Abnormal functional connectivity in radiologically isolated syndrome: A resting-state fMRI study.

BACKGROUND: Radiologically isolated syndrome (RIS) patients might have psychiatric and cognitive deficits, which suggests an involvement of major resting-state functional networks. Notwithstanding, very little is known about the neural networks involved in RIS. OBJECTIVE: To examine functional connectivity differences between RIS and healthy controls using resting-state functional magnetic resonance imaging (fMRI). METHODS: Resting-state fMRI data in 25 RIS patients and 28 healthy controls were analyzed using an independent component analysis; in addition, seed-based correlation analysis was used to obtain more information about specific differences in the functional connectivity of resting-state networks. Participants also underwent neuropsychological testing. RESULTS: RIS patients did not differ from the healthy controls regarding age, sex, and years of education. However, in memory (verbal and visuospatial) and executive functions, RIS patients' cognitive performance was significantly worse than the healthy controls. In addition, fluid intelligence was also affected. Twelve out of 25 (48%) RIS patients failed at least one cognitive test, and six (24.0%) had cognitive impairment. Compared to healthy controls, RIS patients showed higher functional connectivity between the default mode network and the right middle and superior frontal gyri and between the central executive network and the right thalamus (pFDR < 0.05; corrected). In addition, the seed-based correlation analysis revealed that RIS patients presented higher functional connectivity between the posterior cingulate cortex, an important hub in neural networks, and the right precuneus. CONCLUSION: RIS patients had abnormal brain connectivity in major resting-state neural networks and worse performance in neurocognitive tests. This entity should be considered not an "incidental finding" but an exclusively non-motor (neurocognitive) variant of multiple sclerosis.

Eye-of-the-Tiger Sign with an Unexpected Pathological Diagnosis.

BACKGROUND: Clinical diagnosis of atypical parkinsonisms may be challenging. The eye-of-the-tiger sign on brain MRI, typical of neurodegeneration with brain iron accumulation, has been anecdotally observed in cases clinically diagnosed as atypical parkinsonisms. OBJECTIVES: To show how clinical syndromes and even neuroimaging sometimes may lead the neurologist to a misunderstanding, just as to emphasize the important role of pathology to establish the final diagnosis in these cases. METHODS: Clinico-pathological case. RESULTS: A 67-year-old-woman presented with progressive painful stiffness and allodynia in her left arm. On examination, she presented parkinsonism without tremor with greater involvement of left limbs. She developed dystonia, with myoclonic tremor and hypoesthesia involving her left arm, as well as an impairment of balance with falls, a significant axial involvement with disabling rigidity, supranuclear gaze abnormalities, facial dystonia, dysphonia, severe dysphagia, and anarthria. There was no response to levodopa. Syndromic diagnosis and findings on neuroimaging are discussed. Afterwards, the underlying pathology is revealed. CONCLUSIONS: We present the first case of neuropathologically confirmed multiple system atrophy with the eye-of-the-tiger sign on brain MRI. The presence of supranuclear vertical gaze palsy further complicated a correct clinical diagnosis. A pathological postmortem study remains essential to establish a definite diagnosis in atypical parkinsonisms.

SURINPARK: Safinamide for Urinary Symptoms in Parkinson's Disease.

BACKGROUND: Urinary symptoms are common, disabling and generally unresponsive to treatment in Parkinson´s disease (PD). Safinamide is approved as an add-on therapy to levodopa to improve fluctuations. METHODS: Retrospective analysis of electronic records of nondemented PD patients seen consecutively in a Movement Disorders Unit (November 2018-February 2019). All were assessed with Scale for Outcomes in Parkinson's disease for Autonomic Symptoms-Urinary subscale (SCOPA-AUT-U) by the attending neurologist, and a month afterwards by an independent researcher blinded to treatment and clinical records in a routine clinical practice setting. Clinical variables were compared among patients who were prescribed safinamide (SA+) for the treatment of motor fluctuations and those with different treatment regimes (SA-). RESULTS: From 169 patients screened initially, 54 were excluded due to severe incontinence, absence of urinary symptoms or previous safinamide treatment. Thirty-five patients were included in SA+ and 79 in SA-. Both groups were comparable in terms of clinical variables, except in basal urinary symptoms, with more severity in the SA+ group. In the follow-up assessment, total SCOPA-AUT-U, as well as urgency, incontinence, frequency and nocturia subscales improved significantly in the SA+ group, while the SA- group remained unchanged. CONCLUSIONS: Safinamide could be helpful in the improvement of urinary symptoms in PD.

Use of the Cardiovascular Polypill in Secondary Prevention of Cerebrovascular Disease: A Real-Life Tertiary Hospital Cohort Study of 104 Patients.

