[Triptans in clinical practice: effectiveness, tolerance and patient's satisfaction with medication (TRIPRACLI study)]. / Los triptanes en la practica clinica: eficacia, tolerancia y satisfaccion del paciente con los farmacos (estudio TRIPRACLI).

INTRODUCTION AND AIMS: This study was aimed determining the effectiveness, tolerance and satisfaction of patients with migraine as regards different triptans, according to the characteristics of their attacks. At the same time it sought to establish a predictive model that can be used to recommend one or another, depending on those characteristics. PATIENTS AND METHODS: Retrospective observation-based study conducted in headache units in a number of different centres. Patients included in the study were those with migraine who used the same triptan to treat their attacks. Data concerning preference, effectiveness, speed and tolerance were analysed. RESULTS: The analysis included 160 patients (88 females), with a mean age of 42.92 years. The most commonly used triptans were eletriptan, almotriptan and rizatriptan. Both patients and doctors reported a high degree of satisfaction (88% and 65%) with the triptan that was used. In the surveys on preference, patients preferred their current triptan to the previous one (83%) or to non-specific drugs. The overall score on a visual analogue scale was above 7 for all the triptans, without any differences from one to another. On analysing the use of a particular triptan depending on the characteristics of the attacks, no statistically significant differences were found. CONCLUSIONS: In this selected group of patients, triptans are a treatment that patients claim to be very satisfied with. Although there are no overall differences in the scores among different triptans, the fact that certain triptans are used more by patients after previous experiences with others suggests that they are more effective. We did not find any parameter that predicts the use of a particular triptan.

[Effectiveness of topiramate in migraine prophylaxis, an observational study in a consecutive case-serie]. / Valoración de la efectividad del topiramato en el tratamiento preventivo de la migraña. Estudio observacional de una serie consecutiva de pacientes.

INTRODUCTION: Open-label studies and three large and controlled trials had demostrated the efficacy of topiramate in migraine prophylaxis. OBJECTIVES: The objective of this study was to assess the effectiveness and tolerability of topiramate in patients not previously treated with any prophylactic drug. PATIENTS AND METHODS: Patients selection was made on sequential patients attending our outpatient clinic. Patients were adults diagnosed of either transformed migraine or migraine with a frequency of more than four migraine attacks per month. Topiramate was started at 25 mg and titrated in 4 weeks by weekly increments of 25 mg, up to 100 mg/day. Patients were then followed up for a 12-week maintenance phase. Efficacy was assessed by change in mean monthly migraine attack frequency from baseline. Additional assessments included responder rates, mean number of migraine days and global impression by a seven-point improvement scale. RESULTS: Mean monthly migraine attacks decreased significantly from baseline (from 5.2 +/- 2.6 to 2.1 +/- 2.2; p < 0.0001). Sixty-nine percent of patients were considered responders and mean reduction rate in migraine was 55.6 %. Topiramare was overall well tolerated. Twentyfive (28.4 %) patients stopped treatment due to adverse events. The most common adverse events were paresthesia, weight loss and cognitive effects. Some grade of satisfaction was reported by 55 % of patients at the end of the study. CONCLUSION: This naturalistic study confirms clinical trial data that 100 mg/day is an effective target dose for patients with migraine and presents the possible beneficial effect in transformed migraine.

[Economic evaluation of acute migraine attack treatment with triptans in Spain]. / Evaluación económica del tratamiento de la crisis aguda de migraña con triptanes en España.

OBJECTIVE: To perform an economic evaluation of migraine attack treatment comparing standard doses of existing triptans in 2003, and using different outcome measurements of anti-migraine effectiveness. METHODS: A cost-effectiveness analysis was performed from the National Health System perspective, using 2003 prices, comparing almotriptan 12.5 mg, eletriptan 40 mg, naratriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 50 mg, sumatriptan 100 mg, zolmitriptan 2.5 mg and zolmitriptan 5 mg. Effectiveness measurements were obtained from an efficacy meta-analysis of published clinical trials, and they consisted of therapeutic gain (crude effect of triptan after placebo effect subtraction) for 2 h--anti-migraine response, pain free at 2 h, and 24 h--sustained pain free. Rescue medication use and 24 h-attack relapse rates were assessed. RESULTS: Thirty-eight clinical trials (19,872 patients) were used to assess triptans effectiveness. Eletriptan 40 mg and rizatriptan 10 mg showed the highest 24 h-sustained pain free response (20.2 % in both cases), pain-free at 2 h (27.7 % and 32.2 %) and antimigraine response at 2 h (38.6 % and 31.3 %), respectively. Less rescue medication was used with eletriptan 40 mg and sumatriptan 50 mg (21 % and 20 %), and the lowest 24 h-relapse rates were observed with eletriptan 40 mg and naratriptan 2.5 mg (27 % and 21 %). Eletriptan 40 mg and sumatriptan 50 mg showed the lowest costs per successfully treated attacks with 2 h--anti-migraine response (16.50 and 17.44e) and with 24 h--sustained pain free (31.47 and 33.61e), while the lowest costs per attack that was pain free at 2 h were observed with rizatriptan 10 mg (21.36e) and eletriptan 40 mg (22.99e). CONCLUSIONS: Considering the cost-effectiveness measurements assessed, eletriptan 40 mg was the most costeffective triptan in the majority of economic analyses carried out.

