Encefalitis multifocal como manifestación neurológica de la infección por COVID-19 / Multifocal encephalitis as a neurological manifestation of COVID-19 infection

No disponible

Transcranial duplex ultrasound monitoring of intracranial arterial stenosis treated with ELUTAX "3" drug-eluting balloon.

We report the results of transcranial ultrasound monitoring in three patients with intracranial arterial stenosis of the middle cerebral artery treated with the only drug-eluting balloon certificated for intracranial use in highly symptomatic intracranial arterial stenosis, ELUTAX "3" (AR Baltic Medical). We performed transcranial Doppler ultrasounds 24 h, 72 h, 10 days, 15 days and 30 days after the angioplasty, thereby measuring mean flow velocity (MFV) in the maximum stenosis area in patients with symptomatic steno-occlusive disease of the middle cerebral artery treated with ELUTAX "3". Two patients were treated during mechanical thrombectomy (MT) due to acute ischemic stroke and one patient was treated on elective basis due to symptomatic pre-occlusive stenosis, with recurrent transient ischemic attacks (TIAs) refractory to medical therapy. In Case 1, the first transcranial Doppler ultrasounds evidenced MFV of 348 cm/s, with progressive MFV reduction until 15 days post-treatment, with MFV of 177 cm/s. In Case 2, 24 h after angioplasty had an MFV of 258 cm/s, decreasing to 103 cm/s at 30 days. Case 3 had an MFV of 436 cm/s before angioplasty that immediately decreased after the procedure to 364 cm/s, with a final MFV of 260 cm/s at 30 days. We have recorded a progressive MFV reduction in intracranial arterial stenosis, with better outcomes in patients treated during MT. In our experience, the use of ELUTAX "3" for the treatment of symptomatic intracranial arterial stenosis achieves a progressive improvement of stenosis, evident in the first weeks, to a higher extent in cases of occlusive thrombosis. More studies are needed to provide more information about this device.

Hemodynamic effects of proximal supra-aortic artery stenosis on anterior cerebral artery.

Alternating flow in the anterior cerebral artery is a rare finding, associated with innominate artery stenosis. We present a series of four patients with this finding on transcranial color coded sonography, under basal conditions. In all of these patients, vascular studies detected an ipsilateral proximal stenosis, three in the innominate artery and, for the first time, one at the left common carotid artery origin. Successful angioplasties with stenting were performed, resulting for the first time in the normalization of orthograde flow in all cases. We conclude that an early systolic hemodynamic compromise in the first segment of the anterior cerebral artery, in the form of alternating flow, is an indirect indicator of ipsilateral proximal stenosis in the supra-aortic arteries, either in the innominate artery or at the origin of the left common carotid artery.

Efecto de la lacosamida sobre la calidad de vida del paciente con epilepsia / Effect of lacosamide on the quality of life of patients with epilepsy

Introducción. La epilepsia provoca trastornos psiquiátricos en un 20-40% de los pacientes y repercute de forma negativa en su calidad de vida. La lacosamida es un nuevo antiepiléptico que se utiliza como terapia añadida en crisis parciales con o sin generalización. Objetivo. Hemos realizado un estudio para valorar el impacto de la lacosamida en cuanto a la calidad de vida del paciente con epilepsia. Se han utilizado la escala hospitalaria de ansiedad y depresión (HADS) y la escala de calidad de vida en la epilepsia (QOLIE-10). Se ha valorado la eficacia y la tolerabilidad. Pacientes y métodos. Se recogen prospectivamente pacientes con epilepsia mal controlada y a los que se añade lacosamida. Se realiza una visita basal, a los tres y a los seis meses. Se cumplimentan los cuestionarios y se recaban los datos sobre la epilepsia. Resultados. Se incluyen 31 pacientes, con una edad media de 45,5 ± 17,2 años, un 64,5% varones. El número de crisis mensuales previas es de 1,6 ± 1,8. La HADS para ansiedad muestra una mejoría significativa a los tres y seis meses. La HADS para depresión refleja una mejoría significativa en los parámetros cualitativos. La QOLIE-10 muestra mejoría significativa para el grupo con baja calidad de vida previa a los tres y seis meses. Tras seis meses, el 61,3% de los pacientes presenta una reducción de las crisis igual o superior al 50%, y el 54,8% está libre de crisis. El mareo es el efecto secundario más frecuente (22,8%). El 74,2% continúa con el tratamiento. Conclusiones. La lacosamida podría mejorar la ansiedad, depresión y calidad de vida del paciente epiléptico con independencia del control de las crisis. La respuesta al tratamiento, la adhesión y los efectos secundarios son similares a estudios previos (AU)

