Variantes normales de aspecto epileptiforme en el electroencefalograma. Revisión de la bibliografía e implicaciones clínicas / Normal variants with an epileptiform appearance in electroencephalograms. A literature review and clinical implications

Las variantes normales de aspecto epileptiforme, o variantes epileptiformes benignas, son un reto diagnóstico en la interpretación de los electroencefalogramas que requiere su conocimiento y una amplia experiencia por parte de los responsables del informe electroencefalográfico. Incluyen un grupo heterogéneo de hallazgos, algunos muy infrecuentes, que inicialmente se relacionaron con epilepsia y patologías neurológicas diversas. En la actualidad, la mayoría se consideran variantes sin significado patológico, y su sobreinterpretación habitualmente acarrea diagnósticos erróneos y tratamientos innecesarios. Los datos de prevalencia de estas variantes son muy diversos y proceden habitualmente de poblaciones seleccionadas, por lo que son difícilmente extrapolables a población sana. No obstante, estudios con electrodos invasivos y series más recientes vuelven a asociar algunas de estas variantes con epilepsia. Nuestro objetivo es revisar las características y la prevalencia de las principales variantes epileptiformes benignas y actualizar su significado clínico. (AU)

[Normal variants with an epileptiform appearance in electroencephalograms. A literature review and clinical implications]. / Variantes normales de aspecto epileptiforme en el electroencefalograma. Revisión de la bibliografía e implicaciones clínicas.

Normal epileptiform-like variants or benign epileptiform variants are a diagnostic challenge in the interpretation of electroencephalograms, which require the knowledge and extensive experience of those responsible for the electroencephalographic report. They include a heterogeneous group of findings, some quite uncommon, initially related to epilepsy and various neurological conditions. Most of them are currently considered variants with no pathological significance, and their over-interpretation usually leads to misdiagnosis and the establishment of unnecessary treatments. Prevalence data are variable and usually come from selected populations, so they are difficult to extrapolate to a healthy population. Studies with invasive electrodes and recent series link some of these variants with epilepsy. We aim to review the characteristics and prevalence of the main benign epileptiform variants and to update their clinical significance.

TITLE: Variantes normales de aspecto epileptiforme en el electroencefalograma. Revisión de la bibliografía e implicaciones clínicas.Las variantes normales de aspecto epileptiforme, o variantes epileptiformes benignas, son un reto diagnóstico en la interpretación de los electroencefalogramas que requiere su conocimiento y una amplia experiencia por parte de los responsables del informe electroencefalográfico. Incluyen un grupo heterogéneo de hallazgos, algunos muy infrecuentes, que inicialmente se relacionaron con epilepsia y patologías neurológicas diversas. En la actualidad, la mayoría se consideran variantes sin significado patológico, y su sobreinterpretación habitualmente acarrea diagnósticos erróneos y tratamientos innecesarios. Los datos de prevalencia de estas variantes son muy diversos y proceden habitualmente de poblaciones seleccionadas, por lo que son difícilmente extrapolables a población sana. No obstante, estudios con electrodos invasivos y series más recientes vuelven a asociar algunas de estas variantes con epilepsia. Nuestro objetivo es revisar las características y la prevalencia de las principales variantes epileptiformes benignas y actualizar su significado clínico.

Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms.

SARS-CoV-2 infection can associate diverse neurological manifestations. Several studies have provided proof to support the theory of neurotropic involvement of SARS-CoV-2. Alpha-synuclein has been described as a native antiviral factor within neurons, and upregulation of this protein can be seen in animals that suffered other neuroinvasive infections. To assess if increased expression of this protein takes place in COVID-19 patients with neurological symptoms, we analyzed serum total alpha-synuclein levels in three groups: seven COVID-19 patients with myoclonus, Parkinsonism and/or encephalopathy; thirteen age- and sex-matched COVID-19 patients without neurological involvement and eight age- and sex-matched healthy controls. We did not find differences among them. In a subset of four patients, the change in serum alpha-synuclein before and after the onset of neurological symptoms was not significant either. Cerebrospinal fluid alpha-synuclein levels were also similar between neurological COVID-19 and healthy controls. Overall, these results cannot support the hypothesis of alpha-synuclein upregulation in humans with neurological symptoms in COVID-19. Further research taking into account a larger group of COVID-19 patients including the whole spectrum of neurological manifestations and disease severity is needed.

