Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: Experience from a national multicenter registry.

OBJECTIVE: To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic-clonic seizures (GTCS). METHODS: This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure-free rate after 3, 6, and 12 months and tolerability throughout the follow-up. RESULTS: A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of 14 months (range = 1-57) with a median dose of 4 mg (range = 2-10). The retention rates at 3, 6, and 12 months and last follow-up were 93.8%, 89.3%, 80.9%, and 71.4%, respectively. The retention rates according to the type of monotherapy (primary vs conversion) did not differ (log-rank P value = .57). Among the 98 patients, 61.2% patients had seizures throughout the baseline period, with a median seizure frequency of 0.6 seizures per month (range = 0.3-26). Responder rates at 3, 6, and 12 months were 79.6%, 70.1%, and 52.8%, respectively, and seizure freedom rates at the same points were 62.7%, 56.1%, and 41.5%. Regarding the 33 patients who had GTCS in the baseline period, 87.8% were seizure-free at 3 months, 78.1% at 6 months, and 55.1% at 12 months. Over the entire follow-up, PER monotherapy was generally well tolerated, and only 16% of patients discontinued PER due to adverse events (AEs). Female patients were found to be at a higher risk of psychiatric AEs (female vs male odds ratio = 2.85, 95% confidence interval = 1-8.33, P = .046). SIGNIFICANCE: PER demonstrated good effectiveness and a good safety profile when used as primary therapy or conversion to monotherapy at relatively low doses, in a clinical setting with patients with focal seizures and GTCS.

Attention Deficit Hyperactivity Disorder in Adults With Migraine.

INTRODUCTION: Several studies have shown increased occurrence of migraine in ADHD patients. However, there is less evidence on whether migraine patients also have a higher ADHD frequency. The aim of this paper is determining whether the prevalence of ADHD symptoms or impulsivity is higher in patients with episodic migraine. METHODS: An observational cohort study has been conducted. Patients with episodic migraine were included. The ADHD Rating scale, the Adult ADHD Self-Report Scale, and the scale of impulsiveness of Plutchik were used. RESULTS: The mean value of inattention, hyperactivity and impulsivity scores on the ADHD scale was 5 ± 3.8 in cases and 2.7 ± 2.2 in controls (p < .00001), 4 ± 3.2 in cases and 2.5 ± 2.4 in controls (p = .000621) and 2 ± 1.5 in cases and 1.1 ± 1 in controls (p = .000407), respectively. CONCLUSION: Adults with migraine have a higher prevalence of ADHD symptoms. This should be considered when assessing these patients.

Electroconvusive therapy in dementia.

The use of electroconvulsive therapy (ECT) in the clinical practice in patients with dementia syndromes continues to cause controversy. In this case, the clinical difficulty existing when making a differential diagnosis between depressive episodes and incipient dementia picture is presented. The interrelation between these two pictures and the possible common etiological origin are also evaluated. Electroconvulsive therapy is effective and safe in functional improvement in affective and dementia disorders in elderly patients.

Remedies for headaches in a closet for ladies and gentlewomen (1608).

Seventeenth-century English closets were books containing a wide repertoire of household supplies targeted at female readers. Such volumes typically included medical recipes, as early modern women also used to be responsible for preserving and restoring the health of relatives and close neighbors. A Closet for Ladies and Gentlewomen (Sir Hugh Platt, 1608), in particular, incorporates 13 medicinal remedies devised for the therapeutic management of 3 different types of headaches: head-ache, migraine and pain in the head. This article historically contextualizes the text, offers a valid classification of headaches in 17th-century England, and describes the composition of the homemade pharmaceutical forms recommended to female caregivers, the guidelines for administration and its potential pain-relieving effects.

[Risk factors, etiology and prognosis in patients older than 80 years old with ischemic stroke]. / Factores de riesgo, etiología y pronóstico en pacientes mayores de 80 años con accidente cerebrovascular.

