[Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis]. / Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple.

OBJECTIVE: To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFß) in patients with multiple sclerosis (MS), identifying causes and associated factors. MATERIAL AND METHOD: A retrospective observational study that included patients with MS treated with INFß during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients' area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. RESULTS: The study included 131 patients. Mean follow-up was 74 ± 26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFß therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFß1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%). CONCLUSIONS: treatment of MS patients with IFNß is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients' views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment.

[Sexual dysfunction management in multiple sclerosis]. / Abordaje de la disfunción sexual en la esclerosis múltiple.

INTRODUCTION: Sexual dysfunction is a frequent disorder associated to multiple sclerosis, that contributes to the worsening of life quality of these patients. AIM: To ascertain how it is managed in a demyelinating disease unit. PATIENTS AND METHODS: It was done an anonymous poll to multiple sclerosis patients in a demyelinating disease unit. The following variables were analysed: age, sex, marital status, education degree, sexual dysfunction, vesical dysfunction, gait disturbances and duration of illness. RESULTS: 67 of 97 patients answered. 74.6% females. Average age was 43.7 years. Average developing time was 11.3 years. 58% of the patients had vesical dysfunction. 43% had sexual dysfunction. There was relation with statistical significance between sexual and vesical dysfunction but not among the rest of variables. 63% of the patients with sexual dysfunction had never talked about this problem with their doctors. That the patient talked about sexual dysfunction was related with the fact that the neurologist asked for or not, and if sexual dysfunction was an important problem for the patient. The neurologist had asked for dysfunction sexual symptoms to 30% of the patients, and this was more frequent if the patient was male and if he or she had gait disturbances. CONCLUSIONS: Sexual dysfunction is a frequent and important problem for patients with multiple sclerosis. According to our results, this problem is raised up in an insufficient manner as much for patients as for neurologists.

[Leukocytes and primary intracerebral hemorrhage]. / Leucocitos y hemorragia intracerebral primaria.

INTRODUCTION AND OBJECTIVE: The association between the leucocyte count and prognosis observed in ischemic cerebrovascular disease and subarachnoid hemorrhage has rarely been reported in primary intracerebral hemorrhage. The objective of our study is to assess the importance of the number of leukocytes in the peripheral blood during the first 24 hours for prognosis of mortality. PATIENTS AND METHODS: We made a prospective analysis of supratentorial primary intracerebral hemorrhages seen during the first 24 hours during the period 1987-1994. We evaluated the relationship between age, sex, size of hematoma, blood found in the ventricles, level of consciousness on admission, survival and prognosis after 30 days, level of glucaemia, arterial hypertension and leucocyte count. RESULTS: We considered 186 primary intracerebral hemorrhages (64% men and 36% women); the average age was 64 years (Standard Deviation: 10 years). There were 63% deep and 37% lobar hemorrhages. Thirty five percent of the patients died. Leucocytosis was associated with survival (p = 0.003), prognosis (p = 0.0005) and intraventricular bleeding (p = 0.03). We found a significant relationship between the size of the hematoma (r = 0.256; df = 186; p < 0.0001), level of glycaemia on admission (r = 0.282; df = 186; p < 0.0001), level of consciousness (r = -0.263; df = 186, p < 0.0001) and leukocyte count. CONCLUSIONS: The peripheral blood leucocyte count was significantly associated with prognosis and increased mortality. It may therefore be considered to be another parameter of bad prognosis in primary intracerebral hemorrhage.

[Ischemic stroke and auricular septal aneurysm: six cases]. / Ictus isquémico y aneurisma del septo auricular: estudio de seis casos.

