Botulismo alimentario durante la pandemia por el SARS-CoV-2. Descripción de un caso y de un posible brote familiar en Barcelona / Food borne-botulism during SARS-CoV-2 pandemic time. A case and a possible familial outbreak in Barcelona

Introducción. El botulismo es un síndrome neuroparalítico hoy en día infrecuente, potencialmente fatal, causado por neurotoxinas de Clostridium botulinum. El origen es alimentario en el 25% de los casos. Caso clínico. Describimos el caso confirmado de botulismo alimentario en una paciente atendida en nuestro hospital en septiembre de 2020 y la sospecha de un segundo caso en un familiar de la paciente, no confirmado éste por las pruebas de laboratorio. La instauración en pocos días de una afectación bilateral de pares craneales, incluyendo disfagia, disnea y disartria, junto con midriasis y tetraparesia graves, precedida de diarrea, constituyó la presentación clínica en el primer caso; mientras que en su familiar cursó con síntomas inespecíficos y transitorios. Constatamos disautonomía consistente en hipotensión arterial en ambos casos. Teniendo en cuenta la situación pandémica en aquel momento, se descartó repetidamente la infección por SARS-CoV-2 antes de plantear alternativas diagnósticas. La neurotoxina B de C. botulinum fue detectada en las heces de la paciente, confirmando el diagnóstico de botulismo, que relacionamos con la ingesta de una conserva casera de alubias. Se completó el diagnóstico diferencial del cuadro descartando otras posibles etiologías. Conclusión. La sospecha clínica temprana, confirmada con los hallazgos de laboratorio y neurofisiológicos y que llevaron al manejo específico de la paciente, fueron cruciales para la evolución favorable. No fue necesario aplicar medidas de salud pública, a excepción de la notificación a sus allegados de la contaminación detectada. Conocer la existencia de esta patología puede contribuir a su pronóstico.(AU)

Introduction. Botulism is a potentially fatal neuroparalytic syndrome caused by Clostridium botulinum neurotoxin. The 25% are food-borne botulism cases. Case report. We describe a confirmed case of botulism attended in our hospital in September 2020, together with a second case in a patient’s relative, suspected but not confirmed by laboratory tests. Clinical presentation consisted on general weakness, bilateral cranial palsy, mydriasis, and rapidly progressive tetraparesis in case 1, involving respiratory and swallowing function so she required hospitalization and support treatment. Non specific and transient symptoms occurred in case 2. SARS-CoV-2 infection was initially suspected in both cases due to pandemic situation in our country, ruled out by negative PCR. When B neurotoxin was detected in stool sample of patient 1 we confirmed the diagnosis of food-borne botulism probably linked to home-made conserved beans. Conclusion. Early clinical suspicion, together with laboratory and electromyography findings, and support treatment provided at hospital were crucial for favourable outcome. Being aware of this rare syndrom might contribute to its better management.(AU)

Food borne-botulism during SARS-CoV-2 pandemic time. A case and a possible familial outbreak in Barcelona. / Botulismo alimentario durante la pandemia por el SARS-CoV-2. Descripción de un caso y de un posible brote familiar en Barcelona.

INTRODUCTION: Botulism is a potentially fatal neuroparalytic syndrome caused by Clostridium botulinum neurotoxin. The 25% are food-borne botulism cases. CASE REPORT: We describe a confirmed case of botulism attended in our hospital in September 2020, together with a second case in a patient's relative, suspected but not confirmed by laboratory tests. Clinical presentation consisted on general weakness, bilateral cranial palsy, mydriasis, and rapidly progressive tetraparesis in case 1, involving respiratory and swallowing function so she required hospitalization and support treatment. Non specific and transient symptoms occurred in case 2. SARS-CoV-2 infection was initially suspected in both cases due to pandemic situation in our country, ruled out by negative PCR. When B neurotoxin was detected in stool sample of patient 1 we confirmed the diagnosis of food-borne botulism probably linked to home-made conserved beans. CONCLUSION: Early clinical suspicion, together with laboratory and electromyography findings, and support treatment provided at hospital were crucial for favourable outcome. Being aware of this rare syndrom might contribute to its better management.

TITLE: Botulismo alimentario durante la pandemia por el SARS-CoV-2. Descripción de un caso y de un posible brote familiar en Barcelona.Introducción. El botulismo es un síndrome neuroparalítico hoy en día infrecuente, potencialmente fatal, causado por neurotoxinas de Clostridium botulinum. El origen es alimentario en el 25% de los casos. Caso clínico. Describimos el caso confirmado de botulismo alimentario en una paciente atendida en nuestro hospital en septiembre de 2020 y la sospecha de un segundo caso en un familiar de la paciente, no confirmado éste por las pruebas de laboratorio. La instauración en pocos días de una afectación bilateral de pares craneales, incluyendo disfagia, disnea y disartria, junto con midriasis y tetraparesia graves, precedida de diarrea, constituyó la presentación clínica en el primer caso; mientras que en su familiar cursó con síntomas inespecíficos y transitorios. Constatamos disautonomía consistente en hipotensión arterial en ambos casos. Teniendo en cuenta la situación pandémica en aquel momento, se descartó repetidamente la infección por SARS-CoV-2 antes de plantear alternativas diagnósticas. La neurotoxina B de C. botulinum fue detectada en las heces de la paciente, confirmando el diagnóstico de botulismo, que relacionamos con la ingesta de una conserva casera de alubias. Se completó el diagnóstico diferencial del cuadro descartando otras posibles etiologías. Conclusión. La sospecha clínica temprana, confirmada con los hallazgos de laboratorio y neurofisiológicos y que llevaron al manejo específico de la paciente, fueron cruciales para la evolución favorable. No fue necesario aplicar medidas de salud pública, a excepción de la notificación a sus allegados de la contaminación detectada. Conocer la existencia de esta patología puede contribuir a su pronóstico.

[Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia]. / Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.

INTRODUCTION: Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity. AIM: To analyze and summarize different questions about the use of BTA in our clinical practice. DEVELOPMENT: A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc. CONCLUSION: This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.

TITLE: Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.Introduccion. La toxina botulinica de tipo A (TBA) ha supuesto una verdadera revolucion terapeutica en neurologia, y en la actualidad es el tratamiento rutinario en las distonias focales y la espasticidad. Objetivo. Plantear, revisar y responder cuestiones controvertidas en relacion con la neurofarmacologia de la TBA y su uso en las distonias en la practica clinica habitual. Desarrollo. Un grupo de expertos en trastornos del movimiento reviso una lista de temas controvertidos relacionados con la farmacologia de la TBA y su uso en las distonias. Revisamos la bibliografia e incluimos articulos relevantes especialmente en ingles, pero tambien, si su importancia lo merece, en castellano y en frances, hasta junio de 2016. El documento se estructuro como un cuestionario que incluyo las preguntas que podrian generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. Incluimos preguntas sobre diferentes aspectos de la neurofarmacologia, especialmente el mecanismo de accion, la bioequivalencia de los diferentes preparados y la inmunogenicidad. En relacion con el subapartado de las distonias, se incluyeron aspectos sobre la evaluacion y el tratamiento de las distonias focales. Conclusiones. Esta revision no pretende ser una guia, sino una herramienta practica destinada a neurologos y medicos internos residentes interesados en esta area, dentro de diferentes ambitos especificos del manejo de la TBA.

[Myths and evidence on the use of botulinum toxin: spasticity in adults and in children with cerebral palsy]. / Mitos y evidencias en el empleo de la toxina botulinica: espasticidad del adulto y del nintilde;o con paralisis cerebral.

INTRODUCTION: Spasticity is a medical problem with a high incidence that significantly impact on the quality of life of patients and their families. AIM: To analyze and to answer different questions about the use of botulinum toxin type A (BTA) in our clinical practice. DEVELOPMENT: A group of experts in neurology develop a list of topics related with the use of BTA. Two big groups were considered: spasticity in adults and in children with cerebral palsy. A literature search at PubMed for English, French, and Spanish language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow for modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of spasticity in adults, such as methods for evaluating spasticity, infiltration techniques, doses, number of infiltration points, etc. Regarding spasticity in children with cerebral palsy, the document included questions about minimum age of infiltration, methods of analgesia, etc. CONCLUSIONS: This review is a tool for continuous training for neurologist and rehabilitation specialist and residents of both specialties, about different specific areas of the management of BTA.

TITLE: Mitos y evidencias en el empleo de la toxina botulinica: espasticidad del adulto y del nintilde;o con paralisis cerebral.Introduccion. La espasticidad es un problema medico frecuente que impacta de forma significativa en la calidad de vida de los pacientes y sus familias. Objetivo. Analizar y dar respuesta a diferentes cuestiones en el uso de la toxina botulinica tipo A (TBA) en nuestra practica clinica habitual. Desarrollo. Un grupo de expertos en neurologia elaboro una lista de temas relacionados con el uso de la TBA. Se consideraron dos grandes bloques: espasticidad del adulto y del nintilde;o con paralisis cerebral. Se realizo una revision de la bibliografia que incluyo los diferentes articulos publicados en espantilde;ol, ingles y frances hasta junio de 2016. El documento se estructuro como un cuestionario que incluyo las preguntas que, segun el criterio del panel, podrian generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. A continuacion, el texto final fue validado. Se incluyeron diferentes preguntas sobre diferentes aspectos de la espasticidad en adultos: evaluacion de la espasticidad, tecnicas de infiltracion, dosis, numero de puntos, etc. En cuanto a la espasticidad en los nintilde;os con paralisis cerebral, se analizaron preguntas como: edad minima de infiltracion, metodos de sedoanalgesia, etc. Conclusiones. Esta revision constituye una herramienta para neurologos, medicos rehabilitadores y residentes de ambas especialidades, dentro de diferentes ambitos especificos del manejo de la TBA.

