnaires were applied at public health care centers, where 100% of the milkers had vesicular lesions on their hands (98.1%) and on their arms (6.9%). The most frequent clinical symptoms in humans were: local swelling (74.2%), headache (20.7%), fever (10.4%) and inguinal lymphadenopathy (74.2%). Only 19.98% of milkers aged between 39 and 58 years were seroreactive to VACV and were immunized with the human anti-smallpox vaccine. There was an increase in the frequency of BV in older individuals due to their natural decrease in specific immunity. It has been shown that the implementation of zootechnical management techniques and health planning are important for the prevention of BV in animals and humans.

RESUMO: Vaccinia bovina (VB) é uma doença vesicular induzida pelo Vaccinia virus (VACV) que afeta a produção de leite e é uma zoonose ocupacional. Este trabalho teve os seguintes objetivos: (i) detecção de VACV por qPCR em bovinos com suspeita clínica de doença vesicular; (ii) caracterização dos sintomas apresentados por animais e ordenhadores com suspeita clínica da doença e detecção do vírus em humanos; e (iii) identificação de fatores de risco para infecção por VACV em rebanhos de vários estados brasileiros. Um total de 471 amostras de epitélio bovino de fazendas leiteiras, em 15 estados brasileiros, foram avaliados entre 2007 e 2012. As amostras foram testadas por PCR quantitativa (qPCR) usando reagentes SYBR Green®, validados com um limite inferior de detecção de 100TCID50/50μL (1,7x100 partículas virais) e 45,1% das amostras positivas de VACV foram detectadas. Usando formulários oficiais de investigação epidemiológica (FORM-IN), os fatores de risco para infecções por VACV em bovinos foram determinados como fazendas com falta de instalações tecnológicas (P=0,029) e presença de roedores (P=0,001). Houve um efeito da sazonalidade no gado com maior ocorrência de VB durante a estação seca. Um total de 420 questionários epidemiológicos foram aplicados nos centros públicos de saúde, onde 100% dos ordenhadores apresentaram lesões vesiculares nas mãos (98,1%) e nos braços (6,9%). Os sintomas clínicos mais frequentes em humanos foram: inchaço local (74,2%), cefaleia (20,7%), febre (10,4%) e linfadenopatia inguinal (74,2%). Apenas 19,98% dos produtores de leite com idade entre 39 e 58 anos foram sororreagentes ao VACV e foram imunizados com a vacina contra a varíola humana. Houve um aumento na frequência de BV em indivíduos mais velhos devido à sua diminuição natural na imunidade específica. Demonstrou-se que a implementação de técnicas de gestão zootécnica e planejamento sanitário são importantes para a prevenção da VB em animais e seres humanos.

ABSTRACT: Bovine vaccinia (BV) is a vesicular disease induced by the Vaccinia virus (VACV) that affects milk production and is an occupational zoonosis. This research had the following objectives: (i) detection of VACV by qPCR in cattle with clinical suspicion of vesicular disease; (ii) symptoms characterization in animals and milkers with clinical suspicion of the disease and virus detection in humans; and (iii) identification of risk factors for infections of VACV in herds from several Brazilian states. A total of 471 bovine epithelial samples from dairy farms, in 15 Brazilian states, were evaluated between 2007 and 2012. The samples were tested by quantitative PCR (qPCR) using SYBR Green® reagents, validated with a lower limit of detection of 100 TCID50/50µL (1.7x100 viral particles), and 45.1% of VACV positive samples were detected. Using official forms for epidemiological investigation (FORM-IN), the risk factors for VACV infections in cattle were determined to be farms with a lack of technological facilities (P=0.029) and the presence of rodents (P=0.001). There was an effect of seasonality in cattle with a higher occurrence of BV during the dry season. A total of 420 epidemiological questionnaires were applied at public health care centers, where 100% of the milkers had vesicular lesions on their hands (98.1%) and on their arms (6.9%). The most frequent clinical symptoms in humans were: local swelling (74.2%), headache (20.7%), fever (10.4%) and inguinal lymphadenopathy (74.2%). Only 19.98% of milkers aged between 39 and 58 years were seroreactive to VACV and were immunized with the human anti-smallpox vaccine. There was an increase in the frequency of BV in older individuals due to their natural decrease in specific immunity. It has been shown that the implementation of zootechnical management techniques and health planning are important for the prevention of BV in animals and humans.

