[Evaluation of autonomic cardiovascular functioning in patients with syncope]. / Valoracion de la funcion autonomica cardiovascular en pacientes con sincope.

INTRODUCTION: According to the current literature on the subject, patients with syncope suffer a dysfunction of the autonomic nervous system (ANS). Yet few studies offer a clear explanation of this dysfunction. Moreover, the evaluation of cardiovascular reflexes is a simple, useful method of studying the functional status of the ANS. This work was designed to evaluate the existence of dysautonomia in syncope patients by means of the autonomic cardiovascular stimulation tests; it has been the most comprehensive of those published to date. SUBJECTS AND METHODS: We studied 170 healthy volunteers and 188 patients with syncopes in the previous months, paired by age and sex. Cardiovascular stimulation tests were conducted, in accordance with Ewing and Clark's methodology, together with the cold test. A rating scale was included to evaluate the symptoms related to ANS involvement. RESULTS: Syncope patients display lower reactivity in tests involving cardiovascular stimulation of the ANS, regardless of whether they are taken individually or as a whole (67% in patients and 39% in controls) (p = 0.0001), except in the cold test. They also show an increase in the clinical symptoms of an autonomic origin (2.82 +/- 0.17) with respect to control subjects (0.78 +/- 0.09) (p = 0.0001). CONCLUSIONS: Our syncope patients have a dysautonomia that appears as a sympathetic and parasympathetic hypofunction. These findings confirm the value of autonomic cardiovascular stimulation tests in the study of these patients. Moreover, the search for other symptoms of autonomic involvement can be a great aid in evaluating this pathology.

[Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in the province of Alicante]. / Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en la provincia de Alicante.

INTRODUCTION: Post-authorisation studies are important to confirm whether the outcomes of clinical trials are reproduced in usual clinical practice. AIMS: To evaluate the effectiveness and safety of fingolimod in clinical practice in the province of Alicante. PATIENTS AND METHODS: A retrospective multi-centre study was conducted with remitting multiple sclerosis patients treated with fingolimod. Demographic, clinical and pharmacological data were collected. We report on the effectiveness of the drug -annualised relapse rate (ARR) and percentage of patients free from attacks- at one and at two years after treatment in relation to the previous year, and data concerning side effects are also provided. RESULTS: The sample consisted of 89 patients. Previous treatment was with immunomodulators (interferon beta or glatiramer acetate) in 54 patients and natalizumab in 32. Fifty patients changed due to failure with the immunomodulator and 31 owing to positive serology for JC virus (JCV+). Overall ARR decreased by 67.3% the first year (p < 0.0001) and by 84.1% the second (p = 0.0078). It diminished in patients with immunomodulator failure (85.6% the first year, p < 0.0001; 88.9% the second year, p = 0.0039) and increased in a non-significant manner in JCV+ patients in the first year. The percentage of patients free from relapses in the overall population increased from 32.6% to 68.1% in the first year (p < 0.0019) and to 82.6% in the second (p = 0.0215). This increase was not observed in JCV+ patients. Side effects were reported by 13 patients, which led to the drug being withdrawn in two of them. CONCLUSION: In clinical practice in the province of Alicante, levels of effectiveness and safety of fingolimod proved to be slightly higher than those found in clinical trials.

TITLE: Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en la provincia de Alicante.Introduccion. Los estudios postautorizacion son importantes para confirmar si los resultados de los ensayos clinicos se reproducen en la practica clinica habitual. Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en la provincia de Alicante. Pacientes y metodos. Estudio multicentrico retrospectivo de pacientes con esclerosis multiple remitente tratados con fingolimod. Se recogen las caracteristicas demograficas, clinicas y farmacologicas. Se describe la efectividad del farmaco ­tasa anualizada de brotes (TAB) y porcentaje de pacientes libres de brotes­ al año y a los dos años de tratamiento en relacion con el año previo y datos de efectos secundarios. Resultados. Se incluyo a 89 pacientes. El tratamiento previo fue inmunomodulador (interferon beta o acetato de glatiramero) en 54 pacientes y natalizumab en 32. Cincuenta pacientes cambiaron por fracaso con el inmunomodulador y 31 por serologia positiva del virus JC (VJC+). La TAB global disminuyo el 67,3% el primer año (p < 0,0001) y el 84,1% el segundo (p = 0,0078). Disminuyo en los pacientes con fracaso del inmunomodulador (el 85,6% el primer año, p < 0,0001; el 88,9% el segundo año, p = 0,0039) y aumento de forma no significativa en los pacientes VJC+ en el primer año. El porcentaje de pacientes libres de brotes en la poblacion global aumento del 32,6 al 68,1% en el primer año (p < 0,0019) y al 82,6% en el segundo (p = 0,0215). Este aumento no se observo en los pacientes VJC+. Trece pacientes tuvieron efectos secundarios, que obligaron a la retirada del farmaco en dos de ellos. Conclusion. En la practica clinica de la provincia de Alicante, el fingolimod mostro una efectividad y una seguridad ligeramente superiores a las de los ensayos clinicos.