[Cost effectiveness of treatment with triptanes in Spain]. / Coste eficacia del tratamiento con triptanes en España.

INTRODUCTION: Migraine is a very common disorder and frequent cause of consultation of the neurologist. The triptanes have been a great advance in the treatment of migraine attacks. At present it is the treatment of choice in severe attacks of migraine, but it is more expensive than the other drugs used for this. Taking into account the greater efficacy and the saving in direct and indirect costs which may be due to treatment with triptanes, its use may not only be effective but also efficient. OBJECTIVE: To analyze the cost effectiveness of the triptanes sold in Spain (sumatriptan, naratriptan, zolmitriptan, rizatriptan, almotriptan). MATERIAL AND METHODS: We analyzed the efficacy, therapeutic gain and number of different triptanes needed for treatment. We evaluated the cost of multiplying the result of the number needing treatment by the price of each unit of the drug. The results are expressed in pesetas and in euros. RESULTS: Rizatriptan gave the best results and was the cheapest triptan, followed by sumatriptan and zolmitriptan. When criteria of efficacy were used, naratriptan was the most expensive triptan, in spite of being the cheapest per unit. CONCLUSIONS: In chronic, recurrent disorders such as migraine, when the cost of treatment using triptans is assessed, one has not only to evaluate the cost per unit but also to introduce other parameters such as the efficacy of the drug, which is one of the most important.

[The importance of headaches in neurology clinics. Study groups of neurologists of Aragon]. / Importancia de las cefaleas en las consultas de neurología. Grupo de estudio de Neurólogos Aragoneses.

OBJECTIVE: To analyze the patients sent to Neurology Clinics for headache and to investigate the differences in epidemiology, clinical findings and therapeutics as compared with those consulting for other neurological disorders. PATIENTS AND METHODS: Eighteen neurologists from all the Outpatient Departments of the Community of Aragon Health Service were analysed using a specially designed questionnaire for all the patients who attended the Neurology Clinics for the first time during a period of three months. RESULTS: Of 3,489 patients assessed, 25.5% complained of headache. Of these, 70% were women of an average age of 41.2 +/- 18.8 years. In 42% the consultation was for migraine followed by chronic tension headache in 30.1%. Family doctors sent 86.7% of the patients and requested complementary tests for 31.1%. Cerebral TAC (12.4%) and EEG (7.6%) were the investigations most often requested. Treatment was given to 68.6% of the patients with headache. Calcium-antagonists and anti-depressants were the drugs most used. CONCLUSIONS: Headache is the commonest cause for consulting a neurologist. It affects young adults, with marked predominance of the female sex. There are significative differences in clinical attention (fewer complementary tests are requested and less follow-up is necessary, although more treatment is given) than for other neurology patients.

[Burden and management differences between migraine with and without aura in neurology clinics]. / Impacto y diferencias asistenciales de la migraña con o sin aura en las consultas de neurología.

BACKGROUND: Migraine is one of the most important reason of neurological consultation in Spain. OBJECTIVE: The aim of the present study was to analyse the profile of the patient with migraine and investigate epidemiological, clinical and therapeutical differences between migraine with aura o without aura. PATIENTS AND METHOD: For three consecutive months all patients attending for the first time the Neurology clinics of the Health Service of Aragón, were given a specially designed questionnaire. RESULTS: 374 patients who met migraine diagnostic criteria were included. They were 10.7% of the all patients. The majority of the patients were women (70%). Patients with migraine without aura were 299 (79.9%). The average age was 33.6 +/- 15.1. The family doctor referred 87% of the patients. Further investigations were requested in 20% of the patients with migraine without aura and 49.3% with aura. Cerebral CT was performed in 5.6% of migraine without aura and in 38.6% of migraine with aura patients, MR in 0.6% of migraine without aura and in 6.6% of migraine with aura patients. Treatment was given to 73% of the migraine patients attending for the first time. Calcium antagonists (45.3%) were the most common used drugs. CONCLUSIONS: Migraine generates a considerable demand for neurological consultations. There are significant differences in investigations requested, treatments and follow-ups of patients with migraine with o without aura.

[Basilar artery rostral occlusion syndrome. Clinico-radiological assessment of 56 patients]. / Síndrome por oclusión rostral de la arteria basilar. Valoración clinicorradiológica de 56 pacientes.