Cefalea cardíaca: cuando la isquemia miocárdica llega a la consulta del neurólogo / No disponible

No disponible

Síndrome de Pisa agudo tras tratamiento con betahistina en un paciente con deterioro cognitivo leve / Acute Pisa syndrome secondary to betahistine treatment in a patient with mild cognitive impairment

No disponible

Encefalopatía hiperamoniémica en relación con mieloma múltiple / Hyperammonemic encephalopathy associated with multiple myeloma

No disponible

Safety, efficacy and outcome-related factors of perampanel over 12 months in a real-world setting: The FYDATA study.

BACKGROUND: Real-world data of current antiepileptic drugs (AEDs) used to treat focal seizures is of importance to understand the efficacy and safety outside of the clinical trial setting. Here we report real-world data from a large series of patients treated with perampanel for 1year. METHODS: FYDATA was a multicentre, retrospective, 1-year observational study assessing the efficacy and safety of adjuvant perampanel in patients ≥12 years of age with focal epilepsy in a real-world setting. At 12 months, the proportion of patients who were seizure free, median percentage seizure reduction, proportion of responders, retention rate and proportion of patients with adverse events (AEs) were assessed. Analyses were also performed to identify any patient-, medication- and disease-related factors associated with a large clinical response or carry a risk for AEs. RESULTS: A total of 464 patients were included in the study with a retention rate of 60.6% at 1year. The mean number of prior AEDs was 7.8. The median percentage reduction in overall seizures was 33.3% (75% for secondary generalised seizures) after 1year, with 7.2% of patients achieving seizure freedom. Furthermore, patients on non-enzyme-inducing AEDs were more likely to achieve seizure freedom, and logistic regression revealed that patients aged ≥65 years, those with epilepsy due to a vascular aetiology and those who had received fewer prior AEDs showed a better clinical response to perampanel. A total of 62.9% of the patients experienced AEs at 12 months; dizziness, somnolence and irritability were the most frequent AEs. Patients with prior psychiatric comorbidities (hyperactivity and personality disorder) were more likely to experience psychiatric AEs with perampanel, and slower titration schedules were associated with less AEs overall. CONCLUSION: Perampanel, for the treatment of focal epilepsy in a real-world setting in a refractory population, over 1year, demonstrates a similar efficacy and safety profile to that observed in clinical trials. Our results have implications for the optimisation of perampanel use in a clinical setting.

[Analysis of the nutritional status and body composition of persons with intellectual disability]. / Analisis del estado nutricional y composicion corporal de personas con discapacidad intelectual.

INTRODUCTION: Intellectual disability refers to substantial limitations in intellectual functioning, affecting 0.7-1.5% of the population. People with intellectual disability have higher rates of obesity, since caloric values and nutritional status, are deficient. AIMS: To determine the nutritional habits, analyze the effectiveness of nutritional education and evaluate the possible effect of improvement introducing exercise and nutrition workshops, in a group of people with intellectual disability. PATIENTS AND METHODS: Clinical, nutritional and anthropometric (weight, height, body mass index, body fat, waist circumference) assessment was conducted in 47 patients. An ad hoc survey was designed in which exercise habits, medical and dietary history, record of 72 hours (including 2 weekdays and 1 weekend) and the adherence to Mediterranean diet data were collected. The workshops of exercise and nutrition counted with a structure of theoretical-practical explanation and games. RESULTS: 76.1% presented weight excess at baseline. After the intervention values of total body fat (-0.94 ± 4.4%) and visceral fat (-0.86 ± 2%), weight (-0.4 ± 3.3 kg) and body mass index (-0.2 ± 1.6 kg/m2) decreased, more in women than in men. 60.5% of subjects did not meet a high adherence to the Mediterranean diet. After nutritional intervention, a significant difference (p <= 0,001) was observed in the KidMed score. The workshop of physical activity had positive effects on the anthropometry of subjects. CONCLUSIONS: Both the intake and the prevalence of obesity in this group of people are inadequate. Nutritional education and physical exercise workshops are useful for working with this group, achieving significant changes to prevent obesity and improve their health.

