A Practical Overview on the Molecular Biology of Meningioma.

PURPOSE OF REVIEW: Meningioma is a common intracranial neoplasm currently classified in 15 histologic subtypes across 3 grades of malignancy. First-choice therapy for meningioma is maximum safe resection for grade I tumors, and surgery plus optional and mandatory adjuvant radiotherapy for grade II and III, respectively, given the increased rate of recurrence even in the event of complete resection. The WHO 2016 histopathologic grading of meningioma has been questioned due to subjectivity and its controversial predictive power for recurrence. RECENT FINDINGS: Novel DNA methylation profiling has simplified classification into six classes that seem to improve prognostic accuracy. We review five main topics of molecular biology research regarding tumorigenesis and natural history of meningioma from the clinician's perspective: the histopathologic diagnostic features and pitfalls of the current tumor classification; the molecular integrated diagnosis supported by identification of genetic alterations and DNA methylation profiling; the general landscape of the various signaling pathways involved in meningioma formation; the pathogenic theories of the peri-tumoral edema present in meningioma and its therapy implications; and a summarized review on the current treatments and plausible targeted therapies directed to meningioma. It seems likely that molecular assessment will be introduced within the next update of the WHO classification of meningiomas, acknowledging the promising value of DNA methylation profiling. This integrated diagnostic protocol will simplify tumor subtype categorization and provide improved accuracy in predicting recurrence and outcome. Although much effort is being done in identifying key gene mutations, and elucidating specific intracellular signaling pathways involved in meningioma tumorigenesis, effective targeted therapies for recurrent meningiomas are still lacking.

Suicide in primary headaches in 48 countries: A physician-survey based study.

Aim To investigate the relationship between primary headache types and accomplished or attempted suicide in countries from all world regions. Methods Data were obtained using a questionnaire about suicide due to headache in a face-to-face interview with 203 physicians with expertise in headaches. They came from 48 countries, and from all continents. Results Primary headaches cause one suicide per 1,000,000 population each year (1% of the suicide rate due to all causes). Cluster headache and migraines account for 70-80% of them. Suicide attempts are 10 times more frequent than accomplished suicides. Cluster headache poses more risk than migraine. This risk is not often acknowledged, and is increased if there is previous psychiatric history. More than half of the physicians interviewed think it could be reduced with a more aggressive treatment of headaches. Conclusions Cluster headache and migraine are not always benign, and are the cause of the majority of suicides due to headache.

Los tics y su relación con las dificultades de aprendizaje: estudio longitudinal de la prevalencia de los tics primarios y comorbilidad asociada en población escolar / Tics and its relationship with academic difficulties: Prevalence of tics and comorbid behavioral disorders in schoolchildren

Con el objetivo de estudiar la prevalencia de los trastornos con tics y la asociación con las dificultades de aprendizaje, se realizó un estudio epidemiológico en una muestra de 1.139 escolares. Los resultados señalaron una prevalencia del 16.86% (IC 95% del 14.10 - 19.63). Además se encontraron dificultades académicas en el 11.9% de los escolares, y la presencia de tics en el 8.6%. La presencia de trastornos de tics no se asoció con el bajo rendimiento académico en la cohorte. Los resultados obtenidos fueron contradictorios con relación a otros estudios publicados anteriormente. Como consecuencia de la divergencia en los resultados, se diseña un segundo estudio, que toma como punto de partida el seguimiento longitudinal de la cohorte de los escolares estudiados. En el análisis de regresión de Cox, durante el periodo de seguimiento de 4 años, la repetición de curso se asoció con una menor frecuencia de apoyo psicológico en el centro escolar (HR = 17.5; IC del 95% 5.7 a 53.9) y menor practica de deporte (HR = 4.02, 95% CI 01/03 a 11/08). No se encontró una asociación entre los tics y mayor riesgo de repetir curso.

