Spanish expert consensus on the use of safinamide in Parkinson's disease.

Safinamide is a new add-on drug to levodopa for the treatment of Parkinson's disease (PD) with motor fluctuations. Due to the recent incorporation of safinamide into routine clinical practice, no post-authorisation phase IV studies on the safety of safinamide have been conducted to date. This study provides clinical management guidelines for safinamide based on the opinion of a group of experts in movement disorders. This project was developed in 2 phases: 16 local meetings in phase 1 and a national meeting in phase 2. The meetings followed a pre-established agenda. The present clinical practice guidelines are based on the main conclusions reached during the national meeting. The group concluded that safinamide is effective in reducing motor and non-motor fluctuations. PD patients with mild-to-moderate fluctuations benefit most from treatment, although the drug may also improve the clinical status of patients with advanced PD. The dose of other dopaminergic drugs may be reduced after introducing safinamide, which would contribute to reducing such adverse reactions as impulse control disorder. At doses higher than those usually prescribed, safinamide may also improve dyskinesia. The experts agreed that safinamide is well tolerated and causes few adverse reactions when compared with placebo.

Spanish expert consensus on the use of safinamide in Parkinson's disease. / Consenso de expertos españoles sobre el uso de la safinamida en la enfermedad de Parkinson.

Safinamide is a new add-on drug to levodopa for the treatment of Parkinson's disease (PD) with motor fluctuations. Due to the recent incorporation of safinamide into routine clinical practice, no post-authorisation phase IV studies on the safety of safinamide have been conducted to date. This study provides clinical management guidelines for safinamide based on the opinion of a group of experts in movement disorders. This project was developed in 2 phases: 16 local meetings in phase 1 and a national meeting in phase 2. The meetings followed a pre-established agenda. The present clinical practice guidelines are based on the main conclusions reached during the national meeting. The group concluded that safinamide is effective in reducing motor and non-motor fluctuations. PD patients with mild-to-moderate fluctuations benefit most from treatment, although the drug may also improve the clinical status of patients with advanced PD. The dose of other dopaminergic drugs may be reduced after introducing safinamide, which would contribute to reducing such adverse reactions as impulse control disorder. At doses higher than those usually prescribed, safinamide may also improve dyskinesia. The experts agreed that safinamide is well tolerated and causes few adverse reactions when compared with placebo.

Topiramato y glaucoma agudo / Topiramate and acute glaucoma

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[Atypical clinicoradiological course in a case panancephalic variant of Creutzfeldt-Jakob]. / Evolución clinicorradiológica atípica en un caso de variante panencefálica de la enfermedad de Creutzfeldt-Jakob.

INTRODUCTION: Creutzfeldt-Jakob disease (CJD) is the most frequent of the human transmissible spongiform encephalopathies. Pathogenic mechanisms of CJD are still unknown. Sporadic CJD, the most habitual, is clinically characterized by rapidly progressive dementia, myoclonia and ataxia. Panencephalic variant CJD, typically from Japan, is characterized by extensive involvement of the cerebral white and gray matter. International interest has grown from more than one decade ago in relation to the diagnosis of new variant (vCJD). New protocols of MR imaging have contributed to the early diagnosis of CJD with specific signs. CASE REPORT: We report a case of panencephalic CJD, with atypical clinical presentation and unusual MR imaging findings. DISCUSSION: Our patient developed visual and psychiatric symptoms. Brain MR imaging showed extensive white matter lesions in posterior parietal lobe and occipital regions, which disappeared after steroid treatment. The most characteristic radiological sign for sporadic CJD is the high signal intensity of the basal ganglia, for vCJD the pulvinar sign and, for panencephalic CJD the presence of periventricular white matter lesions, with tendency to the spread when the disease progress. In serial MR imaging studies of our patient, we could see how typical signs were appearing. However, the complete and unusual resolution of the original white matter lesions makes us to think about a possible inflammatory component, in some time in the evolution of white matter damage.