BACKGROUND: The use of the cardiovascular polypill, a fixed-dose combination treatment, is conceived to improve adherence. However, randomized controlled trials (RCTs) may overestimate it. Studies focusing on cerebrovascular disease and real-life efficacy compared with conventional treatment are lacking. METHODS: This is a retrospective, hospital-based cohort study of acute ischaemic stroke patients who were prescribed a polypill (aspirin 100 mg, atorvastatin 20/40 mg, ramipril 2.5/5/10 mg) versus conventional treatment (aspirin 100 mg and other blood pressure/lipid-lowering agents) in secondary prevention (2017-2018). Clinical records were reviewed 90 days after discharge for stroke recurrence, vascular risk factor control, and safety. Adherence was assessed using the adapted Morisky-Green scale. RESULTS: A total of 104 patients were included (61% male; mean age 69.7 ± 13.9 years); 54 were treated with the polypill and 50 with conventional treatment. No baseline differences in clinical or demographic variables were detected. No recurrences were registered in the polypill group, compared to 1 recurrence in the conventional treatment group. A significant reduction of systolic blood pressure (SBP) was achieved in the polypill group (12.1 mm Hg) compared to the conventional treatment group (6.8 mm Hg) (p = 0.002). No significant differences were detected regarding the goal of LDL cholesterol ≤70 mg/dL (41 vs. 44%). The adverse events were mild and their frequency was similar in the two groups (9 vs. 2%, ns). Adherence was similarly good in the two groups (93 vs. 88%, ns). Polypill group adherence was similar to that reported in a previous meta-analysis of RCTs (93 vs. 84%, ns). CONCLUSION: In our experience, the cardiovascular polypill achieved a higher reduction in SBP levels and was well tolerated. Adherence was similar to that found in the previous literature, which is remarkable given the real-life setting of our study.

La medicina rural a principios de siglo XX. A propósito de Martínez Saldise (1855-1937), socio de honor de la Sociedad de Pediatría de Madrid en 1927 / Rural medical practice at the beginning of the 20 th century. Martínez Saldise (1855-1937), honorary member of Paediatric Society of Madrid in 1927

INTRODUCCIÓN: En el centenario de la Sociedad de Pediatría de Madrid se quiere realizar un homenaje a la medicina rural de aquella época. Hay escasez documental sobre la historia de la medicina rural. El objetivo es describir el marco del ejercicio médico rural a finales del XIX y principios del XX en tanto que se desarrolla una revisión histórica biográfica de Manuel Martínez Saldise, que fue médico titular de Cazalegas (Toledo). En 1927 fue nombrado socio de honor por la Sociedad de Pediatría de Madrid. MATERIAL Y MÉTODOS: Búsqueda en repositorios de prensa digitalizada, portales web de historia de la medicina, pubmed, IME, archivos locales de diputaciones y colegio de médicos. Se revisó el archivo familiar con la colaboración de uno de sus descendientes. RESULTADOS: La contratación de los médicos rurales se realizaba por los ayuntamientos, el sueldo en gran parte dependía además del ejercicio privado, de las «igualas». Los médicos titulares participaban en las epidemias, en medicina legal, en las medidas de higiene; también tenían conflictos con alcaldes, caciques, con colegas y con el intrusismo. Se hace un resumen de aspectos biográficos y laborales de Manuel Martínez Saldise.comentarios:Los médicos rurales se entregaban a la sociedad de su época, ante los problemas que surgían, denunciaban las carencias de la administración local, dedicaban esfuerzos a su familia y a los más desfavorecidos

INTRODUCTION: On the centenary of the foundation of the Paediatrics Society of Madrid, a tribute is presented to rural medical practice of that time, although there are few documents on the history of rural medicine. The main objective is to describe the context of the rural medical practice in the late 19th and beginning 20th century, while presenting a historical biographical review of Manuel Martínez Saldise, who was medical specialist from Cazalegas (Toledo). He was appointed an Honorary Member by the Paediatrics Society of Madrid in 1927. MATERIAL AND METHODS: A search was carried out in repositories of digitized media, web portals of history of medicine, PubMed, IME files of local councils and medical colleges. The family archives were reviewed with the collaboration of his descendants. RESULTS: The hiring of rural doctors was carried out by the municipalities, and the salary largely depended on private practice as well as "retainers". Specialist physicians took part in epidemics, legal medicine, and in hygiene measures. They also had disputes with mayors, chiefs, with colleagues and with protectionism. A summary of the biography and occupational activity of Manuel Martínez Saldise is presented.comments: Rural doctors were subjected to the society of their time, with the issues that arose, denouncing the shortcomings of the local administrations, dedicated efforts to their family and the most disadvantaged

[Rural medical practice at the beginning of the 20th century. Martínez Saldise (1855-1937), honorary member of Paediatric Society of Madrid in 1927]. / La medicina rural a principios de siglo XX. A propósito de Martínez Saldise (1855-1937), socio de honor de la Sociedad de Pediatría de Madrid en 1927.

INTRODUCTION: On the centenary of the foundation of the Paediatrics Society of Madrid, a tribute is presented to rural medical practice of that time, although there are few documents on the history of rural medicine. The main objective is to describe the context of the rural medical practice in the late 19th and beginning 20th century, while presenting a historical biographical review of Manuel Martínez Saldise, who was medical specialist from Cazalegas (Toledo). He was appointed an Honorary Member by the Paediatrics Society of Madrid in 1927. MATERIAL AND METHODS: A search was carried out in repositories of digitized media, web portals of history of medicine, PubMed, IME files of local councils and medical colleges. The family archives were reviewed with the collaboration of his descendants. RESULTS: The hiring of rural doctors was carried out by the municipalities, and the salary largely depended on private practice as well as "retainers". Specialist physicians took part in epidemics, legal medicine, and in hygiene measures. They also had disputes with mayors, chiefs, with colleagues and with protectionism. A summary of the biography and occupational activity of Manuel Martínez Saldise is presented. COMMENTS: Rural doctors were subjected to the society of their time, with the issues that arose, denouncing the shortcomings of the local administrations, dedicated efforts to their family and the most disadvantaged.