In order to study the prevalence of tic disorders and their association with learning difficulties, we conducted an epidemiological study based on a sample of 1,139 schoolchildren. The results showed a prevalence of 16.86% (95% CI 14.10 to 19.63). Besides we found academic difficulties at 11.9% of schoolchildren, and the presence of tics at 8.6%. The presence of tic disorders was not associated with a poor school performance in the cohort. The results were contradictory in relation to other previously published studies. As a consequence of the divergence in the results, we designed a second study, which takes as its starting point the longitudinal follow-up of the cohort studied. In the Cox regression analysis, during the follow-up period of 4 years, the repetition of an academic year was associated with a lower frequency of psychological support at school (HR = 17.5; 95% CI 5.7 to 53 9) and a lower sports practice (HR = 4.02, 95% CI 01/03 to 11/08). We don't found an association between tics and a higher frequency of repeat an academic year.

Energy Balance in Huntington's Disease.

INTRODUCTION: Little is known about the energy needs in Huntington's disease (HD). The aims of this study are to analyze and compare the total energy expenditure (TEE) and energy balance (EB) in a representative sample of HD patients with healthy controls. METHODS: This is an observational, case-control single-center study. Food caloric energy intake (EI) and TEE were considered for estimating EB. A dietary recall questionnaire was used to assess the EI. TEE was computed as the sum of resting energy expenditure (REE), measured by indirect calorimetry and physical activity (PA) monitored by an actigraph. RESULTS: A total of 22 patients were included (36% men, mean age 50.3 ± 15.6 years, motor Unified Huntington's Disease Scale 27.9 ± 23.7, total functional capacity 11.0 (7.0-13.0), EI 38.6 ± 10.0 kcal/kg, PA 5.3 (3.0-7.4) kcal/kg, REE 30.9 ± 6.4 kcal/kg, TEE 2,023.4 (1,592.0-2,226.5) kcal/day) and 18 controls (50% men, mean age 47.4 ± 13.8 years, EI 38.6 ± 10.3 kcal/kg, PA 8.4 (5.0-13.8) kcal/kg, REE 30.8 ± 6.6 kcal/kg, TEE 2,281.0 (2,057.3-2,855.3) kcal/day). TEE was significantly lower in patients compared to controls (p = 0.03). PA was lower in patients compared to controls (p = 0.02). CONCLUSIONS: Although patients with HD appeared to have lower energy expenditure, mainly due to decreased voluntary PA, they were still able to maintain their energy needs with an adequate food intake. © 2015 S. Karger AG, Basel.

[Impact of rural or urban areas on disability after a stroke]. / Estudio del impacto del medio rural o urbano sobre la discapacidad residual tras un ictus.

OBJECTIVES: To assess the residual disability in a sample of patients after suffering a first episode of a stroke and to compare the disability of those patients who live in rural areas with those living in urban areas. METHODOLOGY: An observational, longitudinal study of a cohort of 89 patients from a Neurology Unit, affected by cerebrovascular accident. The following factors were assessed: sociodemographic and environmental factors, co-morbidity, functional status, disability, depression and anxiety, and quality of life. The different clinical and demographic variables were compared after admission to the unit, at hospital discharge, and 3 months afterwards. Regression analyses were also carried out in order to study the association between the clinical and sociodemographic factors, and post-stroke disability. RESULTS: Compared to their previous clinical state, after suffering a stroke patients showed a higher rate of co-morbidity (P<.0001), disability (P<.0001), depression (P=.002), and a poorer quality of life (P=.013). The difference between patients coming from rural and urban areas was not statistically significant in terms of disability, quality of life, anxiety, depression, or co-morbidity. CONCLUSIONS: The level of disability, depression and co-morbidity that patients showed after suffering a stroke was similar to the results obtained in other studies. As a novel feature, there were no differences between patients living in rural areas after suffering a stroke and those living in urban areas, as regards disability, depression, or co-morbidity.