We studied 56 patients, 30 women and 26 men ranging from 30 to 79 years of age (average age 64.5 +/- 10.4), who were admitted to our hospital between 1982 and August 1995 with clinical features compatible with occlusion at the level of the bifurcation of the basilar artery. The patients were selected following clinical and neuro-radiological criteria. All patients included in the study had two or more recent infarcts in the vertebro-basilar territory, related to involvement of the rostral region of the basilar artery. The diagnosis was confirmed by CT or MR scanning. The infarcts were in the thalamus, brain-stem, cerebellum and parieto-occipital lobe. A thalamic infarct associated with an infarct in another region was the most frequent lesion. The CT-MR findings in the 56 cases were: 29 patients presented with a unilateral thalamic infarct associated with another infarct (23 occipital, 8 parietal, 6 brain-stem and 2 cerebellum). There were eight patients with bilateral thalamic infarcts and seven with bilateral occipital infarcts. In six patients the occipital infarct was associated with another infarct at a different level (parietal or cerebellar) and six patients had cerebellar infarcts together with an infarct of the mid-brain. In 22 of the patients, lesions were found in three or more areas. The commonest clinical findings were: Motor deficit (69.6%), abnormal eye movements (44.5%), cerebellar dysfunction (42.8%), altered level of consciousness (32.1%), visual field defects (28.5%), pupil anomalies (19.6%). The most frequently associated risk factors were: Arterial hypertension (58.9%), a history of ACV (32.1%) and atrial fibrillation (21.4%). Mortality was 5.7%. In contrast to the classical descriptions, motor defecit was the commonest symptom in our series.

[Multicenter transverse study of the neurological ambulatory care in the Spanish Health System in Aragon: overall results]. / Estudio transversal multicéntrico de las consultas externas de Neurología de la Seguridad Social en Aragón. Resultados globales. Grupo de Estudio de Neurólogos Aragoneses.

OBJECTIVE: To evaluate clinical, diagnostic and therapeutic aspects and how the Neurology Outpatient Departments of Aragon work in practice. MATERIAL AND METHODS: For three consecutive months all patients attending the Neurology Outpatient Departments of the Health Areas of the Health Service of Aragón for the first time were given a specially designed questionnaire. RESULTS: The majority of the patients were women (57%). The average age was 51.5 +/- 20.6 years. The family doctor referred 79.5% of the patients. The average waiting time for patients to be seen was 12.4 +/- 10.7 days. Further investigations were requested in 48.9% of the patients (cerebral CT in 18.1%, MR in 2.6%, EEG in 12% and ENG-EMG in 6.8%). The commonest diagnoses were headache (25.5%), cerebrovascular pathology (12.5%), extrapyramidal pathology (7.5%), syncope (6.5%), convulsions (6%), vertigo (5.9%), psychiatric disorders (5%), non-neurological disorders (4.4%). No treatment was given to 15.64% of the patients attending for the first time. The commonest drugs used were: calcium antagonists (32.5%), platelet antiaggregants (20.9%), antidepressives (17%), antiepileptic drugs (15.6%) and NSAIDS (5.3%). CONCLUSIONS: There is a considerable demand for neurological consultations and there are few neurologists in proportion to the population. Better selection of the patients sent for consultation and a better understanding by family doctors of the commoner neurological disorders would considerably reduce the number of patients sent to the Outpatient Department.

[A descriptive epidemiological study of a neurological outpatient clinic]. / Estudio epidemiológico descriptivo de una consulta externa de Neurología.

OBJECTIVE: To evaluate the clinical, diagnostic, therapeutic and functional aspects of a Neurology Outpatient Clinic. MATERIAL AND METHOD: An epidemiological survey was made of 552 neurology patients first seen in the Neurology Outpatient Clinic during a three month period. RESULTS: There was a predominance of women (57.6%). The average age was 45.1 years in both sexes. 84.7% of the patients were sent by their family doctor. There was an average wait of nine days. Complementary investigations were asked for in 56% of the patients (cerebral CT scan in 13.7%, MR in 5%, EEG in 21%, ENG-EMG in 5.7%). The diagnostic groups were headache 30%, followed by vascular pathology (11.7%); psychiatric, syncopes, extrapyramidal syndromes, epilepsy and vertigo each made up 6-7% of the total. 53% of patients attending for the first time received no treatment. The most commonly used drugs were: calcium antagonists (20%), antidepressives (15%), antiepileptics (10%), platelet antiaggregants (8.4%), anti-Parkinson drugs (7.3%) and beta-blockers (4.6%). CONCLUSIONS: Since there is a great demand for neurological attention (as with other specialties) more neurologists are required. Headache was the commonest reason for consultation. Improved selection of the patients, particularly the psychiatric patients and those with psychosomatic pathology, would considerably reduce the number of patients seen.