Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios / From in-person didactic sessions to videoconferencing during the COVID-19 pandemic: satisfaction survey among participants

Introducción y objetivo: La pandemia de COVID-19 ha trastornado la actividad hospitalaria, incluyendo la docente. Se describe el cambio de un sistema presencial a otro de sesiones en línea en un servicio de neurología, y se analizan la satisfacción y las opiniones de los usuarios. Material y métodos. Exposición de las medidas adoptadas para pasar a modalidad en línea y análisis de una encuesta entre los participantes. Resultados: Se pasó de tres a dos sesiones semanales, con restricción del público presencial. El público virtual superó al presencial. Contestaron la encuesta 49 participantes, un 51% mujeres, con una media de 40,5 años (rango: 25-65). La satisfacción de los asistentes fue mayor para las sesiones presenciales (8,68) que para las en línea (8,12) (p = 0,006). Existía una correlación inversa significativa entre la edad y la satisfacción con las sesiones en línea (r = –0,37; p = 0,01) que no se daba para las sesiones presenciales. El 75,5% fue partidario de mantener las sesiones virtuales cuando se eliminaran las restricciones de aforo. Una mayoría (87,8%) apoyó sesiones interhospitalarias y recomienda que las autoridades sanitarias faciliten aplicaciones informáticas seguras (53,1%). Conclusiones: La introducción de sesiones virtuales es una medida fácil de implementar en un servicio de neurología, con un alto grado de satisfacción de los usuarios, aunque menor que con las sesiones presenciales. Existen problemas no resueltos respecto al uso de plataformas comerciales y conexión interhospitalaria. Sería recomendable que las autoridades sanitarias y educativas desarrollaran aplicaciones seguras y fomentaran la educación médica en línea.(AU)

Introduction and aim: COVID-19 pandemic has disturbed many hospital activities, including medical education. We describe the switch from in-person didactic sessions to videoconferencing in a Neurology department. We analyse the opinions and satisfaction of participants. Material and methods: Narrative description of the adopted measures; Online survey among participants. Results: One of the three weekly sessions was cancelled, and two switched to videoconferencing. There were more participants online than in the conference hall. 49 users answered the survey, 51% women, mean age 40.5 years (range 25-65). Satisfaction was higher for previous face-to-face meetings (8.68) than for videoconferencing (8.12) (p=0.006). There was a significant inverse correlation between age and satisfaction with virtual sessions (r=-0.37; p=0.01), that was not found for in-person attendance. Most users (75.5%) would prefer to continue with online sessions when the pandemic is over, and 87.8% support inter-hospital remote meetings, but the safety of web platforms is a concern (53.1%). Conclusions: The change from in-person to virtual sessions is an easy measure to implement in a neurology department, with a good degree of satisfaction among users. There are some unsolved problems with the use of commercial web platforms and inter-hospital connection. Most users recommend leadership and support from educational and health authorities.(AU)

[From in-person didactic sessions to videoconferencing during the COVID-19 pandemic: satisfaction survey among participants]. / Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios.

INTRODUCTION AND AIM: COVID-19 pandemic has disturbed many hospital activities, including medical education. We describe the switch from in-person didactic sessions to videoconferencing in a Neurology department. We analyse the opinions and satisfaction of participants. MATERIAL AND METHODS: Narrative description of the adopted measures; Online survey among participants. RESULTS: One of the three weekly sessions was cancelled, and two switched to videoconferencing. There were more participants online than in the conference hall. 49 users answered the survey, 51% women, mean age 40.5 years (range 25-65). Satisfaction was higher for previous face-to-face meetings (8.68) than for videoconferencing (8.12) (p=0.006). There was a significant inverse correlation between age and satisfaction with virtual sessions (r=-0.37; p=0.01), that was not found for in-person attendance. Most users (75.5%) would prefer to continue with online sessions when the pandemic is over, and 87.8% support inter-hospital remote meetings, but the safety of web platforms is a concern (53.1%). CONCLUSIONS: The change from in-person to virtual sessions is an easy measure to implement in a neurology department, with a good degree of satisfaction among users. There are some unsolved problems with the use of commercial web platforms and inter-hospital connection. Most users recommend leadership and support from educational and health authorities.

