Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry.

Introduction: We aimed to evaluate if prior oral anticoagulation (OAC) and its type determines a greater risk of symptomatic hemorrhagic transformation in patients with acute ischemic stroke (AIS) subjected to mechanical thrombectomy. Materials and Methods: Consecutive patients with AIS included in the prospective reperfusion registry NORDICTUS, a network of tertiary stroke centers in Northern Spain, from January 2017 to December 2019 were included. Prior use of oral anticoagulants, baseline variables, and international normalized ratio (INR) on admission were recorded. Symptomatic intracranial hemorrhage (sICH) was the primary outcome measure. Secondary outcome was the relation between INR and sICH, and we evaluated mortality and functional outcome at 3 months by modified Rankin scale. We compared patients with and without previous OAC and also considered the type of oral anticoagulants. Results: About 1.455 AIS patients were included, of whom 274 (19%) were on OAC, 193 (70%) on vitamin K antagonists (VKA), and 81 (30%) on direct oral anticoagulants (DOACs). Anticoagulated patients were older and had more comorbidities. Eighty-one (5.6%) developed sICH, which was more frequent in the VKA group, but not in DOAC group. OAC with VKA emerged as a predictor of sICH in a multivariate regression model (OR, 1.89 [95% CI, 1.01-3.51], p = 0.04) and was not related to INR level on admission. Prior VKA use was not associated with worse outcome in the multivariate regression model nor with mortality at 3 months. Conclusions: OAC with VKA, but not with DOACs, was an independent predictor of sICH after mechanical thrombectomy. This excess risk was associated neither with INR value by the time thrombectomy was performed, nor with a worse functional outcome or mortality at 3 months.

[Zonisamide in the preventive treatment of refractory migraine]. / Zonisamida en el tratamiento preventivo de la migraña refractaria.

INTRODUCTION: Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. PATIENTS AND METHODS: Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment. RESULTS: Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. CONCLUSIONS: These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migraine.

Zonisamida en el tratamiento preventivo de la migraña refractaria / Zonisamide in the preventive treatment of refractory migraine

Introducción. La migraña crónica refractaria al tratamiento preventivo habitual es una situación frecuente en consultas de neurología. Se pretende analizar la experiencia con zonisamida en el tratamiento de pacientes con migraña frecuente refractaria. Pacientes y métodos. Aquellos pacientes sin respuesta o con intolerancia a topiramato y al menos otro fármaco preventivo para la migraña recibieron zonisamida. El fármaco se incrementó a razón de 25 mg/semana, hasta un máximo de 200 mg/día. La eficacia de la zonisamida se evaluó en términos de ‘respuesta’ (disminución en la frecuencia de las crisis al menos del 50%) al tercer mes del tratamiento. Resultados. Nuestra serie comprende 172 pacientes de entre 22 y 69 años. El 81% eran mujeres. Las dosis de zonisamida oscilaron entre 50 y 200 mg/día, y la dosis más frecuentemente administrada fue de 100 mg/día. La zonisamida mostró eficacia (respuesta) en 76 (44%) de los pacientes; la respuesta fue excelente en 22 (13%). La puntuación en el test de MIDAS se redujo en un 43,2%. Un 27% de los pacientes no toleró el fármaco, fundamentalmente por bradipsiquia subjetiva o clínica digestiva. Conclusiones. Estos resultados, obtenidos en un número amplio de pacientes refractarios o intolerantes a topiramato y otros fármacos, indican que, al menos en condiciones de práctica clínica, la zonisamida, en dosis relativamente bajas, es una opción que se debe considerar en el tratamiento preventivo del paciente con migraña frecuente

Introduction. Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. Patients and methods. Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of ‘response’ (reduction in attack frequency below 50%) at the third month of treatment. Results. Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. Conclusions. These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migrainev

Anticuerpos neutralizantes de interferón beta: ¿tienen valor clínico en pacientes con esclerosis múltiple? / Neutralizant antibobies of interferon beta: ¿Do they have clínical value in patients with multiple sclerosis?

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Síndrome de Susac. Diagnóstico diferencial / Susac syndrome. Differential diagnosis

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