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1.
Rev Neurol ; 78(S01): S1-S10, 2024 Jun 30.
Artigo em Espanhol | MEDLINE | ID: mdl-38916176

RESUMO

Most patients with Parkinson's disease experience motor fluctuations or 'off' periods, which impact on their daily activities, increase their disability and diminish their quality of life. They suffer from these fluctuations despite multiple adjustments to the schedules, doses and intake of medication. In this context, on-demand or rescue treatments are necessary to attempt to improve 'off' periods, with drugs that have the pharmacokinetic advantage of a much faster onset of action because their routes of administration are not oral. There are currently three on-demand therapies for the treatment of fluctuations: subcutaneous apomorphine, inhaled levodopa and sublingual apomorphine. Of the three alternatives, subcutaneous apomorphine generally has the fastest onset of action, sublingual apomorphine provides the longest clinical effect, and inhaled levodopa has the most favourable side effect profile. Each of these drugs has its own characteristics: the time before onset of action, the duration of action and different side effect profiles. The choice for each patient will depend on their individual needs and circumstances. To mark the first year of the introduction of inhaled levodopa, we review these therapies, focusing on the experience with this new dosage form of levodopa.


TITLE: Levodopa inhalada: de la evidencia a la experiencia.La mayoría de los pacientes con enfermedad de Parkinson sufren fluctuaciones motoras o períodos off, que impactan en sus actividades cotidianas, aumentan su discapacidad y empeoran su calidad de vida. A pesar de realizar múltiples ajustes en los horarios, en las dosis y en las tomas de medicación, no se consigue que estén libres de estas fluctuaciones. Es en este contexto en el que son necesarios los tratamientos a demanda o de rescate para tratar de mejorar los períodos off, con fármacos que tienen la ventaja farmacocinética de un inicio de acción mucho más rápido debido a que sus vías de administración no son orales. En la actualidad existen tres terapias a demanda para el tratamiento de las fluctuaciones: apomorfina subcutánea, levodopa inhalada y apomorfina sublingual. En general, la apomorfina subcutánea tiene un inicio de efecto más rápido, la apomorfina sublingual ofrece el efecto clínico más prolongado y la levodopa inhalada tiene el perfil de efectos secundarios más favorable entre las tres opciones. Cada uno de estos medicamentos tiene características únicas: tiempo de inicio, duración de acción y diferentes perfiles de efectos secundarios. La elección para cada paciente dependerá de sus necesidades y circunstancias individuales. Aprovechando el primer año de la introducción de la levodopa inhalada, revisamos estas terapias, centrándonos en la experiencia acumulada con esta nueva presentación galénica de levodopa.


Assuntos
Antiparkinsonianos , Levodopa , Doença de Parkinson , Humanos , Levodopa/administração & dosagem , Levodopa/farmacocinética , Doença de Parkinson/tratamento farmacológico , Antiparkinsonianos/administração & dosagem , Antiparkinsonianos/farmacocinética , Antiparkinsonianos/uso terapêutico , Administração por Inalação , Apomorfina/administração & dosagem , Apomorfina/farmacocinética , Apomorfina/uso terapêutico
2.
J Prev Alzheimers Dis ; 10(3): 488-496, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37357289

RESUMO

BACKGROUND: People with cognitive impairment (CI) need to be identified early because of the risk of progression to dementia. OBJECTIVES: The primary objective of the study was to analyze the usefulness of the community pharmacy for early detection of CI in older people through their caregivers. As secondary objective the risk factors related to IQ-CODE classification of risk of CI were identified. DESIGN: A cross-sectional observational study was designed. SETTING: Caregivers were selected by pharmacists from Spanish community pharmacies. PARTICIPANTS: Subjects with a close relationship to persons over 70 years of age who were not previously diagnosed with CI and who did not live in a nursing home or were hospitalized participated in the study. MEASUREMENTS: The proportion of older people who were classified as "at risk of CI" was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), which was completed by the caregiver. RESULTS: A total of 197 pharmacists selected 910 caregivers with an average age of 53 years, 75.5% of whom were women. In 324 people over the age of 70 (38.5%), "risk of CI" was observed, increasing with age. The risk of CI was 4.3 times higher in older people who complained of memory loss (p<0.001), 2.5 times higher if they had had a stroke in the last two years (p=0.007), 1.9 times higher if they were smokers (p=0.045) and 1.6 times higher if they were diabetic (p=0.028). CONCLUSION: Detection of risk of CI from the community pharmacy showed prevalence figures consistent with the CI figures observed in the Spanish primary care setting, demonstrating the capacity of the community pharmacy to contribute to early detection of CI.