INTRODUCTION: Aneurysms of the atrial septum (AAS) are uncommon. They have been considered to be related to embolic phenomena. They are usually associated with other cardiac anomalies, especially persistence of the formen ovale. PATIENTS AND METHODS: We studied six patients diagnosed during a period of 24 months as having ischemic ictus and AAS. They were investigated for vascular risk factors and possible causes of cardiac embolism by means of ECG, transthoracic and transoesophagic echography (ETE). Cases with the clinical characteristics of embolism were anticoagulated. RESULTS: Five patients were men with an average age of 47.6 years. Three had the clinical features of established ictus, one of RIND and two of AIT. Three patients had vascular risk factors. The TSA study showed pathology of the carotid arteries to be present in three patients. In all six cases the AAS was identified on ETE. There were no thrombi in the atria in any case, and in two there was left-right communication. In four patients the condition was considered to have a cardio-embolic origin. No patient has had further episodes of cerebral ischaemia. DISCUSSION: It seems there is a certain risk of cerebral embolus associated with AAS. The simultaneous presence of alterations in cardiac rhythm together with other structural cardiac pathology seems to have a synergic effect on this. Paradoxical embolism, arrhythmias and intra-aneurysmal thrombi appear to be the mechanisms involved in the appearance of emboli. The best therapeutic approach is still unknown. New studies are therefore necessary to establish whether or not it is necessary to anticoagulate these patients.

[Drug-induced parkinsonism. Clinical aspects compared with Parkinson disease]. / Parkinsonismo inducido por fármacos. Aspectos clínicos comparativos con la enfermedad de Parkinson.

INTRODUCTION: Drug-induced Parkinsonism (DIP) is the second commonest cause of Parkinson syndrome, after Parkinson disease (PD) and represents between 10% and 30% of all patients with Parkinsonism. OBJECTIVES: To study the frequency and drugs responsible for DIP and to compare some of the clinical characteristics of these patients and those with PD. PATIENTS AND METHODS: A retrospective community based study in Bajo Aragon district to determine the frequency of PD and other Parkinsonism, including DIP. PD was diagnosed on the criteria proposed by the United Kingdom Parkinson's Disease Society Brain Bank and DIP on the criteria of Jiménez et al. RESULTS: Calcium antagonists were the cause of 73% of the DIP, followed by neuroleptic drugs (11.5%). There were 73% women (19/26). The patients with DIP were older than those with PD when their symptoms started (p = 0.02). In patients with DIP, 48% presented with bilateral symptoms as compared with 7% in PD (p < 0.0001). CONCLUSIONS: 1. Cinarizine is the main drug responsible for DIP (58%) 2. As compared with patients with PD, patients with DIP are mainly women, older, more frequently have bilateral onset of symptoms and consult the doctor sooner.

[Comparative clinical study of patients with Parkinson disease and essential tremor]. / Estudio clínico comparativo entre pacientes con enfermedad de Parkinson y temblor esencial.

INTRODUCTION AND OBJECTIVE: Some studies have shown that essential tremor (ET) occurs more frequently in Parkinson disease (PD) patients and opposite, suggesting these disorders are pathogenically related. To evaluate this relationship, we have compared some clinical features between patients with ET and with PD. PATIENTS AND METHODS: PD patients (N = 134) and patients with ET (N = 46), were collected from Bajo Aragon district. A diagnosis of PD was taken according to the United Kingdom Parkinson's Disease Society Brain Bank criteria. A diagnosis of ET was confirmed on the basis of Rajput et al criteria. RESULTS: A statistically significant higher number of females with ET were founded (p < 0.05). An earlier mean age at tremor onset was observed in ET patients (p < 0.0001). More than half ET patients had a positive had a positive family history of ET (p < 0.0001). Interval period between tremor onset and first medical consulting was higher in ET patients (p < 0.01). Depression was more common in PD patients (p < 0.05). CONCLUSIONS: A statistically significant differences about mean age at tremor onset, duration of illness, positive family history of ET, one side or bilateral tremor onset and frequency of depression were observed between these two disorders. The differences found in clinical features and others described previously about necropsy findings and TEP with 18F-Dopa studies, don't support the possibility that PD and ET are pathogenically related.

[Thromboangiitis obliterans with cerebral involvement]. / Tromboangeítis obliterante con isquemia cerebral.

We report the case of a male with Buerger's disease and neurologic involvement. Cerebral arteriography showed multiple distal arterial obliterans with left-sided Moya-moya phenomena. Thromboangiitis obliterans is a chronic segmental occlusive disease affecting medium-sized and small arteries and veins throughout the body. Neurologic signs are rare, occurring in fewer than 2 % of cases, and most often found on the cortical surface and adjacent territories. We review the most common signs of this entity and its main diagnostic difficulties.