Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

Crisis convulsivas. Concepto, clasificación y etiología / Convulsive seizures. Concept, classification and aetiology

Las crisis epilépticas son síntomas de disfunción cerebral que producen una descarga hipersincrónica o paroxística de un grupo de neuronas, hiperexcitables, localizadas en el cortex cerebral. Las manifestaciones clínicas son muy variables y autolimitadas. Pueden ser reactivas a un estrés cerebral transitorio o a lesiones permanentes o bien forman parte de un síndrome neurológico más amplio denominado síndrome epiléptico. La prevalencia es de 5 por mil, en cuanto a epilepsia crónica, y la incidencia de crisis es superior a 50 casos por 100.000 habitantes y año. Las crisis epilépticas pueden ser parciales o focales (simples, complejas y con evolución a generalizadas) y generalizadas (ausencias, mioclonias, tónicas, clónicas, tónico-clónicas y atónicas). Se discute la etiopatogenia de las crisis, revisando los diferentes mecanismos involucrados en las crisis de comienzo parcial (inhibición defectuosa de los receptores GABA-A, activación defectuosa de los receptores GABA por las proyecciones provenientes del hipocampo, tamponamiento defectuoso del calcio intracelular, activación aumentada de los receptores NMDA, incremento de la sincronización neuronal debido las interacciones efácticas o incremento de la sincronización o activación debido a redes colaterales recurrentes excitadoras) y en las de comienzo generalizado en las que tienen una importancia fundamental las interacciones tálamo-corticales (AU)

Epileptic -convulsive- crises represent a symptom of cerebral dysfunction involving hypersynchronic or paroxystic discharge of a group of hyperexcitable neurons located in the cerebral cortex. The clinical manifestations are highly variable and self-limited. Convulsive seizures may be reactive to transient cerebral stress, or they my be secondary to permanent lesions or represent a part of a wider neurological syndrome termed “epileptic syndrome”. The prevalencc is some 5% as affects chronic epilepsy, and the seizure cases incidence exceeds 50 cases per 100,000 inhabitants and year. Epileptic seizures may be partial or focal (simple, complex and with evolution towards generalised seizures) and generalised (absences, myoclonia, tonic, clonic, tonico-clonic and atonic seizures). The etiopathogenesis of the seizures is still discussed. And we review the various mechanisms involved in partial crises (deficient inhibition of GABA-A receptors, deficient activation of GABA receptors from hippocampal projections, deficient buffering of intracellular calcium, increased activation of NMDA receptors, increased neuronal synchronisation due to ephactic interactions or to the activation or synchronisation caused by recurrent (excitatory) collateral networks and by those of generalised instigation that have a fundamental significance in thalamo-cortical interactions (AU)

[Costs study in Alzheimer's disease]. / Estudio de costes en la enfermedad de Alzheimer.

UNLABELLED: The Alzheimer disease (AD) it constitutes one of the socio-sanitary and economic problems and more important in the systems of health of the developed countries. Also, this problem will be increased in next years with the population's progressive aging and the biggest incidence of this illness. The family will support the biggest load in the care of these patients. The devices like the units by day will give a bigger independence to these families. OBJECTIVES: It is sought to study the direct sanitary and social costs of a group of patients with AD that live in the area of health of Guadalajara. They will be evaluated the global cost and I average according to the degree of deterioration, sex, and age. The aspects will be determined that more they influence in these costs, as the epidemic variables and the associate comorbility. MATERIAL AND METHODS: An observational and descriptive study was designed on 337 patients of EA, selected according to the registries of the section of neurology of the university and General Hospital of Guadalajara, the registrations EAP of the centres of health of the area, and the existent ones in two nursing homes of our environment. For the obtaining of the data the clinical histories were used. The used computer systems were: the EPINFO V.6 & SPSS V, DBASE IV, EXCEL, and the system of hospital costs of the University and General Hospital of Guadalajara. For the analysis of the data an error typo I p < 0.05 was used, this analysis began with the test of Kolmorov-Smirnov to contrast the normality of the curves of distribution of data of each variable. RESULTS: 76% was women and the rest males. The global stocking of age was of 73 0.63 years, with more age in the women. The associate comorbility was bigger in the men. The stocking of the consumption of pharmacotherapy was of 3.1. The costs of the consultations carried out for these patients were of a stocking of 2.064,75 euros patient/year, and that of the complementary explorations of 639 euros for patient/year. The pharmacy cost was of 4.560 euros patient/year, with more expense in women and in the degree sick persons II of the EA. The hospital half stay was of 10.8 days with a cost for each entrance and patient of 2.778 euros. In Primary Attention the cost for patient and year was of 8.615 euros. The cost of these patients in the residences was of 11.900 euros for patient and year, in those of private administration, and of 12.982 euros in those of mixed administration, according to the degree of deterioration, the pharmacy expense was of 2.470 euros for those of degree I, of 141.359 euros for those of degree II and of 31.059,10 euros for those of the degree III. CONCLUSIONS: The half cost of the attendance is three times adult that the pensions received by these sick persons, for that that the patients and/or the families support more than 60% of the direct cost. The families don't have this way more remedy than to increase their expenses because neither the society neither the sanitary system have still given an appropriate answer to the problem of this illness.

