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Mayneris-Perxachs J, Arnoriaga-Rodríguez M, Garre-Olmo J, Puig J, Ramos R, Trelis M, Burokas A, Coll C, Zapata-Tona C, Pedraza S, Pérez-Brocal V, Ramió L, Ricart W, Moya A, Jové M, Sol J, Portero-Otin M, Pamplona R, Maldonado R, Fernández-Real JM. Presence of Blastocystis in gut microbiota is associated with cognitive traits and decreased executive function. ISME J 2022; 16:2181-2197. [PMID: 35729225 PMCID: PMC9381544 DOI: 10.1038/s41396-022-01262-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 05/28/2023]
Abstract
Growing evidence implicates the gut microbiome in cognition. Blastocystis is a common gut single-cell eukaryote parasite frequently detected in humans but its potential involvement in human pathophysiology has been poorly characterized. Here we describe how the presence of Blastocystis in the gut microbiome was associated with deficits in executive function and altered gut bacterial composition in a discovery (n = 114) and replication cohorts (n = 942). We also found that Blastocystis was linked to bacterial functions related to aromatic amino acids metabolism and folate-mediated pyrimidine and one-carbon metabolism. Blastocystis-associated shifts in bacterial functionality translated into the circulating metabolome. Finally, we evaluated the effects of microbiota transplantation. Donor's Blastocystis subtypes led to altered recipient's mice cognitive function and prefrontal cortex gene expression. In summary, Blastocystis warrant further consideration as a novel actor in the gut microbiome-brain axis.
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Affiliation(s)
- Jordi Mayneris-Perxachs
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain.
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
| | - María Arnoriaga-Rodríguez
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Serra-Hunter Fellow, Department of Nursing, University of Girona, Girona, Spain
| | - Josep Garre-Olmo
- Serra-Hunter Fellow, Department of Nursing, University of Girona, Girona, Spain
- Research Group on Aging, Disability and Health, Girona Biomedical Research Institute (IdibGi), Girona, Spain
| | - Josep Puig
- Serra-Hunter Fellow, Department of Nursing, University of Girona, Girona, Spain
- Institut Investigació Germans Trias i Pujol (IGTP), Comparative Medicine and Bioimage of Catalonia, Barcelona, Spain
- Medical Imaging, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Radiology (IDI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Rafael Ramos
- Serra-Hunter Fellow, Department of Nursing, University of Girona, Girona, Spain
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en Atenció Primària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Maria Trelis
- Parasite & Health Research Group, Department of Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Burjassot, 46100, Valencia, Spain
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, Valencia, Spain
| | - Aurelijus Burokas
- Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Clàudia Coll
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Cristina Zapata-Tona
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Serra-Hunter Fellow, Department of Nursing, University of Girona, Girona, Spain
| | - Salvador Pedraza
- Serra-Hunter Fellow, Department of Nursing, University of Girona, Girona, Spain
- Medical Imaging, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Radiology (IDI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Vicente Pérez-Brocal
- Area of Genomics and Health, Foundation for the Promotion of Sanitary and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Lluís Ramió
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Wifredo Ricart
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Serra-Hunter Fellow, Department of Nursing, University of Girona, Girona, Spain
| | - Andrés Moya
- Area of Genomics and Health, Foundation for the Promotion of Sanitary and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institute for Integrative Systems Biology (I2SysBio), University of Valencia and Spanish National Research Council (CSIC), Valencia, Spain
| | - Mariona Jové
- Department of Experimental Medicine, University of Lleida-Lleida Biomedical Research Institute (UdL-IRBLleida), E-25198, Lleida, Spain
| | - Joaquim Sol
- Department of Experimental Medicine, University of Lleida-Lleida Biomedical Research Institute (UdL-IRBLleida), E-25198, Lleida, Spain
- Institut Català de la Salut, Atenció Primària, Lleida, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain
| | - Manuel Portero-Otin
- Department of Experimental Medicine, University of Lleida-Lleida Biomedical Research Institute (UdL-IRBLleida), E-25198, Lleida, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, University of Lleida-Lleida Biomedical Research Institute (UdL-IRBLleida), E-25198, Lleida, Spain
| | - Rafael Maldonado
- Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
| | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain.
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
- Serra-Hunter Fellow, Department of Nursing, University of Girona, Girona, Spain.