TITLE: Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios.Introducción y objetivo. La pandemia de COVID-19 ha trastornado la actividad hospitalaria, incluyendo la docente. Se describe el cambio de un sistema presencial a otro de sesiones en línea en un servicio de neurología, y se analizan la satisfacción y las opiniones de los usuarios. Material y métodos. Exposición de las medidas adoptadas para pasar a modalidad en línea y análisis de una encuesta entre los participantes. Resultados. Se pasó de tres a dos sesiones semanales, con restricción del público presencial. El público virtual superó al presencial. Contestaron la encuesta 49 participantes, un 51% mujeres, con una media de 40,5 años (rango: 25-65). La satisfacción de los asistentes fue mayor para las sesiones presenciales (8,68) que para las en línea (8,12) (p = 0,006). Existía una correlación inversa significativa entre la edad y la satisfacción con las sesiones en línea (r = ­0,37; p = 0,01) que no se daba para las sesiones presenciales. El 75,5% fue partidario de mantener las sesiones virtuales cuando se eliminaran las restricciones de aforo. Una mayoría (87,8%) apoyó sesiones interhospitalarias y recomienda que las autoridades sanitarias faciliten aplicaciones informáticas seguras (53,1%). Conclusiones. La introducción de sesiones virtuales es una medida fácil de implementar en un servicio de neurología, con un alto grado de satisfacción de los usuarios, aunque menor que con las sesiones presenciales. Existen problemas no resueltos respecto al uso de plataformas comerciales y conexión interhospitalaria. Sería recomendable que las autoridades sanitarias y educativas desarrollaran aplicaciones seguras y fomentaran la educación médica en línea.

Demencia rápidamente progresiva como forma de presentación del síndrome de Cushing / Rapidly progressing dementia as a form of presentation of Cushing síndrome

No disponible

Código ictus en paciente portador de dispositivo de asistencia ventricular externa / "Code stroke" activation in a patient with an external ventricular assist device

No disponible

La codificación como instrumento en la gestión clínica de las unidades del dolor / The codification as tool in the clinic management of pain units

Introducción: los principales instrumentos de información para la gestión clínica se basan en la recogida sistemática de datos clínicos, que se materializa en el CMBD, y en la utilización de sistemas de clasificación de pacientes, siendo los AP-GRD los adoptados en nuestro país por la administración sanitaria. Los datos necesarios para realizar la agrupación en GRD están contenidos en el CMBD y entre ellos están: diagnóstico principal, intervenciones o procedimientos y diagnósticos secundarios, que deben estar codificados con la CIE-9-MC. El sistema GRD es un instrumento de gestión, que permite una contabilidad analítica, a través de los pesos relativos de cada GRD. Objetivos: mostrar la codificación de los diagnósticos que se realizan en una Unidad Multidisciplinar de Dolor Crónico mediante la CIE-9-MC, único sistema reconocido a nivel institucional, y evidenciar la importancia que tiene la codificación correcta de los diagnósticos de dolor para obtener los GRD que describan más adecuadamente el grado de complejidad de los procesos tratados, con su correspondiente 'coste por proceso'. Material y métodos: se han revisado las historias clínicas para obtener la información necesaria para realizar la codificación. A cada diagnóstico se le asigna un código principal y si es preciso uno o varios códigos secundarios. Se debe asignar un código para el procedimiento realizado. Una vez realizada la codificación, junto con los datos necesarios de cada paciente, se obtienen los diferentes GRD, con sus pesos correspondientes. Resultados: se han codificado diagnósticos con la CIE-9-MC desde el año 2002 al 2012, realizando una base de datos con la codificación de los diagnósticos más frecuentes en una Unidad de Dolor. Se ha obtenido cada año información sobre la agrupación de patologías mediante GRD, y su peso correspondiente. De 2002 a 2009 el GRD más frecuente fue el 243, 'Patología médica de columna vertebral' en el 57% de los casos. A partir del año 2010 se introdujo la nueva codificación que incluye el código 338 y como consecuencia cambiaron los GRD. La categoría 338, 'Dolor no clasificado bajo otros conceptos', se enmarca dentro del capítulo de Enfermedades del Sistema Nervioso y Órganos de los Sentidos. Los GRD más frecuentes han sido: 035, 'Otros trastornos del sistema nervioso, sin CC' en el 42,28% de los casos; 243 'Patología médica de columna vertebral' en el 18% y 019 'Trastornos de nervios craneales y periféricos sin CC' en el 15,5%. Se describen las características de estos GRD y los diagnósticos de dolor que se han incluido en cada uno de ellos. Conclusiones: el uso de la codificación de diagnósticos y procedimientos con la CIE-9-MC supone un esfuerzo por unificar el lenguaje que se utiliza en la práctica clínica. Es preciso que la codificación se realice correcta y consistentemente para obtener resultados que reflejen la actividad real que se realiza en un servicio y lo que cuesta. Para que realmente la codificación influya en la gestión clínica por procesos, es fundamental que los responsables de las unidades conozcan estas herramientas. A medio plazo, se instaurará en la actividad clínica en España el uso de la CIE-10-MC (AU)

