Neurological presentations of Bartonella henselae infection.

OBJECTIVE: Neurological symptoms in patients with cat-scratch disease (CSD) have been rarely reported. The aim of this study is to analyze the frequency of neurological CSD (NCSD) and describe the disease clinical presentation, management and outcome. MATERIAL AND METHODS: We retrospectively selected patients with a CSD syndrome and Bartonella IgG titers > 1:256. Data regarding epidemiological, clinical, management, and follow-up features were analyzed and discussed. A comparison between NCSD and non-neurological CSD (NNCSD) was established. RESULTS: Thirty-nine CSD patients were selected. NCSD frequency was 10.25%. No children were found affected in the NCSD group. A 65.7% of NNCSD and the entirety of the NCSD group had a history of cat exposure. Immunosuppression was only present in the NNCSD group (8.6%). NCSD presentations were as follows: isolated aseptic meningitis (25%), neuroretinitis (50%), and isolated optic neuritis (25%). A greater proportion of patients in the NCSD group had fever and raised levels of acute phase reactants and white blood cells. 85.7% of NNCSD had a complete recovery, whereas only 50% of the NCSD patients experienced a full recovery. CONCLUSION: NCSD may be a distinctive group compared to NNCSD due to its later age of presentation, the more intense systemic response, and the poorer outcome.

Perampanel effectiveness and safety as early add-on treatment for focal-onset seizures: PEREAGAL study.

BACKGROUND: Perampanel (PER) is an effective adjunctive therapy for controlling focal-onset seizures (FOS), but few studies have examined its effects as an early add-on for the treatment of FOS in daily clinical practice. METHODS: Our retrospective, multicenter, observational study evaluated the effectiveness and safety of PER as an early add-on in 77 patients with FOS, with and without focal to bilateral tonic-clonic seizures (FBTCS) after 3, 6 and 12 months in a real-world setting. RESULTS: After 12 months of treatment (median dose 6 [4,8] mg/day), the retention rate was 79.2 % and 60 % of patients (39/65) experienced a ≥50 % reduction in seizure frequency relative to baseline. The seizure-free rate was 38.5 % for all seizures (25/65) and 60 % for FBTCS (12/20). The responder rate at 12 months was significantly higher when PER was given with one concomitant AED (72.2 %) compared to when PER was given with two concomitant AEDs (44.8 %). Drug-related adverse events (AEs) were reported in 40.3 % of patients, most of them being mild (64.2 %). Twelve patients (15.6 %) discontinued treatment because of AEs. CONCLUSIONS: PER is an effective and safe early add-on for patients with refractory FOS, especially for those with FBTCS.

[Ulysses in the medical literature]. / Ulises en la literatura médica.

INTRODUCTION: Cultural manifestations are frequently used as a source of descriptors in the field of the health sciences. The story of Odysseus (Ulysses) is one of the oldest and most influential works of world literature and has given rise to many subsequent creations, with strong roots in popular culture. AIMS: To consider the use of the story of Odysseus in the medical literature, to describe the terms in which it is used, and to discuss its relevance. DEVELOPMENT: From a review performed in PubMed, 112 medical publications with references to the myth of Odysseus were found, out of a total of 343 results. Five different conditions named directly after Ulysses were found (three Ulysses syndromes, the Ulysses contract and the Ulysses conflict), together with two others that have been given the names of other characters who are part of the same cycle (Elpenor syndrome and Penelope syndrome), which we analyse in a critical manner referring to the original material from which they have been taken. CONCLUSIONS: The story of Odysseus constitutes one of the most frequent sources of inspiration in medicine, both for the creation of descriptors and for the use of similes, metaphors or other rhetorical figures, particularly in the area of neuroscience.