Evolución clinicorradiológica atípica en un caso de variante panencefálica de la enfermedad de Creutzfeldt-Jakob / Atypical clinicoradiological course in a case panancephalic variant of Creutzfeldt-Jakob

Introducción. La enfermedad de Creutzfeldt-Jakob (ECJ) es la encefalopatía espongiforme transmisible más frecuente; su fisiopatogenia aún no se conoce con exactitud. La forma esporádica es la más habitual caracterizada por la tríada: demencia rápidamente progresiva, mioclonías y ataxia. La ECJ tipo panencefálico, descrita excepcionalmente fuera de Japón, se caracteriza por la afectación difusa de la sustancia gris y blanca. El interés internacional por esta enfermedad surge hace más de una década con el descubrimiento de la nueva variante. Desde entonces los avances en resonancia magnética (RM) han contribuido al diagnóstico pre mortem de la enfermedad con la descripción de signos específicos. Caso clínico. Presentamos un caso de ECJ tipo panencefálico en nuestro medio con una evolución clinicorradiológica atípica. Discusión. Nuestra paciente comenzó con síntomas visuales y psiquiátricos. La RM cerebral mostró lesiones inespecíficas de sustancia blanca en regiones parietal posterior y occipital bilateral que se resolvieron tras tratamiento esteroideo. El hallazgo radiológico más característico en las formas esporádicas es la hiperintensidad bilateral y simétrica de los ganglios de la base, en la nueva variante del núcleo pulvinar y en la variante panencefálica, la presencia de lesiones de sustancia blanca de distribución periventricular con tendencia a la extensión local a medida que la enfermedad progresa. En los sucesivos estudios de RM de nuestra paciente pudimos ver cómo los signos característicos iban apareciendo; sin embargo, la resolución completa de las lesiones iniciales nos permite plantear la posible implicación de mecanismos inflamatorios en algún momento de la evolución de las lesiones de sustancia blanca (AU)

Introduction: Creutzfeldt-Jakob disease (CJD) is the most frequent of the human transmissible spongiform encephalopathies. Pathogenic mechanisms of CJD are still unknown. Sporadic CJD, the most habitual, is clinically characterized by rapidly progressive dementia, myoclonia and ataxia. Panencephalic variant CJD, typically from Japan, is characterized by extensive involvement of the cerebral white and gray matter. International interest has grown from more than one decade ago in relation to the diagnosis of new variant (vCJD). New protocols of MR imaging have contributed to the early diagnosis of CJD with specific signs. Case report: We report a case of panencephalic CJD, with atypical clinical presentation and unusual MR imaging findings. Discussion: Our patient developed visual and psychiatric symptoms. Brain MR imaging showed extensive white matter lesions in posterior parietal lobe and occipital regions, which disappeared after steroid treatment. The most characteristic radiological sign for sporadic CJD is the high signal intensity of the basal ganglia, for vCJD the pulvinar sign and, for panencephalic CJD the presence of periventricular white matter lesions, with tendency to the spread when the disease progress. In serial MR imaging studies of our patient, we could see how typical signs were appearing. However, the complete and unusual resolution of the original white matter lesions makes us to think about a possible inflammatory component, in some time in the evolution of white matter damage (AU)

[Subacute uveomeningoencephalitis as the presenting symptom of acute infection by the human immunodeficiency virus]. / Uveomeningoencefalitis subaguda como forma de presentación de la infección aguda por el virus de la inmunodeficiencia humana.