Introduction: The main tools of information for clinical management are based on the systematic collection of clinical data, which is embodied in the MDS (Minimum Basic Data Set), and the use of patient classification systems, being the AP-DRGs those adopted in our country for the health administration. The data needed to perform the grouping DRGs are contained in the MDS and among them are: The main diagnosis, interventions or other procedures performed and secondary diagnoses, which should be coded with ICD-9-CM. The DRG system is a management tool that allows an analytical accounting system, through the relative weights of each DRG. Objectives: To show the codification of diagnoses that are carried out in a Multidisciplinary Unit of Chronic Pain by ICD-9- CM, unique system officially recognized by our health services, and demonstrate the importance that correct coding of diagnoses of pain has to obtain the DRGs that best describe the degree of complexity of the processes that are treated, with the corresponding 'cost per case'. Material and methods: We reviewed the medical records to obtain the information necessary to perform the encoding. For each diagnoses a master code (main diagnoses) is assigned and if necessary one or more secondary codes are added. It is assigned a code for the procedure performed. Once the codification is obtain, along with the necessary data for each patient, the various DRGs are obtained, with their corresponding weights. Results: Diagnoses were coded with ICD-9-CM from 2002 until 2012, performing a database with encoding of the most common diagnoses in a chronic pain unit. It has been obtained each year information about grouping of pathologies by DRG, and its weights. From 2002 to 2009 the most common DRG was the 243, 'Medical pathology of spine', that account for 57% of cases. Beginning in 2010, the new codification was introduced, including the code 338 and as a consequence the DRGs changed. The category 338, 'Pain not classified under other concepts', is part of the chapter of Diseases of the Nervous System and Senses Organs. The most frequent DRGs were: 035 'Other disorders of nervous system without CC', 42.28% of cases; 243 'Medical pathology spine' 18% and 019 'Disorders of cranial and peripheral nerves without CC' 15.5%. The characteristics of these DRGs are described together the diagnoses of pain that are included in each of them. Conclusions: The use of coding diagnoses and procedures with ICD-9-CM is an effort to unify the language used in clinical practice. It is necessary that the coding is done correctly and consistently to get results that reflect real activity that takes place in a service and what it costs. In order for the codification to become relevant in the clinical management by processes, it is essential that the unit managers must be familiar with these tools. In the medium term, the used of ICD-10-CM will be established in clinical practice in Spain (AU)

Infiltrative cervical lesions causing symptomatic occipital neuralgia.

BACKGROUND: Occipital neuralgia is a well-recognized cause of posterior head and neck pain that may associate mild sensory changes in the cutaneous distribution of the occipital nerves, lacking a recognizable local structural aetiology in most cases. Atypical clinical features or an abnormal neurological examination are alerts for a potential underlying cause of pain, although cases of clinically typical occipital neuralgia as isolated manifestation of lesions of the cervical spinal cord, cervical roots, or occipital nerves have been increasingly reported. CASE REPORTS: We describe two cases (one with typical and another one with atypical clinical features) of occipital neuralgia secondary to paravertebral pyomyositis and vertebral relapse of multiple myeloma in patients with relevant medical history that aroused the possibility of an underlying structural lesion. DISCUSSION: We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia, even when typical clinical features are present and neurological examination is completely normal.

