Eyelid myokymia in patients with migraine taking topiramate.

OBJECTIVE: Although ocular side effects of topiramate are common, neuroophthalmologic manifestations such as blepharospasm, myokymia and oculogyric crisis are scarcely reported. METHODS: We present a serie of 8 patients with migraine who developed eyelid myokymia after treatment with topiramate. We reviewed all patients with migraine treated with topiramate attending the headache outpatient clinic of our hospital from January 2008 to December 2012. RESULTS: During the study period, a total of 140 patients with migraine were treated with topiramate in our headache clinic. Eight presented eyelid myokymia after beginning treatment with topiramate (5,7%). Topiramate was stopped and myokymia disappeared in all patients, it was prescribed again and eyelid myokymia reappeared with their previous characteristics in all patients. CONCLUSIONS: Eyelid myokymia is an underreported side-effect of topiramate in patients with migraine, of unknown cause, so that in future, further studies are need to examine whether patients with migraine are predisposed or not to this adverse effect.

[Ambulatory neurological care in a prison population]. / Atencion neurologica ambulatoria a una poblacion penitenciaria.

AIMS: Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim of this study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. PATIENTS AND METHODS: We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved the following variables: age, sex, personal history, reason for visiting and diagnosis. RESULTS: A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequent reason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation). CONCLUSIONS: No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy.

[Retinopathy secondary to treatment with Interferon beta-1a in a patient with multiple sclerosis]. / Retinopatía secundaria a tratamiento con interferón beta 1a en paciente con esclerosis múltiple.

INTRODUCTION: Although visual symptoms of multiple sclerosis (MS) are very frequent, they are rarely related with treatment with interferon. This is the first case reported in the literature of retinopathy associated with subcutaneous interferon beta-1a, and the second related to interferons in MS. CASE REPORT: A 30-year-old female diagnosed with relapsing-remitting MS who, at 3 months after starting treatment with subcutaneous interferon beta-1a (44 microg/3 times a week), displayed visual disorders. Retinal lesions in the form of cotton wool spots were found as symptoms of microinfarctions in the retina. The lesions got better after stopping treatment and the patient was found to be asymptomatic. CONCLUSIONS: The existence of retinopathy secondary to interferon has been known in the treatment of hepatitis C and neoplasias with interferon alfa since 1990. Despite being a frequently occurring complication, it is usually a mild condition and disappears on withdrawing treatment, or even if it is continued. It is attributed to deposits of immunocomplexes and complement activation in the blood vessels of the retina. Only one other case associated to treatment of MS with interferon beta has been reported in the literature, more specifically related to subcutaneous interferon beta-1b. The clinical characteristics of both cases are identical to those associated to interferon alfa. Despite the fact that the frequency of appearance seems to be lower than in the case of interferon alfa, the physician must bear in mind the possibility encountering this complication.

[Ischemic stroke as a presentation of essential thrombocythemia. Four case reports]. / Ictus isquémico como forma de presentación de trombocitemia esencial. A propósito de cuatro casos.

INTRODUCTION: Essential thrombocythemia (ET) is a myelodysplastic syndrome that constitutes an infrequent cause of ischemic stroke. Few clinical reports have been published describing the clinical onset of ET in the form of a vascular accident. CASE REPORT: We describe four cases of patients with no known haematological pathology who began with an ischemic stroke and were later diagnosed as suffering from ET, following an aetiological investigation. The patients were all young, under 45 years of age, with no significant vascular risk factors, who presented a clinical picture of ischemic stroke and platelet counts above normal values, although in two cases they were below 600 x 10(9)/L. As they progressed, their platelet counts were constantly above this threshold and a diagnosis of ET was reached. CONCLUSIONS: Although ET is an infrequent cause of ischemic stroke, it must be taken into account even in young patients and when platelet counts do not exceed 600 x 10(9)/L. Antiplatelet drug therapy must be indicated in all cases and the clinician must evaluate the suitability of cytoreductive therapy in patients with a high risk of thrombotic event recurrence, especially if platelet counts are above 600 x 10(9)/L.

[The value of acetylcholinesterase inhibitor therapy in the serious phases of Alzheimer's disease]. / Relevancia del tratamiento con inhibidores de la acetilcolinesterasa en las fases graves de la enfermedad de Alzheimer.

INTRODUCTION: The effectiveness of these drugs in the serious stages of the disease has still to be determined. No studies have been published which evaluate the possible influence of pharmacological therapy in patients in the serious stages of Alzheimer type dementia. AIMS: The aim of this study is to compare the progress of deterioration between patients in serious stages of the disease submitted to treatment with anticholinesterase drugs (ACD) and those who, for some reason, are not currently taking them. PATIENTS AND METHODS: A prospective study involving the observation of 20 patients who were diagnosed as suffering from Alzheimer s disease (AD) and who presented serious and/or very serious deterioration. A basal evaluation and a five month follow up were conducted. Three scales, which the patients caregivers filled out by means of an interview, were employed: the Katz index, the Holden communication scale and the Clifton behaviour assessment scale. RESULTS: No statistically significant differences were found between the scores obtained by patients receiving ACD therapy and those who were not on any of the scales used which proved the value of these drugs in the most serious phases of the disease. CONCLUSIONS: Acetylcholinesterase blocking drugs have not proved to be effective in the serious phases of AD. The lack of data based on solid evidence means that we have little idea of the parameters involved in making a decision about whether to interrupt or to continue the treatment in these phases.

[Olfactory seizures and parasellar meningioma]. / Crisis olfatoria y meningioma paraselar.

INTRODUCTION: Partial olfactory seizures are infrequent. They are related to the presence of lesions in the uncinate area of the temporal lobe. Patients describe smells during the ictal phase that are generally unpleasant. We report the cases of two patients with olfactory disorders of a paroxysmal nature caused by a parasellar meningioma. CASE REPORTS: Case 1: a 43 year old male who presented paroxysmal episodes in which he perceived a bitter smell, with dysphoria, linked to the presence of a left side parasellar meningioma. Case 2: a 45 year old female who presented paroxysmal episodes during which she could smell formaldehyde and this was linked to the presence of a left side parasellar meningioma. DISCUSSION: Olfactory seizures are related to structural alterations to the amygdala. The most frequent causes are associated to the presence of mesial temporal sclerosis and, above all, to tumours situated in the temporomesial structures that have diverse aetiologies.