[Vertebrobasilar ischemia of thrombotic and embolic origin]. / Isquemia vertebrobasilar de origen trombótico y embólico.

OBJECTIVE: To analyze the mechanisms involved in the appearance of ischemia in vertebro-basilar territory, especially those of embolic or thrombotic characteristics. DEVELOPMENT: The mechanism of vertebro-basilar ischemia had not been adequately studied until a few years ago. This had led to the belief that most were due to a haemodynamic mechanism. However, in recent years studies of large numbers of patients, in whom cardiological and neurovascular evaluation had been systematically carried out, has shown that this is not so. In general, the commonest mechanism is embolism, both of arterial and of cardiac origin. Local thrombosis and a haemodynamic mechanism are less common. The arterial lesions most often associated with intra-arterial embolism have their origins in the intracranial segment of the vertebral artery. The most frequent sites of blockage by emboli are the distal segments of the basilar artery, the superior cerebellar artery, the posterior cerebral artery and the intracranial region of the vertebral artery-posteriorinferior cerebellar artery. CONCLUSIONS: The mechanism of vertebro-basilar ischemia is not homogeneous and can not be taken for granted in any patient in particular. For this reason it is necessary to carry out a full clinical study of patients with these symptoms, similar to that done for patients with carotid ischemia. This permits not only individualized, correct treatment of each patient but also a more complete knowledge of the mechanisms of ischemia in this territory.

[Neurology in Internet]. / Neurología en Internet.

OBJECTIVE: The quantity and complexity of the information to be found on the Internet makes anyone who has dared to navigate on the Net feel perplexed. To access the Net without a predetermined route to follow may prove to be a waste of time and very exasperating, as a tremendous amount of completely irrelevant information is discovered. The objective of this article is to give the reader of the REVISTA DE NEUROLOGIA an informative guide to help find useful information on the Net, and a classified list of potentially useful Internet addresses. DEVELOPMENT: We have analyzed the concept of 'search tool', and the types and characteristics of these. Specific search tools (both English and Spanish) which are currently available, are considered. We have searched the Net using various tool (Yahoo, Lycos, Altavista, Trobador and Olé) to find relevant information for the terms 'neurosciences' and 'neurology', and to verify the relevant interest of the sites on the Net thus encountered. CONCLUSIONS: We present the URL of 50 search tools and the 244 sites on the Net related to Neurology and the Neurosciences, classified according to the entity or group to which they correspond, and their ambit (Latin American/Spanish vs others). A short list of those which may be of most interest is also included.

[Quality and life style as risk factors in acute cerebrovascular disease]. / Calidad y estilo de vida como factores de riesgo de enfermedad vascular cerebral aguda.

INTRODUCTION: In some series of patients with acute cerebral vascular disease (CVD) it has been seen that, prior to the episode of CVD, the patients already had a poorer quality of life than other people of their age. The object of this study is to evaluate their previous life style and quality of life as risk factors (RF) in acute CVD. MATERIAL AND METHODS: A case-control study was done of a total of 151 patients admitted to two hospitals with acute CVD and 151 persons, who were not hospitalized and acted as the control group, paired (one to one) for age, sex and hospital. In both groups data were collected regarding basic general health, previous quality of life (Nottingham Health Profile-NHP-, life style and self-perception of social support. The relative risks were estimated by calculating the odds ratios and conditional logistic regression. RESULTS: Regular moderate physical exercise acts as a protective factor with an OR of 0.32 (IC 95%: 0.14-0.76). Consumption of tobacco and alcohol increased the risk of CVD but did not reach statistical significance. No relationship was found between perceived social support and risk of CVD. Physical mobility, evaluated using the NHP showed a statistically significant negative association with acute CVD (OR: 0.32; IC 95%: 0.14-0.71). CONCLUSIONS: Our results seem to suggest that the previous overall quality of life cannot be considered a RF in acute CVD, except for physical mobility as evaluated on the NHP. Reduction of this constitutes a RF and moderate physical exercise behaves as a protective factor.