Evaluación rápida del ataque isquémico transitorio en un hospital sin guardias de neurología / Rapid assessment of transient ischaemic attack in a hospital with no on-call neurologist

Introducción: Los pacientes que presentan un ataque isquémico transitorio (AIT) tienen un alto riesgo de tener un ictus a corto plazo. Una atención urgente puede reducir dicho riesgo. El objetivo es describir y comprobar la eficacia de un protocolo de atención rápida a estos pacientes en un hospital sin guardias de neurología. Métodos: En febrero del 2007 se puso en marcha en nuestro hospital un protocolo de evaluación rápida del AIT, con el objetivo de priorizar la atención urgente y disminuir ingresos hospitalarios sin aumentar riesgo de recurrencias. Se analizan los resultados tras los primeros 5 años, incidiendo especialmente en los tiempos de valoración neurológica y neurovascular, motivos de ingreso y tasa de recurrencia a los 90 días. Resultados: Han sido evaluados 411 pacientes, de los cuales 282 (68,6%) fueron finalmente AIT. Entre los otros diagnósticos, los más frecuentes han sido el episodio vasovagal (5,6%) y el cuadro confusional (4,6%). La demora entre la llegada a Urgencias y la valoración del neurólogo fue < 24 h en el 82% de casos y < 48 h en el 93,9%. Tras la valoración neurológica, se decidió el ingreso en el 28,7% de pacientes (causas más frecuentes: hallazgos en el Doppler y AIT de repetición). A los 3 meses, 10 pacientes (3,55%) presentaron un ictus, 7 de ellos (70%) en la primera semana desde el episodio. Conclusiones: En un hospital sin guardias de neurología, es posible una evaluación rápida de los pacientes con AIT, de acuerdo con las recomendaciones de las guías, evitando la mayoría de ingresos y con un bajo índice de recurrencias

Background: Risk of stroke soon after a transient ischaemic attack (TIA) is high. Urgent care can reduce this risk. Our aim is to describe and evaluate the efficacy of rapid assessment of TIA patients in a hospital without a neurologist available 24 hours a day. Methods: In February 2007, we set up a protocol of rapid management of patients with symptoms consistent with acute TIA, with the aim of prioritising urgent care and reducing hospital admissions, without increasing risk of recurrences. We analyse our results since the protocol was implemented with particular focus on the analysis of delay in neurological and neurovascular assessment, percentage and reasons for hospitalisation, and stroke recurrence rates after 3 months. Results: Four hundred and eleven patients were studied, with a final diagnosis of TIA in 282 (68.6%). Among other diagnoses, the most frequent were a vasovagal reaction (5.6%) and confusional syndrome (4.6%). Delay between emergency arrival and neurovascular assessment was < 24 h in 82% of the cases, and <48 h in 93%. After neurological evaluation, 28.7% of the patients were immediately admitted to hospital (most common causes: severe stenosis of a large artery and crescendo TIA). The incidence of ischaemic stroke in TIA patients was 3.55% after 3 months and 70% of them suffered the recurrence within the first week after the initial TIA. Conclusions: In a hospital without a neurologist available 24 hours a day, early assessment and management of TIA patients can be carried out in accordance with the guidelines, and may avoid hospitalisation in most cases without increasing recurrence rates

Registro de Ictus del Hospital de Mataró: 10 años de registro en un hospital comarcal / The Mataró Stroke Registry: a 10-year registry in a community hospital

Introducción: Un registro prospectivo de ictus permite mejorar el conocimiento de la historia natural de la enfermedad. Presentamos los datos del Registro del Hospital de Mataró. Métodos: En febrero de 2002 se inició en nuestro hospital el registro prospectivo de pacientes ingresados con un ictus agudo. Se recogen variables sociodemográficas, antecedentes, clínicas, topográficas, etiológicas y pronósticas. Analizamos los resultados obtenidos después de los primeros 10 años de registro. Resultados: Se han registrado 2.165 pacientes, el 54,1% varones, con una edad media de 73 años. El factor de riesgo más frecuente es la hipertensión (65,4%). Mediana de la NIHSS al ingreso: 3 (rango intercuartílico, 1-8). Un 79,7% han sido infartos cerebrales, un 10,9% hemorragias y un 9,4% AIT. De los isquémicos, la etiología ha sido cardioembólica en el 26,5%, aterotrombótica en el 23,7% y lacunar en el 22,9%. La localización más frecuente de las hemorragias ha sido lobar (47,4%), y se han atribuido a hipertensión el 54,8%. La mediana de la estancia hospitalaria ha sido de 8 días. Al alta, un 60,7% pudieron volver directamente al domicilio y un 52,7% eran independientes para las actividades de la vida diaria. A los 3 meses, las cifras fueron 76,9 y 62,9% respectivamente. La mortalidad intrahospitalaria ha sido del 6,5% y a los 3 meses del 10,9%. Conclusiones: El perfil de los pacientes en nuestra área no difiere de las otras series, aunque la severidad de los ictus ha sido discretamente menor. Constatamos unas cifras óptimas de estancia hospitalaria y de discapacidad y mortalidad tanto a corto como a medio plazo