Abstract. Muscle MRI has emerged as a valuable tool in the diagnosis of neuromuscular-disorders. The Dixon fat-water separation technique allows objective intra-muscular fat quantification. There are few reports concerning measurement standardisation with Dixon technique. The objective of this study was to evaluate the variability in fat quantification using Dixon's technique in a cohort of patients with congenital myopathies, by analysing intra-segment, intra-muscle, and inter-muscle variability of 60 muscles in each patient. Whole body MRI was performed on 31 patients, 23 with congenital myopathies and 8 healthy controls, aged between 10 months and 35 years old, from January 2014 to June 2016. The mean fat-fraction in healthy patients was around 5%, with less than 2% intra-muscle variability. An intra-muscle variability between 3.1-7.8% was estimated in patients with congenital myopathies. It may be concluded that there is high intra- and inter-muscle fat-fraction variability among patients with congenital myopathies, and this is an observation that should be incorporated in the analysis of fat replacement.

Resumen. La resonancia magnética muscular ha emergido como una valiosa herramienta de apoyo diagnóstico en enfermedades neuromusculares. La técnica de Dixon permite objetivar la fracción grasa muscular, pero no existe consenso sobre la estandarización de estas mediciones. El objetivo de este estudio fue evaluar la variabilidad en la determinación de fracción grasa utilizando la técnica de Dixon, estudiando la variabilidad intrasegmentaria, intramuscular e intermuscular en 60 músculos por paciente. Se realizó RM de cuerpo completo a 31 pacientes: 23 con miopatía congénita y 8 controles, entre 10 meses y 35 años de edad, desde enero del 2014 a junio del 2016. En pacientes sanos se estimó una fracción grasa promedio cercana al 5%, con una variabilidad intramuscular inferior al 2%. En pacientes con miopatías congénitas existe una variabilidad entre el 3,1-7,8%. El estudio permite concluir que existe una alta variabilidad intra e intermuscular en pacientes miopáticos, que no se observa en pacientes sanos.

Hereditary muscular diseases are rare disorders, due to a genetic defect that causes an alteration in the structure or function of the muscle fibers. They may present at any stage of life and their definitive diagnosis usually requires muscle biopsy. While the most frequent hereditary myopathies have a relatively characteristic clinical presentation, there is a substantial part thereof in which the symptoms are non-specific and the definitive diagnosis may take a long time. Magnetic Resonance Imaging (MRI) has earned a place in the diagnostic process of this last group of myopathies, confirming the presence of muscle involvement and raising diagnostic approaches based on its distribution, information that guides the immunohistochemical and/or genetic study necessary for the definitive diagnosis. In this article we review the basic study protocols with MRI of the myopathies and their interpretation, also showing some cases of these diseases.

Las enfermedades musculares hereditarias son patologías raras, debidas a un defecto genético que causa una alteración en la estructura o funcionamiento de las fibras musculares. Pueden debutar en cualquier etapa de la vida y su diagnóstico definitivo suele requerir de biopsia muscular. Si bien las miopatías hereditarias más frecuentes tienen una presentación clínica relativamente característica, existe una parte importante de ellas en que los síntomas son poco específicos y su diagnóstico definitivo puede tomar largo tiempo. La Resonancia Magnética (RM) ha ganado un espacio en el proceso diagnóstico de este último grupo de miopatías, confirmando la presencia del compromiso muscular y planteando aproximaciones diagnósticas en base a su distribución, información que acota el estudio inmunohistoquímico y/o genético necesario para el diagnóstico definitivo.En el presente artículo revisaremos los protocolos de estudio básico con RM de las miopatías y su interpretación, mostrando también algunos casos de estas enfermedades.

