Depression is Associated with Impulse-compulsive Behaviors in Parkinson's disease.

BACKGROUND: Depression and impulse control disorders (ICDs) are both common in Parkinson's disease (PD) patients and their coexistence is frequent. Our aim was to determine the relationship between depression and impulsive-compulsive behaviors (ICBs) in a large cohort of PD patients. METHODS: PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were included in the study. The QUIP-RS (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale) was used for screening ICDs (cutoff points: gambling ≥6, buying ≥8, sex≥8, eating≥7) and compulsive behaviors (CBs) (cutoff points: hobbyism-punding ≥7). Mood was assessed with the BDI-II (Beck Depression Inventory - II) and major, minor, and subthreshold depression were defined. RESULTS: Depression was more frequent in PD patients with ICBs than in those without: 66.3% (69/104) vs 47.5% (242/509); p<0.0001. Major depression was more frequent in this group as well: 22.1% [23/104] vs 14.5% [74/509]; p=0.041. Considering types of ICBs individually, depression was more frequent in patients with pathological gambling (88.9% [8/9] vs 50.2% [303/603]; p=0.021), compulsive eating behavior (65.9% [27/41] vs 49.7% [284/572]; p=0.032), and hobbyism-punding (69% [29/42] vs 49.4% [282/571]; p=0.010) than in those without, respectively. The presence of ICBs was also associated with depression (OR=1.831; 95%CI 1.048-3.201; p=0.034) after adjusting for age, sex, civil status, disease duration, equivalent daily levodopa dose, antidepressant treatment, Hoehn&Yahr stage, non-motor symptoms burden, autonomy for activities of daily living, and global perception of QoL. LIMITATIONS: Cross-sectional design. CONCLUSIONS: Depression is associated with ICBs in PD. Specifically, with pathological gambling, compulsive eating behavior, and hobbyism-punding.

Quality of life and non-motor symptoms in Parkinson's disease patients with subthreshold depression.

BACKGROUND: The role of subthreshold depression (subD) in Parkinson's Disease (PD) is not clear. The present study aimed to compare the quality of life (QoL) in PD patients with subD vs patients with no depressive disorder (nonD). Factors related to subD were identified. MATERIAL AND METHODS: PD patients and controls recruited from the COPPADIS cohort were included. SubD was defined as Judd criteria. The 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8) were used to assess QoL. RESULTS: The frequency of depressive symptoms was higher in PD patients (n = 694) than in controls (n = 207) (p < 0.0001): major depression, 16.1% vs 7.8%; minor depression, 16.7% vs 7.3%; subD, 17.4% vs 5.8%. Both health-related QoL (PDQ-39; 18.1 ±â€¯12.8 vs 11.6 ±â€¯10; p < 0.0001) and global QoL (EUROHIS-QOL8; 3.7 ±â€¯0.5 vs 4 ±â€¯0.5; p < 0.0001) were significantly worse in subD (n = 120) than nonD (n = 348) PD patients. Non-motor Symptoms Scale (NMSS) total score was higher in subD patients (45.9 ±â€¯32 vs 29.1 ±â€¯25.8;p < 0.0001). Non-motor symptoms burden (NMSS;OR = 1.019;95%CI 1.011-1.028; p < 0.0001), neuropsychiatric symptoms (NPI; OR = 1.091; 95%CI 1.045-1.139; p < 0.0001), impulse control behaviors (QUIP-RS; OR = 1.035; 95%CI 1.007-1063; p = 0.013), quality of sleep (PDSS; OR = 0.991; 95%CI 0.983-0.999; p = 0.042), and fatigue (VAFS-physical; OR = 1.185; 95%CI 1.086-1.293; p < 0.0001; VAFS-mental; OR = 1.164; 95%CI 1.058-1.280; p = 0.0001) were related to subD after adjustment to age, disease duration, daily equivalent levodopa dose, motor status (UPDRS-III), and living alone. CONCLUSIONS: SubD is a frequent problem in patients with PD and is more prevalent in these patients than in controls. QoL is worse and non-motor symptoms burden is greater in subD PD patients.

