Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: Experience from a national multicenter registry.

OBJECTIVE: To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic-clonic seizures (GTCS). METHODS: This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure-free rate after 3, 6, and 12 months and tolerability throughout the follow-up. RESULTS: A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of 14 months (range = 1-57) with a median dose of 4 mg (range = 2-10). The retention rates at 3, 6, and 12 months and last follow-up were 93.8%, 89.3%, 80.9%, and 71.4%, respectively. The retention rates according to the type of monotherapy (primary vs conversion) did not differ (log-rank P value = .57). Among the 98 patients, 61.2% patients had seizures throughout the baseline period, with a median seizure frequency of 0.6 seizures per month (range = 0.3-26). Responder rates at 3, 6, and 12 months were 79.6%, 70.1%, and 52.8%, respectively, and seizure freedom rates at the same points were 62.7%, 56.1%, and 41.5%. Regarding the 33 patients who had GTCS in the baseline period, 87.8% were seizure-free at 3 months, 78.1% at 6 months, and 55.1% at 12 months. Over the entire follow-up, PER monotherapy was generally well tolerated, and only 16% of patients discontinued PER due to adverse events (AEs). Female patients were found to be at a higher risk of psychiatric AEs (female vs male odds ratio = 2.85, 95% confidence interval = 1-8.33, P = .046). SIGNIFICANCE: PER demonstrated good effectiveness and a good safety profile when used as primary therapy or conversion to monotherapy at relatively low doses, in a clinical setting with patients with focal seizures and GTCS.

Electroconvusive therapy in dementia.

The use of electroconvulsive therapy (ECT) in the clinical practice in patients with dementia syndromes continues to cause controversy. In this case, the clinical difficulty existing when making a differential diagnosis between depressive episodes and incipient dementia picture is presented. The interrelation between these two pictures and the possible common etiological origin are also evaluated. Electroconvulsive therapy is effective and safe in functional improvement in affective and dementia disorders in elderly patients.

Remedies for headaches in a closet for ladies and gentlewomen (1608).

Seventeenth-century English closets were books containing a wide repertoire of household supplies targeted at female readers. Such volumes typically included medical recipes, as early modern women also used to be responsible for preserving and restoring the health of relatives and close neighbors. A Closet for Ladies and Gentlewomen (Sir Hugh Platt, 1608), in particular, incorporates 13 medicinal remedies devised for the therapeutic management of 3 different types of headaches: head-ache, migraine and pain in the head. This article historically contextualizes the text, offers a valid classification of headaches in 17th-century England, and describes the composition of the homemade pharmaceutical forms recommended to female caregivers, the guidelines for administration and its potential pain-relieving effects.

[Risk factors, etiology and prognosis in patients older than 80 years old with ischemic stroke]. / Factores de riesgo, etiología y pronóstico en pacientes mayores de 80 años con accidente cerebrovascular.

INTRODUCTION: The aim of this study was to analyze differences between patients aged 80 years or less and those aged more than 80 years old a hospital series of ischemic stroke. MATERIAL AND METHODS: We performed a retrospective review of all patients with ischemic stroke or transient ischemic attack requiring admission to the Neurology Service of the Dr. Negrín University Hospital of Gran Canaria (Spain) between January 1, 2004 and December 31, 2006. Data were gathered on hypertension, diabetes mellitus (DM), hyperlipidemia, ischemic cardiopathy (IC), atrial fibrillation (AF), the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, as well as the National Institutes of Health (NIH) scale and the modified Rankin scale (mRS) at discharge. RESULTS: A total of 850 patients were included. Age was >80 years in 106 (12.4%) and was <80 years in 744 (87.6%). In the group aged>80 years, 43.4% were men and 56.6% were women (64.1% men and 35.9% women in the group aged<80 years). Hypertension was present in 81.1% of patients aged>80 years (68.1% in those aged<80 years); previous DM was found in 29.2% (39.3% in the group aged<80 years); hyperlipidemia was present in 26.4% (40.2% in the group aged<80); IC was found in 16.9% (15.8% in the group aged<80); AF was found in 40% (20.9% in the group aged<80 years). In the group of patients aged>80 years, 23.6% had atherothrombotic stroke (19.3% in those aged<80 years); 38.7% were cardioembolic (19.3% in the group aged<80 years); 10.4% were lacunar (22.6% in the group aged<80 years); and 24.5% was of undetermined origin (28.6% in the group aged<80 years). The mRS at discharge was 80 years. CONCLUSIONS: Ischemic stroke in patients over 80 years old leads to certain differences in relation to risk factors, stroke etiology and stroke severity.