Assuntos
Disfunção Cognitiva , Farmácias , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Masculino , Estudos Transversais , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Cuidadores , Inquéritos e Questionários
3.
Rev Neurol ; 77(11): 277-281, 2023 Dec 01.
Artigo em Espanhol | MEDLINE | ID: mdl-38010785

RESUMO

The detection by biomarkers of the pathophysiological and molecular processes involved in misfolding protein diseases making it possible to delineate the natural history of these processes. The great majority of protein misfolding diseases have a prolonged preclinical phase, in which the biological changes are patent. The clinical manifestations (i.e., phenotypes) do not have a univocal correspondence with the underlying pathology, despite the fact that pathological eponyms have been used for the description of the clinical syndromes, which has favored diagnostic inaccuracy. In order to perform an adequate clinical management, we must know the 3 planes that currently define the most common neurodegenerative processes. Diagnostic accuracy will be a prerequisite for new therapies aimed at modifying the course of brain protein misfolding diseases.


TITLE: La nueva era de las enfermedades neurodegenerativas. La base de los nuevos abordajes.La detección por biomarcadores de los procesos fisiopatológicos y moleculares implicados en las enfermedades cerebrales por plegamiento anormal de proteínas está permitiendo delinear la historia natural de estos procesos. La gran mayoría de ellos tiene una fase preclínica prolongada, en la que los cambios biológicos son patentes. Las manifestaciones clínicas (fenotipos) no tienen una correspondencia unívoca con la patología subyacente, a pesar de que se han utilizado los epónimos anatomopatológicos para la descripción de los síndromes clínicos, lo que ha favorecido la imprecisión diagnóstica. Para realizar un adecuado manejo clínico debemos conocer los tres planos que definen actualmente los procesos neurodegenerativos más frecuentes. La precisión diagnóstica será un prerrequisito para las nuevas terapias dirigidas a modificar el curso de las enfermedades por plegamiento proteico cerebrales.


Assuntos
Doenças Neurodegenerativas , Deficiências na Proteostase , Humanos , Doenças Neurodegenerativas/diagnóstico , Proteínas , Deficiências na Proteostase/tratamento farmacológico , Deficiências na Proteostase/patologia , Biomarcadores
5.
Neurologia (Engl Ed) ; 33(2): 107-111, 2018 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27474365

RESUMO

INTRODUCTION: The clinical problems of patients with movement disorders (MD) are complex, and the duration and frequency of face-to-face consultations may be insufficient to meet their needs. We analysed the implementation of an e-mail-based query service for our MD unit's patients and their primary care physicians (PCPs). METHODS: We retrospectively reviewed all consecutive emails sent and received over a period of 4 months, one year after implementation of the e-mail inquiry system. All patients received the during consultations, and PCPs, during scheduled informative meetings. We recorded and later analysed the profile of the questioner, patients' demographic and clinical data, number of queries, reason for consultation, and actions taken. RESULTS: From 1 January 2015 to 30 April 2015, the service received 137 emails from 63 patients (43% male, mean age 71±10.5) diagnosed with Parkinson's disease (76%), atypical parkinsonism (10%), and others (14%); 116 responses were sent. Twenty (32%) emails were written by patients, 38 (60%) by their caregivers, and 5 (8%) by their PCPs. The reasons for consultation were clinical in 50 cases (80%): 16 (32%) described clinical deterioration, 14 (28%) onset of new symptoms, and 20 (40%) side effects or concerns about medications. In 13 cases (20%), the query was bureaucratic: 11 were related to appointments (85%) and 2 were requests for clinical reports (15%). In response, new appointments were scheduled in 9 cases (14%), while the rest of the questions were answered by email. Patients were satisfied overall and the additional care burden on specialists was not excessive. CONCLUSIONS: Implementing an e-mail-based consultation system is feasible in MD units. It facilitates both communication between neurologists and patients and continued care in the primary care setting.


