"The Triptan's Hangover": A Multicentric Cross-sectional Observational Study of the Adverse Events of Triptans in Patients With Migraine.

ABSTRACT: The emergence of triptans represented a breakthrough in the treatment of migraine, but in clinical practice, patients describe symptoms that resemble those of a hangover after taking them. We propose the use of the Hangover Symptoms Scale (HSS) to evaluate this syndrome in patients that take triptans, which may help identify patients at higher risk of presenting these adverse effects that may interfere with therapeutic compliance.A cross-sectional observational pilot study with prospective data collection through a clinical-demographic questionnaire and the HSS was carried out on patients with migraine treated in headache units in 3 tertiary hospitals in Madrid.Sixty-six patients were included in the study. The median HSS was 4 and all symptoms were present in at least 15% of the patients, with difficulty to concentrate being the most frequent (57.6%). No significant differences were found between the presence of a higher HSS score and the sociodemographic characteristics of the patient or his migraine. The presence of aura was associated with a higher percentage of trembling (P = 0.029) and fatigue (nonvisual, polymodal auras; P = 0.017).According to our study, triptans are responsible for a set of symptoms overlapping with those that occur during a hangover. Therefore, we propose that the HSS could be a useful tool for the evaluation and quantification of these effects in patients receiving triptans. In addition, we found that clinical features could be more frequently associated with the appearance of these adverse effects that, however, are not related to any particular patient profile.

Quality assurance in specialized headache units in Spain: an observational prospective study.

OBJECTIVE: To assess the quality of the therapeutic approach in Specialized Headache Units in Spain. METHODS: An observational (prospective) study was conducted. Anonymized data of 313 consecutive patients during a defined period of time were analyzed and a comparison of performance in 13 consensual quality indicators between Specialized Headache Units and neurology consultations was calculated. Specialized Units and neurology consultations represented the type of provision that Spaniards receive in hospitals. RESULTS: The consensus benchmark standard was reached for 8/13 (61%) indicators. Specialized Headache Units performed better in the indicators, specifically in relation to accessibility, equity, safety, and patient satisfaction. Patients attended in Specialized Headache Units had more complex conditions. CONCLUSION: Although there is variability among Specialized Headache Units, the overall quality was generally better than in traditional neurology consultations in Spain.

Efectividad de la lacosamida en el tratamiento del dolor neuropático refractario: estudio observacional abierto / Effectiveness of lacosamide in the treatment of refractory neuropathic pain: an open observational trial

Introducción. Aunque se dispone de diferentes tratamientos para el dolor neuropático, en muchas ocasiones estos pacientes son refractarios, lo que hace necesario probar tratamientos que, por su utilidad en otras patologías, podrían ser eficaces en el dolor neuropático. Pacientes y métodos. Se recogieron las historias clínicas de pacientes que hubieran sido tratados con lacosamida para el dolor neuropático, en diferentes hospitales de la zona centro peninsular, y que cumplieran unas características similares en cuanto a refractariedad a otros tratamientos estándares, en un seguimiento de al menos seis meses, o que hubiesen tenido que suspender el tratamiento con dicho fármaco por cualquier motivo. Se obtuvo una muestra de 114 pacientes, 61 varones y 53 mujeres, con una edad media de 60,5 años. Resultados. Las causas de dolor neuropático más frecuentes fueron: polineuropatía diabética (31,6%), neuralgia postherpética (22,8%), neuralgia del trigémino (17,5%), neuralgia suboccipital y lumbociatalgia (un 12,3% en ambas). La eficacia fue buena/muy buena en la mayoría de los pacientes, con un descenso medio en la escala analógica visual tras seis meses de 7,7 a 4,8. No se registraron efectos secundarios graves en ningún paciente, pero en 12 y 10 pacientes no hubo registro más allá de seis meses, por ineficacia e intolerancia al tratamiento, respectivamente. Conclusiones. El tratamiento con lacosamida en el dolor neuropático de diferentes causas podría considerarse como una alternativa efectiva y bien tolerada para aquellos pacientes que no respondan a los tratamientos estándares (AU)

