Transcutaneous Supraorbital Stimulation as a Preventive Treatment for Chronic Migraine: A Prospective, Open-Label Study.

BACKGROUND AND OBJECTIVE: Successful preventive treatment in chronic migraine (CM) remains an unmet need in some cases, and new therapeutic strategies are emerging. We aimed to test the effect of noninvasive, transcutaneous supraorbital nerve stimulation (tSNS) in a group of patients with CM. PATIENTS AND METHODS: This was an open label, quasi-experimental design. Twenty-five CM patients were recruited from two hospital headache clinics. After a one-month baseline period, monthly visits were scheduled during three months. Headache occurrence, its intensity, and symptomatic medication intake were recorded through a diary kept by each patient. Both a per-protocol analysis and an intention-to-treat analysis were performed for the main outcome measures. RESULTS: Twenty-one and 24 patients were included in the per-protocol and the intention-to-treat analyses, respectively. In the per-protocol analysis, a significant four-day decrease in the mean monthly days with moderate or severe headache was observed from baseline to the end of the study (t test, P = 0.0163), and there was a nonsignificant reduction of 2.95 in the mean monthly total headache days. In the intention-to-treat analysis, a nonsignificant 3.37 reduction in the mean monthly days with moderate or severe headache was observed for the same period, and there was a significant 2.75 reduction in the mean monthly days with any headache (t test, P = 0.016). CONCLUSIONS: tSNS could hold preventive properties in the treatment of CM, but the effect may be either mild or controversial. Double blind, sham-controlled studies are essential to confirm these findings and to outline their clinical relevance in the CM therapeutic scenario.

A novel treatment-responsive encephalitis with frequent opsoclonus and teratoma.

Among 249 patients with teratoma-associated encephalitis, 211 had N-methyl-D-aspartate receptor antibodies and 38 were negative for these antibodies. Whereas antibody-positive patients rarely developed prominent brainstem-cerebellar symptoms, 22 (58%) antibody-negative patients developed a brainstem-cerebellar syndrome, which in 45% occurred with opsoclonus. The median age of these patients was 28.5 years (range = 12-41), 91% were women, and 74% had full recovery after therapy and tumor resection. These findings uncover a novel phenotype of paraneoplastic opsoclonus that until recently was likely considered idiopathic or postinfectious. The triad of young age (teenager to young adult), systemic teratoma, and high response to treatment characterize this novel brainstem-cerebellar syndrome.

Safety of intra-cerebrospinal fluid chemotherapy in onco-haematological patients: a retrospective analysis of 627 interventions.

Intra-cerebrospinal fluid chemotherapy (ICC) is used widely to treat or prevent neoplastic meningitis (NM), although its safety has not been thoroughly assessed. We aimed to analyse the incidence, severity and cause of the adverse reactions provoked by ICC in a cohort of onco-haematological patients. We retrospectively reviewed all the adverse reactions related to ICC procedures performed by the same researcher over a 5-year period. We classified them according to their severity and cause, and examined their association with certain characteristics of the patients and interventions. A total of 627 procedures were performed on 124 patients, in which 59 adverse reactions were documented (9.4 %). Thirty-two (54 %) of these were considered severe and 30 (51 %) were due to the drug itself. NM was associated with a higher incidence of adverse reactions (p = 0.002) and severe adverse reactions (p < 0.001). Adverse reactions were more common (p = 0.028) and more often severe (p = 0.008) when an Ommaya reservoir was used, as opposed to the lumbar puncture procedure. The use of liposomal cytarabine was also associated with a higher incidence of adverse reactions (p < 0.001) and serious adverse reactions (p < 0.001) than immediate-release drugs. Liposomal cytarabine provoked more adverse reactions attributable to the drug when administered by lumbar puncture (p = 0.192), whereas the remaining drugs had higher risk when administered via Ommaya reservoir (p = 0.015). ICC seems a relatively safe procedure. Adverse reactions appear to be more frequent when NM is already present. Lumbar puncture seems to be safer than the Ommaya reservoir, except when liposomal cytarabine is administered.

How to facilitate early diagnosis of CNS involvement in malignant lymphoma.