Assuntos
Comunicação , Correio Eletrônico/estatística & dados numéricos , Doença de Parkinson/complicações , Médicos de Atenção Primária , Encaminhamento e Consulta/estatística & dados numéricos , Especialização , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos
6.
Rev Neurol ; 67(s01): S1-S21, 2018 11 26.
Artigo em Espanhol | MEDLINE | ID: mdl-30484273

RESUMO

«Apuntes en Neurologia¼ is an initiative in which prominent national and international leaders, with broad academic recognition, came together to synthesise the most outstanding clinical aspects within their area of interest and to discuss the latest developments in a more accessible language. Understanding the factors that affect the onset and progression of any neurological disease through a review is important to be able to develop strategies to reduce the burden of these diseases. Moreover, knowledge of the clinical aspects is essential to solve the problems of daily clinical practice. The data collected here reflect the weight of evidence and some of them anticipate a promising future in the treatment of these diseases. This first edition focuses on common paroxysmal neurological disorders such as migraine, epilepsy and sleep disorders, as well as neurodegenerative disorders such as Parkinson's disease and cognitive impairment. These are clearly different pathologies, although some of them such as migraine and epilepsy, may share clinical symptoms. Sleep disorders, however, are important manifestations of neurodegenerative diseases that are sometimes clinically apparent long before the onset of other neurological symptoms. After recalling pathophysiology and diagnosis, the current review focuses on bringing together the main advances in five of the major neurological diseases.


TITLE: «Apuntes en Neurologia¼: una sintesis de la evidencia en trastornos neurologicos comunes paroxisticos y en trastornos neurodegenerativos.«Apuntes en Neurologia¼ es una iniciativa en la cual lideres de primera linea nacional e internacional, con amplio reconocimiento academico, se reunieron para sintetizar los aspectos clinicos mas destacables dentro de su area de interes y acercar las novedades en una lengua mas proxima. Entender los factores que afectan al inicio y progresion de cualquier enfermedad neurologica a traves de una revision es importante para el desarrollo de estrategias en pro de reducir la carga de estas enfermedades, y conocer los aspectos clinicos es esencial para poder resolver los problemas de la practica clinica diaria. Los datos aqui recogidos reflejan el peso de la evidencia y algunos de ellos anticipan un futuro prometedor en el tratamiento de estas enfermedades. Esta primera edicion se centra en trastornos neurologicos comunes paroxisticos como la migraña, la epilepsia y las alteraciones del sueño, y en trastornos neurodegenerativos como la enfermedad de Parkinson y el deterioro cognitivo. Se trata de patologias claramente diferentes, si bien algunas de ellas, como la migraña y la epilepsia, pueden compartir sintomatologia clinica. Los trastornos del sueño, por su parte, son manifestaciones importantes de enfermedades neurodegenerativas que, en ocasiones, son clinicamente evidentes mucho antes del inicio de otros sintomas neurologicos. Tras recordar la fisiopatologia y el diagnostico, la revision actual se centra en acercar los principales avances en cinco de las principales enfermedades neurologicas.