Documento de Consenso interdisciplinar para el tratamiento de la fibromialgia / Interdisciplinary Consensus Document for the treatment of fibromyalgia

Antecedentes. La elevada prevalencia y enorme impacto clínico y social de la fibromialgia, junto a la complejidad de su tratamiento, exigen consensos de actuación que sirvan de guía a los profesionales de la salud. Aunque existían algunos documentos similares en nuestro idioma, la mayoría habían sido realizados desde la perspectiva de una única disciplina. Objetivo. Desarrollar un consenso sobre el tratamiento de la fibromialgia realizado por representantes seleccionados y avalados por las principales sociedades médicas que intervienen en su tratamiento (reumatología, neurología, psiquiatría, rehabilitación y medicina de familia), así como representantes de las asociaciones de pacientes. Por otra parte, se enfatizó la comprensión de la enfermedad no como un trastorno homogéneo, sino como la suma de diferentes subtipos clínicos, con características sintomáticas específicas y necesidades terapéuticas distintas. Este abordaje representaba una necesidad percibida por los clínicos y una novedad respecto a consensos previos. Método. Se revisaron las diferentes clasificaciones clínicas que se han propuesto en fibromialgia, así como la evidencia científica de los tratamientos utilizados en esta enfermedad. Para la selección de la clasificación empleada y para la realización de las recomendaciones terapéutica, se emplearon algunas de las técnicas habituales para realizarlos consensos (grupo nominal y brainstorming). Conclusión. La clasificación de Giesecke de la fibromialgia en 3 subgrupos parece ser la que cuenta con mayor evidencia científica y la más útil para el clínico. La guía ofrece una serie de recomendaciones generales para todos los pacientes con fibromialgia. Pero, además, para cada subgrupo existen una serie de recomendaciones específicas de tipo farmacológico, psicológico y de modificación del entorno, que permitirán un abordaje personalizado del paciente con fibromialgia en dependencia de sus características clínicas individuales (dolor, depresión, niveles de catastrofización, etc) (AU)

Backgrounds. The elevated prevalence and enormous clinical and social impact of fibromyalgia, together with the complexity of its treatment, require action consensuses that guide health care professionals. Although there are some similar documents in our language, most have been made from the perspective of a single discipline. Objective. To develop a consensus on the treatment of fibromyalgia made by selected representatives and supported by the principal medical associations that intervene in its treatment (rheumatology, neurology, psychiatry, rehabilitation and family medicine) and representatives of the associations of patients. On the other hand, understanding the disease not as a homogenous disorders but also as the sum of different clinical subtypes, having specific symptomatic characteristics and different therapeutic needs is stressed. This approach represented a need perceived by the clinicians and a novelty regarding previous consensuses. Methods. The different clinical classifications proposed in fibromyalgia and the scientific evidence of the treatments used in this disease were reviewed. For the selection of the classification used and performance of the therapeutic recommendations, some of the usual techniques to obtain the consensus (nominal group and brainstorming) were used. Conclusion. The classification of Giesecke of fibromyalgia into 3 subgroups seems to have the greatest scientific evidence and the most useful for the clinician. The guide offers a series of general recommendations for all the patients with fibromyalgia. However, in addition, for each subgroup, there are a series of specific pharmacological and psychological-type recommendations and those of modification of the environment, which will make it possible to have a personalized approach to the patient with fibromyalgia in accordance with their individual clinical characteristics (pain, catastrophizing levels, etc.) (AU)

[Meralgia paraesthetica: a report on a series of 140 cases]. / Meralgia parestésica: a propósito de una serie de 140 casos.

INTRODUCTION: Meralgia paraesthetica is a pathology that is frequently seen in visits to extra-hospital neurology services. Nevertheless, the diagnosis, treatment and prognosis of this condition remain somewhat unclear. PATIENTS AND METHODS: A retrospective study was conducted involving 140 patients. Data were collected concerning demographic aspects, clinical picture, diagnostic study, aetiology, treatment and progression. RESULTS: There was a predominance of males, with a mean age of 54 years. The mean follow-up time was 25 months. The symptoms that were reported were as follows: numbness, burning pain, tingling or prickling in the nerve territory. Hypaesthesia was the most frequent sign found in the examination. History of another compressive neuropathy was present in 13.6% of patients. The diagnosis was based on the patient record and the neurological examination. The neurophysiological study and complementary tests were reserved for atypical cases. The most common causation was spontaneous and only three cases were found to be secondary to a structural lesion. A third of the patients were receiving pharmacological treatment. Although the clinical picture was benign, in most cases it tended to become chronic. Patients treated pharmacologically did not show a significant improvement in comparison to those who were not given treatment. The most important data for forecasting improvement of the clinical picture were the identification and correction of the factors precipitating compression of the nerve. CONCLUSIONS: Meralgia paraesthetica is a frequent, benign pathology but with a tendency to become chronic that responds poorly to pharmacological treatment. It is important to identify and correct mechanical factors and only in exceptional cases is it secondary to a structural lesion.