Introduction. Epilepsy causes psychiatric disorders in 20-40% of patients impacting negatively on their quality of life. Lacosamide is a new antiepileptic as adjunctive therapy in partial seizures with or without generalization. Aim. We conducted a study to assess the impact of lacosamide as to the quality of life of epileptic patients. We used the HAD scale for anxiety and depression and QOLIE-10 scale for quality of life. We evaluated the efficacy and tolerability. Patients and methods. We collected prospectively poorly controlled epileptic patients are and added lacosamide treatment. Baseline visit, at 3 and 6 months were performed. The questionnaires are completed and the epilepsy information has been collected. Results. 31 patients, age 45.5 ± 17.2 years, 64.5% males are included. Number of previous monthly crisis 1.6 ± 1.8.HAD anxiety scale shows a significant improvement at 3 and 6 months. HAD scale for depression reflects a significant improvement in quality parameters. QOLIE-10 shows significant improvement for the group with low quality of life after 3 and 6 months. After 6 months 61.3% of patients have a seizure reduction equal or more than 50% and 54.8% are seizure free. Dizziness is the most common side effect (22.8%). 74.2% continued treatment. Conclusions. Lacosamide may improve anxiety, depression and quality of life of epileptic patients regardless of seizure control. Response to treatment, adherence and side effects are similar to previous studies (AU)

[Effect of lacosamide on the quality of life of patients with epilepsy]. / Efecto de la lacosamida sobre la calidad de vida del paciente con epilepsia.

INTRODUCTION: Epilepsy causes psychiatric disorders in 20-40% of patients impacting negatively on their quality of life. Lacosamide is a new antiepileptic as adjunctive therapy in partial seizures with or without generalization. AIM: We conducted a study to assess the impact of lacosamide as to the quality of life of epileptic patients. We used the HAD scale for anxiety and depression and QOLIE-10 scale for quality of life. We evaluated the efficacy and tolerability. PATIENTS AND METHODS: We collected prospectively poorly controlled epileptic patients are and added lacosamide treatment. Baseline visit, at 3 and 6 months were performed. The questionnaires are completed and the epilepsy information has been collected. RESULTS: 31 patients, age 45.5 ± 17.2 years, 64.5% males are included. Number of previous monthly crisis 1.6 ± 1.8. HAD anxiety scale shows a significant improvement at 3 and 6 months. HAD scale for depression reflects a significant improvement in quality parameters. QOLIE-10 shows significant improvement for the group with low quality of life after 3 and 6 months. After 6 months 61.3% of patients have a seizure reduction equal or more than 50% and 54.8% are seizure free. Dizziness is the most common side effect (22.8%). 74.2% continued treatment. CONCLUSIONS: Lacosamide may improve anxiety, depression and quality of life of epileptic patients regardless of seizure control. Response to treatment, adherence and side effects are similar to previous studies.

TITLE: Efecto de la lacosamida sobre la calidad de vida del paciente con epilepsia.Introduccion. La epilepsia provoca trastornos psiquiatricos en un 20-40% de los pacientes y repercute de forma negativa en su calidad de vida. La lacosamida es un nuevo antiepileptico que se utiliza como terapia añadida en crisis parciales con o sin generalizacion. Objetivo. Hemos realizado un estudio para valorar el impacto de la lacosamida en cuanto a la calidad de vida del paciente con epilepsia. Se han utilizado la escala hospitalaria de ansiedad y depresion (HADS) y la escala de calidad de vida en la epilepsia (QOLIE-10). Se ha valorado la eficacia y la tolerabilidad. Pacientes y metodos. Se recogen prospectivamente pacientes con epilepsia mal controlada y a los que se añade lacosamida. Se realiza una visita basal, a los tres y a los seis meses. Se cumplimentan los cuestionarios y se recaban los datos sobre la epilepsia. Resultados. Se incluyen 31 pacientes, con una edad media de 45,5 ± 17,2 años, un 64,5% varones. El numero de crisis mensuales previas es de 1,6 ± 1,8. La HADS para ansiedad muestra una mejoria significativa a los tres y seis meses. La HADS para depresion refleja una mejoria significativa en los parametros cualitativos. La QOLIE-10 muestra mejoria significativa para el grupo con baja calidad de vida previa a los tres y seis meses. Tras seis meses, el 61,3% de los pacientes presenta una reduccion de las crisis igual o superior al 50%, y el 54,8% esta libre de crisis. El mareo es el efecto secundario mas frecuente (22,8%). El 74,2% continua con el tratamiento. Conclusiones. La lacosamida podria mejorar la ansiedad, depresion y calidad de vida del paciente epileptico con independencia del control de las crisis. La respuesta al tratamiento, la adhesion y los efectos secundarios son similares a estudios previos.