Hipersexualidad en relación con safinamida / Hypersexuality associated with safinamide

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[Epilepsy and breastfeeding: from myth to reality]. / Epilepsia y lactancia materna: del mito a la realidad.

INTRODUCTION: In clinical practice, it is common to find cases of epileptic women being treated with antiepileptic drugs (AEDs) whom we have to advise on the compatibility of these AEDs with breastfeeding. AIMS: In order to offer correct guidance, we must be well informed about the pharmacokinetic characteristics of the different AEDs, in addition to being aware of the clinical experience in this regard. This review stems from the paucity of information on this topic. DEVELOPMENT: The World Health Organisation recommends that breastfeeding should be the norm for all women, even in epileptic mothers that are taking AEDs, who must always be given special attention in order to watch for the appearance of adverse effects in the infant, and always avoiding sudden weaning in order to avoid withdrawal symptoms. CONCLUSIONS: Very few AEDs are incompatible with breastfeeding. The decision to breastfeed should take into account not only the AED, but also its number, dose, serum levels, transmission and elimination rates in the infant, and the conditions of the newborn infant. Ethosuximide and felbamate are probably high risk and incompatible with breastfeeding. Lamotrigine, phenobarbital, pregabalin, primidone, tiagabine, eslicarbazepine, brivaracetam, perampanel, zonisamide, lacosamide or the sporadic use of benzodiazepines in low doses are considered quite safe, with a low risk for breastfeeding. The other AEDs present a very low risk for breastfeeding.

TITLE: Epilepsia y lactancia materna: del mito a la realidad.Introduccion. En la practica clinica es habitual encontrar el caso de una mujer epileptica en tratamiento con farmacos antiepilepticos (FAE) a la que deberemos asesorar sobre la compatibilidad de esos FAE con la lactancia materna. Objetivo. Para realizar un asesoramiento correcto deberemos estar bien informados sobre las caracteristicas farmacocineticas de los diferentes FAE, asi como estar al tanto de la experiencia clinica al respecto. La intencion de esta revision nace de la escasez de informacion a este respecto. Desarrollo. La Organizacion Mundial de la Salud recomienda que la lactancia materna debe ser la norma en todas las mujeres, incluso en las madres epilepticas que toman FAE, a las cuales debe prestarse siempre especial atencion para vigilar la aparicion de efectos adversos en el lactante, eludiendo siempre el destete brusco para evitar el sindrome de abstinencia. Conclusiones. Son muy pocos los FAE incompatibles con la lactancia materna. La decision de amamantar debe tener en cuenta no solo el FAE, sino su numero, la dosis, los niveles sericos, los porcentajes de transmision y eliminacion en el lactante, y las condiciones del neonato. La etosuximida y el felbamato presentan un riesgo probablemente alto y son incompatibles con la lactancia materna. La lamotrigina, el fenobarbital, la pregabalina, la primidona, la tiagabina, la eslicarbacepina, el brivaracetam, el perampanel, la zonisamida, la lacosamida o el uso puntual y en bajas dosis de benzodiacepinas se consideran bastante seguros, con riesgo bajo para la lactancia. El resto de FAE presenta muy bajo riesgo para la lactancia materna.

Neurological presentations of Bartonella henselae infection.