[Stressful life events as risk factors in acute cerebrovascular disease]. / Acontecimientos vitales estresantes como factor de riesgo de enfermedad vascular cerebral aguda.

INTRODUCTION: The influence of psychosocial stress on the origin of acute cerebral vascular disease (CVD) has received very little attention. The objective of this paper is to evaluate the role of psychosocial stress due to events occurring in daily life as a risk factor (RF) in acute CVD. MATERIAL AND METHODS: A case-control study was done of a total of 151 patients who were admitted to two hospitals with acute CVD and 151 persons, who where not hospitalized and acted as the control group, paired (one to one) for age, sex and hospital. In both groups data were collected regarding basic general health, consumption of tobacco and alcohol and stressful incidents (SI) in their lives during the previous two years. The stress derived from SI was measured on the 'Inventory of SI and Recent Experiences' of Holmes and Rahe. The frequency of serious SI was also considered. The relative risks were estimated by the odds ratio calculations. RESULTS: A positive association was found for the RF defined in relation to acute CVD. We did not find any relationship between psychosocial stress derived from SI and risk of acute CVD (either when considering scores on the Holmes and Rahe Inventory or evaluation of serious SI). CONCLUSIONS: Psychosocial stress from SI does not seem to represent a RF in acute CVD.

[Life events, quality of life and social support prior to acute cerebral vascular disease, as predictive factors of the quality of life and functional state following stroke]. / Acontecimientos vitales, calidad de vida y apoyo social previos a la enfermedad vascular cerebral aguda, como factores predictores de la calidad de vida y situación funcional posteriores al ictus.

INTRODUCTION: The repercussion of stroke on quality of life has been evaluated but not the possible relation between the quality of life before and months after an acute stroke. OBJECTIVE: To study the possible relation between quality of life, social support, stressful life events prior to the stroke and quality of life, social support and functional state months after. PATIENTS AND METHODS: A prospective study was made of 34 patients (71.7 +/- 8 years; 19 (56%) men; 15 (44%) women with stroke, by means of two evaluations: personal interview within the first 36 hours (quality of life--Nothingham health profile (NHP)-, perception of social support and stressful life events--Holmes and Rake inventory-) and an interview over the phone 16.5 +/- 5.3 months after the stroke (NHP, perception of social support and functional state--Rankin scale-). RESULTS: Following the stroke there was deterioration in perception of social support (19.8 +/- 3 vs 12.5 +/- 8; p = 0.000) and in the degree of social isolation of the NHP (9.4 +/- 20 vs 21.1 +/- 30; p = 0.03). The only relation found was between the following variables: pain at the first evaluation and pain (r = 0.45; p = 0.007) at the second evaluation; mobility at the first evaluation and emotional state (r = 0.39; p = 0.029) and social support (r = 0.37; p = 0.027) at the second evaluation; sleepiness at the first evaluation and energy (r = 0.55; p = 0.0006), pain (r = 0.39; p = 0.022), emotional state (r = 0.35; p = 0.038), mobility (r = 0.34, p = 0.048) and sleepiness (r = 0.51; p = 0.001) at the second evaluation. CONCLUSION: Our results indicate that there is little relationship between the previous state and that following stroke, and that the deterioration in perception of support and social isolation is due to the stroke itself.

[Hyperuricemia as a risk factor for cerebrovascular accident: a case-control study]. / La hiperuricemia como factor de riesgo del accidente vascular cerebral: estudio caso-control.