INTRODUCTION: The aim of this study was to analyze differences between patients aged 80 years or less and those aged more than 80 years old a hospital series of ischemic stroke. MATERIAL AND METHODS: We performed a retrospective review of all patients with ischemic stroke or transient ischemic attack requiring admission to the Neurology Service of the Dr. Negrín University Hospital of Gran Canaria (Spain) between January 1, 2004 and December 31, 2006. Data were gathered on hypertension, diabetes mellitus (DM), hyperlipidemia, ischemic cardiopathy (IC), atrial fibrillation (AF), the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, as well as the National Institutes of Health (NIH) scale and the modified Rankin scale (mRS) at discharge. RESULTS: A total of 850 patients were included. Age was >80 years in 106 (12.4%) and was <80 years in 744 (87.6%). In the group aged>80 years, 43.4% were men and 56.6% were women (64.1% men and 35.9% women in the group aged<80 years). Hypertension was present in 81.1% of patients aged>80 years (68.1% in those aged<80 years); previous DM was found in 29.2% (39.3% in the group aged<80 years); hyperlipidemia was present in 26.4% (40.2% in the group aged<80); IC was found in 16.9% (15.8% in the group aged<80); AF was found in 40% (20.9% in the group aged<80 years). In the group of patients aged>80 years, 23.6% had atherothrombotic stroke (19.3% in those aged<80 years); 38.7% were cardioembolic (19.3% in the group aged<80 years); 10.4% were lacunar (22.6% in the group aged<80 years); and 24.5% was of undetermined origin (28.6% in the group aged<80 years). The mRS at discharge was 80 years. CONCLUSIONS: Ischemic stroke in patients over 80 years old leads to certain differences in relation to risk factors, stroke etiology and stroke severity.

Actividad delta rítmica intermitente occipital como patrón intercrítico en un adulto con epilepsia focal / Occipital intermittent rhythmic delta activity as the interictal pattern in an adult with focal epilepsy

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Jacques Guillemeau's 16th-century account of ophthalmoplegia.

In 1585, the renowned French royal surgeon Jacques Guillemeau published his Traité des maladies de l'oeil. The book is divided into 9 unequal sections devoted to the description of eye anatomy and ophthalmological diseases including muscle, membrane, and humor disorders; optic nerve damage; and eyelid affections. Section 3, in particular, focuses on a form of ophthalmoplegia involving progressive paralysis of extraocular muscles. Here we describe and discuss Guillemeau's theoretical framework and practical approach to this ophthalmological disorder. To determine whether this physician was possibly influenced by the thought of antique and contemporary learned men, we reviewed some fundamental ideas on cranial nerves and their paralysis as presented by authors such as Herophilus of Chalcedon, Erasistratus of Ceos, Claudius Galen, Andreas Vesalius, and Leonhard Fuchs.

[Thrombosis of the cerebral venous sinuses in the differential diagnosis of idiopathic intracranial hypertension in young obese females: is it a real problem?]. / Trombosis de senos venosos cerebrales en el diagnostico diferencial de la hipertension intracraneal idiopatica en mujeres jovenes obesas: un problema real?

INTRODUCTION: Idiopathic intracranial hypertension (IICH) typically presents in young women with obesity or a recent weight increase. The differential diagnosis of IICH includes thrombosis of the cerebral venous sinuses (TCVS), which can also present as an isolated intracranial hypertension syndrome. We review the frequency with which patients with a typical IICH profile presented TCVS as their diagnosis. PATIENTS AND METHODS: The study consisted in a retrospective review of all the admissions due to intracranial hypertension syndromes in our centre between 2000 and 2011. The cases selected were those with a normal cerebrospinal fluid study and computerised axial tomography scan of the head that presented as an isolated intracranial hypertension syndrome; those who manifested a focal neurological picture, however, were excluded. From the patients that were included, a subgroup made up of females between 16 and 35 years of age with a body mass index of above 25 were selected. RESULTS: A total of 37 cases were obtained. Of these, 35 (94.6%) were cases of IICH and two (5.4%) were TCVS. The time elapsed between the onset of symptoms and diagnosis was less than seven days in both cases of TCVS (100%) and in two cases (5.4%) of IICH. CONCLUSIONS: Up to 5.4% of patients with a typical IICH profile that present with an intracranial hypertension syndrome can present TCVS. The presence of prothrombotic factors and a high D-dimer can suggest this possibility, although there is still a need for well-established parameters that allow decisions to be made in emergencies in the absence of any chance of performing an urgent MR phlebography scan.

