Epileptic peri-ictal psychosis, a reversible cause of psychosis.

INTRODUCTION: Epileptic psychoses are categorised as peri-ictal and interictal according to their relationship with the occurrence of seizures. There is a close temporal relationship between peri-ictal psychosis and seizures, and psychosis may present before (preictal), during (ictal) or after seizures (postictal). Epileptic psychoses usually have acute initial and final phases, with a short symptom duration and complete remission with a risk of recurrence. There is no temporal relationship between interictal or chronic psychosis and epileptic seizures. Another type of epileptic psychosis is related to the response to epilepsy treatment: epileptic psychosis caused by the phenomenon of forced normalisation (alternative psychosis), which includes epileptic psychosis secondary to epilepsy surgery. Although combination treatment with antiepileptic and neuroleptic drugs is now widely used to manage this condition, there are no standard treatment guidelines for epileptic psychosis. CLINICAL CASES: We present 5 cases of peri-ictal epileptic psychosis in which we observed an excellent response to treatment with levetiracetam. Good control was achieved over both seizures and psychotic episodes. Levetiracetam was used in association with neuroleptic drugs with no adverse effects, and our patients did not require high doses of the latter. CONCLUSIONS: Categorising psychotic states associated with epilepsy according to their temporal relationship with seizures is clinically and prognostically useful because it provides important information regarding disease treatment and progression. The treatment of peri-ictal or acute mental disorders is based on epileptic seizure control, while the treatment of interictal or chronic disorders has more in common with managing disorders which are purely psychiatric in origin. In addition to improving the patient's quality of life and reducing disability, achieving strict control over seizures may also prevent the development of interictal psychosis. For this reason, we believe that establishing a treatment protocol for such cases is necessary.

[DISCREPA study: treatment of advanced Parkinson's disease and use of second-line treatments in Catalonia]. / Estudio DISCREPA: tratamiento de la enfermedad de Parkinson avanzada y utilización de terapias de segunda línea en Cataluña.

INTRODUCTION: The treatment of Parkinson's disease (PD) is complex, and the establishment of second-line therapies in advanced PD remains controversial. AIM: To analyze the assistance of patients with PD in Catalonia, with special attention to the use of second-line therapies in advanced PD. SUBJECTS AND METHODS: Online self-administered survey to neurologists in Catalonia who treated patients with PD, through the Catalan Society of Neurology. RESULTS: 72 neurologists who visited a monthly average of 38 PD patients (37.3% motor complications) participated. 86% routinely asked about motor. The main reasons for indicating second-line therapies were disability in off (83.1%), impact of dyskinesias (76.9%), impact of time in off (75.4%) and time in off (73.8%). 70% of neurologists declared limitations to establish second-line therapies: lack of resources in their hospital, lack of time to visit the patient or to perform administrative tasks and lack nursing support. Second-line therapies is not used in 72% of patients who could potentially be candidates, especially due to patient rejection (37.9%). CONCLUSIONS: The majority of neurologists in Catalonia who visit patients with PD routinely ask about motor complications without using specific tools. Although neurologists are well aware of the indications for the establishment of second-line therapies, the refusal of the patient, the lack of time and the lack of defined care protocols to refer patients, they can contribute to a lower use of second-line therapies in advanced PD.

TITLE: Estudio DISCREPA: tratamiento de la enfermedad de Parkinson avanzada y utilización de terapias de segunda línea en Cataluña.Introducción. El tratamiento de la enfermedad de Parkinson (EP) es complejo y la instauración de terapias de segunda línea en la EP avanzada sigue siendo controvertida. Objetivo. Analizar la asistencia de pacientes con EP en Cataluña, con especial atención a la utilización de las terapias de segunda línea en la EP avanzada. Sujetos y métodos. Encuesta en línea autoadministrada a través de la Societat Catalana de Neurologia a neurólogos de Cataluña que atendían a pacientes con EP. Resultados. Participaron 72 neurólogos que visitaban una media mensual de 38 pacientes con EP (el 37,3% con complicaciones motoras). El 86% preguntaba rutinariamente por complicaciones motoras. Los principales motivos para indicar terapias de segunda línea fueron la discapacidad en off (83,1%), el impacto de las discinesias (76,9%), el impacto del tiempo en off (75,4%) y el tiempo en off (73,8%). El 70% de los neurólogos declaró limitaciones para instaurar terapias de segunda línea: escasez de recursos en su hospital, falta de tiempo para visitar al paciente o para realizar tareas administrativas y falta de soporte de enfermería (33,3%). No se utilizan terapias de segunda línea en el 72% de los pacientes que podrían ser potencialmente candidatos, sobre todo por rechazo del paciente (37,9%). Conclusiones. La mayoría de los neurólogos en Cataluña que visitan pacientes con EP pregunta rutinariamente por complicaciones motoras sin utilizar herramientas específicas. Aunque los neurólogos conocen bien las indicaciones de instauración de terapias de segunda línea, la negativa del paciente, la falta de tiempo y la falta de protocolos asistenciales definidos para derivar a pacientes pueden contribuir a una menor utilización de terapias de segunda línea en la EP avanzada.

