<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2631-2581</journal-id>
<journal-title><![CDATA[Revista Ecuatoriana de Neurología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Ecuat Neurol]]></abbrev-journal-title>
<issn>2631-2581</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Médica Ecuatoriana de Neurología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2631-25812023000300030</article-id>
<article-id pub-id-type="doi">10.46997/revecuatneurol32300030</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Disappointing Agreement In The Interpretation Of Neurological Adverse Events Following Immunization With SARS-Cov-2 Vaccines. A Case-Series Study.]]></article-title>
<article-title xml:lang="es"><![CDATA[Pobre Concordancia En La Interpretación De Eventos Adversos Neurológicos Después De La Inmunización Con Vacunas Contra El SARS-Cov-2. Estudio De Una Serie De Casos.]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nader-Kawachi]]></surname>
<given-names><![CDATA[Juan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Flores-Silva]]></surname>
<given-names><![CDATA[Fernando Daniel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gutierrez-Romero]]></surname>
<given-names><![CDATA[Alonso]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pino-Peña]]></surname>
<given-names><![CDATA[Yaima]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Flores-Aldama]]></surname>
<given-names><![CDATA[Marco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[H. Del Brutto]]></surname>
<given-names><![CDATA[Oscar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Soto-Ramírez]]></surname>
<given-names><![CDATA[Luis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peniche-Echazarreta]]></surname>
<given-names><![CDATA[Adriana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Médica Sur Hospital Neurology and Neurosurgery Center ]]></institution>
<addr-line><![CDATA[Mexico City ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Especialidades Espíritu Santo School of Medicine and Research Center ]]></institution>
<addr-line><![CDATA[Samborondón ]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Médica Sur Hospital Infectious Disease Service ]]></institution>
<addr-line><![CDATA[Mexico City ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Médica Sur Hospital Internal Medicine Service ]]></institution>
<addr-line><![CDATA[Mexico City ]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2023</year>
</pub-date>
<volume>32</volume>
<numero>3</numero>
<fpage>30</fpage>
<lpage>33</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.senescyt.gob.ec/scielo.php?script=sci_arttext&amp;pid=S2631-25812023000300030&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.senescyt.gob.ec/scielo.php?script=sci_abstract&amp;pid=S2631-25812023000300030&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.senescyt.gob.ec/scielo.php?script=sci_pdf&amp;pid=S2631-25812023000300030&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Background:  A sizable proportion of the world's population has been vaccinated to prevent SARS-CoV-2 infections. In clinical practice, however, almost any neurological manifestation occurring after vaccination has been attributed to the vaccine, generating doubts on their safety. In 2013, the WHO created the Adverse Event Following Immunization (AEFI) criteria to establish the relationship between a vaccine and side effects, but they seem not to dispel doubts regarding severity and causality of neurological events following SARS-CoV-2 vaccination. This study aims to analyze consistency of the AEFI to designate probable side effects of SARS-CoV-2 vaccines among patients who develop neurological symptoms after vaccination.  Methods:  We measured the level of agreement using the Fleiss kappa methodology. Seventeen observers (five neurologists, four infectious disease specialists, and eight internal medicine residents) independently rated 11 cases treated in our service presenting neurological symptoms within 21 days after SARS-CoV-2 vaccination according to the AEFI criteria.  Results:  We found low concordance agreements among the 17 raters regarding severity (k=0.088) and causality (k=0.025). When analyzing by raters&#8217; subgroups, agreement for severity was moderately higher among neurologists (k=0.383) and for causality among internal medicine residents (k=0.117).  Conclusions:  AEFI criteria do not allow, by themselves, to establish the relationship between a vaccine and adverse neurological effects. Therefore, it is essential to create more useful tools that allow doctors and lay people to be more confident in this challenge.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Antecedentes:  Una proporción considerable de la población mundial ha sido vacunada para prevenir infección por SARS-CoV-2. En la práctica clínica, sin embargo, casi cualquier manifestación neurológica que se produzca después de la vacunación se ha atribuido a la vacuna, generando dudas sobre su seguridad. En 2013, la OMS creó los criterios de Efectos Adversos Posteriores a la Inmunización (AEFI), por sus siglas en inglés, para establecer la relación entre una vacuna y sus efectos secundarios, pero éstos parecen no disipar las dudas sobre la gravedad y la causalidad de la vacunación.  Métodos: Se midió el nivel de concordancia mediante la metodología kappa de Fleiss. Diecisiete observadores (cinco neurólogos, cuatro especialistas en enfermedades infecciosas y ocho residentes de medicina interna) calificaron de forma independiente 11 casos tratados en nuestro servicio, que presentaban síntomas neurológicos dentro de los 21 días posteriores a la vacunación contra el SARS-CoV-2 según los criterios de la AEFI.  Resultados:  Se encontró pobre concordancia entre los 17 evaluadores en cuanto a severidad (k=0,088) y causalidad (k=0,025). Al analizar por subgrupos de evaluadores, la concordancia para la gravedad fue moderadamente mayor entre los neurólogos (k = 0,383) y para la causalidad entre los residentes de medicina interna (k = 0,117).  Conclusiones:  Los criterios AEFI no permiten, por sí solos, establecer la relación entre una vacuna y efectos neurológicos adversos. Por lo tanto, es esencial crear herramientas más útiles que permitan a los médicos y legos tener más confianza en este desafío.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[SARS-CoV-2]]></kwd>
<kwd lng="en"><![CDATA[Covid-19]]></kwd>
<kwd lng="en"><![CDATA[Vaccine]]></kwd>
<kwd lng="en"><![CDATA[Adverse Event Following Immunization]]></kwd>
<kwd lng="en"><![CDATA[Kappa statistics.]]></kwd>
<kwd lng="es"><![CDATA[SARS-CoV-2]]></kwd>
<kwd lng="es"><![CDATA[Covid-19]]></kwd>
<kwd lng="es"><![CDATA[Efectos adversos luego de inmunización]]></kwd>
<kwd lng="es"><![CDATA[Estadísticas Kappa.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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