[Description of the follow-up protocol for idiopathic intracranial hypertension in the neuro-ophthalmological unit of a tertiary hospital]. / Descripcion del protocolo de seguimiento para la hipertension intracraneal idiopatica en una unidad de neurooftalmologia de un hospital terciario.

AIM: To review the results of implementing a protocol for following up patients with idiopathic intracranial hypertension (IICH) in a neuro-ophthalmological unit (NOU). PATIENTS AND METHODS: A review of the literature was conducted in order to determine the examinations that needed to be included in the follow-up protocol, as well as the optimum frequency of visits and the most adequate duration of the follow-up. Later, a prospective review was performed of the patients that have been included since the NOU was set up and they were compared with the patients included in the IICH register prior to the creation of the NOU. RESULTS: Since the protocol was implemented, visual acuity and the visual field have been evaluated in 100% of patients at three months, at six months and at one year after diagnosis. Moreover, the visual field was examined at three months, at six months and at one year after diagnosis in 91%, 72.8% and 100% of patients with IICH, respectively. Before our follow-up protocol was implemented, 190 had been carried out, which is roughly three per patient. Eleven lumbar punctures have been performed since the NOU was set up. CONCLUSIONS: The creation of a multidisciplinary NOU makes it possible to optimise resources and improve the care given to patients with IICH. This should result in an improvement in the functional prognosis of these patients.

TITLE: Descripcion del protocolo de seguimiento para la hipertension intracraneal idiopatica en una unidad de neurooftalmologia de un hospital terciario.Objetivo. Revisar los resultados de la implantacion de un protocolo de seguimiento de pacientes con hipertension intracraneal idiopatica (HICI) en una unidad de neurooftalmologia (UNO). Pacientes y metodos. Se realizo una revision bibliografica para determinar las exploraciones necesarias que debian incluirse en el protocolo de seguimiento, asi como la frecuencia optima de las visitas y la duracion adecuada del seguimiento. Posteriormente, se revisaron de forma prospectiva los pacientes incluidos desde la creacion de la UNO y se compararon con los pacientes incluidos en el registro de HICI previo a la creacion de la UNO. Resultados. Desde la implantacion del protocolo, en el 100% de los pacientes se ha valorado la agudeza visual y la campimetria visual a los tres meses, a los seis meses y al ano del diagnostico. Ademas, en un 91%, 72,8% y 100% de los pacientes con HICI se realizo una campimetria visual a los tres meses, a los seis meses y al ano del diagnostico, respectivamente. Antes de la implantacion de nuestro protocolo de seguimiento, se habian realizado 190, lo que corresponde a unas tres por paciente. El numero de punciones lumbares realizadas desde la creacion de la UNO es de 11. Conclusiones. La creacion de una UNO multidisciplinar permite optimizar los recursos y mejorar la asistencia a los pacientes con HICI. Esto deberia redundar en una mejoria del pronostico funcional de estos pacientes.