OBJECTIVE: Neurological symptoms in patients with cat-scratch disease (CSD) have been rarely reported. The aim of this study is to analyze the frequency of neurological CSD (NCSD) and describe the disease clinical presentation, management and outcome. MATERIAL AND METHODS: We retrospectively selected patients with a CSD syndrome and Bartonella IgG titers > 1:256. Data regarding epidemiological, clinical, management, and follow-up features were analyzed and discussed. A comparison between NCSD and non-neurological CSD (NNCSD) was established. RESULTS: Thirty-nine CSD patients were selected. NCSD frequency was 10.25%. No children were found affected in the NCSD group. A 65.7% of NNCSD and the entirety of the NCSD group had a history of cat exposure. Immunosuppression was only present in the NNCSD group (8.6%). NCSD presentations were as follows: isolated aseptic meningitis (25%), neuroretinitis (50%), and isolated optic neuritis (25%). A greater proportion of patients in the NCSD group had fever and raised levels of acute phase reactants and white blood cells. 85.7% of NNCSD had a complete recovery, whereas only 50% of the NCSD patients experienced a full recovery. CONCLUSION: NCSD may be a distinctive group compared to NNCSD due to its later age of presentation, the more intense systemic response, and the poorer outcome.

[Myasthenia gravis and treatment with intravenous immunoglobulins. Reply]. / Miastenia grave y tratamiento con inmunoglobulinas por via intravenosa. Replica.

Miastenia grave y tratamiento con inmunoglobulinas por via intravenosa. Replica.

[Cognitive and neuropsychiatric disorders in Parkinson's disease]. / Trastornos cognitivos y neuropsiquiátricos en la enfermedad de Parkinson.

INTRODUCTION: In Parkinson's disease there are patients with isolated and multiple cognitive impairment, and their cognitive performance ranges from normal to an advanced degree of dementia. Most patients present an executive deficit, either in isolation or combined with other cognitive disorders, which is considered to be the most characteristic aspect of the disease, and 30-40% of those affected will end up with a clinically-defined dementia. DEVELOPMENT: The presence of a mild cognitive disorder in patients with Parkinson means that the risk of dementia appearing at some time during the development of the disease is high. The dementia associated with Parkinson's disease is specifically related with neuropsychiatric signs and symptoms, which may have three possible explanations: disorders affecting the mesolimbic pathways, diffuse limbic and cortical compromise, or associated Alzheimer-type phenomenology. Psychotic episodes tend to present more often in patients with dopaminergic treatment and the clinical spectrum of Parkinson-related psychosis covers visual illusions, visual-audio-olfactory hallucinations, delirium and severe paranoid hallucinatory psychosis. All the antiparkinsonian drugs can give rise to hallucinations and psychosis, but the dopamine agonists are the ones with the greatest capacity to do so. CONCLUSIONS: In managing these problems, it is crucial for prevention as well as diagnosis and treatment to be carried out as soon as they are detected. Doses of antiparkinsonian drugs must be reduced, although this is not usually enough, and so it will be necessary to associate atypical antipsychotics, which act mainly on 5-HT receptors and, in most cases, do not produce D2 blockage.

PANDAS, variante del adulto / PANDAS, variant of the adult

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Síndrome 18q asociado a blefarospasmo / 18q syndrome associated with blepharospasm

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[The usefulness of timed motor tests in assessing Parkinson's disease]. / Utilidad de los test motores cronometrados en la evaluación de la enfermedad de Parkinson.

INTRODUCTION: At present, the evaluation of Parkinson's disease (PD) relies on clinical scales, mainly Unified Parkinson's Disease Rating Scale (UPDRS); however, other objective methods have been considered including timed tests. PATIENTS AND METHODS: We studied the motor performance of 53 patients with PD (34 male, 19 female; age 61.9 +/- 8.9 years; age at onset 51.9 +/- 11 years, clinical stage: 2.6 +/- 0.73). Motor evaluation comprised UPDRS and CAPIT timed tests including pronation-supination, finger dexterity, movement between two points or tapping, and walking test. Clinical evaluation was performed in baseline conditions (twelve hours off their medication) and in their best on state, after a standard dose of 200 mg of levodopa. RESULTS AND CONCLUSIONS: All CAPIT timed tests, especially tapping, maintained an excellent correlation with UPDRS in both off and on state. Tapping seems to be the best CAPIT timed test for objective motor evaluation of PD.