TITLE: Analisis del estado nutricional y composicion corporal de personas con discapacidad intelectual.Introduccion. La discapacidad intelectual, definida como limitaciones sustanciales en el funcionamiento intelectual, afecta al 0,7-1,5% de la poblacion. Estas personas presentan mayores tasas de obesidad, y sus valores caloricos y estado nutricional son deficientes. Objetivos. Conocer los habitos nutricionales, analizar la eficacia de la educacion nutricional y evaluar la posible mejora, introduciendo talleres de ejercicio fisico y nutricion, en la discapacidad intelectual. Pacientes y metodos. Se realizo una valoracion clinica, nutricional y antropometrica (peso, talla, indice de masa corporal, grasa corporal, perimetro de la cintura) a 47 sujetos con discapacidad intelectual. Se registraron los habitos deportivos, la historia clinica y la historia dietetica mediante un registro alimentario y un cuestionario de adhesion a la dieta mediterranea (KidMed). Los talleres de nutricion y ejercicio fisico contaron con una estructura de explicacion teorica, practica y juegos. Resultados. El 76,1% presentaba exceso ponderal en el inicio del estudio. Tras la intervencion, los valores de grasa corporal (­0,94 ± 4,4%) y grasa visceral (­0,86 ± 2%), asi como el peso (­0,4 ± 3,3 kg) y el indice de masa corporal (­0,2 ± 1,6 kg/m2), disminuyeron, mas en las mujeres que en los hombres. El 60,5% no cumplia con una alta adhesion a la dieta mediterranea. Tras la intervencion, se observo una diferencia significativa (p <= 0,001) en la puntuacion del KidMed. El taller de actividad fisica tuvo efectos positivos sobre la antropometria. Conclusiones. La alimentacion fue inadecuada en la mayoria de los individuos. La prevalencia de obesidad fue elevada. Los talleres de educacion nutricional y de ejercicio son una herramienta util para trabajar con este colectivo, y consiguen cambios significativos para prevenir la obesidad y mejorar su salud.

[Usefulness of electroencephalograms in evaluating transient global amnesia]. / Utilidad de la electroencefalografia en la valoracion de la amnesia global transitoria.

INTRODUCTION: Transient global amnesia (TGA) is a perfectly well defined clinical picture, but nevertheless even today its aetiology remains unknown. The three most widely accepted theories suggest it has a vascular origin, it is related with the pathophysiology of migraine or it is of an epileptiform nature. AIM: To analyse whether there is an electroencephalographic pattern that is consistently repeated in a series of electro-encephalograms (EEG) carried out on patients with TGA. PATIENTS AND METHODS: The study consists in a retrospective analysis of a sample of 345 patients referred to have an EEG after an episode of TGA. RESULTS: In almost 20% of the EEGs something that could be considered abnormal was found, although most of these findings (64%) were of little pathological significance. Of the remaining 26%, attention should be drawn to the cases of two patients with subclinical rhythmic electroencephalogram discharges of adults (a pattern with a meaning that is not altogether clear and which has previously been associated with TGA). CONCLUSIONS: A considerable percentage of patients have TGA and EEG alterations, although most of them are of scarce pathological significance or can be attributed to some other underlying condition. We have not succeeded in identifying any pattern that is consistently repeated. Our results suggest that the EEG is a test with low diagnostic effectiveness in this pathology and it is necessary to reconsider the need to systematically perform such tests in suspected cases of TGA.

[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)

El papel diagnóstico del Holterelectroencefalograma ambulatorio: experiencia y resultados en 264 registros / The role of ambulatory electroencephalogram monitoring: experience and results in 264 records

Introducción. La monitorización continua con Holterelectroencefalograma(Holter-EEG) permite el registro encefalográficoambulatorio de un paciente durante un tiempoprolongado. El objetivo de este estudio es describir yanalizar los resultados obtenidos con la determinación delHolter-EEG en nuestra práctica clínica.Métodos. Se analizaron de forma retrospectiva los resultadosde los 264 registros de Holter-EEG, agrupados segúnel motivo de solicitud: a) grupo 1: evaluación diagnósticade los episodios de naturaleza epiléptica; b) grupo 2:evaluación diagnóstica de episodios paroxísticos, y c) grupo 3:valoración del riesgo de recidiva durante la retirada del tratamientoanticomicial en determinados pacientes epilépticos.Resultados. a) Grupo 1 (n=137): en 54 registros (39,4%)el resultado fue normal, en 20 (14,6%) se detectó actividadepileptiforme generalizada (5 con actividad ictal), en 57 (42%)se detectó actividad epileptiforme focal (8 con actividad ictal)y en 6 (4%) el diagnóstico del EEG fue inadecuado por lapresencia de artefactos; b) grupo 2 (n=99): en 47 registros(47,5%) no se registró ningún episodio y el Holter-EEG fuenormal, en 14 (14,2%) se documentó un episodio clínico sinregistrarse anomalías críticas en el Holter-EEG y en 29(29,3%) se registró actividad epileptiforme focal (ictal en 4)y generalizada (ictal en 1) en 4 pacientes (4%). En 5 registros(5%) el diagnóstico del EEG fue inadecuado, y c) grupo3 (n=28): el estudio fue normal en 15 casos (53,6%), mostrabaactividad epileptiforme focal interictal en 8 (28,6%) ygeneralizada en 5 (17,8%).Conclusiones. Consideramos que los registros de Holter-EEG en casos adecuadamente seleccionados puedenaportar una importante información complementaria en laevaluación global del paciente epiléptico (AU)

