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Friday, August 04, 2006

Half'-brain can become Full brain?


I have just finished reading and analyzing 2 journalistic information appeared yesterday, in La República and in El Comercio, related to ablative surgery [extirpation http://www.elcomercioperu.com.pe/edicionimpresa/html/2006%2D08%2D03/imecvidayfuturo0551974.html of part of brain´s temporal lobe - frequent seat of epilepsy focus and isolation of the : frontal-amigdalian-insular lobes, from the temporal lobe] and functional disconnection of both cerebral hemispheres (left epileptic brain, isolated), in order to control refractory epilepsies to the treatment with anticonvulsivant medicines. As it is read in both articles and according to declared by the surgeon which operated to Alonso Muñoz Espinoza (11 years old), the seizures attacks has disappeared completely, 40 days after made the surgery (¿it is not 1 year the recommendable period of observation?). As the news lacks an adequate reply, the readers have assimilated the note, as an epic episode. We estimate, that we must in this point, to adapt to the humility of Ian Wilmut (cloner of the Dolly ewe), who after 279 failed attempts and one single successful, said that he needed much to learn. There is a feeling of certain lacking things in the journalistic notes, because we need alternative and opposite offering opinions, in scientific subjects so controverted as the present. If this news had been published by BBC online, The Guardian unlimited, NYTimes, Die Welt, Le Monde, etc, we have the security that they had leaned next to the main note, at least one contrary opinion. With greater reason if there are only single 4 peruvian cases of Rasmussen Syndrome, if it is the first operation (little experience) and is performed in the brain : an organ in which every physical nanospace, is vital.

We need here, several specialists, in order to think and clarifies advantages and disadvantages to short and long term (motor body and speech paralysis, cognitives, http://jnnp.bmjjournals.com/cgi/content/full/75/1/149 spatial and view’s fields inadequations, subdural hemorrhage, postsurgical death, meningitis, etc), of this type of surgery (hemispherectomy), that implies functional lack of average half brain and elimination of certain basic connections. We know that hemispherectomy has more chances of success if the patient is smaller in age (3-4 years), because the brain’s plasticity tend to turn the half brain into a complete one, according to the law of compensation (an extirpated kidney promotes the hipertrophy of the other). However, we intuited, that within few years the made thing, could be considered an act of barbarism or, yatrogeny (bad surgical procedure), like we now viewed certain surgical procedures of the recent past, – in that time considered the best-. It is not possible to be said: - we do this, because it is the unique procedure that we have in as much., because other alternatives exist. For us cerebral surgery, must be limited only to 100 % successful procedures (elimination of hemorrhages, suture of blood vessels, growing tumors, etc).

Ethically and reasonable we must promote non-invasive treatments without breaking delicate neuronal networks (the best construction of the nature, until now). In several studied cases of refractory epilepsy, the biopsies demonstrate glial tissue almost always glial in nature http://www.braintumor.org/patient_info/surviving/tumor_types/gliomas.html(gliomas), interposed between active neurons, opposing to the flow of the normal electric trasmission, which promotes fast, massive, hypersincronic unloading of neurons to overcome obstacles, establishing epileptoids focus. Would not be better chance, to overcome these average obstacles making them less bloody?, like implanting in the cerebral cortex: artificial nano-neurotrasmitters to restore deteriorated electric impulses, or, to seed cerebral silenced areas, with stem cell or, pieces of peritoneum in order to pave or, bypass them.

?Un solo hemisferio cerebral, puede reemplazar a un cerebro completo?

-Acabo de leer y analizar 2 informes periodisticos aparecidos el dia de ayer, en La República y El Comercio, relacionados con cirugía ablativa [extirpación de parte del lóbulo temporal - asiento frecuente de focos epileptógenos y aislamiento de los lóbulos : frontal-amigdaliano-insular-, del lóbulo temporal] y desconexión funcional de ambos hemisferios cerebrales (aislando al epileptógeno, izquierdo), a fin de controlar epilepsias refractarias al tratamiento con medicamentos anticonvulsivantes. Como consta en ambos articulos y a lo declarado por el cirujano que operó al niño: Alonso Muñoz Espinoza (11 años), los ataques convulsivos han desaparecido por completo, 40 dias después de realizada la operación (¿no es 1 año, el periodo de observación?). Como la noticia, carece de réplica, los lectores han asimilado la nota, asumiéndola como una hazaña épica. Estimo, debiésemos, en este punto, apropiarnos de la humildad de Ian Wilmut (clonador de la oveja Dolly), quien trás 279 intentos frustros y solo 1 exitoso, afirmó que le faltaba mucho por aprender. Hay cierta incompletud en las notas periodisticas, al casi nunca ofrecer opiniones alternas u, opuestas, en temas cientificos tan controvertidos como el presente. Si esta noticia hubiese sido propalada por BBC online, The Guardian unlimited, NYTimes, Die Welt, Le Monde, etc, tengan la seguridad de que hubiesen adosado al lado de la nota principal, por lo menos una opinión contraria. Con mayor razón si solo existen 4 casos de Síndrome de Rasmussen en el Perú, se opera por primera véz (experiencia escasa) y en un órgano, donde c/ nanoespacio fisico, es vital.

Se necesitaba acá, que varios especialistas, opinen y aclaren beneficios y consecuencias a corto y largo plazo (parálisis motoras y del habla, inadecuaciones cognitivas y de los campos visuales, hematomas subdurales, muerte, meningitis postquirúrgicas,etc), de este tipo de cirugía (hemisferectomia), que implica pérdida funcional de medio cerebro, eliminadora de ciertas conexiones básicas de un correcto funcionamiento cerebral. Sabemos que la hemisferectomia, tiene más probabilidades de éxito, cuanto menor edad (3-4 años), tenga el paciente, en razón de la plasticidad cerebral que tenderia a convertir medio cerebro en uno completo, en función de la ley de compensación (un riñón extirpado promueve compensatoriamente, la hipertrofia del otro). No obstante, intuimos, que dentro de pocos años, lo realizado, podria ser también visto como un acto de barbarie o, yatrogenia (mala práctica), médica -tal como ahora visualizamos ciertos procedimientos quirúrgicos -de hace algunos años atrás- estimados como buenos-. No se puede decir : -hacemos esto, porque es lo único que tenemos- en tanto, existen otras alternativas. Para nosotros la cirugia cerebral, deberia limitarse a procedimientos 100 % exitosos (eliminación de hematomas, sutura de vasos, tumores de crecimiento rápido, etc).

Lo ético y razonable debiese ser la promoción de tratamientos no invasivos, promotores de un buen funcionamiento cerebral, sin romper delicadas redes neuronales (la más preciosa construcción realizada por la naturaleza hasta ahora). En casos bien estudiados de epilepsia refractaria, las biopsias casi siempre demuestran tejido glial (gliomas), interponiéndose entre neuronas activas, oponiéndose al flujo de la actividad eléctrica trasmisora normal, lo que insta a las neuronas a descargar rápida, masiva e hipersincrónicamente, para vencer el obstáculo, estableciendo focos epileptógenos. No seria mejor acaso, vencer estos obstáculos por medios menos sangrientos?, como implantar en la corteza cerebral nano-neurotrasmisores artificiales para restablecer impulsos eléctricos deteriorados, o, sembrar áreas cerebrales silenciadas, con células madre o, trozos de peritoneo, a fin de viabilizarlas o, bypasearlas?.
























































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