Present and Future of Parkinson's Disease in Spain: PARKINSON-2030 Delphi Project.

Parkinson's disease (PD) is a chronic progressive and irreversible disease and the second most common neurodegenerative disease worldwide. In Spain, it affects around 120.000-150.000 individuals, and its prevalence is estimated to increase in the future. PD has a great impact on patients' and caregivers' lives and also entails a substantial socioeconomic burden. The aim of the present study was to examine the current situation and the 10-year PD forecast for Spain in order to optimize and design future management strategies. This study was performed using the modified Delphi method to try to obtain a consensus among a panel of movement disorders experts. According to the panel, future PD management will improve diagnostic capacity and follow-up, it will include multidisciplinary teams, and innovative treatments will be developed. The expansion of new technologies and studies on biomarkers will have an impact on future PD management, leading to more accurate diagnoses, prognoses, and individualized therapies. However, the socio-economic impact of the disease will continue to be significant by 2030, especially for patients in advanced stages. This study highlighted the unmet needs in diagnosis and treatment and how crucial it is to establish recommendations for future diagnostic and therapeutic management of PD.

Management of Patients With Unclassified Epileptic Seizures in Outpatient Clinics in Spain. Results of the RETO Study.

PURPOSE: The objective of this study was to determine the approach and management of specialists in patients with unclassified epileptic seizures in outpatient clinics in Spain. METHODS: Observational, multicenter, and cross-sectional study. Ninety-three neurologists or neuropediatricians documented consecutive patients with a history of at least two difficult to classify or unclassified epileptic seizures. Patient demographics, quality of life (QOLIE-10-P), disease characteristics, and anticonvulsant treatment were captured. Physicians were asked about their therapeutic approach for the selection of an antiepileptic drug and underlying reasons. RESULTS: A total of 725 patients were included. At the time of the survey, 81% were treated (69% with monotherapy). Most frequently given reasons for starting antiepileptic therapy were ([mean] on a scale of 1­5) efficacy, (3.9), safety (3.61), and broad-spectrum effectiveness (3.5). Reasons given for switching therapy (226/725) included need for broader spectrum of action: 70 (31.0%); simpler dosing regimen: 25 (11.1%); quality of life considerations: 24 (10.6%); lack of adherence to therapy: 24 (10.6%); comorbidities: 13 (5.8%); drug interactions: 12 (5.3%); and possibility of pregnancy 6 (2.7%). CONCLUSIONS: When deciding on starting or switching therapy for patients with difficult to classify or unclassified epilepsy, the most important consideration for the specialists included efficacy, safety, and broad-spectrum efficacy.

Epidemiological study of mortality in epilepsy in a Spanish population.

PURPOSE: Studies concerning mortality in epilepsy have been performed primarily in Northern-Central Europe and US. The aim of this study was to provide information about mortality in people with epilepsy in Southern European countries. METHOD: We studied a Spanish prevalence and incidence cohort of 2309 patients aged ≥14 years with epilepsy who were treated in an outpatient epilepsy clinic between 2000 and 2013. The deceased were identified through Civil Registries. Causes of death were determined using death certificates, forensic autopsies, hospital reports, family practitioners, and care-givers' records. Standardised mortality ratios (SMRs) were calculated. RESULTS: In a total of 15,865 person-years of follow-up, 152 patients died, resulting in an SMR of 2.11 (95% CI 1.79-2.47), which was higher for those aged 14-24. There was also a high rate of death for symptomatic epilepsies, progressive causes (SMR=6.12, CI 3.50-9.94), and remote causes (SMR=2.62, CI 2.12-3.21). High SMRs were found for all kinds of epilepsy and for respiratory and tumoural causes. Patients who died of epilepsy itself were 12.5%. Sudden unexpected death in epilepsy incidence was 0.44:1000. Death from status epilepticus incidence was 20:100,000. SMRs for external causes were of no statistical significance. CONCLUSIONS: This is the first epidemiological study to examine rate of mortality in epilepsy in a Southern European country. The identified mortality pattern is similar to the one provided by researchers from developed countries. The similarities between our results concerning epilepsy-related deaths and those provided by population-based studies are the result of the scarcely selected character of our study cohort.

[Healthcare management of an epilepsy clinic: factors involved in the demand for health care and clinical situation of patients]. / Gestion sanitaria de una consulta de epilepsia: factores implicados en la demanda asistencial y situacion clinica de los pacientes.

INTRODUCTION: Epilepsy is a chronic illness that requires a long-term periodic follow-up of the patient and this means that as time goes by the number of patients attended increases, with the ensuing added cost for the healthcare system. AIM: To determine the factors involved in the time until an epileptic patient's next visit. PATIENTS AND METHODS: Our sample consisted of a selection of patients who visited the epilepsy clinic at our hospital consecutively during one year. Their clinical situation and relationship with the medical advice they were given, together with the factors involved in the time elapsed until the next visit, were analysed by means of predictive econometric models. RESULTS: There is a clear association between the patient's clinical situation and the modification of the treatment proposed by the neurologist in the previous visit. The factors involved in the time until the next visit were the frequency of seizures, adverse side effects from medicines -above all those that affect cognition- and the medical advice given to the patient. Polytherapy, psychoaffective disorders or the patient's social situation were not found to be significant. CONCLUSIONS: Follow-up visits in a specific epilepsy clinic improves the patient's situation. This is the first analysis of the demand for healthcare in patients with epilepsy conducted by means of econometric methods and from a mixed physician-patient perspective. Since the factors that determine the time until the next visit can be modified, the number of visits per year could be reduced, thus improving patients' clinical situation. We suggest a greater amount of time should be spent per visit so as to be able to have a bearing on it and thereby cut costs in the long term.

