Falls Predict Acute Hospitalization in Parkinson's Disease.

BACKGROUND: There is a need for identifying risk factors for hospitalization in Parkinson's disease (PD) and also interventions to reduce acute hospital admission. OBJECTIVE: To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort. METHODS: PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson's DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit. RESULTS: Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up after the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065-5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319-6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757-8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124-4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080-8.322; p = 0.035) was an independent predictor of AH. CONCLUSION: Falls is an independent predictor of AH in PD patients.

Sleep apnea syndrome and patent foramen ovale: a dangerous association in ischemic stroke?

BACKGROUND: The coexistence of patent foramen ovale (PFO) and sleep apnea syndrome (SAS) might be related to the pathogenesis of cryptogenic stroke (CS). We aimed to determine the prevalence of SAS in patients with cryptogenic stroke and PFO. METHODS: This is a prospective case-control study in which we included ischemic stroke patients consecutively admitted to our hospital's Acute Stroke Unit. Contrast transcranial Doppler (c-TCD) and sleep polygraphy within the first 72 h after stroke onset were performed to detect PFO and SAS. Demographic and clinical characteristics, time of stroke onset, score in the National Institute of Health Stroke Scale (NIHSS), and stroke subtype were registered. RESULTS: A total of 97 patients were studied. Overall, 76% were men, with a mean ± SD age of 61 ± 13 years, and an NIHSS of 5 ± 5. Subtype of stroke was cryptogenic (CS) in 28 (29%) and non-CS in 69 (71%) of patients. PFO was more frequent among patients with CS (64% vs 29%, p = 0.002) and without SAS (60% vs 32%, p = 0.013). SAS was diagnosed in 74% of the whole group, with a higher prevalence in patients with known stroke etiology (83% vs 53%, p = 0.003). Finally, the prevalence of SAS and PFO coexistence was similar in patients with or without cryptogenic stroke (25% vs 22%, p = 1), and when comparing the group of patients with cryptogenic wake-up stroke to the other stroke patients (43% vs 21%, p = 0.35). CONCLUSIONS: According to our results, there is no evidence of an association of PFO and SAS in the pathogenesis of cryptogenic stroke.

[The application of telemedicine for stroke in the Balearic Islands: the Balearic Telestroke project]. / Telemedicina aplicada al ictus en las Islas Baleares: el proyecto Teleictus balear.

INTRODUCTION: Currently, clinical benefits of stroke units and thrombolysis in ischaemic stroke are evidence-based. However, inequities in coverage and in treatment provided to these patients still persist due to geographical differences in residence, technological capacity and organization among health care systems. Telestroke is considered to be an effective tool for reducing inequities in coverage and health outcomes of stroke patients. DEVELOPMENT: This paper reviews the requirements of implementation of telestroke units, their deployment in the Health Service of the Balearic Islands, and the main experiences reported so far. Further, preliminary results of an ongoing formal assessment of effectiveness and safety of telestroke relative to conventional stroke treatment are advanced. CONCLUSIONS: Implementation of a telestroke system is feasible and allows increasing specialized treatment coverage. The Health Service of the Balearic Islands is fulfilling its goal of improving thrombolysis coverage by means of telestroke. Its effectiveness and safety appear to be similar to those of conventional treatment.

[Head tremor]. / Temblor de la cabeza.

INTRODUCTION: Head tremor, either as an isolated symptom or as part of a symptomatic complex, occurs in patients with different neurological diseases. Little research has been carried out to analyse the clinical features of this neurological symptom. AIM: To review the symptomatology, aetiology and therapeutics of brain tremors. DEVELOPMENT: Two main types of brain tremor can be distinguished: tremor of the whole brain (holocephalic tremor) and segmented brain tremor (tremor of the jaw, tongue, chin, soft palate, task-specific, orthostatic orolingual and undetermined). Essential tremor, the main cause of brain tremor, and dystonic tremor give rise to holocephalic-type tremor in the vast majority of cases. Brain tremor in Parkinsonism is characteristically of the segmented type. The effectiveness of the pharmacological treatment of brain tremor is very limited. Botulinum toxin is a promising therapy for brain tremors of any causation. In severe cases of brain tremor, functional surgery by means of deep brain stimulation of the intermediate ventral thalamic nucleus is useful, but must be performed bilaterally. CONCLUSIONS: The semiological characteristics of brain tremor are a valuable aid in the aetiological diagnosis. Pharmacological therapy is very limited. Botulinum toxin and functional surgery of the intermediate ventral thalamic nucleus are useful in selected patients.