Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients.

BACKGROUND: Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. METHODS: In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. RESULTS: A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). CONCLUSIONS: Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.

Relationship Between Antipsychotic Medications and Cerebrovascular Disease in Patients With Serious Mental Illness.

INTRODUCTION AND OBJECTIVES: Cerebrovascular disease (CVD), especially in its asymptomatic forms, is relatively common in patients with serious mental illness (SMI). Nevertheless, the literature on this topic is scarce and sometimes contradictory. Antipsychotic medications, especially atypical agents, play an important role in the overall cardiovascular health of these patients. The goal of this study was to analyze the frequency of CVD in patients with and without SMI. PATIENTS AND METHODS: This retrospective cohort study compared the frequency of CVD, including silent forms, in a group of patients without mental illness and without a history of taking antipsychotic medication, with another group of patients diagnosed with SMI who had received antipsychotic treatment. The 2 groups were matched for age and sex, and the mean age of the subjects in the 2 groups was 63 years. RESULTS: The frequency of CVD was the same in both groups and it was not modified by the use of antipsychotic medications. A nonsignificant trend toward an association between CVD and prolonged use of antipsychotic polypharmacy was found. CONCLUSIONS: In this study, in contrast to previous reports, use of antipsychotic medications and the presence of SMI were not associated with an increased risk of CVD.

Is cerebrovascular disease a silent condition in patients with chronic schizophrenia-related disorders?

Patients with chronic schizophrenia-related disorders are at a heightened risk of developing cardiovascular disease. The presence and interpretation of cerebral vascular lesions in neuroimaging tests in these patients represents a common clinical challenge. Nevertheless, the literature on cerebrovascular disease in this population is scarce and contradictory. The aim of this study was to analyse the relationship between schizophrenia-related disorders and cerebrovascular morbidity. A case-control study compared cerebrovascular morbidity in a group of patients with schizophrenia-related disorder versus a group of patients with another severe mental illness. The risk of presenting cerebrovascular morbidity was four times higher and statistically significant in patients with schizophrenia-related disorders compared with controls, paired by age and sex. However, both groups were homogeneous in terms of cardiovascular risk factors. There were significant differences between the two groups only in the time using first-generation antipsychotic drugs and taking two or more antipsychotic medications simultaneously. The relationship between chronic schizophrenia-related disorders and cerebrovascular disease may be beyond the classic cardiovascular risk factors and related to certain medications. This is one of the first studies to focus on the relation among cerebrovascular morbidity, antipsychotic drugs and disorders related to schizophrenia in middle-aged and elderly adults.

Schizophrenia and cerebrovascular disease. A description of a series and bibliographic reivew.

INTRODUCTION: The state of health of patients with schizophrenia is a field of growing interest that has probably not received sufficient attention in the past. It is currently held that physical health should form a part of the overall therapeutic strategy in these patients since reference is made to certain treatable conditions that may affect the final prognosis. One example is cardiovascular disease and its associated reduction in life expectancy. DEVELOPMENT: We carried out a retrospective study in which we described the consultations held between the psychiatric acute care service and the neurology service during a one-year period. We have analyzed the frequency of cerebrovascular complications in our sample and have included a summary of the most relevant published data regarding cerebrovascular disease (CVD) in patients with schizophrenia. CONCLUSIONS: We have described the high frequency of CVD in both our series of patients with severe mental illness receiving attention as well as in those from the neurology service (25.7%), and in the subgroup presenting psychotic disorders (25%). There are several studies focusing on the possible causes of increased cardiovascular morbidity and mortality, especially in schizophrenia. However, in regards to CVD specifically, little has been found in the literature and that found shows contradictory results. Given the direct relation between cardiovascular disease and CVD, a consistent relation between CVD and schizophrenia is to be expected.

Esquizofrenia y enfermedad cerebrovascular. Descripción de una serie y revisión bibliográfica / Schizophrenia and cerebrovascular disease. A description of a series and bibliographic reivew