TITLE: Ulises en la literatura médica.Introducción. Es frecuente el empleo de manifestaciones culturales como origen de descriptores en el campo de las ciencias de la salud. La historia de Odiseo (Ulises) es una de las obras más antiguas e influyentes de la literatura universal y ha dado lugar a múltiples creaciones posteriores, con un fuerte arraigo en la cultura popular. Objetivo. Ponderar el uso del relato de Odiseo en la literatura médica, describir los términos en los que se emplea y discutir la pertinencia de estos. Desarrollo. Tras una revisión en PubMed, se hallaron 112 publicaciones de carácter médico con referencias al mito de Odiseo, de un total de 343 resultados. Se recogen hasta cinco entidades diferentes directamente nombradas a partir de Ulises (tres síndromes de Ulises, el contrato de Ulises y el conflicto de Ulises), y dos más sobre otros personajes que forman parte de su ciclo (síndrome de Elpenor y síndrome de Penélope), las cuales analizamos de forma crítica respecto al material original del que se parte. Conclusiones. La historia de Odiseo constituye una de las fuentes de inspiración más frecuentes en la medicina, tanto para la elaboración de descriptores como para el empleo de símiles, metáforas u otras figuras retóricas, particularmente en el área de las neurociencias.

[Epilepsy and breastfeeding: from myth to reality]. / Epilepsia y lactancia materna: del mito a la realidad.

INTRODUCTION: In clinical practice, it is common to find cases of epileptic women being treated with antiepileptic drugs (AEDs) whom we have to advise on the compatibility of these AEDs with breastfeeding. AIMS: In order to offer correct guidance, we must be well informed about the pharmacokinetic characteristics of the different AEDs, in addition to being aware of the clinical experience in this regard. This review stems from the paucity of information on this topic. DEVELOPMENT: The World Health Organisation recommends that breastfeeding should be the norm for all women, even in epileptic mothers that are taking AEDs, who must always be given special attention in order to watch for the appearance of adverse effects in the infant, and always avoiding sudden weaning in order to avoid withdrawal symptoms. CONCLUSIONS: Very few AEDs are incompatible with breastfeeding. The decision to breastfeed should take into account not only the AED, but also its number, dose, serum levels, transmission and elimination rates in the infant, and the conditions of the newborn infant. Ethosuximide and felbamate are probably high risk and incompatible with breastfeeding. Lamotrigine, phenobarbital, pregabalin, primidone, tiagabine, eslicarbazepine, brivaracetam, perampanel, zonisamide, lacosamide or the sporadic use of benzodiazepines in low doses are considered quite safe, with a low risk for breastfeeding. The other AEDs present a very low risk for breastfeeding.

TITLE: Epilepsia y lactancia materna: del mito a la realidad.Introduccion. En la practica clinica es habitual encontrar el caso de una mujer epileptica en tratamiento con farmacos antiepilepticos (FAE) a la que deberemos asesorar sobre la compatibilidad de esos FAE con la lactancia materna. Objetivo. Para realizar un asesoramiento correcto deberemos estar bien informados sobre las caracteristicas farmacocineticas de los diferentes FAE, asi como estar al tanto de la experiencia clinica al respecto. La intencion de esta revision nace de la escasez de informacion a este respecto. Desarrollo. La Organizacion Mundial de la Salud recomienda que la lactancia materna debe ser la norma en todas las mujeres, incluso en las madres epilepticas que toman FAE, a las cuales debe prestarse siempre especial atencion para vigilar la aparicion de efectos adversos en el lactante, eludiendo siempre el destete brusco para evitar el sindrome de abstinencia. Conclusiones. Son muy pocos los FAE incompatibles con la lactancia materna. La decision de amamantar debe tener en cuenta no solo el FAE, sino su numero, la dosis, los niveles sericos, los porcentajes de transmision y eliminacion en el lactante, y las condiciones del neonato. La etosuximida y el felbamato presentan un riesgo probablemente alto y son incompatibles con la lactancia materna. La lamotrigina, el fenobarbital, la pregabalina, la primidona, la tiagabina, la eslicarbacepina, el brivaracetam, el perampanel, la zonisamida, la lacosamida o el uso puntual y en bajas dosis de benzodiacepinas se consideran bastante seguros, con riesgo bajo para la lactancia. El resto de FAE presenta muy bajo riesgo para la lactancia materna.

[Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Galicia]. / Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en Galicia.

INTRODUCTION: The effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis (RRMS) have been proven in clinical trials. Yet, due to their limitations, it is important to know how it behaves under everyday clinical practice conditions. Hence, the aim of this study is to evaluate the effectiveness and safety of fingolimod after 12 months' usage in clinical practice in Galicia. PATIENTS AND METHODS: We conducted a retrospective, multi-centre study (n = 8) of patients with RRMS who were treated with one or more doses of fingolimod, 0.5 mg/day. Effectiveness was assessed -annualised relapse rate (ARR), changes in the score on the Expanded Disability Status Scale (EDSS), percentage of patients free from relapses, free from progression of disability and free from activity in resonance- for the total number of patients and according to previous treatment. Safety was assessed based on the percentage of patients who withdrew and presented adverse side effects. RESULTS: After 12 months' use, fingolimod reduced the ARR by 87% (1.7 to 0.23; p < 0.0001) and, consequently, 81% of patients were free from relapses. The score was reduced by 9%. In all, 91% of patients were free from progression of disability and 72% were free from resonance activity. No signs of disease activity were found in 43% of the patients. Most of the benefits of fingolimod differed depending on previous treatment. About a third of the patients reported adverse side effects, but only 2% of them withdrew for this reason. CONCLUSIONS: In clinical practice, most of the results on the effectiveness of the clinical trials conducted with fingolimod were observed during the first 12 months of treatment. A better safety profile was observed than that reported in the clinical trials.

TITLE: Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en Galicia.Introduccion. La efectividad y seguridad del fingolimod en pacientes con esclerosis multiple remitente recurrente (EMRR) se demostro en ensayos clinicos. Sin embargo, por las limitaciones de estos, es importante saber como se comporta en condiciones de practica clinica habitual. Asi, el objetivo de este estudio es evaluar la efectividad y seguridad del fingolimod despues de 12 meses de uso en la practica clinica en Galicia. Pacientes y metodos. Estudio retrospectivo y multicentrico (n = 8) de pacientes con EMRR y tratados con una o mas dosis de fingolimod, 0,5 mg/dia. Se evaluo la efectividad ­tasa anualizada de brotes (TAB), cambio en la puntuacion de la escala expandida del estado de discapacidad (EDSS), porcentaje de pacientes libres de brotes, libres de progresion de discapacidad y libres de actividad en resonancia­ para el total de pacientes y segun tratamiento previo. Se evaluo la seguridad a partir del porcentaje de pacientes que discontinuaron y que presentaron efectos adversos. Resultados. Despues de 12 meses de uso, el fingolimod redujo un 87% la TAB (de 1,7 a 0,23; p < 0,0001) y, en consecuencia, un 81% de pacientes estuvo libre de brotes. La puntuacion de la EDSS disminuyo un 9%. Un 91% de pacientes estuvo libre de progresion de discapacidad y un 72%, libre de actividad en resonancia. En el 43% de los pacientes no se evidenciaron signos de la actividad de la enfermedad. La mayoria de los beneficios del fingolimod difirieron segun el tratamiento previo. Alrededor de un tercio de los pacientes comunicaron efectos adversos, pero solo el 2% discontinuo debido a ellos. Conclusiones. La mayoria de los resultados de efectividad de los ensayos clinicos del fingolimod se observa durante los 12 primeros meses de tratamiento en la practica clinica. Se observo un mejor perfil de seguridad al comunicado en los ensayos clinicos.

[Myasthenia gravis and treatment with intravenous immunoglobulins. Reply]. / Miastenia grave y tratamiento con inmunoglobulinas por via intravenosa. Replica.

Miastenia grave y tratamiento con inmunoglobulinas por via intravenosa. Replica.