INTRODUCTION: The uveo-meningitic syndrome, or the combination of chronic or recurrent meningitis and acute uveitis, has a specific differential diagnosis. This syndrome can be the clinical debut of systemic disorders, vasculophathies, connective tissue disorders and inmuno-mediated diseases. In patients with AIDS, the syndrome often appears in relation with an opportunist concomitant infection of the central nervous system (CNS). CASE REPORT: We present one case of subacute uveo-meningitic syndrome as symptomatic presentation of a early infection of HIV. The patient was a man, 37 years-old. He was inmunocompetent and did not know his seropositivity for HIV type 1. We relate the results of the neurologic examination and complementary tests. Only serologic test for HIV type 1 and detection of IgG anti-HIV in cerebrospinal fluid were positives. CONCLUSIONS: In patients HIV-positive the ocular infection, usually a posterior uveitis, appears together with systemic disorders or central nervous infections. In other hand, the cause of meningitic infection depends on grade of immunocompromise. Aseptic meningitis, for early stages of the disease, is usually no symptomatic. After, opportunist infections or neoplasic infiltration of CNS can be cause of meningoencephalitis. In this patient, the early infection of HIV causes an subacute uveomeningoencephalitis. Early infection of HIV increases the possibilities of aetiological diagnosis of uveomeningitic syndrome.

Uveomeningoencefalitis subaguda como forma de presentación de la infección aguda por el virus de la inmunodeficiencia humana / Subacute uveomeningoencephalitis as the presenting symptom of acute infection by the human immunodeficiency virus

Introducción. El síndrome uveomeníngeo (SUM) resulta de la combinación de una uveítis anterior y una meningitis linfocitaria, aguda recurrente o crónica. Puede corresponder al debut de una enfermedad sistémica, una vasculopatía, una enfermedad del colágeno o de procesos inmunomediados. En los pacientes con sida, acompaña con frecuencia a infecciones oportunistas del sistema nervioso central (SNC). Caso clínico. Varón de 37 años, inmunocompetente, sin conductas de riesgo, que consultó por inflamación ocular derecha y un síndrome meníngeo. Durante su evolución sufrió un déficit neurológico focal transitorio. Todas las exploraciones practicadas fueron normales con excepción del estudio licuoral, que mostró hiperproteinorraquia y ligera linfocitosis. El estudio serológico frente al VIH tipo 1 fue positivo, y se confirmó además la producción intratecal de anticuerpos IgG frente al virus. Conclusiones. En los pacientes positivos para el VIH, la infección ocular que acompaña a enfermedades sistémicas o infecciones del SNC, habitualmente, es una uveítis posterior o coriorretinitis. Por otra parte, el perfil etiológico de la infección meníngea varía en función de la afectación inmunitaria del paciente seropositivo. En las fases precoces de la enfermedad la primoinfección por el VIH suele provocar una meningitis linfocitaria que cursa de manera asintomática. En fases más avanzadas, la meningoencefalitis del paciente con sida tiene habitualmente un origen infeccioso o infiltrativo. En nuestro paciente, la infección por el VIH tuvo un debut excepcional, el de una uveomeningoencefalitis subaguda. La infección aguda por el VIH amplía las posibilidades de diagnóstico etiológico frente al SUM (AU)

Introduction. The uveo-meningitic syndrome, or the combination of chronic or recurrent meningitis and acute uveitis, has a specific differential diagnosis. This syndrome can be the clinical debut of systemic disorders, vasculophathies, connective tissue disorders and inmuno-mediated diseases. In patients with AIDS, the syndrome often appears in relation with an opportunist concomitant infection of the central nervous system (CNS). Case report.We present one case of subacute uveomeningitic syndrome as symptomatic presentation of a early infection of HIV. The patient was a man, 37 years-old. He was inmunocompetent and did not know his seropositivity for HIV type1.We relate the results of the neurologic examination and complementary tests. Only serologic test for HIV type 1 and detection of IgG anti-HIV in cerebrospinal fluid were positives. Conclusions. In patients HIV-positive the ocular infection, usually a posterior uveitis, appears together with systemic disorders or central nervous infections. In other hand, the cause of meningitic infection depends on grade of immunocompromise. Aseptic meningitis, for early stages of the disease, is usually no symptomatic. After, opportunist infections or neoplasic infiltration of CNS can be cause of meningoencephalitis. In this patient, the early infection of HIV causes an subacute uveomeningoencephalitis. Early infection of HIV increases the possibilities of aetiological diagnosis of uveomeningitic syndrome (AU)

[Posttraumatic headache. Pathophysiology, clinical, diagnostic and therapeutic aspects]. / La cefalea postraumática. Fisiopatología, aspectos clínicos, diagnósticos y terapéuticos.

