[Clinical trial with educational intervention in perimenopausal women with cardiovascular risk factor]. / Ensayo clínico con intervención educativa en mujeres perimenopáusicas con un factor de riesgo cardiovascular.

OBJECTIVE: To assess whether an educational intervention in women in perimenopausal age with diabetes mellitus, hypertension and/or dyslipidemia could improve aspects of quality of life and exercise. METHODS: A randomized clinical trial. VARIABLES: physical activity, quality of life and weight in women aged 45-60 years (n = 320) at time 0 and 12 months after surgery. intervention group (IG): 3 interactive workshops on cardiovascular disease prevention and control group (CG): information by mail. RESULTS: The IG obtained better scores on the mental component of quality of life one year later (p < 0.05) and showed a significant increase in physical activity (p < 0.01). GI women maintained their weight while in CG women it increased (p < 0.01). CONCLUSIONS: A simple educational intervention in premenopausal women with a cardiovascular risk factor improves aspects of quality of life and of healthy habits such as physical activity.

Associated Inosine to interferon: results of a clinical trial in multiple sclerosis.

BACKGROUND: Uric acid (UA) could act as a natural peroxynitrite scavenger with antioxidant properties. It has been proposed that hyperuricemia might protect against multiple sclerosis (MS). METHODS: Patients with relapsing-remitting MS starting treatment with interferon beta-1a 44 µg sc 3/week were randomly assigned to receive either inosine 3 g/day or placebo in a double-blind manner. Follow-up was 12 months. Outcome measures were adverse events and UA laboratory results. Secondary end point was clinical and radiological activity of MS. Relapse rates, percentage of patients without relapses, and progression to secondary MS (SPMS) were assessed. RESULTS: Thirty six patients were included. Two patients in the inosine group showed UA serum level above 10 mg/ml, and symptoms derived from renal colic not leading to hospital admission. Ten additional patients had asymptomatic hyperuricemia (>7 mg). Efficacy parameters (clinical and radiological) were similar between groups. No patient progressed to SPMS CONCLUSIONS: Inosine administration was associated with hyperuricemia and renal colic with no additional effect on MS. We cannot conclude inosine is a safe and well-tolerated drug. Doses of around 2 g/day may be more appropriate for future trials.

Epilepsy training needs for Spanish neurologists: ARPE study results.

INTRODUCTION: This study was designed to create an updated training program on epilepsy to solve whatever problems that general neurologists may detect in patients during consults. OBJECTIVES: To understand general neurologists' training needs in order to plan a specific program that may improve/standardize the clinical management of patients with epilepsy. MATERIAL AND METHODS: 122 general neurologists non-subspecialized on epilepsy were surveyed in all regions of Spain regarding the following issues: initial diagnosis, treatment, special situations by population group and/or comorbidity, prognosis and follow-up as well as whatever other topics the training program should cover. RESULTS: Neurologists agreed that treatment was the most interesting topic for them (100%), followed by diagnosis (46.67%), special situations by population group and/or comorbidity (30%), and prognosis/follow-up (7.14%). There were insignificant differences attributable to age and sex. CONCLUSIONS: Training ensures success, provided that it takes into account pedagogical considerations and professional targets to be trained, as well as technological and formal issues.

[Catastrophes caused by neurologic diagnostic procedures]. / Catástrofes derivadas de las técnicas complementarias de diagnóstico neurológico.