Jacques Guillemeau's 16th-century account of ophthalmoplegia.

In 1585, the renowned French royal surgeon Jacques Guillemeau published his Traité des maladies de l'oeil. The book is divided into 9 unequal sections devoted to the description of eye anatomy and ophthalmological diseases including muscle, membrane, and humor disorders; optic nerve damage; and eyelid affections. Section 3, in particular, focuses on a form of ophthalmoplegia involving progressive paralysis of extraocular muscles. Here we describe and discuss Guillemeau's theoretical framework and practical approach to this ophthalmological disorder. To determine whether this physician was possibly influenced by the thought of antique and contemporary learned men, we reviewed some fundamental ideas on cranial nerves and their paralysis as presented by authors such as Herophilus of Chalcedon, Erasistratus of Ceos, Claudius Galen, Andreas Vesalius, and Leonhard Fuchs.

[Thrombosis of the cerebral venous sinuses in the differential diagnosis of idiopathic intracranial hypertension in young obese females: is it a real problem?]. / Trombosis de senos venosos cerebrales en el diagnostico diferencial de la hipertension intracraneal idiopatica en mujeres jovenes obesas: un problema real?

INTRODUCTION: Idiopathic intracranial hypertension (IICH) typically presents in young women with obesity or a recent weight increase. The differential diagnosis of IICH includes thrombosis of the cerebral venous sinuses (TCVS), which can also present as an isolated intracranial hypertension syndrome. We review the frequency with which patients with a typical IICH profile presented TCVS as their diagnosis. PATIENTS AND METHODS: The study consisted in a retrospective review of all the admissions due to intracranial hypertension syndromes in our centre between 2000 and 2011. The cases selected were those with a normal cerebrospinal fluid study and computerised axial tomography scan of the head that presented as an isolated intracranial hypertension syndrome; those who manifested a focal neurological picture, however, were excluded. From the patients that were included, a subgroup made up of females between 16 and 35 years of age with a body mass index of above 25 were selected. RESULTS: A total of 37 cases were obtained. Of these, 35 (94.6%) were cases of IICH and two (5.4%) were TCVS. The time elapsed between the onset of symptoms and diagnosis was less than seven days in both cases of TCVS (100%) and in two cases (5.4%) of IICH. CONCLUSIONS: Up to 5.4% of patients with a typical IICH profile that present with an intracranial hypertension syndrome can present TCVS. The presence of prothrombotic factors and a high D-dimer can suggest this possibility, although there is still a need for well-established parameters that allow decisions to be made in emergencies in the absence of any chance of performing an urgent MR phlebography scan.

[Description of the follow-up protocol for idiopathic intracranial hypertension in the neuro-ophthalmological unit of a tertiary hospital]. / Descripcion del protocolo de seguimiento para la hipertension intracraneal idiopatica en una unidad de neurooftalmologia de un hospital terciario.

AIM: To review the results of implementing a protocol for following up patients with idiopathic intracranial hypertension (IICH) in a neuro-ophthalmological unit (NOU). PATIENTS AND METHODS: A review of the literature was conducted in order to determine the examinations that needed to be included in the follow-up protocol, as well as the optimum frequency of visits and the most adequate duration of the follow-up. Later, a prospective review was performed of the patients that have been included since the NOU was set up and they were compared with the patients included in the IICH register prior to the creation of the NOU. RESULTS: Since the protocol was implemented, visual acuity and the visual field have been evaluated in 100% of patients at three months, at six months and at one year after diagnosis. Moreover, the visual field was examined at three months, at six months and at one year after diagnosis in 91%, 72.8% and 100% of patients with IICH, respectively. Before our follow-up protocol was implemented, 190 had been carried out, which is roughly three per patient. Eleven lumbar punctures have been performed since the NOU was set up. CONCLUSIONS: The creation of a multidisciplinary NOU makes it possible to optimise resources and improve the care given to patients with IICH. This should result in an improvement in the functional prognosis of these patients.