[Environmental-analytical risk factors influence on the phenotype of amyotrophic lateral sclerosis in a rural setting]. / Influencia de los factores ambientales-analiticos sobre el fenotipo de esclerosis lateral amiotrofica en un medio rural.

INTRODUCTION: There are discrepancies in the different studies that attempt to correlate the risk factors of developing amyotrophic lateral sclerosis (ALS) and the impact on their prognosis. Some of these factors are intrinsic to the rural livelihood. Therefore, we propose to study if any of these influence the onset and/or prognosis of the disease in the health region of Lleida, a predominantly rural area. PATIENTS AND METHODS: Variables related to general factors, clinical, environmental and laboratory were collected and analyzed at the time of diagnosis of ALS in 38 patients and were retrospectively related to the onset of the disease and its survival. RESULTS: The family history of ALS (p < 0.02) and elevated CK (p < 0.0001) were associated with increased survival. Smoking (p < 0.04), physical work (p < 0.03), low creatinine (p < 0.03), elevated CK (p = 0.0005) were associated with an early onset of the disease. The bulbar onset form was significantly related to a late onset of the disease (p < 0,01). Total cholesterol and PCR did not influence the onset or course of ALS. There is a non-significant trend at statistical level in favor of moderate physical exercise being associated with a later onset, while intense exercise at an early onset of ALS. CONCLUSIONS: The results suggest that there are a number of factors that influence the development and prognosis of ALS, some of which are more prevalent in rural areas, such as physical work.

TITLE: Influencia de los factores ambientales-analiticos sobre el fenotipo de esclerosis lateral amiotrofica en un medio rural.Introduccion. Existen discrepancias en los diversos estudios que intentan correlacionar los factores de riesgo de desarrollar esclerosis lateral amiotrofica (ELA) y el impacto en su pronostico. Algunos de dichos factores son intrinsecos al medio de vida rural. Por ello, proponemos estudiar si alguno de estos influye sobre el inicio o el pronostico de la enfermedad en la region sanitaria de Lleida, un ambito predominantemente rural. Pacientes y metodos. Se recogieron y analizaron variables relacionadas con factores generales, clinicos, ambientales y de laboratorio en el momento del diagnostico de ELA en 38 pacientes, y se relacionaron retrospectivamente con el inicio de la enfermedad y su supervivencia. Resultados. Los antecedentes familiares de ELA (p < 0,02) y la creatincinasa elevada (p < 0,0001) se asociaron a mayor supervivencia. El tabaquismo (p < 0,04), el trabajo fisico (p < 0,03), la creatinina baja (p < 0,03) y la creatincinasa elevada (p = 0,0005) se asociaron a un inicio precoz de la enfermedad de modo estadisticamente significativo. La forma de inicio bulbar se relaciono significativamente con un inicio tardio de la enfermedad (p < 0,01). El colesterol total y la proteina C reactiva no influyeron en el inicio ni en el curso de la ELA en nuestra muestra. Existe una tendencia estadisticamente no significativa a favor de que el ejercicio fisico moderado se asocia con un inicio mas tardio, mientras que el ejercicio intenso se asocia con un inicio precoz de la ELA. Conclusiones. Los resultados apuntan a que existe una serie de factores que influye en el desarrollo y pronostico de la ELA, y alguno de estos es mas prevalente en el ambito rural, como el trabajo fisico.