Posttraumatic headache (PTHA) is, usually, one of several symptoms of the posttraumatic syndrome and therefore may be accompanied by somatic, psychological or cognitive disturbances. The aetiology of these symptoms in individuals with mild traumatic brain injury or whiplash injury has been a subject of some controversy with explanations ranging from neural damage to malingering. PTHA can resemble a tension-type headache, migrainous or cervicogenic headaches. Post-whiplash headache habitually is a pain radiating from the neck to the forehead, with moderate intensity and benign, but prolonged course. The pathogenesis of PTHA is still not well-known but might share some common headache pathways with primary headaches. In this chapter, we review recent investigations in the pathophysiology of PTHA, review recognised risk factors for a poor outcome and give some recommendations of management. We also discuss the new diagnostic criteria of IHS Classification, 2004, for PTHA and Headache attributed to whiplash.

La cefalea postraumática. Fisiopatología, aspectos clínicos, diagnósticos y terapéuticos / Posttraumatic headache. Pathophysiology, clinical, diagnostic and therapeutic aspects

La cefalea postraumática (CPT) es el síntoma más prevalente de los que forman parte de un síndrome postraumático. La etiología de este complejo sintomático en individuos con un traumatismo craneal leve o latigazo cervical (whiplash) sigue siendo motivo de controversia. Mientras algunos autores defienden el origen orgánico del síndrome, otros justifican el mantenimiento de los síntomas en la interacción con factores psicosociales estresantes, e incluso en la intencionalidad del paciente en caso de existir un litigio legal pendiente. La CPT tiene una enorme variabilidad clínica, siendo la cefalea de tensión la variante más frecuente seguida de la migraña y la cefalea cervicogénica. Respecto a su fisiopatología, se contempla la posibilidad de que la CPT pueda compartir vías comunes de activación del dolor con cefaleas primarias y que en el caso particular de la migraña postraumática compartan mecanismos de sensibilización central y periférica. En este trabajo revisamos los conocimientos actuales en la fisiopatología de las CPT, los factores de riesgo para su cronificación y algunas recomendaciones terapéuticas basadas en ensayos prospectivos recientes. Analizamos también críticamente las modificaciones introducidas por la nueva clasificación de la International Headache Society (IHS, 2004) en los criterios diagnósticos para la CPT y la cefalea atribuida a whiplash

Posttraumatic headache (PTHA) is, usually, one of several symptoms of the posttraumatic syndrome and therefore may be accompanied by somatic, psychological or cognitive disturbances. The aetiology of these symptoms in individuals with mild traumatic brain injury or whiplash injury has been a subject of some controversy with explanations ranging from neural damage to malingering. PTHA can resemble a tension-type headache, migrainous or cervicogenic headaches. Post-whiplash headache habitually is a pain radiating from the neck to the forehead, with moderate intensity and benign, but prolonged course. The pathogenesis of PTHA is still not well-known but might share some common headache pathways with primary headaches. In this chapter, we review recent investigations in the pathophysiology of PTHA, review recognised risk factors for a poor outcome and give some recommendations of management. We also disenss the new the diagnostic criteria of IHS Classification, 2004, for PTHA and Headache attributed to whiplash

Hipotensión intracraneal espontánea: evolución de la imagen en resonancia magnética y confirmación mediante ventriculografía isotópica / Spontaneous intracranial hypotension: progression of the images obtained by magnetic resonance and confirmation by means of a gated blood pool scan

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Cefalea por abuso de triptanes / Triptans overuse headache

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