TITLE: Descripcion del protocolo de seguimiento para la hipertension intracraneal idiopatica en una unidad de neurooftalmologia de un hospital terciario.Objetivo. Revisar los resultados de la implantacion de un protocolo de seguimiento de pacientes con hipertension intracraneal idiopatica (HICI) en una unidad de neurooftalmologia (UNO). Pacientes y metodos. Se realizo una revision bibliografica para determinar las exploraciones necesarias que debian incluirse en el protocolo de seguimiento, asi como la frecuencia optima de las visitas y la duracion adecuada del seguimiento. Posteriormente, se revisaron de forma prospectiva los pacientes incluidos desde la creacion de la UNO y se compararon con los pacientes incluidos en el registro de HICI previo a la creacion de la UNO. Resultados. Desde la implantacion del protocolo, en el 100% de los pacientes se ha valorado la agudeza visual y la campimetria visual a los tres meses, a los seis meses y al ano del diagnostico. Ademas, en un 91%, 72,8% y 100% de los pacientes con HICI se realizo una campimetria visual a los tres meses, a los seis meses y al ano del diagnostico, respectivamente. Antes de la implantacion de nuestro protocolo de seguimiento, se habian realizado 190, lo que corresponde a unas tres por paciente. El numero de punciones lumbares realizadas desde la creacion de la UNO es de 11. Conclusiones. La creacion de una UNO multidisciplinar permite optimizar los recursos y mejorar la asistencia a los pacientes con HICI. Esto deberia redundar en una mejoria del pronostico funcional de estos pacientes.

Plexopatía braquial secundaria a tumor maligno de la vaina del nervio periférico / Brachial plexopathy secondary a malignant tumor of the peripheral nerve sheath

Introducción: el plexo braquial puede verse afectado por patología neoplásica tanto primaria como secundaria. Los tumores primarios del plexo braquial son entidades poco frecuentes, aunque algunos, como el tumor maligno de la vaina del nervio periférico pueden tener un comportamiento agresivo. Caso clínico: se presenta una mujer de 31 años con disestesias y debilidad progresiva en el miembro superior izquierdo. El estudio neurofisiológico mostró afectación del plexo braquial izquierdo. En la resonancia magnética se observó una masa de tejido blando que invadía el plexo braquial. El estudio histológico fue compatible con un tumor maligno de la vaina del nervio periférico. Conclusiones: el tumor maligno de la vaina del nervio periférico es un tumor altamente agresivo que puede aparecer en pacientes sin datos clínicos de neurofibromatosis tipo 1. Debe mantenerse un elevado nivel de sospecha con el objetivo de no retrasar el diagnóstico para así poder realizar un tratamiento lo más conservador posible.

Introduction. Malignant peripheral nerve sheath tumor (MPNST) are sarcomas that are rarely located in the upper limb. Clinical case. We present a 31- year-old woman with progressive dysesthesia and weakness of the left upper limb. The neurophysiological study showed damage in the left brachial plexus. A soft tissue mass that was invading the plexus was observed in the magnetic resonance image. The anatomopathological study was compatible with MPNST diagnosis. Conclusions. Intrinsic tumors of the brachial plexus are uncommon. A MPNST is an extremely aggressive mesenchymal tumor that is seldom rooted in the brachial plexus.

Tratamiento combinado con antitrombóticos en la prevención secundaria del ictus isquémico: [revisión] / Combined treatment with antithrombotics in secondary prevention of the isquemic stroke: [review]

El ictus isquémico constituye un problema sanitario de primer orden debido a su alto riesgo de recurrencia. La búsqueda de estrategias eficaces y seguras para la prevención de eventos vasculares en los pacientes con un ictus isquémico debe ser una prioridad, con el objetivo de disminuir la mortalidad y discapacidad asociada con el mismo. Diversos estudios han analizado el tratamiento combinado con antitrombóticos para intentar mejorar la eficacia de estos fármacos en la prevención secundaria de eventos vasculares tras un primer ictus isquémico. En este trabajo se revisa el estado actual de la evidencia científica en cuanto a la terapia combinada con antitrombóticos en pacientes con un primer ictus isquémico...

Ischemic stroke constitutes a fundamental health issue due to its high level of recurrence. Developing efficient and safe strategies to prevent vascular episodes in patients with ischemic stroke must be a top priority, with the purpose of diminishing associated mortality and disability. Several studies have examined combined antithrombotic therapy in depth, trying to improve its efficacy in secondary prevention of vascular events after a first ischemic stroke. This work reviews the current state of clinical evidence related to combined antithrombotic therapy in patients presenting a first ischemic stroke...