Meralgia parestésica: a propósito de una serie de 140 casos / Meralgia Paraesthetca: a report on a series of 140 cases

Introducción. La meralgia parestésica es una patología frecuente en la consulta de neurología extrahospitalaria. Apesar de ello, el diagnóstico, tratamiento y pronóstico de este cuadro no están bien establecidos. Pacientes y métodos. Estudioretrospectivo de 140 pacientes. Se recogen datos demográficos, clínica, estudio diagnóstico, etiología, tratamiento y evolución.Resultados. Hubo un predominio masculino, con una mediana de 54 años. El seguimiento medio fue de 25 meses. Lossíntomas narrados fueron: acorchamiento, dolor urente, hormigueo o pinchazos en el territorio nervioso. En la exploración sehalló hipoestesia como signo más frecuente. Hubo historia de otra neuropatía compresiva en el 13,6%. El diagnóstico se basóen la historia clínica y la exploración neurológica. El estudio neurofisiológico y las pruebas complementarias se reservaronpara casos atípicos. La etiología más frecuente fue la espontánea, y se hallaron sólo tres casos secundarios a lesión estructural.Un tercio de los pacientes recibió tratamiento farmacológico. Aunque el cuadro fue benigno, en la mayoría tendióa cronificarse. Los pacientes tratados farmacológicamente no mostraron una mejoría significativa frente a los que no recibierontratamiento. El dato pronóstico más importante para la mejoría del cuadro fue la identificación y corrección de los factoresdesencadenantes de compresión del nervio. Conclusiones. La meralgia parestésica es una patología frecuente, benigna,pero con tendencia a cronificarse, en la que es importante identificar y corregir factores mecánicos, con pobre respuesta altratamiento farmacológico, y sólo en casos excepcionales secundaria a lesión estructural (AU)

Introduction. Meralgia paraesthetica is a pathology that is frequently seen in visits to extra-hospital neurologyservices. Nevertheless, the diagnosis, treatment and prognosis of this condition remain somewhat unclear. Patients andmethods. A retrospective study was conducted involving 140 patients. Data were collected concerning demographic aspects,clinical picture, diagnostic study, aetiology, treatment and progression. Results. There was a predominance of males, with amean age of 54 years. The mean follow-up time was 25 months. The symptoms that were reported were as follows: numbness,burning pain, tingling or prickling in the nerve territory. Hypaesthesia was the most frequent sign found in the examination.History of another compressive neuropathy was present in 13.6% of patients. The diagnosis was based on the patient recordand the neurological examination. The neurophysiological study and complementary tests were reserved for atypical cases. Themost common causation was spontaneous and only three cases were found to be secondary to a structural lesion. A third of thepatients were receiving pharmacological treatment. Although the clinical picture was benign, in most cases it tended to becomechronic. Patients treated pharmacologically did not show a significant improvement in comparison to those who were not giventreatment. The most important data for forecasting improvement of the clinical picture were the identification and correction ofthe factors precipitating compression of the nerve. Conclusions. Meralgia paraesthetica is a frequent, benign pathology butwith a tendency to become chronic that responds poorly to pharmacological treatment. It is important to identify and correctmechanical factors and only in exceptional cases is it secondary to a structural lesion. (AU)

Formación médica continuada en neurología: un reto necesario / Continuing medical education in neurology: a necessary challenge

Introducción. Los conocimientos y competencias en laespecialidad de neurología adquiridos durante el posgradodeberán desarrollarse posteriormente con la actividad desempeñadacomo especialistas. El crecimiento exponencialde los conocimientos científicos y su correlato práctico yasistencial determinan que, para un óptimo desarrollo denuestra actividad profesional sea imprescindible el aprendizajepermanente o lifelong learning.Revisión. Se han revisado los aspectos más relevantesreferentes al aprendizaje y desarrollo continuado del neurólogo.Se presentan y analizan los modelos actuales y las distintaspropuestas planteadas por los organismos y sociedadesmédicas, nacionales e internacionales, sobre la formaciónmédica continuada y el desarrollo profesional continuado.Conclusión. Se debaten diversos aspectos sobre la necesidadde la formación médica continuada y desarrolloprofesional continuado, entre los que destaca si esta formacióncontinuada debe ser un compromiso voluntario de cadaprofesional o bien una obligación regulada por los organismoscompetentes, y recabamos la conveniencia de serpartícipes y protagonistas de los cambios que sobre esta temáticapudieran suceder en nuestro entorno (AU)