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Palomo-Buitrago ME, Sabater-Masdeu M, Moreno-Navarrete JM, Caballano-Infantes E, Arnoriaga-Rodríguez M, Coll C, Ramió L, Palomino-Schätzlein M, Gutiérrez-Carcedo P, Pérez-Brocal V, Simó R, Moya A, Ricart W, Herance JR, Fernández-Real JM. Glutamate interactions with obesity, insulin resistance, cognition and gut microbiota composition. Acta Diabetol 2019; 56:569-579. [PMID: 30888539 DOI: 10.1007/s00592-019-01313-w] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023]
Abstract
AIMS To investigate the interactions among fecal and plasma glutamate levels, insulin resistance cognition and gut microbiota composition in obese and non-obese subjects. METHODS Gut microbiota composition (shotgun) and plasma and fecal glutamate, glutamine and acetate (NMR) were analyzed in a pilot study of obese and non-obese subjects (n = 35). Neuropsychological tests [Trail making test A (TMT-A) and Trail making test B (TMT-B)] scores measured cognitive information about processing speed, mental flexibility and executive function. RESULTS Trail-making test score was significantly altered in obese compared with non-obese subjects. Fecal glutamate and glutamate/glutamine ratio tended to be lower among obese subjects while fecal glutamate/acetate ratio was negatively associated with BMI and TMT-A scores. Plasma glutamate/acetate ratio was negatively associated with TMT-B. The relative abundance (RA) of some bacterial families influenced glutamate levels, given the positive association of fecal glutamate/glutamine ratio with Corynebacteriaceae, Coriobacteriaceae and Burkholderiaceae RA. In contrast, Streptococaceae RA, that was significantly higher in obese subjects, negatively correlated with fecal glutamate/glutamine ratio. To close the circle, Coriobacteriaceae/Streptococaceae ratio and Corynebacteriaceae/Streptococaceae ratio were associated both with TMT-A scores and fecal glutamate/glutamine ratio. CONCLUSIONS Gut microbiota composition is associated with processing speed and mental flexibility in part through changes in fecal and plasma glutamate metabolism.
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Affiliation(s)
- María Encarnación Palomo-Buitrago
- Department of Diabetes, Endocrinology and Nutrition, Hospital of Girona "Dr Josep Trueta", Institut d'Investigació Biomèdica de Girona (IDIBGI), Avinguda de França s/n, 17007, Girona, Spain
| | - Mònica Sabater-Masdeu
- Department of Diabetes, Endocrinology and Nutrition, Hospital of Girona "Dr Josep Trueta", Institut d'Investigació Biomèdica de Girona (IDIBGI), Avinguda de França s/n, 17007, Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERobn, CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Jose Maria Moreno-Navarrete
- Department of Diabetes, Endocrinology and Nutrition, Hospital of Girona "Dr Josep Trueta", Institut d'Investigació Biomèdica de Girona (IDIBGI), Avinguda de França s/n, 17007, Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERobn, CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Estefanía Caballano-Infantes
- Department of Diabetes, Endocrinology and Nutrition, Hospital of Girona "Dr Josep Trueta", Institut d'Investigació Biomèdica de Girona (IDIBGI), Avinguda de França s/n, 17007, Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERobn, CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - María Arnoriaga-Rodríguez
- Department of Diabetes, Endocrinology and Nutrition, Hospital of Girona "Dr Josep Trueta", Institut d'Investigació Biomèdica de Girona (IDIBGI), Avinguda de França s/n, 17007, Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERobn, CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Clàudia Coll
- Department of Neurology, Institut d'Investigació Biomèdica de Girona (IDIBGI), Hospital of Girona "Dr Josep Trueta", Girona, Spain
| | - Lluís Ramió
- Department of Neurology, Institut d'Investigació Biomèdica de Girona (IDIBGI), Hospital of Girona "Dr Josep Trueta", Girona, Spain
| | | | - Patricia Gutiérrez-Carcedo
- Medical Molecular Imaging Research Group, Vall d'Hebron Research Institute, Instituto de Salud Carlos III (ISCIII), CIBBIM-Nanomedicine, CIBER-bbn, Barcelona, Spain
| | - Vicente Pérez-Brocal
- Genomics and Health Area, Foundation for the Promotion of Sanitary and Biomedical Research (FISABIO), València, Spain
- CIBER de Epidemiology y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Endocrinology, Vall d'Hebron Research Institute, Instituto de Salud Carlos III (ISCIII), CIBERDEM, Barcelona, Spain
| | - Andrés Moya
- Genomics and Health Area, Foundation for the Promotion of Sanitary and Biomedical Research (FISABIO), València, Spain
- CIBER de Epidemiology y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Wifredo Ricart
- Department of Diabetes, Endocrinology and Nutrition, Hospital of Girona "Dr Josep Trueta", Institut d'Investigació Biomèdica de Girona (IDIBGI), Avinguda de França s/n, 17007, Girona, Spain
- CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERobn, CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - José Raúl Herance
- Medical Molecular Imaging Research Group, Vall d'Hebron Research Institute, Instituto de Salud Carlos III (ISCIII), CIBBIM-Nanomedicine, CIBER-bbn, Barcelona, Spain.
| | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Hospital of Girona "Dr Josep Trueta", Institut d'Investigació Biomèdica de Girona (IDIBGI), Avinguda de França s/n, 17007, Girona, Spain.
- CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERobn, CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain.
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Calvó-Perxas L, Turró-Garriga O, Aguirregomozcorta M, Bisbe J, Hernández E, López-Pousa S, Manzano A, Palacios M, Pericot-Nierga I, Perkal H, Ramió L, Vilalta-Franch J, Garre-Olmo J. Psychotropic drugs in patients with Alzheimer's Disease: a longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia, Spain. J Am Med Dir Assoc 2014; 15:497-503. [PMID: 24637090 DOI: 10.1016/j.jamda.2014.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/04/2014] [Accepted: 02/05/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Psychotropic drugs are usually prescribed to deal with behavioral and psychological symptoms of dementia, especially when nonpharmacologic approaches are not available or have limited efficacy. Poor outcomes and serious adverse events of the drugs used must be addressed, and risk-benefit ratios need to be considered. The aim of this longitudinal study was to describe the evolution of dispensation of psychotropic drugs in patients with Alzheimer's disease (AD) and to identify the associated demographic and clinical variables. METHODS Longitudinal study using 698 cases with AD included in the Registry of Dementias of Girona in 2007 and 2008 and followed up during 3 years. Drugs were categorized according to the Anatomical Therapeutic Chemical classification. Binary logistic regression analyses were used to detect the variables associated with the use of antipsychotics, selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and hypnotics. RESULTS Of the patients, 51.2% consumed antipsychotics at least once during the three years of the study, whereas 73.3% and 58.2% consumed SSRIs and anxiolytics, respectively; 32.8% used hypnotics. Antipsychotic use was associated with a diagnosis of AD with delusions) [odds ratio (OR) = 5.7] and with increased behavior disorders (OR = 1.2). Patients with AD with depressed mood were more likely to be treated with SSRIs (OR = 3.1), while being a woman was associated with increased dispensation of anxiolytics (OR = 1.9) and SSRIs (OR = 2.2). CONCLUSIONS Consumption of psychotropic drugs by the patients with AD registered in the Registry of Dementias of Girona is very high. Despite all the described adverse effects and recommendations of caution in their use, antipsychotics still are extensively used.
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Affiliation(s)
- Laia Calvó-Perxas
- Institute of Biomedical Investigation of Girona (IdIBGi), IAS Research Unit, Salt, Catalonia, Spain
| | - Oriol Turró-Garriga
- Institute of Biomedical Investigation of Girona (IdIBGi), IAS Research Unit, Salt, Catalonia, Spain.