Utilidad de los test motores cronometrados en la evaluación de la enfermedad de Parkinson / The usefulness of time motor test in assessing parkingon´s disease

Introducción. En el momento actual, la evaluación de la enfermedad de Parkinson (EP) se basa en escalas clínicas, especialmente la Unified Parkinson’s Disease Rating Scale (UPDRS); sin embargo se han sugerido otros métodos de valoración que incluyen los test cronometrados. Pacientes y métodos. Hemos valorado la actividad motora de 53 pacientes con EP (34 hombres y 19 mujeres; edad media: 61,9 ± 8,9 años; edad inicial: 51,9 ± 11 años; estadio clínico: 2,6 ± 0,73). La evaluación consistió en la aplicación de la UPDRS, además de los test cronometrados del protocolo CAPIT, incluidos la pronosupinación, la habilidad digital, el movimiento entre dos puntos o tapping y el test de la marcha. La evaluación se desarrolló en cada caso en condiciones basales, a primera hora de la mañana, tras 12 horas sin medicación y, posteriormente, en situación on confirmada, tras una dosis estándar de 200 mg de levodopa. Resultados y conclusiones. Todos los test cronometrados CAPIT, especialmente el tapping mantuvieron una correlación significativa con la escala UPDRS, tanto en off como en on. El tapping, por su sencillez, parece ser el mejor test cronometrado CAPIT para la valoración objetiva de la EP (AU)

Introduction. At present, the evaluation of Parkinson’s disease (PD) relies on clinical scales, mainly Unified Parkinson’s Disease Rating Scale (UPDRS); however, other objective methods have been considered including timed tests. Patients and methods. We studied the motor performance of 53 patients with PD (34 male, 19 female; age 61.9 ± 8.9 years; age at onset 51.9 ± 11 years, clinical stage: 2.6 ± 0.73). Motor evaluation comprised UPDRS and CAPIT timed tests including pronation-supination, finger dexterity, movement between two points or tapping, and walking test. Clinical evaluation was performed in baseline conditions (twelve hours off their medication) and in their best on state, after a standard dose of 200 mg of levodopa. Results and conclusions. All CAPIT timed tests, especially tapping, maintained an excellent correlation with UPDRS in both off and on state. Tapping seems to be the best CAPIT timed test for objective motor evaluation of PD (AU)

[Stiff-person syndrome: a case report]. / Síndrome de la persona rígida: a propósito de un caso.

INTRODUCTION: Stiff-person (stiff-man) syndrome is characterised by symptoms of muscular rigidity and spasms, which are generally of an axial nature. Involuntary contractions of the agonist and antagonist muscles caused by activity of the motor units during rest are the main clinical and electrophysiological marker of the disease. The nature of the syndrome is considered to be autoimmune, with positive glutamic acid decarboxylase (anti-GAD) antibodies in most patients. These antibodies exert an influence over GABAergic transmission. CASE REPORT: A 29-year-old female who was admitted to hospital with a diagnosis of psychogenic mutism. While in hospital the patient developed a clinical picture consisting in generalised stiffness that was predominantly axial and proximal with hyperreflexia in the four limbs and strong contraction of the muscles of the abdomen. The most striking lab finding was the presence of anti-GAD, anti-parietal cells, anti-microsomal/TPO and antithyroglobulin antibodies, together with oligoclonal immunoglobulin G bands in the cerebrospinal fluid. Treatment was established with benzodiazepines, antispastic agents and corticosteroids, and the clinical symptoms progressively improved until they had partially remitted at two months. The lab findings and clinical features are compatible with stiff-person syndrome in a patient with associated psychiatric comorbidity. CONCLUSIONS: Anti-GAD antibodies are not exclusive to stiff-person syndrome and can also be found in a number of other autoimmune disorders. Other mechanisms which can also produce a dysfunction of the GABAergic system have also been suggested. The syndrome can be difficult to diagnose from the clinical point of view and it must therefore be borne in mind in patients who begin with unexplainable stiffness and spasms because it is a potentially treatable pathology.