Introduction. The knowledge and skills acquired inthe neurology specialty during post-graduate studies mustbe developed later as a specialist. Exponential growth of thescientific knowledge and its practical application make lifelong learning essential for optimal development ofour professional activity.Revision. The most relevant aspects of the learning andcontinued development of the neurologist have been reviewed.Current models and different proposals made by nationaland international medical organizations and societieson continuing medical education and the continuing professionaldevelopment are presented and analyzed.Conclusion. Several aspects regarding the need forcontinuing medical education and the continuing professionaldevelopment are discussed. Included amongthese are whether continuing education should be a voluntarycommitment by each professional or an obligationregulated by specialist organizations. We have theopportunity to play a leading role in the changes thatwill affect us in this field

[Continuing medical education in neurology: a necessary challenge]. / Formación médica continuada en neurología: un reto necesario.

INTRODUCTION: The knowledge and skills acquired in the neurology specialty during post-graduate studies must be developed later as a specialist. Exponential growth of the scientific knowledge and its practical application make lifelong learning essential for optimal development of our professional activity. REVISION: The most relevant aspects of the learning and continued development of the neurologist have been reviewed. Current models and different proposals made by national and international medical organizations and societies on continuing medical education and the continuing professional development are presented and analyzed. CONCLUSION: Several aspects regarding the need for continuing medical education and the continuing professional development are discussed. Included among these are whether continuing education should be a voluntary commitment by each professional or an obligation regulated by specialist organizations. We have the opportunity to play a leading role in the changes that will affect us in this field.

[Nocturnal sleep-related eating disorder that responds to topiramate]. / Sindrome de ingesta nocturna relacionada con el sueno con respuesta al topiramato.

INTRODUCTION: Nocturnal sleep-related eating disorder is a non-REM sleep parasomnia that is associated to other sleep disorders, especially sleepwalking. It becomes chronic, is not remitting and consists in episodes of compulsive eating during the night, which are then partially or completely forgotten by the patient. This condition must be differentiated from night-eating syndrome, which is far more common and is linked to endocrinological and psychiatric disorders, as well as to other disorders involving eating behaviour during sleeping hours. CASE REPORT: A 28-year-old male who had suffered from the clinical picture every day for 10 years; this condition consisted in nocturnal episodes of binge eating in a state of semi-sleepiness, with no remembrance of what had happened the next morning. The patient had no history of psychiatric pathologies or any other eating disorder, but he did not rest adequately at night, was overweight and had a family and personal history of other sleep disorders. Since he did not respond to other treatments, we decided to try therapy with topiramate; as a result, the episodes disappeared, tolerance was excellent and effectiveness was maintained throughout the two years' follow-up. CONCLUSIONS: In this paper we review eating disorders that occur during sleep, nocturnal sleep-related eating disorder and its therapeutic possibilities, while highlighting the usefulness of topiramate to treat this condition.

Síndrome de ingesta nocturna relacionada con el sueño con respuesta al topiramato / Nocturnal sleep-related eating disorder that responds to topiramite

El síndrome de ingesta nocturna relacionada con el sueño es una parasomnia de sueño no REM, asociadaa otros trastornos del sueño, en especial al sonambulismo, crónica, no remitente y que consiste en episodios de ingesta compulsiva de alimento durante la noche con amnesia parcial o completa del episodio. Este cuadro debe ser diferenciado del síndrome de la cena durante el sueño, que es mucho más frecuente y se asocia a trastornos endocrinos y psiquiátricos, y deotros trastornos de la conducta alimentaria durante el sueño. Caso clínico. Varón de 28 años, con un cuadro diario de, al menos, 10 años de duración, consistente en episodios nocturnos de ingesta compulsiva en un estado de semisomnolencia, con amnesia del suceso a la mañana siguiente. El paciente no tenía historia de patología psiquiátrica o de otro trastorno de la alimentación,pero sí un descanso nocturno pobre, sobrepeso y antecedentes familiares y personales de otros trastornos del sueño.No respondió a otros tratamientos, por lo que se probó el topiramato con casi total desaparición de los episodios, excelente tolerancia y mantenimiento de la eficacia durante dos años de seguimiento. Conclusiones. Revisamos en este artículo lostrastornos de la conducta alimentaria durante el sueño, el síndrome de ingesta nocturna relacionada con el sueño y sus posibilidades terapéuticas, señalando la utilidad del topiramato en este cuadro