Introduction: A prospective stroke registry leads to improved knowledge of the disease. We present data on the Mataró Hospital Registry. Methods: In February-2002 a prospective stroke registry was initiated in our hospital. It includes sociodemographic data, previous diseases, clinical, topographic, etiological and prognostic data. We have analyzed the results of the first 10 years. Results: A total of 2,165 patients have been included, 54.1% male, mean age 73 years. The most frequent vascular risk factor was hypertension (65.4%). Median NIHSS on admission: 3 (interquartile range, 1-8). Stroke subtype: 79.7% ischemic strokes, 10.9% hemorrhagic, and 9.4% TIA. Among ischemic strokes, the etiology was cardioembolic in 26.5%, large-vessel disease in 23.7%, and small-vessel in 22.9%. The most frequent topography of hemorrhages was lobar (47.4%), and 54.8% were attributed to hypertension. The median hospital stay was 8 days. At discharge, 60.7% of patients were able to return directly to their own home, and 52.7% were independent for their daily life activities. After 3 months these percentages were 76.9% and 62.9%, respectively. Hospital mortality was 6.5%, and after 3 months 10.9%. Conclusions: Our patient's profile is similar to those of other series, although the severity of strokes was slightly lower. Length of hospital stay, short-term and medium term disability, and mortality rates are good, if we compare them with other serie

The Mataró Stroke Registry: a 10-year registry in a community hospital.

INTRODUCTION: A prospective stroke registry leads to improved knowledge of the disease. We present data on the Mataró Hospital Registry. METHODS: In February-2002 a prospective stroke registry was initiated in our hospital. It includes sociodemographic data, previous diseases, clinical, topographic, etiological and prognostic data. We have analyzed the results of the first 10 years. RESULTS: A total of 2,165 patients have been included, 54.1% male, mean age 73 years. The most frequent vascular risk factor was hypertension (65.4%). Median NIHSS on admission: 3 (interquartile range, 1-8). Stroke subtype: 79.7% ischemic strokes, 10.9% hemorrhagic, and 9.4% TIA. Among ischemic strokes, the etiology was cardioembolic in 26.5%, large-vessel disease in 23.7%, and small-vessel in 22.9%. The most frequent topography of hemorrhages was lobar (47.4%), and 54.8% were attributed to hypertension. The median hospital stay was 8 days. At discharge, 60.7% of patients were able to return directly to their own home, and 52.7% were independent for their daily life activities. After 3 months these percentages were 76.9% and 62.9%, respectively. Hospital mortality was 6.5%, and after 3 months 10.9%. CONCLUSIONS: Our patient's profile is similar to those of other series, although the severity of strokes was slightly lower. Length of hospital stay, short-term and medium term disability, and mortality rates are good, if we compare them with other series.

Rapid assessment of transient ischaemic attack in a hospital with no on-call neurologist.

BACKGROUND: Risk of stroke soon after a transient ischaemic attack (TIA) is high. Urgent care can reduce this risk. Our aim is to describe and evaluate the efficacy of rapid assessment of TIA patients in a hospital without a neurologist available 24 hours a day. METHODS: In February 2007, we set up a protocol of rapid management of patients with symptoms consistent with acute TIA, with the aim of prioritising urgent care and reducing hospital admissions, without increasing risk of recurrences. We analyse our results since the protocol was implemented with particular focus on the analysis of delay in neurological and neurovascular assessment, percentage and reasons for hospitalisation, and stroke recurrence rates after 3 months. RESULTS: Four hundred and eleven patients were studied, with a final diagnosis of TIA in 282 (68.6%). Among other diagnoses, the most frequent were a vasovagal reaction (5.6%) and confusional syndrome (4.6%). Delay between emergency arrival and neurovascular assessment was <24h in 82% of the cases, and <48 h in 93%. After neurological evaluation, 28.7% of the patients were immediately admitted to hospital (most common causes: severe stenosis of a large artery and crescendo TIA). The incidence of ischaemic stroke in TIA patients was 3.55% after 3 months and 70% of them suffered the recurrence within the first week after the initial TIA. CONCLUSIONS: In a hospital without a neurologist available 24 hours a day, early assessment and management of TIA patients can be carried out in accordance with the guidelines, and may avoid hospitalisation in most cases without increasing recurrence rates.

[Cryptogenic infarct. A follow-up period of 1 year study]. / Infartos criptogénicos. Estudio de 1 año de seguimiento.

OBJECTIVE: To analyze the outcome of patients with a cryptogenic infarct (CI) after a follow-up period of 1 year. METHODS: From our prospective registry of stroke, during a 4-year period, we've identified 121 consecutive patients with a CI (15.1% of all infarcts). They have been followed up for 1 year and we have registered stroke recurrence, cardiovascular events and other incidences. RESULTS: Mean age 70.6 years-old, 53% male. Middle cerebral artery (MCA) was the most often involved territory (52 cases), 70% of them with cortical involvement. No patient died during admission, 95.8% received antiplatelet therapy and 4.1% oral anticoagulant. Fourteen patients were lost of follow-up. During 1-year period, atrial fibrillation (AF) was detected in 7 patients (6.54%), their mean age was 75 years-old, in 5 of them the CI was in MCA territory (4 with cortical involvement, 1 only deep infarct). Three patients (2.76%) suffered a recurrent ischemic stroke, in weeks 15, 16 and 44 after the CI. In all 3 cases the infarct was considered cryptogenic again. Two patients suffered a myocardial infarction and 4 died during follow-up period. CONCLUSION: In our series rate of stroke recurrence and cardiovascular events after a CI was low. An 11% of patients with a CI involving cortical MCA territory developed FA during the following year.