Perfil clínico y satisfacción con el tratamiento anticoagulante en pacientes con fibrilación auricular no valvular atendidos en consultas de medicina interna y neurología de España / Clinical profile and satisfaction with anticoagulated treatment in patients with non-valvular atrial fibrillation attended in Internal Medicine and Neurology departments of Spain

Objetivo. Determinar el perfil clínico, el manejo del tratamiento anticoagulante y la satisfacción relacionada con la anticoagulación en pacientes con fibrilación auricular no valvular atendidos en consultas de neurología o medicina interna de España. Pacientes y métodos. Estudio prospectivo, transversal y multicéntrico en el que se incluyó a 1.337 pacientes, que completaron los cuestionarios Anti-Clot Treatment Scale, Self-Assessment of Treatment Questionnaire y EuroQol-5 dimensions. Resultados. 865 pacientes (64,7%) provenían de consultas de neurología, y 472 (35,3%), de medicina interna. Los atendidos en medicina interna eran mayores, tenían más hipertensión, diabetes, insuficiencia cardíaca, insuficiencia renal y arteriopatía periférica. Los pacientes atendidos en neurología tenían más antecedentes de ictus. Globalmente, la escala CHADS2 fue 3,2 ± 1,3; CHA2DS2Vasc, 4,8 ± 1,5, y HAS-BLED, 2,0 ± 0,9, y las puntuaciones más altas fueron en neurología. El 56,1% tomaba antagonistas de la vitamina K, lo que era más común en medicina interna. El porcentaje de tiempo en rango terapéutico adecuado fue del 47% (Rosendaal), sin diferencias entre los grupos. La satisfacción con el tratamiento anticoagulante oral fue elevada en ambos grupos, aunque mayor en los sujetos atendidos en neurología, y mayor con los anticoagulantes orales de acción directa que con los antagonistas de la vitamina K. Conclusiones. Aunque existieron ciertas diferencias en el perfil clínico de los pacientes con fibrilación auricular atendidos en neurología o medicina interna, todos presentaban múltiples comorbilidades y un riesgo tromboembólico elevado. A pesar de que el control del índice internacional normalizado fue pobre, el anticoagulante oral más empleado fueron los antagonistas de la vitamina K. La satisfacción con el tratamiento anticoagulante oral fue alta (AU)

Aim. To determine the clinical profile, management of anticoagulant treatment and satisfaction related to anticoagulation in outpatients with nonvalvular atrial fibrillation attended in Neurology or Internal Medicine departments of Spain. Patients and methods. Cross-sectional and multicenter study, in which 1,337 outpatients were included. Patients fulfilled ACTS, SAT-Q and EQ-5D questionnaires. Results. 865 patients (64.7%) were recruited from Neurology department and 472 (35.3%) from Internal Medicine department. Those patients attended in Internal Medicine department were older and had more frequently hypertension, diabetes, heart failure, renal insufficiency and peripheral artery disease. Those patients attended in Neurology department had more commonly prior stroke. Overall, CHADS2 score was 3.2 ± 1.3, CHA2DS2-Vasc 4.8 ± 1.5 and HAS-BLED 2.0 ± 0.9. All scores were higher in those patients attended in Neurology department. Globally, 56.1% of patients were taking vitamin K antagonists, more commonly in Internal Medicine department. The adequate percent of time in therapeutic range was 47% (Rosendaal), without significant differences between groups. Satisfaction with oral anticoagulation was high in both groups, but higher in those attended in Neurology department, and higher in those individuals taking direct oral anticoagulants compared with vitamin K antagonists. Conclusions. Although there were some differences in the clinical profile of patients with atrial fibrillation attended in Neurology or Internal Medicine departments, all of them had many comorbidities and a high thromboembolic risk. Despite INR control was poor, the most common oral anticoagulant used were vitamin K antagonists. Satisfaction related to oral anticoagulation was high (AU)

¿Es imprescindible la realización de una punción lumbar en todos los casos para el diagnóstico de la hipertensión intracraneal idiopática? / Is it really necessary to perform a lumbar puncture in all cases in the diagnosis of idiopathic intracranial hypertension?

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Manifestaciones neurooftalmológicas como forma de presentación de la neurosífilis / Neuro-ophthalmological manifestations presenting as neurosyphilis

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Pupila tónica como manifestación inicial de un síndrome de Sjögren / Tonic pupil as an initial manifestation of Sjögren's syndrome

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