Assuntos
Demência , Epilepsia , Transtornos de Enxaqueca , Doenças Neurodegenerativas , Doença de Parkinson , Transtornos do Sono-Vigília , Demência/diagnóstico , Demência/terapia , Epilepsia/diagnóstico , Epilepsia/terapia , Medicina Baseada em Evidências , Humanos , Transtornos de Enxaqueca/terapia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/terapia , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Transtornos do Sono-Vigília/diagnóstico
7.
Rev Neurol ; 45(9): 513-8, 2007.
Artigo em Espanhol | MEDLINE | ID: mdl-17979079

RESUMO

INTRODUCTION: Migraine interferes with the quality of life of patients. Prophylactic medication is an option to be considered in cases showing inefficiency of symptomatic medication or an increase in the number of attacks. AIM: To evaluate the characteristics of patients that start on prophylactic treatment for migraine. PATIENTS AND METHODS: A multicenter epidemiologic survey was conducted in 110 neurological outpatient clinics and hospitals among adult patients of both sexes who required prophylactic treatment for migraine. Pain intensity was measured through a three-category scale: mild, moderate, or severe. Daily disability was measured by a disability questionnaire. RESULTS: A total of 735 patients with migraine who had started prophylactic treatment were considered valid for the analysis. The patients reported an average of 9.7 days with migraine in the previous month, 32% of the episodes lasting more than 24 hours. Half of the patients referred working or home disability due to migraine with a total average score of 15.1 on the disability scale (grade III). A 48% of the patients had previously received prophylactic treatment, the medications most commonly prescribed being flunarizine, propranolol and amitriptyline. At the study visit, the most commonly prescribed medications were topiramate, flunarizine, propranolol, and amitriptyline. CONCLUSIONS: Our study reveals that starting prophylactic treatment is in the majority of cases due to a high attack frequency. A clear evolution is being observed in prophylactic medication prescription, with a shift from flunarizine or propranolol to topiramate, which is prescribed more frequently nowadays.


Assuntos
Transtornos de Enxaqueca/prevenção & controle , Adulto , Idade de Início , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Amitriptilina/uso terapêutico , Avaliação da Deficiência , Gerenciamento Clínico , Feminino , Flunarizina/uso terapêutico , Frutose/análogos & derivados , Frutose/uso terapêutico , Cefaleia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos de Enxaqueca/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Periodicidade , Propranolol/uso terapêutico , Índice de Gravidade de Doença , Espanha/epidemiologia , Topiramato
8.
Rev Neurol ; 65(9): 405-408, 2017 Nov 01.
Artigo em Espanhol | MEDLINE | ID: mdl-29071699

RESUMO

AIM: Cognitive impairment is underdiagnosed in the elderly. We aimed to study the rate of positive responses to an informant-based questionnaires and functional disability after hospital discharge. PATIENTS AND METHODS: Observational prospective case series of patients aged 70-85 years-old admitted for hospitalization in an Internal Medicine ward. All medical records were reviewed and those patients with no previous diagnosis of dementia or related neurological conditions, no previous recent hospitalization or not having a caregiver were evaluated after signing an informed consent. A medical interview including the Alzheimer's Disease 8 (AD8), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Barthel Index was completed. Barthel Index was obtained three months after discharge. RESULTS: During a 3-month period a total of 809 admissions were screened and 79 (9.7%) fulfilled the study criteria. Patient's mean age was 80 years-old. Common comorbidities were arterial hypertension (83.5%), major surgery (54.4%) and heart disorders (50.6%). The most frequent cause of admission was infectious disease (37.9%). Test positivity for cognitive impairment was 30.3% for IQCODE and 34.1% for AD8. At admission 37.9% of the patients were functionally independent. At three months this percentage dropped to 24%. CONCLUSIONS: In this small sample size, almost a third of older patients, without major comorbidities or neurological disorders, admitted to a general hospital showed an informant-based suggestion of cognitive impairment previously undiagnosed. Functional impairment affects almost a quarter of these patients three months after admission.