Nocturnal sleep-related eating disorder is a non-REM sleep parasomnia that is associated to othersleep disorders, especially sleepwalking. It becomes chronic, is not remitting and consists in episodes of compulsive eating during the night, which are then partially or completely forgotten by the patient. This condition must be differentiated fromnight-eating syndrome, which is far more common and is linked to endocrinological and psychiatric disorders, as well as to other disorders involving eating behaviour during sleeping hours. Case report. A 28-year-old male who had suffered from the clinical picture every day for 10 years; this condition consisted in nocturnal episodes of binge eating in a state of semisleepiness,with no remembrance of what had happened the next morning. The patient had no history of psychiatric pathologies or any other eating disorder, but he did not rest adequately at night, was overweight and had a family and personal history of other sleep disorders. Since he did not respond to other treatments, we decided to try therapy with topiramate; as a result, the episodes disappeared, tolerance was excellent and effectiveness was maintained throughout the two years’ follow-up.Conclusions. In this paper we review eating disorders that occur during sleep, nocturnal sleep-related eating disorder and its therapeutic possibilities, while highlighting the usefulness of topiramate to treat this condition

[Sensory ganglionopathy as a manifestation of celiac disease]. / Ganglionopatia sensitiva como manifestacion de enfermedad celiaca.

INTRODUCTION: The neurological manifestations of celiac disease (CD) may be caused by the disease itself, by associated autoimmune diseases or by complications from the tumours that may develop in the long term. We report a case of sensory ganglionopathy associated to CD. CASE REPORT: A 59-year-old female with chronic diarrhoea and loss of weight, who visited because of a clinical picture of gait disorders that progressed to the point where she was barely able to walk. Having been diagnosed with CD, finding a sensory ganglionopathy with dysautonomia (an atypical manifestation of this disease) led to a diagnosis of associated Sjogren's syndrome (SS). CONCLUSIONS: The neurological manifestations of CD are very varied, but in the presence of a sensory ganglionopathy, a neurological picture that is atypical in this disease, it becomes necessary to suspect SS, which is an infrequent but well established association. Likewise, all patients with SS must be screened for CD, which (albeit subclinically) can be complicated in the long term by the development of tumours. The differential diagnosis of the neurological manifestations of CD and of sensory ganglionopathy, as well as the association between celiac disease and SS, is also discussed.

Ganglionopatía sensitiva como manifestación de enfermedad celiaca / Sensory ganglionopathy as a manifestation of celica disease

Introducción. Las manifestaciones neurológicas de la enfermedad celiaca (EC) pueden deberse a la propia enfermedad, a las enfermedades autoinmunes asociadas o a complicaciones de los tumores que pueden desarrollar a largo plazo. Presentamos un caso de ganglionopatía sensitiva asociada a una EC. Caso clínico. Mujer de 59 años con diarrea crónica y pérdida de peso, que acude por un cuadro de trastorno de la marcha, que progresa hasta llegar a impedirla. Diagnosticada como EC, el hallazgo de una ganglionopatía sensitiva con disautonomía, manifestación atípica para esta enfermedad, llevó al diagnóstico de un síndrome de Sjögren (SS) asociado. Conclusiones. Las manifestaciones neurológicas de la EC son muy variadas, pero ante la presencia de una ganglionopatía sensitiva, cuadro neurológico atípico en esta enfermedad, es obligado sospechar un SS, asociación infrecuente, pero bien establecida. De igual manera, en todo paciente con SS debe realizarse un cribado de EC, que, aunque subclínica, puede complicarse a largo plazo con el desarrollo de tumores. Discutimos el diagnóstico diferencial de las manifestaciones neurológicas de la EC y de la ganglionopatía sensitiva, así como la asociación entre la celiaquía y el SS