Introducción. El estado de salud de los pacientes con esquizofrenia es un campo de creciente interés que probablemente no ha recibido la atención necesaria en el pasado. Actualmente se considera que la salud física debería formar parte de la estrategia terapéutica global en estos pacientes ya que hace referencia a algunas patologías tratables y que pueden modificar el pronóstico final. Un ejemplo es la enfermedad cardiovascular y la reducción en la esperanza de vida asociada a ella. Desarrollo. Realizamos un estudio retrospectivo en el que describimos las interconsultas realizadas desde la unidad de agudos de psiquiatría al servicio de neurología durante un año y analizamos la frecuencia de complicaciones cerebrovasculares en nuestra muestra. Exponemos asimismo, un resumen de los datos más relevantes publicados acerca de la enfermedad cerebrovascular (ECV) en pacientes con esquizofrenia. Conclusiones. Describimos una alta frecuencia de ECV tanto en el global de nuestra serie de pacientes con enfermedad mental severa a los que se realizó una interconsulta a Neurología (25,7%) como en el subgrupo que presenta Trastornos psicóticos (25%). Hay diferentes estudios centrados en las posibles causas de la elevada morbimortalidad cardiovascular, especialmente en esquizofrenia, pero respecto a la ECV en concreto hay poca literatura y con resultados contradictorios. Dada la relación directa entre enfermedad cardiovascular y ECV, se puede esperar una relación consistente entre ésta y la esquizofrenia

Introduction. The state of health of patients with schizophrenia is a field of growing interest that has probably not received sufficient attention in the past. It is currently held that physical health should form a part of the overall therapeutic strategy in these patients since reference is made to certain treatable conditions that may affect the final prognosis. One example is cardiovascular disease and its associated reduction in life expectancy. Development. We carried out a retrospective study in which we described the consultations held between the psychiatric acute care service and the neurology service during a one-year period. We have analyzed the frequency of cerebrovascular complications in our sample and have included a summary of the most relevant published data regarding cerebrovascular disease (CVD) in patients with schizophrenia. Conclusions. We have described the high frequency of CVD in both our series of patients with severe mental illness receiving attention as well as in those from the neurology service (25.7%), and in the subgroup presenting psychotic disorders (25%). There are several studies focusing on the possible causes of increased cardiovascular morbidity and mortality, especially in schizophrenia. However, in regards to CVD specifically, little has been found in the literature and that found shows contradictory results. Given the direct relation between cardiovascular disease and CVD, a consistent relation between CVD and schizophrenia is to be expected

Mielopatía cervical espondilótica aguda como causa de síndrome del ‘hombre en el barril / Cervical spine mielopathy as a cause of man-in-the-barrel syndrome

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Estimulación dopaminérgica en los trastornos no motores de la enfermedad de Parkinson / Dopaminergic stimulation in the non-motor symptoms of Parkinson’s disease

Introducción y desarrollo. Los síntomas no motores de la enfermedad de Parkinson tienen un gran impacto en términos de calidad de vida. Frecuentemente se infradiagnostican y la experiencia clínica indica que la terapia dopaminérgica no sólo es ineficaz sino que en muchos casos es responsable de la aparición de algunos de estos síntomas. Diferentes estudios han llamado la atención sobre la implicación de las vías dopaminérgicas en la patogénesis de algunos síntomas no motores. Se ha observado que pueden experimentar fluctuaciones en relación a la estimulación dopaminérgica, generalmente en estados de wearing off, demostrándose una correlación significativa con las fluctuaciones motoras y una respuesta clínica con terapia dopaminérgica continua.Conclusión. Aunque revisiones recientes demuestran una evidencia insuficiente para el tratamiento de los síntomas no motores con la terapia dopaminérgica, la implicación de las vías dopaminérgicas en la etiopatogenia de algunos de estos trastornos y la observación clínica de que dichos síntomas experimentan fluctuaciones en relación a la estimulación dopaminérgica pulsátil, nos puede hacer replantear el posible papel de la terapia dopaminérgica en el tratamiento de estos síntomas (AU)

Introduction and development. The non-motor symptoms of Parkinson’s disease have a great impact in terms of quality of life. They are frequently underdiagnosed and clinical experience suggests that not only is dopamine therapy ineffective but that in many cases it is also responsible for the appearance of some of these symptoms. Different studies have drawn attention to the involvement of the dopaminergic pathways in the pathogenesis of some non-motor symptoms. It has been observed that they can undergo fluctuations in relation to dopaminergic stimulation, generally in wearing off states, while displaying a significant correlation with motor fluctuations and a clinical response with continuous dopaminergic therapy. Conclusions. Although recent reviews offer insufficient evidence for treatment of non-motor symptoms with dopaminergic therapy, involvement of the dopaminergic pathways in the aetiopathogenesis of some of these disorders and the clinical observation that such symptoms undergo fluctuations in relation to pulsatile dopaminergic stimulation may lead us to reconsider the possible role of dopaminergic therapy in the treatment of these symptoms (AU)