INTRODUCTION: Although several collateral studies have been made of the relationship between hyperuricemia and cerebral vascular accidents (CVA), no definite conclusion has been reached. OBJECTIVE: To analyze the possible relationship between hyperuricemia and CVA. PATIENTS AND METHODS: We studied the cases and controls paired for age, sex and hospital. They included patients with CVA (125) and controls (250 ophthalmological patients). Both groups contained 50.4% men and 49.6% women with an average age of 70 +/- 11 years. Data regarding vascular risk factors, a known personal history of hyperuricemia were recorded and serum uric acid levels determined in both groups. The relative risks were calculated using the Odds Ratio (OR) with a confidence interval of 95% (CI 95) and a conditional logistic regression study made. RESULTS: A statistically significant relationship was found between CVA and: arterial hypertension (OR: 6.32; CI 95: 3.43, 11.65); smoking (OR: 3.79; CI 95: 1.36, 10.58); alcoholism (OR: 2.54; CI 95: 1.11, 5.41); ischemic cardiopathy (OR: 2.37; CI 95: 1.2, 4.70) and previous CVA (OR: 5.93; CI 95: 3.17, 11.09). No relation was found with: a history of hyperuricemia (OR: 1.53; CI 95: 0.63, 3.73), serum uric acid levels (OR: 0.86, CI 95: 0.36, 2.00 when the uricemia was between 5 and 5.99 mg/dl and OR: 0.46, CI 95: 0.21, 1.02, when the uricemia was over 6 mg/dl). CONCLUSION: Our results suggest that hyperuricemia is not an independent risk factor for CVA.

[Key informers. When and How?]. / Informadores clave. ¿Cuándo? ¿Cómo?

INTRODUCTION: When information obtained through duly designed and developed studies is not available, the solution to certain problems that affect the population or that respond to certain questions may be approached by using the information and experience provided by the so-called key informer. DEVELOPMENT: The key informer is defined as a person who is in contact with the community or with the problem to be studied, who is considered to have good knowledge of the situation and therefore who is considered an expert. The search for consensus is the basis to obtain information through the key informers. The techniques used have different characteristics based on whether the experts chosen meet together or not, whether they are guided or not, whether they interact with each other or not. These techniques include the survey, the Delphi technique, the nominal group technique, brainwriting, brainstorming, the Phillips 66 technique, the 6-3-5 technique, the community forum and the community impressions technique. CONCLUSION: Information provided by key informers through the search for consensus is relevant when this is not available or cannot be obtained by other methods. It has permitted the analysis of the existing neurological care model, elaboration of recommendations on visit times for the out-patient neurological care, and the elaboration of guidelines and recommendations for the management of prevalent neurological problems.

[Neuropsychological assessment of the effectiveness of OROS-methylphenidate in attention deficit hyperactivity disorder]. / Evaluación neuropsicológica de la eficacia del metilfenidato-OROS en el trastorno por deficit de atención/hiperactividad.

INTRODUCTION: There is wide evidence about dopaminergic and noradrenergic mechanisms in fronto-striatal circuits which are thought to be related with attention deficit hyperactivity disorder (ADHD) neurobiology. That dysfunction may explain core symptoms and part of executive deficits in cognitive functioning. Methylphenidate is effective in alleviating core symptoms, enhancing dopaminergic and noradrenergic biodisponibility. Less evidence in improving executive functions, specially working memory is found. AIMS: To assess if methylphenidate-OROS has a potential effect increasing working memory and attention parameters in ADHD children, and to determine if initial working memory and attention differences between ADHD and control group disappear after one month of daily methylphenidate-OROS treatment. SUBJECTS AND METHODS: Eleven children with ADHD were selected and as control group was chosen eleven children compared in age, intelligence quotient, school grade, and social-demographic status. Neuropsychological battery was administered in naive ADHD patients at three times, before treatment, after the first methylphenidate-OROS dose, and after one month of daily treatment. Simultaneously neuropsychological battery was administered to control group. RESULTS. Statistically significant differences were found in neuropsychological variables of working memory after one month daily treatment with methylphenidate-OROS and attention parameters after only one dose in ADHD group. Differences between naive ADHD and control group in terms of working memory were statistically significant before treatment but not after one month daily treatment. CONCLUSION: Methylphenidate-OROS improves attention achievement after the first dose and working memory after one month of daily treatment.

[Neuropsychological assessment of memory in attention deficit hyperactivity disorder: the role of executive functions]. / Evaluación neuropsicológica de la memoria en el trastorno pordéficit de atención/hiperactividad: papel de las funciones ejecutivas.