Estudio del impacto del medio rural o urbano sobre la discapacidad residual tras un ictus / Impact of rural or urban areas on disability after a stroke

Objetivos: Evaluar la discapacidad residual en una muestra de pacientes tras un primer episodio de ictus y comparar dicha discapacidad entre los pacientes que viven en un medio rural y en un medio urbano. Metodología Estudio observacional, longitudinal, de una cohorte de 89 pacientes afectados por enfermedad cerebrovascular ingresados en el Servicio de Neurología. Se evaluaron factores sociodemográficos y medioambientales, comorbilidad, estado funcional, discapacidad, depresión y ansiedad y calidad de vida. Se realizaron comparaciones de las diferentes variables clínicas y sociodemográficas al ingreso, al alta del centro hospitalario y a los 3 meses, así como un análisis de regresión para estudiar la asociación entre factores clínicos y sociodemográficos con discapacidad postictus. Resultados Comparados con su situación clínica previa, los pacientes tras sufrir un ictus presentaron mayor frecuencia de comorbilidad (p < 0,0001), discapacidad (p < 0,0001), depresión (p = 0,002) y menor calidad de vida (p = 0,013). No hubo diferencias estadísticamente significativas cuando se compararon los pacientes procedentes de un área rural con los de un área urbana en términos de discapacidad, calidad de vida, ansiedad, depresión y comorbilidad. Conclusiones Los grados de discapacidad, depresión y comorbilidad que presentaron los pacientes tras un episodio de ictus fueron similares a los obtenidos en otros estudios. Como aspecto novedoso, no existieron diferencias en cuanto a discapacidad, depresión y comorbilidad al comparar los pacientes del medio rural y urbano tras sufrir un ictus (AU)

OBJECTIVES: To assess the residual disability in a sample of patients after suffering a first episode of a stroke and to compare the disability of those patients who live in rural areas with those living in urban areas. METHODOLOGY: An observational, longitudinal study of a cohort of 89 patients from a Neurology Unit, affected by cerebrovascular accident. The following factors were assessed: sociodemographic and environmental factors, co-morbidity, functional status, disability, depression and anxiety, and quality of life. The different clinical and demographic variables were compared after admission to the unit, at hospital discharge, and 3 months afterwards. Regression analyses were also carried out in order to study the association between the clinical and sociodemographic factors, and post-stroke disability. RESULTS: Compared to their previous clinical state, after suffering a stroke patients showed a higher rate of co-morbidity (P<.0001), disability (P<.0001), depression (P=.002), and a poorer quality of life (P=.013). The difference between patients coming from rural and urban areas was not statistically significant in terms of disability, quality of life, anxiety, depression, or co-morbidity. CONCLUSIONS: The level of disability, depression and co-morbidity that patients showed after suffering a stroke was similar to the results obtained in other studies. As a novel feature, there were no differences between patients living in rural areas after suffering a stroke and those living in urban areas, as regards disability, depression, or co-morbidity (AU)

Trastornos digestivos en la enfermedad de Parkinson: disfagia y sialorrea / Digestive disorders in Parkinson’s disease: dysphagia and sialorrhea

Introducción. Los síntomas no motores de la enfermedad de Parkinson representan un trastorno frecuente y a menudo infradiagnosticado. Entre los diferentes síntomas no motores cabe destacar la disfagia y la sialorrea, relativamente habituales en estadios avanzados de la enfermedad por su importante repercusión funcional y por la comorbilidad asociada. Desarrollo y conclusiones. Durante los últimos años se han desarrollado diferentes escalas de valoración para su uso clínico y el cribado de dicha sintomatología. Dentro de las diferentes opciones terapéuticas, la toxina botulínica representa el tratamiento de elección para la sialorrea. En cambio, la logopedia, junto con una optimización del tratamiento antiparkinsoniano, suelen ser medidas útiles para la disfagia, reservándose la gastrostomía endoscópica percutánea para aquellos pacientes parkinsonianos con disfagia grave

Introducción. The non-motor symptoms of Parkinson ’s disease are a frequent and often under-diagnosed disorder. Two of the most significant non-motor symptoms are perhaps dysphagia and sialorrhea (which are relatively common in advanced stages of the disease) owing to their important functional repercussions and to the associated comorbidity. Development and conclusions. In recent years, different evaluation scales have been developed for clinical use and in screening the aforementioned symptoms. Of the different therapeutic options available, botulinum toxin represents the preferred treatment for sialorrhea. In contrast, speech therapy and an optimisation of the antiparkinsonian therapy are generally useful measures to treat dysphagia, percutaneous endoscopic gastrostomy being reserved for patients suffering from Parkinson who have severe dysphagia (AU)