Introduction. Ambulatory electroencephalogram (EEG)monitoring allows for long-term, mobile electroencephalographicrecordings of patients. This study aims to describeand analyze the results obtained with ambulatory EEG inour clinical practice.Methods. We have analyzed the results of 264 ambulatoryEEG records, grouped according to the reasonfor the request: a) group 1: diagnostic evaluation of episodesof epileptic nature; b) group 2: diagnostic evaluationof paroxysmal episodes, and c) group 3: evaluationof the risk of relapse during anti-seizure treatment withdrawalin certain epileptic patients.Results. a) Group 1 (n=137): normal results werefound in 54 records (39.4%). There was generalized epilepticactivity in 20 (14.6%) of them (5 with ictal activity)and focal epileptic activity was detected in 57 cases(42%) (8 with ictal activity). No EEG diagnosis could bereached in 6 (4%) recordings due to the presence of artefacts;b) group 2 (n=99): in 47 records (47.5 %), therewere no episodes and the Holter-EEG was normal. Therewas a clinically documented episode without anomaliesduring Holter-EEG registration in 14 cases (14.2%). In 29records (29.3%), focal epileptic activity was recorded (ictal 4)and generalized epileptic activity (ictal in 1) was recordedin 4 patients (4%). No EEG diagnosis could be reached in5 cases (5%), and c) group 3 (n=28): the study was normalin 15 cases (53.6%) and showed focal interictal epilepticactivity in 8 (28.6 %) and generalized interictal epilepticactivity in 5 of them (17.8%).Conclusion. We believe that the ambulatory EEG recordingsin correctly selected cases can provide importantadditional information regarding global assessmentof patients with epilepsy (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.

[The role of ambulatory electroencephalogram monitoring: experience and results in 264 records]. / El papel diagnóstico del Holterelectroencefalograma ambulatorio: experiencia y resultados en 264 registros.

INTRODUCTION: Ambulatory electroencephalogram (EEG) monitoring allows for long-term, mobile electroencephalographic recordings of patients. This study aims to describe and analyze the results obtained with ambulatory EEG in our clinical practice. METHODS: We have analyzed the results of 264 ambulatory EEG records, grouped according to the reason for the request: a) group 1: diagnostic evaluation of episodes of epileptic nature; b) group 2: diagnostic evaluation of paroxysmal episodes, and c) group 3: evaluation of the risk of relapse during anti-seizure treatment withdrawal in certain epileptic patients. RESULTS: a) Group 1 (n=137): normal results were found in 54 records (39.4%). There was generalized epileptic activity in 20 (14.6%) of them (5 with ictal activity) and focal epileptic activity was detected in 57 cases (42%) (8 with ictal activity). No EEG diagnosis could be reached in 6 (4%) recordings due to the presence of artefacts; b) group 2 (n=99): in 47 records (47.5 %), there were no episodes and the Holter-EEG was normal. There was a clinically documented episode without anomalies during Holter-EEG registration in 14 cases (14.2%). In 29 records (29.3%), focal epileptic activity was recorded (ictal 4) and generalized epileptic activity (ictal in 1) was recorded in 4 patients (4%). No EEG diagnosis could be reached in 5 cases (5%), and c) group 3 (n=28): the study was normal in 15 cases (53.6%) and showed focal interictal epileptic activity in 8 (28.6 %) and generalized interictal epileptic activity in 5 of them (17.8%). CONCLUSION: We believe that the ambulatory EEG recordings in correctly selected cases can provide important additional information regarding global assessment of patients with epilepsy.

[The pathophysiology of migraine. Reflections on the glutamatergic hypothesis]. / Fisiopatologia de la migrana. Reflexiones sobre la hipotesis glutamatergica.

INTRODUCTION AND DEVELOPMENT: Migraine is an episodic primary headache defined by its clinical characteristics. Several pathophysiological hypotheses have been put forward in an attempt to explain the mechanism by which headaches develop in patients suffering from migraine. We believe that there are enough data available to consider that in the cerebral cortex, and in certain situations, there may be either an alteration in the balance of glutamate in the extracellular space or generation of excitatory post-synaptic potentials at rest based on the activation of slightly increased AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) and kainate receptors, which would account for the cortical hyperexcitability and the interictal changes observed in patients with migraine. CONCLUSIONS: Further knowledge about the mechanisms that start and trigger migraines is essential for the development of new therapeutic approaches.