INTRODUCTION: There is an important agreement on the consideration of attention deficit hyperactivity disorder (ADHD) as a condition characterized by neurodevelopmental dysfunction of fronto-striatal dopaminergic and noradrenergic circuits with resultant executive deficits in cognitive functioning. AIM: To assess the existence of memory deficits in children with ADHD associated with a poor performance executive. SUBJECTS AND METHODS: We assess 14 children diagnosed with ADHD combined type and 14 controls matched on intellectual coefficient, age and level of schooling, in a neuropsychological evaluation protocol designed to assess executive functions and memory skills using Auditory Verbal Learning Test, Memory for Stories Test -Test of Memory and Learning (TOMAL)-, Complex Figure Text, Visual Selective Reminding Test (TOMAL), Tower of Hanoi, Memory Phrases Test (Siegel and Ryan), Digit Span (Wechsler Intelligence Scale for Children-Revised) and Tapping Test (Wechsler Memory Scale III). RESULTS: The ADHD group showed deficits in the learning and free recall of verbal material, in procedural and working memory. No group differences were observed in the visual memory tasks. CONCLUSIONS: The results are analyzed in terms of difficulty in coding strategies, storage and search of information previously stored in the group with ADHD, at least for the kind of verbal information. These difficulties are associated with deficits in executive functioning.

[The neurologist when faced with stroke]. / El neurólogo ante el ictus.

The role of the neurologist during the entire care process involving patients who suffer a stroke is stressed. His/her intervention in this process is of fundamental importance given the existence of widely verified scientific evidence that this significantly improves the survival expectancies and the independence of these patients and that it is profitable for the health care system. An improvement in the quality of life of both the patients and their family is obtained from this intervention.

[Neurologist regarding the dependence law]. / El neurólogo ante la ley de dependencia.

INTRODUCTION: The approval of the "project of promotion of personal autonomy and care to people on dependence" situation law now opens the parliamentary process to the approval of the mentioned law around October- November 2006. Should the neurologist know its content and express his/her opinion about it? DEVELOPMENT: We analyze the role of neurological disorders as a cause of dependence, the law principles, the involvement of the neurologist in the social-health care coordination, the health administrations involved in the law development and the role of Spanish Neurological Society and regional societies as mediators with the different health administration, the involvement of the neurologist in accreditation, education, research and development, independence promotion, and dependence evaluation. CONCLUSION: Given that the project will be modified in the course of its parliamentary process, and the relevance of its reglamentary development, the door has been left open for the role of the neurologist to be accepted at the moment when the law is developed and applied. In any case, the well-being and quality of life of our patients should not be overlooked. We think that the Spanish Neurological Society will have an important role in this process.

Alteraciones genéticas en el trastorno por déficit de atención con hiperactividad: relación con variables neuropsicológicas / Genetic variations in attention deficit hyperactivity disorder: relationship with neuropsychological variables

El Trastorno por Déficit de Atención con Hiperactividad (TDAH) es una patología frecuente de la infancia con una fuerte contribución genética. Tras unos años dedicados al estudio de los genes específicos que explicaban la sintomatología nuclear del trastorno (inatención, hiperactividad e impulsividad), en la actualidad el interés de los investigadores se ha ampliado, considerando la repercusión neuropsicológica que estas alteraciones genéticas tienen en los sujetos afectos de esta patología. En este trabajo revisamos la literatura existente sobre los correlatos genéticos de los déficits cognitivos del TDAH. Estas nuevas estrategias de investigación, necesariamente multidisciplinares, pretenden conseguir, además del incremento en la caracterización neurobiológica de esta patología, líneas de tratamiento alternativas a las existentes que respondan a la relación comentada entre genes y cognición en el TDAH

Attention Deficit/Hyperactivity Disorder (ADHD) is a frequent disorder in childhood with a strong genetic contribution. After a few years studying the specific genes that could explain the nuclear symptomatology of the disorder (inattention, hyperactivity, and impulsivity), actual research has been extended considering the neuropsychological repercussion that these genetic alterations have in subjects with ADHD. In this work we review the existing literature on the genetic basis of the cognitive deficits in ADHD. These new research strategies, necessarily multidisciplinary, try to explain a better neurobiological characterization of this pathology, plus alternative new lines of treatment based on the relationship between genes and cognition in ADHD

[Evaluation of the quality of inter-clinic documents. Does their proper filling out by the family doctor affect the reply obtained from the specialist?]. / Evaluación de la calidad del documento de interconsulta. 'Influye la adecuada cumplimentación del médico de familia en la respuesta que obtiene del especialista?