Introduction. The neurological manifestations of celiac disease (CD) may be caused by the disease itself, by associated autoimmune diseases or by complications from the tumours that may develop in the long term. We report a case of sensory ganglionopathy associated to CD. Case report. A 59-year-old female with chronic diarrhoea and loss of weight, who visited because of a clinical picture of gait disorders that progressed to the point where she was barely able to walk. Having been diagnosed with CD, finding a sensory ganglionopathy with dysautonomia (an atypical manifestation of this disease) led to a diagnosis of associated Sjogren’s syndrome (SS). Conclusions. The neurological manifestations of CD are very varied, but in the presence of a sensory ganglionopathy, a neurological picture that is atypical in this disease, it becomes necessary to suspect SS, which is an infrequent but well established association. Likewise, all patients with SS must be screened for CD, which (albeit subclinically) can be complicated in the long term by the development of tumours. The differential diagnosis of the neurological manifestations of CD and of sensory ganglionopathy, as well as the association between celiac disease and SS, is also discussed

Neuralgia supraorbitaria: una alternativa intervencionista. Réplica / Supraorbital neuralgia: an interventionist alternative. Reply

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Labor del médico rehabilitador dentro de una Unidad Multidisciplinar del Dolor / The role of the rehabilitation doctor in a Multidisciplinary Pain Unit

Introducción. Las Unidades del Dolor tienden a estar formadas por un equipo multidisciplinar de especialistas. En 1947 Bonica, basándose en el éxito de una colaboración con un ortopeda, un neurocirujano y un psiquiatra estableció la primera clínica multidisciplinar del dolor. El objetivo del trabajo es describir la labor del médico rehabilitador en la Unidad del Dolor del Hospital 12 de Octubre. Material y método. Se describe el organigrama de trabajo del médico rehabilitador en una Unidad del Dolor y el proceso de evaluación y tratamiento que habitualmente lleva a cabo. También se ha realizado un análisis descriptivo de los pacientes que han sido atendidos durante 10 meses (noviembre 2004-agosto 2005). Resultados. Consiste en una colaboración un día por semana en la que los pacientes tras ser vistos por el equipo fijo de la Unidad reciben una valoración y tratamiento desde el punto de vista rehabilitador. Se valoraron 74 pacientes con una edad media de 59,9 años. El motivo de consulta principal fue el de dolor lumbar. Realizaron rehabilitación el 69 % y se recomendaron medidas ortoprotésicas al 46 %. El grado de satisfacción tras la visita con el médico rehabilitador de la Unidad fue bueno en el 54 % de los pacientes. Conclusiones. La experiencia de los distintos especialistas y una visión multidisciplinar del dolor ayudan a mejorar la atención y el tratamiento de nuestros pacientes. La presencia de un médico rehabilitador en una Unidad Multidisciplinar del Dolor enriquece la atención y las opciones terapéuticas de los pacientes con dolor crónico

Introduction. In a Chronic Pain Unit works a multidisciplinary equipment of specialist. In 1947, Bonica made the first multicisciplinary clinic of being based on the success of a collaboration with an orthopedics, a neurosurgerist and a psychiatrist. The objective of this work is to describe the work of the Rehabilitation doctor in the Unit of the Pain Hospital 12 de Octubre. Material and method. A description of the organizational chart of work of the rehabilitator doctor in a Unit of the Pain, and the process of evaluation and treatment has taken place that habitually carries out. Also a descriptive analysis of the patients has been made who have been taken care of during 10 months (November 2004-Agost 2005). Results. A day per week consists of a collaboration in which the patients after being seen by the stationary equipment of the Unit, receive a valuation an treatment from the rehabilitator point of view. 74 patients with an average age of 59,9 years valued themselves. The main reason for consultation was the one of lumbar pain. Of the valued patients they made rehabilitation 69 % and ortoprotésicas measures in 46 % of the cases were recommended. The degree of satisfaction after the visit with the rehabilitator doctor of the unit was good in 54 % of the patients. Conclusions. The experience of the differents specialist and the multidisciplinary viewpoint of the pain, help to improve the attention and treatment of our patients. We have shown how consultant rehabilitation doctor can be useful in a Pain Unit and improves the health care and the range of therapeutic options provided to patients with chronic pain