INTRODUCTION: Making the diagnosis of secondary CNS involvement in lymphoma can be difficult due to unspecific signs and symptoms, limited accessibility of brain/myelon parenchyma and low sensitivity and/or specifity of imaging and cerebrospinal fluid (CSF) examination currently available. Areas covered: MRI of the total neuroaxis followed by CSF cytomorphology and flow cytometry are methods of choice when CNS lymphoma (CNSL) is suspected. To reduce the numerous pitfalls of these examinations several aspects should be considered. New CSF biomarkers might be of potential diagnostic value. Attempts to standardize response criteria are presented. Expert commentary: Diagnosing CNSL remains challenging. Until diagnostic methods combining high sensitivity with high specifity are routinely introduced, high level of awareness and optimal utilization of examinations currently available are needed to early diagnose this potentially devastating disease.

Neurooncología: por una subespecialidad transversal y colaborativa / Neuro-oncology: towards a cross-cutting and collaborative sub-specialty

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¿Está aumentando la incidencia del gliobastoma en el área sanitaria del Hospital Rey Juan Carlos? / No disponible

El glioblastoma o glioma de grado IV es el tercer tumor más común del sistema nervioso central (14,9%) y el tumor maligno más frecuente dentro de estos (46,6%). Se caracteriza por una supervivencia menor del 5% a los 5 años tras diagnóstico. Por ello nos planteamos este estudio para conocer si ha existido variación en cuanto a la incidencia del glioblastoma primario en el área sanitaria del Hospital Rey Juan Carlos (HRJC). Se realizó un estudio retrospectivo descriptivo de todos los pacientes con diagnóstico anatomopatológico de glioma de alto grado en el área sanitaria del Hospital Rey Juan Carlos durante el periodo comprendido desde el 1 de enero de 2014 hasta el 31 de diciembre de 2017. Se seleccionaron 143 pacientes con diagnóstico anatomopatológico de glioma de alto grado, glioblastoma, glioblastoma multiforme o astrocitoma grado IV del Hospital Fundación Jiménez Diaz y Hospital Rey Juan Carlos. Además se las variables sociodemográficas se han recogido datos clínicos, anatomopatológicos y radiológicos como clínica principal y acompañante al debut de la lesión, localización de la lesión, la progresión tumoral, hallazgo en pruebas complementarias, tipo de intervención, aplicación de protocolo STUPP y fecha de inicio de RT. Los datos obtenidos en este estudio no han sido significativamente estadísticos. Es por ello, que cabe especular sobre la tendencia al alza de la incidencia del glioblastoma en nuestra zona sanitaria. Al ser el glioblastoma el tumor maligno más frecuente del SNC se esperaría, al menos, un registro nacional de casos nuevos en España, esto permitiría que se pudiera comparar y analizar sus diferencias sociodemográficas y poder llegar a establecer una posible variación sociodemográfica

Glioblastoma or grade IV glioma is the third most common tumor of the central nervous system (14.9%) and the most frequent malignant tumor within these (46.6%). It is characterized by a survival of less than 5% at 5 years after diagnosis. Therefore we consider this study to know if there has been variation in the incidence of primary glioblastoma in the health area of the Rey Juan Carlos Hospital (HRJC). A retrospective, descriptive study of all patients with pathological diagnosis of high-grade glioma in the health area of the Hospital Rey Juan Carlos was carried out during the period from January 1, 2014 to December 31, 2017. A total of 143 patients were selected. With anatomopathological diagnosis of high grade glioma, glioblastoma, glioblastoma multiforme or grade IV astrocytoma of Hospital Fundación Jiménez Diaz and Rey Juan Carlos Hospital. In addition to the sociodemographic variables clinical, anatomopathological and radiological data have been collected as main clinical and accompanying to the debut of the lesion, location of the lesion, tumor progression, finding in complementary tests, type of intervention, application of STUPP protocol and date of start of RT. The data obtained in this study have not been statistically significant. That is why we can speculate on the upward trend in the incidence of glioblastoma in our health area. Since glioblastoma is the most common malignant tumor of the SNS, at least one national registry of new cases would be expected in Spain, this would allow that its sociodemographic differences could be compared and analyzed and a possible sociodemographic variation could be established

Epicrania fugax como forma de inicio de ataques de migraña / Epicrania fugax as the initial presentation of migraine attacks

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