Efecto de los ácidos grasos poliinsaturados omega-3 sobre la función cognitiva en pacientes con deterioro cognitivo leve / No disponible

Introducción: el deterioro cognitivo leve (DCL) afecta a entre el 3 y el 17 % de la población anciana, con tasas de conversión a demencia del 10 % al año. Distintos estudios publicados han mostrado el beneficio de los ácidos grasos poliinsaturados omega-3 (omega-3) en pacientes con DCL. Objetivo: evaluar el efecto de un complemento alimenticio a base de ácidos grasos omega-3 (ácido docosahexaenoico [DHA] y ácido eicosapentaenoico [EPA]) sobre el estado cognitivo y anímico en mayores de 60 años con DCL. Materiales y métodos: se seleccionaron 60 pacientes mayores de 60 años con DCL que fueron divididos aleatoriamente en dos grupos: grupo con complemento de omega-3 (grupo omega-3) y grupo control. Se efectuó una visita basal y otra a las 24 semanas. En cada visita se realizó: test de mini-mental (MMSE por sus siglas en inglés), test de Barcelona abreviado (TB-A) y escala de calidad de vida EQ-5D. Se analizaron las diferencias obtenidas entre las dos visitas y entre ambos grupos. Resultados: 46 (76,7 %) pacientes completaron el estudio: 25 del grupo omega-3 y 21 del grupo control. No encontramos diferencias entre ambos grupos en la puntuación del MMSE. Se halló mejoría significativa (p = 0,025) a favor del grupo omega-3 en el ítem «Memoria de textos diferida (preguntas)» del TB-A y mejoría significativa en el apartado ansiedad/depresión del EQ-5D a favor del grupo omega-3 (p = 0,005). El complemento de omega-3 fue bien tolerado. Conclusión: tras 24 semanas de seguimiento, el complemento de omega-3 ha mostrado un efecto positivo en la memoria y en el estado anímico. Estos resultados son equiparables a los publicados anteriormente, aunque se trata del primer estudio de estas características realizado en España (AU)

Introduction: Mild cognitive impairment (MCI) affects between 3-17% of the elderly, with conversion rates to dementia of 10% per year. Different published studies have shown the benefit of omega-3 polyunsaturated fatty acids (omega-3) in patients with MCI. Objective: To assess the effect of an omega-3 polyunsaturated fatty acids (docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]) food supplement on cognitive state and mood in people aged 60 years and above with MCI. Methods: 60 patients aged 60 years and above with MCI were recruited and were randomly divided into two groups: group with an omega-3 supplement (omega-3 group) and control group. A basal visit and a visit after 24 weeks were conducted. A minimental state examination (MMSE), an abbreviated Barcelona test (a-BT) and a EQ-5D quality of life scale were made in every visit. The differences between both visits and both groups were analyzed. Results: 46 patients completed the study (76.7%), 25 from the omega-3 group and 21 from the control group. There were no differences between both groups for the MMSE score. A significant improvement (p = 0.025) in favour of the omega-3 group for the "Deferred text memory (questions)" item in the a-BT and a significant improvement (p = 0.005) in favour of the omega-3 group for the anxiety/depression section in the EQ-5D were found. Omega-3 supplement was well tolerated. Conclusion: After 24 weeks of follow-up, the omega-3 supplement has shown a benefit on memory and mood. These results are comparable to those published earlier, although this is the first time that such a study has been conducted in Spain (AU)

Tratamiento del dolor neuropático con lacosamida / Treatment of neuropathic pain with lacosamide

Introducción. La lacosamida es un nuevo fármaco antiepiléptico con un mecanismo de acción novedoso al favorecer, de forma selectiva, la inactivación lenta de los canales de sodio dependientes del voltaje, sin actuar sobre la inactivaciónrápida. Existen estudios en la bibliografía sobre su eficacia para el control del dolor neuropático.Casos clínicos. Se describe el uso de la lacosamida intravenosa en el tratamiento de tres enfermos con dolor neuropático: una mujer con dolor neuropático en la primera rama del trigémino derecho durante la fase aguda de un herpes zóster, una mujer con un dolor central secundario a un síndrome de Déjerine-Roussy por una neoplasia cerebral y un varón con dolorfacial debido a una infiltración del trigémino por un linfoma secundario del sistema nervioso central. En los tres casos, la administración de lacosamida intravenosa ha significado una llamativa mejoría del dolor. La dosis de lacosamida ha sido de 200 mg/día, con una excelente tolerabilidad. Conclusión. La lacosamida puede ser una alternativa eficaz y bien tolerada en el tratamiento del dolor neuropático y, además, el uso intravenoso puede acelerar el control del dolor o ser adecuado en caso de no tolerar la vía oral (AU)