Infartos criptogénicos. Estudio de 1 año de seguimiento / Cryptogenic infarct. A follow-up period of 1 year study

Objetivo. Analizar la evolución de los pacientes con un infartocriptogénico (IC) tras 1 año de seguimiento.Método. De nuestro registro prospectivo de ictus, durante unperíodo de 4 años, identificamos 121 pacientes consecutivos con unIC (15,1% del total de infartos). Se recogen datos de recurrencia delictus, eventos cardiovasculares y otras incidencias tras 1 año de seguimiento.Resultados. Edad media: 70,6 años, 53,7% de varones. La arteriacerebral media (ACM) fue el territorio más afectado (52 casos), el70% de ellos con afectación cortical. Ningún paciente falleció duranteel ingreso, un 95,8% recibió tratamiento antiagregante y un4,1% anticoagulante. En 14 pacientes no se pudo completar el añode seguimiento por diferentes motivos.Durante el período de seguimiento se detectó fibrilación auricular(FA) a 7 pacientes (6,54%), su edad media fue 75 años y en 5 deellos el IC había sido en el territorio de la ACM (4 superficial y 1 profundo).Tres pacientes (2,76%) sufrieron una recurrencia de ictus isquémicoen las semanas 15, 16 y 44 después del IC. En los 3 casos elictus fue considerado de nuevo criptogénico. Dos pacientes sufrieronun infarto agudo de miocardio y 4 fallecieron (infarto de miocardio,neoplasia de esófago, neumonía y muerte súbita).Conclusión. En nuestra serie, la tasa de recurrencia y de episodioscardiovasculares en el primer año tras un IC es baja. Un 11% depacientes con un IC en el territorio cortical de la ACM desarrollaronuna FA en el año siguiente (AU)

Objective. To analyze the outcome of patients with a cryptogenicinfarct (CI) after a follow-up period of 1 year.Methods. From our prospective registry of stroke, during a4-year period, we’ve identified 121 consecutive patients with a CI(15.1% of all infarcts). They have been followed up for 1 year andwe have registered stroke recurrence, cardiovascular eventsand other incidences.Results. Mean age 70.6 years-old, 53 % male. Middle cerebralartery (MCA) was the most often involved territory (52 cases),70% of them with cortical involvement. No patient died duringadmission, 95.8% received antiplatelet therapy and 4.1% oralanticoagulant. Fourteen patients were lost of follow-up.During 1-year period, atrial fibrillation (AF) was detected in7 patients (6.54%), their mean age was 75 years-old, in 5 of themthe CI was in MCA territory (4 with cortical involvement, 1 onlydeep infarct). Three patients (2.76 %) suffered a recurrent ischemicstroke, in weeks 15, 16 and 44 after the CI. In all 3 cases theinfarct was considered cryptogenic again. Two patients suffereda myocardial infarction and 4 died during follow-up period.Conclusion. In our series rate of stroke recurrence and cardiovascularevents after a CI was low. An 11 % of patients with aCI involving cortical MCA territory developed FA during the followingyear (AU)

Reconocimiento de los síntomas del ictus y respuesta frente a ellos en la población / Knowledge about stroke symptoms and attitude towards them in the population

Introducción. Conocer el significado de los síntomas de un ictus y tener percepción de urgencia ante ellos es un factor decisivo para reducir la demora extrahospitalaria. El objetivo es analizar el grado de reconocimiento de sus síntomas en los pacientes con un ictus, su actitud ante ellos y los factores que influyen en el conocimiento de la enfermedad. Métodos. Se estudian prospectivamente 292 pacientes consecutivos diagnosticados de ictus mediante un protocolo de recogida de datos que incluye 76 variables. Se realiza análisis univariante y multivariante para identificar las variables que se asocian independientemente con una mejor interpretación de sus síntomas y percepción de urgencia. Resultados. Sólo un 34% de pacientes reconoció saber que estaba sufriendo un ictus. El antecedente de ictus previo (OR: 3,97), vivir en una residencia (odds ratio [OR]: 3,20), tener síntomas motores (OR: 1,92) y un ictus más grave (OR: 1,05) se asociaron de forma independiente a un mejor reconocimiento de los síntomas. Sólo un 31,8 % de pacientes (41% de los que reconocieron los síntomas del ictus) decidió acudir inmediatamente al hospital o llamó a una ambulancia. La etiología cardioembólica del infarto (OR: 2,62), no tener hipertensión (OR: 0,48) y reconocer correctamente sus síntomas (OR: 0,62) son factores asociados de forma independiente a una mayor percepción de urgencia. Conclusión. Sólo un 14 % de los pacientes tienen un buen conocimiento del ictus y actúan correctamente cuando éste ocurre. Es necesario desarrollar programas de formación de la población en los que se resalte la urgencia ante la presencia de síntomas sugestivos de ictus (AU)