TITLE: Deterioro cognitivo como factor independiente de riesgo hospitalario: estudio DECOFIRH.Objetivo. El deterioro cognitivo esta infradiagnosticado. El estudio DECOFIRH pretende detectar la tasa de deterioro cognitivo no conocido y su impacto en la situacion funcional de estos pacientes tras un ingreso hospitalario mediante cuestionarios realizados a un informador. Pacientes y metodos. Estudio observacional prospectivo realizado sobre una serie de casos, de pacientes comprendidos entre 70 y 85 años, que ingresan en el Servicio de Medicina Interna de un hospital terciario. Se excluyo a los pacientes con diagnostico de demencia o enfermedades neurologicas graves, asi como a los que habian sido hospitalizados recientemente. Los tests empleados en la deteccion de deterioro cognitivo fueron Alzheimer's Disease 8 (AD8) e Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Asimismo, se evaluo la situacion funcional mediante el indice de Barthel en el momento del ingreso y tres meses despues. Resultados. Durante los tres meses de seguimiento ingresaron 809 pacientes y cumplieron los criterios de inclusion 79 (9,7%) de ellos. Su edad media era de 80 años. Mediante el IQCODE se detecto una tasa de deterioro cognitivo del 30,3%, y con el AD8, del 34,1%. En el ingreso, el 37,9% de los pacientes era funcionalmente independiente. A los tres meses, este porcentaje cayo al 24%. Conclusiones. En nuestra muestra, casi un tercio de los ancianos sin comorbilidades sistemicas o neurologicas graves dio positivo para la deteccion de deterioro cognitivo segun nuestros tests basados en el informador, sin ser este conocido previamente. El deterioro funcional afecta casi a una cuarta parte de estos pacientes a los tres meses del ingreso.


Assuntos
Disfunção Cognitiva/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/diagnóstico , Progressão da Doença , Feminino , Hospitalização , Humanos , Masculino , Estudos Prospectivos , Medição de Risco
9.
Rev Neurol ; 58(7): 308-17, 2014 Apr 01.
Artigo em Espanhol | MEDLINE | ID: mdl-24677154

RESUMO

The new diagnostic criteria for Alzheimer's disease (AD) include brain imaging and cerebrospinal fluid (CSF) biomarkers, with the aim of increasing the certainty of whether a patient has an ongoing AD neuropathologic process or not. Three CSF biomarkers, Aß42, total tau, and phosphorylated tau, reflect the core pathological features of AD. It is already known that these pathological processes of AD starts decades before the first symptoms, so these biomarkers may provide means of early disease detection. At least three stages of AD could be identified: preclinical AD, mild cognitive impairment due to AD, and dementia due to AD. In this review, we aim to summarize the CSF biomarker data available for each of these stages. We also review the actual research on blood-based biomarkers. Recent studies on healthy elderly subjects and on carriers of dominantly inherited AD mutations have also found biomarker changes that allow separate groups in these preclinical stages. These studies may aid for segregate populations in clinical trials and objectively evaluate if there are changes over the pathological processes of AD. Limits to widespread use of CSF biomarkers, apart from the invasive nature of the process itself, is the higher coefficient of variation for the analyses between centres. It requires strict pre-analytical and analytical procedures that may make feasible multi-centre studies and global cut-off points for the different stages of AD.


TITLE: Biomarcadores en la enfermedad de Alzheimer.Los nuevos criterios diagnosticos para la enfermedad de Alzheimer (EA) incluyen la posibilidad de practicar tecnicas de neuroimagen o analisis del liquido cefalorraquideo con el objeto de aumentar la certeza de que un paciente presenta un proceso neuropatologico relacionado con la EA. Tres biomarcadores del liquido cefalorraquideo (Aß42, tau total y tau fosforilada) reflejan las caracteristicas patologicas centrales de la EA. Estos procesos neuropatologicos se inician decadas antes de que sean detectables sintomas, por lo que se esta determinando si estos biomarcadores pueden ser utiles en la deteccion precoz y prevencion de la demencia. Podemos definir tres estadios de la EA: estadio preclinico, deterioro cognitivo leve debido a EA y demencia por EA. En esta revision, se resumen las evidencias de biomarcadores en cada uno de estos estadios. Tambien se revisan los estudios que investigan biomarcadores para la EA en sangre. Los estudios en ancianos asintomaticos y en portadores de mutaciones autosomicas dominantes de EA han mostrado alteraciones en los biomarcadores que permiten la segregacion en estos estadios preclinicos. Estos estudios permitiran identificar las poblaciones diana de los ensayos clinicos futuros y evaluar de manera objetiva si se producen modificaciones sobre el proceso patologico de la EA. El desarrollo de los biomarcadores del liquido cefalorraquideo requiere unos procedimientos normalizados preanaliticos y analiticos estrictos que hagan fiables los estudios multicentricos y universalicen los puntos de corte de la tecnica en los distintos estadios de la EA.