Background: Spinal Muscular Atrophy (SMA) is an autosomal recessive disorder affecting the anterior horn cells of the spinal cord resulting in muscle weakness and atrophy, linked to the homozygous disruption of the survival motor neuron 1 (SMN1) gene. It is the leading genetic cause of infant death. It has been classified into three types based on the severity of symptoms. Type I SMA is the most severe form with death within the first 2 years of life. Type II and III SMA patients show intermediate and mild forms of the disorder. Aim: To describe the clinical and electrophysiological findings of 26 Chilean patients with SMA with molecular confirmation. Patients and Methods: Retrospective multicenter analysis of patients with SMA assessed between 2003 and 2010. The diagnosis was suspected on clinical and electrophysiological criteria. Since 2006 molecular genetics confirmation was implemented in one of our centers. Results: Twenty-six patients between 2 months and 18 years of age at presentation were analyzed; 15 (58%) were males. SMA I, II and III clinical criteria were observed in 4 (15.4 %), 11 (42.3%) and 11 (42.3%)patients, respectively. All had proximal muscle weakness and atrophy. Electromyography showed features of acute denervation or re-innervation with normal motor and sensory nerve conduction. Nine patients required a muscle biopsy. The genetic confirmation of the disease by PCR technique followed by restriction fragment length polymorphism method disclosed the SMN1 gene deletion in all 26 cases. All patients died secondary to respiratory failure, between eight and 14 months of life. Conclusions: An adequate clinical and molecular diagnosis of spinal muscular atrophy will help for a better management of these patients.

Satoyoshi  syndrome is a rare multisystemic disease of presumed autoimmune etiology characterized by progressive painful intermittent muscle spasms, diarrhea frequently associated with malabsorption, alopecia, skeletal abnormalities and endocrine disorders with a poor long-term prognosis due to early crippling. We report a 14-year-old Chilean girl with clinical and radiological features of the syndrome who has been successfully treated with prednisone and carbamazepine. She remarkably recovered from muscle spasms, alopecia and diarrhea. At follow up, 24 months later, she persists asymptomatic with considerable improvement in her quality of life.

Background: Tourette syndrome is a neuropsychiatric disorder characterized by motor and vocal tics, attentional deficit, poor control of impulses and obsessive compulsive disorder. Pharmacological treatment is often disappointing due to partial response and frequent poor tolerance to neuroleptic drugs which are otherwise the most effective therapy so far. Aim: To report a lasting improvement obtained with a new drug, aripiprazole that acts modulating both dopaminergic and serotoninergic neurotransmission. Material and methods: Ten patients refractory to their usual therapy, aged 10 to 35 years, were switched to aripiprazole in an open trial. Results: Nine of the 10 patients showed a significant response assessed by the Yale severity tics rating scale and the clinical global impression scale (p <0.01). No relevant adverse effects were observed. Conclusions: Aripiprazole may be a good pharmacological option for patients with Tourette syndrome

Neurological abnormalities associated with spiculated, "acanthocytic" red cells in blood have been described as neuroacanthocytosis. This is a heterogeneous group of conditions that can be clearly subdivided on the basis of recent genetic findings. The McLeod Syndrome, one of the core neuroacanthocytosis syndromes, is a rare X-linked disorder caused by mutations of the XK gene, an X-chromosomal gene of unknown function characterized by haemopoietic abnormalities and late-onset neurological and muscular defects. We report two Chilean brothers with the McLeod phenotype who showed important psychiatric features. The diagnosis may be elusive if the presence of acanthocytosis is not properly studied. We describe a method which allowed the diagnosis that unmasked acanthocytosis. Otherwise the condition could have remained undiagnosed as it had been for decades in this family. This syndrome must be considered when assessing a familial movement disorder, specially affecting males with relevant psychiatric features. A reliable test for acanthocytosis assessment is available