Introduction. To know the meaning of stroke symptoms and to perceive them as an emergency is a decisive factor to reduce hospital admission delay. The aim of the study is to analyze the degree of recognition of stroke symptoms by the patients, their attitude towards them, and which factors contribute to a better knowledge on cerebrovascular diseases. Methods. A total of 292 patients diagnosed of stroke were studied prospectively, following a protocol designed for data collection that included 76 variables. Univariate and multivariate analyses were conducted to identify which variables were independently associated with a better interpretation of stroke symptoms and emergency perception. Results. Only 34% of all patients recognized they were suffering a stroke. The background that was independently associated with a better interpretation of symptoms included previous stroke (odds ratio [OR]: 3.97), institutionalized subjects (old people's home) (OR: 3.20), motor symptoms (OR: 1.92) and more serious stroke (OR: 1.05). Only 31% of all patients, 41% of whom had recognized stroke symptoms, decided to go immediately to hospital or call for an ambulance. Variables that were independently associated with a better perception of emergency included cardioembolic stroke (OR: 2.62), not having hypertension (OR: 0.48) and a correct interpretation of stroke symptoms (OR: 0.62). Conclusion. Only 14% of all patients have a good knowledge about stroke and correctly act when it occurs. It is necessary to develop education programs aimed at the population that emphasize the emergency when symptoms suggesting stroke appear (AU)

Eficacia y tolerabilidad del levetiracetam en pacientes con temblor esencial: datos de un ensayo abierto de 11 semanas de seguimiento / Effectiveness and safety of levetiracetam in patients with essential tremor data from an open 11-week follow-up trial

Introducción. Es bien conocida la relativamente alta proporción de pacientes con temblor esencial refractarios a varios fármacos conocidos en la actualidad para su tratamiento. Objetivo. Evaluar la eficacia y la tolerabilidad del levetiracetam (LEV) en pacientes que hubieran mostrado respuesta escasa o nula o efectos secundarios intolerables en tratamiento con betabloqueadores o primidona, o presentasen contraindicaciones para el inicio de estos tratamientos. Pacientes y métodos. Llevamos a cabo un estudio piloto, abierto, de 11 semanas de duración en pacientes con las características descritas previamente. Las medidas principales de respuesta se basaron en la escala de temblor de Fahn, Tolosa y Marín (FTM), variables acelerométricas y efectos adversos. La dosis máxima de LEV fue de 3.000 mg, a la que llegaron los pacientes que no presentaron beneficio con dosis inferiores, tras una semana de tratamiento con 1.000 mg y cuatro semanas de tratamiento con 2.000 mg. Resultados. La muestra consistió en 14 pacientes con temblor esencial, con una media de edad de 70,08 (7,99) años y una mediana de 11,5 años de clínica. Aunque se observaron pequeños descensos en la escala de FTM y en la amplitud del temblor al final del estudio, ninguna de las diferencias observadas fue significativa. Seis pacientes abandonaron el estudio por falta de eficacia o efectos adversos. Conclusión. El LEV no produjo modificaciones estadísticamente significativas en ninguna de las variables controladas en este perfil de pacientes

Introduction. It is a well-known fact that a relatively high proportion of patients with essential tremor are resistant to a number of pharmaceuticals currently used to treat the condition. Aim. To assess the effectiveness and safety of levetiracetam (LEV) in patients who displayed little or no response or intolerable side effects under treatment with beta blockers or primidone, or who presented contraindications against beginning such treatments. Patients and methods. We conducted an open 11-week pilot study in patients with the characteristics described above. The main response measurements were based on the Fahn-Tolosa-Marín (FTM) tremor rating scale, accelerometric variables and side effects. The maximum dose of LEV was 3000 mg, which was reached by patients who did not benefit from lower doses, after one week’s treatment with 1000 mg and four weeks’ treatment with 2000 mg. Results. The sample consisted of 14 patients with essential tremor, with a mean age of 70.08 (7.99) years and an average clinical history of 11.5 years. Although by the end of the study small decreases were observed on the FTM rating scale and in the amplitude of the tremor, none of the differences were significant. Six patients dropped out of the study because of a lack of effectiveness or to side effects. Conclusion. LEV did not produce any statistically significant modifications in any of the variables that were monitored in this group of patients

[Knowledge about stroke symptoms and attitude towards them in the population]. / Reconocimiento de los síntomas del ictus y respuesta frente a ellos en la población.

INTRODUCTION: To know the meaning of stroke symptoms and to perceive them as an emergency is a decisive factor to reduce hospital admission delay. The aim of the study is to analyze the degree of recognition of stroke symptoms by the patients, their attitude towards them, and which factors contribute to a better knowledge on cerebrovascular diseases. METHODS: A total of 292 patients diagnosed of stroke were studied prospectively, following a protocol designed for data collection that included 76 variables. Univariate and multivariate analyses were conducted to identify which variables were independently associated with a better interpretation of stroke symptoms and emergency perception. RESULTS: Only 34% of all patients recognized they were suffering a stroke. The background that was independently associated with a better interpretation of symptoms included previous stroke (odds ratio [OR]: 3.97), institutionalized subjects (old people's home) (OR: 3.20), motor symptoms (OR: 1.92) and more serious stroke (OR: 1.05). Only 31% of all patients, 41% of whom had recognized stroke symptoms, decided to go immediately to hospital or call for an ambulance. Variables that were independently associated with a better perception of emergency included cardioembolic stroke (OR: 2.62), not having hypertension (OR: 0.48) and a correct interpretation of stroke symptoms (OR: 0.62). CONCLUSION: Only 14% of all patients have a good knowledge about stroke and correctly act when it occurs. It is necessary to develop education programs aimed at the population that emphasize the emergency when symptoms suggesting stroke appear.