TITLE: Gestion sanitaria de una consulta de epilepsia: factores implicados en la demanda asistencial y situacion clinica de los pacientes.Introduccion. La epilepsia es una enfermedad cronica que implica un seguimiento periodico del paciente a largo plazo, lo que supone un aumento del numero de pacientes visitados con el tiempo y, por tanto, un coste al sistema sanitario. Objetivo. Determinar los factores implicados en el tiempo para la siguiente visita de un paciente epileptico. Pacientes y metodos. Seleccion de pacientes durante un ano que acuden consecutivamente a consulta de epilepsia de nuestro hospital. Se analiza su situacion clinica y relacion con el consejo medico dado, y los factores implicados en el tiempo transcurrido hasta la siguiente visita mediante modelos econometricos predictivos. Resultados. Existe una clara asociacion entre la situacion clinica del paciente y la modificacion del tratamiento propuesta por el neurologo en la visita anterior. Los factores implicados en el tiempo hasta la siguiente visita fueron frecuencia de crisis, efectos adversos medicamentosos, sobre todo los que afectan a la cognicion, y consejo medico al paciente. No resultaron significativos la politerapia, los trastornos psicoafectivos ni la situacion social del paciente. Conclusiones. El seguimiento en una consulta especifica de epilepsia mejora la situacion del paciente. Se trata del primer analisis de demanda asistencial en pacientes con epilepsia realizado mediante metodos econometricos y desde una perspectiva mixta medico-paciente. Dado que los factores que determinan el tiempo para la siguiente visita son modificables, podria disminuir el numero de visitas al ano, mejorando la situacion clinica de los pacientes. Proponemos una mayor duracion por visita para poder incidir en ello y reducir costes a largo plazo.

Prevalence and clinical characteristics of epilepsy in the South of Spain.

PURPOSE: Epilepsy is a common neurological disorder found in all societies. There are extensive epidemiologic studies of different European areas. However, not much information about the South-West of Europe exists. In Málaga, Health Care is free and there are only two public hospitals with Neurological Services that assist Eastern or Western areas depending on the case. The purpose is to estimate the epidemiology in Málaga through a hospital-based study and compare it to the other European studies. METHODS: Review on the hospital data base and gathering of consecutive patients with a diagnosis of active epilepsy served by the Epilepsy outpatient clinic in Virgen de la Victoria Hospital throughout a year. RESULTS: 2 281 patients fulfilled the criteria and 515 patients were recruited in order to study the epidemiologic characteristics. Male gender and focal onset seizures predominate (75.5%). Medium age 40. 58% of patients have been seizure-free in the last year. Known etiology in half of the patients. 54% of patients are treated with monotherapy. Valproic acid is the commonest drug. Other epidemiologic and demographic important data are provided. Data are analysed and compared to other European studies. CONCLUSIONS: Prevalence rate in Western Málaga is 4.79 cases/1000 inhabitants. Characteristics of the sample are similar to those of other European studies. Although this is a hospital-based study, the particular characteristics of the Health Care System in our region enable us to gather real data concerning epidemiology and prevalence.

[Does Jeavons syndrome exist? A report of a series of 10 cases]. / Existe el síndrome de Jeavons? Aportación de una serie de 10 casos.

INTRODUCTION: Jeavons syndrome (JS) or eyelid myoclonia (EM) with or without absences is an epileptic syndrome characterised by EM on closing the eyes, in bright environments, which coincides on the electroencephalogram with brief generalised polyspike and polyspike-wave discharges at 3-6 Hz. Photoparoxysmal response is associated in photostimulation. The ILAE recognises EM as a special type of myoclonic seizures, yet it still does not include JS as a separate condition in its classification of epileptic syndromes. AIM: The aim of this article is to report on a series of 10 cases, with special attention given to their clinical-electro-encephalo-graphic description. We believe it is a condition that is not infrequent, but one which is underdiagnosed. Moreover, we also want to highlight the pros and cons determining the fact that today there is still controversy about whether or not it should be recognised as an independent epileptic syndrome. PATIENTS AND METHODS: We conducted a retrospective study of 10 cases collected over the period between 2002 and 2009 in our adult Epilepsy Unit. RESULTS: All our patients fulfilled JS criteria. There is a predominance of females (n = 8), with the existence of cases of idiopathic generalised epilepsy in the family (n = 5), which are associated with clonic-tonic generalised seizures in nearly all of them (n = 9) and are well controlled with treatment in monotherapy, although the EM persist in three cases. The results of a neurological exploration and neuroimaging are normal in all cases. CONCLUSIONS: JS is a photosensitive epilepsy that is not easily confused with other conditions; nevertheless, there can be an overlap with other idiopathic generalised epilepsy syndromes that lead to their being underdiagnosed. Genetics and functional neuroimaging will determine whether it is an independent condition or not.