OBJECTIVE: To analyse the filling out of the inter-clinic form (IF) at a centre with special fields of care (CS) and to assess whether its proper filling out in primary care (PC) affects the reply from specialist care. DESIGN: Cross-sectional, descriptive study. SETTING: Primary health care area in the Community of Valencia. PARTICIPANTS: Randomised sample of IFs of patients referred for the first time from PC to specialists. MAIN MEASUREMENTS: Evaluation criteria were grouped in two: those IFs were considered acceptable (IFCA) in which the family doctor included the reason for consultation or his/her diagnostic impression, as well at least one of the following: anamnesis, personal background, physical examination, further tests or current medication. The remaining IFs were considered inadequately filled out (IFCI). RESULTS: The sample analysed for the IF audit of the CS was 392 people. The result of the audit in the specialist clinics was that 243 IFs were blank (62.0%); the specialist doctor was identified in 19% of cases; the diagnosis was given in 23.5%; treatment, in 21%, and the follow-up plan, in 20%. In the PC evaluation, there were no blank IFs; anamnesis was recorded in 41.8%; reason for consultation in 73%; suspected diagnosis in 58.2%, and treatment in 11.5%. The sample to analyse the differences in the filling of the form in specialist care according to the quality of the PC filling out was 529 IFs. 56.3% of the IFs were considered acceptable. No statistically significant differences were found in the filling of any of the criteria of evaluation by the specialist doctor between the IFs from PC of acceptable and inadequate quality, except on the question of specifying treatment. CONCLUSIONS: We found no relationship between the quality of the IF from PC and the reply from specialist care. Currently, the filling out of IFs continues to be deficient.

Informadores clave. ¿Cuándo? ¿Cómo? / Key informers. When and How?

Introducción. Cuando no se dispone de información obtenida a travésde estudios debidamente diseñados y desarrollados, es posible abordarla solución de determinados problemas que afectan a la poblacióno responder a determinadas preguntas aprovechando la información yexperiencia aportada por los denominados informadores clave.Desarrollo. El informador clave se define como una persona encontacto con la comunidad o con el problema a estudiar, a quien sereconoce un buen conocimiento de la situación y, por lo tanto, esconsiderado experto. La búsqueda del consenso es la base para la obtenciónde información a través de informadores clave. Las técnicasutilizadas tienen características diferentes en función de que los expertoselegidos se reúnan o no, sean conducidos o no, interaccionenentre sí o no. Estas técnicas incluyen la encuesta, la técnica Delphi, latécnica del grupo nominal, el brainwriting, el brainstorming, la técnicaPhillips 66, la técnica del 6-3-5, el forum comunitario y la técnicade impresiones de la comunidad.Conclusiones. La información aportada por informadores clavea través de la búsqueda del consenso es relevante cuando ésta noestá disponible o no es posible su obtención por otros métodos. Hapermitido el análisis del modelo de asistencia neurológica existente,la elaboración de recomendaciones sobre tiempos de visita para laasistencia neurológica ambulatoria y la elaboración de guías y recomendacionespara el manejo de problemas neurológicos prevalentes (AU)

Introduction. When information obtained through duly designedand developed studies is not available, the solution to certainproblems that affect the population or that respond to certainquestions may be approached by using the information and experienceprovided by the so-called key informer.Development. The key informer is defined as a person whois in contact with the community or with the problem to be studied,who is considered to have good knowledge of the situationand therefore who is considered an expert. The search for consensusis the basis to obtain information through the key informers.The techniques used have different characteristics based onwhether the experts chosen meet together or not, whether theyare guided or not, whether they interact with each other or not.These techniques include the survey, the Delphi technique, thenominal group technique, brainwriting, brainstorming, the Phillips66 technique, the 6-3-5 technique, the community forumand the community impressions technique.Conclusion. Information provided by key informers throughthe search for consensus is relevant when this is not available orcannot be obtained by other methods. It has permitted the analysisof the existing neurological care model, elaboration of recommendationson visit times for the out-patient neurological care,and the elaboration of guidelines and recommendations for themanagement of prevalent neurological problems (AU)