[Effectiveness and safety of levetiracetam in patients with essential tremor: data from an open 11-week follow-up trial]. / Eficacia y tolerabilidad del levetiracetam en pacientes con temblor esencial: datos de un ensayo abierto de 11 semanas de seguimiento.

INTRODUCTION: It is a well-known fact that a relatively high proportion of patients with essential tremor are resistant to a number of pharmaceuticals currently used to treat the condition. AIM: To assess the effectiveness and safety of levetiracetam (LEV) in patients who displayed little or no response or intolerable side effects under treatment with beta blockers or primidone, or who presented contraindications against beginning such treatments. PATIENTS AND METHODS: We conducted an open 11-week pilot study in patients with the characteristics described above. The main response measurements were based on the Fahn-Tolosa-Marin (FTM) tremor rating scale, accelerometric variables and side effects. The maximum dose of LEV was 3000 mg, which was reached by patients who did not benefit from lower doses, after one week's treatment with 1000 mg and four weeks' treatment with 2000 mg. RESULTS. The sample consisted of 14 patients with essential tremor, with a mean age of 70.08 (7.99) years and an average clinical history of 11.5 years. Although by the end of the study small decreases were observed on the FTM rating scale and in the amplitude of the tremor, none of the differences were significant. Six patients dropped out of the study because of a lack of effectiveness or to side effects. CONCLUSION: LEV did not produce any statistically significant modifications in any of the variables that were monitored in this group of patients.

[Clinical utility of outpatient videoelectroencephalogram monitoring]. / Utilidad clínica del videoelectroencefalograma en régimen ambulatorio.

OBJECTIVE: To analyze the utility of outpatient videoelectroencephalogram (VEEG) in a general neurology department to detect an ictal event. PATIENTS AND METHODS: One hundred and five patients with ictal phenomenology of unknown etiology, suspicion of pseudoseizures, refractory epilepsy with very frequent seizures, underwent outpatient VEEG monitoring from 30 minutes to five hours of duration, between June 1, 1999 and June 30, 2003. Patient medication was not modified to perform the recording. RESULTS: Among the 105 outpatient VEEG monitoring, 33 clinical pathologic events were identified; these comprised 14 epileptic seizures, 12 pseudoseizures, four syncopes, and three non epileptic abnormal movements. Outpatient VEEG monitoring duration was as follows: 30 minutes in 12 patients, between 30 minutes and two hours in another 12, and more than two hours in 9. In 19 patients, the VEEG recording allowed a definitive diagnosis; in one case, it changed the epileptic seizure type, and in 11 patients, it helped to better characterize the epileptic seizure type. CONCLUSION: Although the percentage of pathologic events during an outpatient VEEG monitoring of 30 minutes to five hours of duration is low, its clinical repercussion is very important and the added cost is low.

Utilidad clínica del videoelectroencefalograma en régimen ambulatorio / Clinical utility of outpatient videoelectroencephalogram monitoring

Objetivo. Analizar la utilidad de los registros por video-electroencefalograma (VEEG) en régimen ambulatorio realizados en un servicio de neurología general para la detección de un episodio crítico. Pacientes y métodos. Desde el 1 de junio de 1999 hasta el 1 de junio de 2003 realizamos 105 exploraciones por VEEG, de 30 minutos a 5 horas de duración, en pacientes con crisis de etiología no aclarada, ante la sospecha de pseudocrisis o en presencia de una epilepsia farmacorresistente y crisis muy frecuentes. No modificamos la medicación del paciente para realizar la exploración. Resultados. En 33 pacientes se registraron eventos clínicos patológicos; en 14 se trató de crisis epilépticas, en 12 de pseudos crisis, en 4 de síncopes y en 3 de movimientos anormales no epilépticos. La duración del registro fue de 30 minutos en 12, de entre 30 minutos y 2 horas en 12 y de más de 2 horas en 9 pacientes. En 18 pacientes el VEEG fue la exploración diagnóstica. En un caso cambió el diagnóstico del tipo de crisis epiléptica que sufría el paciente, y en 11 pacientes nos ayudó a caracterizar sus crisis epilépticas. Conclusión. Si bien el porcentaje de registro de eventos patológicos durante un estudio por VEEG ambulatorio de 30 minutos a 5 horas de duración es bajo, su repercusión clínica es muy alta y el coste añadido, escaso