Assuntos
Doença de Alzheimer/diagnóstico , Biomarcadores/líquido cefalorraquidiano , Proteínas tau/líquido cefalorraquidiano , Doença de Alzheimer/sangue , Doença de Alzheimer/líquido cefalorraquidiano , Doença de Alzheimer/genética , Peptídeos beta-Amiloides/sangue , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Apolipoproteína E4/sangue , Apolipoproteína E4/genética , Biomarcadores/sangue , Transtornos Cognitivos/diagnóstico , Disfunção Cognitiva/líquido cefalorraquidiano , Disfunção Cognitiva/diagnóstico , Diagnóstico Diferencial , Progressão da Doença , Diagnóstico Precoce , Predisposição Genética para Doença , Humanos , Valor Preditivo dos Testes , Presenilina-1/genética , Proteínas tau/química
11.
Neurologia ; 21(6): 289-96, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-16799903

RESUMO

INTRODUCTION: Several controlled clinical trials have demonstrated safety, tolerability, and efficacy of galantamine in patients with Alzheimer's disease (AD). We present an observational and multicenter study carried out in Spain. Its main objective was the assessment of the safety and tolerability of galantamine in the treatment of mild to moderately severe dementia of the Alzheimer type under real clinical conditions. METHODS: The study had five visits over a 6-month period. Titration of galantamine was performed on a standard basis. All the adverse events (AE) reported were recorded. Serious AE were particularly considered. Effectiveness was also assessed covering cognitive, functional, behavioral and sleep domains. RESULTS: 723 patients were enrolled but 74 were excluded, a sample of 649 (71% women and 29% men) remaining. A total of 56.3% patients completed all visits. Baseline Mini-Mental mean score was 19,4 (SD: 4,7). Up to 400 AEs were collected from 29.3% of the patients. The commonest AEs were: nausea (9.7%), vomiting (7.1%), dizziness (4.6%), and diarrhea (4.5%). Mini-Mental scores were stable over time and favorable and significant differences in behavioral and sleep evaluations were observed. CONCLUSIONS: Galantamine is a safe and well-tolerated treatment, and provides cognitive, functional, and behavioral benefits in patients with mild to moderately severe AD.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/uso terapêutico , Galantamina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/fisiopatologia , Sintomas Comportamentais , Inibidores da Colinesterase/efeitos adversos , Comorbidade , Feminino , Galantamina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade
12.
Neurologia ; 10(2): 110-13, 1995 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-7695939

RESUMO

Demyelinating neuropathy is considered a rare complication of Lyme borreliosis. We report a case of meningoradiculitis due to Borrelia burgdorferi in which the neurophysiological analysis showed evidence of restricted demyelinating involvement of the nerve roots and plexus, with no peripheral involvement or signs of distal axonal lesions. Lyme disease, therefore, can in fact be associated with demyelinating polyradiculitis with no peripheral nerve damage.


Assuntos
Doenças Desmielinizantes/etiologia , Doença de Lyme/complicações , Polirradiculopatia/complicações , Idoso , Grupo Borrelia Burgdorferi/isolamento & purificação , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Humanos , Injeções Intravenosas , Doença de Lyme/tratamento farmacológico , Doença de Lyme/microbiologia , Masculino , Resultado do Tratamento
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