Serious complications (catastrophes) resulting from diverse neurological diagnostic procedures can be caused by erroneous indication and omission, as well as by delay and erroneous execution or interpretation. Headache, caused by cerebrospinal fluid (CSF) hypotension, is a frequent complication of lumbar puncture; hematic patch is a therapeutic option for severe cases. The most serious complication is cerebral herniation and, for its prevention, computed tomography (CT) or cerebral magnetic resonance imaging (MRI) must always be performed before lumbar puncture: a lesion with evident mass effect is a contraindication. Some cases of minor subarachnoid hemorrhages can produce sentinel headache: when the findings of CT scans are normal, lumbar puncture must be performed for diagnosis and prevention of a catastrophic recurrence. Edrophonium testing can be complicated with bradycardia and/or asystole. The lack of indication of this procedure is a cause of under-diagnosis of myasthenia gravis, especially in older people. Electromyography produces few complications (rare cases of paraspinal hematomas and pneumothorax). Ultrasound, CT angiography and MR angiography examinations have decreased the indications for cerebral angiography, whose main complications -in addition to contrast reactions, hemorrhage and infection at the injection site- are neurological deficits caused by vascular dissection or atheromatous embolus. Video-electroencephalogram (EEG) recording with medication suppression can be used in the presurgical evaluation of epilepsy, which can precipitate repeated seizures with the risk of injuries and status epilepticus. The possible complications of studies performed with invasive electrodes are infections and intracranial hemorrhages. Cerebral biopsy is indicated when treatable disease is suspected but the therapeutic options (radiotherapy, chemotherapy) have potential serious adverse effects. Furthermore, cerebral biopsy can aggravate previous neurological deficits or produce new deficits. Genetic testing is not indicated in healthy children when an untreatable disease is suspected. In adults, genetic testing is appropriate in selected cases, but detailed previous information should be gathered and the possibility of triggering serious emotional reactions should always be considered.

[Isolated hypoglossal nerve palsy secondary to an atlantoccipital joint synovial cyst. Case report and literature review]. / Parálisis aislada del nervio hipogloso secundaria a quiste articular atlanto-occipital. Presentación de un caso y revisión de la literatura.

Hypoglossal nerve palsy is commonly associated with the involvement of other cranial nerves. His injury is rarely isolated. We present a patient in which paralysis is due to the presence of a "juxtafacet cyst" of the atlanto-occipital joint. We review the anatomy of the hypoglossal nerve, different therapeutic options, the differential diagnosis and papers published to date.

[Music and neurology]. / Música y neurología.

Music perception and output are special functions of the human brain. Investigation in this field is growing with the support of modern neuroimaging techniques (functional magnetic resonance imaging, positron emission tomography). Interest in the music phenomenon and the disorders regarding its processing has been limited. Music is not just an artistic activity but a language to communicate, evoke and reinforce several emotions. Although the subject is still under debate, processing of music is independent of common language and each one uses independent circuits. One may be seriously affected and the other practically unharmed. On the other hand, there may be separate channels within the processing of music for the temporary elements (rhythm), melodic elements (pitch, timbre, and melody), memory and emotional response. The study of subjects with absolute pitch, congenital and acquired amusias, musicogenic epilepsy and musical hallucinations has greatly contributed to the knowledge of how the brain processes music. Music training involves some changes in morphology and physiology of professional musicians' brains. Stress, chronic pain and professional dystonias constitute a special field of musicians' disturbances that concerns neurological practice. Listening to and playing music may have some educational and therapeutic benefits.

[Simultaneous meningitis caused by Candida and tuberculosis as manifestation of AIDS]. / Meningitis simultánea por candida y tuberculosis como debut de SIDA.

Opportunistic germs meningoencephalitis plays an important role within neurologic pathology in aids. Treponema pallidum and Mycobacterium tuberculosis among bacteries, Cryptococcus neoformans in fungus group, Toxoplasma gondii in protozoos group and Papovavirus JC in virus one are the most frequently implicated germs. Sometimes infections are mixed. We present a simultaneous meningitis case produced by Candida albicans and Mycobacterium tuberculosis that coursed with neutrophilic pleocytosis in CSF and normal glucose CSF levels, consisting the clinical debut of aids. Repeated CSF examinations are the diagnostic clue owing, as in our case, instauration of early treatment. Present case of simultaneous tuberculous and candidiasic meningitis is the first one described in a HIV positive patient.

[Autosomal recessive chorea-acanthocytosis linked to 9q21]. / Corea-acantocitosis autosómica recesiva ligada a 9q21.

A 34-year-old male, son of consanguineous parents, had a progressive neurological illness characterized by seizures, tics, choreic movements and mood changes. Acanthocytosis was present in blood. The level of creatine kinase was elevated. Normobetalipoproteinemia was noted. No KX group changes of McLeod syndrome were found. Serial neuroimaging studies demonstrated progressive caudate atrophy. Muscular biopsy confirmed the existence of non-specific myopathy. Genetic study demonstrated homozigosity for the 9q21 region.