Objective. To analyze the utility of outpatient videoelectroencephalogram (VEEG) in a general neurology department to detect an ictal event. Patients and methods. One hundred and five patients with ictal phenomenology of unknown etiology, suspicion of pseudoseizures, refractory epilepsy with very frequent seizures, underwent outpatient VEEG monitoring from 30 minutes to five hours of duration, between June 1, 1999 and June 30, 2003. Patient medication was not modified to perform the recording. Results. Among the 105 outpatient VEEG monitoring, 33 clinical pathologic events were identified; these comprised 14 epileptic seizures, 12 pseudoseizures, four syncopes, and three non epileptic abnormal movements. Outpatient VEEG monitoring duration was as follows: 30 minutes in 12 patients, between 30 minutes and two hours in another 12, and more than two hours in 9. In 19 patients, the VEEG recording allowed a definitive diagnosis; in one case, it changed the epileptic seizure type, and in 11 patients, it helped to better characterize the epileptic seizure type. Conclusion. Although the percentage of pathologic events during an outpatient VEEG monitoring of 30 minutes to five hours of duration is low, its clinical repercussion is very important and the added cost is low

Tratamiento de la epicondilitis lateral con toxina botulínica / Treatment of lateral epicondylitis with botulinus toxin

La toxina botulínica tipo A (TXA) es una neurotoxina que se ha utilizado en el tratamiento del estrabismo, el blefarospasmo, la espasticidad y los movimientos musculares anormales, así como en el dolor secundario a la contractura muscular excesiva. Presentamos el caso clínico de una paciente que padecía una epicondilitis lateral de 12 meses de evolución, a la que se le habían realizado dos infiltraciones de corticoides y 20 sesiones de rehabilitación sin mejoría alguna y que, tras infiltración con TXA en el músculo extensor radio corto del carpo mejoró espectacularmente, hasta la resolución total del cuadro (AU)

Estenosis intracraneales. Estudio y seguimiento de 38 pacientes / Intracranial stenosis. Study and follow-up of 38 patients

Introducción: Describir el perfil de riesgo vascular, repercusión funcional y evolución de los pacientes con estenosis intracraneal (EIC).Métodos: Se revisan las historias clínicas de todos los pacientes diagnosticados de EIC mediante una técnica angiográfica (angiorresonancia o angiografía convencional) entre el 1/4/1999 y el 30/11/2001. Se incluyen 38 pacientes con 56 EIC, seguidos durante una media de 18 meses. Se utilizan como grupos control una serie de 44 pacientes con ictus y cardiopatía embolígena (CE) y otra de 67 con ictus y estenosis extracraneal sin EIC. Resultados: La edad media fue 69,7 años, con 76,3 por ciento de varones. Diecisiete pacientes (44,7 por ciento) tenían asociada una estenosis de carótida extracraneal superior al 50 por ciento. La EIC fue múltiple en 12 pacientes. La diabetes mellitus fue significativamente más frecuente en el grupo de EIC respecto ambos grupos control y el tabaquismo sólo respecto al grupo de CE. En 25 casos, la EIC fue sintomática, y en 13, un hallazgo tras un infarto en otro territorio. Del grupo de EIC sintomáticas, en 22 (88 por ciento) la escala de Rankin modificada al alta fue 2 o inferior y durante el período de seguimiento su tasa de incidencia de reinfartos fue de 15 por 100 pacientes-año. Conclusiones: La diabetes mellitus se muestra como el factor de riesgo más predisponente a EIC. Las EIC fueron múltiples en el 32 por ciento y asociadas a estenosis extracraneal moderada o severa en el 44,7 por ciento. Los pacientes con infartos secundarios a EIC presentaron poca dependencia funcional al alta. La tasa de incidencia de reinfarto fue de 15 por 100 pacientes-año (AU)

[Intracranial stenosis. Study and follow-up of 38 patients]. / Estenosis intracraneales. Estudio y seguimiento de 38 pacientes.

INTRODUCTION: To describe vascular risk factors of patients harboring intracranial arterial stenosis (IAS) as well their final outcome. METHODS: We reviewed clinical reports of all patients admitted to our Institution from April 1, 1999 to November 30, 2001 with the diagnosis of IAS. Diagnosis was made by means of magnetic resonance angiography (MRA) or four-vessels digital subtraction angiography. Thirty-eight patients harboring 56 IAS were identified. Mean follow-up was 18 months. Two control groups were selected: one was a group of 44 patients with stroke and embolic cardiopathy (EC) and the other was a group of 67 patients with stroke and extracranial stenosis without IAS. RESULTS: Mean age was 69.7 years, with male preponderance (76.3 %). Seventeen cases (44.7 %) had associated extracranial carotid stenosis greater than 50 %. Multiple IAS were found in 12 patients. Diabetes mellitus was significantly more frequent in the IAS group than in both control groups. On the other hand, cigarette smoking was more common in the IAS group with respect to the EC group. IAS was symptomatic in 25 cases, whereas in 13 patients IAS was found in the work-up for cerebral ischemia in another territory. From the group of symptomatic patients, 22 (88 %) had a Rankin scale 2 or lower on discharge and, in the long term follow-up, their incidence rate of recurrent ischemic stroke was 15 per 100 patients/year. CONCLUSIONS: Diabetes mellitus was the most specific risk factor for IAS. IAS was multiple in 32% of patients and in extracranial stenosis from moderate to severe degree was found in 44.7% of the cases. Stroke secondary to IAS caused a low dependency level at discharge. Incidence rate of recurrent ischemic stroke was 15 % patients/ year.