Síndrome de la persona rígida: a propósito de un caso / Stiff-person syndrome: A case report

Introducción. El síndrome de la persona rígida (stiff-man) se caracteriza por un cuadro de rigidez muscular y espasmos, generalmente de carácter axial. Las contracciones involuntarias de los músculos agonistas y antagonistas causadas por la actividad de las unidades motoras durante el reposo son el principal marcador clínico y electrofisiológico de la enfermedad. La naturaleza del síndrome se considera autoinmune, con anticuerpos antidecarboxilasa glutámica ácida (anti-GAD)positivos en la mayoría de los pacientes. Estos anticuerpos influyen en la transmisión gabérgica. Caso clínico. Mujer de 29 años que ingresó con el diagnóstico de mutismo psicógeno. Durante su ingreso desarrolló un cuadro que consistía en una rigidez generalizada de predominio axial y proximal con hiperreflexia en las cuatro extremidades y una importante contracción de la musculatura abdominal. En los estudios analíticos destacó la presencia de anticuerpos anti-GAD, anticélulas parietales, antimicrosomales TPO y antitiroglobulina, junto con la presencia de bandas oligoclonales de inmunoglobulina G en el líquido cefalorraquídeo. Se instauró un tratamiento con benzodiacepinas, antiespásticos y corticosteroides, con una mejoría progresiva del cuadro, hasta remitir parcialmente a los dos meses. Los hallazgos de laboratorio y el cuadro clínico son compatibles con un síndrome de la persona rígida en una paciente con comorbilidad psiquiátrica asociada. Conclusiones. Los anticuerpos anti-GAD no son exclusivos del síndrome de la persona rígida y también se pueden encontrar en numerosos trastornos autoinmunes. También se han postulado otros mecanismos por los cuales se produce una disfunción del sistema gabérgico.El síndrome puede ser de difícil diagnóstico desde el punto de vista clínico, por lo que debemos tenerlo presente en pacientes que comiencen con rigidez y espasmos inexplicables, dado que se trata de una patología potencialmente tratable

Introduction. Stiff-person (stiff-man) syndrome is characterised by symptoms of muscular rigidity and spasms, which are generally of an axial nature. Involuntary contractions of the agonist and antagonist muscles caused by activity of the motor units during rest are the main clinical and electrophysiological marker of the disease. The nature of the syndrome isconsidered to be autoimmune, with positive glutamic acid decarboxylase (anti-GAD) antibodies in most patients. These antibodies exert an influence over GABAergic transmission. Case report. A 29-year-old female who was admitted to hospital with a diagnosis of psychogenic mutism. While in hospital the patient developed a clinical picture consisting in generalised stiffness that was predominantly axial and proximal with hyperreflexia in the four limbs and strong contraction of the musclesof the abdomen. The most striking lab finding was the presence of anti-GAD, anti-parietal cells, anti-microsomal/TPO and antithyroglobulin antibodies, together with oligoclonal immunoglobulin G bands in the cerebrospinal fluid. Treatment was established with benzodiazepines, antispastic agents and corticosteroids, and the clinical symptoms progressively improveduntil they had partially remitted at two months. The lab findings and clinical features are compatible with stiff-person syndrome in a patient with associated psychiatric comorbidity. Conclusions. Anti-GAD antibodies are not exclusive to stiffperson syndrome and can also be found in a number of other autoimmune disorders. Other mechanisms which can also produce a dysfunction of the GABAergic system have also been suggested. The syndrome can be difficult to diagnose from the clinical point of view and it must therefore be borne in mind in patients who begin with unexplainable stiffness and spasms because it is a potentially treatable pathology

Monitorización motora ambulatoria (actigrafía) / Outpatient motor monitoring (actigraphy)

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