Introduction. Although different treatments are available for neuropathic pain, these patients are often refractory, which makes it necessary to test treatments that, as they have proven useful in other pathologies, could be effective in neuropathic pain. Patients and methods. The study made use of the medical records of patients who had been treated with lacosamide for neuropathic pain in different hospitals in the central area of the peninsula and who fulfilled similar characteristics in terms of refractoriness to other standard treatments, in a follow-up that lasted at least six months, or who had had to stop treatment with that drug for some reason or another. A sample of 114 patients (61 males and 53 females) with a mean age of 60.5 years was obtained from the data. Results. The most common causes of neuropathic pain were: diabetic polyneuropathy (31.6%), post-herpes neuralgia (22.8%), trigeminal neuralgia (17.5%), suboccipital and lumbar-radicular neuralgia (both 12.3%). Effectiveness was good/ very good in most patients, with the mean score on the visual analogue scale after six months dropping from 7.7 to 4.8. No serious side effects were reported in any of the patients, but in 12 and 10 patients no recordings were made beyond six months, due to ineffectiveness and intolerance to the treatment, respectively. Conclusions. Treatment with lacosamide in neuropathic pain due to different causes could be considered an effective and well-tolerated alternative for patients who fail to respond to standard treatments (AU)

[Effectiveness of lacosamide in the treatment of refractory neuropathic pain: an open observational trial]. / Efectividad de la lacosamida en el tratamiento del dolor neuropatico refractario: estudio observacional abierto.

INTRODUCTION: Although different treatments are available for neuropathic pain, these patients are often refractory, which makes it necessary to test treatments that, as they have proven useful in other pathologies, could be effective in neuropathic pain. PATIENTS AND METHODS: The study made use of the medical records of patients who had been treated with lacosamide for neuropathic pain in different hospitals in the central area of the peninsula and who fulfilled similar characteristics in terms of refractoriness to other standard treatments, in a follow-up that lasted at least six months, or who had had to stop treatment with that drug for some reason or another. A sample of 114 patients (61 males and 53 females) with a mean age of 60.5 years was obtained from the data. RESULTS: The most common causes of neuropathic pain were: diabetic polyneuropathy (31.6%), post-herpes neuralgia (22.8%), trigeminal neuralgia (17.5%), suboccipital and lumbar-radicular neuralgia (both 12.3%). Effectiveness was good/very good in most patients, with the mean score on the visual analogue scale after six months dropping from 7.7 to 4.8. No serious side effects were reported in any of the patients, but in 12 and 10 patients no recordings were made beyond six months, due to ineffectiveness and intolerance to the treatment, respectively. CONCLUSIONS: Treatment with lacosamide in neuropathic pain due to different causes could be considered an effective and well-tolerated alternative for patients who fail to respond to standard treatments.

TITLE: Efectividad de la lacosamida en el tratamiento del dolor neuropatico refractario: estudio observacional abierto.Introduccion. Aunque se dispone de diferentes tratamientos para el dolor neuropatico, en muchas ocasiones estos pacientes son refractarios, lo que hace necesario probar tratamientos que, por su utilidad en otras patologias, podrian ser eficaces en el dolor neuropatico. Pacientes y metodos. Se recogieron las historias clinicas de pacientes que hubieran sido tratados con lacosamida para el dolor neuropatico, en diferentes hospitales de la zona centro peninsular, y que cumplieran unas caracteristicas similares en cuanto a refractariedad a otros tratamientos estandares, en un seguimiento de al menos seis meses, o que hubiesen tenido que suspender el tratamiento con dicho farmaco por cualquier motivo. Se obtuvo una muestra de 114 pacientes, 61 varones y 53 mujeres, con una edad media de 60,5 años. Resultados. Las causas de dolor neuropatico mas frecuentes fueron: polineuropatia diabetica (31,6%), neuralgia postherpetica (22,8%), neuralgia del trigemino (17,5%), neuralgia suboccipital y lumbociatalgia (un 12,3% en ambas). La eficacia fue buena/muy buena en la mayoria de los pacientes, con un descenso medio en la escala analogica visual tras seis meses de 7,7 a 4,8. No se registraron efectos secundarios graves en ningun paciente, pero en 12 y 10 pacientes no hubo registro mas alla de seis meses, por ineficacia e intolerancia al tratamiento, respectivamente. Conclusiones. El tratamiento con lacosamida en el dolor neuropatico de diferentes causas podria considerarse como una alternativa efectiva y bien tolerada para aquellos pacientes que no respondan a los tratamientos estandares.

