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BACKGROUND: Erenumab was approved in Europe for migraine prevention in patients with ≥ 4 monthly migraine days (MMDs). In Spain, Novartis started a personalized managed access program, which allowed free access to erenumab before official reimbursement. The Spanish Neurological Society started a prospective registry to evaluate real-world effectiveness and tolerability, and all Spanish headache experts were invited to participate. We present their first results. METHODS: Patients fulfilled the ICHD-3 criteria for migraine and had ≥ 4 MMDs. Sociodemographic and clinical data were registered as well as MMDs, monthly headache days, MHDs, prior and concomitant preventive treatment, medication overuse headache (MOH), migraine evolution, adverse events, and patient-reported outcomes (PROs): headache impact test (HIT-6), migraine disability assessment questionnaire (MIDAS), and patient global improvement change (PGIC). A > 50% reduction of MMDs after 12 weeks was considered as a response. RESULTS: We included 210 patients (female 86.7%, mean age 46.4 years old) from 22 Spanish hospitals from February 2019 to June 2020. Most patients (89.5%) suffered from chronic migraine with a mean evolution of 8.6 years. MOH was present in 70% of patients, and 17.1% had migraine with aura. Patients had failed a mean of 7.8 preventive treatments at baseline (botulinum toxin type A-BoNT/A-had been used by 95.2% of patients). Most patients (67.6%) started with erenumab 70 mg. Sixty-one percent of patients were also simultaneously taking oral preventive drugs and 27.6% were getting simultaneous BoNT/A. Responder rate was 37.1% and the mean reduction of MMDs and MHDs was -6.28 and -8.6, respectively. Changes in PROs were: MIDAS: -35 points, HIT-6: -11.6 points, PIGC: 4.7 points. Predictors of good response were prior HIT-6 score < 80 points (p = 0.01), ≤ 5 prior preventive treatment failures (p = 0.026), absence of MOH (p = 0.039), and simultaneous BoNT/A treatment (p < 0.001). Twenty percent of patients had an adverse event, but only two of them were severe (0.9%), which led to treatment discontinuation. Mild constipation was the most frequent adverse event (8.1%). CONCLUSIONS: In real-life, in a personalized managed access program, erenumab shows a good effectiveness profile and an excellent tolerability in migraine prevention in our cohort of refractory patients.
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Trastornos Migrañosos , Anticuerpos Monoclonales Humanizados , Europa (Continente) , Femenino , Humanos , Persona de Mediana Edad , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/prevención & control , Sistema de Registros , EspañaRESUMEN
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Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/diagnóstico por imagen , Tomografía de Emisión de Positrones , Imagen por Resonancia MagnéticaRESUMEN
Los aneurismas gigantes suelen manifestarse en forma de hemorragia subaracnoidea o cefalea. La presentación clínica de un aneurisma gigante intracraneal como epilepsia parcial es inusual, como lo indican los pocos casos recogidos en la literatura. Se presenta el caso de un aneurisma gigante intracraneal de arteria carótida interna derecha, que debuta con crisis focales del lóbulo temporal, manteniéndose sin otra manifestación a lo largo de años a pesar de las llamativas dimensiones.
Giant intracranial aneurysms are usually manifested as subarachnoid hemorrhage or headache. The clinical debut of a giant intracranial aneurysm as partial epilepsy is unusual and indicates the few cases reported in the literature. For giant aneurysm of an intracranial internal carotid artery occurs. Debuts with focal seizures of the temporal lobe, remaining without further demonstration over the years despite the striking dimensions.
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Convulsiones , Hemorragia Subaracnoidea , Arteria Carótida Interna , Aneurisma Intracraneal , Epilepsias Parciales , CefaleaRESUMEN
TITLE: Descripcion de un caso de trastorno del movimiento hipercinetico en la enfermedad inflamatoria multisistemica de inicio neonatal o sindrome cronico infantil neurologico, cutaneo y articular.
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Síndromes Periódicos Asociados a Criopirina/complicaciones , Hipercinesia/etiología , Antidiscinéticos/uso terapéutico , Proteínas Portadoras/genética , Corea/tratamiento farmacológico , Corea/etiología , Antagonistas de Dopamina/uso terapéutico , Humanos , Hipercinesia/tratamiento farmacológico , Recién Nacido , Masculino , Mutación Missense , Proteína con Dominio Pirina 3 de la Familia NLR , Fenotipo , Pimozida/uso terapéutico , Mutación Puntual , Tics/tratamiento farmacológico , Tics/etiologíaAsunto(s)
Malformación de Arnold-Chiari/complicaciones , Descompresión Quirúrgica/métodos , Siringomielia/complicaciones , Neuralgia del Trigémino/etiología , Adulto , Malformación de Arnold-Chiari/cirugía , Tos/etiología , Encefalocele/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Inducción de Remisión , Estornudo , Siringomielia/cirugía , Nervio Trigémino/patología , Neuralgia del Trigémino/fisiopatología , Neuralgia del Trigémino/cirugía , Núcleo Espinal del Trigémino/patología , Insuficiencia Venosa/complicacionesRESUMEN
Se presenta un caso de infección tuberculosa con osteomielitis de clivus con afectación de tejidos vecinos y debut como cefalea refractaria sin clínica pulmonar. La osteomielitis tuberculosa de clivus es una entidad descrita en la literatura de forma excepcional y más propia de áreas con alta prevalencia de tuberculosis. Este caso debutó con clínica neurológica poco específica y se llegó al diagnóstico por el resultado del estudio microbiológico de nódulos pulmonares coexistentes sin clínica pulmonar asociada.
We report a case of tuberculous infection of exceptional location: clivus with involvement of surrounding tissues and refractory headache without pulmonary clinic. Tuberculous osteomyelitis of the clivus is a rare entity described in areas with highest tuberculosis prevalence. This case debuts with unspecific neurological symptoms and was diagnosed by the results of microbiological study of coexisting pulmonary nodules, without associated pulmonary clinic.
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