Estudio de costes en la enfermedad de Alzheimer / Costs study in Alzheimer's disease

La enfermedad de Alzheimer (EA) constituye uno de los problemas sociosanitarios y económicos más preocupantes en los sistemas de salud de los países desarrollados. Además este problema se agravará en los próximos años con el envejecimiento progresivo de la población y la mayor incidencia de la EA. La familia va a soportar la mayor carga en el cuidado de estos pacientes. Los dispositivos como las unidades de día van a dar una mayor independencia a estas familias. Objetivos. Se pretende estudiar los costes sanitarios y sociales directos de un grupo de pacientes con EA que residen en el área de salud de Guadalajara. Se evaluará el coste global y promedio según el grado de deterioro, sexo y edad. Se determinarán los aspectos que más influyen en estos costes, como las variables epidemiológicas y/o la comorbilidad asociadas. Material y métodos. Se diseñó un estudio observacional y descriptivo sobre 337 pacientes con EA del área de salud de Guadalajara, seleccionados según los registros de la sección de neurología del Hospital General y Universitario de Guadalajara, los registrados por los equipos de Atención Primaria (EAP) de los centros de salud del área y los existentes en dos residencias de nuestro entorno. Para la obtención de los datos se utilizaron las historias clínicas. Los sistemas informáticos utilizados fueron el EPINFO V.6 SPSS V & DBASE IV, EXCEL, y el sistema de costes hospitalarios del Hospital General y Universitario de Guadalajara. Para el análisis de los datos se utilizó un error tipo 1 de p<0,05.Este análisis se inició con la prueba de Kolmorov-Smirnov para contrastar la normalidad de las curvas de distribución de datos de cada variable. Resultados. El 76 por ciento fueron mujeres y el resto varones. La media global de edad fue 73ñ0,63, con mayor edad en el sexo femenino. La comorbilidad asociada fue mayor en varones. La media de la cantidad de consumo de fármacos fue de 3,1. Los costes de las consultas realizadas para estos pacientes fue de una media de 2.064,75 por paciente/año y el de las exploraciones complementarias de 639 por paciente/año. El coste de farmacia fue de 4.560 por paciente/año, con mayor gasto en mujeres y los de grado II de la EA. La estancia media hospitalaria fue de 10,8 días, con un coste por cada ingreso y paciente de 2.778. En Atención Primaria el coste por paciente y año fue de 8.615. El coste de estos pacientes en las residencias fue de 11.900 por paciente y año en las de gestión privada y de 12.982 para las gestionadas de forma concertada. Según el grado de deterioro el gasto de farmacia fue para los del grado I de 2.470 , para los del grado II de 141.359 y para los de grado III de 31.059,10 .Conclusiones. El coste medio de la asistencia es tres veces mayor que las pensiones recibidas por estos enfermos, por lo que los pacientes y/o las familias soportan más del 60 por ciento del coste global directo. Así, las familias no tienen más remedio que aumentar sus gastos debido a que ni la sociedad ni el sistema sanitario han dado aún una respuesta adecuada a la problemática de esta enfermedad (AU)

Bases biológicas de las migrañas / Biological basis of migraine

No disponible

Tratamiento de las cefaleas / Treatment of headache

No disponible

[Spinal epidural abscess. 8 years' experience]. / Absceso epidural espinal. Experiencia de ocho años.

We present four cases of spinal epidural abscess diagnosed in Clinica Puerta de Hierro between 1982 and 1990. In three cases the localization was thoracic and in one it was lumbar. Fever and vertebral pain were the more constant clinical symptoms. Lumbar punction showed findings in Cerebro-Spinal Fluid compatible with a parameningeal inflammation focus in the three cases it was performed. Diagnosis was established with myelography or Computerized Axial Tomography. Treatment in two cases was laminectomy and systemic antibiotics: and only antibiotics in the other two cases. Evolution was favorable in the patients who underwent surgery, but the patients treated conservatively had a fatal outcome.