Neurobehçet: a propósito de un caso / NeuroBehçet: a case

La enfermedad de Behçet es un trastorno inflamatorio sistémico, caracterizado por aftosis orogenital así como por alteraciones oftalmológicas y cutáneas. Un 5% de los pacientes presenta manifestaciones neurológicas. Se presenta un caso de neurobehçet con participación neurológica inhabitual.Varón de 28 años con antecedente de aftas orales y genitales recurrentes e historia de foliculitis, que acudió por cuadro de 48 h de fiebre, cefalea, náuseas, paresia del sexto par craneal y del miembro superior derecho. El análisis del líquido cefalorraquídeo reveló pleocitosis linfocitaria con hiperproteinorraquia, se inició tratamiento antibiótico de amplio espectro. Se realizó resonancia magnética cerebral, que mostró lesiones hiperintensas de predominio troncoencefálico con realce tras infusión de gadolinio y trombosis del seno transverso izquierdo. El paciente mejoró progresivamente con tratamiento intravenoso con corticoides hasta quedar asintomático.La afectación neurológica en la enfermedad de Behçet es infrecuente y más aún la coexistencia de lesiones intraparenquimatosas y extraparenquimatosas. Habitualmente, presenta buena respuesta al tratamiento inmunosupresor (AU)

Behçet′s disease is an inflammatory systemic disorder, with oral and genital ulcers, as well as ophthalmologic and cutaneous disturbances. 5% of the patients have neurological alterations. We present a case of neuroBehçet with a rare neurological involvement.A 28 years-old male patient with recurrent oral and genital ulcer history and folliculitis presents 48h progressive fever, headache, nausea, right sixth cranial nerve palsy and right upper limb paresis. The CSF showed lymphocyte pleocytosis and high proteinorrachia, so antibiotic treatment was initiated. Cerebral MR found hyperintense enhancing lesions in the brainstem and left transverse sinus thrombosis. Patient improved with endovenous corticosteroids and was discharged asymptomatic.Neurological involvement in Behçet′s disease is rare and moreover the coexistence of parenchymatous and non-parenchymatous alterations in the same patient. It normally has a good response to immunosuppressant treatment (AU)

[NeuroBehçet: A case]. / Neurobehçet: a propósito de un caso.

Behçet's disease is an inflammatory systemic disorder, with oral and genital ulcers, as well as ophthalmologic and cutaneous disturbances. 5% of the patients have neurological alterations. We present a case of neuroBehçet with a rare neurological involvement. A 28 years-old male patient with recurrent oral and genital ulcer history and folliculitis presents 48h progressive fever, headache, nausea, right sixth cranial nerve palsy and right upper limb paresis. The CSF showed lymphocyte pleocytosis and high proteinorrachia, so antibiotic treatment was initiated. Cerebral MR found hyperintense enhancing lesions in the brainstem and left transverse sinus thrombosis. Patient improved with endovenous corticosteroids and was discharged asymptomatic. Neurological involvement in Behçet's disease is rare and moreover the coexistence of parenchymatous and non-parenchymatous alterations in the same patient. It normally has a good response to immunosuppressant treatment.

Ateromatosis del arco aórtico y riesgo de ictus isquémico: a propósito de un caso / Atheroma of the aortic arch and risk of ischemic stroke: a case

Las placas de ateroma del arco aórtico son un factor de riesgo poco conocido de ictus isquémico, generalmente por la producción de embolias arterioarteriales. Presentamos el caso de un varón de 67 años que llegó a nuestro hospital con un ictus hemisférico izquierdo con estudio etiológico rutinario negativo. En el ecocardiograma transesofágico (ETE), se detectó una gran placa de ateroma en arco aórtico, ulcerada y complicada, con trombo móvil en su pared, presuntamente causante del cuadro actual. La ateromatosis del arco aórtico es un factor de riesgo independiente de infarto cerebral, especialmente las placas grandes, ulceradas o trombosadas, y aparece en un porcentaje elevado de pacientes con ictus criptogénico. La actitud diagnóstica y terapéutica es controvertida en estos casos, pero se suele aconsejar el ETE, como método de referencia diagnóstico, y la antiagregación, como prevención secundaria. En el momento actual, son necesarios más estudios epidemiológicos, así como ensayos clínicos, para elaborar guías de tratamiento en estas situaciones (AU)

Aortic arch atheroma is a poorly understood risk factor for stroke, usually producing arterial embolisms. A 67 year-old male was admitted to our hospital with a left hemispheric stroke with a negative routine aetiological study. Transesophageal echocardiography (TEE) showed atherosclerosis of the aortic arch with mobile thrombus, presumably causing the actual stroke. Aortic arch atheromatosis is an independent risk factor for cerebral infarction, particularly large, ulcerated or thrombotic plaques, and it is found in many patients with cryptogenic stroke. Diagnosis and treatmnent is not clear in these cases, but TEE is used as gold-standard complementary test with antiplatelets as secondary prevention. Further epidemiological studies and clinical trials are necessary for the preparation of clinical guides (AU)

Infección cutánea diseminada por Mycobacterium chelonae tras administración de toxina botulínica en paciente inmunodeprimida / Disseminated cutaneous infection by Mycobacterium chelonae after botulinic toxine injection in an immunosuppressed patient

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