| | | | - Josep Bisbe
- Neurology Department, Hospital d'Olot, Olot, Catalonia, Spain
| | - Erélido Hernández
- Dementia Unit, Serveis de Salut Integrats del Baix Empordà, Palamós, Catalonia, Spain
| | - Secundino López-Pousa
- Institute of Biomedical Investigation of Girona (IdIBGi), IAS Research Unit, Salt, Catalonia, Spain; Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain; Department of Medicine, University of Girona, Girona, Catalonia, Spain
| | - Anna Manzano
- Neurology Department, Hospital de Campdevànol, Campdevànol, Catalonia, Spain
| | - Mónica Palacios
- Pharmacy Unit, Health Region of Girona, Girona, Catalonia, Spain
| | | | - Héctor Perkal
- Geriatrics and Neurology Department, Hospital de Blanes, Blanes, Catalonia, Spain
| | - Lluís Ramió
- Neurodegenerative Disease Unit, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - Joan Vilalta-Franch
- Institute of Biomedical Investigation of Girona (IdIBGi), IAS Research Unit, Salt, Catalonia, Spain; Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain; Department of Medicine, University of Girona, Girona, Catalonia, Spain
| | - Josep Garre-Olmo
- Institute of Biomedical Investigation of Girona (IdIBGi), IAS Research Unit, Salt, Catalonia, Spain; Department of Medicine, University of Girona, Girona, Catalonia, Spain
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Ramió L, Rivera M, Ramírez A, Concha I, Peña A, Rigau T, Rodríguez-Gil J. Dynamics of motile-sperm subpopulation structure in boar ejaculates subjected to “in vitro” capacitation and further “in vitro” acrosome reaction. Theriogenology 2008; 69:501-12. [DOI: 10.1016/j.theriogenology.2007.10.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 10/23/2007] [Accepted: 10/29/2007] [Indexed: 11/28/2022]
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Sancho S, Rodríguez-Gil JE, Pinart E, Briz M, Garcia-Gil N, Badia E, Bassols J, Pruneda A, Bussalleu E, Yeste M, Casas I, Palomo MJ, Ramió L, Bonet S. Effects of exposing boars to different artificial light regimens on semen plasma markers and “in vivo” fertilizing capacity. Theriogenology 2006; 65:317-31. [PMID: 16009411 DOI: 10.1016/j.theriogenology.2005.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Revised: 05/11/2005] [Accepted: 05/12/2005] [Indexed: 11/17/2022]
Abstract
This study was designed to assess the effects of exposing boars to an artificial photoperiod on semen quality in terms of sperm concentration, sperm vitality, sperm motility and acrosome integrity. We also determined biochemical semen plasma variables, such as total protein concentration, phosphorylated tyrosine residues and fructose, glucose and sorbitol contents, along with their effects on the fertility, prolificacy and libido of the boars. Three groups of 10 males were kept for 3 months under experimental conditions of 24, 12 and 0 h of artificial light, and a constant temperature of 21 +/- 1 degrees C and 60-75% humidity. The animals were fed a nutritious diet and subjected to semen collection twice per week. Semen samples were analyzed throughout the entire experimental period. Our results indicate that, while the extreme photoperiods (0 and 24 h of light) affected semen quality in terms of sperm concentration, acrosome integrity and semen volume, its fertilizing capacity was only significantly reduced under conditions of absolute darkness. Sperm motility was found to be a poor indicator of fertilizing ability, while other sperm factors, such as acrosome integrity or other functional variables seemed to behave better. The photoperiod was found to affect the production of accessory sex gland secretions more than their composition. In addition, light effects on fertility, prolificacy and libido seemed to be achieved through independent mechanisms.
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Affiliation(s)
- S Sancho
- Biotechnology of Porcine Reproduction, University of Girona, Campus de Montilivi, s/n, 17071 Girona, Spain.
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Osuna MT, Burcet J, Ramió L, Ustrell X, Silva Y, Molins A. [Hyperammonemic encephalopathy associated with valproate acid]. Neurologia 2003; 18:347-50. [PMID: 12838456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
We report 4 clinical cases of hyperammonemic encephalopathy (HE) associated with valproate acid (VPA) and review the literature on its pathophysiology. In all four cases, hepatic function was normal and valproic levels were within the therapeutic range. Elevated ammonium levels were found as the only biochemical abnormality. Patients showed decreased level of consciousness, confusion, ataxia and seizures. In 1 case the EEG showed diffused triphasic waves with frontal predominance. After suppression of treatment with VPA there was remission of clinical manifestations, and ammonium levels returned to normal. In order to obtain the correct diagnosis of HE, in all patients treated with either VPA mono or polytherapy, ammonium levels should be considered.
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Affiliation(s)
- M T Osuna
- Sección de Neurología, Hospital Dr. Josep Trueta Girona, Palma de Mallorca, Spain.
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Segura T, Ramió L. [Bilateral polar infarct]. Neurologia 2000; 15:403. [PMID: 11195148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Affiliation(s)
- T Segura
- Sección de Neurología, Hospital Universitario Dr. Josep Trueta, Girona
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