Introduction. Lacosamide is a new antiepileptic drug with a novel mechanism of action, as it selectively promotes the slowinactivation of voltage-dependent sodium channels without affecting fast inactivation. There are studies in the literature regarding its effectiveness in controlling neuropathic pain. Case reports. We describe the use of intravenous lacosamide in the treatment of three patients with neuropathic pain: a woman with neuropathic pain in the first branch of the right trigeminal nerve during the acute phase of herpes zoster, a woman with central pain secondary to Déjerine-Roussy syndrome due to a malignant brain tumour, and a man with facial pain due to infiltration of the trigeminal nerve by a secondary lymphoma of the central nervous system. In the three cases, the administration of intravenous lacosamide has led to a considerable improvement in pain. The lacosamide dose has been 200 mg/day with excellent tolerability.Conclusion. Lacosamide can be an effective and well-tolerated alternative in the treatment of neuropathic pain and, moreover, its intravenous use can achieve pain control faster or be suitable when it is not tolerated orally (AU)

[Treatment of neuropathic pain with lacosamide]. / Tratamiento del dolor neuropatico con lacosamida.

INTRODUCTION: Lacosamide is a new antiepileptic drug with a novel mechanism of action, as it selectively promotes the slow inactivation of voltage-dependent sodium channels without affecting fast inactivation. There are studies in the literature regarding its effectiveness in controlling neuropathic pain. CASE REPORTS: We describe the use of intravenous lacosamide in the treatment of three patients with neuropathic pain: a woman with neuropathic pain in the first branch of the right trigeminal nerve during the acute phase of herpes zoster, a woman with central pain secondary to Dejerine-Roussy syndrome due to a malignant brain tumour, and a man with facial pain due to infiltration of the trigeminal nerve by a secondary lymphoma of the central nervous system. In the three cases, the administration of intravenous lacosamide has led to a considerable improvement in pain. The lacosamide dose has been 200 mg/day with excellent tolerability. CONCLUSION: Lacosamide can be an effective and well-tolerated alternative in the treatment of neuropathic pain and, moreover, its intravenous use can achieve pain control faster or be suitable when it is not tolerated orally.

Common carotid artery intima-media thickness and intracranial pulsatility index in non-ST-elevation acute coronary syndromes.

BACKGROUND: Common carotid intima-media thickness (CIMT) has been related to cardiovascular risk factors, coronary atherosclerosis and a higher risk of myocardial infarction. Evaluation of intracranial arteries by transcranial Doppler explores the presence of vascular dysfunction at this level. We tested the hypothesis that CIMT and Doppler Pulsatility Index (DPI) can be related to the Thrombolysis in Myocardial Infarction (TIMI) risk score for non-ST-elevation acute coronary syndrome (nST-ACS). The relation to the prognosis after an acute event was also assessed. METHODS: We recruited 126 consecutive patients (80 males; mean age: 66.6 +/- 13.1 years) admitted with nST-ACS. A carotid assessment with bidimensional mode, measuring the CIMT in the posterior wall of the common carotid artery, and a transcranial Doppler assessment of the middle cerebral artery, with measurement of the Pulsatility Index were carried out. Clinical follow-up at 6 months was performed for endpoints (cardiovascular death, recurrent ACS or revascularization). RESULTS: Fifty-nine patients had an abnormal (> or =0.8 mm) CIMT, whilst 70 patients had an abnormal DPI (> or =1.2). CIMT was correlated with TIMI risk score (Pearson r: 0.26; p = 0.004), whilst abnormal DPI was associated with TIMI risk scale (p < 0.001). Using a logistic regression analysis, the presence of an abnormal CIMT was only related to age > or =65 (p = 0.0012) and diabetes mellitus (p = 0.0028). Abnormal DPI was also associated with age > or =65 (p < 0.0001) and diabetes mellitus (p = 0.0466). Neither CIMT nor DPI were related to 6 months' clinical outcome. CONCLUSIONS: Patients with nST-ACS have a high prevalence of dates of abnormal DPI, which was associated with increased CIMT. Both variables were related to age and diabetes but not with clinical outcomes.